Medicine and politics cannot be separated. Many nations around the world are dealing with this sort of integration. The current healthcare system is not designed to create a healthier population and clearly if people were healthier, countries would not need to spend so much money on making them better.
It can be argued that drug and healthcare companies earn their money by developing new drugs to make people better, rather than stopping people from getting ill in the first place. It is not in their commercial interest to invest in care that would prevent patients from needing their product. Yet, while some people do become ill because of bacterial or genetic defect, more often, the root of illness stems from the stress of financial worry, the context of unemployment, the unhealthy life style often associated to poor education, low income and substandard work environments. Medical professionals are not trained to engage with the issues they might use to encourage their patients to avoid illness. We have to do scientific research on the question, what keeps people healthy? But this research is very rare. For this we need a new medical paradigm, a desirable, holistic approach to medicine.
When politicians decide which disease to fund and which research to endorse on the basis of misconceptions, it ceases to be a winning strategy. Political, social and religious views have no role in science-funding decisions or in the validation of scientific research. Although HEC Higher Education Commission is responsible for the decision to allocate funds to research, how that money is spent once allocated should be decided by Universities who can expertly assess the potential of a research project and anticipate its impact. The continued politicization of science will impede scientific advances that would stimulate economic, social and medical benefits in Pakistan.
If there is any tempering force in politics, it is close contact with groups different from their own. It might be that medicine needs more politics and politics more medicine. Doctors do not do nearly enough to advocate on behalf of their experience as researchers and are captives in a money-centric, regulation-ridden health system. Instead of leveraging their position to influence the economic and social factors affecting their patients, they shy away from the research process due to the dirty politics. Governments rightly request the advice of doctors on matters of fact that affect the public good, from polio to cancer screening and doctors must then assess available data and present recommendations based on the data. But what is the role of research and doctors when politicians see these recommendations as inconvenient.
Most factors influencing health are present in communities, not in hospitals. Economics strongly influences life expectancy than cholesterol, and drugs and suicide kill more every year. And yet, too often doctors remain silent.But the deeper significance of a more politically present medical profession lies not in its advocacy of issues, but in its approach to people. The broader, potentially transformative consequence could be the propagation of research and development, an ethos that would take medicine and cure into the future.
In an enlightened society, surely medicine must serve and enhance the public good, and even the best medical research will not attain this goal until its significance reaches policymakers and the public in a way that leads to improvements in health. If medicine is to offer anything over opinion polls, researchers must report unbiased observations in an objective fashion, whether or not the data are comforting, expected, or even easily understood.
Researchers cannot selectively emphasize the aspects of their work that will meet with the widest approval, as politicians sometimes do. Nonetheless, researchers particularly those invited by the government to provide expertise bear responsibility for communicating their work with sensitivity to its context and anticipated impact. This kind of attention to public interpretation of their work may not be what many researchers are trained for or desire, but without it there seems little hope that scientific evidence particularly when it conflicts with the goals of politicians will emerge beyond barriers of indifference, suspicion, or even hostility and appropriately inform policy.
But however diligently doctors work to ensure the integrity of their work and the accuracy of its public perception, they alone cannot realize the potential of medicine to improve society. For real progress to occur, those with power to implement change must act on the evidence. Politicians must not ignore nor attempt to discredit legitimate science that doesn’t happen to support their political goals; to do so erodes public trust not only in researchers but in politicians themselves. In the case of health research, politicians must remember that society encompasses not only the corporate engines of economic growth and decline, but also individuals whose lives depend on the quality of health care data.
If governments are to engage in reform that improves health, and not only the economic structures through which health care is provided, those governments must develop and support systems to judge the quality of health research independent of vested interests and political expedience. Informed citizens should expect and require their governments to continue inviting independent scientists on board, to heed their advice in navigating, and not to jettison scientific evidence when weathering a political storm.
The writer is a professor of psychiatry and consultant forensic psychiatrist in the UK. He can be contacted at [email protected]