What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Saturday, February 25, 2006

Curing Cancer

One of the great things about being a politician is you can make grandiose statements about future events, (like twenty years down the road), take credit for it, but not be around twenty years down the road to be held accountable. My kids still hold me accountable for things that I did and said thirty years ago.
Take, for example, our previous Prime Minister of Canada. He was going to fix health care for a generation back in 20004 and it seems we still have a few problems. Our Alberta premier Ralph Klein is going to put one billion plus dollars into cancer diagnoses and treatment in Alberta and decrease cancer deaths by fifty percent. I really doubt that either of these gentlemen arrived at those statements through any kind of scientific process. It reminded me of Craig Ferguson on the “Late, Late, Show” when he makes an outrageous statement, then states: “Actually, I just made that up, but it IS possible, it is, really, actually it is POSSIBLE”.
About ten years ago one of Alberta’s deputy health ministers, while talking to a large group of women in Toronto made the statement: “Although Canada has spent many billions of dollars on diagnosis and treatment of cancer in the last fifty years, there are as many people who die of cancer today (per thousand population), as there was fifty years ago. Although the statement is likely true, this statement and premier Klein’s, reveal an incredible naivety of medicine and medical statistics, and are probably made purely as political statements.
Let us examine the ways to reduce cancer deaths in Alberta. One of the obvious ways would be by shortening life expectancy. Since most cancers are age related, we could forget about seat belts, helmets, treating cardiovascular disease, etc, which would prevent people from getting old and therefore prevent cancer. We can only hope Mr. Klein was not thinking of applying this form of “cancer prevention! Perhaps I’m being a bit facetious, but the point that needs to be made is; “the longer our life expectancy, the more likely we will develop cancer. The corollary to this is: “The better we prevent and treat other causes of death, the more people will die of cancer”. Everyone eventually dies and there are a few major things we die from; cardiovascular disease, vital and multiple organ failure, cancer, trauma, suicide, infections, and progressive degenerative diseases. As we improve in our prevention and treatments of other diseases, more deaths will occur from cancer unless prevention and treatment of cancer keeps pace. In the last ten to fifteen years incredible strides have been made in the prevention and treatment of strokes and heart attacks. Many of these same people now die of cancer instead of their cardiovascular disease. This does not represent a failure of cancer treatment or prevention, but reflects a huge success story in the treatment of cardiovascular disease. If we ever have a program for identifying and adequately treating the 65% of our hypertensive and hyper-lipidemic patients who are not being treated, or who are inadequately treated, we will see further significant reductions in cardiovascular deaths and further increases in cancer and degenerative deaths.
There has been much talk about the increase in Alzheimer’s disease in Canada. Like cancer, this reflects to a large degree the increase in life expectancy. Is it reasonable to expect that our treatments of non cancer conditions is going to stand still, and that life expectancy will not continue to increase? I would hope not. All the life style changes that are beneficial in preventing cancer would appear to have a positive effect in preventing other causes of mortality as well. Furthermore, the factors influencing the incidence and treatment of cancer are complex and multifactorial. Although cancers have many characteristics in common there are also many different cancers that have unique characteristics. The likelihood of making one grand discovery that can be applied to all cancers is slim to none.
An early diagnosis usually has a beneficial effect in treating and curing cancer. Does that mean we are going to have more family doctors with better access to specialists and diagnostic tools? As an editorial in today’s Calgary Herald suggests cancer treatment and prevention needs to be looked at within the context of our total health care. The only significant statistics regarding cancer are:
1) cases per 1000 population/age specific,
2) Length of life from date of diagnosis,
3) Average age of cancer patients at the time of death, and
4) Quality of life from the time of diagnosis until death.
Using the above criteria we can measure progress.
It is possible that the Alberta Government will propose a type of Northern Mayo Clinic. Although this would have some positive aspects to Albertans, the primary benefit would be to Canada as a whole and then only if other provinces would agree to utilizing it. To obtain expertise and world recognition there must be a sufficient volume of patients to justify the latest in equipment, treatment modalities and professionals. Having two such centers in Alberta flies in the face of this type of project.
It would appear mostly our Premier is looking for an acceptable place to spend money and establish some kind of legacy. All the talk of cancer prevention and a fifty percent decrease in cancer deaths twenty years from now is just that-----talk.

1 Comments:

Blogger Lanny said...

Considering the information in your blog and the people getting bad information, poor treatment, and no family doctor, in this system we are lucky if we can stop 50% of deaths from lack of medical care!!!

27/2/06 6:52 AM  

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