Tuesday, August 7, 2012

FoSiM: Motivations of Founders and Members. It doesn't add up...

The more I've researched the field of Medicine and Healthcare Reform, the more I've come to wonder:
Just why did Dwyer and his Famous Five setup the ISM "mini-me", Friends of Science in Medicine (FoSiM) in the first place?
Why have over 500 practicing and former Medical Practitioners and Researchers publicly identified as supporters of FoSiM?
The usual rubric is "Follow the Money!".

But from what FoSiM tell the world, there's no (real) money involved.
Which may be true at one level from their output and reliance on a rather over-worked CEO with a penchant for hyperbole and aggressive deprecation of others.

The problem is, I find that either an altruist, hobby/amateur or volunteer organisation just doesn't make sense in one of the largest, most important sectors of the economy, with the most powerful/aggressive vested interests (think Big Pharma) of any Industry including Tobacco, with so many powerful Political and Industry Lobby Groups already extant it makes your head spin and with the decades of research, published material and competing proposals from many sources, each highly funded and staffed with Academic, Practitioner and Maths/Stats experts.

This isn't even "David and Goliath", nor even "Ant vs Elephant"... For every one dollar FoSiM have, more than a million is spent by the other players (guesstimate).

Not to mention that litigation at this, the Big End of Town, is not only normal, it's to be expected at some point - especially if you aren't careful with your words or if you put a contrarian viewpoint. The other existing players have deep pockets and aren't shy of protecting their positions: why would you willingly jump into a bear-pit like that without adequate resources to defend yourself?

What are they thinking, getting into this area without being backed by deep pockets?
Or is there something we're not being told?

Of the many Working and Retired Medical Practitioners and Researchers supporting FoSiM:

  • Have they carefully informed themselves of the FoSiM agenda, statements and actions?
    • Perhaps some, like the AMA Federal President, will drop out when they catch on.
  • Have they signed up, thinking the Medical world needs more strong representation?
    • If so, do they think FoSiM has the resources, knowledge and staffing to properly carry out that mission? There can be severe professional and political consequences to over-reaching and failing.
  • Do any of them think membership of FoSiM will be Career Advancing or Career Limiting?
    • It's very hard to see how an amateur/volunteer/hobby organisation, no matter who's names are associated with it, will ever have the clout or respectability to help advance Medical or Academic careers. Their sphere of influence and Lobbying power is necessarily limited by funds and staffing: at some point, they'll fail to meet promises or make savage PR or Political mistakes, without the resources to address or correct them...
    • The Internet creates a Permanent Public Digital record: belonging to FoSiM will not be forgotten. Those 500 supporters are punting their entire careers on FoSiM never being discredited or failing spectacularly. Looking at the credentials of the CEO and the extreme,  attacking language in publications by her and some of the other Founders, I can't see a future for FoSim without deep controversy, tumult and even serious litigation.

Dwyer's "Famous Five" Founders, come in 4 flavours:
  • Retired, Non-medical, non-scientist, "Consumer Advocate", Loretta Marron.
  • Working Medical, Academic: MacLennan, Costa
  • Working non-Medical, Academic: Morrison
  • Retired Medical, Academic: Dwyer
I can see why the Academics, working or not, would have an interest in Healthcare Reform, especially a reform that's Ideologically based. Be clear on this point: the ISM/FoSiM position is both extremist and fundamentalist. Advocating for "more Science in Medicine" might sound uncontroversial and obvious, but exam their policies and the implications, and they want to change laws of Healthcare practice around the world banning Healthcare Fields they consider wrong and urge authorities to "aggressively pursue" anyone violating those new laws.

The "Science in Medicine" movement is Ideological not rational, not theory-based, only values based. Insisting that their one model is all that can be and they'll just keep changing the goal-posts so all non-Medical Healthcare is deemed wrong and hence they'd like it to be illegal.

The very process they tout, "Follow the Scientific Method" and "Show me the Evidence", they do not apply to themselves nor their Reform Agenda. There is a huge body of Evidence and prior work out there on what the real problems are with Healthcare and what the implementable solutions to them are: none of that work calls for "More Science".

The fact that FoSiM do not reference the established Field of Healthcare Reform, nor cite the Evidence, screams "This is an Ideological Jihad/Crusade against the Non-Believers, they shall be brought to heel or we will die trying". Anything but "Scientific" or "Evidence Based", which is wonderfully ironic...

The Retired folk - yes, it's a way to spend time and energy, to be involved, to still be relevant, perhaps even to make a difference. I can image Dwyer has a lot of pent-up frustration, regret and resentment resulting from feeling impotent to act against people, well intentioned and not, who attempted to treat his early HIV patients with "non science".

Given that Medicos, Teachers and Academics all suffer the Occupational Hazards of Professional Arrogance and Omniscience, Infallibility (and Absolutism: "One True Answer") with a tendency to personal narcism, even overbearing/berating behaviour, then in the confluence of all three, it must be rare to find people who are humble, self-deprecating and willing to listen to competing views.

So I 'get' the four Academics: they believe they have are Right and want to change the world in their image.

I 'get' those who practice or research in Medicine: they know their field of practice and can't envision any alternative approaches.

For those still working, it may even be useful in advancing their career, even securing project funding.

But Marron, a non-medical, non-Academic in retirement, what's driving her?

More importantly, what does she get out of this gig, both personally and professionally?

It isn't:

  • Career Advancement
  • Professional Interest, Practice, Recognition or Prestige
  • Funding research programs
  • Solving Medical or Scientific Puzzles
  • Creating a Better Healthcare system for the community
  • helping any individuals directly with improving their Healthcare outcomes
  • and not for the wages, according to what's public.
So if she's spending her own time and money, what does she get back in return, especially as she's retired, this 'work' can only only be done For Personal Interest.

This is Psychology 101: Humans need Motivation to continue engaging in an activity.

I can't figure Marron's motivation - it isn't anything Professional nor about helping Individuals, which leaves Internal emotional-defiicit drivers, as far as I can see.

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