The Geriatric Nation.

                   There are 5,580,9000 Canadians over the age of  65 as of this summer.
 There has been 0.09% population growth in the past year.  There are more seniors than children for the first time in Canada's history.
 

      We tend to generalize when we are talking about health care and other social responsibilities   As long as we are talking about statistics of age and  health care and the philosophy of "free" medical care, everyone with a brain will sooner or later come to the conclusion that with growing numbers of old people and falling numbers of  productive young wage earners the system is sooner or later going to go broke. When reduced to a more personal level it becomes more difficult to decide how the pie will  have to be divided.
     If your best friend had an illness that was serious but treatable with very expensive drugs that he could not afford and you had a savings account to send your kids to University, how much of it would you contribute of the fund towards his life-saving treatment.  Bearing in  mind, there may be  little chance of you getting it back, would you be prepared to give him ten percent, twenty-five per fifty percent if there was a reasonable chance of prolonging his life?    Maybe you would give him a hundred percent, if you were close enough.  Perhaps your generosity would be influenced by the nature of his illness and be less generous if his complaints were largely self-inflicted by such conditions as alcohol or drug abuse or other forms of self abuse.
      Now picture the situation with regard to someone you don't know at all.    How  much  of your retirement savings and your children's future would you be prepared to give him?  How do you feel  about providing a more comfortable life in prison to most criminals often with better medical care than to elderly patients in Nursing Homes.  How do  you feel about supporting those who have never contributed to the health care system, not because they couldn't, but because they didn't want to.Most elderly patient have worked hard all  their life, but it's not politically correct to  make a prisoner work for his keep.  I have seen many of those criminals better provided for and get better medical care than the elderly.
    As the health care budget becomes more and more inadequate with medical  technology becoming prohibitively expensive  and life span continuing  to lengthen, we may have to re-evaluate how health care is distributed.  Everything for everybody will not be available for much  longer, so we had better get our heads out of the sand and start devising a rational way to see that everyone gets as fair a dealt as possible, based on our societal value and that the huge amount of waste within  the health care system is drastically reduced.

Feel free to comment if you dare. 

The High Cost of Health Care.

 

"In 2015, the estimated average payment for public health care insurance ranges from $3,789 to $12,055 for six common Canadian family types, depending on the type of family.
For the average Canadian family, between 2005 and 2015, the cost of public health care insurance increased 1.6 times faster than average income, 1.3 times as fast as the cost of shelter, and 2.7 times as fast as food."

- See more at: http://www.fraserinstitute.org/studies/price-public-health-care-insurance-2015-edition#sthash.kIQn37GP.dpuf

In 2015, the estimated average payment for public health care insurance ranges from $3,789 to $12,055 for six common Canadian family types, depending on the type of family.
For the average Canadian family, between 2005 and 2015, the cost of public health care insurance increased 1.6 times faster than average income, 1.3 times as fast as the cost of shelter, and 2.7 times as fast as food.
- See more at: http://www.fraserinstitute.org/studies/price-public-health-care-insurance-2015-edition#sthash.kIQn37GP.dpuf

In 2015, the estimated average payment for public health care insurance ranges from $3,789 to $12,055 for six common Canadian family types, depending on the type of family.
For the average Canadian family, between 2005 and 2015, the cost of public health care insurance increased 1.6 times faster than average income, 1.3 times as fast as the cost of shelter, and 2.7 times as fast as food.
- See more at: http://www.fraserinstitute.org/studies/price-public-health-care-insurance-2015-edition#sthash.kIQn37GP.dpuf

