Does U.S. educated reporter hate Canadian health care system?

The headline screams "Crohn's research at Robarts hits world stage." Is the headline true? Yes. Is it the whole story? Not by a long shot.

Dr. Brian Feagan is the director of Robarts Clinical Trials at the Robarts Research Institute in London, Ontario. Last year Feagan was among those awarded the 2013 Scientific Achievement Award by the Crohn’s & Colitis Foundation of America (CCFA). Feagan has long been known for, as they say, pushing the needle forward in the quest for cures to these diseases.

The man is amazing. A quick Google search shows he has been at the forefront of inflammatory bowel disease research since late in the last century at least. His latest work is, not surprisingly, a continuation and a validation of research which has attracted global interest for years. He is a longtime player on the world health care stage.

Londoners should be proud of medical scientists like Feagan and proud of the work being done at the Robarts Research Institute. Researchers like Feagan and their studies are among the reasons I have the institute on my short list for an annual charitable donation. Because of the work done there, I am increasing my donation this year.

If you have been reading the series of articles run by The London Free Press and carried by Sun Media across the chain, you would think that Canadians are receiving second rate health care when compared to what is available south of the border in the States. The story tells readers "many provinces won't pay" for an aggressive approach for treating Crohn's disease.

A quick Google search turned up this online post by a woman in Salt Lake City, Utah:

In November, my new gastroenterologist . . . started me on Humira. It's a biological medication to decrease inflammation that has been successful to treat some people's Crohn's disease. . . .

The insurance denied the claim when the the pharmacy tried to get payment, because after a couple of refills at a local pharmacy, it's only covered when it comes from a "specialty pharmacy," called Acredo. After three hours either talking with people at Acredo, the specialty pharmacy, or having my doctor's office or the University pharmacy techs talk with people at Acredo and the insurance company, I left without the medication.

The patient ended her tirade saying, "Sigh. I wish private enterprise wouldn't get between patients and treatment"

Yes, some provinces resist paying for aggressive and expensive treatments for Crohn's disease as the first line approach -- but so do many private insurance plans around the globe. These are often plans that the patients thought were excellent until they were denied coverage for a drug like Humira.

I will leave the last word to Beth, the lady with Crohn's disease that I quoted out of Salt Lake City.

"I shouldn't be surprised [at the denial of coverage], since Anthem Blue Cross is beholden to stockholders before patients. Private business, in my opinion, is NOT always the best way to get things done, especially when it comes to health issues."

The Free Press article wasn't wrong. It wasn't error filled. But it wasn't balanced either.

Where are the editors?

The Globe and Mail needs to hire some editors. They are running way too thin. A recent story was trying to be hip and cool by making reference to "Llewyn Davis, the vagrant folk singer imagined by the Cohen brothers, who opened a show for Elvis Presley."

The problem is that the movie making brothers are the Coens. No 'h'. And the movie, Inside Llewyn Davis, shows Davis appearing on stage immediately before Bob Dylan. Not Elvis Presley.

It just makes one want to scream: "Aaauuugghh!"

When the James Bond film franchise hit the 50-year mark, Heather Hiscox on CBC went on and on about her favourite Bond film, Goldfinger, in which Bond stops Auric Goldfinger from stealing gold stored in Fort Knox. She goes on and on about the amazing planned theft. Trouble is Goldfinger never planned to steal the gold. Too bulky. Too heavy. He was going to explode a dirty bomb in Fort Knox. This would contaminate the gold and leave it worthless.

When newspapers and high-paid news anchors cannot get facts right, facts so easily checked, how are we to be certain  they are getting their facts right about a situation like the one unfolding in Ukraine.

That's Ukraine and not the Ukraine. When I worked at The London Free Press an editor put me straight.

What the world can learn from India concerning health care

Today I read an interesting article in the Harvard Business Review on what is being done right in India when it comes to keeping health care costs in check. It makes an interesting counterpoint to the stories being run by the local paper. The London Free Press seems to have hate on for the Canadian single-payer health care system. The writers at the paper deliver criticism in spades, not that our system doesn't at times deserve it, but the paper fails to offer many detailed solutions.

