It's only fair to share…

It is an interesting contrast that bad news sells in the media but not in medical research. Doom and gloom is more likely to sell papers or get clicks in the media. Yet when it comes to medical stories we are only interested in breakthroughs and miracle cures.

Not surprisingly then most medical stories are of the breakthrough variety. This applies not only to treatments but also to screening programs. One of the best ways to spin any finding is to use relative rather than absolute changes. A reduction in heart attacks from 1% to 0.75% can be presented as a 25% reduction (in relative terms) or a 0.25% reduction (in real terms).

There are no prizes for guessing which one is used.

Screening programs will take the credit for significant improvements in outcomes for assorted diseases. Those who make the most noise usually stand to benefit from more funding if they can claim that what they are doing makes a big difference. So clearly there is incentive to spin numbers to your advantage.

It gets more intriguing.

Changed laws now mean that payments to doctors are made public. If a doctor claims that a particular treatment is worthwhile we can see whether or not they have been paid by the manufacturer, and how much. This does not mean that they are saying anything they do not believe to be true or that they are ‘”spruikers” but it does mean that they are not independent. To go further, they may be 100% correct in what they say. Being paid does not of itself make you wrong.

However it is useful for the rest of us to know all the facts.

Whilst doctors are, rightly, subject to greater scrutiny, charities and advocacy groups are not. A paper in the New England Journal of medicine found 83% of 104 large patient-advocacy organisations received financial support from drug, device, and biotechnology companies, and industry executives often serve on governing boards.

This is a staggeringly high figure. These groups are rarely questioned because we falsely believe that a “not for profit” organisation is somehow morally superior to one which is for profit. Both seek to make money. The only difference is how it is distributed. Some not for profit groups make enormous profits. But they retain it or pay it out in ways other than dividends.

Public health academics also seek to take the moral high ground. Yet they are constantly seeking funding of their pet projects whether or not these projects are in the “greater good” or not.

And herein lies the biggest problem. Increasingly medicine is dominated by academics creating guidelines. They also tend to dominate public policy debates.

There is an intrinsic clash between this and the day-to-day practice of medicine.

This has always puzzled me.

But I have finally found a brilliant explanation of the clash of cultures between medicine and public health. John Slater writing in The Spectator summed it up “Its important to understand that unlike medicine, which treats individuals based on symptoms, the study of public health is predicated on using the machinery of the state to provide blanket solutions to health problems from the macro standpoint of society as a whole. Accordingly, public health ‘experts’ have every incentive to bolster their own power and relevance by proposing far reaching tax and spend policies aimed at re-engineering a healthier purer society”.

Macro approaches worked for epidemics of infectious diseases in the early 20th century but do not work for lifestyle related conditions like type two diabetes, obesity or even heart disease. Thus the public health, one-size fits all models have failed. And that is before one recalls that much of their advice (like eat low fat) is wrong.

So the bad news is that there is much to fix in the disease (health) systems worldwide. The good news is that the better informed you are the better you are placed to make decisions that work for you.