Making Sense of Healthcare

Health Professional or Health Proprietor: Struggles to Understanding Health ‘Care’

Date: Thursday, September 27th at 7pm

In brief… Health. Health care. Health care institutions. Health practitioners. A lot of words, with potential for a lot of confusion. Canada is world renowned for it’s institutionalized health care systems, but how do WE, the residents of this country really feel about it? What is our on the ground experience with doctors? What are the challenges that we face when attempting to unravel our personal health woes (physical, mental or emotional) and those of people close to us? What responsibility do doctors have in helping or educating us? And how can people take control of the knowledge surrounding health? A lot of questions, with a lot of different answers.

A recap from Jason Hirsch:  

Thoughts and Resources on the Role of Conventional Medicine in Addressing Disease 

Through the 1950s-1970s, demographic historian Thomas McKeown argued that the great infectious diseases of the 19th century (smallpox, tuberculosis, cholera, etc.) were defeated not by medical vaccines, but by social factors, especially the Industrial Revolution’s rising incomes and corresponding improvements in nutrition (here).  There has been much discussion and critique of his thesis since.  Many tenets have fallen, in light of new research with sharper statistical techniques.  But the one part that seems to have remained strong is that most of the reduction in mortality from most of these diseases occurred before the introductions of the corresponding vaccines.  See here a great review of the discussion, and, for hard mainstream cred, a review in The Lancet here.
Next, I want to introduce Simon Szreter, a contemporary social historian and one of McKeown’s critics.  This piece here is a thrilling read for anyone politically inclined and interested in health.  He says that the neoliberal right seized on McKeown’s thesis to claim that there was little role for the state in creating public health.  They used McKeown to argue that economic growth was the ultimate solution to all of our problems, and any public health measures that got in the way of growth were ultimately counter-productive, or at least beside the point.  Szreter argues that, while the rising incomes and improved nutrition of the Industrial Era improved the public health, other aspects of Industrial Era life were root causes for the infectious disease.  Going back over McKeown’s stats, Szreter argues that public health measures, such as improved sanitation and clean drinking water, which McKeown minimized, were actually central in rolling back infectious disease.  That’s where he points to the archaeological record I mentioned at the salon – that human history seems to show that vast economic growth is abysmal for human health, and that after each major economic shift, we take a long, slow climb back to health, presumably learning how to live healthy lives in our new environments.  He calls this the proper practice of public health.
At the Salon, I just added an Ayurvedic spin on top of this – that our health is basically a function of the proper fit between our bodies and the rest of our ecology.  What passes for public health today is basically still aiming at infectious disease – food and water inspection, vaccines, etc.  Like conventional medicine, public health hasn’t acknowledged that the nature of disease has changed as our relationship with our ecology changed.  The post-industrial city, with its consumer economy, has brought chronic disease in place of infectious, and we need to be looking for trace antibiotics, toxic preservatives and corn in our food much more than we need to be looking for E. coli.
——

The topic of this Salon stems from the experience of a fellow Salonite. His learnings have inspired him to open the conversation, with you. So come on out and share your thoughts, ideas and strategies. We know you got ‘em.

Nick’s Story:

I am no doctor and I know very little about medicine but I’ve recently become extremely interested in the field. For most of my life, visits to my GP usually consisted of a few pokes here and there and the same questions: ‘do you smoke?’ – ‘no’ – ‘Get some exercise now and then?’ – ‘yes’, followed by the same diagnosis: ‘you seem to be in good health, etc..’. It didn’t inspire a great deal of confidence but it gave me the impression that medicine was a simple affair. If I needed something else, the system would probably let me know.

I was always confident that ‘conventional’ medicine worked well and that ‘alternative’ treatments were more entertainment than anything else. But then my health began to change and I began to ask more questions. I found my doctor, who had always seemed to understand what was going on, to be short on answers and a bit to hasty with prescribing medication while politely hurrying me out the door.

So I began to take things into my own hands, looking things up online, reading books, asking people around me how they understood their health. In doing so, I found my confidence in all medical practices to be severely shaken. Conventional medicine was influenced by big business (e.g. pharmacology corporations) and the competition for vast sums of research funding. Alternative practices lacked the endorsement of governments and clinical verifications. Accusations of quackery and misleading claims were commonly made and, just as commonly, ignored.

When it became necessary for me to find a new doctor in Toronto a few months ago, I found the process to be very stressful. Sure, it was difficult enough to find someone who was taking new patients, but my frustration was compounded by my uncertainties about exactly what I was looking for. How ‘conventional’ or open-minded should a 21st century doctor be? How much would they be interested in helping me work toward holistic health, rather than just writing out another prescription? How much time would they have to teach me to prevent illness? How much time would they have to see me when I failed to do so? While I’ve since found a temporary fit (hopefully more than that), these questions still concern me.

I tell this story because I believe that most people have probably struggled with similar issues. I think that the topic of health care holds the potential for many interesting Civic Salons but I would like to propose that we start by considering the following questions:

Questions

-How do you feel about your health in light of the myriad options and attitudes that currently exist in the world of healthcare?

