Re: A 7/7 NHS: what price equity? and accompanying comment piece - publication bias in the BMJ?
John Appleby's review of the data relating to the cost of a 'seven-day-service' in the NHS is a welcome addition to a discussion that has so far focussed on whether or not increased mortality at the weekend can be addressed by expanding services (see Freemantle et al. BMJ 2015;351:h4596 and responses). Appleby points out that even if one assumes that providing a seven day service could prevent all excess mortality, the cost of doing so may exceed the current NICE threshold of value for money for new drugs of £20,000-£30,000 per QALY. He concludes that 'the existence of an inequality is not enough justification for spending money to reduce it'.
This article should lead us to further question the government's pursuit of a seven-day-service and the attack on doctors' working conditions that it supposedly requires. Why then has the BMJ published a comment piece by Des Spence in the same issue which contends that 'the pressure to provide a seven day health service is an unstoppable cultural juggernaut of expectation', and that the current industrial action by the BMA is therefore a 'bad idea'? Dr. Spence also repeats the government's assertion that the public do not support strike action whilst providing no evidence to support that claim.
I find it strange that the BMJ have decided to publish Dr Spence's comments, even including the headline 'Why striking is a bad idea' on the front of the issue's print edition, as it provides a false sense of disunity within the profession on the issue of industrial action. Dr. Spence has criticised the biased nature of publishing in the past in relation to evidence based medicine (BMJ 2014;348:g22), yet his views representing the 2% off doctors who voted against industrial action are given prominent place in an international journal.
Whilst debate about the merits of industrial action is clearly necessary, giving such a large amount of space to such a minority opinion is misleading at best.
Rapid Response:
Re: A 7/7 NHS: what price equity? and accompanying comment piece - publication bias in the BMJ?
John Appleby's review of the data relating to the cost of a 'seven-day-service' in the NHS is a welcome addition to a discussion that has so far focussed on whether or not increased mortality at the weekend can be addressed by expanding services (see Freemantle et al. BMJ 2015;351:h4596 and responses). Appleby points out that even if one assumes that providing a seven day service could prevent all excess mortality, the cost of doing so may exceed the current NICE threshold of value for money for new drugs of £20,000-£30,000 per QALY. He concludes that 'the existence of an inequality is not enough justification for spending money to reduce it'.
This article should lead us to further question the government's pursuit of a seven-day-service and the attack on doctors' working conditions that it supposedly requires. Why then has the BMJ published a comment piece by Des Spence in the same issue which contends that 'the pressure to provide a seven day health service is an unstoppable cultural juggernaut of expectation', and that the current industrial action by the BMA is therefore a 'bad idea'? Dr. Spence also repeats the government's assertion that the public do not support strike action whilst providing no evidence to support that claim.
I find it strange that the BMJ have decided to publish Dr Spence's comments, even including the headline 'Why striking is a bad idea' on the front of the issue's print edition, as it provides a false sense of disunity within the profession on the issue of industrial action. Dr. Spence has criticised the biased nature of publishing in the past in relation to evidence based medicine (BMJ 2014;348:g22), yet his views representing the 2% off doctors who voted against industrial action are given prominent place in an international journal.
Whilst debate about the merits of industrial action is clearly necessary, giving such a large amount of space to such a minority opinion is misleading at best.
Competing interests: No competing interests