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Interview with
Margaret McCartney

“Many screening programmes show evidence of benefit... But many also have evidence of harm”
Author of “The Patient Paradox”, Margaret McCartney is a GP in Scotland (Glasgow) and a die-hard supporter of the notion that sexed up medicine is bad for people’s health. A regular contributor to the British Medical Journal and the lay media (she is well-known for her participation in Radio 4's Inside Health program), Margaret McCartney will be in Lisbon, in July 2014, for a singular and controversial lecture. 
Suffice to say that this Scottish doctor believes patients must have real autonomy to deny screenings and that, sometimes, social justice can do more to prolong people´s lives than the use of preventive medicines.

What are the main ideas that you want to introduce in your lecture during the WONCA Europe Conference 2014, in Lisbon?
Margaret McCartney - Politicians seem to have the idea that the best prevention medicine is medicines – when it’s really about social inequalities, education, and fair public health law. Statins really can’t compete with social justice for making people’s lives longer and better. It seems that doctors have accepted the responsibility for public health at an individual level, and in turns, individuals are stigmatised for their lack of responsibility over their ‘poor health’. I think this is the wrong way about. There is definitely a place for good preventative medicine, but it is wrong to think that GPs doing risk factor management can replace a fair society. 

Why is "sexed up medicine" bad for our health?
When we make decisions about our health based on overselling, unfair claims, bias, conflicts of interest, or incomplete information, we are not going to be making the most informed choice. All medical interventions come with risks and benefits. Unfortunately, profit-making enterprises frequently minimise the risks and hype up the benefits. 

You wrote in an article, published in The Independent, that "I am a GP, and I do not go for cervical smears. Nor do I know what my cholesterol level is, and when I reach 50 and am invited to mammography screening, I will not be turning up”. What drove you to make these statements?
For too long, people – especially women – have been simply told to get their screenings done, and have been made to feel irresponsible if they don’t. Many screening programmes show evidence of benefit... But many also have evidence of harm – not least, people sometimes avoiding doctors when they are ill to avoid being encouraged into a screening test they don’t want. We have to be more mature about risk and the balance of risk; patients are autonomous and have the right to a fair discussion of risk and benefit. We have to respect that autonomy. 

Do you think national health authorities are spending unnecessary resources on tests and screenings for healthy people?
Probably. There are many NHS tests, like the ‘health checks’ being offered that are not evidence based. Most others have a mixture of benefit and risk. If we really wanted to make a difference to people’s lifespan there are very effective ways to do it, without screening - it seems illogical to me that in the UK we offer non-evidence based screening, but seem to be having massive opposition to plain cigarette packaging or minimum alcohol pricing. In the meantime, the problem with many screening tests, for example, mammography, is the production of over diagnosis – diagnosing cancer and being treated for it even though it would never naturally have come to attention or needed treatment. If we were more honest about the pros and cons, I suspect many people would opt out – and this would prevent over diagnosis. 

How can family physicians prevent excess prevention?
There are two issues; the things we do as individuals and the things that governments do. Because people are invited to screenings centrally, most GPs don’t have much ability to offer people evidence based advice and help them make an autonomous choice. In the consulting room, I find it very difficult in a few minutes to try and ensure people are getting enough fair information. Pushing for change, via organisations like Informed Choice about Cancer Screening, in the UK, I hope will have some measurable difference. 

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