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Bob - The President actually has quite a lot of power to direct any of the agencies and/or staff under his control. The HHS reports directly to the President as set forth in the hierarcy of the executive branch of government. But, yes you are correct that the details of those directions from the President to staff below him may not always be revealed to the public at large.
It is also the case in government that the "Chief Honcho" moves quite quickly on to other priorities unless someone keeps knocking at the door keeping the noise targeted to a specific issue, so that he and/or his staff do not loose sight of it.
In Washington it is dangerous to make too many assumptions. It is best if one gets promises in writing or even better yet on tape
and then keep circling the wagons to keep the attention where it is needed.
Courtney Miller did accomplish a great coup, by getting the President on tape addressing how little he knows about the illness, but also that he committed to do some type of follow up review. It is just hard to tell at this point in time if this contact while initially appearing to be promising may have been reinterpreted by staff below him. It is worrisome to many that the "highest priority" for ME/CFS has somehow headed the government's efforts to help this illness in a direction that appears more sideways, backwards and upside down than would logically make any sense unless the definition of the "highest level of priority" has somehow been changed.
I believe Jeannette Burmeister's latest blog entry at "Thoughts About Me" expresses the head shaking response that some people are having to the government's continued machinations in its attempts to address patients and medical experts requests for help with this illness. (See,
http://thoughtsaboutme.com/2014/02/07/p2p-patients-to-purgatory-or-the-jury-model-stood-on-its-head/)
I realize that there are many who are active on this Forum who may not be as familiar with the political landscape here in the U.S., but if you want to play in Washington, you have to know how to dance with the politicians. Unfortunately for this illness, we seem to be somewhat lacking in having a cohesive dance team that understands how to master this particular dance.
It is a somewhat complicated and very time consuming process, so professional lobbyists are often what is needed in the long run to sustain a strong presence to advocate one's cause. This is not to say that a less seasoned approach cannot be effective, but you still need to understand how to dance and which partners you need to convince to dance with you.
Wally