Fallacies and Misconceptions

A letter by Dr Patrick Kee Chin Wah, in which where he tries to dispel certain "fallacies and misconceptions" which surround our healthcare system, is published in Today today.

As doctors, we no doubt consider ourselves better-informed when it comes to discussion about the healthcare system, and we are probably right - we have a better background knowledge of the healthcare system and of the cost and benefits of medical treatment; we are perhaps better able to identify fallacies and misconceptions regarding the healthcare system.

However, what makes a 'good' healthcare system is not merely a matter of facts and figures, but also one of value judgement - we can arrive at precise figures of how much it costs to separate a pair of conjoined twins, for example, but whether we should do so is not a matter of facts and figures, but of value judgement.

While Dr Kee makes several valid points in his letter, he also presents fallacies and misconceptions of his own and imposes his own value system on what he considers to be a good healthcare system, and that of course goes beyond his stated aim of just addressing fallacies and misconceptions.

I happen to disagree with some of Dr Kee's points, which I will discuss below.

1. "Providing compassionate and competent end of life care is the humane answer to euthanasia which is an evil that we need to be fully aware of."

Here Dr Kee commits the fallacy of 'false dicotomy': the choice is between compassionate end-of-life care and euthanasia, and one is humane and therefore the other is evil.

Well, there really is no reason why we can't have both options available - euthanasia for those who desire it, and quality hospice care for those who do not choose euthanasia. Whether or not euthanasia is evil is not a matter of facts or misconceptions, but one of values.

2. "We need to recognise and prevent the rising incidence of "disease mongering"... Risk factors are portrayed as diseases. An enormous market for drugs are created when healthy people are convinced that they are sick and in need of medicines."

I hate to say this but I think it is Dr Kee who is fear-mongering here by being ambiguous. Which risk factors does Dr Kee think we should not treat? Obesity? High blood pressure? High cholesterol? Dr Kee does not specify any risk factor, yet concludes that those who have risk factors are "healthy" and not in need of treatment.

3. "The cost of medical care to the sick can only be reduced when the running cost of our hospitals and clinics are paid by a common fund through the tax that we pay."

Again Dr Kee is being vague. Is he advocating free healthcare funded solely by tax moneys? Or a subsidy system, which we already have? Is that the *only* way to reduce running costs?

The fact is we can reduce the cost of healthcare overnight by just providing a lower standard of care, so a "common fund" is not the *only* way to reduce costs. In fact, contrary to what Dr Kee stated, a "common fund" may create a moral hazard, encouraging people to consume more healthcare resources than they need.

I would have to say that Dr Kee's claim is in fact itself a fallacy.

4. "Our Ministry of Health is a misnomer - it is more a Ministry of Medical Services. Health is not the absence of disease but the ability to overcome disease. The healthy will not fall sick in the first place and when they do, they will recover. We need a Ministry of Health to focus on helping us to adopt healthy lifestyles, develop healthy families and maintain a healthy environment."

Of all the points Dr Kee made this is the one I found most offensive, because it is simply untrue and an insult to the people who do good work at the Ministry of Health.

The statement "[t]he healthy will not fall sick in the first place and when they do, they will recover" is a meaningless one, since it is but Dr Kee's own definition of what makes an individual "healthy". More importantly, it perpetuates the misconception that everyone can become "healthy" if they "adopt healthy lifestyles, develop healthy families and maintain a healthy environment", and if people are not it is because the Ministry or they themselves who are not doing enough. So is my patient with a congential heart malformation unhealthy because he didn't adopt a healthy lifestyle, Dr Kee? Or did my patient killed in a car accident die because he was not "healthy"?

The Ministry of Health does encourage people to adopt healthy lifestyles - remember the Health Promotion Board, Dr Kee? - and the National Environmental Agency and our public works departments work hard at giving us a healthy environment. To imply that the Ministry of Health only provides medical services and not perform health promotion is disingenuous.

We all have our own value systems and it is not wrong to want to shape how our world operates according to those values; what is wrong is spreading misconceptions and utilising fallacies when we argue our position. Well, according to my values anyway.