Pritpal S Tamber: Moustaches, fund raising, and independence from the current healthcare system

pritpal_tamber_2014I am growing a moustache. This is not the kind of thing you usually need to broadcast, but I am growing it as part of Movember because I believe these kinds of mission specific campaigns are crucial to finding new ways to fund health related services.

To be honest, I have always hated campaigns to raise money for healthcare. I live in the UK and part of our social contract is that we pay taxes so that we can get healthcare for “free,” a dumb way of saying we don’t pay for it when we need it as we’ve already paid. But these days, I increasingly believe that we need to find alternative ways to approach health and care, including funding it, and that the existing healthcare system is not best placed to lead this search.

It’s well documented that existing systems struggle to do anything other than incremental change, and yet what we need in healthcare is radical reinvention. Nothing illustrates this more than the increasingly accepted fact that healthcare is massively wasteful, and yet seems unable to do anything about it. In the United States, the Institute of Medicine has shown that the system is 30% waste, largely owing to overtreatment and the use of questionable technology. In the UK, the Academy of Medical Royal Colleges suggests it’s 20%.

Do we really believe the US and UK healthcare systems will lead the search for new approaches to health and care, which might reduce their revenues by US$800bn and £20bn, respectively? I don’t.

To illustrate how unlikely this is, consider this recent Perspective in NEJM, illustrating how thyroid cancer has become rapidly overdiagnosed in the Republic of Korea as a result of a national cancer screening programme. There are two amazing parts to this story: first, thyroid cancer screening was not even part of the programme, it was added by hospitals and doctors’ offices because it was easy to do; and second, the majority of new cancers that were identified were not life threatening. All in all, this seems to be a case of hospitals and doctors’ offices using their positions to advocate overtreatment in order to line their pockets.

Note that I’m not saying that individual doctors are specifically looking to line their pockets, more that the system they operate in encourages such behaviour. When clinicians are brave enough to work outside the system, they often say it like it is—and to great effect. My two favourite examples this week—and there are good examples every week—are doctors Benjamin Davies and Rupert Whitaker. Davies wrote a brilliant piece about inappropriate claims in direct to consumer advertising in the New York Times and the New Yorker. I especially loved his use (and perhaps coining) of the term “hopeium”—pushing false hope to sick, and hence vulnerable, people. Whitaker wrote an insightful analysis of how when we limit health to physician centred approaches, we limit what we can truly achieve.

Radical reinvention of health and care will only happen from outside the existing system, and will only be possible if there are resources to experiment with. That’s where Movember comes in. It was started in 2003 by two blokes in Melbourne, Australia, who joked about bringing the ‘tache back into fashion. They didn’t raise money that year but they got 28 others to join them. The next year 480 got involved and they raised over £21 000. In 2013, the figure was £77m. That’s a half decent wodge of cash with which to search for future approaches to men’s health and care.

Despite my enthusiasm for Movember (and my willingness to look like a total idiot), I do think their current approaches are overly bio-medical, perhaps inevitably so given their Global Scientific Committee is made up of doctors and biomedical scientists. However, what Movember is illustrating is how consumers can be corralled around a specific mission to raise money. The fact that this money is independent of the current healthcare system is a big deal and needs to be capitalised upon—perhaps more than it already is so far.

It’s important to note that there are organisations within the current healthcare system trying to change their approach, principally by focusing on population health as well as healthcare. One such organisation is Nemours Children’s Health System. They recently used a grant to reduce hospital admissions of children with asthma. They saw some success, but fewer admissions meant less revenue. As the CEO, David Bailey, said:

“As a business executive, it puts me in a quandary. I’m going to have to fill in the [lost revenue] from someplace. Do I take it from bone marrow transplants? Behavioural health? We’re going to have to work very hard to move reimbursement to allow for these new approaches, and still keep our doors open.”

Bailey’s honesty is an excellent example of the kind of leadership needed within the failing system that is healthcare. It also illustrates precisely why money raised through endeavours like Movember cannot become trapped in what healthcare is today; it has to be used to find what it can be tomorrow.

To help Movember, to aid the search for ways to approach men’s healthcare, and to make it easier for me to continue to look like a total idiot until the end of the month, please sponsor me. Thanks.

Pritpal S Tamber is an explorer of the future of health and an adviser on transformative innovation in healthcare. His work is informed by his experience as the physician editor of TEDMED; the medical director of Map of Medicine, a company that helps clinicians improve the quality of care; and numerous roles in medical publishing, including at BioMed Central, the company that proved open access publishing was commercially sustainable. Pritpal honed his ideas through a movement called Wellthcare, in which he explored the idea of creating health through community. This work has led to the Creating Health Collaborative. Follow him on Twitter.

Competing interests: None declared.

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