In the light of recent political discontent, many voters may be looking afresh at their choices. Science Punk and The Lay Scientist have blogged for the Guardian about the science policies of various political parties, and Gimpy has blogged about the implications of their policies for research: I was disappointed to see how the Greens came out. However, on seeing their current manifesto on health policy, the
Green Party’s Green Party of England and Wales’ credibility quickly disappeared.
A number of aspects of the manifesto are strikingly flawed, to the point of being offensive. Many people rely on the NHS – and for a serious party to come up with a health policy this bad is frankly insulting.
The manifesto insists (HE103) that
Health services can create dependence on the part of users, which is itself unhealthy.
Absolutely, people can become dependent on services in unhealthy ways. However, while self-management of many conditions is desirable, it can be perfectly healthy and sensible for people to depend on health services for some aspects of their care. For example, Type 1 diabetics depend on access to a supply of insulin while many people depend on a supply of anti-retroviral medication.
It would be nice if more people could manage without any health services. However, for many of people, in the absence of miracle cures the alternative to reliance on particular interventions is understandably unappealing.
The Green Party argue (HE300) that “complementary and alternative medicine” should be one of the interventions that is
available without charge at the time of need.
If these ‘complementary’ interventions have good evidence of safety and efficacy – great. For example, there is a good argument for making it easier for people to speak to dietitians on the NHS to discuss nutritional inventions for a number of conditions. However, if interventions lack evidence of efficacy – or have been shown to be ineffective or harmful – this is not an appropriate use of public funds. I would also wonder how (given that the Greens hold that the NHS should be freed from market forces – HE104) they would deal with the demand for ‘complementary’ interventions such as massage.
We are told (HE308) that
The Green Party will set up within legislation the practice of patient empowerment, with the right of individuals who are to receive treatment to have full and detailed knowledge as to their condition and the range of treatments available, both conventional and complementary/alternative
There is a lot that is positive about this promise. However, the devil is in the detail. One important question is – when patients are given full information re ‘complementary’ treatments, will this include an accurate assessment of efficacy, risks etc? If a ‘complementary’ therapy carries non-trivial risks, and has been shown to be ineffective, will patients be told outright that it won’t work and could hurt them? I would also be concerned that – given that there is a dazzling array of dubious interventions for conditions such as autism – this approach could lead to patients being swamped with unhelpful information.
HE308 goes on to state that
Patient empowerment would eventually encompass choice of treatment backed by NHS funding for patients’ preferred treatment whether it be within the conventional framework of treating an illness and/or utilising alternative therapies.
Again, the key issue here is whether or not a treatment has been shown to be safe and effective. Patient choice is important, but these choices can literally be a matter of life and death.
I fully support the right of patients to make really bad health decisions – for example, to turn to outright quackery as an alternative to lifesaving medical treatments – but I think it is very sad when they do so. I do not think that the Government should be encouraging such bad decisions, or that we should all be funding them through our taxes.
Worryingly, the Green Party have stated elsewhere that they
oppose attempts to regulate complementary medicine, except by licensing and review boards made up of representatives of their respective alternative health care fields.
Inadequately regulated medical interventions are highly disempowering for patients – whether these interventions are drugs which were licensed based on flawed research or ‘complementary’ therapies.
The Green Party promises (HE312) to
encourage the development of a wider and more relevant range of research techniques, including methods appropriate to the assessment of complementary therapies.
This is an odd claim – approaches such as the randomised controlled trial (RCT) are appropriate for assessing a wide variety of medical interventions. They often show that ‘complementary’ approaches don’t work – but this no more indicates a problem with the RCT than an undesirable reading from my bathroom scales shows that I need to find a complementary way to assess my weight. While those working in ‘complementary’ health – including Patrick Holford – often criticise the use of RCTs, their arguments are rather unconvincing.
I was rather surprised by the Green Party’s focus on mercury fillings (HE331):
All mercury amalgam fillings are subject to constant erosion and the mercury released can accumulate in the body, potentially causing or aggravating a wide range of serious illnesses.
The Green Party would therefore ban immediately the use of mercury in dental materials. In addition:
1.Patients should be given enough information about their treatment to enable them to give informed consent.
2.A range of non-mercury filling materials should be available to all patients, which should be biocompatibility tested for each individual.
3.Investment should be provided to train and equip all dentists to use alternative filling materials successfully.
4.Investment should be provided to continually improve safety and effectiveness of alternative dental materials and procedures.
5.Dental restorations and appliances containing mercury, nickel and Bisphenol-A should be banned immediately for children
under eighteen. Because minors have no right of self-determination, our society should take responsibility for applying the precautionary principle on their behalf.
We have no particular brief to defend mercury fillings. They may carry some risks. However, the amount of mercury released by the fillings seems too small to cause significant problems. Given that they are extremely widely used, and adverse affects are rare enough that large studies tend to fail to detect them, we are not likely to be talking about anything drastic. I struggle to see why so much attention – and detail – is given to this issue in the manifesto.
We would have more sympathy for this if the Manifesto addressed other significant issues in dentistry: for example, the serious shortage in NHS dentists – (which will not be helped if they are forced to spend a lot more time on processes such as biocompatibility testing – is addressed (HE329) in massively less deal than mercury filling. We would also have expected to see the Greens give some consideration to the costs of all these measures.
Especially worrying, though, is what the Green Party fails to discuss. For example, ‘disability’ is mentioned only three times in the context of health, very briefly*. While I would be sympathetic of attempts to over-medicalise disabilities, there is no getting away from the fact that the NHS does play a significant role in providing medical treatments for various impairments.
The Manifesto argues (DY301) that
The medical model will not be invoked with reference to ‘disability’ but will be utilised only in the assessment of impairments as part of the process of meeting an individual’s desired (or, in restricted cases, perceived) need to receive support etc. and for the purposes of defining the ‘disabling’ factors in society that are to be reconstructed.
I would sympathise with many aspects of this approach. However, it is important to acknowledge that the NHS has been – and will almost certainly continue to be – playing a major role in helping people to deal with various impairments: providing everything from artificial limbs to pain relief. These issues do need to be considered in the context of health provisions. It is disappointing that these important issues gets so little coverage, compared to much more minor concerns such as mercury fillings.
In a way, this manifesto is thus an excellent demonstration of the dangers of ‘alternative’ medicine. The Green Party apparently wants to waste some money on this, and wants to give patients support in making some bad decisions. More significant, though, is the opportunity cost of all this. The Green Party has some excellent policies but – by obsessing over issues such as mercury fillings and ‘alternative’ research modalities – they are left with a health policy with gaping holes.
This focus on ‘complementary’ health and an end to ‘dependence’ is actually rather out-of-place in what tends to be viewed as a left-wing party. As Ben Goldacre argues, ‘complementary’ health can turn into
a manifesto of rightwing individualism – you are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 78. You deserve it. Not like them.
A sustainable society should support the health of all its members: including those who have been disadvantaged by socio-economic factors, or who have simply made bad decisions. This will often involve enabling people to manage their own health better – but it will also include providing people with the services and drugs that they rely on, and with the support that is needed in order to make good decisions. Anything else would not be worth calling sustainable.
* One of these references (H303) is to “learning disabilities”. There is currently debate as to whether this term is appropriate. For example, the advocacy group People First argue that
we believe that people labelled as having a learning difficulty are disabled by society. We choose to use the term ‘learning difficulty’ instead of ‘learning disability’ to get across the idea that our learning support needs change over time.