Too much medicine?

Editor,

At the heart of the current government reforms of the NHS is the
belief that the main problems to be addressed are chronic underfunding and
inconsistent quality of care(i). As society has become more consumerist
and less satisfied by a paternalistic approach, policies of evidence based
medicine, clinical governance, risk management and revalidation of doctors
have been implemented to regain the public’s trust. These reforms however
do not address many of the wider issues regarding the role of medicine in
society discussed in Moynihan and Smith’s editorial in the BMJ(ii).

The danger is that the present political climate is stoking
unattainable public expectations of the ongoing reforms. The general
public needs to be told that medicine has limitations even with proper
funding and a well-trained professional workforce. Many rationing
decisions ultimately rest on difficult ethical debates that the general
population must become fully engaged in. Clinical evidence can help inform
the decision-making process in some cases but has a number of limitations
inherent within it. For example, the structure of trials means it is
difficult to provide conclusive evidence on interventions that are complex
or heterogeneous such as many complementary therapies and some forms of
psychotherapy. With the medicalisation of life, medicine is being drawn
into areas it does not have a right or capacity to adjudicate over.

The present health reforms heavily promote the authority of medicine
as a science that can always provide answers. Whereas in the 16th century
Copernicus’ heliocentric view of astronomy was attacked for being
blasphemous, we now accuse schoolteachers who advocate creationist
theories of being unscientific(iii). To promote medicine as king is to
avoid recognising its limitations. Society needs to face its fear of
mortality and discuss the importance of rights, responsibilities and
equity in the modern NHS.

i Check against delivery [Prime Minister's speech on the NHS]. 2001
Dec 6. Available from: URL: http://www.number-
10.gov.uk/news.asp?NewsId=3233&SectionId=32

ii Moynihan R, Smith R. Too much medicine? BMJ 2002; 324: 859-860

iii McKie R. Bishop warns Blair over danger of creationism. Observer 2002
Apr 7.