Sometimes the clamour coming from the health sector sounds like nothing so much as a bunch of whining kids. My problem’s bigger than yours. No it’s not. Yes it is.
The noise can become deafening when one cancer group competes against another — poor old us in prostate cancer are so badly done by compared with those lucky women in breast cancer — or when the cancer lobby unites to assert its superiority over heart disease.
Of course it’s useful to know the relative costs and impacts of various heath problems, but the competition for the most impressive casualty count is becoming, quite literally, sickening.
This disease-based jockeying for media headlines and policy/funding attention is unhealthy in reinforcing a narrow focus on risk factors for specific diseases. To stress the role of smoking in one particular disease alone is unlikely to lead to sensible tobacco control policies.
While it’s understandable that disease-based groups might want to lobby for better treatments in their particular area, it’s debateable whether this narrow approach best serves the broader community or even their patient group. Often the most meaningful improvements to patient care will come from systemic changes to service delivery more broadly.
As well, many health problems have similar underlying causes – smoking, alcohol, inactivity, poor quality diets or adverse childhood experiences are common culprits — and perhaps we would have more luck in tackling them if the heart disease, cancer, mental health and diabetes mobs worked more in collaboration than competition.
Focusing on risk factors for specific diseases also tends to distract attention from efforts to tackle the broader social and structural factors promoting ill health. It’s so much easier, for example, to make people worried or guilty about what they’re eating than to ensure a healthier food supply.
Too often the media are complicit in the disease wars, happy to amplify the loudest voices rather than taking time to sift the signal from the noise.
One recent example is an Access Economics report funded by The Australian Lung Foundation stressing the toll of chronic obstructive pulmonary disease and calling for widespread screening.
The report was widely and uncritically reported. Most recently, The Weekend Australian repeated its claim that COPD kills 16,000 Australians annually.
No mention was made of Simon Chapman’s recent Crikey article questioning the unprecedented magnitude of these figures. Chapman is not Robinson Crusoe. Here are a few comments from other senior figures in public health and epidemiology.
University of Sydney Professor of Public Health Bruce Armstrong:
I saw coverage of the Access Economics report and the Lung Foundation’s recommended actions on television. My immediate conclusions were those Simon Chapman has reached in his article. The Access Economics numbers for COPD are grossly overstated and the Lung Foundation’s recommendations based on them are not ones that the Australian governments should consider accepting.
The University of Queensland Professor of Medical Statistics and Population Health Alan Lopez:
I would be extremely sceptical of the scientific rigour underlying the Access Economics Report. This may well be a case of good advocates being terrible epidemiologists. That is a scenario that can have significant implications for public policy, as Chris Murray and I discovered when doing the original Global Burden of Disease Study. Our estimates for leading causes of global health interest, including malaria and measles, were much lower than what well meaning advocates had advised WHO. While COPD is a comorbid condition for many other diseases caused by smoking, it is unlikely to cause anywhere the number of deaths that Access Economics attribute. We need to be careful that public policies and programs to control tobacco are based on evidence, not advocacy.
The University of Queensland Professor of Public Health Policy Wayne Hall: “I very much endorse Simon’s recent piece on Access Economics’ report on COPD.”
I also know of at least one other senior figure in the area who has been privately critical of the report but doesn’t wish to go on the record.
Lynne Pezzullo, a director at Access Economics, was most unimpressed when I sought her response to these comments. She stressed the report’s accuracy and her consultancy’s integrity, and also made some disparaging comments about Chapman, including that he is a “troublemaker”, and the “rubbish” that appears on Crikey.
She noted that critics of the reports are associates of Chapman. (For the record, I should declare that I am as well, having an honorary appointment at the University of Sydney).
Pezzullo was also most unimpressed by my analysis of the “disease wars”, describing it as a “tired old line”. Maybe she’s right. But I reckon it’s got more mileage left in it than that other tired old line, my disease is bigger than yours…