Sue Ieraci: Upping the ante on hype

THE ballyhoo in federal politics when derogatory remarks were made about Prime Minister Julia Gillard at an anti-carbon-tax rally in Canberra made me think about some of the extreme views we often see in medicine.

A recent comment article in MJA InSight by Jane McCredie about circumcision inspired just the type of rhetoric Jane had described in the article.

Like human nature itself, any question relating to health services is rarely black or white. And yet, when opposing forces argue, they almost always take extreme positions.

Proponents of cultural circumcision described a practice that has lasted millennia, while opponents used language like “barbaric”.

Can they both be right? Whose advice should we give to patients?

Emotive areas of health care often involve babies or children. Childbirth is a case in point, with homebirth advocates vehemently opposed to the elective caesarean — or perhaps any kind of intervention at all.

To the “natural” childbirth movement, intervention represents assault. To some in the medical profession, independent homebirth midwives are irresponsible and dangerous.

Can they both be right? What advice should we give to patients?

The same heat is evident in the immunisation debate.

Many who have followed the New South Wales Health Care Complaints Commission’s investigation of complaints made against the vocal anti-vaccination group, the Australian Vaccination Network (AVN) and the exposure of discredited UK researcher Andrew Wakefield will consider the views of AVN and Wakefield irresponsible and dangerous.

The anti-vaccine brigade accuses doctors of being caught up in the web of drug company profits.

What tends to mark all these arguments, and to make their proponents vulnerable to criticism, is the extreme positions taken. For example, we all know that vaccines are not 100% effective and that some of the more recently developed vaccines may be for conditions that are rarely severe and much more rarely fatal.

We need to explain to the community ― and to recognise for ourselves ― that modern medicine is a science of diminishing returns.

The quantum gains in infectious diseases, child mortality and obstetric mortality have already been made. Polio and epiglottitis have almost disappeared.

We now have a society that is risk-averse and has high expectations, coupled with a medical system that wants to keep progressing.

However, we need to be honest about effectiveness and risk ― both to ourselves and to the community.

We can’t keep insisting that health care is in “crisis” and that every childhood illness has to be eliminated despite health outcomes being better than ever before.

If we do, we only give the zealot anti-vaccinationists and populist “natural” therapists more credibility when they say “too much medicine”.

Dr Ieraci is a specialist emergency physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. She also runs the health system consultancy SI-napse.

Posted 28 March 2011