So here's the question: if people won't stop hurting themselves, can they really expect the same medical treatment as everyone else? Health care in Canada is supposed to be about equal treatment for all comers.
John Oakley: Big Brother in the back seat: Ontario's ban on smoking in cars with kids
March 06, 2008
John Oakley Ontario Premier Dalton McGuinty must have forgotten he’s a Liberal when he got it right the first time; a ban on smoking in cars with kids is a slippery slope. Now he’s reversed himself and says the legislation will go ahead. He’s apparently capitulated to that school of thought that sees coercive government action as the answer to all social ills. The issue really cuts to the role of government itself. Big Brother, evidently, not only has a place in the autos of our nation but increasingly in all other areas of our lives. We can’t trust individual responsibility to make the right call. But take that argument to, in the Premier’s words, “the logical next step” and where do we find ourselves? Do we use the full force of the law to crack down on parents who endanger their children with diets dripping in trans-fats? Or who let them play on the jungle Jim without a helmet? Or try to sneak a puff of, lest you’ve forgotten, a legal substance in the sanctity of their own homes, but the smoke sets off the second-hand smoke alarm? The government says it’s all about protecting the children. It always is in the nanny state. John Oakley can be heard from 5:45 a.m.-10 a.m. EST Monday to Friday on AM 640 Toronto Radio Read
A NAUGHTY LITTLE VIRUS THIS AD-36! February 7, 2009
Since obese people do not hurt anyone else but maybe themselves and since forcing other people to lose weight is not totally socially acceptable…yet, the lifestyle trend setters aka politicized scientists and their pharmaceutical funders, are slowly but surely introducing the notion that obesity is contagious.
They started by introducing a study that claimed that people who hang around or live with obese people take up the bad habits and lifestyles of the obese and therefore become obese themselves. Second hand obesity if you prefer. But obviously that was not a strong enough ''finding'' to declare obesity a true contagious ‘’disease’’ in the strictest term of the word. They needed something more compelling to stigmatize people who are overweight or obese and wouldn’t you know it, they found it! The E4orf1 gene of Ad-36 of course!
How could science have missed it all these years ? For centuries people have lived in even closer contact with each other than today and there were all types and sizes of people: Skinny, regular, overweight, fat, super fat, without the ad-36 playing any tricks on them, yet today this little rascal of a virus decided to become a lobbyist for the pharmaceutical industry and travel from body to body (all expenses paid) causing an obesity pandemic. Naughty little virus indeed! Someone must have promised this little troublemaker a hefty commission from the sales of diet pills, Splenda, bariatric surgery, vaccines and anything else Big Pharma will invent to force stigmatized people to comply by using their products and means to attain ‘’normality’’ and stop hurting other people.
So if you have anyone to blame for your weight, kindly refer to AD-36 from now on. And please stay away from your children and our children, for their own good of course! Read
Not yielding to the sum of all fears THE MÉTROPOLITAIN • 29 MAI 2008 • VOL. I, NO 3 LA PATRIE 11 Kevin Mulvina We live in strange times. In the forefront of conventional wisdom is the following notion: smokers are weak and dependent. Reality reveals however they may be the only ones in society not lead by the principles of fear. We looked at the risks and walked right through them. The impression we get nothing in return is absurd. We are the one group in society to be feared, even our opinions are shunned as connected to some industry which feeds only the supply of a product which is entirely legal to purchase and use. The nanny nation comprised of the truly coddled and weak now fear even our scent. It prefers the smell and safety of burning oil products. It covets air miles cards and pays daily tithes to the banks. It seeks out chances to buy a prized product which sparks excitement because it includes the name “new”. A nation composed of people led to believe they will never die or succumb to disease if they yield to the sum of all fears. The hopelessly naïve, by their own choosing, follow the hopelessly greedy. Those who demand we live as frightened mice. A measure of their lack of integrity is seen in their back door campaigns too fearful to ban tobacco in spite of an ability to do so. Far better to sell alternatively addictive gateway products and increase the overall market. Sold with endorsements from the state purse and of the very charity groups who created the science of smoker hatred. Cowards intent to sneak around creating science equating risk to cause and trendy phrases to undermine our consequence. While we laughed at their tactics, they were able to grow in popularity by conning others into supporting their vision of weak begetting weaker, as if that could make them stronger or more resilient.. Society battering itself until all that remains is a watered down version of what it once was: strong and audacious, brave