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Source: Editorial in BMJ
BMJ
2013;
346
doi: http://dx.doi.org/10.1136/bmj.f2809
(Published 14 May 2013)
Cite this as:
BMJ
2013;346:f2809
- Leonore Tiefer, convenor, New View Campaign1,
- Kim Witczak, co-founder, WoodyMatters2,
- Iona Heath, immediate past president3
The sense that medicine is out of control is generating a rising tide of concern that includes the BMJ’s Too Much Medicine campaign.1
Throughout history, unscrupulous people have preyed on our universal
fears of suffering and death and made money by selling dubious remedies.
The hope that the growing scientific foundation for medical practice
would consign such activity to historical oblivion has proved to be a
vain one. Indeed, contemporary enthusiasm for the commercialization and
marketing of healthcare seems to offer ever wider opportunities to sell
medical treatments. The results of medical research are often distorted
or suppressed for commercial gain, and systems that attempt to control
clinicians’ behaviour through payment by results drive overdiagnosis and
overtreatment.2 3 Patients experience well documented harms as more and more often financial imperatives are allowed to trump clinical judgment.4 Harm is also caused by well meaning doctors trying to save lives by diagnosing serious conditions earlier,5
which inevitably drives up overdiagnosis and overtreatment. Well
meaning doctors, patients, politicians, and journalists consistently
overestimate the benefits and underestimate the harms of most medical
treatments.
These problems have been increasingly aired
and analysed on websites, in editorials, and in dozens of recent books
by investigative journalists, crusading physicians, earnest advocates,
and academic reformers.6
Proposed solutions include greater regulation of the medical and
scientific communities to improve accountability and to expose conflicts
of interest, greater transparency in publishing and education, much
greater patient involvement in decision making, and higher standards of
professional integrity. Yet the fundamental problems remain and the
situation seems to get worse each year.
A comprehensive
social health movement that combines the perspectives and resources of
healthcare professionals, patient representatives, and consumer
advocates in a partnership that aims to counter overdiagnosis and
overtreatment is well overdue. A partnership model that affirms themes
of mutual respect and collaboration can enable questions and concerns to
be raised in different voices for different audiences; can foster wider
dissemination of key messages to enlarge collective action; and can
generate diverse strategies to promote public awareness and policy
change.
A recent international conference (www.sellingsickness.com)
held in Washington, DC, brought together many different stakeholders in
healthcare, including professionals and consumer advocates, to discuss
how to end disease mongering and how to challenge the undue commercial
influences that distort so many aspects of healthcare research and
practice. This self funded grassroots conference deliberately sought to
model the possibility of a new social health movement with equal
representation of professional and advocate perspectives and extended
time for discussion.
A “Call to Action on Selling
Sickness” was developed by a diverse group over a period of months,
uploaded on to the Selling Sickness conference website for preview, and
opened for signatures from the final day of the conference. Among its
list of concerns were the problems of biased science, hidden data,
inflated diagnostic categories, unnecessary screening and treatment, and
the widespread neglect of social factors when treating illness. Its
recommendations included a call for a new movement of alliances and
actions to “ensure a firewall between commercial influences and medical
guidelines.” The campaign aims to bring an end to direct-to-consumer
advertising of diagnostics and drugs, ensure appropriate testing of new
drugs and devices, put forward reform of the patent system, and promote
responsible health journalism. Although there was no systematic effort
to obtain signatures from the more than 240 conference attendees, 35
people signed the call for action by the end of the conference. They
represented nonprofit organizations, university research groups,
clinical enterprises, the Public Library of Science journals, and law
offices to name a few, and came from Canada, the United Kingdom,
Germany, Russia, the Netherlands, New Zealand, and the United States.
The call to action on Selling Sickness is now online (www.sellingsickness.com/final-statement) and open for individual and organizational endorsement.
Using
professional-advocate collaborations to tackle the problem of medical
overtreatment is not a new idea. In a recent project, “Choosing Wisely,”
designed by the American Board of Internal Medicine together with
Consumer Reports,7
medical specialty organizations identify practices prone to overuse in
their specialties and partner with Consumer Reports to disseminate
consumer friendly educational materials. The list of participating
specialty organizations continues to grow (www.choosingwisely.com).
The alltrials.net movement has used social media to stimulate publicity
and now has thousands of signatures on its petition for open access to
all clinical trial data (www.alltrials.net/).
The Selling Sickness call to action, promoted by an emerging
advocate-professional partnership, will add strength to the new social
movement for healthcare reform that may prove crucial to global health
in the 21st century.
Notes
Cite this as: BMJ 2013;346:f2809
Footnotes
- Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.
- Provenance and peer review: Commissioned; not externally peer reviewed.
References
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