  I have no doubt at all that the high cost of Health Care could consume the entire national budget.  Much  as we love the  concept of everything related to the promotion of health being entirely paid for by the state (taxpayer), commonsense and a little basic math make it clear that this is not and cannot be possible in the long term.  As the population continues to age and people grow older and sicker, requiring more sophisticated and more expensive care, the diminishing  number of young  healthy adults that have always formed the base of the social pyramid that finances the system gets smaller.  The concept of a 'free' health care system is, of course a deliberate political device to fool the populace into thinking the Government is providing them with something for nothing, rather than confiscating their money and dispersing it in  the way that they deem most appropriate.  If you believe that the government can use your money more effectively than you can manage it yourself, then you have the ideal, or almost ideal  system, until the money runs out or the young to middle aged feel over-burdened to the extent that they are prepared to rebel.    If you believe that is the best we can do then you have a responsibility to see that your elected representatives are acting in  your best interests and are accepting the exact same level of care as you do.  (If you think that is the case at present, you are a little naive).   Clearly, they are not doing the best that can be done and unfortunately public reaction  is largely  indifference unless one is unfortunate enough to get caught up  in the morass that the generally poorly  informed administridiots devise to keep the system limping along until  after the next election.  It frequently seems to limp along sufficiently well for the patient to  get acceptable care, mainly riding on  the backs of the health care workers who still care and work  hard to make the system work.  Unfortunately,even the most dedicated find things are wearing thin when a government that is asking them to work harder and longer hours  than most civil servants can even imagine, is at the same time cutting physicians fee schedule by almost five per cent.  Nurses also are feeling the pinch, while the administridiots award themselves what in many cases are obscene salaries and even bonuses. (Go figure!)   As far as I can tell, restraints seem rarely to effect the administrative layer, who feel they should have salaries at least comparable with the most successful in industry.  That is the reason that the health care system has been transformed into the health care industry.  That attitude is so pervasive that it it is finally infiltrating the infrastructure of the health system, the doctors and nurses.  Physicians are no longer prepared to work around the clock, often on a pro bono basis, as they once were.  There are many reasons for this but physician burnout is another huge topic for another day.   Suffice it to say, that the idealism that carried generations of physicians through a difficult but rewarding career has withered on the vine.  Medical residents have a union so powerful that it would have been both unimaginable, unacceptable and unprofessional in my student and resident days.   The idealistic, committed medical professionals of yesteryear and beyond are being replaced by a cadre of civil service medical technician.  They will demand and they will get all the benefits of being civil servants and will behave accordingly.  All it will cost them is their freedom, their independence and their medical 'souls'
     I am afraid it will cost patients a great deal more, fortunately they will never know how much. 

Health Care Equality.

  What if I  need a prescription for $1 and you need one for $200,000 and we both  pay $10,000 / yr income tax?  

   Hilary Clinton is screaming.  A little Wall Street Shit (Hedge Fund Scavenger) called Martin  Shkreli, took a vital $14 pill and upped the price to $750 / pill and his greed did inestimable damage to the Pharmaceutical Industry.   As is the feckless way of the milksops who control Wall Street and the corridors of Washington, they will be unable to distinguish between  the hardworking, often brilliant researchers who spend years developing and bringing to us medications that cure or ameliorate disorders that were untreatable a few years ago and the hedge fund scavengers that we shamefully allow  to  ravage the financial system.
Why prescription drug prices are soaring
Why are pharmaceutical prices rising so rapidly?
Drug developers need to cover their R&D costs to develop a drug, but consumers often forget that drug developers are also looking to recoup losses tied to research into dozens, hundreds, or even thousands of failed discovery, preclinical, or clinical therapies that didn't make it to pharmacy shelves.
Drugmakers are also making a strong push into treating orphan diseases (indications with 200,000 or fewer people in the U.S.) and developing medicines that are personalized and focus on a specific gene or protein within a patient. The move makes a lot of sense on the part of drug developers, as there's minimal competition and little reason for insurers to deny coverage. This push toward specialization has been a major reason why prescription drug prices keep heading higher.

Source: Flickr user Dan Moyle.

