Canadian Medicare: through the eyes of Peter Gzowski

Canadian Medicare: through the eyes of Peter Gzowski

Health Care 1: Diagnosis

I am sitting on a hard chair in the X-ray wing of a very good—I am to learn—hospital. I have two gowns on: one that opens from the back, one from the front. The combination protects my modesty, I suppose, but I still feel vulnerable. They can get at me either way and stick things in me where I don’t want them to. The gowns don’t match; one is pale blue, the other green. I can’t figure out how to tie them. My scrawny legs jut out from under their hems. My knees show. My feet are encased in floppy cotton slippers, which tie at the ankle, like mukluks, except I can’t figure out how to do them up, either. My dignity is back in the changing cubicle, along with my trousers. The receptionist, young enough to date one of my sons, calls me Peter, as if I have no last name. A technician passes by without looking at me. She is in a peach pantsuit made, like my gown ensemble, of cotton. She looks sharp. Why can’t I have something like that?

I’m tense and, to tell you the truth, a bit scared. I’m sure at least one of my charts will reflect what doctors call “white coat syndrome”—blood pressure that rises because someone’s taking your blood pressure. Except as a visitor, hospitals—health-care facilities of any kind—are foreign turf for me. Not that I’ve looked after myself all these years. More, in fact, that I haven’t. And now I’m getting the works. “Chest X-ray,” the doctor said last week when, at last, I’d actually gone for a visit. “Blood tests, CAT scan, ultrasound, something-oscopy, barium ene—”

“Barium?” I said. “Don’t they—?”

“We’ll make the arrangements,” he said. “Don’t worry.”

Yeah, don’t worry. He isn’t sitting in borrowed jammies, in a world where strangers who call you by your first name stick things into places on your body even you haven’t seen.

Emmett Hall died recently, in a nursing home in Saskatoon. He was ninety-seven. The Globe and Mail called him the “father of medicare,” and so, on the radio, did I. At least one Globe reader and at least one Morningside listener wrote in to say, “Hold on, now, Mr. Justice Hall was a great man, all right, but the father of medicare was Tommy Douglas.” Well, sure, if you want. Tommy Douglas was premier of Saskatchewan when the first provincial health-insurance legislation came in, in 1962, and it wasn’t until 1964 that Mr. Justice Hall’s report was published. But that report gave us the plan for universal, national health care, and that plan, amended and expanded over the years, has been one of the defining characteristics—perhaps the defining characteristic—of the Canada we have built. Medicare helps to make us who we are. And now, as I sit bare-legged in an unfamiliar waiting room, edgily anticipating the end of my privacy, the man who mapped it out for us is gone.

The technician in peach returns. “Peter…?” she says, glancing at her clipboard. I have the impression she would try my last name, but the extra consonants dissuade her. An occupational hazard where she works, I guess. I realize, too, that my revery on Mr. Justice Hall has lasted perhaps five minutes at the most; I have scarcely been waiting at all. “Come with me,” the technician says, and leads me down the hall.

It’s not nearly as bad as I’d feared. I have been, as a doctor I know puts it, “hanging crêpe”—imagining the worst. When I actually get in to the darkness of the ultrasound room, my fears turn out to be unfounded. People are nice to me. They work quickly. They explain what they’re doing. They warm the gel before spreading it on my tummy. They make me feel…not at home, but as if I’m being looked after, cared for. Even the barium ene…well, let’s not talk about the barium, okay? The point is I’m in good hands.*

There’s a lot of pressure on those hands these days. Everywhere, governments are wondering how much of this we can afford. But the politicians haven’t been sitting in their jammies, either, thinking of Mr. Justice Emmett Hall.

I worried about a lot of things when I was in the hospital—maybe some of them too much. But one of them wasn’t money. I like it that way, don’t you?

* As you’ll see in the piece that follows, those hands and their instruments, as it turned out, almost certainly saved my life.

