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Rapid Responses: Rapid Responses published:
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The well and insured
- Diyanath S Samarasinghe (22 April 2005)
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Yes, we are feeling scared
- Ian P Peacock (22 April 2005)
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"Health Care" maybe an oxymoron.
- Christopher M . Buttery (22 April 2005)
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what is preventative medicine?
- benjamin dean (22 April 2005)
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THE DILEMMA OF THE AGED
- Dr. Rajesh Chauhan, Dr. Akhilesh Kumar Singh. MBBS, MD. Dr. Parul Kushwah. MBBS, MISCD. (22 April 2005)
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Preventive Medicine deserves more respect.
- Kelechi E Nnoaham (25 April 2005)
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The economics of health and disease: a poignant truth of our times
- Priyamvada Tripathi (26 April 2005)
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Lifestyle versus drugs
- Stephen J Redmond (26 April 2005)
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It may be bad for doctors, too
- Christine M Gaston (26 April 2005)
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Preventative HC vs risk HC
- Anita Evangelista (28 April 2005)
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Prevention article makes me miserable
- Brian Neeson (28 April 2005)
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Kept alive--but for what?
- Richard Smith (29 April 2005)
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Morituri te salutamus
- Peter Davies (30 April 2005)
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Both the well and the sick need health care
- Sian JA Harris (5 May 2005)
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Health for All – Building Partnerships for Primary Care in the Developing World
- David Mark Jones (12 May 2005)
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not miserable
- Raymond G. Britt (16 May 2007)
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Diyanath S Samarasinghe, Associate Professor Faculty of Medicine, Colombo University, Sri Lanka
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Iona Heath says, probably correctly, 'It is contingency—chance, fate, uncertainty—that makes life beautiful'. This beauty, in the thrilling and uncertain life, has clearly failed to grip - given the overwhelming popularity of medical insurance in the rich well world. In seeking to redirect inefficiently used medical expenses, that spent on insurance is not for the medical sector to consider better using. It is in the hands of a diferent industry. The time has come for the medical sector to take on the medical insurance business and use the not- too-inconsiderable profits to improve health - whether through prevention or through cure. Competing interests: None declared |
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Ian P Peacock, Insurance Underwriter & Claims Assessor Bournemouth, England, BH8 8AL
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Thank you to Dr Heath for an interesting article. As a patient (not of hers) and as an individual who deals with insurance related medical issues each day I feel that the fear factor is definitely growing. Most people want to live to old age with the hope that they are relatively well by then and able to enjoy a reasonable standard of life and therefore it appears helpful to understand some risk factors. The problem is that the huge amount of information available causes uncertainty, misinterpretation and yes, fear. The essential question is 'How do I know when I am ill and require medical help ?' This has of course always been the question we ask ourselves when we feel unwell, but these days we trawl the net and think we may have one of many different illnesses. We can only continue to see our GP's if we think we need to, but I do very much agree with Dr Heath's comment that doctors should be interested in reducing the burden of fear and emphasing health. Knowing when to just listen and reassure, arrange tests, treatment or specialist referral is the particular skill of the GP, but perhaps a more holistic approach to patient care and promoting overall good health would be beneficial ? How many GP's have the time or resources to do this though ? Competing interests: None declared |
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Christopher M . Buttery, Professor of Public Health Virginia Commonwealth University, VA 23298