Consumers aren't happy about rising drug prices
With drug cost inflation not expected to slow anytime soon, patients with rare diseases, or diseases that suddenly have breakthrough cures, have been faced with mammoth price tags -- and some consumers aren't happy about it.
Last year, Gilead Sciences (NASDAQ: GILD) had to answer to Congress after placing a $1,000/day price tag on its once-daily pill for hepatitis C, Sovaldi, and a $1,125/day price tag on once-daily HCV therapy Harvoni. A genotype 1 patient with liver cirrhosis who's been treated previously could be looking at a treatment cost of $189,000 with Harvoni! Of course, Gilead's therapies also provided a 90%-plus cure rate in most clinical studies and drastically improved patients' quality of life during treatment vis-à-vis manageable side effects, a far cry from any preceding HCV therapies.
Vertex Pharmaceuticals' (NASDAQ: VRTX) Orkambi, a drug designed to treat cystic fibrosis patients with the F508del mutation, has drawn even more ire with its $259,000 per year wholesale cost. Unlike Sovaldi and Harvoni, which promise a cure to a vast majority of patients taking them, Orkambi merely offers an improvement in lung function to the roughly 8,500 patients in the U.S. who may qualify for the drug.  
The world's most expensive drugs in 2015
But neither Orkambi or Gilead's HCV duo even crack the top five when it comes to the world's most expensive drugs in 2015. In fact, a handful of drugs priced in the $300,000-$360,000 annual cost range didn't make the list! Today we'll take a brief look at what medicines will set insurers and consumers back the most.
However, before we do that, two points of caution. First, drug developers have a tendency to change drug prices on a quarter-to-quarter basis, meaning this list could look different even three months from now. The other point worth noting is the cost for these treatments can depend on where you are in the world. Harvoni might run $1,125 per pill on a wholesale basis in the U.S., but in emerging markets overseas with price caps in place the same pill might run as low as $10. In other words, pricing is a bit subjective, and you should keep that in mind as you read on.

Source: Pictures of Money via Flickr.

With that out of the way, here are the world's five most expensive drugs:
1. Glybera: $1.21 million wholesale cost per year
We knew that one day we would see the world's first seven-figure drug in terms of cost. Based on an approval in the EU last year for UniQure (NASDAQ:QURE), we now have one.
Glybera is a gene therapy that helps restore LPL enzyme activity, which is critical to removing fat-carrying chylomicron particles in the intestines following a fat-containing meal. Specifically, it treats an extremely rare condition known as familial lipoprotein lipase deficiency, which affects only one in 1 million people -- thus Glybera's market potential is only around 150 to 200 people in the EU. Primary care physicians administer the drug in a one-time series of up to 60 intramuscular injections in a patients' legs.
When you consider its one-and-done dosing and extremely small patient pool, it's slightly less shocking that UniQure settled on a 1.1 million euro price tag for Glybera.
2. Soliris: $700,000 wholesale cost per year
Alexion Pharmaceuticals' (NASDAQ:ALXN) Soliris has actually been the most expensive drug in the world for years, so seeing it fall out of the top spot may come as a surprise to many. Within the U.S. Soliris had a wholesale cost of nearly $537,000 last year, but the Patented Medicines Price Review Board notes that Soliris' annual cost in Canada can be as high as $700,000 per patient.

Source: Alexion Pharmaceuticals

Soliris has two current indications: as a treatment for paroxysmal nocturnal hemoglobinuria (PNH), and as a treatment for atypical hemolytic uremic syndrome. Both are very rare indications with no current competition, thus the ability of Alexion to command such a high price tag for Soliris. More importantly, patients with PNH often live for 10 to 15 years following their diagnosis, so despite a small patient population, Alexion has a source of long-term recurring revenue with Soliris. After delivering $2.2 billion in revenue in 2014, Alexion is projected by Wall Street to more than double to $5 billion in 2018, mostly on the heels of Soliris.
3. Naglazyme: $485,747 wholesale cost per year (based on 2014 pricing)
Based on data provided by FiercePharma last year, BioMarin Pharmaceutical's (NASDAQ:BMRN) Naglazyme will handily take the third spot, with an annual cost approaching a half-million dollars. I looked far and wide for an update on pricing for Naglazyme in 2015, but not a trace of an update was to be found. That's probably because the drug is only prescribed to a few dozen patients on a per year basis, according to EvaluatePharma.
Naglazyme is an enzyme replacement therapy designed to treat a disease known as mucopolysaccharidosis type VI, which is also known as Maroteaux-Lamy syndrome. This is a progressive disease that can cause organ enlargement and skeletal abnormalities, and it often leads to shortened life expectancies for those diagnosed.

