It was nice to read the article Michael Mosley’s Five Biggest Health Myths this weekend. On the same weekend I was in a store and overheard a conversation between customers about managing their common colds – they related their remedies of high doses of vitamin C and echinacea and were disappointed that it was still too cool to indulge in salt water. The first two methods are unproven in randomised trials and well, the latter, who knows.
Although I didn’t agree with all of Mosley’s advice (and he admitted some of it was based on early data) his underlying point is correct. We use our health knowledge (or health literacy) to inform our health choices.
Unfortunately many people really have poor health literacy – a lady I’ve treated for ovarian cancer for 18 months recently asked me where her pelvis is. The problem is aggravated by a proliferation of health myths. A lot of common information about diet and exercise is basically wrong or was ill-formed and made part of wide-spread public health initiatives.
One of the things we need to do to promote preventive medicine is actually provide accurate health information about diet and exercise rather than old-fashioned myths.
After that we need to know how to nudge people to follow the advice but that will be part of another blog post.
The Wiki Leaks Party is proposing to promote ‘scientific policy’; decision-making based on research, evidence and clear, transparent principles. It is also supporting Internet freedom: “the WikiLeaks Party will be fearless in its opposition to the creeping surveillance state, driven by globalised data collection and spying agencies, both state and corporate controlled. We will demand that all information on data seizure and storage of citizens’ data by government agencies and allied corporations be made public.”
Both of these are laudable aims.
Now explain to me how the Wiki Leaks Party will operationalise these actions in relation to health care and health care data. Over the last few decades best practice in health care has been driven by the evidence based medicine (EBM) movement so the Wiki Leaks Party has a solid platform to base its’ promotion of scientific policy making. Interestingly EBM is now coming into collision with the era of big data. The problem is that we don’t have enough access to the data we already have and we aren’t collecting and using enough of the data we need to really inform the decision making process. By we I mean health care providers both Governmental and private.
I guess the trite response is that the approach to health care data will be through the principle of transparency. Well there are already many claims about transparency from the existing powers and health care providers. So lets have some detail about the the Wiki Leaks Party will handle big health data.
Australia, like many parts of the world, has an approach to alternative medicine and therapies that involves turning a blind eye to therapies that at face value seem harmless and able to be regulated with a lower level of rigour than conventional medicines. These therapies provide often provide false hope for patients with life threatening illnesses like cancer. Equally they are misleading for less immediately life-threatening problems. My wife is constantly receiving spam/junk advertising for weight loss programs that promise unrealistic weight loss – some of these have been in the press for serious side effects (and of course no weight loss except that attributable to the complications).
The alternative therapy industry is critical of the profit motive of ‘big pharma’ but these guys could equally be called ‘big herbal’. Australia spends approximately 9-10 billion dollars per annum on conventional medications and direct costs to patients accounts for 10-15% of this. Yet in 2005 more than 3 billion was spent on alternative therapies. If Australia parallels the US then current expenditure on alternative therapies might be 6 billion dollars or more.
A tax on these therapies – which bear minimal costs for development and proof of effectiveness and which rely predominantly on marketing for sales – could potentially raise enough funds to save 5% on the national medicines budget. There is no reason why a tax couldn’t be imposed – the government does it for tobacco, alcohol and luxury goods. And realistically – isn’t alternative medicine a luxury good.
So I work in health and well to be frank health is not exactly thriving.
I am associated with 3 public hospitals with a collective EOFY debt of around 50 million dollars. The way the powers want to catch up is with cuts. But the problem with cuts is that it doesn’t actually deal with the fact that service needs to be delivered.
People being to hospital costs money so the logical way to deuce expense is to stop people being admitting to hospital is to reduce admissions. The only real way to achieve this is to stop people being admitted to hospital. The only way to achieve this is to provide outpatient services that otherwise meet the inpatient demand.
The problem is that ‘new’ outpatient services is a new expense and the system can’t countenance that.
Well I think I fact of life is that sometimes you have to spend a dollar to save a dollar.
The real issue is that health services want business cases: well tell me how much you are willing to spend to save a dollar. I’ve heard one dollar for 3 saved but this is a clowd-cuckoo-land number. I agree 1 for 1 isn’t a gain but 1 for 2 is a tangible benefit
Regardless of the breakpoint let’s get a number to inform our business cases.
A number of my colleagues have complained to me that patients expect so much of their doctors but don’t actually do anything in return – by this I mean they don’t actually follow the instructions of their doctors, take their medicines, listen to the advice, etc, etc.
Which leads me to the question – should I give my patients homework? We are meant to be in the era of patient/consumer empowerment. This means taking responsibility for one’s own healthcare (decisions). Doing homework might be a way of completing the deal.
Any doctor knows that his/her patients spend a lot of time consulting diverse sources to become health literate. This ranges from consulting aunt Mavis to asking the boys at the pub to searching the internet. Mostly it is searching the internet.
Rather than letting the patients search blindly and discovering somewhere in the corners of Google that Mexican Cafe Latte Enema Therapy cures cancer why not prescribe a homework program that actually sends people to reliable information and education?
Homework is used in cognitive-behavioural therapy to good effect. Maybe there are other applications.