“Can you name a research paper that has changed your life?”
This question is an in-joke in medical circles, because it is very common to be asked this in medical job interviews. Doctors have so many job interviews that they get very good at answering this query a lot, and with increasing sincerity. I have become very good at pretending that a) research articles have had a life-changing consequence upon me, and b) I’ve actually read the paper beyond the first few sentences. It’s not far from the truth that I have spent hours vigorously arguing the benefits of one laxative over its competitor across the boardroom with my esteemed colleagues.
Imagine the sense of irony I felt when, one year ago, I actually read a paper that would change my life. It convinced me to leave my profession. The article was called, ‘A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data’ by John Ioannidis. John is one of the most cited scientists in medicine.
… Short-term extreme social distancing and lockdowns may be bearable. How long, though, should measures like these be continued if the pandemic churns across the globe unabated? How can policymakers tell if they are doing more good than harm? … the consequences of long-term lockdowns are entirely unknown …
I was already considering a break from medicine before the health crisis. As a frontline doctor I was observing the growing waves of patients suffering with their psychological health and wellbeing. They and I were frustrated by the lack of resources and the long waiting times for few therapies that were available. The health service was clearly struggling to adapt to the pace of a fast-changing world.
Quietly I was starting to collect and develop strategies for patients who felt anxious and overwhelmed. I was finding solutions to help them feel better. Before everything changed, I was beginning to wonder if there was an opportunity for Sarah and I to offer something new alongside my career in traditional medicine. Sarah had already volunteered yoga classes to the local psychiatric unit and the effect it had on patients made a big impression on me.
So when the health crisis hit, I already knew the fragile traditional service was going to suffer. But John’s words hit home for me that lockdown was going to make a bad situation worse. Were we neglecting all health and wellbeing, for the sake of an intervention for which there was no evidence that it was going to have any effect?
One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health ... locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.
I remember last year that the media stories and images of the crisis abroad were very harrowing. I didn’t want stories and images – I needed hard facts and analysis of the situation. John’s number crunching of the limited data available gave me the real medicine and real hope.
But the gift of John’s article was not the data analysis, but to point out that a new illness should be assigned a value in relation to other diseases. Give too much priority to one illness, and there was the risk that people’s health and wellbeing as a whole would suffer more in the long-term. It was this argument that convinced me to step away and create something new with Sarah. And in the late summer of 2020, we did.
…Unpredictable evolutions may ensue, including financial crisis, unrest, civil strife, war, and a meltdown of the social fabric … with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.
John was waking up the academics and clinicians of the world with strong words to begin a wider scientific debate. This is a necessary step in order to find solutions and consensus. Sadly we have witnessed no consensus – only opinion and back-biting. Absolute worst-case scenarios have been adopted as policy and used to bolster people’s existing convictions. Perhaps John should have saved some time and just re-printed his paper, ‘Why most research findings are false.’ That way he could continue his argument that most data is distorted by researcher and institutional bias, alongside some eye-watering financial conflicts of interest.
But there is hope. I am very proud of the courses that Sarah and I have created. With The Hidden Gateway I believe we are coming up with great solutions for health and wellbeing. The last nine months of creating and piloting our work has been so much fun. Thank you to everyone who has been involved in our incredible journey.
This crisis has kickstarted an urgent need to define good health, how it is best achieved and where the responsibility for good health lies. We're up for taking part in this debate. If society doesn't find the answers to these questions soon then we can only expect more harmful interventions. We are feeling very optimistic that more chaos can be avoided. But everyone must get creative, and begin to start challenging the medicine that causes more harm than good. Otherwise the ‘unpredictable evolutions’ John warned of will only take a step closer. So, let’s get started!
The Hidden Gateway is open …