Taken from Peter Gzowski’s book: Friends, Moments, Countryside. Selected columns from Canadian Living, 1993 -98. Here is a review and a place to order. http://januarymagazine.com/nonfiction/gzowski.html. Great summer reading!

Methadone maintenance. Reforming practices in Ontario

The Government of Ontario has responded to task force report recommendations recommending reform to methadone maintenance practices in the province.

The full report can be found at:
http://www.methadonetaskforce.com

Here are the links to two Toronto Star articles:
http://www.thestar.com/News/Ontario/article/239983

http://www.thestar.com/News/article/240446

Here is the governments response:

July 26, 2007: McGuinty Government Increasing Access to Methadone Treatment: Investing $2 Million To Improve Treatment For People With Opioid Addictions

TORONTO- The McGuinty government is increasing access to methadone maintenance treatment for people with opioid addictions by investing an additional $2 million in treatment initiatives across Ontario, Health and Long-Term Care Minister George Smitherman announced today.

“Our government is committed to providing better treatment for people who are addicted to heroin and other opioids,” said Smitherman. “This new funding will allow for continuous improvement of professional services and increase awareness in communities about the value of methadone maintenance treatment.”

The $2 million announced today will be allocated to improve methadone maintenance treatment (MMT) in Ontario as follows:

$1 million to recruit more doctors to prescribe methadone and other treatments, expand training and professional supports at the Centre for Addiction and Mental Health and develop best practice guidelines for nurses, counsellors and pharmacists

$200,000 to the College of Physicians and Surgeons of Canada to enhance enforcement of best practice guidelines and quality assurance initiatives related to methadone services

$500,000 to increase public awareness regarding the benefits of MMT and issues related to opioid dependence.

$300,000 to develop a resource guide to assist in the proper introduction of MMT into local communities including the funding of local “Citizen Engagement Committees”

This brings the province’s annual total funding for MMT initiatives to $4.3 million.

After having consulted with experts in the field, the government intends to finalize changes to the OHIP fee codes that govern payment for testing performed in physician's offices related to methadone maintenance programs. This move will provide greater accountability and help to eliminate unnecessary testing and is expected to save approximately $3 million per year.

In April 2006, the government created the Methadone Maintenance Treatment Practices Task Force to provide advice on access to methadone, best practices and training, payment models, quality assurance and assessment, and community engagement. As part of today’s announcement the government also released the Report of the Methadone Maintenance Treatment Practices Task Force which outlines 26 recommendations directed at all key stakeholders involved in methadone maintenance treatment in the province.

“We want to thank the task force members for their hard work, analysis and dedication in participating in the Task Force and for lending their collective expertise to this important matter,” said Smitherman. “The government is working with stakeholders to implement several of the recommendations.”

“We are pleased the government is taking action on the recommendations of the Task Force report by increasing access to methadone treatment for people with opioid addictions,” said Anton Hart, Chair of the Methadone Maintenance Treatment Practices Task Force.

It is estimated that the social, economic and health care costs of untreated opioid addictions exceeds $1 billion including lost productivity and premature mortality along with costs associated with law enforcement and the use of the criminal justice system.

Diet soda linked to higher heart disease risk: study

[blog editors note] Pharmacists inducing their customers to drink cheap pop -- please take note.

Written by: SHERYL UBELACKER

TORONTO (CP) - For those who drink diet pops in the belief that sugar-free beverages are healthier than regular soft drinks, new research suggests they should think again.

A huge U.S. study of middle-aged adults has found that drinking more than one soft drink a day - even a sugar-free diet brand - may be associated with an elevated risk for metabolic syndrome, a cluster of factors that significantly boosts the chance of having a heart attack or stroke and developing diabetes.

"We found that one or more sodas per day increases your risk of new-onset metabolic syndrome by about 45 per cent, and it did not seem to matter if it was regular or diet," Dr. Ramachandran Vasan, senior investigator for the Framingham Heart Study, said Monday from Boston.