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Your writer, Dr. Heath, writes from the point of view of a practitioner who delivers direct medical care, not health care. Although the writer declaims wasting money on uneccessary or inappropriate health care the discussion is about poor use of medical care. For example money spent on useless medical interventions, or use of multivitamins and patent medicines by the elderly in the belief they can be returned to their youth. Another example of often useless intervention is that delivered by for-profit weight loss centers that have their clients yo-yoing up and down with the latest fad while reaping exhorbitant profit. Before decrying preventive medicine the writer should have thought about defining the term. The best of preventive medicine has saved more lives and reduced more suffering at far less cost than all medical interventions. Immunizations against once common diseases such as smallpox, measles and diphtheria have saved many lives and reduced associated disability. Improved sanitation has reduced hookworm and malaria by remove sewage from rivers and draining swamps. vitamin A deficiency dramatically increased childhood morbidity and mortality from infectious disease and that a 4-cent dose of vitamin A not only prevented and cured the eye disease but also reduced childhood deaths by 34 percent. Simple preventive interventions have done wonders in developing countries. Far more than sending in teams of medical practitoners Changing diet has reduced heart disease. Early intervention in hypertension has reduced stroke. Prophylaxis for TB infection has reduced clinical tuberculosis. Prevention is about population interventions which are usually low cost and lead to reduced disability and death. I believe that the writer is really talking about expensive interventions for chronic disease, usually the result of excess use of uneeded drugs such as alcohol and tobacco, or lack of exercise among others When these behaviors catch up with the individual they go to a doctor, having read of medical miracles in the newspapers and believe medical intervention will return them to health. These activities on behalf of older people in developed countries (which I believe is what the writer is talking about) are NOT prevention (primary or secondary). If this editorial helps people think twice about the use of the terms "health care" and "medical care" and learn to distinguish between them it will have been useful. I believe there are better uses of national and individual resources than the medical fad of the minute sold by plastic surgeons, orthopedists and the Viagra bunch in the media. The policy and philosophical issues of prevention versus medical care are important, This editorial confused the issues. Preventive medicine is a well defined discipline. The terms prevention and 'Health Care' are often used incorrectly by medical and lay persons. I encourage the editors to devote an issue to the advances in prevention in both developed and developing nations over the past 50 years to provide your readers with a clearer understanding of prevention versus medical care. Competing interests: None declared |
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benjamin dean, dr oxford
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Having read the articles by Iona Heath and Fional Godlee, I am slightly frustrated at their view of preventative medicine. They both argued against excessive drug prescribing and treating risk factors, seeing these as aspects of preventative medicine. The questions I want to ask is what is preventative medicine?, and why does preventative medicine have to be practised by the medical profession? I agree with both authors on the futility of merely postponing death while undermining health; surely the medical profession could use its knowledge more constructively? Currently short termism is rife in our politics and in our daily life; this becomes abundantly clear at election time when policies are designed to win votes and not with our long term interest at heart. In last months BMJ (1) this paper demonstrated how medical knowledge can be used to improve people's health, but only if the government is willing to make big changes in cooperation with big industry. This is where there is massive room for improvement. Every week new trials come to light that demonstrate minimal benefits of a new medical therapy, often resulting in increased drug presribing. Year by year this approach, financed strongly by drug companies, continues to provide increasingly inefficient health gains. So where should preventative medicine be today? Our medical knowledge should be used to be truly preventative. Government policy needs to be changed drastically to make it easy for the nation to stay healthy. Schools need compulsory nutritional standards, increased hours of exercise on a daily basis and improved overall education levels so that the population is aware of how to stay healthy. The government needs to work with the food industry to tax unhealthy foods and smoking must be banned in public places. The environment which includes water and air quality must be preserved by policies. These are just a few examples of where medical knowledge can be used to make a real difference. Surely if a tiny percentage of the drug budget of our pensioners went towards better school nutrition and school sports facilities, then the money would be better spent. Thus I believe there is a great potential role for preventative medicine, even if it will not be administered by doctors, Yours, Dr B Dean ps my daily run doesn't make me miserable 1. Improving diet and physical activity: 12 lessons from controlling tobacco smoking. Derek Yach, Martin McKee, Alan D Lopez, Tom Novotny, for Oxford Vision 2020. BMJ 2005;330:898-900, Competing interests: None declared |
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Dr. Rajesh Chauhan, Consultant Family Medicine & Communicable Diseases. 309/9 AV Colony, Sikandra, AGRA -282007. INDIA, Dr. Akhilesh Kumar Singh. MBBS, MD. Dr. Parul Kushwah. MBBS, MISCD.