and passionate. Canadians watch, with little voice and less recognition of their own humanity, while the new prohibitionists stumble around fighting over what will be restricted next. The measures of real risk, or reductions of real risk, are debates which remain out of bounds, less we start to see some cracks in the statocratic stats. Much better to maintain the more dangerous illusions allowing us to die off in silence, protecting only the science that can make us believe. Smokers have among them the most inventive, the most creative and the most dynamic of personalities. Without them we would not have the art, music, literature, or philosophy that is the soul to society’s sinews. Those who chose to smoke seemed always to be challenging established norms and tore right through superstition and common belief. The aging process may well cut our longevity due to our choice but that is a choice we assume for ourselves. No one has a right to protect those who do not seek that protection. Helping little old ladies across the street can be seen as noble, unless that is not where she wanted to go, which could be defined as something much less than noble. When we lived rejecting fear, life was a much more enjoyable ride. Living fast and dying young has its advantages. Those are choices freedom affords us all. And as Simone Weil has written, “Liberty, in its most basic sense, rests in the freedom to choose.” Once smokers were a majority, now we are not. This constriction parallels the expansion of collectivist thinking. Our individual weaknesses seek comfort in communal “norms”. A mindset that has often been the precursor to the downfall of great civilizations. Few in our society see little to oppose today. A prelude to the loss of all hope. We are a dependant and weak people. Our leaders rise to the top by saying little and doing less. Running between the raindrops garnering status and privilege. Relying on the efficiencies of advertising that have now become the greatest threat to the consequence of our individuality. Power brokers grow their influence through slogans and soundbites. They want to be the will and the way. “We are all doomed by green house gases if we don’t change their ways”. “Globalization is inevitable”. “We don’t live in silos”. In fact we live in self-constructed cages of the mind imprisoning our states of consciousness. We fear speech, thought even assembly. People are encouraged to turn on each other for the slightest mater of “political incorrectness”. Subliminal Stalinism triumphant. We smokers chose to live outside the rules of fear the illusionists sell. Smokers’ total numbers haven’t declined, only our prevalence in society has changed. The total population numbers have risen but our numbers have stayed constant. Surprised? Don’t be. This is just another reality check challenging ongoing conventional wisdom. A real inconvenient truth. Society is taught to rage against those who smoke, embracing traditional hatreds against non-conformists. But we make our own fun. We date the best people. We don’t live in fear. We live full and productive lives. The cowards dread every morning. The risk takers awake to seek out new challenges. Many among us have been robbed of dignity and honor being conditioned by deliberate government social engineering. We are told we are less than what we are. Spoken about as a disease which needs to be cured. The power of mass media often leads society to fight many straw men. Today we need to rage against the real enemy. Those leaders of coercive greed and their manipulative campaigns that imprison us in the politics of fear. Read Read More: Smoker Bans / Federal dictates http://lieberaldictators.blogspot.com/
Putting a lid on keggers -ON December 20, 2006
By JON WILLING, OTTAWA SUN Ontario police chief urges province to launch country's first beer keg registry Ontario could become the first province in Canada with a beer keg registry to help cops trace empty casks back to the buyers. The plan is being strongly pursued by London Police Service Chief Murray Faulkner, who said yesterday that many police services in the province face problems stemming from out-of-control parties near post-secondary school campuses. Faulkner is pitching the idea to the alcohol and gaming committee of the Ontario Association of Chiefs of Police, which will decide how to proceed on his proposal. The idea is to make people identify themselves during the purchase and mark the kegs accordingly. If there's a shakedown at a keg party, cops could easily link the keg with the person who bought it. Ottawa police often conduct enforcement campaigns in the Sandy Hill area, cracking down on liquor and noise violations. The neighbourhood's city councillor says officials already scout out how many kegs are being purchased at nearby Beer Stores to prepare for any rowdy behaviour. "We keep tabs on the kegs that are going in and out," Coun. Georges Bedard said. It would be "extremely helpful" if there was a more formal way of keeping track of keg distribution, Bedard said. Ab Campion, spokesman for the Alcohol and Gaming Commission of Ontario, said staff are reviewing the concerns expressed by some police agencies over beer kegs. Faulkner said people, particularly students, are becoming more "creative" with how they're buying kegs. At one time they would get all the