If patriotism is the last refuge of a scoundrel, then news about news is the last refuge of a desperate editor. In an editorial in the BMJ this week, Ben Goldacre and Carl Heneghan report on ‘extensive news coverage’ of a ‘leaked letter’ from the Chief Medical Officer to the Academy of Medical Sciences asking for an enquiry into how society should judge the safety and efficacy of drugs. This is hardly the stuff of which crackling headlines are made. Dr No missed it, and so too did most of the media. According to google news, only the BBC and The Guardian covered the story in the national media, with remaining coverage confined to such erstwhile journals as the PharmaTimes of Freakistan. The leak, it turns out, was about as newsworthy as a damp patch on an incontinent’s mattress.
It is not hard to see why. Though the subject, which is close to Dr No’s heart, indeed he has written about it on many occasions, is quite literally of vital importance, by the time it is wrapped up in CMOs and AMSs, not to mention news about news and reports about reports, it loses its appeal. Nor does the BMJ editorial do anything to help. It provides a ‘brief tour’ of ‘six domains’ and hints that those six are just for starters. Once talk of domains is in the air, suffocation is never far behind. A nausea for overlapping Venn diagrams and Wheel charts overcomes the reader. The brief tour takes on the musty air of a brief tour of empty booths in an academic library. No wonder the news bombed.
Another reason for the lack of interest, Dr No suspects, is that for most people, including doctors who should know better, the matter is a non-question. For half of us, it is axiomatic that medicine is science based, and drugs work – why otherwise would the doctor prescribe them? – and for the other half it is equally axiomatic that doctors are charlatans, and their pills and potions snake oil, more likely to harm us than help us, with Big Pharma and the profession in cahoots against the laity. In either of these opposing mindsets, there is little room for counter-intuitive truths, such as the fact that most of us take our blood pressure pills so that someone else might not have a stroke, or our statins so that someone else might not have a heart attack.
The editorial’s startling opening part of its headline, How Medicine is Broken, doesn’t do anything to help itself either. Such a headline might work over startling news that evidence based medicine is all wrong, and the four humours had it right all along, but over a piece that is in the most part a brief tour of six domains of administrative corrections, it reeks of over-egging, and leaves behind a whiff of hydrogen sulphide. Rather more pungent, and surely at odds with the thrust of the surveyed domains, is the aroma generated by the announcement, buried low in the AMS’s press release, that the work, which will focus on statins, is to be part sponsored by a not entirely disinterested medical charity, the British Heart Foundation. But we should be grateful for small mercies: at least it’s not Pfizer.
Over-medicating healthy people on the basis of dubious evidence is beyond doubt one of the great follies of our times. It is driven by patients who, understandably, want to believe their doctors, by statistically ignorant doctors who, understandably, want to help their patients, and financially savvy drug companies who, understandably, want to turn a profit. To this list, we might even add David Cameron, who, understandably, wants to pump up big business. With so many fair winds, is it any surprise that so many of us pop a pill for every ill?
Nor is it a surprise that so few of us see that it is a folly, or even that there is a problem. Before we embark on briefs tours of corrective domains, we need to get it firmly and widely understood that there is a problem to be corrected in the first place. We might start by telling our patients that all medicines are a game of white (the pill may help you) and black (the pill may harm you) Russian roulette. We could add that sometimes we don’t even really know what is in the loaded chamber, and then have fun using the number of chambers as an analogy for the number needed to treat. That way, even the tabloids might pick up the story, and possibly reuse a classic headline. Super Doctor Goes Ballistic, Statins Are Atrocious? Or, shorter and even simpler: Shoots You, Sir.