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.

6 Comments:

Blogger michie said...

Sounds suspiciously like the HMO situation in the US, doesn't it?

28/1/08 12:43 PM  
Blogger Al said...

Of course. Our provincial governments are exactly like the U.S HMO's. The questions arrising are:
1) Who is most efficient and capable of providing the best healthcare services at the lowest cost (competitive bodies or a momopoly) and
2) Is it ethically and morally justifiable to not offer choice to the consumer. Any other monopoly we would scream to high heaven.
I'm sure many people reading my entry would say that comparing torturing of terrorists to people suffering in wait lists is not at all the same; I agree. There MAY be justifications for torturing a terrorist to obtain information that could save hundreds of lives----I don't want to debate that. But as a monopoly provider of healthcare, including pain relief and suffering, what is the justification for, through omission, causing the poor and chronically ill to suffer? And to me "causing to suffer and endure pain" could be a reasonable definition of torture.

29/1/08 12:07 PM  
Anonymous Lanny said...

After the stories I've heard lately, I think I might opt for waterboarding!

19/2/08 5:35 PM  
Anonymous Anonymous said...

No it is not like HMO's in the U.S.- I get Remicade in the U.S. thru my HMO every 8 weeks, without being put into a flare every period to prove i need it! That is maintaining a remission, rather than putting me out of remission to get a drug to barely get me into one for a brief time!

2/7/09 9:37 PM  
Anonymous Anonymous said...

Of course. Each HMO and each province has its list of "coverage". At least with an HMO you can shop for your coverage. In a province you are stuck with what the coverage they approve; but in every other way each province is an HMO.

3/7/09 8:19 AM  
Anonymous virus classification said...

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

22/6/10 8:02 PM  

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