If you are interested in the rising cost of health care,  read: India's Secret to Low-Cost Health Care. The article makes a number of interesting claims, but two that really stood out are:

1. The health care available in Indian hospitals is cheaper even when you adjust for wages: For example, even if Indian heart hospitals paid their doctors and staff U.S.-level salaries, their costs for open-heart surgery would still be one-fifth of those in the U.S.
2. When it comes to innovations in health care delivery, these Indian hospitals have surpassed the efforts of other top institutions around the world.

Plus ça change, plus c'est la même chose.

The idea that "the more things change, the more they stay the same" is a common one around the world. No doubt because it's true.

The late Horace Judson was a famous and well respected journalist. His most famous book was Eighth Day of Creation, a history of molecular biology. Published way back in 1996, I believe this book is still in print. Of course, the fact that his daughter Olivia Judson is the well known evolutionary biologist and popular writer also keeps his name current.

While reading a review of Horace Judson's book on heroin addiction, published in 1974, I was struck by how little the world has moved forward in the intervening forty years.

The reviewer, Gerald McLaughlin, Associate Professor of Law at Fordham University School of Law, wrote:

Apart from government moneys being spent on drug law enforcement, apart from the countless government research grants given academics every year, entire industries have begun to grow up around the drug cure business - methadone clinics staffed by private physicians have become booming business, drug analysis and urinalysis centers have sprung up to serve their needs, and private drug research firms have been created. Like the fabled "military-industrial" complex of the Eisenhower years, a "drug abuse-industrial complex" has been created. Once created, it is hard to dismantle. To put it another way, with so much money at stake, there is an incentive not to let the problem die or at least there is an incentive to push for one's own special treatment modality. The law enforcers want to keep their funds, so they push for new law enforcement programs to end the heroin traffic; the methadone maintenance advocates push for more money for more centres; sociologists and psychologists request further grants to test this or that theory of addiction. Quite often some of these diverse elements or the "drug abuse-industrial complex" lobby against new alternatives simply to prevent money from being siphoned off to fund new programs or approaches. Fiscal preservation is an age-old vice of man.

Of course, some things do change. I must add that in the years following the publication of Judson's book, Heroin Addiction in Britain - What Americans can learn from the English experience, the British government turned more and more towards the American model. The Brits even appointed a drug czar in 1998. 

The changes failed.

Kalydeco: What is the whole story?

The other night I caught a little foreign film in which the woman protagonist was one difficult lady to love. She had a young niece who was also damn difficult. Thrown into the mix was a boyfriend who had his own little, and so little, quirks. The movie ended on an upbeat note but with such a convoluted story it was difficult to know how all would play out in the end.

Sun Media is using the story to attack Ontario Liberals.

Now take the news. Everyday we read, hear and watch stories reported in the media. They are usually good tales with strong, neat story lines. Maybe too neat. I often have the feeling there is more to these stories than we are being told. Life is depicted by the media more as bad fiction than rich reality.

Take the story of the young Ontario girl taking the very expensive Kalydeco (ivacaftor) to treat a rare form of cystic fibrosis (CF). Sun Media reports it costs $348,000 annually in Canada for this unique drug. This is completely out of the financial reach of most people. At this point, the Ontario government is refusing to assist this young girl and her family as they struggle to cope with this massive expense.

The government has stated that it would like to help and to this end it and a number of other Canadian provinces are in negotiations with Vertex, the maker of the drug. At this point, the company and the provincial drug consortium in Ontario are at loggerheads over the price of the drug which is perceived by many to be outrageously expensive.

The kicker in this is that the genetic variation of CF the drug treats is rare. It is so rare that only about 20 people in the province would be helped by taking Kalydeco. The entire cost to the province would be less than $8 million.

Read the story at news.com.au.

What has the mainstream media left unsaid? Well to start, it is not just bureaucrats in Ontario balking when confronting the high cost of the Vertex drug. Health care bureaucrats around the world have choked when confronting the high cost.

