I shall start first with an announcement and a request that I received tonight. It goes like this....
"The Inaugural USA Science & Engineering Festival will be the country’s first national science festival and will descend on the Washington, D.C. area in the Fall of 2010. The Festival promises to be the ultimate multi-cultural, multi-generational and multi-disciplinary celebration of science in the United States. On this blog, you can keep updated on Festival events and scheduling, and follow along as the Festival's organizers and presenters further discuss the ideas and themes that shape the agenda.
NIH Director Francis Collins' 5 Critical Pathways for Science Thanks for helping us get the word out about the USA Science and Engineering Festival"
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What follows is a short article in which Dr. Collins names "5 critical pathways for the future of health sciences"
you can check it out....
This is where I want to put my head in the water like the ducks above.
Instead I write back to them about their request to tweet or facebook or social network on behalf of the conference. Is it just me....that is getting tired of the language and the tone?
So, here goes ..... Dear .....
With due respect to Dr. Collins I would like to disagree about some of the points made in the announcement of this conference.
In the 3rd point he stresses the need to develop a science of health care reform by measuring outcomes, assessing efficacy, and developing "personalized" medicine. In fact, the science of health care reform would be much more important and effective if we would act on and expand the research about what determines health and more emphatically explore the connections between social and community influences on human health.
Health reform has two main elements first, quality improvement and cost-effectiveness efforts directed at our current medical system and second, improving access to this system for more people. However, the five biomedical and technological areas Dr. Collins suggests in this post will not improve quality, access or reduce costs of medical care, the cannot.
We have obsessively spent our time, money, and intellect on the uni-modal biomedical model and we have tweaked the medical system enough to demonstrate that:
a. The health care system as described includes only the formal medical system and thus, includes a very limited set of places and activities. We can keep fixing the formal system and rearranging its elements but it will not produce health in the population or the individual. Health reform efforts that ignore community-based inputs and impacts will be limited in their reach-- in fact, the working estimate is that the health care system is responsible for only 10% of the "health" experienced by the American population although it garners 97% of health resources (dollars). We indeed know a lot about the individual but too little about their context and how that context interacts to create or undermine "health".
b. human health is intricately and demonstrably associated with social and psychological factors that have more "weight" than many of the traditional risk factors we are so fond of emphasizing. I think the health care reform we need is first conceptual. What is happening in the homes and streets is more important than the hospital. If we simply improved high school graduation rates in the US we would have a more sizable and lasting effect on the health of Americans by any standard measure than any of the activities suggested in the post above.
The health care reform needed is transformational and should include a demand by health workers and the public for a system that that produces health, promotes well-being, prevents disease, cares for illness, and assists in rehabilitation and comfort.
I have worked with Dr. Collins and I know he appreciates that population and community forces are critical components of the "health system" and to creating health. However, what is described here is limited to the commodity of health care delivery and I fear the entire conference will be a festival celebrating genetics, the biomedical model, and simply more of the same.
Finally, I am concerned that the global health strategy of "de-risking" thus, encouraging private sector engagement assumes profitability that may not be true or good. Some activities are investments and will not bear profits for some time if ever. Educating children, clean water that is tested and widely accessible, fire stations, and libraries are all activities with benefits that far exceed the individual and will not likely be profitable business ventures. In fact, I am not aware of them being profitable anywhere. Investment in communities may sometimes require more than the profit motive and the "de-risking" alluded to-- recognizing that there was not enough space to adequately define the term-- could also come with great harm.
The announcement asks the recipient to share it through our social networks however, unless I was reassured that the conference had a more balanced and innovative plan I would actually encourage people to miss it. Thus, my twitter feed will remain quiet for now.
Respectfully,
Sharon McDonnell MD MPH
Associate Professor Dartmouth Medical School and
The Dartmouth Institute
2 comments:
De-risking? This is crazy. I think the man should stick to genes.
Great points, Sharon. I have very mixed feelings about the field of biomedical research right now. On one hand your post makes me reluctant to support the field with tweets, and on the other I'm sorry to see the plug pulled on stem cell research and think proponents of this work should speak out.
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