David Cameron today is defending his government’s proposals to change the English NHS. Interestingly, this debate seems to be happening as if there isn’t another functioning model in Scotland! There is – why not refer to it? Maybe there are aspects of the Scottish NHS which are better than the English model? Why not learn from them? Maybe there are aspects which are worse. Why not learn from them too?
The fundamental problem with all the health services of course is that they are actually disease management services, not health services at all. Almost all of health care has a primary focus on disease, and only a secondary one on health. Cameron says the NHS in England has to change – and in particular he says “we’ve got and that is to change and modernise the NHS, to make it more efficient and more effective and above all, more focused on prevention, on health, not just sickness. We save the NHS by changing it.”
He’s right about that, but what exactly within his proposed changes will produce an NHS “more focused on prevention, on health”?
The BMJ this week has a lead editorial on the issue of disease definition. The problem is that the definitions of diseases keep changing and as they change, more people become “eligible” for drug treatments, and there is enormous drug company influence on disease definition.
the definitions of common conditions are being broadened, so much so that by some estimates, almost the entire adult population is now classified as having at least one chronic disease.
This makes no rational sense. As Fiona Godlee says
I’m struck by the quote from Allen Frances, the psychiatrist who chaired the task force for DSM-IV. “New diagnoses are as dangerous as new drugs, he says. “We have remarkably casual procedures for defining the nature of conditions, yet they can lead to tens of millions being treated with drugs they may not need, and that may harm them.”
Moynihan’s article is a fascinating and thought provoking one. But I finished up reading it thinking, hang on, we don’t even have an agreed definition of health, let alone a host of diseases! Shouldn’t we agree what health is, and then craft a health service towards maintaining and developing health in individuals and the population, instead of one focused on the continually expanding definitions of disease which, literally, plays into the hands of those who want us on drugs for life?
Heroes Not Zombies 
The various attempts at the supposed “scientization” of medicine have two dangerous consequences. First, it may be neither possible, nor advisable to replace quality of medicine with attempted explicit quantifications in many areas. Many medical procedures are of unknown effectiveness. Second, such attempts should be recognized for the dangerous diminution of overall human life that they represent. For individuated medicine, each and every human life is of ultimate value. There is no “hopeless” case. But for scientized statistical medicine, averages and statistical “evidence” assumptions attempt to override and interfere with the Doctor’s control over his own work and his hospital’s allocation of things to help the patient. It represents a corporatist descent of the conception of humanity to the level of “human resources” instead of “human beings”.
Both consequences follow exactly from what Lionel Milgrom called “scientism”, a flawed pseudo-scientific method of thinking, following from a philosophy of pure logical positivism. For details of the “scientism” fallacy, look up Milgrom’s outstanding article “Beware Scientism’s Onward March” (Dr. Leckridge is, no doubt, already quite familiar with it I’m sure).
http://www.anh-europe.org/news/anh-feature-beware-scientism%E2%80%99s-onward-march