Some weeks it really is hard to know where to start or what to write about – not because there is so little but because there are so many topics worthy of covering. With Christmas only, a week away it is also time to wonder where another year and indeed another decade (and yes, I know some of you will contend that the decade only ends in another 12 months). For me , there is refection in realising that I have been writing a regular piece for over ten years.

The 7th Preventing Overdiagnosis conference was held in Sydney in early December. It was probably geared a bit more towards researchers than clinicians. Most of the sessions involved researchers talking to their papers. There were, however, also plenary sessions and panel discussions. The extent of the problem was greater than I had thought. An American dermatologist produced figures estimating that there were 18,000 cases of over diagnosis of Melanoma based on increases in diagnosis over the last forty years. As with breast and prostate cancer there was negligible impact on mortality.

Furthermore, the increase had nothing to do with sun exposure or the much feared tanning salons. It was simply due to removal of lesions which would never have been a problem in the person’s life.

This was an eye opener as I was previously accepted the notion that all melanomas would grow and spread. The difficulty, remains sorting out which is which. In some respects, removing skin lesions does less harm if done needlessly than removing a breast or prostate. However, when I put that question to the panel they pointed out that harms from further surveillance and screening together with the anxiety of diagnosis were forms of harm.

Aside the harm to individuals from treatment for “diseases” they don’t have which includes side effects of medications, costs of treatment and having to live with a “medical condition” there is a big picture consideration. Health (disease) budgets are under pressure worldwide. There is a constant cry for more “funding”. The amount of money spent treating people who do not have a disease and in turn treating the problems that arise from their treatment is considerable. If this were freed up, there would be plenty to cover the costs of those who actually need treatment. And that doesn’t even consider the massive (approximately 30% of the total spend) chewed up by bureaucracy and administration.

The popular view has been that throwing more money is the answer. If what you are doing is not working then doing more of it won’t work any better. There are parallels between the education and health sectors. Both sectors have a, generally, demoralised hard working group of people seeking to deliver services crushed by a stifling unaccountable bureaucracy where few have any front line experience.

The Program for International Student results showed Australia is plummeting down the tables for results in literacy and numeracy. This is despite record amounts of money being spent on education. More money has coincided with poorer results. The government is proposing a review and part of that is to focus on learning phonics. This has been shown repeatedly to be more effective than the “whole of language” approach favoured by academia. Yet this was opposed by, you guessed it, 200 academics.

In health the cry similarly is always for more money. To suggest that we better spend what is already available is not PC enough and anyone making such a call would be labelled as some type of “ist”,”phobe” or denier.

But through it all this year has shown that the vast majority of humans are decent people. They want the best for their families and themselves. They seek to work and contribute to society. They will help those in need. They will listen to reason. They aspire for better. They bear no resemblance to the “woke“ who see doom and gloom everywhere.

The silent people of the world have for centuries been going quietly about their business. They pause at times such as Christmas to celebrate. They look to the new year with hope. They see and want the best in others.

The volcanic eruption in NZ with the tragic loss of life reminds us that our grip on life can be tenuous and that life can change in an instant. Whether Christmas hold religious significance to you or not, spend time with those you love and care about. Enjoy festive food (whatever this means for you) and good cheer.

The world may not be perfect but there has never been a better time to be alive. As the door closes on the twenty “teens” focus on what matters most to you and your loved ones. Say no when you need to and yes when it feels right.

A big thank you to readers for your support.  We will return in late January.

A Merry Christmas and Happy 2020 to all.