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Thursday, May 15, 2014

Former president of American College of Physicians explains the population medicine approach and we should be afraid,very afraid

Dr. Harold C. Sox has played a leadership role in the American College of Physicians  for many years, serving as President of the ACP and long time editor of the Annals of Internal Medicine.

 In the opening paragraph of a commentary in JAMA entitled "Resolving the Tension between Population health can individual health care" (JAMA November 13, 2013,Volume 310, number 18) he states:

"Perhaps the de facto organizing principle of US health care approaching each patient strictly as in individual is obsolete.The population heath approach is an alternative. It aims to improve and maintain health across a defined population."

Later repeating a major theme of the publication,"Medical Professionalism in the new millennium,a physician charter" , Dr Sox says:

"..the physician has an ethical imperative to balance the needs of the individual patient with the needs of  society."

 Dr. Sox  then explains in broad terms how to practice population medicine.

"Planning to optimize population health will mean determining the frequency,causes and consequences of he common medical conditions in a population and devising strategies for dealing with them over a lifetime. "...
resources must be allocated across program to prevent,detect and treat disease and its risk factors. "...One reasonable principle to move resources from groups of patients less likely to benefit to groups more likely to benefit."

With the application of this utilitarian calculus there will be winners and losers which Sox seems to admit implicitly the following paragraph.

"It will take several generations to realize the benefit of investments in disease prevention.In the short run, these investments may draw resources away from the tests and treatment of some sick people.In the long run, diseased prevention and better low-cost technology could reduce the outlay for treatment."

So, in the short run the population medicine approach might deprive some sick patients of treatments but in the long run "the outlay for treatment " could be reduced. Withholding treatment  for those who are sick now for some  purported,future , hypothetical benefit to anonymous  people is completely antithetical to basic medical ethics and has no place in a nation with any remnant of individual freedom remaining.

Dr. Sox after already seemingly condoning  sacrifice of the individual's welfare to some nebulous greater social good then closes the commentary with the following platitude which seems to contradict his earlier statements;
"Much of medical practice has changed but not the basis of patient -centered care."

The term "patient centered care" is a trendy, feel-good cliche without well defined operational meaning but I cannot believe that any generally accepted understanding of that phrase could possibly include not treating the sick to gain some allegedly future benefit to some some subset  of well people.

As someone who did his medical training in the same time frame as Dr. Sox in which the notion of the  physician as the fiduciary of the patient  was sacrosanct   I find his comments wrong on so many levels that I cannot find the words to express it but to the extent that views such as those expressed in his commentary are more widely accepted there is reason to be afraid,very afraid.

Dr Michel Accad critiqued this creed of medical collectivism in his blog writing in part:

"...beyond ignoring the obvious tension between the individual and the group, hoodwinking physicians into practicing "population medicine" is of course the essential means to confuse practitioners into thoughtlessly carrying  out sweeping interventions whose primary benefit is the profit of third parties."

addendum: Several spelling errors and typos corrected on 8/6/2014


Troglodytum Brachiandum said...

What a shame. Dr. Sox's comments read so much better in German. Or perhaps North Korean, if there is such a language.

Kerrie Peacock said...

I have to agree Dr. Sox has some very inaccurate ideas.