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Friday, March 25, 2016

Population medicine-the poster child for the hubris of the progressive medical elite.

 Note: the core ideas expressed below originally appeared in a blog post  published 1/16/15 under the title " Are patients pawns on the chessboard of population medicine?"

 So are patients the pawns on the chess board of population medicine?

They would seem to  be- at least so it appears to be in the presentation of the "population medicine approach"  by Dr. Harold Sox,former editor of the Annals of Internal Medicine, former president of the American College of Physicians (ACP) and former chair of the U.S. Preventive Services Task Force, offered in the November 13 ,2014 issue of  the Journal of the American Medical Association (JAMA).

Here is my thumbnail summary of Dr. Sox's description of  how the population medicine approach would work.

The major important diseases would be identified as would methods for their prevention. With that knowledge in hand , then funds could be transferred across patients and disease processes so that the maximal overall health benefit could be achieved.In this process it might well be that sometimes funds would be diverted away from the testing and treatment of some so that the preventive measures could be funded and then  " in a few generations" the benefit would be fully realized.He is explicit regarding the fact that in the short run some people would be harmed although he does not seem to explain why it would be only the short run as would not new preventative measures always be formulated and have funds diverted to their execution

If that does not exemplify the mega-hubris and naive utopian view of the progressive mind set  possessed by someone  who somehow knows what is best for everyone,I do not know what does. First they determine what the important diseases are,then they glibly state they can discern how to prevent them and then they presume to have the wisdom, authority and power to "transfer" funds for one patient treatment to another person's prevention program so that the overall benefit is maximized though some pawns may have to be sacrificed.

.The population medicine advocates claim the approach to  each patient strictly as a individual is "obsolete" and  are promoting a statistical medicine that claims to be capable of provided the greatest health benefit to the greatest number.Practicing physicians know how difficult it can be to recommend what might be best for the individual patient,the "populationists" glibly claim to know what is best for everyone.Individual freedom and autonomy also is obsolete in this world view. Of course,the presumption of the knowledge of what is best for everyone,irrespective of the wishes and autonomy of the alleged beneficiary of  that betterment, is characteristic of the progressive ( AKA modern liberal).The medical progressive elite is just a subset of the larger category of progressives.

In chess, pawns or for that matter any piece ( except the king), might be sacrificed in executing a strategy of placing the opponent 's king in checkmate. In the case of the population medicine approach the individual patient might be sacrificed in executing a strategy of maximizing the health of the specified population as measured by some metric such as quality adjusted life years  (QALY) per dollar spent ?

I closed another earlier article on Dr Sox's frightening essay with this paragraph:

"...the principles involved in treating patient who requests help from a physician and  and proposing preventive measures for a population are not the same. The population has not requested help and may have not even authorized the "treatment"  A key principle in treating the individual is to respect his/her values. How can one determine the values of a population? Do all member of the population have to agree.? Is disease prevention is only principle to value, do liberty, and avoidance of coercion not matter? Who is to judge what is the fair allocation? Is disease prevention more important than treating the sick which historically is what physician basically did ?What about the possible harms of a preventive program?Should the population members have to agree to the preventive measures? Is informed consent not to be part of population medicine? "

I know-  I have written about this more than once before but I find the concept so antithetical to hundreds of years of traditional medical practice  and ethics and to basic concepts of individual freedom and individual autonomy that I cannot get over those ideas being given voice in one of the country's major medical journals and few voices raised in opposition.  

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