So much for that alternative vote business. What a resounding kicking that took, eh?
It only managed to attract 32% of the votes - that’s one in three of those who voted. Pathetic. I mean it probably would have been enough to become prime minister at the last election - the Tories, after all, secured 36% of the vote.
But that’s different, obviously. Thirty-two per cent is a resounding defeat; 36% a mandate to govern. Nope, definitely nothing wrong with our electoral system.
Not that I was a fan of the alternative vote; it smacked of compromise didn’t it? And anyway, as a friend of mine said: “You can’t win; on the one hand you find yourself agreeing with David Cameron, then with Nick Clegg on the other. Logically they can’t both be wrong but, intuitively, they both most certainly are.” As it is, I think the whole referendum thing struck most people as dull or distracting. We were too busy to worry about constitutional reform and, anyway, we seem to like simple majorities. We like it when the numbers add up.
A recent study has suggested that everyone over 55 ought to be offered drugs to lower cholesterol and blood pressure. The report says age screening for future cardiovascular disease is simpler than current assessments and the age of 55 alone should be the trigger for prescribing. This is a bit like prescribing by a “first past the post” system. It may be that up to 40% of people need drugs but it makes sense to give them to everyone.
The authors also argue that this approach is more cost effective than the current system. They don’t add that it would also offer the pharmaceutical industry a timely boost and, who knows, maybe even lead to some new jobs for pill makers and dispensers everywhere? Anyway, blanket prescribing may really catch on. Antidepressants for everyone over 65 maybe? Anti-obesity drugs for anyone seen buying cake? Botox for the over-40s?
In fact I read this week that scientists have identified a natural supplement made from tomatoes that, if taken daily, could reduce the risk of heart disease and stroke. This supplement will be sold on a high street soon. Or you might just want to eat some tomatoes. That could work too. One wonders if it might make sense to give this supplement out with the drugs? A double whammy if you like. I have no doubt research into this potential marketing opportunity - I mean health benefit - is starting as we speak. Because it is the health of the population we are interested in here, isn’t it? Not new markets. Right?
The idea of generic prescribing raises some interesting philosophical questions. Does it make sense to defer to the public health view that wants to focus on managing disease by managing statistics? If we manage the greatest number in the clearest way, do we do the greatest good? Or, by not individualising our care, do we shift the principles on which we base our work and compromise its quality? And do we belittle the relationship between individuals and their own health by assuming they need drugs?
But it’s not philosophy that informs the modern health service, it’s economics. That which is cost effective is the key policy driver in these austere times and, of course, with every policy idea - as the referendum on the alternative vote reminded us - there are winners and losers. Prescribing by numbers would give at least one overwhelming winner - the pharmaceutical industry. And the losers? Large numbers of people taking drugs that they actually don’t need, maybe?