Betrayal of the oath

For Rachelle Buchbinder and Ian Harris, the benefits of medical treatments are often wildly overstated and the harms understated.

Overtreatment and overdiagnosis are rife, with many people prescribed tests and treatments providing little to no benefit.

It’s for this reason they wrote Hippocrasy, an exposé on what they see as inherent problems

of a medical system that is based on treating, rather than preventing, illness.

Buchbinder, a rheumatologist and clinical epidemiologist, and Harris, an orthopaedic surgeon, were motivated to write the book because they kept seeing, first-hand, the harms that may come from society’s overreliance on medicine.

As Buchbinder says, it’s the three O’s – over-testing, overdiagnosis and overtreatment.

“In essence the medical system is not fit for purpose and is harming people,” Buchbinder said.

“Estimates are that about 30 per cent of what doctors do is ineffective and another 10 per cent is harmful.”

In Hippocrasy, the duo claims that a large reason for the three O’s is a lack of science literacy, with Buchbinder telling The AJN that not only do some medical professionals overestimate the benefits and underestimate the harms, but some are also reluctant to admit that they don’t necessarily know the answers.

“They hold to their own beliefs and the research that supports it rather than changing even in the face of overwhelming evidence that should tell them that they need to change,” she said.

While many doctors know about the problems the medical system is currently facing, and many are already trying to do something about it, Buchbinder says it’s the wider public who need to be aware of what’s happening.

“The general public and our patients are largely unaware,” she said.

“We wanted to tell them about these things so they can be more informed and perhaps a little more sceptical.”

While they don’t want to erode trust in doctors, Buchbinder and Harris hope that the book will empower patients to ask questions, and further help doctors to help their patients.

“Some patients may be afraid to ask questions, so giving them permission or even saying it is expected might help patients to feel comfortable and safe to ask relevant questions,” Buchbinder said.

In 2017, Buchbinder and Harris were awarded the prestigious Rockefeller Foundation Writing Fellowship at the Bellagio Centre in Italy.

It’s here they started planning and writing the book, which, as they say in the foreword, was written to ultimately help doctors and patients.

“Our aim has been to bring knowledge of the problems with modern medicine to a wider audience in the hope that by understanding the problems, we can focus on what needs to change.

“We would like many more doctors (and patients) to experience that ‘joy of healing’ that comes from a more science-informed understanding of the true benefits of medicine and its true harms.”

Hippocrasy is published by NewSouth, $32.99 RRP