Blaming the victim: Antibiotic edition

Having failed to hold back the tides, King Camerute is now taking on the worthy task of stemming the flood of antibiotic resistant microbes, according to a report on the front page of today’s Times. On the inside pages we have an opinion piece by one Theodore Dalrymple, under the title

Patients, not GPs, are to blame for the antibiotics crisis

Since GPs are responsible for prescribing most of the antibiotics in this country, I was curious how they were not to blame. I assumed the story would take one of two tacks (or both):

  1. Patients are obtaining prescriptions under false pretences, perhaps by exaggerating or misrepresenting their symptoms.
  2. Patients are somehow acquiring antibiotics without prescriptions.

Neither of these is mentioned. In fact, despite the headline — which Dr Dalrymple is presumably not responsible for — the article states clearly “The real problem we face is the over-prescription of antibiotics in ordinary medical practice.” Patients are never mentioned in the article until the last paragraph, which states, in full

And, hard though it ma be for some to accept, it would help if patients took their GPs’ advice rather than demanding the drugs they want. Doctor really does know best.

Well, that’s it then. The responsibility does not lie with the GP who actively wrote a prescription. It lies with the stupid but strangely powerful patient who “demanded” it. And it gets worse. We live, it seems, in a “litigious age and doctors are afraid”.

There is, after all, more rejoicing by malpractice lawyers over one missed diagnosis than over 99 people treated unnecessarily with antibiotics.

Presumably the author thinks they should rejoice more over all the people treated unnecessarily with antibiotics? I’m confused. In any case, they’re bad people, so anything that makes them happy is bad for the rest of us.

I’m no expert in British law, but why would a treatment with unnecessary antibiotics prevent a lawsuit? How many doctors have actually been sued, under circumstances where a random antibiotic prescription might have forestalled the lawsuit? Dr Dalrymple doesn’t even have a silly anecdote to offer.

Or could it be that overworked GPs find prescribing antibiotics to be a convenient substitute for actually talking to the patients? Dr Dalrymple, we learn at the bottom, is a “retired prison doctor” which, I think, helps to explain where he acquired his exquisite contempt for patients.

Lazy headline clichés: Obesity edition

Am I the only one who is briefly bemused when a Guardian homepage headline refers to obesity “leaping” in the developing world, or when the headline on the article tells us

Obesity soars to ‘alarming’ levels in developing countries

I understand the need for colourful imagery in headlines, but it shouldn’t clash. Thinking about obesity leaping and soaring makes my head hurt. We might imagine a headline about a “Healthy increase in measles cases”, or “New NHS rules allow GPs to make a killing”.

The striving after punchy language sometimes makes for weird effects when combined with the English language’s exceptional parts-of-speech ambiguity, as in this BBC headline from the time of the BP oil leak in the Gulf of Mexico:

BP caps shattered oil leak wellhead

At first I thought BP had put some caps on, which proved counterproductive because they shattered the wellhead. I forgot that headline writers like to put everything in the present tense (sounds more exciting that way, I guess), so what I thought was a noun (caps) was actually the verb, describing a success, and what looked like a past-tense verb describing the failed effort was actually a participle, referring to the state of affairs that started the whole story.

The cost of anti-terror

By way of Brendan James at The Dish comes this report by Ben Richmond on the disruption of vaccination efforts in rural Pakistan caused by the CIA smuggling a spy into Osama bin Laden’s refuge disguised as a health worker distributing hepatitis B vaccines. I won’t question the justice of killing bin Laden, nor will I call it useless because bin Laden may have been, by that point, barely even a figurehead of al Qaeda. I appreciate the value of propaganda by force in the important struggle against violent Islamists.

But when we reckon the costs against the benefits of killing terrorists, let us consider the 22 vaccination workers killed and 14 injured in retaliation attacks, or the many thousands who will be killed or maimed by polio, now that the realistic hope of soon eradicating that horrible disease has been set back, perhaps for a very long time. One wonders iƒ the cost to public health had any place in President Obama’s decision-making in approving this particular CIA operation. Is there anyone who speaks up for non-American interests? Is there any number of  lives of the poor bystanders for whose sake a US president would judge it worth giving up a symbolic victory in the struggle to save American (and wealthy western more generally) lives? Other than because of threats of diplomatic or military retaliation against Americans.

I’d be genuinely interested if any political theorist has thought through how this calculus works.

Total Impact: Wakefield edition

So it seems Andrew Wakefield is back in the news. As Phil Plait has described well, the man who has done more to undermine public health than any physician since Martini and Rodenwaldt has been given space in The Independent to accuse the British government of inadequate measles prevention. Because his rantings scared lots of parents off the MMR vaccine, and the NHS didn’t want to provide separate measles vaccines instead.

The pathological self-promoters you will have with you always, so there’s no real surprise there. But it got me to thinking about his future in British medical research. Because some denizens of less enlightened lands may not know how IMPACTFUL British research has become: The prime directive for state-sponsored research under the current government (though I think it started already under Labour) is “impact”, defined as

an effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia

because academia is just a province of Faerie, not an actual part of the society or economy. In addition to impact being a crucial part of every grant proposal, and the postmortem on every grant after it’s completed, this definition will guide 20% of the scoring on the Research Excellence Framework (REF) just now getting underway, replacing the Research Assessment Exercise (RAE) last conducted six years ago, because now instead of research being assessed, we agree that it’s all excellent but needs to be frameworked, or something.

So anyway, it’s noteworthy that BENEFIT is only one acceptable form of impact. Any change or effect gets you points for impact, rather in the way the bibliometric citation counting that prevails in many academic fields doesn’t distinguish between citations for your paper providing key insights that inspired follow-on research, and citations that point out yet another bone-headed mistake in the paper that has been confusing researchers and holding back the progress of the field.

What’s more, it’s not clear how anyone would evaluate whether those who benefit from the research are themselves providing a net benefit or harm to society. (Sorry, I mean, to the taxpayer. There’s no such thing as society.) Presumably no one will provide a support letter from bioterrorists, explaining how their headline-generating work would have been impossible without the groundbreaking research of Professor X, but someone like David Li could show evidence that his work formed the industry-wide basis for the multi-billion pound market in mortgage backed securities which (you may have heard) helped to crash the world economy. The fact that he might himself agree that his formula never should have been applied, that the bankers “misinterpreted and misused it“, and that “Very few people understand the essence of the model“, doesn’t detract from the benefit that derived to some people, at least in the short term, and even the worst recession in 75 years certainly counts as a “change in the economy”, demonstrating the IMPACT of the research.

With that in mind, I reveal the hitherto secret Wakefield Impact Case Study, titled “Royal Free Hospital School of Medicine characterisation of risk factors for Autism and Vaccination Policy”. We are confident that the massively impactful Wakefield will quickly be hired by a major research institution and showered with research grants. Continue reading “Total Impact: Wakefield edition”