Disinformation kills. How to convince Poles about prevention? Episode 116

Monika Rachtan
Hi Monika Rachtan. I would like to welcome you very warmly to the series of debates, conversations that we are organising together with the Institute for Patients' Rights and Health Education. Today we are going to touch on a very important topic related to prevention. We will consider what would happen if we decided to provide more money for prevention. Is there then a chance that we would also spend less on treatment? This is what I will be discussing with my guests today, and they are Professor Artur Mamcarz. A very warm welcome to you.

Artur Mamcarz
Good morning.

Monika Rachtan
You are the president of the Polish Society of Holistic Medicine and Igor Grzesiak is with us. Hi.

Igor Grzesiak
Hi, good morning.

Monika Rachtan
Igor is vice president of the Institute for Patients' Rights and Health Education. Igor A simple question for you, because you are close to patients. You are close to the patient organisation. Why don't Poles go for preventive examinations?

Igor Grzesiak
I, for one, am not close to the patients. Much closer to the patients is the Professor sitting here with us. I am closer to the patients' organisations. Yes, that's right, because we are an organisation that primarily focuses on working with patient organisations that bring patients together, that help patients, that bring patients together. It depends what the structure of that is. We did even more last year, a year and a half ago such a survey. My memory is not that good any more, but it was a nationwide health survey where we had quite a large group, more than 1,200 people. This survey was mainly online, of course, but we asked a number of questions there. And there was also a panel, one that was dedicated to prevention. And interestingly enough, patients know that prevention is important, that it helps, that it is effective. They also know, of course, in their declarations. They declare that they go for this examination, they do screening. As part of preventive screening. Well, of course, if we see the statistics, it is only the declarativeness of the patients. If there was a question where we asked for reasons why, why not, they do not use such programmes, because we very often have programmes here dedicated to different groups of patients, as well as we can also use within the framework of POZ. Each of us, as a citizen, can also go and see a doctor and receive such a referral for examination. But one of the main reasons for not taking advantage of preventive examinations was a lack of information. And that is it.

Monika Rachtan
You think patients don't know where to get these tests. They don't know what range of these tests can be preventive. And have you asked them why they don't go to their primary care doctor? They won't ask that.

Igor Grzesiak
Yes, yes, because they don't know that there was also a question just dedicated to that. Did you know that your GP, your general practitioner, can make a referral for tests? Well, and indeed this knowledge was not very high here. However, patients largely declared that they were not aware of this, and this is also confirmed by the lack of this information, the implementation of the programme, which I very much praised 40+, because I am already over 40 and I have used this programme twice and I think it was OK. In principle, the programme was good, because I was able to carry out a number of tests for myself under this programme. Of course, first you had to do a survey at IKP, right? You'd get a referral, there was wide access to a laboratory where you could do that survey. Well really up to that point it was great. What was missing there was just what to do next, which was this kind of coordination.

Monika Rachtan
That is, what is already in our new My Health programme.

Igor Grzesiak
Also when we analysed the 40+ programme why it had such rates, well that is also a lack of information. People simply did not know how to use this programme. They also did not believe in the programme. They claimed that, this accessibility against the odds is not that easy. I even had conversations with our patient organisations where I always praised this programme as a good step in the right direction. And there were voices saying, no, it doesn't work, it doesn't work. And I said, sorry, have you used it? Well, no. But I would encourage you to first check whether something works or not, and only then make statements. Well, as a rule, we assume that, well, we are so negatively disposed towards, however, some good solutions, which, indeed, are sometimes offered by our state, by the Ministry of Health. I now hope that this My Health programme will indeed be a programme to suit our needs. And here we need to put a very strong emphasis as media, as organisations, as doctors, as payers to promote this mechanism and that indeed these tests are performed under this programme and that this translates into public health of our population. Importantly, it's not a 40+ programme, it's from the age of 20 onwards then this cohort is much expanded and that will probably be important here too.

Monika Rachtan
Professor, Igor said that often patients do not have information about the fact that preventive programmes are available to them at all. As you think, Professor, this responsibility for the patient to find out about the prevention programme should be ceded to the doctors, it should be directed precisely to the patients' organisation. However, should the Ministry of Health consider how it can reach out to the public in order to convince the public to participate in preventive examinations. Because it seems to me that the key is to get information and, what is more, with such a positive environment, that it is worth it.

