August's free article
Swine flu: public health has become a public nuisance
The combination of speculative scaremongering by national health
authorities and increasingly absurd directives to GP surgeries in
response to the current flu outbreak confirm that public health has
become a public nuisance.
In July this year health minister Andy Burnham announced that
the swine flu pandemic could no longer be contained and there could
be 100 000 cases a day by the end of August.1 In
response to the suggestion from a TV interviewer that this could
mean 40 deaths a day, Chief Medical Officer Liam Donaldson agreed
that this was possible, and that it could be higher.2
Burnham conceded that his figure was ‘a projection’ not a fact — he
meant that it was a speculation based largely on ignorance, similar
to previous (unfulfilled) predictions of catastrophic mortality
from AIDS, ‘mad cow’ disease and bird flu. Though leading public
health authorities cling to the belief that proclaiming nightmare
scenarios is useful in raising public awareness of disease, in
reality this provokes anxiety out of all proportion to benefit.
On the same day we received in the surgery, by fax and e-mail
(and no doubt shortly also by post) the latest of the almost daily
pandemic flu briefings from the PCT. The headline barks: ‘PPE
procedures to be used for every patient’. The bulletin continues in
the now familiar tone of an exasperated infant school teacher
spelling things out for children who suffer from a combination of
learning difficulties and attention deficit hyperactivity disorder
(though it never goes so far as to explain that PPE stands for
Personal Protective Equipment):
‘GPs are reminded that on seeing a patient with flu-like
symptoms they need to follow all guidance on PPE, including wearing
a surgical mask, gloves and apron.’
This is the sort of advice that could only be given by somebody
who has never set foot in a GP surgery, certainly not since the
onset of the great swine flu scare. The simple fact is that many
patients who have been alarmed by the pandemic propaganda take no
notice of the advice to stay at home and come to the surgery
(bringing their children) and — quite understandably — expect to be
seen. So, after they have sat in the waiting room for hours,
coughing and spluttering, we are then expected to scrub and gown up
as though we were performing open heart surgery and then repeat
this procedure for the 20 other patients in the queue? Dream
on.
I am torn over what has been the most useful guidance we have
received from on high. Is it the diagram showing a cross-section of
the nasopharynx illustrating how to take a throat swab? Or is it
the picture of the container showing how to package the swab for
transport to the laboratory? It was also very helpful to receive
‘real examples’ of ‘what not to do’ detailing just how stupid some
local GPs have been in misinterpreting simple guidelines. It is
shocking to hear that some GPs have even confused WHO pandemic
alert algorithm S5a (for dealing with suspected cases) with
algorithm S5b (for sporadic cases). Is it any wonder that the
pandemic is out of control? Can revalidation come a moment too
soon?
The ascendancy of public health over primary care revealed in
the swine flu scare is an ominous trend. The statements of both
national and local public health practitioners confirm attitudes of
condescension, even contempt, for patients and GPs. For public
health specialists, our patients are merely people committed to
unhealthy lifestyles. Their risk factor epidemiology repackages old
prejudices: people get ill because they are idle, promiscuous,
gluttonous, drunken, and as the spread of swine flu confirms,
dirty. They regard GPs as sadly lacking in the moral fervour
required to transform the deviant behaviour of our patients.
The moralising propaganda of public health has a generally
demoralising effect on society, encouraging fear and anxiety — and
attendant sentiments of stigma and blame. It has a degrading effect
on medical practice and is corrosive of good relations between
doctors and patients. As the swine flu scare confirms, it is also
disruptive of day-to-day medical practice.
Mike Fitzpatrick
References
1. Batty D, Carrell S. UK
swine flu can no longer be contained. The Guardian; 2 Jul.
http://www.guardian.co.uk/world/2009/jul/02/swine-flu-uk
(accessed 7 Jul 2009).
2. Walsh F. Predictions should come with a health warning. BBC
News; 3 Jul.
http://www.bbc.co.uk/blogs/thereporters/ferguswalsh/2009/07/predictions_should_come_with_a_health_warning.html
(accessed 10 Jul 2009).
DOI: 10.3399/bjgp09X453936
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