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William Cayley: “If you build it, they will come”

6 May, 14 | by BMJ

bill_cayley“If you build it, they will come!” So went the catchphrase of Field of Dreams, in which an Iowa farmer is inspired by voices to build a baseball diamond in his cornfield. And, indeed, “they” do come—the movie ends with an endless line of people in cars coming to see a ball game in his remote cornfield. While an inspiring story of seeing a dream through to fruition, it also raises serious questions of practicality—is a remote corner of Iowa really the best place for a historic baseball diamond?

Rhys Davies touched on a similar issue in his recent posting about the Imagining the Future of Medicine conference, where he was rightly skeptical about the true benefits of many of the new, high tech (or in development) medical gizmos that were on display there.

A few years back, an essay in JAMA explored in even more depth our problem with “Gizmo Idolatry” in medicine:

“Gizmo idolatry describes the willingness to accept, in fact to prefer, unproven, technologically oriented medical measures . . . Clinicians and patients should resist the clamor for the new and fancy . . . All stakeholders should encourage and reward diligent bedside care for all who need it.”

Those of us with the luxury to have access to expensive, high tech care may be enamored with the gizmos that modern biotechnological medicine can produce. Yet most of the world (both those in developing countries, and the less fortunate in the so called “developed” world) are not in need of more high tech gadgetry—so much as they are in need of access, quality health information, and basic services. For example:

  • Cervical cancer continues to take its toll on women around the world, but from a global perspective, most of those affected are not those who lack access to high tech screening; rather, they are those who lack access to any screening at all. What is needed here is innovative ways to improve global access to screening for those who have none.
  • As HIFA2015 argues, “People are dying for lack of knowledge.” “Every day, tens of thousands of children, women and men die needlessly for want of simple, low cost interventions – interventions that are often already locally available. A major contributing factor is that the mother, family caregiver or health worker does not have access to the information and knowledge they need, when they need it, to make appropriate decisions and save lives.”
  • A recent blog on the Economist website makes the memorable point that “in the effort to improve health care, it is worth remembering a simple, albeit unsavoury truth: poo matters.” The starting point of healthy living is helping people to have healthy living conditions.

Innovation in medicine is important, and I’m the first to admit I’m engrossed by “tech” innovations (when I was a kid, one of my idols was Caractacus Potts, the questionably brilliant inventor of Chitty Chitty Bang Bang). Now that I’m a bit more grown up, I realize that the latest tech is not necessarily what we need—flying cars and musical candy won’t solve the challenges of global healthcare any more than building a baseball field in a remote corner of Iowa.

The innovations we need to explore have to do with access, information, providing basic services to those who lack them, and (as I’ve posted previously) getting a better handle on “when it is best to do nothing, or when something less expensive or invasive may be equivalent or better, or when it is just a matter of giving a benign condition time to run its course.”

William E Cayley Jr practises at the Augusta Family Medicine Clinic, teaches at the Eau Claire Family Medicine Residency, and is a professor at the University of Wisconsin, Department of Family Medicine.

Competing interests: “I declare that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.”

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