Monday, 17 November 2014

"The Right Care Alliance" – The Statement of Principles

In 2012, The Lown Institute held a conference in Cambridge (Boston) with the motto "Avoiding Avoidable Care” which generated a statement aimed at creating a professional, academic and social movement in favour of a new health system that is sustainable, effective, rational, personalized and fair. You would think, of course, that the The Lown Institute refer only to the American system, which we all know is deeply unfair and expensive. And this would be so, if it wasn’t for the fact that, in a system like the Spanish, which is infinitely fairer than theirs, when we analyze it in detail we can also note the clinical practice’s undesirable variations of a scale comparable with the American’s.

For this reason, I think it's worth having a look at the statement promoted by The Lown Institute: "Declaration of Principles of the Right Care Alliance". Look at the following extract from the explanatory memorandum of the Declaration and judge whether they are timely or not:
  • Modern medicine offers significant benefits, but at the same time also has a great ability to cause damage.
  • The overuse of services is widespread and tacitly accepted by the modern healthcare system
  • Overuse exposes patients to iatrogenic disease.
  • Overuse distracts resources that could be used in real health needs or in investments in other non-health sectors that influence the health of people as social services, education, nutrition, etc.
  • The health sector industry can distort clinical decisions to the point of betraying patients’ trust. 
Towards the end of the document, you will see that there is a section that talks specifically of the support that the "Right Care" movement as mainstream science should provide to the doctors so that they can exert more sober and less defensive medicine. Although to put it into practice, they should demand more time to develop clinical trials with less pressure and thus serve patients more effectively.

Dr. Bernard Lown

For all the above reasons, it’s time to talk about Dr. Bernard Lown, founder of the organization that promotes this movement. Dr. Lown is a cardiologist who has had an extremely active career in cardiology innovation: the defibrillator as we know it today, the cardioverter for arrhythmias, lidocaine for control of heart rhythm disorders and various underling works to prevent death and to establish the organizational basis of modern surveillance units for coronary disease.

But as if an immense medical career was not enough, the greatest notoriety came to him when, during the Cold War, with the help of Dr. Yevgeny Chazov, a citizen of the Soviet Union, created the peace movement: "International Physicians for the Prevention of Nuclear War (IPPNW)” for which the two doctors received the Nobel Peace Prize.

The current President of The Lown Institute, is the cardiologist Vikas Saini (Dr. Lown is Honorary President), had the good sense to appoint the known science journalist, Shannon Brownlee (author of Overtreated) as a Vice President of the Institution, and now both are mostly responsible for summoning a new gathering of the "Right Care", movement which is not only generating a lot of expectations in the academic world, but also in some professional sectors that have a recognized clinical activity.

Finally it seemed appropriate, if you have 5 minutes spare, to attach a video, where Vikas Saini and Shannon Brownlee explain the motivations of the movement. It’s worth hearing the arguments of "Right Care" in their own voice, from which I want to emphasize the following statement from the journalist:

"The (American) politicians have not understood the complexity of the phenomenon of overdiagnosis and overtreatment. It’s not a question of cuts; it’s a complex, multifactor issue that one must approach from a scientific professional perspective and above all from (personal and cultural) values".

Jordi Varela

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