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Dear Editor, The article by Iona Heath, ‘Who needs health care—the well or the sick?’ (BMJ 2005; 330: 954-56), describes the current trend that has to be checked. A mortal fear gets drilled in every once in a while owing to 'recent research findings'. The multinationals do their bit to allay this fearful response by producing 'antidotes' at an equally rapid pace at ‘competitive prices’, lest others overtake them in their philanthropy. What is already known to the many would soon be learnt by the rest. This cannot be avoided in this age of advertisement. Maybe when someone lands on the Mars some day, there would be a big hoarding of possible events/inflictions that can be health hazard, and in another bright area, another equally big, if not bigger, hoarding telling the availability of the range of products as ‘sure’ ‘antidotes’ and ‘investigative facilities’, with possibly a tag mentioning that a percentage of every purchase would be for the poor people of the ‘Earth’. In close knit societies that take care of its weak, infirm and the old, as in the remote villages of India and likewise in Botswana, the aged, infirm and the weak are not that worried as they have the reassurance that they will be looked after till their last. However with the disintegrating families, old and infirm people get worried as there is no one to look after them once they turn more weak, infirm and more aged. Hence their desire for remaining healthy till their very last in order to be able to fend for themselves. To reiterate, most of them do not fear death and have no desire for prolonged life. Their fears are laid to rest by the preventive and proactive actions that they take, based on what they hear and see. Maybe a better and vetted comprehensive health education policy for the masses needs to be in place recommending only the indisputable preventive and proactive measures. Regards, 1. Dr. Rajesh Chauhan. MBBS, DFM, FCGP, ADHA, FISCD Consultant Family Medicine & Communicable Diseases. Ex- Senior Medical Officer, BDF, Botswana. 2. Dr. Akhilesh Kumar Singh. MBBS, MD Senior Resident Neurology Institute of Human Behavior & Allied Sciences, Delhi. 3. Dr. Parul Kushwah. MBBS, MISCD Family Medicine Practitioner. Competing interests: None declared |
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Kelechi E Nnoaham, Public Health Specialist Registrar Cherwell Vale PCT, Oxford Road, Banbury OX16 9AL
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Editor, Iona Heath’s article makes for interesting reading. I agree with the author on many points including the fact that the waning of professional power amongst health care professionals has been wrongly conceived to be in the interest of patient autonomy whereas it is increasing corporate power that has done more harm, albeit indirectly, to patient autonomy. I also agree with the author on the relationship between longevity and self reported illness. The author seems to attribute this to the supposition that when society achieves good health, it seems to have greater expectations of health and consequently more fear and anxiety when health seems threatened by real or perceived risks. The foregoing observation is however not surprising if we conceptualise the response of society to improving health in similar ways to Maslow’s description of the hierarchy of human needs. Society can be considered an individual entity for the purpose of this concept. Accordingly, it is not too surprising that while a society that is still grappling with ill-health will not move onto higher needs-expectations, a society whose basic ill-health issues appear sorted out will naturally expect something higher – longer and quality life as well as abolition of uncertainties in health. According to Maslow, any gaps occurring in the need level at which an individual operates may result in reversion to earlier need levels in order to ‘remove’ the gap. To suggest the devolution of resources away from preventive medicine in an already 'health -primed' society such as as ours will only lead to an unhealthy reversion to a lower needs status with its attendant challenges. For this reason and many more obvious ones, I do not think that preventive medicine has received a fair crack of the whip from the authors. It deserves more respect that has here been accorded. Competing interests: None declared |
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Priyamvada Tripathi, SHO, Obstetrics and Gynaecology Glasgow Royal Infirmary, Glasgow, G4 0SF