Source: BioMarin Pharmaceutical.

4. Vimizim: $380,000 wholesale cost per year
BioMarin Pharmaceutical, a rare disease specialist, also brings us the fourth-most expensive drug in the world with Vimizim.
Vimizim, with its $380,000 per year cost, is an enzyme replacement therapy that's given as a weekly infusion to treat Morquio A syndrome, a disease characterized by the body's inability to break down long-chain sugar molecules. An estimated 800 people have Morquio A in the United States, and Vimizim's developed world market is believed to be about 3,000 people. Analysts predict that despite its relatively small market potential, Vimizm could generate up to a half-billion in sales annually at its peak for BioMarin.
5. Elaprase: $375,000 wholesale cost per year (based on last update in 2010)
Lastly, the spot as fifth-most expensive drug in the world goes to Shire's (NASDAQ:SHPG) Elaprase, an enzyme replacement therapy designed to treat patients with mucopolysaccharidosis II, or Hunter syndrome. You'll note the last conclusive pricing data on Elaprase comes to us from 2010 when it ran $375,000 per year on a wholesale level, but there's little reason to believe its price has fallen since that time with no added competition to the Hunter syndrome indication.
Patients with Hunter syndrome lack an important enzyme (iduronate-2-sulfatase) that helps with the removal of long-chain sugar molecules. If these glycosaminoglycans aren't removed from a patient's body, it can lead to progressive organ decline, specifically of the heart, lungs, liver, and spleen. Incidence of the disease is fairly low, with the EU reported one case per every 140,000-156,000 births.
With little standing in the way of higher prescription drug prices, annual costs in the high six-digit range could soon become a norm in the orphan disease space.

This article is freely plagiarized from anywhere I  could find relevant information.  So sue me!

---

Geriatric Drivers.

