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To fix healthcare, doctors need to take a really good look in the mirror

By Aseem Malhotra - posted Tuesday, 12 March 2024

Several weeks ago, the BMJ published research that reinforced the overwhelming evidence that the United Kingdom's National Health Service should continue to be publicly funded and publicly provided.

A nationalised health system provides better quality care at a lower cost. Conversely, a commercialised healthcare system does the opposite, as best demonstrated by the United States which has the largest healthcare expenditure of the industrialised nations with the worst health outcomes. A marketised healthcare system ensures greater vulnerability to exploitation of the rich and the poor.

The former to over investigation, unnecessary intervention, higher costs and dubious treatments, and the latter to lack of necessary care.


So, why is the NHS failing to adhere Labour MP Aneurin Bevan's founding principles of universalising the best health for all and improving the mental and physical wellbeing of the population?

Perhaps the most important factor is the system's increasing inability to ensure that the medical profession are adhering to the principles of real evidence-based medicine. This is where doctors combine their clinical knowledge, best available evidence, and (most importantly) take into consideration individual patient preferences and values in order to treat illness, manage risks, or relieve suffering.

It doesn't take a rocket scientist to understand that if doctors are making clinical decisions based on biased or commercially corrupted information, at best it will lead to sub-optimal outcomes and at worst cause harm.

With rare exception, the results of pharmaceutical industry-sponsored clinical trials exaggerate the safety and benefits of their products leading to lack of fully informed consent. This is further compounded by the fact that due to 'commercial confidentially' the raw data from clinical trials is rarely independently analysed.

Regulators such as the US FDA, the MHRA in the UK, and the TGA in Australia take a large proportion, if not most, of their money from industry introducing a potential bias into the veracity of clinical guidelines.*

Only two weeks ago, Medscape (a prominent website for medical education) reported that Britain's All Party Parliamentary Group for Pandemic Preparedness have called for an investigation into the UK's drug regulator the MHRA for being a 'serious risk to patient safety'.


The consequences of commercial influence on health policy for society are devastating. Prescribed drugs continue to be one of the leading causes of death globally after heart disease and cancer.

The Choosing Wisely campaign was instigated as a joint initiative with the BMJ in the UK by the Academy of Medical Royal Colleges in 2015. It was aimed at addressing this public health crisis of overdiagnosis and overtreatment to enhance quality of care. Their call to action aimed to enhance patients' understanding of the potential harms of medical interventions and help them accept that doing nothing can often be the best approach.

For example, patients should be encouraged to ask questions such as: Do I really need this test or procedure? What are the risks? Are there simpler safer options? (Such as lifestyle changes.) What happens if I do nothing?

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This article was first published by The Spectator.

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About the Author

Dr Aseem Malhotra is a consultant cardiologist based at at the HUM2N Clinic, London. He is a globally regarded specialist when it comes to diagnosing, preventing, and managing heart disease. His areas of expertise include evidence based medicine, collaborative shared decision-making with patients, obesity, coronary artery disease, preventive cardiology, as well as angina. Dr Malhotra graduated with a degree in medicine from the University of Edinburgh in 2001.

Creative Commons LicenseThis work is licensed under a Creative Commons License.

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