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>The article by Dr Heath was thought provoking and saddening at the same time.Coming from a 'developing' country myself I have often felt awed by the sharp discrepancy between health care provision in the country where I trained as a doctor (India) and the country I practise in (UK). >At the end of the day its money and 'purchasing power'that decide who lives healthy and who languishes in disease. This is all the more relevant in the context of World Poverty day. We all know millions of children die in the developing and underdeveloped world every day for want of life saving drugs. Yet, how much of our current research is directed at finding cost effective health solutions for the third world? >We live in a world dominated by extremes.On the one hand people in the western world are bogged down by 'too much' health care and on the other, so many people in the third world die for want of basic health care. > I think the time has come to re-consider our priorities and ask ourselves if really live in a healthy world. Competing interests: None declared |
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Stephen J Redmond, GP principal Ellergreen Medical Centre, 24, Carr Lane, Liverpool L11 2YA
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Dear Editor, This article raises many important issues that have tended to be submerged by the confidence and statistical savvy of so much work from secondary care, hich show benefits from all sorts and kinds of intrevention in various populations. Often, though, this tends to melt away like mist when approached more closely. To me, for a complex number of reasons, people look to medicine to redeem them from their vices, and for an equally complex set of reasons we pretend to power we have only thanks to statistical power and exclusion criteria. The principle benefits of prevention do not usually depend on strictly medical interventions, but on lifestyle. When a person cannot comply with this we collude with them to pretend that a tablet can convey the same benefit. I do not believe it can, and we end up not at 70% but, with the polypill, with 100% medicalisation.This is to be deplored for a whole raft of reasons, but primarily because,even if in good faith, it is based on a falsehood. In terms of diet,exercise, and the dangers of a culture based around the needs not of people but of motor cars, we are starting to see the price to be paid. But I am optimistic- it is not too late, either for the individual nor for society to redress this emphasis Competing interests: None declared |
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Christine M Gaston, General Practitioner Cambridge CB1
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Iona Heath's article eloquently described the phenomenom of a Western population which is healthier than ever, but also more anxious than ever about health matters. As indicated in previous responses, it did perhaps fail to differentiate between true preventative medicine, and the treatment of risk factors for illness, which now forms a large part of primary and indeed secondary care. Such treatment may be justified in terms of statistics, but also generates considerable anxiety, as it designates whole new groups of well individuals as "patients" requiring treatment. I wonder if it also responsible for some of the decline in morale of many doctors, being a profoundly unsatisfying type of activity, where success is measured by a target achieved rather than suffering eased. Competing interests: None declared |
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Anita Evangelista, Family Nurse Practitioner Aurora, Missouri, USA
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Thanks to the authors for an excellent article, and the respondents who provided so many viewpoints. There is no doubt that the vast community preventative health projects of the past have been successful in eliminating disease scourges -- clean water, immunization, and destroying disease-transmitting insects have contributed to better health and extended life. However, in my clinical practice, there is also no doubt that most of my day is spent attending to patients who are not "truly" sick -- their condition is self-limiting, the type of illness which our mothers and grandmothers would have treated with epsom salts or cod liver oil or mustard plaster ....to just as good effect as our costly sprays & pills. I find it hard to accept the truth that we have bred a generation of adults who don't know the most simple self-care during transient illness, who don't comprehend the importance of handwashing, or basic musculoskeletal care. Not only that, they fully expect to be cared for and medicated for all conditions large and small through the lifespan. Now, throw a few risk-factors onto this population of happily ignorant worried well, medicate them against the chance that they "may" get sick in 35 years. Add to that fear the ever-changing medical "rules": eggs are poison/eggs aid healing; butter will clog your arteries/saturated fat is critically important to good health; coffee destroys arteries/coffee cleans arteries; you'll die if you eat beef/beef is a great source of nutrition; an apple a day keeps the doctor away/apples are toxic due to pesticides.....the innate confidence in our own ability to sustain life is eroded to near-zero. Yes, definitely, the fear of disease is MUCH more significant than the actual existence or risk of disease in Western societies. Is it ethically appropriate to terrify and medicate people with the risk they may die of something decades from now, while their odds of morbity or mortality driving home on the highway today are significantly higher? I don't have answers, and I'll keep on medicating. But, there's something very wrong with this picture. Competing interests: None declared |