     When you are young, energetic, strong, mentally astute and think you are just approaching your prime, it is a little traumatic to get your license renewal form together with a form letter informing you that since you are approaching your eightieth birthday you are required to contact the Ministry of Transport to ascertain that you are in sufficiently robust mental and physical condition to be allowed to renew your driver's license.  I do  a lot of driving, have a good driving record and think I'm in  as good mental condition  (apart from  misplacing a few things now and then) as I have ever been.  It does come as a bit of a shock that anyone could consider it necessary, but one has to go ahead and and pass the required test if one wants to keep driving.  A very important item in maintaining one's independence in  a country with a climate like Canada's.
     So  I set up my appointment for the 'educational and assessment' session as required and was provided with the information that there would not be an actual road driving test, but there would be a vision test that includes assessment of peripheral vision, as well as a screening test for cognitive function.  The remainder of the hour and a half session was an educational presentation to better prepare the elderly for the vicissitudes of driving a vehicle in Canadian conditions.
       I arrived at the appropriate building at eight forty-five am, all ready for the ordeal.   There were about twenty or so folks, some looking their age and some not, split about fifty-fifty between men and women.   We were brought down to the basement cafeteria after being informed that the usual area where the program takes place was being refurbished and there might be some slight delay.  Meanwhile we could sit down in the cafeteria and have a cup of coffee (at our own expense, of course!) and someone would come and get us shortly.  We sat down around a table, while an elderly English gentleman with a broad Yorkshire accent complained about how we seniors in Ontario are discriminated against as the only province in Canada that had a driver evaluation at the age of eighty and every two years thereafter. He informed us this was his third test and he was driving as well as ever.  A delightful elderly lady, accompanied by her younger sister, who was embroidering industriously, informed us that she 'mustn't' lose her drivers license because she has a part-time job and wouldn't be able to get to work.  The conversation was getting really interesting as the folks 'one-upped' each other with stories of their eldest acquaintance driver.  We were up to one whose ninety-seven year old friend had just got a two year renewal, when we were interrupted and brought down to a large board room where we all sat around a table and received our initial briefing.  
     The presentation was well planned and treated the attendees as thought we were mature adults, not presupposing that most folks of our age are in some stage of cognitive decline.   They went to some pains to explain why this program was necessary emphasizing that it was not a witch-hunt to stop older folks driving but a program to enhance road safety and to educate regarding flags to watch for.   Prior to the testing the individual's driving record is scrutinized and taken into consideration.
     The program started with an eye test for each individual and was followed by a presentation sharing current relevant road statistics.  Of interest to all of us oldies was the fact that the oldest driver in Ontario is one hundred and eight and that there are seven drivers of over one hundred!   Then a video clip of common driving errors and some discussion.  Finally, there were two five minute tests of cognitive function, that would be hard to fail if your cognition approaches normal.  The first was to draw the face of a clock, put in the numbers and make the time ten minutes past eleven.  The second is to cross out a given letter of the alphabet in a paragraph of letters.  The letters are all large and clear so anyone functioning normally should have no trouble with this one either.   If there is any problem with any of the above then a road test is scheduled. 
     All things considered I think this is a worthwhile test in that it would likely pick up significant vision deficiencies and gross cognitive disorders.  It also provided some educational content about driving and aging that some folks may not know. 
     I also noted an elderly lady and gentleman getting on extraordinarily well together.  Wouldn't it be exciting to mention at  your wedding, "I met my sweetheart at an over-eighties driving test!"
 No comments required, thank you very much!
 

Every patient needs an advocate in the Health Care Industry.

              When we walked into North York General Hospital our initial  impression was it looked bright and cheerful. The lobby was dressed up really nicely and it had a really impressive gift shop.  My daughter's partner had been admitted two days earlier and had emergency surgery for a bowel obstruction.    I spoke to my daughter (a nurse) the night before and she informed me he was doing well and was already being walked around.  (Seemed a bit early to me, but what would an antiquated old gp know? )
              By the time we got up to the surgical ward the surroundings looked a little less luxurious, in fact one might say a little on the seedy side and the patient was sitting up in bed, cold and clammy,looking rather 'shocky'.  (as though he was about to faint.)  We laid him down flat and called the harassed nurse who was busy trying to get another patient en route to the operating room.    Meanwhile my daughter put a hand on his abdomen and called me over to do the same.  His bowel was grossly distended and he had been given some sort of suppository to accomplish God knows what.   The gastric suction did not appear to be functioning adequately.  Following all of this and I must emphasize that we were pleasant, polite and understanding, we were starting to attract just a little bit of notice.  Unfortunately, that sometimes seems to be necessary to make things happen. My daughter wanted to talk to the doctor or resident and shortly thereafter a bowel x-ray was being arranged.  She cancelled other plans she had and decided that she better stick around and look  after him.
              Now,I am not blaming any of the care givers, but there is something seriously wrong with a system that could allow a post surgery patient to slip into shock in an acute care hospital.
               Not every patient has an advocate in the health care professions, but every seriously ill patient needs an advocate with the patient's welfare at heart,especially when the patient is too ill do so so for himself.    Not to tell the health professionals what to do, but to show  there is someone who cares for the patient as a human being and to provide the care that the often overworked and harassed members of that profession can no longer look after in the Health Care Industry.
              Tell me if you think your family member would need a medical advocate. 
              
                 
                

The letter I almost (but didn't) send to the Minister of Health.