A story similar to the one being played out in Ontario made headlines across Australia. Ellie Haikalis has the type of cystic fibrosis controlled by Kalydeco. Unfortunately, her family cannot afford the treatment and the Australian government refused to assist them.

Her mother, Rachelle, told the media  she and her husband had discussed selling their home but realized that even taking that drastic action would not raise the money demanded by the drug maker.

Almost thirty concerned American doctors banned together to pen a letter to Vertex. They wrote:

It is at best unseemly for Vertex to charge our patient's insurance plans (including strapped state medical assistance plans), $294,000 annually for two pills a day . . . This action could appear to be leveraging pain and suffering into huge financial gain for speculators, some of whom were your top executives who reportedly made millions of dollars in a single day (Boston Globe, May 29).

The dispute over the cost of Kalydeco is just one skirmish in a larger, ongoing war being fought in numerous countries scattered across the globe. But the Kalydeco story on its own is a good one. Many see the price charged for this drug as "unconscionable."

Read the fine Milwaukee-Wisconsin Journal Sentinel story.

A story in Medpage Today, Cystic Fibrosis: Charity and Industry Partner for Profit, points out Vertex developed ivacaftor (Kalydeco) "with the help of a $75 million investment from the Cystic Fibrosis Foundation -- as well as a hefty investment from taxpayers through grants from the National Institute of Health which underwrote the cost of early research."

It isn't just Yanks who have some skin in this game. There are Canadians at the table too, such as Lap-Chee Tsui and John R. Riordan of the Hospital for Sick Children in Toronto. The two research scientists, along with Francis Collins of the University of Michigan, led a team isolating the gene responsible for cystic fibrosis. Medical breakthroughs do not occur in a research vacuum.

On the upside, the drug cost isn't out of sight for everyone. Ian Smith, Vertex executive vice president and chief financial officer, exercised stock options to gross more than $60 million in one day, according to the Milwaukee-Wisconsin Journal Sentinel.

If Smith had the type of CF in question, he could live to be a hundred and never experience any difficulty in paying for his supply of Kalydeco thanks to his after tax profits from just that one day.

Of course, Smith does not have CF. The millionaire has no reason to worry. He can breath easy.

Comparing apples to oranges

Jonathan Sher, a Sun Media investigative reporter working for the chain's London, Ontario, newspaper has filed another story in a series examining health care in Ontario: Health ministry data on hospital overcrowding riddled with errors. From the tone of Sher's past articles and the frequent positive references he has made to the American health care system, one might surmise Sher is no fan of Canadian single-payer health care.

Sher, who may have been born an American citizen, is one bright fellow. After graduating from the University of Virginia with a B.A in history and foreign affairs he went on to earn his Doctor of Law from the University of Southern California in 1992. It has been reported he is a member of the New York State bar association. With his strong background in law, Sher knows how to build a strong argument.

I believe it is safe to say that when Sher slides an apples and oranges comparison into a story he does so knowing full well what he is doing.

Sher tells Sun Media readers:

Ontario has 2.4 hospital beds for every 1,000 residents, less than half the European average. Of 39 countries compared by the Organization for Economic Co-operation and Development, only three had fewer hospital beds: Mexico, India and Indonesia. 

This is not the first time that Sher has compared a Canadian province with the entire continent of Europe. He goes on to compare Ontario with 39 countries in an Organization for Economic Co-operation and Development list. I addressed this debating trick in an earlier post: Hospitals too full to be safe? Not in London, Ontario.

As I wrote in the earlier post:

Let's try comparing apples to apples: countries to countries. According to the most recent numbers released by The World Bank, Canada has 3.2 beds per 1000 people. Both The United States and Britain have a smidgen less at 3.0 beds per 1000. Sweden fared even worse with only 2.7 beds.

According to the newspaper article, Ontario has only 2.4 hospital beds per 1000. It sounds bad and it is bad but Ontario cannot lay claim to the worst numbers on the continent. For lower numbers look south. Ontario has more beds than almost 40% of the American states according to The Henry J. Kaiser Family Foundation. Oregon only has 1.8 beds per 1000 and California, Hawaii and Vermont have numbers that are little better.

