BBC Radio 4 recently broadcast interviews with eminent physicians about ‘slow medicine’. I have heard of ‘slow fashion’, which is a movement that wants people to think in terms of designing and buying clothing for “quality and longevity.” However, I had never heard the term ‘slow’ applied to medicine.
Excessive medical testing
In one programme, Dr. Margaret McCartney, a Glasgow GP, investigated the controversy over what some see as medicine’s currently excessive testing “for traces of disease in people who would otherwise never know about them, or suffer any ill effects,” as she described it.
This reminded me of an octogenarian I met recently called Ernie. He was a former Spitfire pilot and then a successful property developer. Ernie plays golf nearly every day and is as sprightly as many in their 50s. He feels great, but an MRI scan revealed he has an aneurysm. Ernie was quite annoyed that this had been discovered because he feels fine and would have preferred not to know it was there and let nature take its course. He’s still playing golf by the way. Ernie’s story is probably at an extreme end of the spectrum, but I could readily appreciate that not knowing may have advantages over being told every little detail.
Dr McCartney explained that concern is growing, not just in the UK, but worldwide, about the growing number of screening tests and use of diagnostic tools that are finding signs of disease in people who otherwise feel perfectly healthy and show no outward symptoms. Cancer is one area of particular concern, although one imagines that in the case of cancer, people prefer to find out sooner rather than later. However, it is not always beneficial, as this example from South Korea demonstrates.
When diagnostics outperform treatment
The doctor presented an interesting case from South Korea where a mass screening programme for thyroid cancer detected 15 times more cases than had been discovered prior to the project. This sounds like a good public health initiative. Yet, and here’s the rub; there has been no reduction in death rates from the disease as a result. It sounds like a case of diagnostic tools outperforming available treatment. In which case, if you were one of the people diagnosed with thyroid cancer, you’d wonder what was the point of making you aware of it, if they can’t treat it. Furthermore, perhaps you felt on top form until they told you that they had found traces of the cancer.
Slow medicine focuses on wellness
Dr Catherine Calderwood, Chief Medical Officer for Scotland, is another advocate of Slow Medicine, which she believes could keep people in the ‘Kingdom of the Well’ for much longer. As she said on another Radio 4 interview on the topic, “the fundamental problem is that the harder doctors look for disease in people who are apparently well, the more they will find. Yet most of it will never matter to those people.”
It is an interesting conundrum for the medical world. However, the Slow Medicine movement is growing. It puts more emphasis on shared decision making between doctor and patient, and not prescribing every available test or treatment. Those who support it believe that this ‘slow’ approach will keep more people in the ‘Kingdom of the Well’, rather then prematurely consigning them to the ‘Kingdom of the Sick’. It is certainly an interesting debate in the light of an overstretched health service. Do you think ‘slow medicine’ would offer advantages? We’d love to hear your thoughts.