Up to 1800, no-one went near a doctor if they could avoid it. At best doctors might amuse the patient while nature cured the disease – the doctor’s business was to take as much of the credit and the money as possible. The best was rare. In an effort to get the money, doctors liked to pump us as full of stuff as possible, commonly in the process, as most people recognised, hastening our demise.
From shortly after 1800 to around the time the Berlin Wall came down, when we had problems we took them to doctors who operating on the basis of a medical model worked out whether a poison or a mutilation was needed or whether the condition was something that might pass of its own accord, or was terminal and perhaps best not make things worse, shorten a life even further, with a poison or a mutilation. For decades, the magic lay as often in not doing as in doing.
While places like Harley Street and its equivalent in most Western cities were still synonymous with doctors ripping off wealthy patients, the reward for a lot of family doctors came from being able to save a life or prevent a disfigurement. If they gouged some people it was in order to treat others for free.
This was Healthcare. Because we were often in too much pain, too confused and perhaps terrified, rather than interrogate medical staff, we and our families trusted those we sought help from to do for us what they would have done for themselves. We assumed a Duty of Care rather than insisted on consuming health products because of some God-given Right to do so.
Not all was perfect in this world, as women with breast cancer in the 1950s found out. Surgeons were increasingly at odds with well-informed women as to what they might want. And shockingly in the 1960s it became clear that in some leading American hospitals people, instead of getting what they thought was state of the art care, were in fact in research studies without being told of this.
We entered an entirely different world after the Berlin Wall came down. Just before this, medicine, governments and pharmaceutical companies had discovered what they called risk prevention and later health promotion. Forget illness, lets talk wellness Tony Blair and George Bush, Barack Obama and David Cameron told us.
We found our bones, our breathing, our blood lipids and glucose levels, our blood pressure, our moods and all sorts of other things being screened and if there were any hints of abnormalities that might or might not give us problems in some distant future, we were invited to take a bisphosphonate, antihypertensive, hypoglycemic, statin or antidepressant.
Problems like this could be brought to us in a way that pizzas, downloads, and books from amazon can and heart attacks, strokes, fractures and psychoses can’t. Problems that might never materialise became the basis to all but force many of us to consume products (no mention of poisons here) that worked much better than traditional medical efforts to treat a heart attack, or fracture. Thickening bones (abnormally), lowering blood pressure (abnormally) or lowering lipids or glucose (abnormally) and making a perfectly balanced serotonin system highly imbalanced.
We didn’t make much progress at treating heart attacks or psychoses – which stubbornly continued to require close co-operation if we were going to get the right result.
This component of what happened in clinics or hospitals became became part of the service industry and rapidly grew larger than the Healthcare component. Who better to run these new services than professional managers who might rotate in from McDonalds or any other service company and who knew how to run things. Run – not support the most delicate thing we used to do on this earth.
Guidelines also appeared around this point – with the NICE Guidelines being among the most famous. But all Guidelines, including those drawn up by NICE, are based on a ghostwritten literature with no access to the data from the clinical trials done. Long before any politicians or media outlets got into Fake News, the literature on on-patent medicines offered and still offers the greatest concentration of Fake News on the planet.
These Guidelines laid down what doctors should be doing and our new “managers” could put a requirement to keep to Guidelines into a doctors job description, just as they might write some equivalent into the contract for an employee in McDonalds. They could (and do) get rid of any doctors who don’t put patients on hypoglycemics, antihypertensives, statins, antidepressants and other drugs – most of which the doctor wouldn’t take themselves or let any of their family take.
We moved rapidly from taking a brief course of one drug at most at any one time, in the 1980s, to taking 7 or more every single day of the year now. The human body can survive acute poisoning or a skilful mutilation relatively well but chronic and indiscriminant poisoning is another matter and life expectancy is now falling with very few people offering any good explanations as to why.
When in an acute medical crisis we sense a doctor is doing what they would do for their own family, and we trust them, even if things go wrong, a social capital develops.
But if in delivering a health service, a doctor puts us on some sacrament (never say poison) and we get injured and later figure she would never have taken it herself, this is a betrayal. It might make money for the service, who are relatively immune to any action we might take against them – as the O’Neill Inquest brings out – but it destroys social capital.
The world becomes a poorer place. And if doctors betray one person, it probably doesn’t get any easier to stand up for the next person. We can cope with a medicine, where some doctors are following the money or the glory in places like Harley Street, but we can’t cope with a system where the entire apparatus is geared to be indifferent to our interests. The logic of the concentration camp kicks in this case and almost all of us end up doing what we need to do to get by.
More and more of us are faced with the inexorable logic of health services who injure or kill us or people we love but whose employees – decent people – can demonstrate that everyone has kept to Guidelines and everyone has ticked all the boxes that have been put in place by managers who have rotated in from McWherever – boxes aimed minimising risks to the organization rather than look after us.
(The Germans running the concentration camp apparatus were just as well adjusted on all tests of moral and behavioural function as the American troops who liberated the camps. Just as those who operate death row facilities now are screened to ensure they are all entirely normal – and are just doing a job).
Stephen O’Neill’s death, covered over the last two months HERE, is a telling example of this.
Some years ago Onora O’Neill, from the opposite side of the religious divide in Northern Ireland to Stephen, gave the Reith lectures – a British Institution. Her subject was Trust.
She began with this:
Confucius told his disciple Tsze-kung that three things are needed for government: weapons, food and trust. If a ruler can’t hold on to all three, he should give up the weapons first and the food next. Trust should be guarded to the end: “without trust we cannot stand”.
What generates Trust? Key is our sense that the leader in this case recognises his/her Duty to go the extra mile for us and others. S/he will only ask us to go to the wall if s/he is willing to go there – first if need be.
The idea of Rights came later when government became anonymous, supported by functionaries who were regarded as ethical, if they ticked the boxes of policy dutifully, whatever the policy, and posed no risk of recognising any other duty to fellow citizens – any duty in humanity as the phrase goes.
This social capital, critical to everything, is under threat today, no where more clearly than in Health. For millennia, Religion was the primary force shaping us. For a few centuries politics and economics took over. Now health is at the centre of everything.
For a few decades in some but not all countries, Health was a place where you were treated with humanity regardless of your creed, or politics – where battles stopped while people from both sides were removed from the field of battle.
No longer. Doctors now tolerate a medical literature that has been more Fake than any other body of literature on earth, and have been doing so for decades before any of us heard of Russian bots.
If you are injured by a drug or device now, where once they were quick to recognise these injuries and champion us when we were injured, doctors like Stephen O’Neill’s doctors will walk by you, claiming to have done their duty by keeping to Guidelines.
When RxISK began, some of us hoped doctors would fill adverse event forms and we might be able to build maps locating the doctors who could be trusted.
Perhaps we, or those of you filling forms, have just gone about it the wrong way but there is a very strong sense that few doctors now have the guts to put their name to an adverse event report. Without this there can be no HealthCare – simple as that.
In the absence of adverse event reports, however, health services meanwhile will run ever more smoothly – see the processes are working!
Rebuilding a sense of common purpose has to be the task for the next decade. If we don’t make progress very soon we may be doomed – ‘Tis the Season to Rebel.
See also The Pandora Hypothesis.