Richard Smith: Doctors are not interested in health or prevention

Richard Smith“Doctors are not interested in health” is one of my many wild generalisations. My evidence is my experience, a 40 year collection of anecdotes, and the observation that a thousand page medical textbook usually comprises five desultory pages on health and 995 pages detailing disease. Now I have further evidence.

I’ve just attended the World Cardiology Congress in Dubai, an event with more than 10 000 attendees and an A4 programme that is 370 pages long. Not used to such extravagant events, I imagined every session packed with enthusiasts.

In fact when I arrive at a session on “Prevention of cardiovascular disease in emerging economies: the role of pharmacological intervention” I discover that I’m the third person apart from the two chairs and the three speakers. Nobody else arrives, but the session begins.

The first speaker is from China and tells us that stent insertion has been increasing by 30% a year since 2000 but that very little has been done on prevention. He observes as well that 50% of doctors and 70% of cardiologists smoke. It’s perhaps some sort of justice that the doctors’ lack of interest in health and prevention extends to themselves as well as their patients and potential patients. During this first talk, the man sitting in the front row realises that he’s in the wrong session and leaves. This reminds me of my brother’s first performance at the Edinburgh Fringe, when there were seven people on the stage and four in the audience; and because of audience participation it was later eleven on the stage and none in the audience.

We then have two excellent presentations on prevention in Brazil and the role of the polypill, and the audience has grown by three. (One, I suspect, might be the wife or mistress of one of the speakers. Global conferences can be a good time to arrange an assignation with your mistress. I hasten to add that I write this from imagination not experience and have no evidence whatsoever that the woman in the audience with the short skirt is anybody’s mistress.) Although we now have five in the audience, I note that two of them are looking at their Blackberries.

I must admit that the title of the session made me suspicious that the organisers might be pandering to some “higher agenda.” Why “emerging economies” rather than “low and middle income countries?” Perhaps because business, the sponsors of the meeting, are more interested in these countries with huge populations and rapidly growing economies than they are in countries like Rwanda or Sri Lanka. The same considerations might explain the emphasis on drugs rather than lifestyle or public health interventions.

After this session I go and chair another session on prevention (which is why I am here), and now we have an audience of about ten, only five of whom are from the same place as the speakers. During the session, however, one gets a phone call and leaves and three others, who have sat at the back, leave. Perhaps they got a better offer.

I didn’t go to any other sessions, and perhaps they were all equally empty. It might have been that those at the conference followed the advice of a colleague: “Once I’ve learnt three things at a conference I head for the beach or a bar. With luck that happens in the first 20 minutes.” I was told, however, that a session on stents was full to overflowing. Stents mean money, drama, and even beautiful women and a slot on the television.. Prevention, in contrast, is boring, all about what doesn’t happen rather than what does. Plus, were it to be successful it would put cardiologists out of business. Then there would be no more conferences in exotic venues.

Competing interest: RS was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative. He chaired a session at the conference, which is why he was there. His employer, UnitedHealth, paid his expenses, and he taught unpaid a class at a local university on “How to get published.”

  • carolynthomas

    Dr. Smith, this would be downright hilarious if it weren’t also so disturbing.  But let’s face it, in our current modern system of marketing-based medicine, there is little money to be made flogging exercise, heart-smart eating, maintaining a healthy weight, stress management or other lifestyle improvements.  Better to  reach for the prescription pad.

    Distressing that the stent session was jam-packed, yet the prevention sessions were woefully empty.  Says it all, doesn’t it?

  • Guest

    This was objectionable on so many levels.  Not sure what point you were trying to make with your comments about women, but you did manage to offend.

  • David Drew

    Comments so far suggest Doctors not interested in Health, Prevention or Humour. Laughter is the mest medicine. Prophylactic. TxRichard.

  • Richard Smith

    “Never apologise, never explain” was the philosophy of both Bomber Command and T S Eliot, but I will try to explain. The reference to the woman in the short skirt might pretentiously be described as “a literary device.” The woman was there, and by suggesting that she might be the mistress of one of the speakers, which she almost certainly wasn’t, I add to the sense sleaze and corruption that I’m trying to create.

  • Richard Smith

    Freud said that we do everything for “fame and the love of beautiful women.” I was making an oblique reference to that famous quote, and it could of course be “beautiful men.” And, of course, women too can arrange assignations with their lovers.

  • Moppie

    In my early days as a researcher I was told that there is empirical evidence that the primary function of conferences is to rekindle affairs – whether of an illicit or work orientated form, I never enquired. Now a more experienced researcher, I have been to umpteen conferences; and I must add that I have never used a conference to rekindle an affair.

    Being a Confy geek, I have kept a meticulous record of the many national (UK) and international confy’s that I have been to. This began as a work feedback thing, but soon became something that I did as a labour of love – as I said geek – and I now have over 20 documentations of such events. Being also a bit of a foody, they do focus a little too much on the quality of the confy banquets/dinners, which ranged from excellent in Basel (at a restaurant), to little worse than WWII rations (in places I shall not name). This I have thought reflects the approachability of some of the delegates (excellent to standoffish) and ilkewise the quality of the presentations (excellent to WWII-ish).

    All said I think there is definitely a place for confy’s. They are one of the few places where people can still get involved in a Socratic tussle – the best way to derive knowledge. (And all the better when it is done at the bar). A looming presentation forces one to gather thoughts around their work, which can then lead to an article. It’s nice to have a change of scenery and to see a new part of the world – I have went on travels to places where a conference was previously held. And of course there are the said banquet/dinners. If only someone was able to write a funny insightful piece on such confy banquet/dinners; would this not make for an amusing piece in the Christmas edition of BMJ…? 😉 

  • Dr.W

    Bright and edifying. Thank you.

  • notactualsize

    1.      Thanks for the reply. Your clarifications are helpful. The allusion to Freud had been unclear to me. It isn’t now.
    2.      I always enjoy your posts: that’s why I bothered to challenge the apparent sexism.


    This was said centuries before Freud, by the Arcipreste de Hita in “El Libro del Buen Amor”.  By the way, cherchez la femme!

  • Saps

    Dr Smith, thank you for an interesting text although it would have been more interesting if it was not for the assumption that a woman with a short skirt most likely was someone’s mistress. It is sad to learn that sexism is present at all vanues and that if a woman has a short skirt it can not be because she likes the skirt and that it is more probable that she is a mistress to somebody. I did not see the relevannce of that comment in this texts. /Dr.S

  • Simon C

    The humourless, politically correct, strike again. If you had commented on a “Fabio” look-alike with crotch-outlining tight jeans possibly with his gay cardiologist lover that would have been wrong too. I agree with bomber Harris and TS Eliot on this one.