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Demystifying Medicine One Week at a Time

#sellingsickness 2013

ssl-horizontalI attended a fascinating conference called “Selling Sickness” that took place in Washington, D.C. It was three years in the making, as the previous iterations of it took place in Australia in 2006 and Amsterdam in 2010.

How did I wind up there? An academic paper that I co-authored was noticed by some smart folks in the UK, who linked to it on their website. Subsequently, some Twitter friendships developed, and I was quickly made aware of the conference.

What was the conference about? From the material:

We’re at a critical moment in public awareness about overtreatment and overdiagnosis and the harmful consequences in terms of health and financial waste. There is growing awareness, too, of the corruption of science as a result of marketing. This conference is called to raise awareness further and create new collaborations among the stakeholders from academic and consumer worlds.

To whom could such a mission statement appeal? In addition to cranky academics like me, this was a high congress of journalists, patient advocates, and consumer activists–in other words, the best kind of conference for making connections across disciplines and (for me) getting out of the siloed world (think ‘ivory tower’) that is academic medicine.

What are the stakes?

For journalists: Amidst a hemorrhage of job and revenue losses, mission-driven writers and broadcasters are continuing to report about harms from overzealous and often inappropriate application of medical technology. This despite ungodly pressure to produce. Produce now. Produce yesterday. Without fact-checkers or other resources of yesteryear. These stalwarts are telling people’s stories and offering a critique of all-too-frequent medical cheerleading that passes for journalism in our voracious, short-attention-spanned digital news environment of today.

Patient advocates: Many of the attendees were themselves (or had a loved one) harmed by medicine or medical technology. Think of adverse drug reactions; cardiac devices like pacemakers causing trauma, heart injury, bleeding or infection; orthopedic device failures; surgical mesh causing chronic pain. Many of these victims have admirably used monetary settlements to create foundations devoted to preventing others from suffering harm.

Consumer activists: Many representatives of the Consumers Union, the folks that bring us Consumer Reports, were on hand to share their methods of non-biased evaluation, to discuss their projects and seek additional collaboration.

The conference was engaging, and dare I say: fun. I met many people whose work I’d only read or seen online, which is validating. The collaborative aspects build energy. The chance to engage in meaningful discussion and ask lots of questions led to new ideas for projects, papers, and activism.

One thing bothers me, though. At a panel on the harms that can come from screening (see this), I asked a question no one could answer: In a world of inequitable resource distribution, how should the disease mongering/selling sickness movement address the fact that so many worldwide lack for basic health care?

In other words, coming from a state near the bottom of the U.S. in health outcomes, doesn’t it come across as, say, overly entitled (whining?) to complain about over-abundance of health care? I know that the harms of over-medicalization are real; I’m just troubled by the disconnect between two strong advocacy strains in the worlds of health and health care.

Suggestions welcome.

6 Comments

  1. This is an interesting topic. It is all about the perspective from each of the groups described. There is a bias and prejudice in each group. Everyone has a motive.
    There seems to be a distrust by each of the groups of each other . Who is correct ?
    Information presented in the media is of course written with an agenda bias.
    Would be best to find a balanced way to present information to both patients and health care providers .
    The problem is that we are humans with opinions that are as different as snow flakes.
    I say we should always practice with the patient’s best interest as primary. Using moral and ethical judgment should be the guidance of such. We must always remember to keep an open mind as not to fall into the clinical trap of misdiagnosis and the treatment or lack of treatment. Should we have a perfect system with everything covered from a cost point of view “medical utopia” ; would there be better healthcare outcomes? I am not convinced that there would be a huge improvement. Most people seek medical attention for traumatic injury, pain relief for various conditions and the unnecessary antibiotic for a viral illness.
    If you look at the Indian health care system the diseases seem to run in negative directions .
    To educate the public seems to be the best way to approach this. However, you can “lead a horse to water but cannot make it drink.”

    • Raymond Downing

      March 6, 2013 at 7:04 am

      Excellent question. The poor aren’t getting enough health care, yet we are all getting too much. Why the disconnect? One result of my wrestling for many year with the same question is my recent book BIOHEALTH: BEYOND MEDICALIZATION: IMPOSING HEALTH, reviewed this month in Family Medicine journal (http://www.stfm.org/fmhub/fm2013/March/William212.pdf). In brief, the reason we have too much biomedicine is the medicalizing of everything (which is biohealth). That’s not the sort of health care that poor people need more of. The very existence of these sorts of conferences (“Selling Sickness” etc) is a hopeful sign.

  2. I have been practicing hospital medicine for the last year and a half, as a way of seeing how different hospitals and communities do what they do. I’m particularly disturbed by the fact that we do so much for people that doesn’t help them at all, and often hurts them, not least financially. I discharged a patient today who was admitted with pleuritic chest pain, uninsured, got 20 blood tests, an ultrasound, an echo, a CT angiogram and a one day hospital stay with IV fluids, IV antibiotics for assymptomatic bacteriuria, IV pain meds, and she will have a bill in excess of $15,000, I’m guessing. Probably a viral pleurodynia. Just not doing thoughtless medical care would save a tremendous amount of money that could be freed up and eventually come around to support prevention or basic medical care. Thanks for posting about this sort of thing.

    • glasshospital

      March 9, 2013 at 8:28 am

      Yes. And your example resonates with me even more after I’ve just read “Why Doctors Don’t Listen” by Leana Wen and Josh Kosowsky. They are particularly harsh on their ER kinfolk.
      -JS

  3. Undertreatment and Overtreatment are two sides of the same coin and many of us challenging disease-mongering are also active in groups working for greater access, such as the Structural Competency movement.
    I would draw your attention to the Selling Sickness Call to Action http://sellingsickness.com/final-statement/. We have over 600 endorsers already as well about 2 dozen nonprofit organization endorsers. Selling Sickness represents a PARTNERSHIP MODEL FOR A NEW SOCIAL HEALTH MOVEMENT and we are committed to building bridges between consumers and health professionals to use their skills, networks, and vision for healthcare reform.
    Thanks for your support.

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