I would argue that we rather need to emphasize the art of medicine over
the science. An over-reliance on the results of science has got us into
terrible trouble in all sorts of areas over the last 100 years or so
(mind you, I'm currently reading 'The Risk Society', so I might be
biased). But take the response to swine flu (I'm trying to write a paper
on this at the moment, but am finding it very difficult because I keep
changing my mind): the English Govt heavily relied on models that were
populated with evidence relating to avian flu - this made for very scary
reading, but had the Govt involved other specialists more (e.g. field
epidemiologists), they would have learned that very early on in the
swine flu outbreak that swine flu was less serious and deadly than avian
flu, and may have moderated their response accordingly. 

'Science', it seems to me, is taking precedence in social decisions
because Govts, funding bodies etc are desperate for answers (it doesn't
seem to matter if the answers are right). So there is a focus on those
who measure and those who question the measurements are left out in the
cold. There needs to be some kind of rebalance here I think (in terms of
where funders target their funds, etc). 

The swine flu thing brings me onto something that Alan alludes to below.
In the UK swine flu outbreak, people could get hold of antivirals
without going to their GP for prescription. Patrick Dunleavy, I think,
thinks that general direction is a good thing, and sees changes in these
kind of power structures as a positive development. I personally would
be very nervous about developments of that kind though, firstly because
of the cost implications (i.e. people fetching drugs more when they
don't really need them), and secondly (but relatedly) because of the
risk that viruses would soon(er) become resistant to the drugs. I was
wondering whether people lean more towards Partick's or my views on
this, because I will raise it in my swine flu paper. 

Best, 
Adam   

-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Maynard, A.
Sent: 15 August 2010 11:01
To: [log in to unmask]
Subject: Re: On the Mend

Thanks Bob
Wow! "Lean" may hit the US hospital sector over 50 years after Demming 
and others developed this in the reconstruction of Japan. Europe is 
already "infected"!
The nice issue is why has it taken so long to streamline systems and 
reduce the variations endemic in health care systems, public and 
private?. Could it be that George Bernard Shaw was right and that 
professions are" a conspiracy against the laity". Reading Shaw's play, 
the "Doctor's Dilemma" from 1906 still seems very pertinent! For those 
preferring Chicago to the Fabians, Milton Friedman argued that 
occupational licensure reduced the volume and quality of care in his 
"Capitalism and Freedom" in 1962. Managing better the "crews" of health 
care systems would of course redistribute power and money and is 
therefore unacceptable!
Has much changed in the last 100 years?
Have a nice day!
Alan

Bob Pyke Jr.,RN,CPNP wrote:
> John Toussaint and Roger Gerard have published a book entitled On the
Mend: Revolutionizing Healthcare to Save Lives and Transform the
Industry. Ordinarily, you would be well advised to be skeptical of
anyone promising revolution and transformation, but not here.
>
> Here's an excerpt from the introduction:
>
>  
>
> With few exceptions, [government policy] debaters assume that
healthcare costs are fixed, that America's proud history of medical care
and innovation comes with a staggering bill.
>
>  
>
> We know different.
>
> http://goo.gl/b/uhyl
>
> Bob,
>   

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