Andrew Rix

Andrew Rix is an independent research and evaluation consultant, and Honorary Researcher at Swansea University School of Medicine.

Rethinking – interesting choice of word. Not review or assessment – more radical. Rethinking is a form of investigation not bound by the past, nor by a process and not constrained by the ecology of the future. Unlike the other option, a review, it is born of inquisitiveness, nourished by anarchy and unpredictable in its outcomes.

I cannot help but think that the group has given itself the harder of the two options. ​ 
 

Thinking is a subjective, individual activity, dependent on ideas: review a collective endeavour dependent on the establishment of at least a consensus about facts.

If a review were a narrative on a series of pictures in a gallery, a rethink would be an idea for an exhibition, of forms unknown, in a space yet to be imagined.
 
Why medicine rather than health or wellbeing? Narrower, about diagnosis and cure, individuals, not populations. As far back as Ancient Greece, medicine was practised by people trained and set apart from other citizens, bound by an oath still in use today. Public health and civil engineering have saved more lives but have lower kudos: a word coined for the specialist elite making up the premier league of professions. Doctors served the elite; herbalists and wise women, barbers and sawbones, the poor, although the chances are that midwives operated across the economic spectrum.

Science has delivered much but at a cost to communities – we know how to cure but neglect to care.

Scientific medicine is a relatively modern phenomenon –  health, as a collective community activity much older.
 
What needs rethinking is not their history but their relevance and appropriateness in a modern health system. Science has delivered much but at a cost to communities – we know how to cure but neglect to care, a view reflected in investment in institutions not matched in our communities.
 
Here the argument may well founder on what constitutes evidence. Hardline reductionists may well argue that reports and evaluations extolling the psychosocial approach are little more than subjective opinion, singing the praises of like-minded work.
 
The opposing view is that much of the scientific evidence values statistical significance (p =) more than its importance to society (contribution to the quality of life).
 
What is clear is that science has given us choices, but they may not be the choices that matter. At the same time, communities have lost the capacity to define and support what matters. Rethinking the relative values of chalk and cheese is seldom easy, but at least they have calcium in common.

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