Taking Ontario's health monopoly to court

Ontario's health care monopoly almost killed Lindsay McCreith. After suffering a seizure in January, 2006, the 66-year-old Newmarket resident was told he had a brain tumour. But he would have to wait four-and-a-half months to obtain an MRI to rule out the possibility that it was cancerous. Unwilling to risk the progression of what might be cancer, Mr. McCreith obtained an MRI in Buffalo, which revealed the tumour was malignant. Even with this diagnosis in hand, the Ontario system still refused to provide timely treatment, so Mr. McCreith had surgery in Buffalo to remove the cancerous brain tumour in March, 2006.

Andy Barrie spoke with Lindsay McCreith. The retired Newmarket man was told he would have to wait for more than four months for an MRI.Listen. (Runs 6:59)

Chaoulli comes to Ontario

Had he trusted Ontario's government healthcare monopoly to treat him, Lindsay McCreith would likely be dead today. At the very least, his health would have been permanently diminished. Unacceptably long waiting lists for simple diagnostic tests and basic treatments forced the 66-year-old retired auto body shop owner from Newmarket to pay more than US$27,600 out of his own pocket for timely cancer treatment in the United States. Now, with the help of the Canadian Constitution Foundation (CCF), Mr. McCreith is challenging Ontario's ban on private health options. If he wins, Ontarians would finally be allowed to buy insurance that covers their care when the state monopoly fails them, as it too often does.

Why can’t doctors wash their hands?

(Apparently Nurses aren’t much better) Every year, 250,000 Canadians pick up infections while they are in hospitals being treated for something else. That's a staggering one out of every nine Canadians who are admitted to hospital.

Every year, those infections kill more than 8,000 people.

That's more than will die of breast cancer, AIDS and car accidents combined. Most of those deaths can be prevented — by simple hand washing.

In the wake of the SARS outbreak that hit Toronto in March 2003, hand sanitizers have become common in hospitals and other public buildings across the country. Many people use them — others don't. Read the full report here: http://www.cbc.ca/news/background/hospital-infections/

AND IF you want to see the evidence: here is a CBC secret camera report. Chilling. Erica Johnson reports on 'Dirty Doctors'

Are pharmacists content to contribute directly to the epidemics of obesity and type 2 diabetes?

Caroline Apovian, a researcher at Boston University School of Medicine, commented that the study “provides strong, scientifically sound evidence that excess calories from soft drinks are directly contributing to the epidemics of obesity and type 2 diabetes” and that “reducing sugars sweetened beverage consumption may be the best single opportunity to curb the obesity epidemic.” (Apovian CM. Sugar-sweetened soft drinks, obesity, and type 2 diabetes. JAMA. 2004; 292:978–9.).
For a full analysis read: Liquid Candy: How Soft Drinks Are Harming Americans’ Health by Michael F. Jacobson, Ph.D. published by the Center for Science in the Public Interest Washington, D.C.

Suggestions for the consumer & patient. Choosing what and when to eat takes some careful consideration. Here are some healthy tips to help stave off the hunger pangs and keep energy levels up throughout the day. Here are some ideas courtesy of the CBC: http://www.cbc.ca/news/background/health/smart-snacks.html

Suggestions for the clinicians. A complete copy of the 2006 Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children can be found at http://www.cmaj.ca/pressrelease/pgS1-complete.pdf. The word pharmacist or pharmacy does not appear once in these guidelines published by the Canadian Medical Association Journal. What an opportunity!

Suggestions for pharmacists. From the University of Saskatchewan some enlightening news. For starters: Pharmacy and nutrition are taught in the same program. Their College of Pharmacy and Nutrition recommends that you “don't recommend natural weight loss products to patients. The most dependable way to safely lose weight is still lifestyle modification - reducing caloric intake and increasing exercise.”

So if pharmacists want to make a difference – they might start by clearing their shelves of tarts and treats. Check out these photos

DRUG MARTS: PAY ATTENTION

The obesity risk of children increases for each additional glass of sugar-sweetened drink consumed each day.