kegs from one Beer Store, but now they're purchasing one keg at many different stores, Faulkner said. "Now we have no idea where these huge parties are," he said. Police are concerned with keg parties because overcrowded homes become a safety issue and there is an increase in noise complaints, Faulkner said. Keg registries already exist in 30 U.S. states. Some states make it a crime to have an unregistered keg, while one state, Utah, bans kegs altogether. EFFECTIVE LEGISLATION Andrew Murie, executive director of MADD Canada, said keg registries in the U.S. have been effective in holding people accountable. "It makes a tremendous difference in the United States," Murie said. But keg registries aren't on the radar of MADD Canada, mainly because the organization hasn't seen a large problem with keg parties. Murie said colleges and universities in the U.S. have more of a culture of frat parties and sporting events that makes keg registries necessary. Faulkner has been concerned with rowdy parties happening near campuses in London, which has a university and a college. Read
Illegal expenditures of public funds
December 19, 2006 Many need to read Creighton's; A State Of Fear, and consider the work of public health of late. Fear is a motivator, if you are a terrorist involved in coercive activities we can expect it, from a government ministry it becomes scandalous. I am ashamed and appalled Health Canada is the source of hate campaigns which promote unwarranted fears and divisions in Canadian society. Second hand smoke, Fat pandemics, Bird flu pandemics, Mad cow disease and global warming all ad agency campaigns purchased to enhance the pockets of stakeholders. Politics purchased with the public purse. The Canadian Government involved shamelessly in what is referred to in the states as pork barrel politics. We are delivered the messages melded into the real news so well hidden we have no way to distinguish; real news from prepared press releases or essentially purchased commercials. Augment the press releases with regular commercials inducing fears in what are termed denormalization campaigns and we turn society upon itself to achieve results favorable to industry goals being promoted with government funds. In response to a scathing audit health Canada was reinvented as an agency of propaganda. Almost half of the budget 220 million of 450 million allotted is now dedicated to ad agency purchases. In addition 500 million dollars was given to deposed MP Allan Rock to create a traveling medicine show exerting federal pressure across the country in promotion of smoking bans at municipal and Provincial levels. The head scientist was replaced by a professor of political science which should speak volumes in itself. Without a shred of evidence to substantiate any harm derives from second hand smoke .Propaganda is educating us to fear the smoke at any level. A nuisance of sight and smell evolved by controlled consensus into a deadly carcinogen, dangerous at any exposure level irrespective of massive dilutions in outdoor air. Read More
Overeaters, smokers and drinkers: the doctor won't see you now
Health care is meant to be open to everyone equally. But some doctors question, even deny, treatment to those with certain vices.
April 18, 2006
NICHOLAS KOHLER AND BARBARA RIGHTON
It's a touchy subject. So touchy that after an hour-long interview, one Calgary orthopaedic surgeon decides he wants to remain anonymous. From New Brunswick, where a surgeon recently cancelled an operation on a crippled man's leg, a Moncton Hospital spokesperson calls asking Maclean's to stop trying to contact the doctor. At issue: health care for patients with self-destructive vices -- overeating, smoking, drinking or drugs. More and more doctors are turning them away or knocking them down their waiting lists -- whether patients know that's the reason or not. Frightening stories abound. GPs who won't take smokers as patients. Surgeons who demand obese patients lose weight before they'll operate, or tell them to find another doctor. Transplant teams who turn drinkers down flat. Doctors say their decisions make sense: why spend thousands of dollars on futile procedures? Or the decision is the product of frustration: why not make patients accountable for their vices? Others call it simple discrimination. But in a health system with more patients than doctors can treat, where doctors have discretion over whom they'll take on, some say it's inevitable that problem patients will get shunted aside in favour of healthier, less labour-intensive cases.
So here's the question: if people won't stop hurting themselves, can they really expect the same medical treatment as everyone else? Health care in Canada is supposed to be about equal treatment for all comers. For some doctors, however, there are patients who are less equal than others. Winnipeg GP Frederick Ross is one. In 2002, he told his patients he'd no longer see them if they continued smoking. "I said, this is stupid. I told my patients, you have three months to quit or I am going to ask you to find another doctor," recalls Ross, a genial man. "I said, your smoking is impeding my progress in treating you." Some people left in a huff. One challenged him on the basis of human rights (a tribunal later threw the case out). Others -- hundreds, he says -- stayed and quit smoking.
