Ross and Coulter repeat many sensible observations about over diagnosis and over treatment that add little or nothing to the Hippocratic instruction, “First, do no harm."
They suggest that the UK health funding system offers less encouragement to the over prevision of care, than do fee-for-service systems.
That generalisation may appear fair and reassuring, but not to mention exceptions is a little unfair, if understandable in view of space constraints.
The four questions that ‘Choosing Wisely UK’ suggests that a patient asks of any new option:
“What are the benefits ? .. the risks ?.. the alternatives ?.. and if I do nothing?"
do no more than reflect a patient’s essential right to information, and the need, emphasised by defence societies, for doctors to provide all pertinent information about possible side effects, to every patient. Especially so since the UK Supreme Court ruling on the Montgomery case in 2015.
Every weekday, all over the UK, thousands of children and adults are vaccinated, probably unaware that their treatment will contribute to practice income.
Is this financial interest, if undeclared, consistent with our espousal of financial probity in annual NHS appraisals?
How many patients or parents have the chance to ask the attending professional those four questions, above, that ‘Choosing Wisely UK’ suggest that they ask ?
How many even see the vaccine Patient Information Leaflet?
And if patients, or parents, do ask those four questions, concerning the long term effectiveness and side effects of vaccinations, how many of the attending professionals are in a position to give comprehensive answers to those questions?
Anecdotal reports, and patient feedback, are not encouraging about the extent of our professional tendency to do no more than repeat the vaccine industry / JCVI position, at best.
This is the third time in about nine months that I have suggested on this website that the UK has a dysfunctional consent system for vaccination. ( 1,2)
No one has differed, no one has corrected me.
Millions of people and children are involved in these decisions, annually.
Is “Choosing Wisely UK” interested in exploring the subject ?
It is only fair to point out that the BMJ allows this area of practice to be scrutinised and commented on, in a far more open way than is the habit of most professional and media outlets.
Does this reflect the healthy precedent that the BMJ set for itself, seventy years ago, by publishing Killick Millard’s article “The End of Compulsory Vaccination” ? (3)
Killick Millard’s perspective, as Leicester’s MOH (the site of the “Leicester experiment") and the expanded historical context provided by Suzanne Humphries (4 and on youtube) help us realise that the eradication of smallpox was not necessarily the result of vaccination, as we were all taught, and as most of us continue to preach.
Recent unease and public demonstrations concerning mandatory vaccination in Italy, France and Poland, should encourage us to read Killick Millard, in the BMJ archive, and to read and listen to Suzanne Humphries’ contributions.
Rapid Response:
Re: Helping patients choose wisely
Ross and Coulter repeat many sensible observations about over diagnosis and over treatment that add little or nothing to the Hippocratic instruction, “First, do no harm."
They suggest that the UK health funding system offers less encouragement to the over prevision of care, than do fee-for-service systems.
That generalisation may appear fair and reassuring, but not to mention exceptions is a little unfair, if understandable in view of space constraints.
The four questions that ‘Choosing Wisely UK’ suggests that a patient asks of any new option:
“What are the benefits ? .. the risks ?.. the alternatives ?.. and if I do nothing?"
do no more than reflect a patient’s essential right to information, and the need, emphasised by defence societies, for doctors to provide all pertinent information about possible side effects, to every patient. Especially so since the UK Supreme Court ruling on the Montgomery case in 2015.
Every weekday, all over the UK, thousands of children and adults are vaccinated, probably unaware that their treatment will contribute to practice income.
Is this financial interest, if undeclared, consistent with our espousal of financial probity in annual NHS appraisals?
How many patients or parents have the chance to ask the attending professional those four questions, above, that ‘Choosing Wisely UK’ suggest that they ask ?
How many even see the vaccine Patient Information Leaflet?
And if patients, or parents, do ask those four questions, concerning the long term effectiveness and side effects of vaccinations, how many of the attending professionals are in a position to give comprehensive answers to those questions?
Anecdotal reports, and patient feedback, are not encouraging about the extent of our professional tendency to do no more than repeat the vaccine industry / JCVI position, at best.
This is the third time in about nine months that I have suggested on this website that the UK has a dysfunctional consent system for vaccination. ( 1,2)
No one has differed, no one has corrected me.
Millions of people and children are involved in these decisions, annually.
Is “Choosing Wisely UK” interested in exploring the subject ?
It is only fair to point out that the BMJ allows this area of practice to be scrutinised and commented on, in a far more open way than is the habit of most professional and media outlets.
Does this reflect the healthy precedent that the BMJ set for itself, seventy years ago, by publishing Killick Millard’s article “The End of Compulsory Vaccination” ? (3)
Killick Millard’s perspective, as Leicester’s MOH (the site of the “Leicester experiment") and the expanded historical context provided by Suzanne Humphries (4 and on youtube) help us realise that the eradication of smallpox was not necessarily the result of vaccination, as we were all taught, and as most of us continue to preach.
Recent unease and public demonstrations concerning mandatory vaccination in Italy, France and Poland, should encourage us to read Killick Millard, in the BMJ archive, and to read and listen to Suzanne Humphries’ contributions.
1 https://www.bmj.com/content/358/bmj.j4100/rr-2
2 https://www.bmj.com/content/360/bmj.k1378/rr-3
3 https://www.bmj.com/content/2/4589/1073
4 Suzanne Humphries & Roman Bystrianyk, Dissolving Illusions, 2015.
Competing interests: No competing interests