Not the only way

Let me start by saying that I am not a proponent of the way that the United States delivers its health care. However, I am a strong proponent of full and proper debate about what we want out of our health care system and of a complete examination of the options available; I think that there is no one right way to provide health care, and that there is a lot to be learned by looking at innovative systems from around the world. This is why I have tried so hard to engage other students in a debate on these issues at my medical school.

In order for this country to be able to properly debate and decide on health care related issues, I think we need to first remove the phrase “moving toward a US model of health care” from the Canadian vernacular. I think it improperly frames the issue, and is detrimental to any possibilities of progressive thinking.

Here are a few reasons this phrase should be removed:

1) There could not be two more unique forms of health care delivery than the United States and Canada:
-Canada is the only capitalist democracy where the provision of medically necessary services is paid for solely by the public system-by law
- The United States is the only capitalist democracy without some type of national, public health care system.
1) The values of Canadians and Americans are diverging, not converging, which means that the health care system desirable by each nation will continue to be considerably different.
- Polling done by Michael Adams for his book Fire and Ice showed that Canadians were distinct from the United States on 73% of 56 values; with 43% of these values, the differences grew between 1992 and 2000.[1]
3) The highly different political organization of Canada and the United States are the ultimate causes of our different health care systems, which will stop either country from becoming too much like the other:
- The Canadian political structure has facilitated the emergence of a viable social democratic party at the provincial and national levels, which has been used as a channel by labour organizations and less advantaged groups at key historical moments to gain political clout and shape health care and other social policies.
- The U.S. form of federalism, which is marked by the separation of powers between executive and legislative branches and a complex system of checks and balances, makes the emergence and sustainability of state- and national-level third parties all but impossible, leaving organized labour and other grass-roots organizations with no place to go but with one of two parties, each of which have no real need to represent the disadvantaged.[2]

These are just a few of the concrete reasons why such direct comparisons of Canadian and American health care are not helpful. For a number of these same reasons, it seems more likely that an evolving health care system in Canada will have aspects resembling much of Europe or Australia. What is important is that we don’t let this perceived Canada-US dichotomy get in our way of having a healthy and open debate.

With provinces like Alberta now boldly going where no other province has gone before in its approach to private health care delivery, I am reminded of how Canada originally developed a publicly funded health care system in the first place: it took Tommy Douglas in Saskatchewan to make provincial changes and fuel a nation-wide debate about what the rest of Canada wanted from their health care system. Now that we have new ways of delivering care being experimented with in this country (or, as Alberta politicians would call it: The Third Way) let us now debate as a country what we want our future health care system to be, instead of simply saying that we don’t want it to be like the Americans.

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[1] Adapted from Michael Adams Fire and Ice. The United States, Canada and the Myth of Converging Values (Penguin, Canada, 2003)
[2] Adapted from Cecilia Benoit The Politics of Health Care Policy the United States in comparative perspective (Perspectives in biology and medicine, Vol 46: 592-99)

Yet another post on personal organization

I realize that I have already posted on this topic, but I know a number of people in post-graduate study who are going through psychological dilemas right now about the value of still being in school at the price of other missed opportunities. I know this feeling all too well, but have managed to really change my approach in the last year through some changes in my personal organization.

Post-grad students commonly have two conflicting aspects to our lives: we want to change the world, but we are often too busy to think or do anything outside of school itself. This can be a frustrating arrangement psychologically, and it can make us feel as if we are not getting what we want out of our time spent in school.

While we are- in fact- quite busy with school, there are definite personal organization strategies that can help us get more out of our many years of training. Although there are many books written on personal organization, they generally focus on one or the other of two main points: getting a system in place for organizing everything that you have-to and want-to do; and making decisions about what, amongst all of things you have on your plate, to actually spend your time doing.

In the first category, the general emphasis is to get all of the many things on your mind organized into a system that you can rely on, which will allow you to have all of your commitments, projects, and goals stored somewhere outside of your mind. I have written about this before, and although this is a simple idea, it has the potential for unlocking your mind from its constant need to remember everything you have to do, allowing it to concentrate on the things you have-to or want-to do right now.

A good book in this category is Getting Things Done by David Allen. It goes into some detail about how to get organized, but doesn’t get so structured such that you can’t adopt its principles into your own version of personal organization.

In the second category, the focus is on discovering personal priorities over and above doing anything else. The concept being that you should only bother organizing, planning and doing the things that are important to you, and by wasting less time on unimportant tasks you will be free to get the things done that really matter.

Popular in this category are the books The Seven Habits of Highly Effective People by Stephen Covey and Get Unstuck and Get Going…on the Stuff That Really Matters by Canadian Michael Bungay Stanier. Mr. Stanier also writes about similar topics in a web-based format at www.boxofcrayons.biz. All of these resources give inspirational ideas about how to decide what is important to you.

Separately, these two categories of books may leave you unsatisfied: either organized but still bogged down with seemingly unimportant tasks; or with a new zeal for only doing what is important, but too unorganized to actually get anything done. However, combining the strategies from both can lead to powerful, life altering, changes in the way you organize and spend your personal time- changes that might just harmonize your worldly ambitions with your day-to-day reality.

Bad vitamins

The CBC recently broadcasted its investigations into Dr. Ranjit Kumar Chandra’s alleged fraudulent medical research[1]. The CBC claims, with some convincing arguments, that Dr. Chandra’s research career at Memorial University in multivitamins and immunology is littered with fraud. Although only one of his research papers has been formally retracted from literature[2], they claim that many more suspicious papers remain untouched. After watching these reports, two things strike me: if the claims are true, it was all too easy for this fraud to be committed; and even if the claims are untrue, it is presently far too difficult to properly investigate cases of academic fraud.

The lack of checks and balances in the peer review process are part of what makes such fraud possible, but in light of the recent high-profile retraction of Dr. Hwang’s stem cell research from the journal Science[3], I am hopeful that changes to this process are now underway in most medical science journals around the world. However, the other side of the Dr. Chandra story involves the inability to properly investigate the claims of academic fraud against him. Even with investigations at Memorial University apparently concluding that there was evidence of fraud in Dr. Chandra’s research, nothing further was done. I find this shocking.

But what could actually be done? Dr. Chandra published in many journals around the world. Clearly, it would take significant resources to look into all of these separate studies- resources that the individual journals or universities are unlikely to commit. Even if these organizations did investigate individually, who would then litigate the grand total of all of the evidence? There is no official body in Canada that could. This has two end results: fraudulent research remains part of the accepted scientific literature, and those who paid for fraudulent research have no way to get their money back.

Many other countries already have national bodies that can handle these sorts of cases. In the U.S., Finland, France, and Germany, the national bodies simply oversee all of the investigations and provide logistical support to the researcher’s institution, which is expected to actually conduct the investigation. In other countries such as Denmark, Sweden, and Norway, the national bodies actually conduct their own investigations[4].

I think it is time for those who are involved in Canada’s scientific community- universities, academic/professional associations, and scientific journals- to discuss a long term national solution to research misconduct.
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[1] The Secret Life of Dr. Chandra (Parts 1-3), The National (CBC), Jan. 30-Feb. 1, 2006
[2] Nutrition. 2005 Feb;21(2):286
[3] Science. 2006 Jan 20;311(5759):335
[4] MJG Farthing. 'Publish, and be damned...' the road to research misconduct. www.behindthemedicalheadlines.com