What's it Worth?

Today we learn of a small child with a debilitating lifelong disease - Atypical haemolytic uremic syndrome.

Her quality of life can, we are told, be markedly improved by a new vastly expensive medicine costing around £250000 per year, though there might be costs of her current treatment which might be avoided.

Can she have it in a communally funded system?
The details of course need scrutiny - is her quality of life that poor without and would it be much better with the medicine? Is the pharmaceutical company charging a reasonable price? And so on. But supposing they are all true?

And supposing we agree she should have the medicine?

Can we make savings elsewhere?  What about children not yet conceived? How much should we spend on assisted conception? If the parents to be, on investigation, show no tangible disorder apart from advancing age should we still fund treatment? How good are the results of assisted conception in parents of a certain age who have returned broadly normal findings on investigation? Is investment here worthwhile? Have such intending parents perhaps just waited too long to start a family and foregone their opportunity? Should a communally funded system just accept such a situation?

Perhaps we could fund that little girl after all.

Doing Without.

No not doing without healthcare - though many indeed do without.
No
Healthcare is doing without crucial help which would massively improve the help it can give to you and I. The illnesses we experience and the diseases which often are the cause of these illnesses are intimately affected by how we live together. They have a profound social dimension - part political, economic, psychological, chemical and physical. Our social situation is a major element in our well-being - or lack of it. Healthcare would be enormously improved if we had a reasonable understanding of what the social dimensions were and how they operated. For that we need social science. And there is none that is useful. There are of course social scientists aplenty, reading and writing all about healthcare. But nothing that is of the slightest value.
Social science is hard. It is much harder than physical science. It needs the sharpest minds and the most diligent workers. It has neither. Social science is seen in universities and the like as "soft science" and attracts students so motivated.  Social science (or sociology) grasps an issue, gathers a (very) few data, looks up its index of theories, makes the connection comes to the wrong conclusion and publishes. Mercifully few ever read the outpourings. So far so harmless.
Except
Social science is crucial for the improvement of healthcare. Healthcare needs to accept this and get together with universities to devise a programme of teaching, education and research which will address the real and compelling issues which continue to afflict patients and limit their chances of making a full recovery.
It will not happen soon, and the results when it does will be slow to appear (if it is done properly), but we must hope it will happen and our descendants at least will benefit.

Epidemic Obesity

There is an epidemic of obesity.
The core correctives are well known. Eat less and exercise more. Simple, affordable, effective. Eating less is by far the more important. To lose weight solely by exercise is close to impossible for normal individuals.
A couple of points. In eating less keep going with fruit and vegetables and leave off the big starchy foods - bread, potatoes, rice, pasta etc and of course the sugary drinks.
In exercising more, stick to walking - anything else will bring its own problems. Walking more will have most effect in a hilly environment and in colder climes.

Who Does What?

In healthcare there are a wide variety of occupations  and careers. Specialization is universal and makes for better individual elements of care even though you or I might wish a single helpful face to take us through the entire encounter. The different roles have developed over time. (I would say evolved but their might be creationists, sorry intelligent designees , reading this and the benefits of evolution should come even to you who deny it.!)
Major change is needed.
This last 30 years, for the first time in history, we genuinely know how patients with many common illnesses can best be helped.  And it is written down. No longer does every illness in every patient need a complex assessment which can only be done by a massively trained and experienced bio-scientist with the tools to sift the possibilities and the wisdom to select the best approach with much scratching of the head and Umms and Hmmms- recognise your traditional doctor?
Tell your tale to a thoughtful informed practitioner and the best approach will swiftly be forthcoming for your approval. Less time taken, less cost to you.
And more importantly - your traditionally trained doctor can concentrate on those illnesses where we don't  yet have a clear idea on how to help.
And even more importantly your traditional doc does not go crazy with boredom seeing many patients whom he can help without stretching his capabilities in the slightest.

This move is apparent in all the healthcare disciplines. As we generate a bigger better knowledge of how illnesses can be helped we need fewer of the traditionally trained professionals whether they be doctors, nurses, pharmacists, physiotherapists or whomever. We need more people, with simpler training,  friendly and helpful to listen well and deliver the best advice and support which has been developed from a truly global experience of people in similar situations to yourself.
And this is only the beginning.
Watch this space.

Healthcare 101 - in 9 questions.

To understand healthcare and its discontents we will put ourselves in the position of a person who has become ill and who might one way or another ask a number of questions about what will happen next. There are 9 questions and understanding how each might be answered will give you an approach to the strengths and weaknesses of your healthcare system, which in turn gives you the basis for action to improve matters. Each question points to  an essential property of your healthcare system which you would wish to be at its best. Here is how it looks.

Healthcare is getting a bad press. In  any communally funded system, - that is every system apart from those rare situations where the patient pays individually for all the help received at the time -, the public , the payers, think we spend too much on healthcare and the patients in their need think we spend too little. Maybe healthcare is doing just fine! What else should we spend our money on? As individuals we all need a constant supply of air, warmth, water and food and would die if such supplies were interrupted. To do this requires a major part of our expenditures. After that in order of priorities would come health protection and healthcare. Well behind would come a vast raft of comparatively frivolous activities which we could probably cut back with no risk to our well-being or future prospects. Healthcare needs to stand up for itself and shout its case to the four winds. The public then might change its stance and better recognise the value of what we do.

Measuring Healthcare Quality

This is a report by the OECD which sets out the issues