This week Dr Mac Armstrong, former chief medical officer for Scotland, resigned from the British Medical Association in protest at the forthcoming junior doctors' strike, for which no emergency cover will be available. The good doctor's ethical concerns do him credit. Nevertheless, evidence suggests that he may be misguided in his concern.
Curiously enough, it has been shown that patient mortality typically falls during doctors' strikes, a finding replicating on a number of occasions across different nations. Cunningham et al's meta-analysis is the most notable recent review of this peculiar fact. In one of the most entertaining studies in the literature, the researchers interviewed the directors of major Israeli burial societies, who seemed slightly disgruntled at the loss of business associated with a major doctors' strike in 2000.
One, bemused, reported a 39% drop in funerals as compared to the same month in 1999. Another, much more confidently, was sure that his loss of custom was due to the striking doctors, because he had been in business long enough to see the exact same phenomenon occur in 1983, the last time Israeli doctors had walked out.
I think this counterintuitive data raises broader questions about the effects of too much healthcare on the modern constitution, questions which neither the majority of the medical profession nor broader society seem especially willing to engage with. So while perhaps we should not castigate our doctors for striking, perhaps we should take the time to rethink their role in our society – time that, thanks to the strike, we will probably all have more of.
A partial explanation for the fall in death rates during doctors' strikes is that elective surgeries are postponed. Then again, does this not beg the question of how many of these surgeries were really necessary anyway? At the advanced age of 83, great-aunt Agatha's mobility may not be what it was, but does she really need that knee replacement? How often are the risks of surgery greater than the benefits, particularly as old and frail individuals approach the end of their lives?
Surgeries are, of course, just one of many factors in what I believe is a widespread epidemic of overdiagnosis and overtreatment across the developed world. Antibiotic overprescription and misuse are, in the current year, so well-known as to merit no more than a passing mention. Despite noble resistance from GPs, it now seems clear that far too many middle-aged and elderly people have been prescribed statins, supposedly to deal with high cholesterol, with no benefit for the vast majority.
Surgeries are, of course, just one of many factors in what I believe is a widespread epidemic of overdiagnosis and overtreatment across the developed world.
Population screening programmes are even more of a black hole of pointless medical activity and wasted money, particularly so when diagnosis of the disease in question is not straightforward. A report from the Royal College of GPs, one of few medical bodies to really grasp the nettle on this issue, outlines the problems.
In recent years useless screening programmes have been implemented for dementia, type II diabetes, and general health, despite robust evidence spanning many decades of research that such programmes do not work. Apart from the wasted money, the physical and psychological costs to the individual of screening are often not trivial, particularly when a false positive leads to unnecessary medical intervention, as is inevitable in some varying percentage of cases.
In other nations, the issue is probably even worse. I suspect that the NHS's commitment to rationing is probably the best thing about it, since centrally-imposed hard cash limitations may prevent overconsumption of healthcare by the worried well. Perhaps this is why the UK has not, to the best of my knowledge, experienced the American epidemic of prescription drug abuse, largely opioids and benzodiazepines.
Addiction to prescribed opioids can easily turn into heroin addiction when hospitals cut off the supply of opioids, and the addicts have to turn to illegal substances to get their fix. The scale of the problem is staggering; the Center for Disease Control reports a 137% rise in drug overdose deaths since the year 2000, and a 200% rise in opioid poisonings.
More broadly, it seems as though the general health issues caused or exacerbated by modern urban living – anxiety, depression, obesity – are not easily remedied by the traditional biomedical model. Given the increasing mismatch between our evolutionary past and our present way of living, we should not expect anything different.
Perhaps for answers we should look elsewhere – at the Amish, a population who get plenty of exercise, and possess a strong sense of community and a shared faith. Despite their rejection of modern medicine – and technology in general – their lifespans are longer than those of the mainstream American population, and their health quality apparently better.
This could be a coincidence; perhaps the Amish founder population just had extremely good genes. Then again, perhaps that's not the whole story. The theory and evidence we have certainly suggests that we would all benefit from taking a road less travelled, away from the excesses of modern medicine, and incorporating more features of an older, traditional lifestyle into our own.
Andrew Sabisky is an independent research worker and writer. Follow him on Twitter @AndrewSabisky