Why the NHS reforms are like dangerous pseudoscience
This is supposed to be a blog about medical stuff, not about politics, so I hope you'll forgive me writing about the Health and Social Care Bill that's currently going through the UK Parliament on two posts in a row. The bill, if passed, will have a huge impact on the way medicine is practiced here in the UK.
There is a serious disagreement at the moment between the government, who think the Health and Social Care Bill is a fine and noble thing, and most of the medical profession, who think it's a disaster in the making.
Well, people often disagree about things. On the whole, I think disagreements can be divided into 3 categories:
- Some disagreements arise when there really is no "right" answer. Your position depends on matters of opinion, or judgements about the importance you place on competing things. An example might be an argument about whether it's right to raise taxes to pay for increased welfare benefits. The answer simply depends on your opinion on the relative merits of looking after vulnerable members of society versus allowing taxpayers to keep their own money.
- Sometimes there is a right answer, but it may not be clear what it is. Some discussion is therefore necessary before getting to the right answer. Many scientific disputes are settled this way. An exploration of relevant evidence and arguments should in the end lead to agreement.
- Sometimes, someone may put forth an argument which they know to be wrong, but they do so anyway because they have something to gain from it. Much pseudoscience is in this category. Homeopathy practitioners, for example, if they have studied the literature on homeopathy, know that homeopathy is just a placebo. If you point this out, however, you're not likely to be met with rational counter-arguments. You're more likely to be met with either ludicrously flawed arguments that attempt simply to mislead or distract, or, if you're arguing on an online forum, to have your comment deleted. It's the equivalent of a small child sticking his fingers in his ears and shouting "la la la I'm not listening".
Today, the government are holding extensive talks about the Health and Social Care Bill, but have excluded representatives of the medical profession who disagree with the government from those talks.
To me, that puts the government's arguments firmly into category 3. If they were discussing the bill from a position of intellectual honesty, why would they not want to listen to critics? The fact that they do not shows they know they have lost the argument, but they don't care, because they want to go ahead and implement the bill anyway for their own reasons.
What those reasons are is a mystery to me. However, it does seem noteworthy that there are many politicians who have business interests that would do very nicely out of a more commercially oriented NHS.
Good blog as usual, but you missed the 4th type of argument: the Dunning–Kruger argument, where one side is clearly wrong but completely incapable of realising they are wrong. I suspect Lansley's position on the NHS falls into this category.
What worries me is why so many other people in the Government are running headlong with this. I guess they've spent so much political capital on the NHS changes, they've lost focus as they believe they can't afford to back down.
Good point. While the Dunning-Kruger situation has some things in common with my No 3, I think you're right that there are important enough differences that it probably deserves an extra category.
Very hard to know which category the NHS reforms come into. But it sure as hell ain't No 2.
I couldn't see what was wrong with the PCT structure to begin with, so while I like the idea of increasing the role of GPs in making commissioning trade-off decisions for physio/surgery/hospital medicine/community care I am not a natural supporter of the bill. Governments like to remake services in their image for the same reason as business consultants always ALWAYS recommend business process re-engineering. It justifies their existence.
There comes a time in the lifespan of a bill where so much political capital has been sunk into its passage, that abandoning it becomes more damaging than proceeding against the bitterest of opposition. That point has passed months ago, so expecting the government to drop it is like expecting the steak on your plate to moo.
The government has very extensively consulted on the bill as the number of amendments will attest. This has involved them asking for opinion and then being roasted alive in the media by professional groups. When I read analysis by Dr Ben Goldacre that the reason to oppose the bill wasn't because the provisions of the bill were bad in themselves, but that it made possible future bad reforms, I realised that medical professionals had become paranoid.
I think equating the government's action with homeopathy does a disservice to both the government's position and also to the examination of pseudoscience. UK governments over the past 40 years by hook or by crook has done extremely well in controlling the cost of healthcare and keeping it universal. So well, that it is below most comparative nations in terms of cost per person in PPP and absolute terms. It has done this largely in the face of opposition from the healthcare professions. Healthcare inflation is bound to accelerate in the next 20 years and the government is entitled to restructure in order to ameliorate this. Politicians are better placed to understand this than doctors and actually have less conflict of interests.