The two Fs of politics: fascination and frustration. The convoluted ins and outs of political decision making are, like most complex systems, a challenge to understand and difficult to predict. The closer you are to the seat of decision making, the better is your predictive ability. So right now I am developing a political predictive tool and I have started a pilot study to predict whether a nation of 4 million humans and 40 million sheep will have a prostate screening program. It could be potentially a big program although a colleague from NZ's largest off shore island (the big one north of Tasmania) did note that you would have to exclude all the ewes and wethers from the program. PS NZ = New Zealand, not a state of Australia or somewhere near New Mexico
Seriously, NZ could become famous as the first nation in the world to have a national prostate cancer screening program. The decision could be made by a group of politicians who will consult with evidence experts, urological and cancer specialists and men who have prostate cancer.
This heady combination should be balanced by a patient perspective, especially men who do not have prostate cancer and have never been screened. Trouble is the complexity of the issue means that it is very difficult to find such men who are sufficiently well enough informed to be able to provide sufficient insight into the real patient perspective on prostate screening.
The very nature of the political enquiry is that squeaky wheels are the loudest, but consulting with the likes of a prostate cancer men's group is rather akin to asking the Ford Falcon Owners Club what is the best car to buy. Similarly the specialists medical groups for whom a large percentage of their work load is prostate cancer will have a viewpoint resultant from a highly selected patient population. Hopefully a highly selected disease based viewpoint will be balanced by a generalist perspective (i,e, family physician) uncontaminated by specialist opinion. After all in most countries where generalists are the gatekeeper of health. It is us who actually do the screening. The specialists only investigate those who have already been identified as having a potential abnormality.
So look at the politicians who will potentially make the decision. Trying to guess bias associated with political identification (left wing, right wing, Tory, Liberal, conservative, socialist what ever) seems impossible to predict. More importantly, health literacy and personal reflective ability of the politicians should be the influencing factor in this. Can they recognise bias, can they understand science and evidence, are they reflective, can they step outside of political party lines? I hope so :-) and perhaps some of them can, but if we as a profession fail to acknowledge our biases and poor understanding of evidence, we should not expect any different from a political committee.
Reality is that any decision made by the committee will not be right. It could fly in the face of evidence, ignore patient autonomy, fail to oil the squeaky wheels or be one big fiscal drag. Damned if they do, damned if they don't. I hope they will ultimately consider the patient perspective, that of men considering being screened and not that of the Ford Falcon Owners Club.
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