Stadium Medicine

Just to prove that I do have a life outside public involvement in health research, did I mention that I recently went to see Depeche Mode at the O2? Great gig. Never seen them before.

How our experience of live music has changed over the last twenty years? Once I could pretty much get a ticket to any gig. Brilliantly atmospheric venues would come alive as the music washed over us. Your feet would stick to the beer covered floor. There was little room to move (or breathe for that matter given the cigarette smoke). Sweat sodden clothes would stick icily to legs as we exited.

Nowadays tickets seem harder to come by. The prices are exorbitant especially for the good seats. But how you get these prime locations seems to be an ever-deepening mystery since; there are more classes than on your average airline. We all aspire to be in the stalls and standing, but unless we are v v lucky then we end up bobbing half-heartedly at our seat in the Gods.

Still the sound is incredible and the experience is mighty even if the band are small. Plus its safer, and travel to and from is much easier. Though this might be because concerts finish earlier these days so the neighbours are not disturbed.

No one could argue that universal coverage doesn’t exist in this environment. But universal access?

I sometimes wonder whether medicine is not heading the same way to our stadiums, held aloft on chariots each driven by a team of medical research riders.

The front page of today’s Times heralds the (not so new actually) national cancer registry launched by Public Health England. That’s a ‘Coming to your stadium’ soon sort of announcement isn’t it? As was the one a few months ago about the genome mapping initiative in cancer and rarer diseases. (It’s always cancer by the way, he says cynically and unfairly)

These are good things, I utterly agree. But there was a rather unfortunate juxtaposition of stories with that last example – at about the same time the Chair of the NHS Commissioning Board, Sir Malcolm Grant, said in the Daily Telegraph that people needed to get used to the fact that they would be paying for more NHS services in the future. And I can’t help feeling that all those new diagnostic tests underpinning the march of stratified medicine would be prime candidates as industry tries to make the economics work. That’s one way to restrict access while supposedly aspiring to universal coverage.

The drive is also coming from patients. The Medical Innovations Bill would give patients the right to choose to take highly experimental treatments in the event of a terminal prognosis. I have enormous empathy with it. But I also worry that the reality would be far from ideal, with only those ‘of means’ able to afford such a path in a safe environment.

I was trying to check this earlier but couldn’t verify it for sure. Perhaps someone out there can? It’s a quote from the writer Tom Wolfe that ‘class is America’s dirty secret.’ Perish the thought that it might also be the dirty end of medicine’s advance.

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