7:00AM BST 23 Jun 2014
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There is rather more than is immediately apparent in the recent – and unprecedented – assault by doctors’ leaders on the integrity of their colleagues at the National Institute for Health and Care Excellence (Nice) in drawing attention to their “direct financial ties” with drug companies.
The ostensible casus belli may be the controversial proposal to extend, by several millions, the numbers eligible for cholesterol-lowering statins. But there is a more profound issue at stake concerning the rationale for mass medicalisation.
It goes back to 1990, when the influential epidemiologist Prof Geoffrey Rose argued it was more advantageous to target medical interventions at the entire population than just at individuals “at high risk”. This population strategy, as it is called, is essentially a statistical construct and – in reference to the control of alcohol-related health problems – runs as follows.
There is within any society a typical distribution of alcohol consumption, with most drinking modestly and a minority substantially more than is good for them. Prof Rose’s strategy requires that the modest drinkers should all slightly reduce their consumption – say, by one glass of wine a day. This would theoretically shift the distribution of the pattern of alcohol consumption downwards, so there will be fewer heavy drinkers and thus a lower incidence of alcohol-induced medical problems.
This might sound a bit obscure and improbable. But this population approach, and variations upon it, has become the major impetus behind the zealous treatment of all those at low risk of circulatory disorders and other conditions. There is a detailed critique – Punishing the Majority, by John Duffy and Christopher Snowdon – at iea.org.uk.
Psychic phenomenon
Medicine is, for the most part, a rational enterprise with little time for the supernatural. However, the public may have a different view, as suggested by two separate accounts within a week of patients describing a state of “psychic unease” coinciding, it subsequently emerged, with the death of a close relative.
The most thorough investigation of these death coincidences, as they are called, carried out by the Society of Psychical Research over 100 years ago, found their frequency to be nearly 500 times greater than might be expected by chance.
The survey might sound like something of a curiosity, but Prof Tom Dening, of Nottingham University, writing in the journal History of Psychiatry, notes that “by the standards of the time, the methodology was good and well thought-out”.
Thus, in a typical case, a Yorkshireman who had emigrated to Australia reported being woken at night to see the figure of his aunt standing near the foot of his bed. He told his wife of the apparition and, sure enough, in subsequent correspondence, it emerged that – taking into account the time difference between Melbourne and Greenwich – his aunt had appeared in Australia three hours after her death in England.
This is most readily explained as a hypnagogic hallucination, or waking dream. But the difficulty remains in accounting for the timing of his aunt’s apparition at the time of her death. The frequency of such occurrences, unaccountable by chance alone, “challenges the notion” that they are necessarily due to a state of altered consciousness, observes Prof Dening.
Bladder pain
This week’s medical query comes courtesy of Mr TS of Leeds, now in his mid-eighties and “not doing badly”, except that for the past few months he has been afflicted by severe pain – lasting up to an hour – after emptying his bladder. Passing urine itself is painless and he has no other urinary-related symptoms.
He has seen a specialist and had all the tests, which surprisingly turned out to be normal. He has cut out all fizzy drinks (including, sadly, his daily G&T) and other potential bladder irritants, and would be more than grateful for any suggestions.
Email medical questions confidentially to Dr James LeFanu at drjames@telegraph.co.uk. Answers will be published on The Telegraph website every Friday, at telegraph.co.uk/health
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