Dear Minister,

                    I don’t usually write letters to newspapers, politicians or lawyers, mainly because I like the Canadian system and have worked hard to see it work.  I was born in Ireland, studied medicine there, and when I graduated I had to decide what I wanted to do with my life.   I did not choose Canada serendipitously, indeed I had family in the US and classmates from the ‘Colonies’ and was offered employment opportunities that would have enabled me to pay off my considerable student debts as well as make a comfortable living for myself, my wife and baby daughter.  I thought carefully about all of these things and finally decided that I wanted to be a Canadian.  Not an American, not an important Physician in some British Colony and not even a partner in a practice in London, England, where I was an assistant family doctor when I applied to come to Canada.  (Just after I arrived I had a communication from that practice offering me a partnership, as one of the partners in the practice developed angina pectoris.).    Minister, as I was applying for a position in Regina, Saskatchewan, I received a communication from the British Medical Association, warning me of the Socialist system being instituted by Tommy Douglas.   They pointed out it was not supported by the BMA.    That did not deter me and I came to Regina nevertheless, and met many fine people, medical and non-medical, political and non-political and spent thirty five years in medical practice in the province, the last ten years as Professor and Chair of the Department of Family Medicine.   Through all those years, Minister, I believed we had an exemplary health care system that, while far from perfect was striving to offer the best possible use of the available resources.  As the Chair and Professor of the Department of Family Medicine at the University of Saskatchewan I had knowledge of medical care across the country, so I believe my comments to be applicable on a National basis and not to be confined to Saskatchewan, or Ontario, where I have been in practice for the past fifteen years or so, initially as a Faculty Member at UWO and more recently as a physician doing some locum work a day or so a week. 

            The story I am about to tell you Minister, is of a recent incident that shook my confidence in certain aspects of the Canadian Health Care system, of which I have been a proponent, participant and patient for the past fifty years.  It is a story I feel compelled to write, because I am in a position to critically evaluate what is going on and feel these comments should be shared.  It is a story not to criticize the health care providers, but to criticize what has happened to a health care system that was once an example of excellence but has steadily deteriorated over recent years. 

            After an accident in Hilton Head, S. Carolina, in which my seventy-seven year old wife tripped over a concrete parking marker and hit the ground with an impact that I was afraid she had suffered a serious and potentially disastrous head injury, I headed back to Canada the following morning, after observing her throughout the night and deciding her condition was stable and it was safe to travel.  We arrived home, in London Ontario, two and a half days later, after an ordeal, that I’m sure you can imagine.  Indeed, in retrospect, I question the wisdom of my decision, to drive that distance, on minimal sleep.  To cut a long story short, first thing in the morning, after arriving home, we took a trip to the emergency room, at University Hospital, and that’s where this story really starts.

            On the morning of Wednesday, twentieth of February, 2012, I brought my bruised and battered wife to the Emergency room at University Hospital, in London.    Minister, we sat there for five hours.  I am a physician and I was satisfied that my wife was in no immediate danger. I couldn’t help speculating on what might have happened if a patient was bleeding from a subdural hematoma or worse.  Because her hand and arm were grotesquely swollen and bruised, they were the immediate focus of attention.    So, after five hours, limbs were x rayed and the splint that I had already applied was considered to be adequate treatment for the moment.  Her head was either not noticed or considered to be unimportant, despite extensive bruising and tenderness over the zygomatic bones of the face and a black eye.   I brought her home from the emergency room at University Hospital where she had been sitting for five hours without having been assessed for a head injury by a physician, when she was so uncomfortable that she insisted on signing herself out.   Being a physician I was satisfied that she was not bleeding into her brain.  However, this was not known by the staff and it concerns me that someone whose cognition may have been impaired was allowed to leave emergency without any real attempts to explain the possible risks involved..  Equally unbelievable, Minister, was the fact that despite the fact that  Family Medicine programs  try to make our students aware of women’s health issues and of the fact that they must screen for family abuse, nobody asked my wife if she had been beaten up by her husband or otherwise abused..  By the way, there were notices around the emergency room advising this would be screened for, except that it never happened.  I found this almost unbelievable and and think that this aspect of emergency room care needs careful review.