Shoppers Drug Mart recently complained to Longwoods because we drew attention to one store’s multiple displays of thousands of cases of pop and row after row and promo after promo of super sized chocolate bars, other sweets and deep fried treats. Their representative wrote that we failed to make “the point about personal choice and individual responsibility for the choices we make as consumers and the impact that has on our health.” The correspondence also provides this quote: “Success is the sum of small efforts, repeated day in and day out.” Robert Collier.

So we would like to continue our small efforts in bringing to their attention the importance of nutrition in our lives – something we would hope would be promoted by a DRUG MART. The following is from the International Diabetes Federation.

Fight Obesity Prevent Diabetes

FACT SHEET ON DIET & NUTRITION

1. A third of the global burden of disease is probably the result of dietary factors.
2. People who are undernourished in early life and then become obese in adulthood are at a greater risk of developing conditions such as high blood pressure, heart disease and diabetes at an earlier age.
3. The average family spends 15 minutes preparing meals compared to two hours a few years ago.
4. The obesity risk of children increases for each additional glass of sugar-sweetened drink consumed each day.
5. People with diabetes should eat more fibre than people without the condition. Fibre helps prevent stomach problems and lower cholesterol.
6. Low energy diets are the most likely to lead to healthy eating habits and effective weight maintenance.
7. Eating while doing something else can often lead to overeating and thus increase the chances of becoming obese.
8. Reducing malnutrition in pregnant women can prevent their children from becoming overweight later in life and ease the burden of obesity.
9. Diet alone is not considered sufficient for sustained weight loss and needs to be coupled with exercise and a structured eating plan.

Sources:
1. Diabetes and Obesity: Time to Act; International Diabetes Federation 2004
2. Overfed and Underfed: The Global Epidemic of Malnutrition; Worldwatch Paper 150, Worldwatch Institute 2000
3. WHO World Heath Report 2002; World Health Organization 2002

And from a papers by David L. Mowat and David Butler-Jones:

“Current trends, such as an increasing prevalence of obesity (36% of adults are overweight and 23% obese), lack of physical activity (55% of Canadians are not physically active or moderately active [Statistics Canada 2004]) and a rapidly increasing incidence of type 2 diabetes, might well halt or even reverse progress in life expectancy, and certainly pose a threat to the sustainability of the health services system. Tackling these problems solely by curative means or even individually-based preventive approaches is neither affordable nor feasible. Vigorous population-based approaches are essential if these trends are to be reversed.”
See: Healthcare Papers

The Health Council of Canada addresses diabetes. We are reminded . . .

“The way we provide health care today leaves too many people vulnerable to serious health problems that could be avoided, “ said Dr. Ian Bowmer, Vice Chair of the Health Council of Canada. “If we don’t support prevention and change the way we deliver care for chronic health conditions, we are not optimizing care and are putting the quality of life of Canadians at risk.”

. . . . type 2 diabetes affects at least 1.3 million Canadians, plus hundreds of thousands more are unaware that they have the condition. Type 2 diabetes is also a largely preventable disease that is becoming increasingly prevalent among children and adults throughout the country, because of changes in eating and exercise habits that increase the risk of developing this disease.

Three-quarters of the people who live with diabetes also have other chronic health conditions, the Health Council found. Many suffer the serious complications typical of diabetes, such as heart disease, kidney damage, depression, loss of vision, and poor circulation which can lead to amputations. But with the right kind of health care, these health problems – which reduce the quality of life for people with diabetes and drive up the cost of their health care – can be forestalled or prevented, the report concludes.

Screening programs and community initiatives to help people better manage diet and lifestyle choices can have a major impact on preventing or delaying the onset of disease, but we need to take action now, to stem the rising tide of diabetes and related chronic health conditions.

“The lesson is clear. People with diabetes will need less intensive, less expensive, health care in the future, if they get the right care now,” said Dr. Stanley Vollant, a Councillor with the Health Council of Canada. “The way we provide care now is piecemeal and out-of-date. By changing how the health system works, we can improve the well-being of Canadians and make the health care system more sustainable. Canada can do better."