Kudos to Sher for discovering that the overcrowding data compiled by the province had serious errors. Good work. (Here is a second link to the story.)

Overcrowding of hospitals is a serious global problem and not unique to Ontario. Many industrialized countries do attempt to keep occupancy rates at or below 85 percent, just as Sher claims. And many, many hospitals throughout the industrialized world fail at the attempt.

Cuts hammering journalists

The headline warns "Cuts hammering elderly." Oddly, the online picture accompanying the story shows a happy senior being patiently spoon-fed by a caring health care worker.

The image is jarringly inappropriate and, no surprise, it is phony. It is a staged, stock photo image — stock photos are cheap but they are not journalism. I'd say cuts are hammering journalists, too.

Recently I briefly traded tweets with a local reporter who was offended when I called the balance in one of his stories "faux."

I not only stand by my previous comments but I'd like to expand upon them. The media in general, it is not just the local paper, all too often seem to believe that a story is not complete until it is balanced. They believe this until the cost of balance, either in time or money, is deemed too high.

Which brings us to today's article. My guess is the journalist was instructed to write a story on the report "Pushed Out of Hospital, Abandoned at Home" released by the Ontario Association of Speech-language Pathologists and Audiologists (OSLA) and the Ontario Council of Hospital Unions (OCHU).

Before continuing, I want to make one thing clear: I am not claiming the report is error-filled. I am simply saying that a story as inflammatory as this one demands context, demands balance. How does what is happening in Ontario compare to what is taking place outside the province? Are these local problems or are they endemic in the health care approach embraced in a multitude of places?

For instance, the report by the unionized hospital workers and some therapists tells us "one in six patients has an unplanned readmission within 30 days." My response is to ask, "How does this compare to the readmission rate for seniors in other localities?"

A little searching discovers a report, The Revolving Door, on readmissions in the United States. This American report tells us:

The U.S. health care system suffers from a chronic malady — the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving.

Where this all gets interesting is newspaper report places the blame on underfunding. The answer from the union et al. is simple: Throw money at the problem. But the U.S. report puts the blame on its badly fragmented health care system. According to the American report, if patients get the right care the first time many return trips are prevented. Done properly, this costs less money, much less money, not more.

According to The Revolving Door report out of the U.S.:

The [U.S.] federal government has pegged the cost of readmissions for Medicare patients alone at $26 billion annually, and says more than $17 billion of it pays for return trips that need not happen if patients get the right care. This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients.

As a senior, in what I hope is just the early stages of congestive heart failure, I read the news report with great personal interest but I was left with more questions than answers. I know the reporter who wrote The Free Press piece and I am sure that that reporter was also left with lots of unanswered questions. Sadly, neither the reporter's questions nor mine will be answered. I blame cutbacks, newsroom cutbacks.

Take the congestive heart failure example. I keep returning to CHF because the news story told of a patient with CHF who was sent home after being taken to ER. As there isn't enough information in the newspaper concerning this incident, I read the report itself.

It seems the gentleman in question was 89 at the time he was admitted to the ER suffering from pulmonary edema. The doctor in ER immediately gave the gentleman Ventolin. This is widely accepted as a good first response. The ER doctor then wanted to send the gentleman home but his daughter fought this decision.

In the end she was successful at having her dad admitted to the ICU and given morphine. Morphine is a traditional drug for dealing with pulmonary edema but is falling our of favour. According to University Hospital, Cleveland, morphine is no longer indicated to treat pulmonary edema.

The daughter was happy with the morphine but upset about the Ventolin. I don't believe the daughter is a doctor. I'm not sure how much weight to give to either the daughter's praise or to her criticism of her father's care.

Survival times for those 80 years or older are often measured in months rather than years. The gentleman in question lived to be 94. Clearly, something was being done right for this senior. Cuts did not seem to be hammering his man, at least not until he hit 94. The fellow died after undergoing an gastroscopy during which the doctor apparently perforated his esophagus. He died from an actual medical cut.