Comments by Diana F Scholl, Portland
Here is an important article highlighting the on-going issues related to accessibility of drugs within our healthcare system. It is based on the Cleveland Clinic and they fully co-operated with the NYT to get this story out. I saw it in the hospital I worked in when the shortages started a few years ago. It is extremely important to our argument for the reason we need to have a single payer system which is regulated fairly and equitably for all.
You will note that the headline dares to use the verboten word rationing—thank you NYT! It recurs throughout the article as they try to assess how decisions are made as to who actually gets a drug that may be life giving and who does not even if the result may be the end of life. Sample criteria for various drugs: age; weight; whether you are in a clinical trial (or not.) Too many times medical ethics is NOT involved which is shocking to me who has been trained in this field over the past 15 years.
Also note that this story exposes and supports the argument that “ death panels” (via rationing of all types of things from meds to access to treatment at all) may indeed exist as Sarah Palin claimed. But they actually are NOT functioning as she claimed when docs with patients/families are deciding what treatment they want and what they do not want. In my area of work (palliative care and hospice), we probably have more openness and clarity than at any other point in one’s trajectory of using health care during one’s life. That said, we too have a ways to go.
Using “death panels” as scare tactics was a political tactic that touched on anyone’s worst fears. But digging deeply into the issue of who gets treatment and who doesn’t is actually necessary and helps us understand what changes really need to happen. Maybe that’s scary to some (especially if it means a worse bottom line in their business), but I suspect that we can all deal with fear if it is based in knowledge and reality and hopefully highlights a way forward.
Here are some quick bullet points (my emphasis):
+++ “…reasons ranging from manufacturing problems to federal safety crackdowns to drugmakers abandoning low-profit products. But while such shortages have periodically drawn attention, the rationing that results from them has been largely hidden from patients and the public.”
+++ “At medical institutions across the country, choices about who gets drugs have often been made in ad hoc ways that have resulted in contradictory conclusions, murky ethical reasoning and medically questionable practices,…”
+++ “An international group of pediatric cancer specialists was so troubled about the profession’s unsystematic approach to distributing scarce medicine that it developed rationing guidelines that are being released Friday in The Journal of the National Cancer Institute.
+++ “Doctors and hospitals often do not tell patients about shortages and the resulting rationing because they do not want them to worry, especially when alternative drugs are available, or because they feel it would stir up too much anger.”
+++ “Dr. Ivan Hsia, an anesthesiologist in Ontario, Canada, said many physicians in his field adopt what he called “the paternalistic model — like I’ll inform them when I think it’s unsafe enough to inform them.”
The “paternalistic model” of the doctor/patient relationship has been and continues to be broken down but it clearly has a long way to go. “The doctor knows best” approach does not help us achieve delivery of quality health care in a just and fair manner. The hope of our single payer movement is that transparency on issues such as these will work to combat the inequities even if it cannot always eliminate them.
And, yes: learning about things like this and so much more likely WILL “stir up too much anger.” But we can give that response of righteous anger to an unjust system a way to constructively focus its energy on changes for the better.