…..”Contrary to popular opinion, one of the main problems in providing uniformly
excellent healthcare is not lack of money but lack of knowledge – on the part of
both doctors and patients…studies show that many doctors and most patients
do not understand the available medical evidence.”
– in Better Doctors, Better Patients, Better Decisions. Envisioning Health Care 2020. Edited by Gerd Gigerenzer and J. A. Muir Gray. Strungmann Forum Reports, 2011. MIT Press and Frankfurt Institute of Advanced Studies.
Interest in influencing people’s health comes from many directions. Patients themselves have their own best interest first, but the final situation is daunting. Sorting the complexity of choices and the standards to which they are delivered is an issue.
For example, some big pharmaceutical companies admit that due to their corporate commercial structure, they can only involve themselves in products that have the best chance of making the most money. But these products are often presented as gold standards. Many other clouded situations exist. SOHANS studies these models and teaches our students about this complex picture and how to help unravel it.
UK medical practise is some of the best in the world, huge strides have been made in research, and our world ranking is justly deserved. But all too often factors are appearing that have a massive negative influence on human health, the problems that result are known, and increasing.
For example, thalidomide (withdrawn in 1961) -the drug for morning sickness that produced malformed foetuses, was followed by 225 officially withdrawn drugs in western practice over the next 42 years (a rate close to 1 every 2 months). The reasons varied but often involved inadequately researched products that were deftly ushered to market. These products produced severe symptoms ranging from permanent damage to organs, right through to death. Few front line doctors were trained to use these drugs cautiously in the early days, others saw their financial benefit in not saying too much. The battle ground between profit and health was blurred so much, that it was acceptable to experiment with patients’ lives.
In the 1980’s and 90’s, greater controls were established in the development of new drugs, but the pharmaceutical industry just moved on to different classes of drugs that were harder to resolve for harm directly.
In another example, the overuse of antibiotics and antibiotic resistance ( made public by WHO in 2014 -2016) is in greater part due to poor information and the lack of control in prescribing. There were over 2000 deaths and over 50,000 cases of antibiotic resistance in the UK alone in 2015, as well as 30,000 deaths in Europe as a whole in the same year. The need to urgently develop new strategies in infection management were trailing. The need for greater effort in prevention, health maintenance, and sustainability in health (longer periods of good health) ran counter to the interests of industrialised medicine. This applies to both human and veterinary health. SOHANS regards all these issues to be important to teach to our students, as an integral part of their training.
At other levels, environmental factors, pollution, contaminated food chains, and stressors in daily life have not been challenged adequately and account for much social debilitation. Governments are still inclined to sideline these issues and can seem to treat people as if they were disposable at the hands of a racing materialistic economy.
In another area, the cancer rate in the UK is approaching a staggering 1 in 2 people. The government position seems now to say our genetics are faulty and we must have more individual drug development to correct faulty genes. There may be some truth in this, but it is by no means the full or even correct story.
Our studies in theoretical medicine present a different picture of how the above problems may be managed. It has to be through better patient knowledge, and better application of evidenced-based medicine via doctors. New and better strategies can then be applied.
Many simpler methods and interventions in health could well be very effective. For example, our research on latitude and Vit D produced a causal relationship between certain key diseases and Vit D deficiency. Our findings produced in 2011, instructed many individuals to increase their Vit D intake. This included many physicians who also started to research this area and are themselves now habitually taking high doses of Vit D.
Yet the same physicians, when sitting in their consulting rooms, are giving their patients occasional very low doses, and for certain situations only as instructed by the NHS. This area still has not attracted near adequate research funds to give a better picture. At SOHANS, because we are independent and have no links to partisan interests, we are able to suggest strategies that can be both cheaper and potentially very effective.
We have shown that in many areas, simpler strategies in health maintenance can have a huge beneficial effect overall, avoiding later health crises. Just as the availability of clean water was the biggest benefit to health throughout the last century and beyond, balancing simple strategies of a wholesome diet, sufficient exercise, and a balanced relatively stress free lifestyle, are seen as the key health determinants for the future. But industry and commerce through government pressures, increasingly chase different end points.
We do not demote good standards of proven medical care. The medical profession all too often, and particularly in the UK, has been at the front line of brilliantly defending health, such as the forty year battle to demote smoking cigarettes to curb fatal lung disease. Governments then have been slow in taking action fearing huge revenue losses.
Neither do we decry high tech medical advances, they are absolutely necessary in the correct setting. We would however like to see the simpler well researched strategies in place alongside, to make our minds, bodies, and general well-being, truly healthy and sustainable.
GETTING THE BALANCE RIGHT
These are the sorts of values reflected extremely strongly and now very scientifically in the SOHANS Theoretical Medicine degree. Theoretical constructs and findings will be at the forefront of health in the future ( Nature article ref.). Out course teaches all sides of the arguments so it becomes apparent how to place patient health uppermost, rather than health becoming a heavily politicised issue dictated by partisan commercial forces. We know of no other similar course that tackles health matters in this way. This brief introduction outlines the balancing approach we use in our Theoretical Medicine degree, and also in our Biomedical Science degree.
For a fuller list of subjects studied, please see the Theoretical Medicine page of this website.
We will use webinars and online articles and discussions to take these points forward. Alongside the major medical databases and discussions, there will be a full resource of social aspects of health that are discussed.
1. Health (social) Inequalities and Illness. Marmot et al. 2019. http://www.instituteofhealthequity.org. A plethora of brilliant literature on social dimensions of health led by the leading and magnificent exponent.
2. The Health Foundation. www.health.org.uk 2019. A fuller understanding of the social dimensions of health and why there is an urgent need to focus on these issues.
3. Evidence-based Medicine. How to practice and teach EBM. Sackett et al. 2000. Churchill-Livingstone. A landmark book on how to answer questions in medical practice led by the brilliant Dave Sackett.
4. Evidence-Based Healthcare: How to Make Health Policy and Management decisions. J A Muir Gray, 2001. Churchill Livingstone. Again, a seminal book on organisation levels of healthcare by a brilliant research leader.
5. How to implement Evidence-based healthcare 2107. T. Greenhalgh. Wiley – Blackwell. The latest in a string of excellent books on the practice of EBM by a gifted individual.
6. Better Doctors, Better Patients, Better Decisions. Envisioning Health Care 2020. Edited by Gerd Gigerenzer and J. A. Muir Gray. Strungmann Forum Reports, 2011. MIT Press and Frankfurt Institute of Advanced Studies. -The most brilliant book on problems and solutions in modern medical practise.