Debbie,
Unlike John I will reply from the land of the Grand Slam in open mode.
I last did Ob.s some 15 to 20 years ago and I was repeated told then,
that to have a low LSCS rate was impossible to defend as it was clear
evidence of failure to intervene when required.
That generation of Registrars are (or should it be is) now the
Consultant body in the NHS.
One problem I have with people like is we need studies to tell us
obvious things. Clearly we must challenge and seek confirmation of our
views but may I remind you no trial has ever been done to show insulin
is useful for insulin dependent diabetics. It just is.
To do a study would be criminal neglect! So no one does it. One case was
enough.
If there is widespread acceptance of this view then the social pressure
exists. QED.
On the how it has this effect question, my own view is that it probably
varies and it depends circumstances. I am aware of cases where defensive
medicine has harmed individuals. The real question is should doctors put
their patient first, or should they ensure the most cost effective
solution for the population as a whole. The Helsinki declaration is
clear the individual is first, society comes second in this case, as in
the circumstances of health care the greatest benefit to society comes
from caring for those in need not in short term expediency.
John please show us your response. It was probably better phrased and
more eloquent than mine.
Mark Temple.
In message
<[log in to unmask]>,
D.Price <[log in to unmask]> writes
>
>As a pretty much silent member of this list, I very much welcome the type
>of discussion that has been taking place, and I read and learn with interest
>(in a field about which I know very little). I also find it quite easy to delete
>incoming email without opening when it is clear from the subject line that I
>don't want to read it.
>The recent discussion has had me wondering about something - it has
>been repeatedly stated in the course of these exchanges that an increase
>in litigation is one of the causes of increases in c-sections over time
>(ignoring the last couple of years), but has this been shown through
>qualitative and/or quantitative studies? Even if it has, I think that there
>might be two factors at work as regards litigation - one might be purely
>defensive medicine as is being suggested, but the other could be that
>litigation highlights the relative risks of treatment choices, and can lead,
>therefore, to medical practice that on average benefits patients.
>Just a thought,
>Debbie Price
>Sociology Department
>University of Surrey
>
>
>-----Original Message-----
>From: email list for Radical Statistics on behalf of Ray Thomas
>Sent: Fri 08/04/2005 09:54
>To: [log in to unmask]
>Subject: Re: Discussion on Maternity Statistics
>
>I would remind readers of the concerns of Radstats (as stated on the
>inside
>to the cover of the Journal):
>
>* the mystifying use of technical language to disguise social problems as
>technical problems
>
>* lack of control by the community over the aims of statistical
>investigations, the way these are conducted, and the use of the
>information
>produced.
>
>* the power structures within which statistical and research workers are
>employed an which control the work and how it is used.
>
>* the fragmentation of social problems into specialist fields, obscuring
>connectedness
>
>Seems to me that the recent discussions, and especially the contributions
>by
>John Whittington, have demonstrated the importance of these concerns.
>The
>discussions have helped make list members aware of the wide range of
>factors
>that influence the production of medical statistics and that should be taken
>into account in interpreting medical statistics.
>
>The idea that the list should just be a notice board for meetings dismisses
>the importance of these concerns. Meetings, mostly small, mostly in
>London, mostly producer-oriented, don't often provide much opportunity to
>address these concerns. This list does. Three hundred members (some
>as
>far away from London as Buckingham!) can help reduce the ignorance that
>can
>so easily pervade statistical systems.
>
>Ray Thomas
>35 Passmore, Tinkers Bridge, Milton Keynes MK6 3DY
>Email: [log in to unmask]
>Tel/Fax 01908 679081
>***********************
>
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