Because the corn syrup that sweetens most regular soft drinks can cause weight gain and lead to insulin resistance and diabetes, "you would expect to see an association with regular soft drinks - but not diet soft drinks," he said. "Our findings suggest that this is not the case."

"That for me is striking."

Metabolic syndrome is associated with five specific health indicators: excess abdominal fat; high blood sugar; high triglycerides; low levels of the good cholesterol HDL; and elevated blood pressure.

"And other than high blood pressure, the other four . . . all were associated with drinking one or more sodas per day," said Vasan, a professor of medicine at Boston University.

The study included nearly 9,000 observations of middle-aged men and women over four years at three different times. The study looked at how many 355-millilitre cans of cola or other soft drinks a participant consumed each day.

The researchers found that compared to those who drank less than one can per day, subjects who downed one or more soft drinks daily had a:

-31 per cent greater risk of becoming obese (with a body mass index of 30 or more).

-30 per cent increased risk of adding on belly fat.

-25 per cent higher risk of developing high blood triglycerides or high blood sugar.

-32 per cent higher risk of having low HDL levels.

But Vasan and his colleagues, whose study was published Monday in Circulation: Journal of the American Heart Association, are unsure what it is about soft drinks that ratchets up the risk of metabolic syndrome.

"We really don't know," he said. "This soda consumption may be a marker for a particular dietary pattern or lifestyle. Individuals who drink one or more sodas per day tend to be people who have greater caloric intake. They tend to have more of saturated fats and trans fats in their diet, they tend to be more sedentary, they seem to have lower consumption of fibre."

"And we tried to adjust for all of these in our analysis . . . but it's very difficult to completely adjust away lifestyle."

While soft drink consumption is declining in Canada, statistics from 2006 showed that Canadians overall still gulp down an average of 85 litres each per year.

Dr. David Jenkins, director of the Risk Factor Modification Centre at St. Michael's Hospital in Toronto, said previous studies have suggested that diet pops did not have the same effects on weight and health as do naturally sweetened soft drinks.

"The unusual thing that needs comment is they (the study authors) say that the diet colas are the same as the calorically sweetened colas," said Jenkins. "So I think that is the piece that they've put into this puzzle . . . I think we need a lot more scrutiny of that."

Jenkins said he believes that high consumption of soft drinks likely goes along with eating a high-calorie diet.

"I think the disappointing thing is if you thought you were doing (yourself) a major service . . . by taking diet drinks, this is not helping you," he said. "Before we were saying take the diet (drink) and you're OK. Now we're saying: 'Watch it."'

The study findings also beg the question whether there is some ingredient in soft drinks - both regular and diet - that may encourage metabolic syndrome.

Caramel, used to colour colas, is an ingredient that goes through a chemical reaction that has been shown in studies to "be quite toxic," said Jenkins. "It's possible that (such products) increase insulin resistance and cause oxidative stress and damage and all the other things we don't want."

Dr. Arya Sharma, chair of cardiovascular obesity research at McMaster University, said one explanation for the link between diet drinks and metabolic syndrome is that their just-as-sugary taste may condition consumers to crave other foods that bring sweetness to the palate.

"So people who drink diet pop may be eating other sweets, whether that comes in the form of dessert or other things, I don't know," Sharma said Monday from Hamilton. "It may be that people who are drinking diet pop - and we have this effect often with people who go on diets or when people go running or whatever - that you do a little bit of something that you think is good, and then you overcompensate by doing more of something that is bad."

"The idea could be because I'm drinking diet pop, I can afford to splurge on dessert."

Vasan said he cannot out-and-out recommend that people stop drinking pop based on this study, because the findings are based on association, not clear cause and effect. More research is needed, he said.

"The simple message is eat healthy, exercise regularly and everything should be done in moderation," he said. "If you're a regular soda drinker you should be aware that this study adds to the evidence that regular soda may be associated with metabolic consequences."

