On the Low-Income Population Health and Critical Thinking on Medical Care

by | June 4, 2018


By Scott Douglas Jacobsen

Professor Gordon Guyatt, MD, MSc, FRCP, OC is a Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact and Medicine at McMaster University. He is a Fellow of the Canadian Academy of Health Sciences.

Here we talk about the research that helps the low income and the critical thinking stance to take on pseudo-medicines or medicine purporting to help but does not in the end.

In 2017, I had the chance to talk with a leading medical research, distinguished professor Gordon Guyatt. He specializes in evidence-based medicine. I wanted to talk about some important research and some practical tips for the public.

Tips for the public to avoid snake oil and bogus remedies. We started on the research and then moved onto the practical tips. When I asked about the research, I focused on the research with the most potential to improve health outcomes for the low income.

On low-income Canadians, Guyatt stated, “The best way to improve the health of low-income folks is to decrease income gradients and that would have far more impact than any particular health interventions.”

That is, if society could stop or reduce smoking, then this would improve the health outcomes of the entire population. Lifetime smokers have seven few years of life than non-smokers. That is significant. Who would not pay for another 2,000-3,000 days of life, especially near the end of life?

It is a “far bigger gradient that can come from any particular health interventions. So if we can persuade everyone to stop smoking, that would have an enormous impact on health. While medical innovations have made a big impact on both quality and quantity, there are other things like income gradients, like health habits – in particular, smoking – that have a bigger impact,” Guyatt explained.

As a provincial, national, and, indeed, international expert in evidence-based medicine, this became an important point to convey to me. In particular, the clarity comes from the expertise, knowledge, years in the field, and reading the research.

“Medical treatment has made a big impact on various areas, including cardiovascular disease and treatments and cancer. Those were made because those were the biggest sources of morbidity and mortality in society. That is where I see the biggest continuing potential: certainly, within the area of cancer, our understanding biology has advanced enormously,” Guyatt said.

He states that there will be a steady intake of new preventions and therapies. Many fatal cancers will be chronic diseases in the future. This has been happening. He predicts this will continue into the future. When I shifted the conversation to the critical thinking part. I wanted some simple tips.

Guyatt stated, “What they can do is learn the basic principles of deciding what evidence is trustworthy and what is not.  That should be possible. A colleague of mine by the name of Andy Oxlan has completed a large randomized trial in Africa of teaching school-age kids about recognizing, as you put it, snake oil from legitimate health claims.

Oxlan’s randomized trial showed that kids improved substantially in their ability to make the distinctions. At the same time, the parents’ ability to make these decisions improved too. Now, these are highly poor or poverty-stricken areas of the world in parts of the African continent.

We live in a rich country with more resources including information. That would make our job easier in terms of taking a proactive approach to personal health claims.

“Should people decide to educate themselves, they all would be in a position to make judgments themselves. They should certainly be in the position, even with quite limited knowledge,” Guyatt explained, “of asking their clinicians to justify what evidence there is to base what is being suggested and to challenge the physician or the clinician in explaining – to be made knowledgeable of the evidence that supports what they’re doing.”

The British Medical Journal or BMJ had a list of 117 nominees in 2010 for the Lifetime Achievement Award. Guyatt was short-listed and came in second-place in the end. He earned the title of an Officer of the Order of Canada based on contributions from evidence-based medicine and its teaching.

He was elected a Fellow of the Royal Society of Canada in 2012 and a Member of the Canadian Medical Hall of Fame in 2015. He lectured on public vs. private healthcare funding in March of 2017, which seemed like a valuable conversation to publish in order to have this in the internet’s digital repository with one of Canada’s foremost academics.

For those with an interest in standardized metrics or academic rankings, he is the 14th most cited academic in the world in terms of H-Index at 222 and has a total citation count of more than 200,000. That is, he has the highest H-Index, likely, of any Canadian academic living or dead.

He talks here with Scott Douglas Jacobsen who founded In-Sight Publishing and In-Sight: Independent Interview-Based Journal. We conducted an extensive interview before: hereherehereherehere, and here. We have other interviews in Canadian Atheist (here and here), Canadian Students for Sensible Drug PolicyHumanist Voicesand The Good Men Project (hereherehereherehereherehereand here).

Original Publication in The Good Men Project.

Scott Douglas Jacobsen is the Founder of In-Sight: Independent Interview-Based Journal and In-Sight Publishing. He authored/co-authored some e-books, free or low-cost. If you want to contact Scott: Scott.D.Jacobsen@Gmail.com.

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