ONE IN THREE by ADAM WISHART

Improve Performance, Rather than Search for New cures

I’ve just finished reading Better by Atul Gawande. Like his previous book, Complications, this one is full of humane and insightful observations about the complexities of medicine.

There is one particularly fascinating chapter about performance, and how you improve performance in medicine. He tells the story of cystic fibrosis. Medicine has remarkably improved the life expectancy of patients over the last thirty years or so. In the sixties patients made it to just ten years old, now most live into theri mid thirties with some patients living much longer.

Too Much Health

There is a fascinating and timely report about Hormone Replacement Therapy in the Guardian today.

Survey after survey has linked hormone replacement therapy to cancer, strokes, blood clots and heart disease. Why, then, are so many women so relaxed about using it? And why do some doctors insist that the dangers are exaggerated? Sarah Boseley investigates

What it reveals is the continued attraction of HRT, more than a million women continue to take it in the UK, although for some of those women its pretty clear that taking HRT is not the optimum intervention.

What I find interesting about this is how compelling medical solutions can appear and how enduring they can be once the public first accepts them to be true. Once an idea like HRT has been promoted in the public realm, and once there is promotion of various sorts floating around, then its very difficult to get the idea our of the public imagination. None of us seem very attracted to the idea that actually medical intervention is bad for you.

I think many of us are afflicted by it. We go to doctors because we think they can help us. And they sometimes fob us off with placebos or what they think is more or less harmless sorts of drugs and interventions, such as HRT.

Its linked to my favourite piece of commentary of the year. Published on January 2nd, some of the best analysts in the business simply state,

For most Americans, the biggest health threat is not avian flu, West Nile or mad cow disease. It’s our health-care system. You might think this is because doctors make mistakes (we do make mistakes). But you can’t be a victim of medical error if you are not in the system. The larger threat posed by American medicine is that more and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses.

LINK

Although this is a particularly American problem, UK patients are also afflicted. We demand and demand and demand in some situations where doing nothing might be the right thing to do.