“It took a generation of hard work to see a real reduction in the number of Canadians who smoke,” said Dr. Bowmer. “We have to do the same for healthy eating and exercise to prevent chronic health conditions like diabetes. But we have to do it faster.”
See: Health Council of Canada

Shoppers Drug Mart* and other retail healthcare provider organizations should take note!
They can make a difference by discouraging sugar coated, fat laden foodstuffs often offered for “the convenience of our customers”.

Shoppers Drug Mart’s annual report tells readers that the company has captured a significant share of the market in front store merchandise, including over-the-counter medications, health and beauty aids, cosmetics and fragrances, seasonal products and everyday household essentials. They fail to mention that some stores have created a very large category (as many as eight aisle-length shelves) of super-sized chocolate bars, potato chip bags and multiple skids of pop – each holding up to 400 cases of the stuff at very affordable prices. It is difficult to see how this squares with their statement: “So we’re doing everything we can to help you keep healthy.” (The Publisher)

Photo reviews, rants and raves: Tim Hortons

Here it is: the Breakfast Sandwich served by Tim Hortons (34 grams of fat). And now – Tim Hortons adds needle disposals to washrooms

More news from a pharmacist and pharmacy. a.k.a. healthcare providers.

Shoppers Drug Mart at Queen and Carlaw in Toronto removes butter tarts & cheap cakes from the shelves and substitutes hundreds of cases of soft drinks. Check out these photos. This is in support of their corporate commitment found on the web site of the Canadian Diabetes Association. “. . . Shoppers Drug Mart continues to positively influence the health, well being and quality of life for people affected by diabetes.” In the meantime large chain grocery stores nearby are unable able to match this drug mart’s unfailing commitment to chocolate, candy, soft drinks, chips and more.

Fat Zombies, Pleistocene Tastes, Autophilia and the "Obesity Epidemic"

Canadians are fat and getting fatter: so say surveys up to and including the series of papers last August in Health Reports. By actual measurement, nearly a quarter of us (adults) are obese. So what? Obesity is clearly hazardous to health, but reports that 60% of us are "obese or overweight" border on fear-mongering. A body mass index (BMI) over 25 is not a death sentence, and obesity will not bankrupt the healthcare system. The trends, though, are worrying. So will we rebuild cities - and, especially, suburbs - to be more pedestrian-friendly, suppressing auto-induced urban sprawl? Will we take on the fast-food industry as we did tobacco? Obesity is not destiny; Canada could do better.

We Have Met the Enemy, and He Is Us (Sort Of) - Pogo
Does an effective response to obesity include putting MacDonald's and Coca-Cola out of business? Good luck! But if not … ? If sales of calorie-rich, nutrient-poor foods cannot be trimmed back, what hope is there for a lighter population? The industry can claim that it is simply responding to "consumer demand" - which on one level is true. Sellers of tobacco, pornography and illegal drugs could make the same claim (and some have). But influencing the food industry issue is much tougher than trying to suppress a noxious and widely unpopular industry. Promoting healthy eating requires some complex fine-tuning of a large industry with a high level of public support, in ways that will certainly restrict profit opportunities. Not surprisingly, our politicians have little stomach for this.

Effective tobacco control backs up aggressive anti-smoking messages with a combination of heavy taxation, restrictions on industry promotion and legal prohibition of smoking in public spaces. Left on their own, the health promoters would be massively outgunned; they wouldn't stand a chance. Are any of these seriously contemplated for the food industry?

Efforts to keep soft-drink and fast-food promotion out of schools are commendable, and a lot more could be done through the schools - starting very early - to promote both healthy eating and more exercise. (A national daycare program could have provided an effective vehicle.) But that will require making greater fitness a serious public priority, that is, with organization, regulation and money. Like planning and re-building our urban environments, it is a large and long-term commitment. Is anyone really serious about this? Or should we just settle for preaching at the fatties?

[for the full article click on the title]

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Dr. Robert Evans, OC, a faculty member of the Department of Economics at the University of British Columbia, is one of the world's leading health economists.

Dr. Alan Hudson on Wait Lists

A healthy dose of market reality
David Reevely

Ottawa Citizen | 23 January 2007 | C4

Getting a cataract removed in Ontario costs about $580. We know that thanks to a doctor who had the nerve to tell the government that starting to fix public health care would mean subjecting it to market forces.