Artur Mamcarz
Everyone needs to get involved. I thank you for the invitation, of course. And to take advantage of something, like the old saying to win, you have to buy a ticket. So first of all, of course, you have to know, but I think that a lot of people do not know, and even somewhere this information escapes them, because, of course, when we get ill, when we are ill, then probably this visit to the doctor or contact with the doctor is necessary, because we have ailments, symptoms. But this is a disadvantage of prevention programmes and prevention in general, when, as it were, the effect or the benefit, the benefit of joining a programme is so distant, firstly, and secondly, many people think of themselves in a wishful way, that it doesn't affect them, that they don't have to do anything good for themselves, I not only represent the Polish Society of Holistic Medicine, but I also work for the Polish Society of Lifestyle Medicine, which is a key element from the point of view of talking about prevention, because these are health-promoting behaviours, so you have to find out first. But I think it's not that we crave this information, we want it, because it actually appears somewhere in space, but we don't really want to take advantage of it, because sometimes it might be better not to know. It's that this is the attitude of many patients, and maybe it's better not to know what it looks like. For now, I feel fine and this condition will continue. In view of this, everyone needs to talk about it and doctors and journalists and patient organisations so that this message is translated into the language of benefits for the patient, as I call it, then probably in marketing we talk more about the language of benefits, but here in health we also need to talk about it, because it is a question of first finding out what the problem is and then being able, as doctors, to respond in the right way by implementing certain therapeutic programmes or modifying habits, lifestyles. This is a very complex problem and I am talking in acute diseases, hence, for example, the successes of actions in medicine that show acute actions. These successes are easier to show, prove, document and are in the short term. They are sometimes extremely expensive, but they can be seen very clearly. In prevention programmes, on the other hand, we will see the results in a few years, sometimes several. Therefore, it takes a great deal of awareness on the part of society as a whole, of what we are talking about now, in order to build this success, first to learn, then to implement these elements, then to invest in one's own health together and then to consume the success that is seen far away. This is the downside of prevention or prevention. We will probably talk about vaccination, because this is also one element that is extremely important, not only in paediatric medicine and not only paediatricians deal with vaccination, but we have a whole programme of preventive health in adults who need to be vaccinated to avoid certain situations. But this is a separate, also very important problem or programme.

Monika Rachtan
We will talk about vaccination in a moment, and we will indeed return to it. Professor, you said one thing which is very important to me, however, and that is that we should make use of prevention, that prevention should be a part of our lives, because it cannot be just a matter of going for a check-up once a year, because we cannot treat this as prevention. We need to be aware, and just as we all know that smoking cigarettes is harmful, we all know that overeating is not good for our health. However, when we look at this society as a whole, I am of the opinion that it still does not have this awareness. I don't know how you look at it, at this problem, but in my opinion, in the Poles, and this is a programme for Poles, for patients, because you very often speak to doctors, Igor, you very often speak to decision-makers, and I speak to the average Pole who is sitting on the sofa eating a packet of crisps right now. There is something about us, about the Poles, that we are not aware that we need to be vaccinated, that we must not smoke and that nicotine is harmful. Why doesn't this information reach us? Or why are our ears plugged that we can't hear it?

Artur Mamcarz
Building this awareness is such a common task for us. Doctors can't handle it alone, it's too small a group. If we include all systemic health care workers. Physiotherapists. Nurses, paramedics. Public health workers. It is not enough here either. It simply has to be drilled all the time, a drop drills the rock.

Monika Rachtan
Professor, but as Igor said, you are the professor closest to the patients. You meet them face to face in your office.

Artur Mamcarz
I see sick patients. I reach out like all doctors do. We reach out first and foremost to those who already have this problem.

Monika Rachtan
Well, yes, but...

Artur Mamcarz
Also, primary care doctors, GPs have tools, because patients come to them, well, from a wide whole medical space, sometimes for check-ups, for a certificate, for different things, yes? Therefore, they have more tools to deal with prevention as someone who works in a hospital setting, a clinical setting. We exclusively have sick, often very seriously ill patients.

