The Lancet: Opinion: "Offline: Transcending the guilt of global health", Horton

Andy

Andy

Retired committee member
Any western medical institution more than a century old and which claims to stand for peace and justice has to confront a painful truth—that its success was built on the savage legacy of colonialism. Perhaps we deal with uncomfortable pasts by burying them, excusing them, or atoning for them. The Lancet, for example, is a colonial-era institution. Its editors today must be exquisitely sensitive to the ethics of memory. How easy it is for us to pronounce on what others should do from our position of advantage. How simple it is to turn away work held to standards so much harder to achieve in lower-income settings. How effortless it is to say one is seeking to promote a global conversation about health, while at the same time justifying, on the intellectually persuasive yet deceptive grounds of quality, exclusion, inequity, and disempowerment. Some might kindly call it the inevitable contradictions of progress. Others, rank hypocrisy.
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https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32177-4/fulltext

 
How eye-rollingly ironic in a piece calling for self-awareness of colonial prejudices that this is written:

How simple it is to turn away work held to standards so much harder to achieve in lower-income settings.
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Because it is just so much harder to do good science in those colonised places, you know, making sure that outcomes aren't switched during the trial, or ensuing that there are objective outcomes in unblinded trials, or that conflicts of interests are declared and well-managed, or that the corridors are long enough for walking tests ...
 
Is it just me, or does that article come across to you as patronising? When some western countries end up with the leaders they have, and populations so stupid as to take their health advice from Goop, and editors like Horton publish crap like PACE, who is Horton to preach about what should happen anywhere.
 
I used to be a cheerleader for the NHS and the likes of the Lancet, but extraordinary experiences with my late father and the nonsense of my own as yet undiagnosed "tiredness" are leading me to question that faith. There's an arrogance frequently encountered from GPs and everywhere else which is getting bloody tiresome now.
 
Guy who is responsible for promoting and defending fraudulent research harmful to millions not once but twice, both times dismissing critics as irrelevant activists, says what now?

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Any western medical institution more than a century old and which claims to stand for peace and justice ...
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I'm stopping right there. I have never heard of a western medical institution claiming to stand for peace and justice. It's just not what they're for. What on earth is this guy on? Sounds like the cultural studies lecturer in the next classroom to me. Think I'll give it a miss.
 
TheBassist said:
I used to be a cheerleader for the NHS and the likes of the Lancet, but extraordinary experiences with my late father and the nonsense of my own as yet undiagnosed "tiredness" are leading me to question that faith. There's an arrogance frequently encountered from GPs and everywhere else which is getting bloody tiresome now.
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I still am a cheerleader for the NHS, at least in theory. When the NHS collapses and we have to pay for every single interaction with the medical profession, every nurse interaction, every room used, every sticking plaster, stitch and scan, I'm going to have to decide whether to bother or not. I don't want to spend hundreds or thousands of pounds only to be told that my problems are all in my head. After all, the doctors I see will have the same training they have always had, the same prejudices, the same beliefs, and they will be reading the same lies on my medical notes that they have always done. So why should I expect different treatment just because there is a large price tag attached?
 
Trish said:
Is it just me, or does that article come across to you as patronising? When some western countries end up with the leaders they have, and populations so stupid as to take their health advice from Goop, and editors like Horton publish crap like PACE, who is Horton to preach about what should happen anywhere.
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It is standard sermon format. Horton should have been a priest.
'Dearly beloved we are gathered here together to flagellate ourselves because we have been so naughty. But everything is OK as long as you flagellate yourself according to my instructions and put a few used fivers on that silver dish.'
 
From Horton's recent post about having many medical appointments, it would appear he might be suffering from a serious illness. Does anyone know the facts on that? I agree his position is really hypocritical here, as has been his hectoring others about bad science, given his egregious willingness to defend indefensible studies published on his watch.
 
dave30th said:
From Horton's recent post about having many medical appointments, it would appear he might be suffering from a serious illness. Does anyone know the facts on that? I agree his position is really hypocritical here, as has been his hectoring others about bad science, given his egregious willingness to defend indefensible studies published on his watch.
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Yes, he was treated for cancer earlier this year. He mentioned it at the WHA72 in May (video here: https://www.who.int/about/governance/world-health-assembly/seventy-second-world-health-assembly - he's speaking at about 1 h 4 mins in).

He is an absolutely stalwart advocate on so many global issues. It is such a shame he is not on our side on this one. I hope one day he will be.
 
TheBassist said:
Funny seeing talk of activism. We’re by definition not all that active at all, never mind activist
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Horton said some time ago that he is proudly an activist editor. He dismisses everything relating to PACE because it is the work of "activists", nevermind that it isn't true. Nevermind that he is clearly siding with bullies who oppress vulnerable people and that he is very much complicit in highly unethical behavior.

Some people do hypocrisy like others breathe: naturally.
 
Arnie Pye said:
I still am a cheerleader for the NHS, at least in theory. When the NHS collapses and we have to pay for every single interaction with the medical profession, every nurse interaction, every room used, every sticking plaster, stitch and scan, I'm going to have to decide whether to bother or not. I don't want to spend hundreds or thousands of pounds only to be told that my problems are all in my head. After all, the doctors I see will have the same training they have always had, the same prejudices, the same beliefs, and they will be reading the same lies on my medical notes that they have always done. So why should I expect different treatment just because there is a large price tag attached?
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That's a really interesting way of looking at it - at least under the NHS we get abused for free without having to pay for it. I shall learn to count my blessings.
 
TiredSam said:
That's a really interesting way of looking at it - at least under the NHS we get abused for free without having to pay for it. I shall learn to count my blessings.
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Yes, I see your point. However, if I ever break a bone and the bone is sticking out I will be glad that the NHS exists and that it won't cost the equivalent of US$2000 - US$5000 just to call an ambulance. I think abuse of patients is so built in to the medical system nowadays that I never expect it to ever improve no matter how the healthcare system is arranged and financed, so from that point of view I prefer the NHS.
 
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