Killer virus to wipe us all out!!
Ben Goldacre on the risks of reading health pages
Tuesday September 16, 2003
Let’s look at what last month’s news stories would have done for your health. You would be worried – quite inappropriately – about giving your child MMR, putting your child and whole community at risk; you would have stopped your HRT and your Seroxat, or made a panicked beeline for your GP; you would be terrified of the “superbug” that “may kill 150,000”; and you would be convinced that we are four times more likely to die after surgery under the NHS than in the US.
Journalists aren’t employed to keep you healthy, or even informed: it is our job to sell readers to advertisers, to entertain you, and experience has taught us that we can do this very effectively with scare stories. The health pages aren’t here to inform anyone, let alone health professionals, who find them uniformly irritating: they are here for hypochondriacs.
So it’s all the more ironic that the King’s Fund today published a study that blames media hype over health scares for actively putting your well-being at risk, by encouraging people to “change their behaviour in ways that are not in their own best interests”, and by allowing media scares to drive public health policy. The latter would never have happened, of course, in the good old days when doctors ran the health service instead of politicised managers. But we have lost our faith in doctors, largely thanks to these scare stories, and that’s the key point that this study misses.
It’s obvious that scare stories undermine people’s ability to make sensible decisions about their health. But when you undermine doctors, you also undermine the strong placebo effect of any therapeutic intervention, not to mention the morale of everyone who works in the health service.
Last week’s news story – that patients are four times more likely to die post-operatively under the NHS – is an excellent example. It was backed up by a moronic study that compared one famously mediocre district general hospital in the UK, covering everyone in a poor and difficult catchment area, against Mount Sinai Hospital in New York, a private teaching hospital, where you can’t move for professors and which treats only the very rich.
Do I need to remind you that Britain did rather well in the last World Health Organisation ranking of healthcare systems, whereas the US, which spends more than twice as much of its GNP on healthcare, without even managing to provide it for everyone in its population, came in 72nd? Apparently, I do. The US came below Cuba (ranked 36); El Salvador (37); Grenada (49); Columbia (51); Iran (58); and only a nose ahead of Nicaragua (74) and Iraq (75). Britain came in 24th, but we were robbed.
I don’t want to get grumpy, but if you wanted to undermine the morale of all the hundreds of thousands of people who work in the NHS for very little reward, you could at least have the decency to do so with proper data.
But health stories aren’t about data, or a realistic appraisal of risk. If they were, you’d have seen massive coverage for what’s known as the SSSS study, which is famous in the medical world: millions of people are on statin drugs to reduce cholesterol, so it’s clearly relevant – they were a major breakthrough – and this study of 4,444 people (catchy, huh?) showed that the treatment of 100 patients for six years would prevent four deaths from coronary heart disease and seven non-fatal heart attacks at little cost.
Let me tell you, this is much more important than anything you’ve read this week about a glass of wine for your heart, or some ridiculous vitamin for your joints, or chocolate for stress, or some esoteric branch of stem-cell therapy that won’t be available until 2008.
The paradox, of course, is that it’s almost all irrelevant. Because everybody knows how to stay healthy, it’s just that lots of us can’t be bothered. You don’t need a doctor, or a journalist, to tell you to stop smoking, drink moderately, eat your greens, and get regular exercise. If you get that far, and use your GP sensibly, then you’ve covered almost all your risks.
But people get a peculiar thrill from health scares; it’s the same thing that drives them to complementary medicine. We like to feel informed, but we don’t want to feel guilty about our unhealthy lifestyles; we like to feel that we can get one up on doctors, but we can’t spend the time reading up the whole of medicine; when we’re worried about our health, we feel out of control, and we want to get some of that control and understanding back. Perhaps most insidiously, in the UK, where healthcare is provided universally and free at point of access, by the state, we are suspicious of doctors, as agents of the state, rather than our paid servants, which is what they should be.
Maybe we should encourage doctors to manage our anxieties about our health better. But as a recent study on doctors’ careers in the BMJ showed, the media going on the attack, and scaremongering is now being cited by doctors as their reason for leaving the medical profession altogether. And you know what that will do for waiting times. Scared yet?