Knowledge is power.
In the arena of health, for the last hundred years, doctors have kept a firm grip on both. It was in the Victorian era that the sale of therapeutic drugs was first controlled. Since then, doctor power has been enshrined with legislation giving them and other health professionals a monopoly in the prescription of drugs.
Now with Wikipedia and medical databases just a click away, we all appear to have medical knowledge within our grasp. And with the arrival of the online pharmacy individuals for the first time in more than century have the ability to bypass doctors altogether.
The questions raised by this shift are deep and fundamental. Should we welcome this democratisation of healthcare or are we better served by experts determining what they believe is in our best interests? Could self-prescription provide a more effective and more efficient mechanism for first line treatment leading to potentially huge savings in the government’s NHS bill or are the risks too great?
These are questions that seem particularly relevant in the current climate of disillusionment with the medical establishment and the forces that govern it.
We hear all too regularly of clinical mistakes, deliberate sabotage at the hands of health care professionals and, with recent revelations about Stafford Hospital, the systematic failure of whole institutions.
Despite the media frenzy around cases such as these, the democratisation of medicine shouldn’t be misread as a rejection of established practice. It’s far bigger than that.
There has always been a tension between paternalism and autonomy along the lines of doctor and patient. There are increasing worries, too, about communication between these two factions, as well as the distribution of power and the role of choice within healthcare.
For many people, democratisation is about rebalancing the uneven relationship between doctor and patient and seeking more parity in terms of information distribution. It’s not a case of playing doctor, but of taking ownership over their health and having the opportunity to find out more about it. In some factions, there is even a growing demand for scientific papers to be made accessible to the general public and calls to remove the medical filter system that governs the dissemination of this knowledge.
Last year we heard that this democratisation is no longer about just Google and the power of the internet. The future of democratised medicine will incorporate smartphones, social networking and, according to Dr Eric Topol in The Creative Destruction of Medicine: How The Digital Revolution Will Create Better Health Care, even tools that sequence the genome to give consumers control of their own individual information.
"Microchip wireless sensors attached to our bodies will be able to give us up-to-date information on our general health"
Such advances in how we receive and read medical information aren’t merely a break from the past but a revolution. According to Topol, microchip wireless sensors attached to our bodies will be able to give us up-to-date information on our general health. These devices could lead to a patient spending less time in hospital as they could be monitored remotely and would signal a move away from a hospital-centric vision of healthcare.
And behind this radical change there is the question of knowledge itself. Doctors have given the impression, and patients have demanded, that they can determine what is wrong with us and have a solution. Yet often this is an illusion. Will self-prescription encourage the fantasy that there is always somewhere a treatment that will cure? Will this fantasy lead to quack cures and fraudulent claims? Or could we see a future where the effectiveness of treatment is at once apparent through the reporting of previous outcomes?
There are obvious dangers here. Large amounts of unprocessed information made easily available but remaining largely unpoliced, laymen ill-equipped to distinguish fact from fiction, issues of accountability and the loss of personal contact at the hands of a system of e-doctors and e-patients.
Whether it is heralded as an exciting new era in the democratisation of medical practice, or a dangerous exercise in patient freedom, it is an unavoidable phenomenon. The task is to find a satisfactory new way to navigate that changed landscape.