Mind your mindfulness
Simon Wessley, Academic Psychiatrist at Kings College London, is a self-confessed member of the Boring Boffin club who prefers evidence to ideology. Yes, he says, there has been in increase in the true prevalence of mental disorders in students, but it’s not as large as many media reports suggest, and it’s not clear what the reason is.
Likewise, there seems to be a mental health crisis in every single occupation –this has been said of the entire NHS workforce, police, farmers, teachers, dentists, lawyers, students, accountants and so on. Yet population studies that include all of the above, not to mention the government’s own measures of happiness, provide a different picture.
Professor Wessley doubts that the “so-called epidemic of mental health problems” will be solved by an epidemic of counselling. There is a real risk of intervening when we do not yet have a diagnosis, or a cause, for what has gone wrong. The history of mental health interventions, well-intentioned but not based on robust evidence, suggests it is sometimes easier to make things worse than better.
Pay attention at the back!
Just before the 2019 General Election the Editor of the Health Services Journal mused about how Labour might run the NHS, should it win. It’s all a bit academic now, given that Labour’s influence over developments in the NHS will be minimal for some time to come, but the HSJ question is still relevant because it highlights how “NHS campaigners, both inside and outside the party… exercise significant influence on [Labour’s] leadership”.
The campaigners’ contributions include conspiracy theories, catastrophism and over-estimation of risks to the founding principles of the NHS – leftist baggage that crowds out rational policy making. Asking Labour activists how their party would ensure that investment in primary care did not get diverted to rescuing the hospital sector elicits little beyond ‘more funding needed’.
Labour has taken for granted its ownership of the NHS as a politically ideal institution, just as it took for granted its hegemony in Scotland and the ‘Red Wall’. The good news is that Labour will have plenty of time to catch up on health service policy – about 10 years, quite possibly.
Rise of the robots
Robotic surgery – famously the da Vinci technology – has been growing in importance since 2000, first in the USA and more recently in the NHS. A recent US study found that robotic surgery was spreading fast, and replacing minimally-invasive ‘keyhole’ (laparoscopic) surgery.
The Healthline Bulletin gives us insight into the march of the surgical robots. The technology looks more like a video game than a robot. A surgeon sits behind a screen and looks at a magnified view of the surgical site while operating the machine’s robotic arms.
The robotic arms can get into hard-to-reach places, causing less bleeding, allowing faster recovery, reducing the risk of damage to important nerves, and leaving smaller scars than traditional surgical methods.
A single robot costs about $2 million. Some of the attachments that go on the arms are disposable. And robotic surgery generally costs anywhere from $3,000 to $6,000 more than traditional laparoscopic surgery
Fifteen years into use of the da Vinci system, evidence that it trumps other methods is lacking. To justify its price — roughly 10 times that of a traditional laparoscopic operation — da Vinci would need to perform a lot better. Some critics called da Vinci a “solution in search of a problem.”
Nonetheless, da Vinci is used widely in the USA for urological surgery, because it allows minimally invasive prostatectomies to be done, which has not been possible until now. Nearly 90 percent of these procedures are now done robotically.
Patients who undergo robotic prostatectomies lose less blood, but for other outcomes – like how likely they are to be impotent or incontinent after surgery — the robot is no better than open surgery. The only disparity involves recovery. The men who received the robotic-assisted surgery spent less time in hospital.
The manufacturer has undertaken direct-to-consumer marketing for its robots. As a result, American patients often demand robotic-assisted surgery. In the USA hospitals advertise their da Vinci machines as a way of attracting more patients through their doors.
Despite the doubts, NHS Shared Business Services is commissioning robotic surgery machines, training programmes and service management from a small field of producers.
One interpretation of Brexit is that it is a mechanism for Britain to become socially and economically closer to the USA. This might have health consequences. A growing number of middle-aged white Americans, especially those without college degrees, are dying from suicide, drug misuse and alcohol.
According to The Economist this is happening in the US but not in other rich countries, because predatory American capitalism has eroded social capital so much it has triggered a mortality crisis.
Social indicators of well-being, like trade union membership, church attendance, cross-party collaboration and marriage rates, tend to decline in localities harmed by trade and technology changes. Weakened communities have fallen into a cycle of social and economic depression, and are vulnerable to addiction and suicide. We have been warned.
Source: Mourning in America The Economist, January 11th 2020, page 68
Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/