Monika Rachtan
But you, Professor, also have the opportunity to implement elements of prophylaxis for such patients, for example, pneumococcal vaccination in cardiac patients. And you encounter such situations. I would like to find out where the problem is in people, that they do not implement this prophylaxis. Does it happen to you, Professor, that you have a patient who is post myocardial infarction and you, Professor, say that you should be vaccinated against pneumococci at such an age because this is a high cardiovascular risk patient. He turned 55. I don't remember what the criterion is, but around 50.

Artur Mamcarz
60 or 65 in this group.

Monika Rachtan
And that patients negate this, that I argue with the professor that no, I will not be vaccinated because vaccinations kill.

Artur Mamcarz
Some, of course, probably have this opinion, sometimes they don't verbalise in such a confrontation with the doctor when they have a certain medical problem. But I think it's easier to convince patients in what we used to call secondary prevention. And that is prevention of preventing another incident. Then it's easier to reach, but population-wise, when you're dealing with people who have risk factors but don't see that risk, it's much harder. However, in this group you are also right. There are opponents. There are opponents of different modifications. Sometimes it's like this example that keeps surprising us. We talk about something called therapeutic adherence. In patients who already have hypertension, lipid disorders, are post myocardial infarction, have heart failure, they say only in cardiology, but in all disciplines it is the case. Sometimes these diseases don't have big symptoms. They will flare up at the beginning and they don't take medication. So we have a problem not only with lifestyle modification, not smoking, tobacco is harmful, that's obvious. We talk about it all the time, excess, alcohol abuse, poor diet, lack of exercise. But they don't take medication, which would seem to be straightforward. We have evidence that these patients are seeing what their blood pressure is, that it's a good control, that it's lowering their cholesterol. Also the problem is very complex. This education from the ground up and repeated drops drills the rock. It's not like a one-off message will result in such a significant improvement. We have the tools of today, we have phone apps. We can use that app to remind people to take their medication. There are different systems in the world built. Again, I give the example of this adherence, where there are huge successes in many countries in the European Union in controlling blood pressure. But it was all hands on deck. Portugal is such an example where blood pressure control is almost 70%.

Monika Rachtan
Professor, it's also not that these patients forget to take this tablet.

Artur Mamcarz
Intentions sometimes do not do this.

Monika Rachtan
Well, that's what it is, but I wonder what it is because of. This is for me, for me. What I am missing here now is a psychologist to ask what the mechanism is.

Artur Mamcarz
A complex process, it's a lot of different mechanisms that determine this. Sometimes it is a lack of communication. We talk about communication. Again, I come back to the holistic, to talk to the patient, not dividing them into pieces, For the fact that he has hypertension, diabetes, overweight, smokes, that's the patient. Sometimes he has obstructive pulmonary disease, because smoking gives you an increased risk of pulmonary and cardiovascular and oncological complications. Obviously a lot of different complications, to treat it holistically and say we're going to talk about it so you get the benefit. The benefit is prolonging quality of life. Those are also the two elements that we need to talk about. That's why we treat blood pressure, lipids, diabetes, obstructive disease, a lot of different problems, to prolong life and to make the quality of that life good, better than before. Maybe we, because again I am throwing a pebble into my own garden, maybe we speak the wrong language, Maybe we don't know how to build this relationship with the patient, how to convince them, how to use the right arguments.

Monika Rachtan
I think the issue of language is very important here. Igor. I will still come back to this awareness, but I also wonder, I would like some action to propose maybe to the Ministry of Health, because the responsibility is shared. The responsibility is the patients' organisation, because they want to and they do it very often simply because they feel the need and want to help. On the other hand, we have doctors who do their job and, quite simply, somewhere in their profession, this mission of education should also be present, although it is difficult in today's system to meet administrative and medical requirements on the one hand and, on the other, to be in good contact with patients, presenting them the whole background of their illness. There are us journalists who do a job, but we are very much hindered in this by various people on the Internet who sow misinformation. And then there is the most important one, the Ministry of Health, which should also care about our health. And do you have any advice for the Ministry, any ideas on how to encourage Poles to get vaccinated against flu next year, not 3%, but 30%.

