The Doctor's Surgery

Tom Stuttaford

During the war nobody condemned Winston Churchill and his intelligence team for massaging the news to keep up the morale of the nation. He liked to hold back the news of an unexpected disaster until he could reveal some success at the same time so that the impact would be lessened. One of his most important confidants was Lord Moran, his doctor and close friend. One day Churchill told him of the latest calamity to undermine our war effort. At the end of the account he added, so it is said, ‘Now you’re a doctor, you must have come across some bit of good news that will cheer the general public.’ Lord Moran worked at St Mary’s Hospital, where there had been discussion about Oxford scientists’ work on penicillin that had stemmed from Sir Alexander Fleming’s earlier chance discovery at the hospital that some some varieties of penicillin would inhibit the growth of bacteria. He suggested to Churchill that this hitherto unknown discovery might now have huge potential in the treatment of battle casualties. Our propaganda experts did a first-rate job and the prospective value of antibiotics was understood immediately by the public, who were then able to talk about this rather than the latest bad news from the Far East.

The governmental trimming of news stories is understandable and acceptable during a war when the future of civilisation is at stake. It is more difficult to countenance when used for political motives in relatively peaceful times. In Britain we may be in danger of terrorism, but the country’s greatest troubles are financial and there is no greater charge on the national exchequer than the practice of good medicine. The introduction of most of the major advances in medicine have been delayed by officialdom that strives to protect the national coffers from extravagant doctors. This financial caution must have cost Britain tens of thousands of lives as well as hastening the fall of our former international reputation for medical excellence.

There are many medical specialities where financial caution has already too often cost lives. Obvious examples include our slowness in accepting the need to introduce adequate breast screening; our refusal to accept that to wait for symptoms of cancer of the prostate before excluding it is to wait too long; the national apathy in adopting adequate means to control blood pressure; and our reluctance to accept the advantages of statins in averting many heart conditions. This list doesn’t even include the consequences of cost-saving trimming of our ante-natal services, which has had the effect of giving us maternity figures that are among the worst in the Western world, nor does it modify the frequent boast that we are all liable to live to an ever- increasing age. In fact life expectancy of elderly octogenarians, especially male octogenarians, is beginning to fall. The NHS no longer has the necessary funds to make a costly intervention that could give someone who is still active an extra year or two of pleasurable life.

I mention some of these ill effects of misplaced financial caution because I detect the first signs that just when there is a chance that more effective treatment of Alzheimer’s may become available, there is a danger that excessive caution may be used as a means of delaying its introduction. The understanding of the biochemical mechanisms that cause Alzheimer’s disease has leaped ahead and there is now some evidence that science may find a way to alter its progress and outcome. Now is the time to spend every penny that is available to hasten this work, and when there are advances their initial cost must not be used as an excuse for withholding them from the British public. I can’t forget that the use of those existing drugs that treat only the symptoms of Alzheimer’s for a limited time, and don’t effect a cure, was discouraged until the patents on the drugs had expired and the cost therefore was reduced. Now that they are cheaper their prescription is urged; cynics might suggest that this is because it is less expensive to prescribe some pills than find a hospital bed that will cost many hundreds of pounds a week.