Why does it cost so much

Because we need healthcare that actually works, that actually helps real serious threats to our wellbeing and which is safe. That costs. This week there is great concern about the use of antipsychotic drugs in folks with dementia. Yes it happens and yes it probably happens too often. But. Could we do without these drugs here? Depends how much we want to spend. If every dementia sufferer had a nurse beside them around the clock we might be able to keep them safe and comfortable without drugs - not guaranteed but possibly so. That would require 6 or 7 nurses for each and every patient. Not affordable? You must judge If it was your parent and you were paying? If an insurer was paying and you were sharing the premiums to pay for everyone? If it was a public healthcare system and you were paying the taxes? The doctors know that these drugs can calm agitated patients without making them unconscious ( which is another option but vastly more dangerous) offering some relief to all concerned and safer than the usual practical alternative.

The Change

No improvement in healthcare will be possible unless key issues are understood.

The most important is that healthcare is in the middle of a massive once in a millenium change. This change began slowly in the 1960s or so, has gathered pace by now but still has many decades to run. Youngsters now using or working in healthcare will experience a transformation over their lifetimes.

What is this change?

For the first time in history healthcare can offer to ill persons treatments which will reliably help them.

Is that not what happened before?

No.

What happened before and for many illnesses still happens and will continue to happen for many illnesses for a while yet is that ill people were and are offered treatments which are believed to work. Many actually do but many dont.

Sounds a bit dull.

It is not.

It is the most amazing transformation imaginable and its effects reach everyone involved in ways which most of us (including me) cannot yet comprehend. Healthcare, medicine, doctoring, nursing - think of it in any way you choose - will never be the same again - but be sure it will be better than it has ever been before.

I shall explain.

In the mists of time most illnesses were a mystery. Apart from pretty obvious things like injuries no one knew why a person got ill. Assorted explanations were given, many involving what we now know to be the supernatural but few reliable effective remedies emerged.

For the past thousand years or so folks took to observing and thinking about natural events, including illnesses and began slowly at first to understand how they might arise and how they might be helped. The methods of science (science is just thinking about what we see) were being refined and the pace of improved understanding of illness speeded up.

By the middle of the 20th century much was known of the body and its ailments and a little about the mind and its sufferings. From that knowledge suggestions as to how to help ill persons were made a bit like this:"We see you are ill, we see certain abnormalities in your body , we know a bit about how that aspect of your body works and so we suggest you try this which ought to work". Note the key word - the proposed treatment ought to work based on our analysis of your predicament. The method was one of applying rationale to the situation. Seldom could a doctor or whomever put hand on heart and say " We have tried this out on many people in a similar situation to yours and we have found that doing this seems best and will do more good than harm".

Medicine had a vast array of remedies to offer both surgical and medical but none of them were, as we would now demand, "evidence based".

From the 1960s on and with accelerating pace that began to change. More and better studies were done which showed precisely the likely benefits and risks of any given test or treatment and from these studies we selected and recommended those approaches which gave the best results.

All this sounds fairly reasonable and desirable but as we will see it was to transform healthcare beyond recognition. That change began to gather pace in the 1980s, grew amazingly in the 1990s and generated the spin-off effects which we now have. The change is still not nearly complete and will continue for decades improving and transforming healthcare beyond anything we can currently imagine. Read on!

The Debate

President Obama has initiated a debate on the future of healthcare in the USA. What does he get? Posters of his face with a Hitler moustache on it!

Some debate!

More seriously, most debate about healthcare fails because the participants lack knowledge of current issues and future possibilities. We shall progressively examine and display the issues and the possibilities.

The Signal

This blog will concern healthcare.

Healthcare is of central concern to everyone. We never know when we may fall ill and what may become of us. If we do fall ill we wish to be sure that anything that could possibly help will be available. I am committed to the improvement of healthcare as one of the highest measures of a civilised society. The blog is called The Signal because that is what it will contain. In any system of communication there is a signal and there is noise. Most communications are noise - apparently random messages that contribute nothing to the task in hand. Technically folk say that the signal-to-noise ratio is low. Here there will hopefully be no noise (though there will doubtless be some in the comments below). Each post will be a significant contribution to the task of reviving healthcare and fitting it to meet our future needs.

Today's message is this - effective healthcare is essential and the quality of healthcare is a measure of a society's well-being.

Lets improve it!