Igor Grzesiak
Unfortunately, there is no such simple advice, because if there were, we would probably not have all the problems we are discussing today. I would like to return to your earlier question and to the rather synthetic statement made by the Professor, which in fact covered all the elements I also wanted to talk about, namely why there is no information and why these programmes are not translating in any way into improvements in the health of our society, because there are many factors at play here. I would start with the lack of health education.

Monika Rachtan
Which was promised to us.

Igor Grzesiak
Which was promised to us, is promised to us all the time as a voluntary object. Ok, now we can argue whether we cared about that, but as if someone asked me if ....

Artur Mamcarz
I wouldn't argue. I think we were all interested in taking the opportunity to teach kids in an hour for health how to convince their parents. Because through kids you can reach parents beautifully.

Monika Rachtan
And we will probably all raise our hand here that we are in favour of compulsory.

Igor Grzesiak
We are in favour of compulsory, but we will have voluntary. It is certainly a good step in the right direction and I say five years ago I would have really gone in blind, even for such a voluntary subject. It's a shame that it didn't work out to make it compulsory. Ok, I think we still have everything ahead of us, so this education will definitely be from an early age, but what you emphasised, Professor, it cannot just be intentional education, it cannot just be education in Grades 4-8 and then 1-3. It really has to be a lifecycle education. We are missing that and it has to be, it has to be education. If we're campaigning, if we're educating the general public, I mean who? Each of us perceives information differently. Each of us has different competences, skills to understand information, very often complex medical information. So we will also try to target different groups with regard to the risks, for example. Here, we have talked about vaccination, and it is different for healthy people, different for people who are actually in risk groups, different for young people. So this communication really, I think, the key, it has to be tailored to the audience. So that's certainly my one piece of advice, that we don't do this kind of communication en masse, because it, it, it apart from the fact that we'll have a lot of indicators, we'll burn a lot of money on these campaigns, but it won't translate into effectiveness in any way. It's better to do small dedicated campaigns in local communities, in cooperation with local authorities, To get an effect, because we don't need to get an effect of scale as such a big campaign, big numbers and so on. We need to get changes in social attitudes And for example, it is a good solution to propose now within the Ministry of Health a fund for NGOs, patients' organisations for preventive actions. And indeed this has a chance. If it is well distributed, these funds will go to small organisations, not to the big ones here in Warsaw, only to those who carry out these actions in one way or another, but to those who operate in the regions, who have direct contact with the local community and who have ideas on how to reach the local community, it really has a chance to translate into effective, efficient actions in the area of, for example, vaccinations, because we are talking about preventive actions, but also in the area of, for example, using the My Health programme, which will be a big challenge for us to promote. Well, this communication, it seems to me, is the key, but this communication is not learned either, nor is health education in one year. Yes this, this is the education that has to be here from the side properly conducted, from the side of the medical professionals, but also there has to be this communication from the other side, because here come two.

Monika Rachtan
Two worlds.

Igor Grzesiak
Two worlds. Here comes a patient who is burdened by his illness, by his problems, here comes a doctor who, again, is burdened by work, administration, overworked, yes? And this is where the problem can really arise and, as I say, we will not solve it here and now. It is certainly a pity that, in organising such a meeting on prevention, we invited the National Health Fund, which runs various Prevention Wednesdays, for example, and runs a portal with diets, and no one knows about it, no one knows about it, because patients themselves do not know that such tools exist at all. There is a possibility, because I know, after all, that your programme is. It has a very large reach on the internet, there is an opportunity to show it off. There is an opportunity to show off the My Health programme, to introduce it to patients to at least those 30, 40, 50 thousand. I don't know how much of an audience this episode will have. So what...

Monika Rachtan
So that is the advice, however, that they should use the outreach channels with which they can actually reach patients.

Artur Mamcarz
This too.

