I like the talk about patient centric medicine that you highlight. Whether you like it or not modern western medicine is disease centric and not patient centric. In fact, for a healthy outcome doctors must work with their patients cheek by jowl, to borrow your own idiom. The egalitarian view of rationing medical care based on resources does not augur well for patient good. If we stretch this argument a bit further we will arrive at a very sensible point. One heart transplant cost could possibly feed more than one thousand malnourished children suffering from NIDS (nutritional immune deficiency syndrome) which is a bigger burden in this world compared the AIDS. Number wise NIDS beats AIDS hollow. Children with severe NIDS die faster than AIDS patients.. You might argue that it is not your problem, if you took the narrow NHS context.
You will have the MALL-nutrition in the west sooner than later, thanks to the junk food sold in the Malls. Sugar based preserved foods have already started the epidemic of obesity. The poor children suffer from protein calorie sub-nutrition while the Mall-nutrition in the west will have protein sugar calorie malnutrition. The latter damages the liver in addition like the children with kwashiorkor compared with the marasmus.
A word about the data base for research, patient care and for guidelines building that your editorial talks about. Most of our data, if not all of it, is unreliable even if maintained with meticulous care as it is based on surrogate end points and not the real healthy outcomes data following our guideline based management strategies. We have been groping in the dark. Even our RCTs have been placed on an undeservedly high pedestal. No two human beings can be compared as they are not two chemical molecules in the laboratory. RCTs, per force, will have problems when applied to patient care in real life, not to mention the unscientific poly-pharmacy which is the rule rather than exception. Poly-pharmacy has no science base at all.
All is not well. So let us not discuss these things piecemeal.
Rapid Response:
Not the best thing since sliced bread
Dear David,
I like the talk about patient centric medicine that you highlight. Whether you like it or not modern western medicine is disease centric and not patient centric. In fact, for a healthy outcome doctors must work with their patients cheek by jowl, to borrow your own idiom. The egalitarian view of rationing medical care based on resources does not augur well for patient good. If we stretch this argument a bit further we will arrive at a very sensible point. One heart transplant cost could possibly feed more than one thousand malnourished children suffering from NIDS (nutritional immune deficiency syndrome) which is a bigger burden in this world compared the AIDS. Number wise NIDS beats AIDS hollow. Children with severe NIDS die faster than AIDS patients.. You might argue that it is not your problem, if you took the narrow NHS context.
You will have the MALL-nutrition in the west sooner than later, thanks to the junk food sold in the Malls. Sugar based preserved foods have already started the epidemic of obesity. The poor children suffer from protein calorie sub-nutrition while the Mall-nutrition in the west will have protein sugar calorie malnutrition. The latter damages the liver in addition like the children with kwashiorkor compared with the marasmus.
A word about the data base for research, patient care and for guidelines building that your editorial talks about. Most of our data, if not all of it, is unreliable even if maintained with meticulous care as it is based on surrogate end points and not the real healthy outcomes data following our guideline based management strategies. We have been groping in the dark. Even our RCTs have been placed on an undeservedly high pedestal. No two human beings can be compared as they are not two chemical molecules in the laboratory. RCTs, per force, will have problems when applied to patient care in real life, not to mention the unscientific poly-pharmacy which is the rule rather than exception. Poly-pharmacy has no science base at all.
All is not well. So let us not discuss these things piecemeal.
yours ever,
bmhegde
Competing interests: No competing interests