Some Utopian Thinking on Health (Part I)
The NHS is generally a pretty unifying issue. Such is the affection in which it is held, that the Tories realize that great stealth is needed in their assault upon it – and the fact that free and universal healthcare should be so sacrosanct represents perhaps the greatest success of the British Left in the last century. Today, in Scotland, world-class surgeons will operate on destitute people, and the very wealthy will share acute wards with the very poor. Whilst private healthcare does exist here, it is principally used to jump the queue for elective surgery – and the chances are that the afternoon’s private surgeon spent the morning working for the NHS.
Imagine if the same thinking informed the provision of, say education, or transport – how much closer we would be to the kind of country we would want to live in?
Faced with the current proposed upheavals to the service, the response of the Left, the general public and the healthcare professions has been near unanimously conservative – essentially we have demanded that things stay more or less as they are, and that more money should continue to be invested in the service as the population ages. Indeed the latest Scottish Green Party manifesto falls within this consensus, and whilst it says nothing that I would particularly disagree with, I wonder if we couldn’t articulate a more radical vision for how to improve the nation’s health?
The role of pharmacy strikes me as the orthodoxy in greatest need of upset. The public have a good understanding of the problems that privatised healthcare would cause, and yet the damaging effects of the privatised pharmacy are largely overlooked. The drug companies receive 20 billion pounds per year from the NHS, and behave as ethically as you would expect from any other vast corporation – which is to say they reinvest some of that money in skewing research, distorting clinical judgements and applying marketing to a process which is meant to be scientific – all to the detriment of patient care.
The visible part of this effect is drug reps, a tier of highly-paid professionals whose job it is to travel between hospitals and surgeries making the case for certain drugs. The drugs promoted will always be recent patents, and they will always be expensive. No negative findings that may have arisen from trials will be discussed, and the talk will be tailored to exploit the audience‘s ignorance; as they know fine well that junior doctors are not going to be familiar with all of the literature in a specific area, they can get away with much fuzzier science than they could with an audience of specialists. The freebies that accompany these talks have been reigned in in recent years, but the wards remain awash with branded pens and mugs, whilst in the developing world doctors are still offered formalised rewards for set numbers of prescriptions. Kickbacks, essentially. And this is only the visible part of the spectrum – far more pernicious is the way in which these companies distort research priorities and interfere with the peer review process. Because all research they fund must end in a patented pill, this means that;
* complexity is valued over simplicity (evidence suggests that vitamin D deficiency may have a role in causing various common Scottish diseases, however as Vitamin D is a generic product the research would not be profitable, and has therefore not yet been done)
* pharmaceutical solutions are promoted to the near-exclusion of other means (vast amounts of money goes into the development of psychiatric drugs, very little into research around talking therapies)
* a drug which cures is far inferior to one that merely controls symptoms and must be taken lifelong
* the affluence of a patient population is more significant than their need (male pattern baldness is a bigger research priority than malaria)
None of this should come as a surprise. No corporation is ever going to behave any better than it makes commercial sense to, which is why it is so disastrous to leave anything that really matters in their care.
So how did we get here and what do we do about it?