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?

Wednesday, March 29, 2006


We are faced with incredible problems in the world today. It is truly mind boggling. At times I wonder whether it might be better to stay uninformed, insulated against the world tragedies.
In March 29/06 Calgary Herald, page21, Dr. Bob Dickson, a Calgary physician, painted an excellent picture of the situation in the world today as to the status of Tuberculosis. Although he stresses the prevalence and devastation in the developing world, he doesn’t mention the increase in T.B. and the development of resistant strains in some of the large cities in North America. This was in evidence five to ten years ago and continues.
Dr. Dickson points out the synergy between HIV and Tuberculosis. Basically, if our resistance is impaired as it is in HIV, the TB bacterium runs rampant and is more difficult to control. He points out that proper drug treatment can prolong life by as much as five years. I’m sure this is true but we must keep in mind that although predisposition to TB is multifactorial, in the case of Africa and some of the slum areas of our North American cities like San Francisco and New York, AIDS is the primary driver. The resurgence of TB in the world and in North America parallels and follows the increase in AIDS. Equally frightening is the development of resistant strains of TB as a consequence of treating the many AIDS patients who have Tuberculosis.
Much is written in the lay and scientific literature about the development of resistant strains of bacteria. Recently in Canada concern over the deaths caused by C. deficile and the possibility of the development of resistant stains captured headlines. M.R.S (very resistant staph. bacteria) is on the rise in our hospitals. Family physicians are admonished almost daily to avoid using antibiotics in our offices, and when we do, to use amoxicillin where ever possible (e.g. ear infections). At the same time we have to keep in mind that the largest malpractice settlement made in pediatrics was in the U.S. for millions of dollars, because the child with an ear infection treated with amoxicillin, subsequently developed a brain abscess and was rendered a bed ridden invalid. Thousands of Canadians and Americans cross the border every year for a good supply of any antibiotics they want. In many countries antibiotics are bought over the shelf like candy.
I am reminded of a charitable drive to raise money for the purchase of antibiotics for the people of a small country where the life expectancy was thirty seven years of age and the two main causes of death were infections and starvation in that order. These people lived in a country with mountainous terrain and the people above contaminated the water with typhoid, etc. for the people below. Basically all water used was surface water so the children died of intestinal infections or pneumonia when they were weak and debilitated from starvation. When I asked whether the money raised would be better used for development of water purification and better agricultural practices, the organizers were insulted. Somehow, I didn’t see the rational of saving children from infection so they could die of starvation!
No-one can be expected to have the solutions to these dilemmas, but the point I am trying to raise is that the resurgence of Tuberculosis is primarily due to the increasing prevalence of HIV, and we know that the development of resistant strains of tuberculosis corresponds to the increasing use of antibiotics in this patient population. Lengthening their survival time from TB will invite other invaders. Some of our AIDS patients in Canada are on eight to ten medications, most of these being antibiotics and antiviral drugs. These patients certainly live longer and their quality of life is improved, but with the reasonable expectation of developing resistant stains of bacteria and viruses to their drugs. Modified programs such as the Global Drug Facility Plan could improve life expectancy for millions of T.B. patients world wide, but has any one looked at the probability of drug resistance that is likely to develop? As mentioned, we are already seeing this in our Aids patients in North America. Besides, I do not believe we can win the tuberculosis battle without winning the HIV battle first, so is the money being well placed? I do acknowledge the fact that “ it is hard to remember that you came to drain the swamp when you’re up to your ass in alligators”.
This moral dilemma is only one of the ethical issues facing the world today. Many groups of people feel strongly that we, in the “have” countries of the world today, can not humanely stand by and do nothing while these people in dire need of our help are dying. Still, these are the same people who felt we should have stood idly by, while villages in Iraq were being gassed, women were stoned for being raped, and people were beheaded for their beliefs. These may well be the same people who raise their voices loudly when some Canadians wish to change our health care system so that we have the capability of looking after the poor, the chronically ill, and the frail elderly, and allow those who are capable, a venue where they can provide for themselves. I don’t envy the decision makers that have to deal with the many demands imposed upon them by virtue of their positions. Every situation needs to be looked at long and hard, but decisions need to be made and only history will reveal the appropriateness of those decisions.
Of late, Canadians have been far too eager to throw dirt at the U.S. for moving forward in some areas. We in Canada must remember that not making a decision is in fact a decision; a decision to do nothing. For too many years we have coasted in the areas of health care nationally and world affairs internationally. We have lived off of the victories and accomplishments of years gone by and those before us. Perhaps the time has come for Canadians to garner the courage to move forward. History will judge us as a nation, and the world will judge us as a people, but we will be judged.


Blogger Lanny said...

Excellent post!

29/3/06 12:02 PM  

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