One of our biggest problems in advocacy is a failure to engage with the medical community on their terms. Many of us in advocacy are coming from a scientific perspective. Some are from a political perspective, in which I include regulation and laws. However there are two more. The third is a managerial perspective, and the fourth is the irrational mindset found in psycho-psychiatry, and especially psychogenic psychiatry. This last is most clearly exemplified in biopsychosocial thinking. I have a science and logic background. Its not really a science and philosophical background as I didn't study much historical philosophy. In the last 5 years or so I have tried to mentally engage with the political process in medicine in order to advocate better. In the last two years I have had to include evidence based medicine in my thinking. What makes these other views so different? Scientific thinking is about proposing, testing and disseminating hypotheses. Its about evidence and reason. Its about rejecting hypotheses that do not fit the facts. In advocacy many of us are aware of much of the scientific research. We easily see that most of the claims and actions about ME in the world are not consistent with the facts. So we rightly reject them. However we typically fail to communicate that. In the last few years more and more of us have published articles, letters, papers etc. that deal with this issue from a scientific mindset. This is a good sign for advocacy. The person in advocacy I consider leading that charge is Tom Kindlon, whose work I greatly admire. Political advocacy is really a blend of two things, so it might be argued there are even more views, but I want to try to keep it simple for now. The first is law/regulation, and includes concepts like governance, transparency and accountability. The second is political processes like consensus and voting. The governments or regulatory agencies define the regulations and legislature that we have to deal with, so to a large extent laws and regulations are politically determined, which is why I am lumping them together for now. Recently we have engaged in more Freedom Of Information requests, advocacy with elected officials, and even legal challenges. These are all good signs even if we have not succeeded. For a long time there has been a push to make medicine more scientific. Since around the late 1970s there has been a push to regulate medicine. I used to consider this process a political one, based on science, but now I think it is not primarily political and only vaguely influenced by science. I call this the managerial viewpoint. It is more influenced by economics. The managerial viewpoint is dominated by accounting and economics. I regard the first major architect of this approach as Maggie Thatcher. She really did change how the world worked, but I am coming to regard that as more a bad thing than a good thing. Society has limited resources, politicians have to work within that, but politics is becoming increasingly dominated by managerial views, and so is medicine. The managerial mindset is about how to regulate the use of resources in medicine to achieve the most public good at the least cost, and to constrain costs within some limits. Evidence Based Medicine exemplifies the managerial view in medicine. Agencies practicing this include NICE and the IOM. We cannot effectively engage with such agencies without understanding the basis of how they work, and it makes it harder that the evidence-based approach is constantly evolving and unregulated. I am going to leave biopsychosocial and psychogenic medicine alone for now, but please feel free to discuss it too. I created this thread so that issues on perspectives, and how to engage with audiences who operate in those perspectives, can be discussed. We need to reach audiences that are resistant to views from other perspectives, so we have to engage them within their own conceptual framework, or engage in actions that alter their conceptual framework.