Monika Rachtan
You mentioned vaccinations and so a thought occurred to me now, because you, Igor, said on the one hand about these diets, where is the National Health Fund website. I've been on that site myself more than once, I know that site and I wonder if, for example, if I type in diet for insulin resistance, will that site rank somewhere in the first, second and third place on the internet, or will it be flooded by a wave of misinforming articles advertising a cooking device with which you can make healthy meals with a diet for insulin resistance and various other content. And this NFZ is going to fall to the bottom because I wonder why, for example, when we have such good Ministry of Health pages about vaccination, lifelong vaccination and they even position themselves well, because when I look for information about vaccination, unfortunately I don't know all of them by heart. It's usually that Ministry of Health website somewhere up there that pops up and I'm able to use it. And now in the context of vaccinations, Professor, have we gone mad in the last 20 years and started listening to charlatans, various strange people who tell us that vaccinations are killing us, are with speech And all these other arguments that we don't want to repeat. Have we lost all authority related to health? We have stopped believing doctors, that someone is able to tell me that it is not worth vaccinating my child against whooping cough, for example, by deciding to do so.

Artur Mamcarz
Or against diphtheria until recently it seemed that only theoretically we would. I spoke to one of the leaders of Polish vaccinology, who said he had a lecture for students on Monday says. Fortunately, the last disease, a big, serious, What can I talk to you about? Purely theoretical it is diphtheria. And four days later, he admitted a child in serious condition who required ventilator treatment, where the parents intuitively did not vaccinate him, apart from the enormous cost. I do not remember the exact details. All I remember is that vaccination against this two-component vaccine costs around 40. Systemically, it costs that much. On the other hand, the money that was put into the whole chain of epidemiological investigations, interventions with sera in people who were exposed, that is millions of euros in Europe, which had to be borne as a cost, and there was no reflection on the part of the person who did not vaccinate the child, but the vaccinations are. I am optimistic and I think we have a lot to do of course and we are vaccinating more and more adults. There are joint documents coming out which are position papers from both vaccination doctors and pulmonologists, cardiologists, diabetologists to promote these vaccinations in adults who have a very high risk, then you can refer to this as a very simple argument if I don't vaccinate, let's assume that I consider an extremely healthy person, 50-60 years old, from a long-lived family, without hypertension, slim, non-smoker, active, with full financial freedom will not vaccinate, then the probability that he will be harmed by the infection is small, but if we do not do the same in a patient who has chronic obstructive pulmonary disease, is post-stroke, post-biopsy, post-heart attack, has high blood pressure, obesity disease. It is the failure to vaccinate that patient that is the risk of their death. That is the risk that with any trivial viral infection any one of course could be trivial. It could be flu, it could be RSV, it could be COVID, it could be pneumococcus. When the availability of these vaccines is increasing, it is a malpractice not to vaccinate. Simply not talking about vaccination in our environment with patients is a mistake. Is availability is a big deal, it's getting bigger and bigger and we just need to talk about it. I think we are at the beginning of the road, and I don't want to answer the question that we have gone mad as a society. When we are discussing the issues of the biggest in my opinion, not only in my opinion, But if we were ranking the systemic successes in health care, in public health, I think vaccination is, according to the vast majority of opinion, in first place, and certainly that first place is claimed. We can discuss access to food that is bacteriologically clean water. That's what I'm saying the last 100 years is all about when we talk about immunisation. To question this success is simply I don't want to use strong words, well it's just not legitimate. Because this is the biggest success story. The number of people whose lives have been saved, saved from disability is enormous. I probably... Well, I don't wish the students we teach to see what we sometimes saw as students 35-40 years ago. I remember foul-smelling encephalitis in a child. To this day, I remember the epileptic state that this child was in because of this inflammation, which ended up in a bad way. Not vaccinated for immunological reasons immunosuppressive problem or non-intensively just because it could not be. So I would probably show this simply to make the opponents of vaccination realise that this is the safest, most effective public health. Procedure in the history of medicine. That needs to be said so strongly I think.

Monika Rachtan
I think it is time for these strong words, because we talk all the time. You, as doctors, as experts, often use language that is incomprehensible to patients, such as health risks. But it needs to be made clear that the moment you do not vaccinate, you are putting yourself at risk of death.

Artur Mamcarz
Pneumonia and you could die from it.

