MediaMedico

Healthcare Is An Economic Driver

Healthcare delivery should be part of The World Economic Forum Annual Meeting. Healthcare costs are a major driver for governments around the world, and conversely quality healthcare delivery is an economic engine and provides a solid part of an advanced economy’s infrastructure to enable a vibrant and healthy workforce necessary for innovation and economic growth. The challenge and the opportunity for debate, and creative policy solutions are as essential for healthcare delivery as they are for options to address the global credit crisis. For instance, advances in genomic medicine allow for faster analysis and better individual treatment options. This means targeted treatment at a lower cost.  Most healthcare delivery systems are completely unprepared for advances in genomic medicine. If Davos is really about innovation and transforming the everyday lives of people, world leaders need to be talking about the economic engine that is the healthcare industry.

Over a quarter of a million men in the U.S.and Canada are diagnosed with prostate cancer each year. In December 2011, a National Institutes for Health (NIH) expert panel reviewed the scientific evidence. They noted that most men diagnosed with prostate cancers have a low-risk type, the result of a wide-spread proliferation of prostate specific antigen (PSA) blood tests to screen healthy men for potential signs of this slow-growing cancer that will affect most men’s prostates if they live long enough.

An impressive body of research suggests that PSA testing to screen for prostate cancer probably doesn’t reduce all-cause or prostate-cancer specific mortality (BMJ 2010 Sep 14;341:c4543, Cochrane Database Syst Rev 2010 Nov 10;(11):CD004720) but it can certainly lead to further investigations which have both financial and potential personal implications. The American Cancer Society recommends that asymptomatic men should have the opportunity to make informed decisions before having a PSA screening test (CA Cancer J Clin 2010 Mar-Apr;60(2):70). If a screening test shows high PSA levels, a prostate biopsy is usually recommended to determine if cancer is present. A recent study investigated the rates of adverse effects associated with having a prostate biopsy.  Bleeding, infection and pain were the biggest problems.

Amazingly, 90 per cent of men who have a biopsy showing early Prostate cancer choose to have immediate treatment such as surgery or radiation, and risk potentially serious side effects, such as bleeding, pain, impotence or incontinence, without any good evidence about who will live longer as a result. In other words, what’s the cost-benefit of having the treatment? One recent study found no difference in survival between those who had surgery and those who hadn’t been treated unless they went on to develop cancer symptoms (BMJ 2012 Jan 9;344:d7894).

So let’s be clear, it’s not a matter of treatment versus no treatment—it’s about the timing of treatment. Sometimes it’s the old adage: the treatment can be worse than the “lab” disease.

The Latex Glove Treatment (image by Ambro)

NASA says the biggest solar storm in half a century has protons pounding everything from here to Jupiter this week.  And it’s not merely one eruption; solar flare-ups usually come in several waves.  Solar storms can cause all sorts of issues including communication problems for airplanes flying over the poles, and who knows what affect they have on the weather, or people. Fasten your seatbelt and make sure you’ve got your helmet on!

Solar Flare-up Shakes Up World

It’s everywhere. Honking horns, cell phones, microwave ovens, televisions, radios, timers, alarms, washers, dryers, pagers, telephones, police, ambulances, fire department sirens, my computer, other people’s music… the list is endless. Even my car beeps alerts at me. Wow! It’s non-stop noise. Silence is truly golden and it is increasingly rare these days. Is there a movement here? Of course these is.

Jacques Attali wrote a book on the subject called Noise: The Political Economy of Music. He argues that even if the sounds are pleasant, the droning repetition drains the enjoyment out of listening.

In the quaint old 1930s New York radio stations asked listeners to turn the radio down after 9 pm. Today the tyranny of noise is relentless 24/7 barrage, especially in big cities. Maybe we could all turn down television news for a start!

There are lots of challenges living in Canada in winter. One of which is running in January when it’s icy, cold and very windy.  Mega sub zero temperatures mean you have to dress for the extreme cold. I like to use Bodyglide® for my face since the wind can really make things uncomfortable. I also like to wear a liner-sock underneath thermal running socks as if you were cross-country skiing.  If it’s really bad you need to think seriously about double gloves. And for the ultimate in traction I insert Ice Spikes®  in a pair of running shoes I use specifically for icy conditions. Of course, it’s a good idea to slow down as well. Oh, the joys of winter.

Ice Spikes for Running in Icy Conditions

Kibera Rooftops

There is a lot of pain and suffering in this world. Right in one’s own backyard. Then look across the pond to Kibera in Nairobi Kenya.  According to some estimates 60% of the Nairobi live in slums.  A slum according to the United Nations agency UN-HABITAT is a run down area of a city that lacks one or more of the following: sufficient living space, durable housing, security from eviction, access to sanitation and safe drinking water. But what really defines a slum is the human degradation, the smell of burning charcoal, food and human waste. Kibera occupies more than 600 acres, it is home to more than a million people since 1912. Kibera is the largest slum in Africa, making it one of largest in the world.

Now consider how fortunate we really are.

Intrepid followers of this Blog will find that today a quote from an excellent article published in JAMA four years ago by Dr. Steven Woolf called The Power of Prevention and What it Requires. “Turmoil in health care and the economy may be shifting the dynamics for health promotion and disease prevention. Policy makers speak more about prevention, although the gestures are piecemeal (e.g., better insurance coverage). History teaches that citizens and leaders make sweeping changes when they sense a mutual threat. Lifestyles change and schisms give way to accommodation when national security feels threatened (e.g., wartime, climate change). Finding the economy and public health in decline may be what rouses the public to get serious about prevention. Self-interest (living longer and healthier) and common interest (economic stability) may inspire the personal sacrifice of getting healthy and the collective sacrifice (by the private sector and the state) of mobilizing the resources to make it happen.”

Exercise works (image by federico stevanin)

Dr. Woolf is right, until leaders and citizens clearly see the link between a spiraling economy and escalating health care costs, prevention and preventive medicine will continue to be relegated to the “wish list” of noble intentions. So for your own sake, get going.

There is a quiet revolution bubbling below the surface of the rhetoric of health care reform and big money health industry politics. A shift is occurring beyond patient-centered care to citizen-controlled health care delivery. Better-educated, health-informed citizens are increasingly using better online resources creating communities of interest in prevention not just diseases and treatments. Increasingly leading edge providers are shifting their practices in response to these demands. Some day, when every high school student graduates with health literacy and the skill level of a paramedic, we may see authentic communities of caring, and the vision of a true citizen-controlled health care system will transcend the politics of special interests. All it takes is leadership in education. I have a dream.

Health Literacy (image by ddpavumba)

Generational shifts in health care demands coupled with technological advances are changing the expectations and preferences of savvy health care consumers. Gen Xers and Millennials are more interested in taking control of their own health care. They’re less interested in being merely compliant. “Teach me what to look for, and give me the tools and access to treatment.” Point of care diagnostic lab testing and the Internet’s accessibility to information are shifting the role of doctor to teacher, advisor and coach. At least this is what many people look for in a doctor but rarely find it seems. Instead many doctors stick to the old model of diagnosing disease, deciding treatments and overseeing patients’ adherence to regimens. The rise of self-care creates opportunities and challenges for both health care consumers and health care providers.

Ideas go