            Next morning, since my wife (understandably!) refused to go back to emergency at University Hospital, and her head had not yet been looked at, we went to St. Joe’s where the experience was much more acceptable.  The CT scan showed some bone damage, fortunately not severe.   Minister,  I have spent much of my life working (and sometimes living) in hospitals and I understand the difficulties that health care workers have to contend with .   (Indeed, I hardly dare to as both my offspring work in, what has regrettably become  “The Health Care Industry”.    Suffice it to say, that something is amiss in the state of Health Care, that in my opinion is more related to its administration, than to the delivery of health care personnel.. 

       Those inadequacies must be addressed by the administration, as well as by those who deliver the care.   The Health Care System in Canada is deteriorating.  I do not believe you would have settled for that level of care for a member of your own family and neither would most Canadians.

                              Sincerely,

                                                 

 Stanley G.Smith,  MA, MB, B.Ch, BAO, CCFP, FCFP.

                   Professor Emeritus, Dept of Family Medicine, University of Western Ontario.

Poor pieces of Flesh!

             Foreign buyers are flocking to Canada to find surrogate mothers now that Asian countries have cracked down on this practice.  These narcissistic folks are using Canadian Health Care resources to satisfy their desires and their longing for immortality and for the most part are not interested in offering a good life to some baby waiting to be evacuated out of  the womb.  I see their mission as a purely selfish  one, which I resent subsidizing with my health care dollars.   I  would be surprised if most Canadians didn't share my views.   Canadian surrogates should not be covered by medicare and if the practice is allowed at all, should be paid for  by the people buying  the babies.  Many developed countries ban surrogacy outright.  Surrogacy, catering as it does to the whims of the purchaser may take an ugly and immoral  turn.   Recently a Nova Scotia woman who was 'commissioned' to have a child for an  overseas couple found herself carrying triplets.  Although she wanted to carry all three, the 'would-be' parents insisted one of  the fetuses be killed off.  The woman was told that the couple could cut off expense payments if she insisted on keeping all the babies.  The surrogate agreed to  one of the fetuses being killed off.  One of the two remaining fetuses died too.   Apparently, the remaining baby is surviving its hazardous intrauterine journey for the moment.  If it does one has to wonder about the environment into which the poor thing will be born.    If Canada's medical ethicists and other self professed protectors of patient health don't have something to say about this, they certainly are not doing their jobs.                                                        

                                      Perhaps  they just don't understand it. 

 

The Elecronic Medical Record.

Physicians Use of EHR Systems 2014

The survey on Physician Use of EHR Systems 2014 found that close to, or more than half of all respondents, reported a negative impact in response to questions about how their EHR system improved costs, efficiency or productivity.

Physicians have become increasingly unhappy with EHRs. We really did not need a survey to document this.
The real question is why? I think logical thinking can reveal the answer.
Why do we use information technology in general? We use smartphones, pads and computers when they improve our lives. No one makes me buy a computer. I buy the computer because of the value it gives me. I buy software (or apps) because I find them helpful.
Throughout our economy, information technology must provide value. Developers have to demonstrate value to those who spend money on systems.
Electronic health records are being imposed on health care systems. They are not being sold as helping physicians do their work. In addition to this problem, the government has mandated meaningful use (a term that physicians often ridicule). When you impose technology on users, then an important development piece is missed – user friendliness. Every system that my friends describe has made the user’s (physicians, nurses and other health care workers) charting more difficult. No one asked the physicians how they work. No one has designed a system to be health care worker friendly. We are expected to figure out the system, rather than the way most computer programs are developed.
Bob Wachter, in his important book Digital Doctor, explains the care that goes into developing airplane computer systems. No one thinks the same processes occur in health care.
How does this matter? EHRs add time to the physician’s day. EHRs contribute to physician burnout – a major problem that negatively impacts patients. We should all speak out about this problem.

Medicine gone crazy!

