Understanding the Health Bill

Catching some of Sir Paul Nurse’s programme on climate change scepticism, and the wider issue of communicating scientific knowledge and research to the public, I started thinking about the issues raised by this week’s publication of the Government’s Health and Social Care Bill. Sir Paul, speaking to individuals opposing the “consensus” view on climate change, HIV / AIDS, and GM foods, began to think about the responsibility falling upon the scientific community to better communicate its ideas, research papers, and the complexity of scientific knowledge and discovery. By considering scientific coverage in blogs, newspapers, and public opinion, Sir Paul seemed to suggest that the need for a simple narrative ran counter to the considered, hypothetical and provisional conclusions drawn in scientific papers.

Of course mentioned, but never really examined by the programme, was the Andrew Wakefield case, which has received so much coverage in the BMJ this week. The Times journalist Brian Deer has been exposing the ethical and scientific concerns at the heart of Wakefield’s research paper, published in The Lancet in 1998. Wakefield’s case is perhaps analogous to Sir Paul’s argument; that a robust piece of scientific research is no match for a strong narrative (or scare story) in the public opinion.

So how does this bring us onto the Health Bill? In its proposals to abolish Primary Care Trusts (PCTs) and Strategic Health Authorities, the legislation would introduce consortia of GPs as the commissioning bodies for the £80bn NHS budget. This means that family doctors will be tasked with making the decisions on which treatments are financially viable for their patients, rather than this being based on a judgement by the advisors at NICE (who recommend maximum-price treatments, based on the number of quality adjusted life years they would provide) and the accountants at the PCTs. Resource allocation will become much more personal; if a GP has to decide whether or not to provide expensive medication to a long-standing and well-liked patient, the dilemma will be that much more complex than for a PCT bureaucrat (this is not to condone or condemn either approach). Similarly, if a patient is denied treatment due to cost issues, they will know that the decision has been made by their GP, with all sorts of potential issues for doctor-patient relationships (as pointed out by the Royal College of GPs).

These are real, complex issues; could it be that it is about better communication between doctors, or politicians, and patients, or the public, to see the necessity of certain treatments being denied? Can a seriously ill patient relinquish the hope of treatment due to resource issues? And will this be any easier to stomach when decision-making is being conducted in your local surgery? Sir Paul seemed confident about the potential of science to overcome these pitfalls. It will be interesting to see how the changes to healthcare are communicated to – and understood by – the public.

The Neurological Turn at The Future of Medical History Conference

The Future of Medical History Conference, Mary Ward House, Bloomsbury, Hosted by The Wellcome Trust Centre for the History of Medicine at UCL, 15th – 17th July 2010

The Neurological Turn, Friday 16th July.

Last summer I attended this conference with a particular interest in the panel entitled The Neurological Turn which was to be held on Friday 16th July and chaired by Prof. Sonu Shamdasani (The Wellcome Trust Centre for the History of Medicine at UCL). As my research focuses on neurology, psychological medicine and modernist literature I was hoping for some illuminating remarks, and was not disappointed. I attended along with a neuroscientist friend who also found much of use in the panel, which also featured Prof. Roger Cooter, Dr. Stephen Jacyna, Dr. Fabio de Sio  and Sarah Marks who are also all based at The Wellcome Trust Centre for the History of Medicine at UCL.

The conference in general was a well attended, engaging and sociable affair, with drinks and food consisting of a barbeque in a nearby Bloomsbury square. This is a time in which The Future of the History of Medicine is something that really is in question, so it was heartening and inspiring for someone beginning a PhD in this area to see so many academics gathered to consider and discuss the topic.

The Neurological Turn panel focused on some of the sites of neural production and consumption, past and present and was devoted to exploring and discussing some of the pretensions and problems involved, as well as possible methods and directions.

The panel explored how in contemporary society a tendency has emerged to answer all questions of identity in terms of neurology, just as one hundred years ago there was a similar turn towards psychology.

The concern highlighted here was that if the neurological turn becomes the overwhelming focus behind our identities, could this mean that other types of subjectivity are overlooked? This is a repeated worry mentioned when brain scans and descriptions of neural processes are called upon to explain aspects of our subjectivity, and is called up as dangerously reductive by a number of contemporary writers such as Jonah Lehrer. The question the panel asked is that if the neurological turn has become so dominant, how is it possible to denaturalise it? This is perhaps something more easily considered when we compare it to the ‘psychological turn’ which they placed as happening roughly one hundred years ago and ask ourselves how easy it is to consider ourselves now without considering psychology?

There were some further contentious discussions on topics such as the relationship between politics and aesthetics, and whether or not the ‘neurological turn’ is or is not a limited perspective. The highly problematic question was also addressed – but by no means answered – concerning whether there had been a neurological turn in the humanities due to ‘discipline envy’, and whether humanities scholars are losing faith in their own methodologies and so turning to neurology and other sciences as a prop.

However, these contentious issues aside, the most exciting part of the discussion for me was to think about how and if the neurosciences may be opening up new stories and identities to us today in a similar way to what the emergence of psychology did for subjectivity around the turn of the last century.

Workshop on Health and Disease: report now online

On the 10th of September, the Centre for the Humanities and Health (CHH) at King’s College London hosted a one-day workshop entitled “Concepts of Health and Disease”. The aims of the workshop were:

  • to generate real cross-disciplinary interchange between medical scientists/professionals and philosophers; and
  • to increase understanding of the key issues in discussions on health and disease in medicine and philosophy; and
  • to achieve real advances in and integration of our understanding of health and disease from both medical and philosophical perspectives.

The workshop was a great success; it was attended by 30 people from 9 different countries, with backgrounds ranging from Oncology, Epidemiology and Psychiatry to English Literature, Ethics and Political Philosophy. Nearly all participants took an active role in the group discussions and the workshop was praised by many as having successfully provided a rare platform for true cross-disciplinary engagement.

A Draft report on the workshop is now online. For an impression by one of the participants, see Prospect Magazine blog.