Cutting out the cigarettes might have helped some patients avoid an appointment with Dr. Alberto de la Rocha. As a former thoracic surgeon in Timmins, Ont., de la Rocha operated on lung cancer patients for 17 years before quitting. "I burned out in an atmosphere of indifference and lack of accountability -- public and personal accountability," says de la Rocha, who is now a medical officer of health in northeastern Ontario. Smoking, says de la Rocha, goes hand in hand with entitlement. "It goes like this: 'I am sick. You are the guy who is supposed to cure me. You are going to do that in whatever condition I am in and that is my right.' "
Not in my operating room, said de la Rocha, who decreed that his lung cancer patients would have to minimize their risks of a heart attack on the table or of post-op respiratory complications by not smoking for at least five weeks before surgery. "Your surgery will be booked at a time when you are prepared for it," he told them. "And if you continue smoking, I am afraid you are going to have to look for a surgeon hungry enough or foolish enough to take your case as it is." (De la Rocha is no stranger to controversy. In April 1993, he received a suspended sentence, three years probation and a six-month suspension of his medical licence for his role in the October 1991 death of a 68-year-old lung cancer patient. He admitted dosing her with a noxious substance -- potassium chloride -- as well as morphine, on her deathbed. The woman's sons, who did not know at the time about the deadly shot, said they were very satisfied with his humane treatment.)
Meanwhile, Dr. Paul Salo, a Calgary orthopaedic surgeon, says he's reluctant to proceed with surgery on "inveterate" smokers or the "massively overweight." Nicotine impairs bone healing, Salo explains, before adding that the failure rate in operations where bone must heal to bone is five times higher among smokers. Indeed, even the risks associated with surgery are high enough, Salo says, to require smokers to quit three months before an operation. If they don't? He goes ahead, but warns: "Look, if this doesn't heal, I am not going to be very happy and you are going to be miserable." Salo is most definite when it comes to turning down drug addicts. "I have the option to say, 'I can't form a therapeutic contract with you,' " he says. "If someone has an elective problem and they are not going to comply with my treatment recommendations, I am under no obligation to take them on."
Canada's provincial colleges of physicians -- the professional regulatory bodies governing doctors' conduct -- have no specific policies in place to stop the practice of denying treatment. "The physician makes recommendations based on what is in the best interest of the patient's health," notes Dr. Bill Pope, registrar of the College of Physicians and Surgeons of Manitoba. "By refusing to accept advice related to major issues with the patient's health, the patient is saying to the doctor, I don't believe you, I can't trust you, I can't accept you -- and is basically saying I can't work with you."
Dr. Ruth Collins-Nakai, president of the Canadian Medical Association, stresses that doctors will always provide care in emergency situations. She adds, however, that in cases of "lifestyle-induced problems" brought on by such habits as smoking, "the doctor cannot change those things without the co-operation of the patient. And if the patient isn't willing to co-operate, then it becomes very frustrating for the doctor to have to continue looking after the patient." And, though she says doctors who drop such patients are rare, she adds that continuing to treat people who won't change "may not be the wisest use of the few resources we have in terms of doctor-availability."
Doctors across the country told Maclean's of colleagues who would not take "unhealthy patients" -- smokers, drinkers and the obese -- because caring for them would be too complicated, and too much of a burden for their already overcrowded practices. Such patients might, in other words, take longer to treat, reducing the number of patients a doctor can see and bill for. The consequence is an entrenched tendency to choose the gym-goer, the moderate connoisseur of red wine and the non-smoker. Says Dr. Edward Schollenberg, the registrar of the College of Physicians and Surgeons of New Brunswick: "The idea that smoking or drinking or excess weight impacts on your health care is just the way the world is."
Nowhere is this dictum truer than in the realm of the overweight and obese. Dr. David C.W. Lau, an obesity specialist at the University of Calgary, says there are sound medical reasons to explain why doctors are less likely to want to operate on people who are heavy. "Operating on them would pose a significant increased risk of complications," says Lau. "Surgeons don't like to deal with complications and none like to see their post-op complications go up." The Calgary orthopaedic surgeon who doesn't want his name used has done thousands of knee and hip replacements on overweight people -- but he's not pleased about it. "Prostheses have a limited lifespan," he says. "If patients are overweight, they will wear them out much faster." Plus, he says, "Historically, obese people are at higher risk for surgery. There is a higher complication rate. There are healing and pulmonary issues. And they don't mobilize as fast as thin people."
