Editor's Choice

Health reform quackery

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d1711 (Published 17 March 2011) Cite this as: BMJ 2011;342:d1711
  1. Fiona Godlee, editor, BMJ
  1. fgodlee{at}bmj.com

I was picked up for two things in last week’s Editor’s Choice (doi:10.1136/bmj.d1551). First, I said that abdominal CT scans and barium enemas incur eight times the radiation dose of a chest radiograph. I should have said 400 times. The best that can be said of this is that it was in the right direction.

My predecessors always said that the quickest way to see if people are reading the journal is to get Mozart’s birthday wrong. My error did the trick just as well. Thank you to all who wrote in. A correction has been made.

The second pick up was about our article lauding Turkey’s healthcare reforms (doi:10.1136/bmj.c7456). Patients’ outcomes may have dramatically improved but, wrote one reader, our authors didn’t report that doctors and other health professionals are up in arms and soon to take to the streets. French doctors (and patients) are likely to follow suit as their government struggles to bring down the cost of what WHO has called the best health system in the world (doi:10.1136/bmj.d1524).

Perhaps doctors are always against reform. British doctors resisted the setting up of the NHS, and I am writing this from the BMA’s Special Representative Meeting, which has called for the government’s health bill to be withdrawn (doi:10.1136/bmj.d1701).

While recognising the need for change, and that the bill includes some good things, speakers have stressed that the NHS is, according to the Commonwealth Fund, the most cost efficient health service in the world and that things were heading in the right direction. There is much talk of unintended consequences, rushed implementation, and lack of piloting. We have come a long way since Nye Bevan had to stuff our mouths with gold, said one speaker. Let’s show our patients how far we have come. “Medicine is a public service, not a supermarket.”

Is this special interest speaking or is this really in the interests of patients and the public? John Pickstone has no obvious vested interest. He is a professor of history. Yet in his self-styled polemic (doi:10.1136/bmj.d997) he too is excoriating in his criticism of successive healthcare reforms, this one as much as any. While dogmatism and quackery have largely been driven out of medicine, both flourish in health policy, he says. “Since the 1980s, reorganisation of the English NHS has become endemic, hectic, and essentially out of control.

“Dogmatically inclined, unmindful of evidence, and casting about for mechanisms that might deliver quickly, recent governments have proved easy prey to personal enthusiasms, management consultants, sectional interests, and the agents of private companies looking for business. Such were and are the conditions for political quackery, and thus ‘heroic’ policy making is now ascendant.”

Vastly better methods of service development are now available, he says, and the future of a vital institution is at stake. I doubt the bill will be withdrawn—too much political capital is at stake. But as discussants at our roundtable agreed (doi:10.1136/bmj.d1637), it can and should be modified: to allow more gradual and voluntary change; to avoid cherry picking of low risk patients and easy-to-deliver services; and to ensure transparency and accountability for commissioning decisions.

Notes

Cite this as: BMJ 2011;342:d1711

Footnotes

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