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Brian Neeson, Chair, Association for Health Promotion in Ireland HSE Mid Western Area, Parkview House, Pery St, Limerick, Ireland
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Dear Editor, Re: Who needs health care – the well or the sick? You can tell that it’s around Easter by the appearance of articles criticising prevention and health promotion. I was struck first of all by the different businesses included in this broad swipe – national screening programmes, the pharmaceutical industry, health food stores, general practice and NHS health promotion. Some of the referenced targets are fair game – for example hormone replacement therapy or prescribing statins. But the notion that the UK invests huge amounts in “the vast bureaucracy of health promotion” was just laughable. There are around 2,000 health promotion specialists in the UK, out of a total workforce of approximately 1.3million. Less than 2 of every 1,000 NHS staff are devoted to health promotion, and leading out on the national agenda ‘Choosing Health’ alongside colleagues in public health. Evidence for the effectiveness of health promotion is available but not mentioned, e.g. reviews by the Health Development Agency (now NICE) (www.publichealth.nice.org.uk) and by the International Union for Health Promotion and Education (www.iuhpe.org). Clear examples include the reduction in road traffic accidents and in adult smoking rates. Yours in misery, Brian Neeson
Health Promotion Centre,
Health Service Executive,
Mid-Western Area,
Parkview House, Pery Street,
Limerick, Ireland
Competing interests: None declared |
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Richard Smith, Connoisseur of human frailty London SW4
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Iona Heath misses an important argument in making her case that more prevention may make us more miserable. She writes that: “The danger is that the achievement of longer and, by all objective measures, healthier lives, may result in those lives being increasingly dominated by feelings of illness and fear.” Although our lives may be healthier “by all objective measures” in the middle of life, they are probably not at the end of life. The Office of National Statistics reported last year that although life expectancy has increased the length of healthy life has not increased as fast—so the period at the end of life spent in poor health has increased. (1) The concept of “compression of morbidity,” meaning that we’d be playing football, dancing, and reading complex novels at 85 and then fall apart and die over the next three months, seems to be an illusion. In fact, we will spend years demented, depressed, Parkinsonian, arthritic, blind, and deaf—“sans eyes, sans teeth, sans taste, sans everything,” as Shakespeare put it. (Ironically, our teeth might survive—a tribute more to fluoride than dentists.) Still, us baby boomers needn’t worry. If nature won’t fix it, we can. I’m sure that euthanasia will be legalised in Britain before I’m 75. Richard Smith 1. Hébert K. Life expectancy in Great Britain rises—but later years are still spent in poor health. BMJ 2004;329:250 (31 July), doi:10.1136/bmj.329.7460.250-a Competing interests: None declared |
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Peter Davies, GP Shelf Health Centre, Halifax, West Yorkshire, HX3 7PQ
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Heath (1) addresses an important area, but I think starts from a false start point, failing (as do most others) to distinguish between remedial (panacea) and generative (hygeia) uses of “healthcare” spending. Illness treatment is a very different enterprise from generating health and our failure to recognise this is at the root of our failure to develop appropriate concepts and measures of the effectiveness of medical and other interventions. (2) Illness is eventually a part of all our lives, whether we are rich or poor, and it is this fact that justifies the provision of a universal health care service. The ill human is worthy of compassion and appropriate medical intervention, whatever their moral or economic worth. We know that illness will catch up with us at some stage in our lives. We know the risk factors for common illnesses and we can measure these and intervene to partially ameliorate some of their effects, although we achieve this at the cost of other unrecognised physical and psychological effects that Heath describes well. Like Admiral Stockdale in the Hanoi Hilton (3) we need to have the courage both to confront the brutal facts of our situation and to retain faith that we will prevail in the end. For humans the brutal fact is that we will eventually die, and many have lost, as Wordsworth puts it, “the faith that looks through death.” (4) Having