272. Consumerisation of Healthcare

“Be responsible for your own health, says leading GP” was the headline for an article in the Yorkshire Post recently. This was based on a comment made by Dr Clare Gerada, a former Chair of the Royal College of General Practitioners (RCPG). She was advocating that patients should be encouraged to take responsibility for their own health. She commented:

“The idea that you need to consult me as the GP to tell you where to go is a nonsense in tomorrow’s world. In yesterday’s patronising world where I had the knowledge and I kept it from you, fine, but you are just as responsible.

“If you don’t do that I am afraid that what is going to happen is that you have all the power and no responsibility.

“We are going to end up with a burnt-out system where there won’t be health professionals because we can’t take that responsibility.”

She went on to say that it was not the job of GPs to provide patients with information about health, fitness and diet. Instead, people should use the internet. In her own work as a GP she was using technology as an alternative to having a face to face consultation. In any event, the technological advances available to doctors means that a 10-minute consultation is becoming very complex.

A sign of the times

It is now very clear that we are experiencing a massive shift in the way that healthcare is delivered. I have discovered that there are a numerous examples of products and services available. Individuals can search for information using the usual search engines and purchasing is easy with access to the internet.

In a recent article (1), Sam Myers has described some of these developments. He draws an interesting parallel with the big shift in the grocery markets:

“In grocery stores fifty years ago, there used to be a clear divide between the consumers and the goods. Groceries could be accessed only through the shop clerk, who was the gatekeeper. It was useful to have someone from whom to advice, but over time, it became clear that it was a far better to be allowed to make their own decisions.”

Essentially he is making the same point as Clare Gerada. He gives several examples which include:

Werlabs in Sweden that offers detailed blood testing;
Thriva in the UK offers small scale home testing kits;
IESO Health, which enables patients to connect directly with therapists.

In a recent blog, I described the work of Virta Health Clinic in USA, which is having great success in helping people to overcome Type 2 Diabetes (T2D) (2).

Implications

This is clearly a major change in the way healthcare is delivered. It is somewhat surprising how much has happened so far but there is no doubt that the current trends will be maintained and will ultimately have a massive impact. However there are definite pros and cons. On the one hand, there is tremendous scope for achieving huge improvements in public health. Equally beneficial is the potential for reducing the costs of healthcare. On the other hand, if bad advice is presented and/or products promoted that are not effective, or possibly even dangerous, then the consequences would be disastrous.

The focus on nutrition

Nutrition clearly is one of the key issues, especially in relation to T2D. The fundamental problem is that the official advice from the great majority of health professionals to reduce the intake of fat and increase complex carbohydrates is WRONG and invariably the health of patients deteriorates. By contrast, there is overwhelming evidence that those who do the exact opposite of reducing/eliminating carbohydrates and increasing healthy fats such butter, olive oil and avocado invariably recover. If the standard NHS advice is promoted, then this will obviously not work. This is the dilemma we have to confront. It all depends on the validity and suitability of the information/equipment that is being sold/promoted. The big problem is that whether it is the NHS or a private company involved the unfortunate patient may well be vulnerable to exploitation.

Individuals have to take control

This has to be the way forward. Most of have become far too dependent on the opinions of professionals. In fact some people cannot conceive any set of circumstances in which they would reject the advice of their doctor. This makes it very easy for a rogue specialist like Ian Paterson to perform thousands of breast operations that were completely unnecessary (3). In addition there are many procedures that are routinely used despite the lack of reliable evidence to show conclusively that they are genuinely beneficial. In recent blog I discussed how Evidence Based Medicine had been conceived in an attempt to address this issue (4). Unfortunately as John Ioannidis has explained this movement has been hi-jacked by unscrupulous vested interests and can no longer deliver its original objectives. One of the best examples is the use of chemotherapy to treat cancer patients. Dr Peter Wise has noted that at best, many cancer drugs prolong life for a few months, during which time they probably experience a poor quality of life because of nasty side effects and numerous hospital visits (5). He contrasts this with best supportive care (BSC) without the use of drugs, which means a much better quality of life shared with family and friends…well away from hospitals.

What does this mean for patients?

If you are involved in an accident it is obvious that you have to place yourself in the hands of health professionals and be grateful for the treatment that may save your life. However in most other circumstances, it is not necessarily so straight forward. I believe we should attempt to evaluate whatever is recommended. This may well mean dealing with complex topics that are difficult to understand. But there may well be some issues where it is possible to do so. An excellent example is Type 2 Diabetes (T2D). Here the standard advice from the mainstream NHS does not work (6). By contrast, there is an increasing number of professionals within the NHS who are achieving excellent results by helping patients to alter their diet by lowering the intake of sugar and carbohydrates and increasing that of health fats. Their success can be gauged from the fact that the blood glucose is brought under control, the need for drugs is reduced and most lose some body weight (7). On the other hand, I have yet to hear of anyone who has successfully controlled T2D by complying with the conventional advice.

I believe there is a special role for self-help support groups, which can enable individuals to come together in order to share knowledge and experience. This is probably one of the best ways of combatting exploitation by unscrupulous companies and professionals. Such groups have also an important role to play in questioning the dogma churned out by the mainstream medics. For genuine progress to be achieved it is essential that this is challenged so that the weaknesses can be identified and addressed. This approach has huge potential to improve health and reduce costs. Politicians should recognise that this is a positive way forward, which provides a viable solution to the apparently intractable problems faced by the current healthcare strategies that are not working but have an insatiable demand for more and more resources.

References

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