-How can people start to take control of their understanding of health care, and of their own health? What do you do to inform yourself? Who do you trust?

-Why do doctors and healthcare providers face so much suspicion despite the successes of our healthcare system? Is this suspicion a healthy result of critical inquiry, a reaction to corporate encroachment on public institutions, or good old-fashioned paranoia?

-What role does the liberation of information and communication (particularly through internet technology) play in helping people to make better decisions about their health? What dangers does this access to unregulated information pose to the health of individuals?

-Should people be taking the direction of their healthcare into their own hands? How should governments determine which healthcare options should be covered by Medicare? How can people play a part in ensuring that government decisions about Medicare are not influenced by corporate interests? In light of the idea that democracy and science are a dangerous mix, how far should these decisions be democratized?

Background Reading, should you desire…

Medicine and Medicare are perennially popular topics in the media. Here are a few somewhat related and very interesting pieces to check out:

ReCivilization with Don Tapscott, Part 3: Collaborative Health Care (aired on Ideas on CBC –http://www.cbc.ca/ideas/episodes/2012/07/27/recivilization-part-3-collaborative-health-care/)

Canadian Dimension, July/August 2012, Vol. 46 No. 4. (http://canadiandimension.com/magazine/issue/july-august-2012/). Contains a number of articles examining the current state of medicare in Canada and related articles. Highly recommended.

The Walrus, April 2012. “The Errors of their Ways. (http://walrusmagazine.com/articles/2012.04-society-the-errors-of-their-ways/). Interesting discussion of medical error. Sheds light on the pressures and challenges that doctors face in trying to make sound decisions and reduce errors.

-And this to set the stage: From the introduction to The Greatest Benefit to Mankind by Roy Porter. W.W. Norton & Company, New York & London, 1997.

“These are strange times, when we are healthier than ever but more anxious about our health. According to all the standard benchmarks, we’ve never had it so healthy. Longevity in the West continues to rise – a typical British woman can now expect to live to seventy-nine, eight years more than just half a century ago, and over double the life expectation when Queen Victoria came to the throne in 1837. Break the figures down a bit and you find other encouraging signs even in the recent past; in 1950, the UK experienced 26,000 infant deaths; within half a century that had fallen by 80 per cent. Deaths in the UK from infectious diseases nearly halved between 1970 and 1992; between 1971 and 1991 stroke deaths dropped by 40 per cent and coronary heart disease fatalities by 19 per cent – and those are diseases widely perceived to be worsening.

The heartening list goes on and on (15,000 hip replacements in 1978, over double that number in 1993). In myriad ways, medicine continues to advance, new treatments appear, surgery works marvels, and (partly as a result) people live longer. Yet few people today feel confident, either about their personal health or about doctors, healthcare delivery and the medical profession in general. The media bombard us with medical news – breakthroughs in biotechnology and reproductive technology for instance. But the effect is to raise alarm more than our spirits.

The media specialize in scare-mongering but they also capture a public mood. There is a pervasive sense that our well-being is imperilled by ‘threats’ all around, from the air we breathe to the food in the shops. Why should we now be more agitated about pollution in our lungs than during the awful urban smogs of the 1950s, when tens of thousands died of winter bronchitis? Have we become health freaks or hypochondriacs luxuriating in health anxieties precisely because we are so healthy and long-lived that we have the leisure to enjoy the luxury of worrying?

These may be questions for a psychologist but … they are also matters of historical inquiry, examining the dialectics of medicine and mentalities. And to understand the dilemmas of our times, such facts and fears need to be put into context of time and place. We are today in the grip of opposing pressures. For one thing, there is the ‘rising-expectations trap’: we have convinced ourselves that we can and should be fitter, more youthful, sexier. In the long run, these are impossibly frustrating goals, because in the long run we’re all dead (though of course some even have expectations of cheating death). Likewise, we are healthier than ever before, yet more distrustful of doctors and the powers of what may broadly be called the ‘medical system’. Such scepticism follows from the fact that medical science seems to be fulfilling the wildest dreams of science fiction: the first cloning of a sheep was recently announced and it will apparently be feasible to clone a human being within a couple of years. In the same week, an English widow was given permission to try to become pregnant with her dead husband’s sperm (but only so long as she did it in Belgium). These are amazing developments. We turn doctors into heroes, yet feel equivocal about them.

When in 1858 a statue was erected in the recently built Trafalgar Square to Edward Jenner, the pioneer of smallpox vaccination, protests followed and it was rapidly removed: a country doctor amidst the generals and admirals was thought unseemly (it may seem that those responsible for causing deaths rather than saving lives are worthy of public honour). Even in Greek times opinions about medicine were mixed; the word pharmakos meant both remedy and poison – ‘kill’ and ‘cure’ were apparently indistinguishable. And as Jonathan Swift wryly reflected early in the eighteenth century, ‘Apollo was held the god of physic and sender of diseases. Both were originally the same trade, and still continue.’ That double idea – death and the doctors riding together – has loomed large in history…”

A giant thank you to Nick Potovszky for being so gosh darn awesome!

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