But some doctors say there are more insidious factors keeping big Canadians from receiving the same treatment as the rest of us: discrimination. Bluntly put, fat people -- a group that represents over 50 per cent of Canadians -- are more likely to be discriminated against by the general public than drinkers and drug addicts (somewhere in the four per cent range) or smokers (22 per cent) because their affliction is so noticeable (all numbers are from Statistics Canada). And the medical community is as guilty of it as the rest of us. "The attitudes in the medical profession are surprisingly wanting," says Dr. Robert Dent, who heads up a weight-management clinic at the Ottawa Hospital. "The feeling is that if somebody's overweight, it's because they're eating too much and they're lazy." He adds: "If we want to use older language, we find that overweight people are considered guilty of two of the seven deadly sins -- sloth and gluttony." The consequences of such discrimination can be subtle -- or not.
Dr. Arya Sharma, an obesity specialist at McMaster University in Hamilton, has heard his patients complain of doctors who've told them, "Don't break my scale, don't sit on my chair." He adds: "It's not just doctors -- it's nurses, it's dieticians. Health professionals don't like obese people." (For that matter, says eating disorders statistician C. Laird Birmingham at the University of British Columbia, "Obese people hate obese people.")
The problem is so ingrained in the medical profession that even those doctors who specialize in obesity dislike their clients, according to a 2003 Yale University study. Questioning 329 members of the North American Association for the Study of Obesity -- many of them doctors or obesity counsellors -- at their annual meeting in Quebec City, researchers found a pro-thin, anti-fat bias based on something called the Implicit Association Test. Subjects were given a list of words that fit into one of four categories. After a practice run where they paired such things as "flowers" with "good" and "insects" with "bad," the obesity specialists jumped to associate "fat people" with words like "slow," "lazy" and "sluggish," and "thin people" with "determined," "motivated" and "eager." The study concluded that "the stigma of obesity is so strong that even those most knowledgeable about the condition infer that obese people have blameworthy behavioural characteristics that contribute to their problem," even extending to core characteristics of intelligence and personal worth.
Such notions represent an antiquated view, says Dent. In a study aimed at matching the different types of obesity with some 600 different genes that he is conducting with Ruth McPherson, director of the Lipid Clinic at the University of Ottawa Heart Institute, Dent is looking at 1,000 overweight and obese patients cross-referenced with 1,000 patients who are underweight. About half of the thin people "are eating as much or more than our obese patients," says Dent, who then adds the counterpoint example: "We occasionally have some people who won't lose weight on 500 calories a day." (The average Canadian's daily intake is about 3,000 calories.) Some physicians call this the burden of genetics -- something Dent refuses to do. "We don't call those bad genes because they caused the human race to survive across many famines in the history of humanity. A skinny guy like me wouldn't have made it."
Late last year, England weighed in on the question of hip and knee replacements for the obese (who tend to put more strain on artificial joints) when three health boards in East Suffolk said they'd no longer approve them for fat people. "We cannot pretend that this wasn't stimulated by the pressing financial problems of the National Health Service in East Suffolk," Brian Keeble, the director of public health for Ipswich Primary Care Trust in East Suffolk, said at the time. While local doctors threw their support behind the health board's move because replacing weight-bearing joints in the obese is risky anyway, the decision's motives were still about the bottom line.
There's no arguing that in Canada, too, health care costs are skyrocketing. In 2000, Statistics Canada added up the total bill at $97.9 billion. The Conference Board of Canada predicts that, when adjusted for inflation, health care costs will total $147 billion in 2020. Also inarguable: vices such as a penchant for high-fat foods and cigarettes are really ringing up the cash register. The fallout from obesity, says UBC's Birmingham, now accounts for five per cent of our total health care dollars, or $5 billion a year. "You've heard that phrase 'obesity is the new smoking,' " says Ross in Winnipeg. "Well, private health care is going to come into Canada because our public system is going broke over obesity." The ultimate costs of bad behaviour? A new heart -- $80,000. Liver? $150,000. Lung? Somewhere in the neighbourhood of half a million. Indeed, Dr. Gary Levy, the medical director of Toronto General Hospital's multi-organ transplant program, says unhealthy living is simply unaffordable: "We are getting to the point where we can extend life. And that is something society is going to have to come to grips with because technology is more and more expensive. If we can't change people's behaviour, look, I am going to tell you, we are going to run out of money. We probably have run out of money." Levy says 75 per cent of the patients he sees need transplants because of their own excesses.