             A Canadian forensic psychiatrist says he regularly treats sex offenders for impotence with Viagra like drugs and advocates the practice as a way to actually keep them out of trouble.
             Dr. Paul Fedoroff’s comments come as a new American study raises legal and ethical questions about helping convicted sex criminals overcome erectile dysfunction (ED).
              Authors of the paper worry that doing so might help some perpetrators re-offend, while American law bars government health-insurance from covering the treatment’s cost.
But in a response to their article, Fedoroff says prescribing Viagra-type drugs or delivering other ED treatment can be part of a strategy to shift offenders away from criminal behaviour — such as assaulting children — and toward more normal sex.
            I have to wonder if Dr. Fedoroff would like his daughter to be exposed to such an offender fortified with Viagra as part of his treatment to steer him in  the direction  of 'normal sex'.   Come off it, Doc.  Further, our contention that pedophiles often target children only because they’re afraid they will not be able to perform if they try to have sex with an adult partner is nothing short of absurd.  He further asks, “Which sounds like the more dangerous person a person who is engaged in fulfilling, healthy sexual relations with a consenting partner, or someone who has no legal sexual outlets?”  He does not seem to grasp, that if the person  was capable of having the sort of relationship that the learned doctor describes it is unlikely that he would be in jail serving a sentence for pedophilia in the first place.                                                                   
            The issue was raised recently, though, in a study by three Boston-based urologists, who noted in the Journal of Sexual Medicine that coverage for anti-impotence drugs by the United States’ Medicaid program was banned in 2005 in the wake of public “outrage” that tax dollars were used that way..                               
            The doctors say they are not in favour of denying care to all sex offenders, but suggest it is possible in some cases that “treating their sexual dysfunction may increase the risk of sexual recidivism.”
          Still, they say the science is unclear, and complain that urologists lack the training to know whether treating the offender’s impotence is appropriate or not.
“Virtually everyone has some improvement,” the psychiatrist said. “Most find a girlfriend, boyfriend or appropriate partner.”
             Most pedophiles engage in inappropriate touching, kissing or genital contact, and an erection is irrelevant.  Castration would probably be a more appropriate treatment than viagra.
             Just another 'politically correct' misconception by the LWLs, until one of their kids are molested.
             Go figure!!

Social Sickness

                         "Pigs in a blanket- fry 'em like bacon!'
            If that's not hate speech, what is?  Hate speech is not free speech, it's anarchy! 
           America is a dangerous place and rapidly becoming more dangerous.  Violent crimes are escalating and a sizable segment of the population, instead of walking softly and carrying a big stick, are walking as loudly as possible and carrying a Smith & Wesson.  When the police are a major target of the violent crimes, anarchy is not far away.  I'm prepared to bet a hefty sum that a police call these days has a longer response time than has been normal  in recent years and if things continue in the present manner, there may well be cases when there is no response at all.  Not good for the nation.  Until someone takes charge, conditions will deteriorate and the mental and physical health of the nation can only decline.  As long as every malcontent can walk around with a gun in his pocket, the health resources required to deal with gun violence will continue to soak up an extravagant part of the health care and the legal systems budget. 
       When I was growing up, long, long ago in a land far, far away, my mother told me while quite a little  lad, "son, if you are worried or afraid of someone or something, just go up to a policeman and tell him what you're worried about and he will see that you are safe".  And that's the way it was.  There was something pretty healthy about that.  Both mentally and physically.  The police were perceived as friend and protector and they usually were.  They didn't need a gun and the truncheon they wore on their belt rarely came out of its sheath.   My parents didn't have to worry when we kids went out for the day and the greatest danger we could imagine was being home late for supper.   
       We are all proud of the fantastic advances that have been made in individual and public health in conquering and preventing disease in recent years.  Unfortunately, during the same time anarchy has been gaining momentum in our society and resulting in more mortality and morbidity than ever.  If we don't elect leaders who have the courage and integrity to deal with this, we will deserve what we are going to get..  Social sickness may now be a greater threat than physical disease.