A life-saving business

It can be easy to forget that healthcare is big business and can be as much about financial and political interests as it is the practice of sound medicine. This is especially the case with Public Health. A group of doctors and scientists concerned about the failure of the government Department of Health to adhere to evidence-based medicine, and believing patients benefit from the best treatments available, got together and asked for support from health executives across the country…

They wrote the chief executives of 467 NHS Trusts and what happened next demonstrated that public health officials don’t make decisions about what treatments and research to fund based on what works or makes fiscal good sense. Their letter urged the government not to squander limited healthcare resources on unproven and disproved treatments that are costing quite a lot of money — money that the NHS needed to be spending on things that work.

As Dr. David Colquhoun, professor of pharmacology at University College London, writes today at DCScience, it seemed like such a simple and self-evident idea. But…

It turns out that quite a lot of patients are deeply attached to unproven and disproved treatments. They clamour for them and, since “patient choice” is high on the agenda at the moment, they quite often get them… The government often says that it takes the best scientific advice, but the DoH seems to have something of a blank spot when it comes to alternative medicine. Nobody knows why. Perhaps it is the dire lack of anyone with a scientific education in government. Or could there be something in the rumour that the DoH lives in terror of being at the receiving end of a rant from the general direction of Clarence House if it doesn’t behave?

These professionals took on the most egregious examples of modalities lacking in any credible support: “medicines that contain no medicine.” They concentrated on alternative modalities and nutritional therapies that make unjustifiable claims about the ability of diets and vitamins to cure diseases, thinking these would be the most logical place to start. In his article, Dr. Colquhoun goes on to review some of the woo being funded by the government and their discovery of a surprising amount of politics behind things.

It is quite easy to get an impression that some of these fringe forms of medicine work better than they do. They form efficient lobby groups and they have friends in high places. They long for respectability and they’ve had a surprising amount of success in getting recognised by the NHS…

One can argue about whether it was money well-spent, but in the USA almost a billion dollars has been spent on research on alternative medicine by their National Center for Complementary and Alternative Medicine (NCCAM), which was set up as a result of political pressure from the (huge) alternative medicine industry. That has produced not a single effective alternative treatment, but at least it has shown clearly that most don’t work.

The placebo effect may seem harmless as long as people feel better, he said, but promoting modalities that appear to “work” by placebo comes at costs that aren’t often appreciated.

First it must be said that much of the apparent benefit of placebos like homeopathy isn’t a placebo effect, but merely spontaneous recovery. Echinacea cures your cold in only seven days when otherwise it would have taken a week. But when there is a genuine psychosomatic placebo effect, it can be a real benefit. As always, though, one must consider the cost as well as the benefit.

And there are a lot of hidden costs in this approach. One cost is the need to lie to patients to achieve a good placebo effect. That contradicts the trend towards more openness in medicine. And there is a major cost to the taxpayer in the training of people. If the NHS employs homeopaths or spiritual healers because they are nice people who can elicit a good placebo effect, the Human Resources department will insist that they are fully-qualified in myths. “Full National Federation of Spiritual Healer certificate or a full Reiki Master qualification, and two years post certificate experience” (I quote). That is one reason why you can find in UK universities, undergraduates being taught at taxpayers’ expense, that “amethysts emit high Yin energy”.

His article, which was published in The National Health Executive, a publication for Senior Health Service Managers, can be read in full here. He ends with what he was told by a government agency when he asked about the qualifications listed in its Skills for Health and learned there is even a division in charge of guidelines for talking to trees.

This issue of the urgent need for evidence-based medicine has taken on more seriousness in the UK than it has yet to here in the United States. For example, as we’ve looked at repeatedly, while the government spends countless millions of dollars on “healthy” diet and lifestyle programs to address child obesity — that lack evidence and have been shown to be ineffective and potentially harmful for young people — special care baby units now don’t have enough nurses to provide minimal care to sick and premature babies; the NHS is deciding how to ration care and which people are deserving of treatment; and hospitals have resorted to appealing to local residents for funds to buy needed diagnostic equipment for cancer, brain and kidney disorders.

Good doctors and nurses care about this stuff, and are willing to speak out even though it comes with considerable backlash, because they care about people. They touch people’s lives every day. And most of all, they understand that some day each one of our lives may depend on getting the best care. That’s why it’s important to keep hospitals and medical care top class.

Dr. Colquhoun shared an especially touching Christmas memory earlier this month that brought this message home. He described the snowy Christmas Eve when his son was born and rushed to the intensive care unit after his wife, seven months pregnant, developed a life-threatening brain hemorrhage. Thanks to the top-notch care of neurosurgeons, obstetricians and neonatologists, both his tiny son and his wife pulled through. Dr. Colquhoun posted a later photo of him holding his son for the first time. Little Andrew was so tiny he wore doll clothes knitted by volunteers.

No amount of homeopathy or therapeutic touch would have saved the life of his wife or son.