Sunday, 22 January 2012

The cowardice of public health

The Lancet is unhappy about a recommendation from the NHS Future Forum that doctors "make every contact [between doctors and patients] count", ie. they pester us about our diet, drinking and smoking every time they see us. I share The Lancet's unhappiness. It's an awful idea and doctors won't do it anyway (I've said it before, but since I criticise public health so much, it bears repeating: every GP I've ever met has been likable, sensible and not at all like their evil twins in public health. Never mistake 'public health professionals' for real medics).

Lecturing the patient on their lifestyle choices during this time is likely to appear rushed and inappropriate, especially if doctors see the task as a box-ticking exercise. There is a high risk that such an approach will leave the patient feeling frustrated, resentful, and reluctant to return.

Indeed so. Mandatory hectoring would be a terrible idea. It's not that I think that health advice is a bad thing, it's just that it should be relevant and timely.

Having said that, if I'm going to receive health advice I'd rather it came from a qualified GP who has actually met me, not some distant bureaucrat with an advertising account and an axe to grind. This is where I part company with The Lancet, which doesn't seem to approve of the concept of advice at all.

Effective, evidenced-based public health measures do not include nudging people into healthy behaviours or getting NHS staff to lecture patients on healthy lifestyles. They include measures such as raising taxes on cigarettes, alcohol, fatty foods, and sugary drinks, reducing junk food and drink advertising to children, and restricting hours on sale of alcoholic drinks. 

Quelle surprise. This is, after all, The Lancet, where whatever the question is, bans and taxes are the answer.

Here we see the true moral cowardice of public health. They know that any doctor who harasses his patients in the same way that 'public health professionals' harass the population will be assaulted on a daily basis, so they hide behind the government, goading it on to ever greater illiberalism. The public will still feel "frustrated" and "resentful" at having their money and liberties stolen, but they will vent their frustration on politicians, not GPs. Like all bullies, 'public health professionals' are cowards at heart.

The government should show true leadership and make effective legislation the cornerstone of their public health strategy. Focusing on other approaches is foolish. The nudge and nag approaches need one thing: the firm elbow.

The firm elbow, indeed—for when nudging and nagging is no longer enough! You can't say you haven't been warned. Does anyone else find it perverse that politicians want people to get health advice and doctors want to make laws? When exactly did this job swap happen? And would The Lancet care to set up a Doctors' Party and run for office so we can see just how much popular support there is for the firm elbow?


Eric Crampton said...

The more noise doctors are required to provide, the less able patients will be to pull signal out of the mess of recommendations at the visit.

Anonymous said...

Meanwhile in Australia, Public Health has just declared that they want to wipe out smoking within 15 years, and have presented a "plan" to the government:

dearieme said...

Public Health people tend to be far more certain about the science than the evidence warrants. I suppose the great exception is smoking i.e. active smoking. But then the public already knows that the evidence on that is as good as we're going to get, and whatever% puffs on regardless.

SteveW said...

"The government should ... make effective legislation the cornerstone of their public health strategy"

In as much as they have any place in 'public health' then yes, effective legislation should be sought, however, having already proven beyond a reasonable doubt that additional taxation and/or prohibition along with other restrictions on sale or use are ineffective forms of legislation, that does leave the tobacco control lot in a rather awkward position.

Maybe they'll have better luck with plain packaging and banning of displays.

Anonymous said...

This crap is just a cover-up of their own hazards.

In America being a patient in a hospital/nursing home is about 3.7 times more deadly than smoking.

There are about 35 million hospital admissions per year and about 1.5 million nursing home patients for a total of 36.5 million people receiving hospital/nursing home care.

Iatrogenic =induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures

584,136 of those people will die from an iatrogenic death.

The iatrogenic death rate for patients admitted into hospitals or treated by doctors in hospitals is about 160/10,000.

393,000 smoking 'caused' deaths per year per 91 million ever smokers is a rate of 43/10,000.

Don't trust health care!!!

Gary K.