A conversation has been taking place in the British Medical Journal and elsewhere over the past few weeks which some people are referring to as ‘the statins row’, because it is focusing on the debate about whether, when and in whom statins are useful drugs. Much of this debate has occurred in the form of letters to the editor and, as you might imagine, some of those involved are keen supporters (and perhaps prescribers) of these drugs, while others urge caution and appear to be more easily able to understand and empathise with those who prefer to avoid taking such precautionary measures.
I mention all of this as context for one paragraph of this debate which particularly struck me. A letter written by Niall Holland, a semi-retired GP, included the following lines:
“Another subtle but important cost of treatment that is hard to measure, is the loss of the sense of well-being that some patients may experience in being told they need medication, what I seem to recall Tudor-Hart describing as an ink-stain in the clear waters of the patient’s life. This will not show up in the list of side effects unless it triggers measurable morbidity. This does not make this side-effect unimportant.” (Holland 2014)
The ‘loss of the sense of well-being’ that Holland (2014) describes here immediately brought to mind my own ongoing concern (which I know is shared by many others) about the potential consequences of all of these routine tests and interventions that we offer to pregnant and birthing women; consequences which are equally difficult to measure. How do we – whether this is ‘we’ midwives and doctors, or ‘we’ the members of a society that has swallowed the obstetric paradigm whole and embedded its tenets within our lives – impact a pregnant woman’s sense of well-being when we tell her that her labour needs to be induced because her body hasn’t done what it needed to in time and is now posing a threat to her baby? What about the effect of our obsession with ultrasound, and the implication that machines are supposedly better at determining how a baby is doing than the woman who is carrying that baby? Not to mention the impact of being told that you need to take folic acid, vitamins, iron and maybe a few minerals, while submitting yourself to a barrage of tests just in case. What is the cost of the consequences of those things?
I absolutely agree with Niall Holland. The fact that such costs are hard to measure does not make them unimportant.