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?

Sunday, January 27, 2008

Universal Healthcare Torturing Canadian Citizens

Interesting! The headline in the Calgary Herald on Jan 27/08 was “Doctors Critical of Drug Reviews. This headline pertained to various drugs that the Alberta government refuses to cover in its Blue Cross public insurance plan for the chronically ill citizens of Alberta. In particular, the drugs Humira and Enbrel are mentioned in the treatment of “Spinal Arthritis”, more accurately called “Ankylosing Spondilytis”. The government’s argument is “there is no evidence the treatments slow progression of the disease”. Now to be forthright, I have never used these drugs, but over my forty years of practice I have been involved in the management of this condition and the pain these people suffer when afflicted by it. I specifically remember one patient in his thirties whose pain was incapacitating. He only obtained relief from the pain by using a combination of opiates and large doses of an anti-inflammatory drug called indomethasone. Other anti-inflammatory drugs were tried but had little pain relief effect. Without the indomethasone he was in constant pain and unable to be productive; on it he was reasonably comfortable. The only problem was that over a two year period on the indomethasone he had two major life threatening gastro-intestinal hemorrhages with subsequent transfusions (which is not uncommon with indomethasone). This mandated the use of a concomitant proton pump inhibitor drug in an attempt to prevent (but did not guarantee) further hemorrhages. So he remained on three different medications in an attempt to control his PAIN and keep him reasonably productive, albeit exposing him to all the side effect of three different medications, including the aforementioned life threatening hemorrhages.
Would Humira or Enbrel been effective in this patient? I really don’t know; but it would have been an option to be considered by a specialist and the patient if he could afford the drug costs. It seems to me that once again, in our government universal healthcare scenario, the poor are adversely affected; yes to the point of pain and debilitation that would warrant the term “torture” in any civilized country, by any definition, were it being inflicted. Is omission justified when commission is not?
The other drug that stands out from the crowd is the drug Remicade for Crohn’s Disease of the bowel. According to specialists working in the area the drug can only be covered for periods of eight weeks, and I gather, if the patient is in remission, cannot be prescribed again until the patient “flares”. In the article in Sunday’s Herald, Alberta Health officials denied that patients must go off their medications, but then go on to say: “The rules are in place because patients can experience long stretches without symptoms of the disease”. So which is it? Is there a rule or not? It would appear from the article and their own statement that indeed the rule is there. So how do we categorize deliberate withholding of appropriate medication based on cost? Does this justify putting people into repeated episodes of severe abdominal pain and vomiting that may go on for weeks before the medication once again “kicks in” to give them relief?
It should be pointed out that the above drugs have been approved by the federal “Common Drug Review committee” based on their evaluation of both effectiveness and cost effectiveness. One may ask “how does this pertain to our Universal Healthcare system in Canada? Quite simply; provincial governments have the responsibility of providing Canadian citizens with comprehensive healthcare coverage as mandated by the Canada Health Act. If they are short changing you and making “cost cutting medical decisions in pharmaceutical areas, what other areas are they making those judgments or cuts?
Do you know? Not likely. Provincial governments are making numerous healthcare decisions that only physicians and their patients should be making; and people should have options for access, based on their judgment as to their needs. Governments have a finite money resource, namely taxes, and are under continual conflict as to how to apply that money resource to a multitude of priorities. But one thing is clear to me; not allowing options to their citizens smacks of a serious sin of commission, and not meeting their mandate to prevent significant suffering in treatable conditions (relief of suffering short of euthanasia) smacks of an unforgivable sin of omission. If this type of suffering were being inflicted in the prisons at Guatonamo or Afghanistan our news media would be up in arms. As it is, they seem more preoccupied on whether it is appropriate to turn prisoners captured in Afghanistan over to the Afghanistan government. Perhaps it is time to stop the torture going on here within our healthcare system (primarily affecting the poor and uninformed) before getting bent out of shape with what is going on abroad.

Wednesday, January 16, 2008

Obesity Vanquished in Alberta

Tonight I listened to our health minister, Mr. Dave Hancock, expound on his vision of healthcare in Alberta and some of the solutions. I actually have heard all of this before but was quite surprised that he never once used the word “innovation”. Maybe he feels we have innovated our healthcare system into oblivion already and he should avoid the word. In any case, it would seem the solutions at present are the same as the solutions of the past: 1) Healthcare providers should be used in accordance with their training and 2) A greater emphasis needs to be put on “prevention”. As to the first solution he totally missed the point that one of the family physicians made, and that was in his practice, comprehensive care was already too complex for him in the community setting, and that an assistant would be more appropriate than “dumming down” the care givers. As for the second solution he pointed out that he was doing his part as health minister and had lost 75 pounds on his way to a healthier life style. This of course gave me a great idea as to how to beat obesity in Alberta; simply make every obese Albertan a health minister to give them incentive to lose weight. Sometimes solutions are so simple!