How medicine has become unscientific and corrupted by Pharmaceutical Lobby

[Guest guest]

Cargo-cult Science of National Health Service [ how medicine has become

unscientific and corrupted by Pharmaceutical Lobby]

Infostat , cargo-cult science and the policy sausage-machine:

NICE, CHI and the managerial takeover of clinical practice

Prof. Bruce G Charlton MD

In 1993 I published a Lancet Viewpoint entitled ‘Management of science’ in

which I pointed-out that purchasing managers in the National Health Service had

begun implementing very precise contracts which controlled detailed aspects of

clinical practice (Charlton, 1993).

For instance, it became mandatory to specify protocols for beta-blocker and

aspirin treatment following myocardial infarction, and for prescription of

benzodiazepines, antidepressants, and other psychotropic drugs, and for aspects

of skin cancer management. The justification for these blanket recommendations

was that these interventions were ‘scientifically’ proven to be effective

across the board in almost every clinical circumstance - at least according to

the NHS Management Executive’s interpretation of the results of large

randomized trials (although expert clinicians usually disagreed; eg . n,

1995).

But the fundamental problem was structural: the government (agencies) were

creating a managerial structure that separated the power to influence treatment

from clinical responsibility for the consequences of that treatment. For

example, managers were claiming the right to determine the nature of a drug

prescription while doctors remained both morally and legally responsible for the

outcome. This seemed self-evidently unethical, and placed doctors in the

impossible position of being vulnerable to sacking if they were disobedient and

to malpractice suits if they obeyed. The system was also open to corruption,

since political influence could be brought to bear on managers, tending to

generate protocols using criteria dictated by expediency rather than

effectiveness. For example, the call for specified protocols on psychotropic

drugs were unsupported by any rational consensus on what such protocols should

contain, and the instructions concerning ‘skin’ cancer (and the failure to

differentiate between basal cell, squamous cell, and melanomatous malignancies)

seemed more justified by the immediate demands of public relations than by any

body of solid scientific evidence.

Hmmm, sounds like our " Community Standard of Treatment " ? Violate it and you have

your license revoked.

As things turn out, I had underestimated the seriousness of this kind of threat

to clinical practice, and my article unfortunately proved to be prophetic of a

trend which has culminated in the creation of NICE and CHI. The management of

science in medicine is now established by statute, and - even worse - the

criteria of effectiveness have been conflated with economic considerations of

‘cost-effectiveness’. The stage is set for clinical science to be

steamrollered by the demands of power politics.

Read on: http://neuroscientist.com/bgcharlton/cargocult.html