Biomedical blind acceptance

The dominant biomedical (Western) model of healthcare suggests that health problems are the result of failures of biology, hygiene or behaviour. Implicit or explicit is that these health problems require delivery of biomedical treatments – pharmaceuticals, and that delivery is mainly by physicians or other healthcare providers.

This model has been the primary reason why the richer a country, the more money it tends to spend on both health professionals and pharmaceuticals.

But very few studies that have attempted to link specific aspects of the biomedical model – that has enjoyed spectacular growth during the post-WWII period – with population health.

That’s why a study just published in the Journal of Health and Social Behavior by two health sociologists, Hui Zheng from Ohio State University and Linda George from Duke University in North Carolina, is of such interest.

New study – using OECD data

The study’s main focus has been to evaluate underlying mechanisms for a widely accepted theory, epidemiologic transition theory, based on the work of Omran in 1971, that upholds that human development transitions through 3 stages of development. The first stage is the age of pestilence and infectious disease that characterised most of human history, then to receding pandemics in the middle of the 1800s in the developed world, through to advancing age of degenerative and human-created disease (especially cardiovascular disease) in the early 1900s.

In 1986, Olshanky & Ault modified the theory, adding a fourth stage, which is representative of the most technologically advanced and richest societies. This stage is reflected when mortality rates from degenerative diseases, notably heart disease, stroke and cancer, undergo major and unexpected declines.

There is broad acceptance in different societies – and certainly in politics – that this fourth stage of epidemiological transition has been associated with the development of Western medicine and pharmaceutical drugs - the two generally being viewed as intimately associated.

However, in the absence of proof of this mechanism, a number of other theories have persisted, including the conflicting theory of McKeown and colleagues from the mid-‘70s which argues that broad socioeconomic conditions, most notably diet and nutrition, are the root causes of improved population health throughout history, not medical progress.

The Ohio University study looks at three key components of the biomedical model. These are: 1) investment in medical infrastructure, 2) the size and specialisation of the medical workforce, and 3) the size of the pharmaceutical industry. All of the data used in the analysis are derived from a 26 year period (1981-2007) and are sourced from the Organisation for Economic and Co-operation and Development (OECD)).

Study take-homes

Based on these OECD data, the main take-homes from the study are:

• The first two of these factors, in other words healthcare expenditure by a country, and the size and degree of specialisation of the medical workforce, were unsurprisingly found to be positively correlated with health outcomes
• More surprising was that the third component, the size of the pharmaceutical industry, did not correlate consistently with improved health outcomes. In fact, the the scale of the pharmaceutical industry had a particularly negative impact on health outcomes in older women (over the age of 65)
• And finally, the more the pharmaceutical industry expands in a given country, the more it appears to negatively impact the beneficial effect of medical professionalisation and specialisation. Pharmaceuticals therefore appear to compromise the effects of doctors and specialists, rather than facilitating better outcomes.

So what?

In essence these findings drive a coach and horses through conventional wisdom that suggests that it is the combined effect of more drugs and more doctors and specialists, that delivers better health outcomes. That's why as countries get richer, they spend more money on healthcare providers as well as spending more money on drugs. But it is the drugs themselves - generally posited as the key part of most doctors' intervention – that are the 'fly in the ointment'.

The findings shine more light on McKeown's theory from the mid-1970s that it's not medical progress, but more money in the hands of consumers that causes them to consume better diets and have healthier lifestyles, that are the main drivers of better health outcomes.

This study is incredibly timely, as it entirely supports some of the underlying premises in our own position paper on health system sustainability in the UK that’s going out for consultation along with an invitation to endorse the final version during the week beginning 9 April.

If you live in the UK or you’re interested in being involved in the consultation, or might be interested in endorsing the document to give it more political weight, please email the ANH team at [email protected] and include ‘SHS consultation’ in the subject line.

Let us know your organisation or your registration body. We’ll make sure you receive by email during the week commencing 9 April the draft position paper, along with a short guideline document.