"If you're a diet soda drinker, stay tuned for additional research to confirm or refute these findings."

Michael Moore presents the facts in Sicko

There are nearly 50 million Americans without health insurance.

• The Centers for Disease Control and Prevention actually reported that 54.5 million people were uninsured for at least part of the year. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2006. Centers for Disease Control. http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200706.pdf
• The amount of uninsured is rising every year, as premiums continue to skyrocket and wages stagnate. From 2004 to 2005 the number of uninsured rose 1.3 million, and rose up nearly 6 million from 2001-2005. Leighton Ku, "Census Revises Estimates Of The Number Of Uninsured People," Center on Budget and Policy Priorities, April 5, 2007 http://www.cbpp.org/4-5-07health.htm. With 44.8 uninsured in 2005, in 2007 the number will be much higher. Professors Todd Gilmer and Richard Kronick, in "It's The Premiums, Stupid: Projections Of The Uninsured Through 2013," Health Affairs, 10.1377/hlthaff.w5.143, "project that the number of non-elderly uninsured Americans will grow from forty-five million in 2003 to fifty-six million by 2013." According to these authors, by now the number of non-elderly uninsured by this date clearly would be nearly 50 million.

SiCKO: 18,000 Americans will die this year simply because they're uninsured.

• According to the Institute of Medicine, "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage." Insuring America's Health: Principles and Recommendations, Institute of Medicine, January 2004.
  http://www.iom.edu/?id=19175
  

Don't follow your pharmacists lead. Drink Water Instead.

Pushing Sugar? On June 22, 2007, a major drug store chain held 10 of the “best deals ever reported” for soft drinks. And here's what a thousand cases of soft drinks on the store floor looks like. Download PDF

Fortunately (ya, sure) you can go to this pharmacy chain's web site and find out how the pharmacists can help you achieve a healthy lifestyle Read this:

How bad is the abusive consumption of soft drinks? Here’s a major report on this liquid candy. Download PDF

What do our health care economists think about this? Read this: Fat Zombies, Pleistocene Tastes, Autophilia and the “Obesity Epidemic”

Canadian Healthcare: not Michael Moore's perspective

Canadian Healthcare: another perspective watch video

Filmmaker Stuart Browning provides a cautionary lesson about a politicized health care system where politicians and bureaucrats determine medical priorities. To watch the video click here.

Canadian Healthcare: not Michael Moore's perspective

Canadian Healthcare: another perspective watch video

Filmmaker Stuart Browning provides a cautionary lesson about a politicized health care system where politicians and bureaucrats determine medical priorities. To watch the video click here.

A rebuttle to "Sicko" featuring Lindsay McCreath and his wife.

watch video

Film maker Stuart Browning highlights the plight of Lindsay McCreith, an Ontario man with a cancerous brain tumor who crossed the border to the U.S. to get the medical care that is rationed in his home country. Its called: Lindsay McCreath offers a short course in brain surgery -- American style. click here.

Lindsay McCreith speaks out about his brain tumor

Healthcare Reform, Michael Moore and a three-point strategy.

Michael Moore's answer to the problems facing US healthcare policy makers? Rip the system apart, give the federal government control, create a single-payer system that takes for-profit insurance companies out of the equation and regulate pharmaceutical companies "like utilities since they're just as important as electricity and water."

He's got friends. Hillary Clinton, John Edwards, and Barack Obama have all proposed radical overhauls of the health-care industry, with the goal of covering more Americans and lowering costs. California Governor Arnold Schwarzenegger has also laid out a plan for remaking California's health system, in the wake of a similar move by Massachusetts.

The proposal from Obama (D-Ill.) came on May 29 in a speech at the University of Iowa, where he outlined a $50 billion-a-year universal health-care plan for all Americans that would increase taxes on the wealthy and require virtually all employers to offer insurance to workers or face tax penalties.

(source: www.michaelmore.com)