tag:blogger.com,1999:blog-9181810725696409953.post4601498312118922203..comments2024-03-17T04:20:11.083-04:00Comments on The Population Health Blog: Outcomes? You Say You Want Outcomes?Jaan Sidorovhttp://www.blogger.com/profile/05072456803925863874noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-9181810725696409953.post-11764087233209163492010-07-29T19:12:55.214-04:002010-07-29T19:12:55.214-04:00@bradleydean
There are two distinctions that I dr...@bradleydean<br /><br />There are two distinctions that I draw when considering physician/medical advocacy for/against interventions that have health effects.<br /><br />The first is between purely medical and purely non-medical interventions, judged by the how/where/who of the intervention. There will obviously be grey areas, but let's set that aside for now. A purely medical intervention would be something like the often-cited central line infection prevention checklist, or A1C targets for disease management in diabetic patients. A purely non-medical intervention would be something like a soda tax or a Medicaid expansion. They obviously will have effects on health, but are not medical interventions per se.<br /><br />The second distinction is between positive and normative advocacy. Positive advocacy illuminates aspects of a problem or a solution without endorsing a particular solution. Informing the public about the health effects and the public health / social determinants of obesity is positive advocacy. Publicizing the health effects of a soda tax, while arguably an area of research for economics researchers as opposed to physician-researchers, would be positive advocacy. Going from there to saying that a soda tax *should* be implemented is a leap into the normative realm.<br /><br />What I'm wary of is normative advocacy for non-medical interventions that comes from medical organizations and physician leaders. By definition, these non-medical interventions occur via mechanisms and have side effects that are outside the typical purview, training, and expertise of the medical profession as a whole. Medical leadership should certainly play a role in the discussion by highlighting the health effects of these interventions, but crossing the line into normative advocacy is at best likely to be ill-informed at best, and irresponsible at worst.<br /><br />I hope that clears up where I'm coming from on this issue.The Notwithstanding Bloghttp://notwithstandingblog.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-31031538880354319192010-07-28T13:49:34.657-04:002010-07-28T13:49:34.657-04:00Dear Jaan & Notwithstanding:
You make your po...Dear Jaan & Notwithstanding: <br />You make your point, but not your case. What is wrong with, say, physicians advocating for a soda tax? Does personal freedom usurp all other consideration? Ahhh, then you must be strong advocates for abortion rights? But, back to soda and docs - a tax does not outlaw soda, but uses 'societal influence,' via the tax code, to express its mild disapproval. Its vehement disapproval would be expressed through an outright ban. Additionally, the revenues generated could be used to offset the public cost (i.e., Medicare, Medicaid, S-CHIP, ACA, cost-shifting, etc.) of the health consequence of soda in one's daily diet. Should not all health-conscious and public-treasury-conscious citizens be supportive of such a public policy, physicians notwithstanding? Of course, as fee-for-service servants, physicians could hide behind their medical hat and fattened bank accounts and say, as Jaan and Notwithstanding recommend, public health advocacy is "Not my yob, man."Bradley Dean Stephanhttps://www.blogger.com/profile/10735141320100233658noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-39709921118656862972010-07-28T10:39:37.858-04:002010-07-28T10:39:37.858-04:00Notwithstanding is not incoherent and, in my view,...Notwithstanding is not incoherent and, in my view, is quite correct in describing the limits of the medical profession's involvement in the third leg of health. The soda tax is a good example. Being reasonable and balanced makes a lot of sense.Jaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-38222609625650167572010-07-28T08:18:30.200-04:002010-07-28T08:18:30.200-04:00My thanks to DMCB for highlighting this excellent ...My thanks to DMCB for highlighting this excellent commentary. It makes me think the Hippocratic Oath (once again) needs updating: "I will do no harm and will advocate for societal policies that promote the health and wellbeing of my patients, even if they are adverse to my own personal gain."Bradley Dean Stephanhttps://www.blogger.com/profile/10735141320100233658noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-51153214944156294912010-07-27T22:56:10.518-04:002010-07-27T22:56:10.518-04:00Some mildly incoherent thoughts:
I agree that the...Some mildly incoherent thoughts:<br /><br />I agree that the medical profession needs to recognize the "social determinants of health" model, and understand how exactly these determinants affect health directly and in interaction with public health / medical interventions.<br /><br />That said, I think it's worth asking whether influencing these factors, especially through the public policy framework, is an appropriate goal for the medical profession.<br /><br />It's perfectly logical to acknowledge that, for instance, obesity and poverty go hand in hand in part because of the lack of access to affordable healthful foods in some poorer neighbourhoods. It's fine to suggest that improving access to healthful foods in these areas would improve residents' health, and that vegetable subsidies or calorie taxes might achieve these results.<br /><br />In my view, this is where medicine's role should end. Public policy should be driven by more than just health considerations. There are real tradeoffs between the health improvements that would arise from a soda tax, and the economic effects and even (dare I say) the "liberty" costs (to pick one example). This isn't to take a position on the policy, but simply to say that medical leaders should be cautious in doing so. That a policy will improve a certain population's health does not always make it the right one from a social point of view. <br /><br />I think that approaching medicine from this viewpoint risks overmedicalizing some of these social problems. Perhaps they're best thought of as social problems with medical side effects, rather than as medical problems that require the intervention of physicians or physician-leaders.<br /><br />Put another way, is there not a degree to which medicine should treat these social problems -- and social choices -- as exogenous constraints on health, as opposed to objects for medical influence and policy manipulation?Anonymousnoreply@blogger.com