Sunday, 21 October 2012

Science vs. religion? – sounds a bit like the politics of healthcare

I should be heartened by the recent statement from the new Secretary of State for Health that he will be guided by science. Jeremy Hunt is on record as saying that his decisions would be ‘evidence based’. I fail to be convinced as one of his most publicised statements endorses abortion at 12 weeks and another supports the efficacy of homeopathy – neither of which preferences are ratified by the accepted wisdom of current scientific research.

His predecessor, Andrew Lansley seemed to be oblivious of much evidence based research and designed his reforms not based on science but his own form of religion – strongly held beliefs but little evidential back up.

And so it is with the politics of health. Good medicine is based on current scientific evidence balanced with the needs of the patients and available funds. I cannot exclude money from this definition as in the real world, cost benefit analysis will always be key. The politics of health, I believe, has a different definition. It is the balance (often unequal) of science and religion. The religion in health politics is the beliefs and possible bias of the decision makers, moved even further off-kilter by the colour of the party politics involved.

But one must have sympathy for the holder of the heavy and potentially poisoned chalice of the health ministry. I carefully included ‘current’ science in my definition of good medicine. I still shudder when I consider that 26 years ago I used to settle my precious baby on her front to sleep – luckily without ill effect. That was the advice at the time, even though now there is irrefutable evidence that cot death has significantly reduced since parents have been advised to lay their babies on their backs.

We are constantly bombarded with new pearls of wisdom from health researchers, especially when it comes to lifestyle and surgical options.  Working in both the public and private sectors, I am familiar with the anger experienced by patients when a treatment they believe to be essential is not offered by their NHS trust or approved by their particular medical insurer. Hysterectomies used to be ‘ten a penny’  but now there are other, less invasive and more cost effective ways of treating the symptoms that sent women in their droves to the surgeon’s knife.

Times change, health knowledge changes, scientific evidence changes. But all that any medical practitioner, and for that matter health minister can do – is to work within the accepted scientific guidelines of the time, study evidence not hypothesis, and make a decision based on here and now and not hearsay.

And please, whatever you do – leave religion and politics out of it.

Ah well – a girl can dream…


Chairman Chegwin said...

I think you are conflating politics and healthcare in this piece. Which evidence-based research did Mr Lansley ignore? His reforms were (are) reforms of systems, responsibilities and money flows. There was nothing inherently "clinical" in there?

You can of course argue about whether system change was needed at this point in time but that was (for right or wrong) a political judgement. I don't think views on abortion or homeopathy (or anything else) inhabit the same space.

I would also suggest that the "Lansley Reforms" are in fact Steve Field's reforms. The Bill (Act) that emerged post-"pause" was very different to what was presented to the populace before.

Whether you agree with Mr Hunt or not, it is a mistake to conflate those beliefs with what Mr Lansley was trying to do. As far as I can see, Mr Lansley didn't get involved in challenging "clinical" decision making - his priority was reforming a system (which many - including me - would say is dominated by the agendas of clinicians and ripe for REAL reform....)

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