Monika Rachtan
Either your loved one could die, or a small child could be happening right now in the waiting room. Igor you wanted to speak. Sorry, I'm already giving it to you.

Igor Grzesiak
Yes. Well, because vaccination is a perfect example of what the professor said here, that it is the greatest public health success story of the last hundred years. Perhaps in all of history that's how it's been since it's been, we're recording, so accurately. And we have indeed a lot of ills in health, but we also have, we also have some successes and they are really and truly not small. And unfortunately, the problem is that we don't know how to take advantage of it. We as a society no longer do. We as a system, not as doctors, not as patients. We as citizens. As far as the ranking is concerned, which the professor has already mentioned, we have prepared a ranking of the greatest health concerns of Poles.

Monika Rachtan
That's right. And what comes first?

Igor Grzesiak
Oncological diseases, cardiovascular I think as the second. I can't remember exactly, but it was the top three. Oncology, cardiology.

Monika Rachtan
And now Igor. I'll take your word for it. We have the HPV vaccine to prevent.

Artur Mamcarz
Eliminate the likelihood of illness, disease.

Igor Grzesiak
I'll elaborate then, as it were, on this ranking of ours. And then, of course, there were these HPV vaccination programmes. We thought it would be good to ask Poles what their attitudes to vaccination were. And knowing that, within this ranking of Poles' greatest health concerns, oncological diseases are at the top of the list. We perversely asked whether they would use such a tool if cancer prevention came up, yes. Of course, if we are talking about cancer prevention. Yes, of course the majority of the respondents would use such a prevention. Well, but once we got deeper into the survey and started asking questions about the fact that this prophylaxis would be linked to vaccination against HPV, which is a very oncogenic virus that causes all sorts of cancers, well that statement fell on me, and by a lot. And I think it's halved. I'm sorry I can't remember all these results now, but you can read them on our website. There's this report to download. What's kind of comforting about all of this is that when we asked at the end if you would use this programme to safeguard your children, people who wouldn't use this form of safeguarding themselves are already more likely to safeguard their child. So we also think a little differently about our loved ones than we do about ourselves. The problem with vaccination is that we are more afraid of some imaginary problems, adverse reactions that pop up for us. First of all, when we type in vaccination into Google, we get all these different stories, but we are not afraid of the disease. We are more concerned that there will be side effects and less concerned, for example, about a cancer disease that might affect us because of it, or some other disease that might cause...

Artur Mamcarz
The paradox of prophylaxis, we are more afraid of an adverse effect, of some intervention, than of a benefit. That is to say. We consider the risks rather than the benefits. This is how it is in many medical threads, also present, for example, in anti-coagulation treatment, which in patients with atrial fibrillation is a big problem. Cardiovascular prevents stroke, which everyone associates with the patient. Stroke is disabling. The fear of stroke is at least as great as that of oncology. Consequently, we say we will treat so that you don't have a stroke. But when someone reads the leaflet or gets the information, they will be afraid of it. He was afraid he would bleed, because these drugs carry the risk of bleeding, not the theoretical risk of stroke, which doesn't necessarily affect him even if he doesn't take this treatment. This is obvious. The treatment does not prevent it 100 per cent, the state only reduces the likelihood. I think it would be a mistake to allude to this. It was a covid pretext for this when we were talking about this communication wrong again, which is a lot of patients. Now, such an interesting study was carried out by our colleagues who deal with epidemiology and prevention in cardiology. They asked patients who were enthusiastically vaccinated against covid. They had arguments and a question. There were a lot of questions for what reason, How was the eventual illness, Do not regret it, and many of them regretted it and it turned out they regretted it because they got sick despite this vaccination. That is, the message that was emerging. Anyway, we all remember it said vaccinate, you won't get sick. That message was wrong. We all replicated it to argue, to encourage, just to reduce the likelihood of getting sick. And if you do get sick, it's mild.

Monika Rachtan
Yes, you will not die. It seems to me that this is the word here that is not going to die. But when we saw so many deaths during the COVID pandemic, here saying assure someone that they will not die is very meaningful. Because saying I will not get sick, well that was the message.

