Declare all conflicts of interest

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Category : Medical Rants

We want to worship at the altar of science. We want to believe published literature.

There are no facts, only interpretations. – Nietzsche

Every study, every guideline, every review is subject to interpretation. If a drug company pays for any part of a study, we scream from the highest mountain. Dr. RW makes the important point that we should do this for politically motivated articles – Canada’s health care is at least as good as in the U.S., and that’s evidence based!

First, the conflict of interest disclosure reads “Competing interests: None declared.” That may be literally true but it’s deceptive. No conflicts were declared but they certainly do exist. Not very open for an open medical journal, I’d say. It took some serious Googling on my part to find the conflicts.

What I found was that several of the authors are political activists and staunch advocates for the Canadian model. Co-author Steffie Woolhandler, for example, was profiled thusly in the New York Times: “Her plan is simple. Get rid of the private health insurance industry and abolish Medicaid, the government’s health insurance program for the poor. In their stead, set up a national health insurance system that would cover all Americans by expanding Medicare, the old-style Medicare, to include everyone from birth to death.” A co-founder of Physicians for a National Health Program, (PNHP) she’s also on their speaker’s bureau and a board member of the organization. The John Goodman Health Blog had this to say about her: “Not if you’re Steffie Woolhandler, who along with her husband, David Himmelstein, has spent years urging Americans to adopt Canada’s healthcare system.” Himmelstein by the way is another of the co-authors of the paper. Kevin had a few choice words about an earlier Woolhandler study here.

Now I respect those who favor single payer government run health. I disagree with their political view because I believe the externalities have significant negatives. But I know that we cannot compare our current system, an improved system and the system they prefer.

I agree with Dr. RW in objecting to a political commentary masquerading as evidence. Dr. RW makes many lucid points. One which he does not make is that in order to compare US and Canada, we are comparing very different populations. The US has all the advantages and disadvantages of the most diverse population in the world. Our diversity probably leads to disparities and impairs many statistics. We know that disparities exist in Canada and Great Britain despite national health plans.

The debate over universal health plans is worthy of our attention. We should carefully examine all implications of such a system in a vigorous and respectful debate. I fear that many who favor universal health plans see these with religious fervor, denying the necessary debate to really understand the pros and cons.

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