The burden on our health care system is so high that some propose making vice-plagued patients pay. "This is an issue of behaviour and choice," says Nadeem Esmail, a senior health policy analyst with the Fraser Institute. "People can choose to alter their behaviour, can choose to go to the gym more often -- these are choice things." If you can't persuade yourself to live healthier, or so the argument goes, why make the rest of us foot the bill? "We have a universal program, really, to protect people from the fickle hand of fate," says Esmail. "And so the optimal solution is to say to them, your behaviour is going to incur higher health costs over your lifetime and so, because you can control this, you should be paying a higher health premium."
For GPs, it's also a question of a volume-driven health care system that gives them little incentive to tackle time-consuming, complex cases. The more time a doctor spends with a patient, the fewer patients can be seen and the less revenue generated for a doctor's practice. It's the kind of bind that leads to frustration. "Many of these individuals continue their lifestyle unabated," says Lau. "And not only are they not losing weight or holding their weight, they're continuing to gain weight while they're on the surgical waiting list. So, between the time the surgeon sees them and the time they're operated on, there may be a significant increase in weight." In the words of the anonymous Calgary knee and hip surgeon, doctors "feel like we are beating our heads against the wall" trying to treat chronically overweight patients in a climate of underfunded, turnstile medicare.
And then there's the garden-variety prejudice on the part of doctors who believe their patients are unhealthy because they can't control themselves. "Doctors can pick and choose their patients because we have a situation where there are more patients than doctors can handle," says Dr. Andreas Wielgosz, a cardiologist at Ottawa Hospital. "Can they pick the best candidates? Sure." How do doctors pick and choose? The Calgary orthopaedic surgeon says he never refuses to do surgery on overweight people. But, he says, knee and hip replacements are elective. "They are not a matter of life and death." And? "A doctor can sell an operation any way they want. If I see someone with a so-so joint and they are overweight, I may tell them to wait." How long? His waiting list is one to two years.
One patient whose lifestyle ran afoul of her doctor is 45-year-old homemaker Kelley Bartlett, of Burlington, Ont. Bartlett is forthcoming about her weight -- she's five foot eight and weighs 243 lb. Overweight since her early 20s, Bartlett recently lost 50 lb. and was feeling pretty good about herself. Then her GP diagnosed a hernia and sent her to a general surgeon for an assessment. "The hernia is quite large," she says, "and, yes, there is fat on my stomach too." The surgeon was brutal. "After the surgery, you will still have a bulge," he told her before adding: "I am not a plastic surgeon -- I don't do tummy tucks."
Bartlett was struck dumb. "He couldn't have been any blunter. He said there was only a 50 per cent chance of success because of my weight," she says. "He told me to go away and lose weight before I saw him again in April. I tried to tell him that I had already lost quite a bit of weight and that I hoped to lose more." He wasn't interested, Bartlett says. "I didn't choose to be like this," she adds.
In New Brunswick, a surgeon decided Robert Randall could wait -- forever. Illiterate, 42 years old, Randall lives with his wife and two of their four children in a tiny crossroads called Albert Mines, about 50 km south of Moncton. Randall used to fish for lobster and scallops on the Bay of Fundy. But he hasn't done much of anything except wallow in pain since the night in February 2004 when he drove his snowmobile into a tree, fracturing his right femur and shattering his knee. The throttle stuck open, Randall explains, but he also admits he'd been drinking. The accident earned Randall an ambulance ride to a Moncton hospital and emergency surgery to repair a mangled leg. That was soon followed by a second surgery to fix the damage Randall did by trying to balance on his good leg while chopping the wood he uses to heat the family home. A third surgery, during which orthopaedic surgeon Dr. Steven Massoeurs immobilized him in a full body cast, didn't "take," says Randall -- despite the fact that he faithfully used crutches and "went right to the letter on what the doctor told me."