Igor Grzesiak
Of course, I would still add here, because that is the whole message in terms of prevention. Yes, it should be that we do not do these screening tests in order not to get ill. We do them so that we know if something is wrong and what medical interventions should be taken.

Monika Rachtan
And react quickly.

Igor Grzesiak
Whether to change, for example, such simple even change your diet, introduce movement or actually go here and for example under diabetes.

Artur Mamcarz
Will the patient find out they have diabetes?

Igor Grzesiak
Yes, yes.

Artur Mamcarz
Because he doesn't know. That's why, because she hasn't done the research. What will he find out? That she has very high cholesterol? Again, this is a whole lot on the web. About the current misrepresentations, misinformation about drugs that have a very high safety profile also, but there are quite a lot of opponents. I just think we should take this opportunity, these conversations, to say that all those who listen to these whispers when they are not yet ill are not really acting preventively, they are not vaccinating. They don't take medication, but when they do they get sick, because that is clearly linked to the risk of getting sick. Some will have a heart attack, some a cancer problem, some a stroke. They will not go to those whispering wrong information in their ears on the web, but will place a systemic, financial burden on this health care system as well, where there are no full bags of money that we can spend, only that bag is always too empty. Therefore, if we detect. This is the essence of preventive programmes at an early stage of cancer, hypertension, diabetes without complications, then the cost of treatment is much lower.

Artur Mamcarz
If we detect this in its advanced form, the system will generate enormous expenses, because we must nevertheless have an offer for these patients, despite the fact that they have not previously complied with these recommendations. There is a need for some kind of legal and formal regulation, which would make it so that this action, which is not to the detriment of a specific patient, but of those who persuade them to do so, is linked to legal responsibility. Simply so that it can finally be prosecuted, in short, and punished.

Igor Grzesiak
The professor really touched on the clue of the problem and the challenge I think. And I would also put a bit of a stick in the anthill here and a bit over this financial element, the financial costs that we generate. Now of course you have to separate that out. There are vaccinations, for example, for children, so-called compulsory vaccinations. And here we already have the first discussion why mandatory, why not recommended and so on. And then there are vaccinations for adults, where we have a lifelong vaccination calendar for particularly high-risk groups. And now, if there are situations like this, well, each of us. For example, if. If he uses his own car, has his own car, yes. I am already overlooking the fact that he has to go for a check-up once a year. I just went for a check-up today, that's why. Well, I had to go. Well, if I don't go, I pay a fine, I pay a penalty. If I don't pay the OC, I'll pay an even bigger fine for not having OC, but more. If I cause an accident, independently or someone will cause an accident. I will not be at fault. Well, I don't get any more out of this OC. I will be the one responsible for the damage.

Artur Mamcarz
This is not the case in health.

Igor Grzesiak
This is not the case in health. Well, why don't we finally open up the discussion? OK, we are a bit like that. Now we have become a State of the freedoms, so that we decide for our own health. Well, if you decide for your health, for the health of your children, and you make the choice that you don't vaccinate with the compulsory vaccination just diphtheria among other diseases or, or, or other diseases. And then this episode. Maybe this is too soft a wording. There is an occurrence of a disease that burdens ...

Artur Mamcarz
A life-threatening condition, placing a financial burden on the system.

Igor Grzesiak
I'm sorry, you're obliged to pay for it, yes? Well, I know it's not popular.

Monika Rachtan
It's not popular, but that's what I've been saying for many years.

Igor Grzesiak
Because it's difficult, it's not all things that have to be popular, because....

Artur Mamcarz
Because we also need to speak boldly about being in favour of the main preventive procedure in general, we should all hands on deck. And if we see, after all, that some in the public space, including politicians, say that they are against compulsory vaccination. Therefore, it has to be said that this is a message that is absolutely harmful medically, systemically. This is simply also a situation that should not happen in my opinion.

Monika Rachtan
We often talk about how there is hate speech on the web, language that hates, language that harasses. But I believe that if information is coming out of the mouth of a doctor politician, someone who calls themselves a doctor or a doctor, which is not in accordance with medical knowledge, and is inciting behaviour which is not health-promoting, then we should punish these people, and these should be punishments. This is to me, this is incitement to murder, to freedom.