The doctor is Alan Hudson, assigned by Health Minister George Smitherman to slash waiting times for key surgical procedures in Ontario.

Hudson is a South-African-born neurosurgeon, former chief executive of Toronto's University Health Network (UHN). Teaching awards and a research chair are named after him at the University of Toronto. When he met the Citizen's editorial board last week on a swing through Ottawa, he wore the pin that marks him as an officer of the Order of Canada.

Imagining a heavier hitter in Canadian medicine is impossible. And he knows something about market incentives -- the provincial salary disclosure list says Hudson made $374,002 in 2005.

Yet when he was made chief executive of the UHN, Hudson described it to an interviewer as like making a poacher the head gamekeeper, and he's brought that attitude to the job he's been doing since 2004. The health system is full of perverse incentives, he says, the most obvious being that doctors are paid to see patients, while hospitals are paid by the government regardless of how many patients they treat.

"A hospital gets one bag of gold to run for a year," he says. "It's called a global budget. So your incentive in running a hospital, like I was running UHN, is to look after one patient. That's all. You look after two, you've just doubled your costs. There's no profit, there's no margin. So you're incented to look after one patient a year.

"Before I became the CEO I was a surgeon on a piecework, pay-for-performance deal. So my incentive was to operate as much as I could -- maximize my income. So within one company, you've got one incentive going this way, one incentive going the other way."

In 2004, everybody knew the situation was out of hand, but nobody knew how bad it was. Ontario had no system for tracking how long people were waiting for cataract surgery, joint replacements, heart surgery, or anything else. Nobody even knew what those procedures cost.

With half a billion public dollars at its disposal, Hudson's team figured out a way to solve both problems at once: "[We] take a hospital and say, 'Here's your global budget. You've been doing X cataracts a year. God only knows how you ever got that number because there's no system and no way of measuring it, but that's sort of what you did, and presumably you did a little bit more than last year.' So we said: 'That's your base, that's it ... Now on top of that, how many additional cataracts do you want to do at $750 a pop?'

"This is a voluntary contract. So your CEO comes back and says, 'We'll do another 200 or something, on top of' “the cataract surgeries the hospital was already doing.

Before a hospital executive can decide to do 200 more cataract surgeries for $750, he or she has to figure out whether the hospital's per-procedure costs are more or less than that.

Dr. Brian Day, the president-elect of the Canadian Medical Association, is controversial because his regular job is running a private surgical centre in Vancouver, but he's said his proudest accomplishment has been to force B.C. hospitals to figure out how much their procedures cost them. Sometimes they contract out overflow public cases to Day's private clinic. Before any hospital started doing that, its administrators had to find out whether paying Day's fees was cheaper than finding more staff and space for the hospital to do the operations itself.

Here's the clever part of Hudson's plan: Every time the waiting-times team dispenses surgery contracts, it offers less for each procedure. Cataract procedures started out at $750, but by the time the team was done paying out for the last bunch of surgeries, Hudson says, the wait-times team was spending only $580 per procedure. It's like a series of auctions. He's says he's convinced that before long, the price will be down to $400.

Hospitals that wanted to make more money by doing more operations had to join the wait-times information system. The result: 80 per cent of Ontario's hospitals have joined and waiting times for the five procedures Hudson has been assigned to deal with have been slashed almost everywhere in the province.

The next set of conditions the wait-times team is putting on its hospital contracts is participation in a province wide system for tracking safety and quality standards, which is also meant to ensure that hospitals aren't allowing operations on patients who don't really need them.

Smitherman, the Ontario health minister, for all his public raging in defence of the existing public system, has done nothing about Hudson's work other than take credit for it. Good decision. Call it what you like -- pay-for-performance, marketizing, whatever -- as long as you call it progress.

David Reevely is a member of the Citizen's editorial board. E-mail: dreevely@thecitizen.canwest.com

Listen to a recording of the editorial board's meeting with Alan Hudson at 'current features' on ottawacitizen.com .