lost that faith many turn to medicine as if it were a source of meaning in itself. (5) There is a large element of absurdity in medical efforts to postpone death. Heath is right to point this out and shows that risk avoidance can be deeply neurotic, unhealthy and ultimately futile. We need both remedial illness intervention when necessary (which doctors can help with) and a strong view that health is a positive concept, the outcome of a life lived well, through all its stages. This requires coherent philosophy, not drugs. We need to rediscover the ability to live life well, whilst accepting, and welcoming, the inevitability of risk. 1) Heath, I (2005) Who needs health care-the well or the sick? BMJ 330:954- 6 2) Berwick, D (2005) Measuring NHS productivity. BMJ 330:975-6. 3) Described in Collins, J (2001) Good to Great, Random House Business Books, London pages 83-87. 4) Wordsworth, W. Intimations of Immortality from Recollection of Early Childhood. 5) Neuberger, J (1999) The NHS as a theological institution BMJ 1999; 319:1588-1589 Competing interests: None declared |
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Sian JA Harris, general practitioner The Heron Practice, The John Scott Health Centre, Woodberry Down, Green Lanes, London N4 2NU
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Iona Heath (1) relies on the work of Amartya Sen to argue that ‘the more people are exposed to contemporary health care . . . the sicker they feel’. In fact, Sen’s original work (2)is not critical of contemporary health care. Instead, he points to the conclusion that less educated communities with poor access to contemporary health care are unable to identify their symptoms as illnesses. Perceiving symptoms as ‘natural states of being’ does not protect one from problematic consequences. When illness is explored, named, and treated, a patient’s ‘natural state of being’ can be dramatically improved. Iona Heath states ‘it is the enduring truth that we can never know what will happen tomorrow, whether or not we have taken our aspirin and our statin, which makes life thrilling’. Of course we cannot predict the future, but we can reduce the risks of catastrophic life events such as a CVA or MI -- neither of which are thrilling prospects. The article recommends that we ‘relocate our engagement with our patients more in the present of their lives and their immediate concerns’. However future catastrophes will eventually become the present of our patients’ lives. 1. Heath I. Who needs health care – the well or the sick? BMJ 2005; 330:954-956 (23 April). 2. Sen, A. Objectivity and Position: Assessment of health and Well- Being. (December 1990). www.hsph.harvard.edu/hcpds/wpweb/90_01.pdf Siân Harris, general practitioner The Heron Practice, The John Scott Health Centre, Woodberry Down, Green Lanes, London N4 2NU. Sian.Harris@nhs.net Competing interests: None declared |
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David Mark Jones, GP Bridge Health Centre, Bridge, Kent, CT4 5BL
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The following article was written for publication in the RCGP International Newsletter of the British Journal of General Practice. Its inclusion will be later this year. After reading Iona Heath's article I shared "Health for All – Building Partnerships for Primary Care in the Developing World" with her. We decided that I would submit the article as a Rapid Response to her publication "Who needs health care - the well or the sick". It would be a pleasure to hear from anyone that finds the contents of interest. Dr Mark Jones Health for All – Building Partnerships for Primary Care in the Developing World Background Five years ago, building on experiences of healthcare in India that stretch back to the days of medical student electives, our practice in Canterbury decided to become involved in developing primary care services in a rural area of Bihar. Bihar is India’s poorest and most under developed state. It is a state where female literacy is only 20% and over 50% of children are considered chronically undernourished 1. Working in partnership with a small NGO in Bihar that, until this time, had run a rural education programme, we organised fundraising in the UK and used this to develop a rural primary care centre. Health services in the area had previously been non-existent. On the ground in India staff were recruited and a nurse-led primary care team developed, supported by a marvellous and dedicated Bihari doctor. The team is presently working in five villages, soon to be increased to eight. They provide treatment and health education and public health initiatives including the provision of clean water and the development of immunisation programmes. By the formation of women’s self-help groups poverty alleviation through schemes such as micro-credit is being supported. In the UK Health for All has become a registered charity. Its roles include fund raising to support the project, facilitating project development in Bihar and, an aspect to which we attach great importance, supporting training