When Britain’s Dr. Richard Smith speaks, I like to listen. He’s a former editor of the British Medical Journal (and also, coincidentally, a former med school prof who in 2001 resigned from his University of Nottingham teaching post in protest over the school’s acceptance of a £3.8 million gift from a tobacco company). Dr. Smith now offers a cheeky yet revealing overview of what’s wrong with medicine. In fact, I feel compelled to share with you his recent BMJ article, published shortly after returning from the World Cardiology Congress in Dubai. He writes:
“Doctors are not interested in health“.
“This is one of my many wild generalizations. My evidence is:
- my experience
- a 40-year collection of anecdotes
- the observation that a 1,000 page medical textbook usually comprises five desultory pages on health and 995 pages detailing disease.
“But now I have further evidence.
“I’ve just attended the World Cardiology Congress in Dubai, an event with more than 10,000 attendees and an A4 programme that is 370 pages long. Not used to such extravagant events, I imagined every session packed with enthusiasts.
“In fact, when I arrive at a session called “Prevention of cardiovascular disease in emerging economies: the role of pharmacological intervention”, I discover that I’m the third person apart from the two chairs and the three speakers. Nobody else arrives, but the session begins.
“The first speaker is from China and tells us that implantation of coronary stents has been increasing by 30% a year since 2000, but that very little has been done on prevention. He observes as well that 50% of doctors and 70% of cardiologists smoke. It’s perhaps some sort of justice that the doctors’ lack of interest in health and prevention extends to themselves as well as their patients and potential patients. During this first talk, the man sitting in the front row realizes that he’s in the wrong session and leaves. (This reminds me of my brother’s first performance at the Edinburgh Fringe, when there were seven people on the stage and four in the audience; and because of audience participation it was later 11 on the stage and none in the audience).
“We then have two excellent presentations on prevention in Brazil, and the audience has grown by three. (One, I suspect, might be the wife or mistress of one of the speakers. Global conferences can be a good time to arrange an assignation with your mistress. I hasten to add that I write this from imagination – not experience – and have no evidence whatsoever that the woman in the audience with the short skirt is anybody’s mistress). Although we now have five in the audience, I note that two of them are looking at their BlackBerries.
“I must admit that the title of the session made me suspicious that the organizers might be pandering to some higher agenda. Why ’emerging economies‘ rather than ‘low and middle income countries?’ Perhaps because businesses, the sponsors of the meeting, are more interested in these countries with huge populations and rapidly growing economies than they are in countries like Rwanda or Sri Lanka. The same considerations might explain the emphasis on drugs rather than on lifestyle or public health interventions.
“After this session, I go and chair another session on prevention (which is why I am here), and now we have an audience of about ten, only five of whom are from the same place as the speakers. During the session, however, one gets a phone call and leaves, and three others who have sat at the back leave, too. Perhaps they got a better offer.
“I didn’t go to any other sessions, and perhaps they were all equally empty. It might have been that those at the conference followed the advice of a colleague:
‘Once I’ve learned three things at a conference, I head for the beach or a bar. With luck, that happens in the first 20 minutes.’
“I was told, however, that a session on stents was full to overflowing. Stents mean money, drama, and even beautiful women and a slot on the television.
“Prevention, in contrast, is boring, all about what doesn’t happen rather than what does.
“Plus, were it to be successful, it would put cardiologists out of business. Then there would be no more conferences in exotic venues.”
© 2012 Dr. Richard Smith BMJ
Q: What do you make of Dr. Smith’s cynical theories about preventive medicine?