Healthcare – overmedication, undermedication, the biases in research and treatment…

Last week I spent a lot of time thinking about medical issues. I spent a couple of evenings captivated by various TED talks, and then I watched a short video, which I had stumbled across on the BMJ website, that looked at the dangers of overmedication within the US healthcare system. On Thursday 11th October I attended a talk about maternity healthcare in Brazil, hosted by Kings College London.

I found the video produced by the BMJ about the harms of overtreatment in the United States of America absolutely astounding. Follow this link to watch it. It really brought it home to me the extent to which a privatised healthcare system, which is driven solely by money and not by the best possible treatment for the patient, can have disastrous consequences. I will not go into too much detail, and allow you to watch it yourselves. However, this documentary uncovers a number of factors that have a detrimental effect on healthcare quality. Drug companies, having in their grip the commercial power of the markets, drive the full thrust of research. This severely limits research to subjects that benefit and profit (of course) such companies. In fact, for an interesting talk about the biased nature of published research, see the Ben Goldacre talk on TED. The revelation of the numerous deaths and immeasurable suffering caused by physicians’ overtreatment of patients was shocking. In a country where there is so much concern over undertreatment (and undertreatment is indeed rife), the problem of overtreatment on the flip side of the coin just serves to highlight the fundamental problems in the structure of healthcare in the USA. Apparently medicine treated as a commodity to be “sold” as if it were a new car, does not lead to effective and efficient healthcare. Far from it.

Leading on from this, the talk at Kings College was about maternity health care in Brazil. The issue of healthcare being treated as a commodity seems to also be a problem here as well, as it has been promoted as such with the rise in the middle class in Brazil. Child birth is treated as a very surgical process in Brazil, with over 50% (according to the information given by Jacqueline Alves Torres in her presentation) opting to have caesarean section births, rather than normal births. This, as in the USA, is often not the freewill of the patients, but the results of patients being coerced and even bullied into the decision by pushy surgeons who act on their own without any supporting team, such as a midwife. There is not a strong midwife tradition in Brazil as there is in England, but now there are various movements trying to reverse this trend and to promote the rights of the woman’s choice in childbirth, as well as educational efforts.
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So what can be done? I am certain that our NHS is not a perfect oiled machine, but it is something that I will always be proud of, and that I value greatly. Healthcare should not be a commodity to be sold, but should be based on what is right for the patient. To avoid the kinds of issues that occur in the USA and Brazil, as was suggested in the BMJ video, it would seem that the pay structure of surgeons should be revisited to ensure that they are not “rewarded” for simply doing more or less, which encourages doctors (often subconsciously) to take decisions that are not necessarily in the best interests of the patient. Last week only served to make me hope more than ever that the NHS reforms so forcibly pushed through by the current government retain what is so vital to the heart and soul of our health service.

 

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