and professional development of the team in India. Initially support was practice based but this has evolved to involve the wider community, including local schools. Feedback tells us people’s enthusiasm to support the work is largely as a result of the direct involvement, and therefore accountability, of the practice. In recent months, possibly reflecting the success of project in our local community, the Archbishop of Canterbury Rowan Williams, has accepted an invitation to become the charities patron. Education and Training Not surprisingly, as, universally, achieving quality goes hand in hand with education and training, these aspects have become an integral part of the development of the team in India. The Mahatma Ghandi Institute of Medical Sciences, a rural Centre of Excellence in Community Medicine in the state of Maharashtra, a 24-hour train journey from Bihar, had been identified as a resource. I first visited the Institute as a medical student and returned four years ago as a recipient of a RCGP International Travel Scholarship. The team have twice travelled to the Institute in Maharashtra and undergone training. A senior physician in Community Medicine and a Social Scientist have travelled in the opposite direction and have appraised the work, facilitating its development and identifying training issues. Two doctors involved with the project in India, Dr Binod Verma from Bihar and Dr Sherin Varkey from Maharashtra, have obtained RCGP International Travel Scholarships and travelled to the UK in the past few years. In the UK they have enjoyed attachments in primary care and visited the College, most recently looking at developments in quality at the College and within the NHS. A Proposal The main reason for writing this article is not just to share our own project with others, although it is a pleasure to do so. It is to ask “Is anyone else doing anything similar, or just as importantly, would anyone else be interested?” The model that we have developed is based on a number of principles, which, others have suggested, could be replicated to develop health services overseas. There exists a partnership between a small UK organisation, a general practice surgery, and an overseas organisation. The latter may already exist or may need to start from scratch. The success of the work depends on local ownership, of fundraising in the UK by the supporters and, overseas, by the people who provide and use the services. Primarily the purpose of the development is service provision, in areas of the world where little or none presently exists. Service provision is not, of course, the role of the College, but working at arms length or under the umbrella of the International Department of the Royal College of GP’s has already been shown to provide an opportunity for education and training. If there was interest in developing this idea then it may be possible, given the success to date and the accountability that such partnerships provide, to approach larger funding organisations, our own DFID for example, to seek support for developing primary care and education in the areas of the world where it is most needed. Already a separate group of doctors in Canterbury have started planning a similar primary care project building on associations with Sudan. If anyone would like more information or is interested in developing the proposal further please feel free to contact those of us involved in Health for All at the email address below. Your interest would be very much appreciated. Dr Mark Jones MRCGP mark.jones@gp-G82228.nhs.uk 1 India’s National Family Health Survey 1998-99 Competing interests: Trustee of Health for All Registered Charity No 1076913 |
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Raymond G. Britt, retired Blue Heron Ranch, 87743
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Recent research shows that people adapt quickly (about three months) to both good and bad events. The study included winners of lotteries and persons rendered handicapped by medical problems. Emotional Homeostatis? Are blind poeple less happy than sighted people? It is absurd to assume that knowledge of medical risks makes us miserable. Insurable risks are random events. Routine checkups are not random events and usually are not paid for by insurance companies. The system is skewed against prevention, in my opinion. Medical practice remains an art and all medical procedures, whether preventative or curative have a risk element. An acquaintance of mine recently died subsequent to a colonoscopy (punctured intestine) performed because he was deemed at risk for colon cancer. One must weigh the odds. After years of pain pills and a triple bypass, It was recently discoverd that I have diabetes. I am 77. With an early diagnosis both of these costly and disabilating events might have been avoided. I feel I am entitled to all the medical services I am able and willing to pay for. I enjoy life and intend to continue doing so as long as possible. Competing interests: None declared |
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