Well, not quite. Randall is a lifelong smoker (he began at age 10) who refuses to give up despite his surgeon's warning that nicotine would slow the healing process. "I said, 'I've got all the time in the world,' " Randall says, obviously failing to grasp that "slow" might mean not at all. In January, his fourth surgery -- the one he thought would involve a bone graft -- was cancelled with two days' warning, says Randall, after Massoeurs' assistant called to say the surgeon wouldn't operate. There are no plans to reschedule.
Randall says he doesn't understand why his doctor cancelled the procedure. Schollenberg, of the College of Physicians and Surgeons of New Brunswick, says the answer's pretty simple. The central issue "was whether the patient's lifestyle -- including his two-pack-a-day habit -- would impact on the results of surgery." Randall's repeated surgeries didn't help. "Doing that many procedures in the same area is asking for trouble -- and it is compromised significantly by the patient smoking." Whether the benefits of a procedure outweigh the risks is up to the doctor, not the patient, adds Schollenberg. "Robert Randall thought he was entitled."
That doesn't help Randall much. In constant pain and with a right leg that now "bows" with his weight, he survives on welfare, the morphine he gets from his family doctor, and a steady stream of hand-rolled cigarettes. "Just sitting here staring at the walls," says Randall, "if I didn't smoke, I would go crazy."
All of this might come as a shock to those health professionals who side with the notion of justice for all. "If, in our medical system, we start blaming people for whatever condition they have, then we can probably close down our hospitals -- because 90 per cent of the medicine that we do is related to people's lifestyles," says Sharma, the Hamilton obesity specialist. The move in the U.K. to restrict surgical procedures based on weight, says Diane Finegood, scientific director of the Institute of Nutrition, Metabolism and Diabetes for the Canadian Institutes of Health Research, "disturbs me greatly because I am wary of leaving such decisions up to the physician."
But that is exactly what's happening right here, right now. Dr. Pete Sarsfield, the medical officer of health for the Northwestern Health Unit in Ontario, is one doctor who says he's known colleagues to decline problem patients. "And I have sympathy for those docs because I know what it's like to treat addicts -- you pick up the pieces and they don't change their behaviour," he says. Sarsfield has campaigned tirelessly against such destructive behaviour as smoking, but he still doesn't agree with doctors who won't treat smokers. "In this job, we don't have a right to pick and choose. We have a duty of care. Where does it say in the Hippocratic oath, 'I will only treat people who are well?' "
Ross, the Winnipeg doctor who dumped his smoking patients, doesn't mind the notoriety he's generated with the move. When he first tossed out his ultimatum four years ago, his colleagues kept silent. But the media didn't. CNN called him. So did a TV station in New Zealand. Ethicists, meanwhile, lined up to condemn him, citing the Canadian Medical Association's first fundamental responsibility: "Consider first the well-being of the patient." Said Ross at the time, "I have been criticized, vilified and downright denigrated for taking this stance." Still, he never blinked. After all, the CMA's fourth fundamental responsibility is: "Consider the well-being of society in matters affecting health." Says Ross, "Forty-four thousand people a year are still dying in Canada of smoking-related disease. I don't want to hear any more excuses. We can fix this." Why don't more doctors follow his example with more tough love? "Because we are seen as the nice guys. That is our role."
So when can a doctor expect an individual patient -- the smoker, the overeater, the boozer -- to take that long, hard look in the mirror and drop the vice? "Look," says Levy, "We are all guilty. All of us do things that are not good for us. The reality is we go to fast-food restaurants. We drive too fast. We should cut our salt intake. We need to educate all elements of society. We have an obligation: we have to put the brakes on bad living styles. We need to convince people of the value of living healthy lifestyles and what the cost is, not only to themselves and their families, but to society."
De la Rocha is a little more pointed. There are some instances when medical science and expertise are just not good enough to fix the problem, he says. "We have become a society that is complacent, that is soft, that is demanding, that has unrealistic expectations, and that has a deeply ingrained sense of entitlement. We have to say to patients, 'I am sorry, man, you are going to have to become responsible for your own health and that means addressing the issue of your tobacco addiction, addressing the issue of your sedentary life, addressing the issue of your very erratic and unhealthy eating habits, addressing the issue of your excess drinking. Do something for yourself.'