Artur Mamcarz
I understand these arguments, of course, but one's own freedom ends when the freedom of another person begins. And in the system of compulsory vaccination of children, we are also setting up what is called a kind of protective cordon. There is a certain group of children who cannot be vaccinated for health reasons, and this blanket vaccination of the others means that they have a lower risk of falling ill. This is also their freedom. They cannot do it. Their parents, although they would love to do it. They can't afford it. So there it is. Of course, we could develop this theme very much of freedom, but this is my understanding of it, and I think that this responsible, mature treatment of these freedom systems should take into account the freedom of others.

Monika Rachtan
One last question already at the end, because probably our viewers may not be aware that this correlation between how much we spend on treatment today is, as it were, a consequence of the fact that we are not implementing preventive measures at an appropriate level. Because the professor mentioned that. But I will perhaps use an example. If vaccination, let us say, costs 100 PLN for the system, and the treatment of a diphtheria patient costs 100 thousand PLN, in hospital, we can see how much we could save by vaccinating. And I think that because there has been a very loud discussion recently about whether the health premium should be increased, whether it should be lowered, who should have it lowered, why don't we discuss it with the public? What can we do to spend less on treatment through our preventive measures.

Artur Mamcarz
This is the classic example we have been talking about lately. It would probably require another hour-long conversation. There is one of the major medical problems and challenges of today. It is obesity. It is a disease that combines like a lens many cardiovascular, neurological, orthopaedic, oncological risks, all 200 complications.

Igor Grzesiak
All diseases.

Artur Mamcarz
Exactly so. And it is already known today, in systems that behave maturely and preventively towards patients suffering from obesity, that spending one dollar calculated in this way yields a benefit of $7-8, not in the next month, but in years. This is what we should do. This is the prospect of both obesity, overweight in children as early as kindergarten, school children, adolescents, young adults at every stage of life. The earlier we spend this money. The more easily we break the vicious circle that overweight and obesity generate, the greater the systemic benefits will also be. And this is such a classic prevention model also physical activity, not smoking, fine, good quality sleep, relationships between people, because also relationships and lack of relationships increases the risk of many problems of obesity, but oncological diseases as well. So we know what it means to have a lifestyle that promotes health and we know how this prevention should be carried out. We just need all hands on deck and to do something together. Something more.

Igor Grzesiak
Yes. That is, I think we are missing in the space, but such a real discussion on how this health care should look like, how prevention, how important prevention should be in this whole puzzle. There are demands such that the constancy of the health budget should at least 5% be dedicated to a fund that will be dedicated to prevention. And now the question. Who would manage such a fund? Is it precisely the Ministry of Health, which, for good measure, deals with interventions? Or should we perhaps look for another solution in the form of at least a plenipotentiary for public health in the Chancellery of the Prime Minister or some other body that would collect all these dedicated funds, which at the moment they are, They are in various places. After all, we have excise duty money, sugar tax money, cork tax money. And I have just left the unfortunate sugar tax at the end, which is a great solution. We have very high revenues from it, but they in no way fulfil their purpose, because they go into the sack, they go to the NFZ and they are spent on salaries, on benefits, on wages.

Artur Mamcarz
And they were supposed to go towards prevention and promotion of physical activity and a proper nutrition model in children.

Monika Rachtan
Because we could discuss and debate about this prevention, because the thing is very much to do. But I would like to address our viewers and remind you that the latest project of the National Health Fund and the Ministry of Health, which is not present here, concerns and is called My Health. Mine, which means yours. And it is you, above all, who are responsible for whether you implement preventive measures and for what your quality of life will be like in a few years' time. It is worth investing in it. This was a debate organised by the Po Pierwsze Pacjent programme and the Institute for Patients' Rights and Health Education. My guests were Prof. Artur. Mamcarz. Thank you very much, Professor.

Artur Mamcarz
This is me thanking you.

Monika Rachtan
And Igor Grzesiak, thanks to Igor for being here. Thank you very much for your attention. My name is Monika Rachtan and I invite you to my social media and to our next debate. Thank you very much.