Letter sent to MacLean's Magazine
April 20/06 It is all your Fault A Winnipeg doctor has announced that he will no longer treat patients who smoke. In that decision, and the logic that supports it, lies the remedy for all that ails the nation's troubled health care system. There are two central principles at work in the doctor's decision which, if followed with rigor and consistency, will, in an instant, reduce the demand for universal health care, unburden its staff and facilities, and save immense buckets of money. The first principe is patients culpability. Are you sick or injured because of something you did? Wrap your car around a tree because you were on the cell phone? Don't, repeat don't, dial 911. If the illness or injury is your fault, the pain is your own, the suffering belongs just to you, and your doctor may shut the doors of medicare in your face. Smokers' illnesses are their own fault. And cutting off smokers from the health-care system will immediately eliminate 30 per cent of its clients. But, though smokers are legion, they are only a subject of the addicted class. Alcohol addiction is a gold seam of maladies and injuries, both physical and mental. Cutting off the alcoholics will trim the lines in the emergency room and an overburdened health-care system will finally start to hum and buzz like the hygienically oiled machine it's meant to be. If one addiction takes you off the health-care rolls, obviously, another will as well. The hard and soft narcotics, pain-killers and cough drops, prescription and non-prescription pharmaceuticals, the rock of hash and the kick of crack--all of these have an energetic and toxic following. There are whole armies of doped and hooked people out there, whose pursuit of their own addiction brings them to the waiting rooms of our clinics and the taxed attention of clean-living medical staff all over the country. Off with the addicts. The good doctor's wisdom extends beyond addiction. Culpability for one's own
malady is the rule. AIDS is a demanding disease. We will have to discriminate among AIDS victims. Those who suffer its affliction through unsafe sex clearly fall into the category of "those who have brought it on themselves." Under this new regimen, "Go home and moan" will be the watchword. It is too easy to list the obese , the reckless, the sedentary, the fast-food junkies and the extreme sports freaks--but they fall into the grab bag of those who bring pain, injury, misery and unwellness unto themselves. To the fat cardiac or the maimed snowboarder, let the call go out: "The doctor is not in." And here is the second principle: physician rule. Sick people have had the run of the health-care system for too long. Medicine, like war, should be left to the professionals. Doctors, acting on their own, should decide which of the sick and dying are worth their time. A doctor-centered health-care system, one that leaves the doctor to make a preliminary moral decision on those who stumble or fall at his door-- before engaging his attention or calling on his skills--is so much clearer, so much cleaner than this dreadful relic of state-supported, universal, taxpayer-borne, free-for-all, patient-centered freaks how that we have now. Before a patient is even asked for his or her medicare card, the scrupulous physician will bend over the maimed and the halt, with just one critical inquiry. "Is this your own fault?" A "yes" answer, and the wailing hulk is wheeled out to agonize untended, and rage alone at the dying of the light. Cruel, some might say--buts what's a continent of cruelty against a doctor's right to choose?. There's only one refinement I can think of to improve on its near perfection. Our nation's hospitals, paramedics and psychiatrists should push this artful reform one more mile. The sick are the No. 1 burden on health care. The Eastern mystic and the Western psychiatrist have long suspected that the sick are complicit in their own sad condition. Doctors should-- and on the principles outlined here, they will be on solid ground--refuse to treat anyone but the completely healthy. Medicare for the healthy--don't you like the sound of that? It's so tidy. Well, maybe "treat" is not the right word. How's "mingle with"? In this brave new Hippocratic world, the hospitals and clinics will be near empty. Doctors and the very well will have to invent reasons to see each other. I suggest a weekly part. A smugfest. They'll have the space. The poor socialists, they thought health care was for the sick people, doctors served patients, and medicine for those in pain. Damn deluded socialist.
Is smoking an addiction or not?
TO:mailbag@edmsun.com
DATE: April 22, 2006
To the editor: In response to J. Hayward's comment that the ladies in their wheelchairs outside the hospitals ''were not forced to smoke, they chose to smoke'', the government and anti-tobacco industry can't have it both ways. If they're going to trumpet that smokers are as addicted as heroin and cocaine users, they don't stand too well in the eyes of the public when they're forcing these same so-called ''addicts'' out in the elements while offering needles and shelter to heroin addicts. How a separate heated shelter for smoking patients affects non-smoking patients and staff, is beyond any logical person's comprehension. Iro Zannetides
Blainville, Qc
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