Home shows for medical care

The folks behind the medical tourism conference I covered in Las Vegas last May have launched a travelling consumer show for patients to visit and comparison shop for their overeas medical treatment.

The shows start in Texas in October.

Where past such conferences have been strictly geeared toward the business side of things, these shows will be like home shows for medical care -- with overseas hospitals, medical tourism brokers and toruism boards setting up booths to sell their wares.

The idea is to make it easier for those interested to dip a toe into the world of medical tourism, a fast-growing industry in which first world patients fly to third world countires for cheap medical treatments -- and no waiting lists.

So far, only American dates have been set, but the man behind the shows, Skip Brickley, told me in May he hopes to bring the shows to Canada one day. Two of the dates, however, are in Florida in February and March, which should attract a few snowbirds.

Here's a complete list of dates, so far.

-- Oct. 25-26, 2008, Hilton DFW Lakes, Dallas, Texas

-- Nov. 1-2, 2008, Renaissance Hotel, Austin, Texas

-- Dec. 6-7, 2008 Hyatt Regency Crystal City, Arlington, VA

-- Feb. 21-22, 2009 Sheraton Mart Airport, Miami, FL

-- Feb. 28-March 1, 2009 Orlando, FL, location TBD

-- May 8-9, 2009 Marriott Hotel & Marina, San Diego, CA

Nurses and euthanasia

Sometimes merely mentioning something can spark a controversy.

In the May/June 2008 edition of the US-based Pediatric Nursing Journal, on stands now, authors Anita J. Catlin and Renee Novakovich discuss infanticide for children with terminal disease in their column "The Groningen Protocol: What Is It, How Do the Dutch Use It, and Do We Use It Here?"

The protocol allows doctors in the Netherlands, in consultation with parents, to end the life of a child  with a terminal disease. Of the 1,000 babies annually who die in their first year in the Netherlands, 600 die under the protocol, according to the New England Journal of Medicine.

The article has attracted little mainstream attention, but has been a hot topic among medical ethics bloggers. And now, the Drudge Report has picked up on the issue, summarizing some of the arguments of others.

I have not been able to find a full online version of the column, but it seems the two authors do not come right out and argue in favour of infanticide,  instead refering to the issue as "complex" and a "difficult."

But that's enough to get critics talking. American blogger Wesley J. Smith argues that "what we don't condemn, what we claim to be mere `dilemmas,' we eventually are urged to allow."

"Infanticide," Smith says, "is moving into the mainstream of bioethics and the medical intelligentsia."

The article is written from an American perspective, but says that countries such as Canada and Britain, which have socialized medicine, are more likely to look favourably on infanticide as a way to keep costs down and ensure that medicare remains available to all.

It reminds me of conversations I had with McGill medical ethicist Margaret Somerville and Canadian Medical Association president Brian Day a couple of  weeks ago about rationing medical care. The conversations were about how to decide who gets expensive cancer drug treatments, in the wake of the Ontario government saying it would pay for Avastin. But the broader issue is the same: how do we decide who gets medical treatment, and who doesn't? The assumption being, of course, that we can't afford it for all, an issue Day has argued will become increasingly urgent as treatments become more costly and the population ages.

As a counter to the argument that socialized systems are more likely to look at infanticide, commenters to the Drudge Report have said that the private system of the United States already does this.

The longest excerpt of the article that I have been able to find is on Smith's blog:

Issues related to suffering infants, their families, and the nurses and doctors who care for them have been debated for many years. These issues have been examined medically(Carter & Levetown, 2004), ethically (Cassell, 2004), morally(Romesberg, 2003), and legally (Hurst, 2005). In the U.S., with the desire for beneficence (doing good), the lives of extremely premature infants are frequently supported at the estimated cost of nearly one million dollars per hospitalization. The principles of social justice (care for all children) and non-maleficence (allowing no harm) are seen as less important. However, in countries with socialized medicine, the principles of social justice and non-maleficence (avoiding doing `good,' which causes suffering) have been seen as more important. As long as the U.S. health care system supports the use of extensive technology for infants with life-limiting conditions and provides reimbursement for extremely long hospital stays, the dilemma over what some might consider miracles and others view as suffering will continue.

I will keep looking for more.

New Zealand opens door to medical tourists

It seems New Zealand is doing what Brian Day, president of the Canadian Medical Association, would have this country do.

It's entering the world of medical tourism. Already home to several private hospitals, the country now has its first medical tourism company, Medtral, aimed at getting North Americans into the country for cheap and fast surgery. Company founder Edward Watson is now touring North America drumming up business.

The company is positioning itself in the market as more upscale than India or Thailand, which offer some of the cheapest overseas medical care, but cheaper than Singapore -- the designation of choice for those willing to pay for truly upscale care. The target market, Watson says, are patients who want cheap foreign surgery, but amid a more familiar culture. "It's not a foreign experience," he told the Washington Post. "Yeah, it's different, but you still have Starbucks, you have McDonald's."

According to pricing charts on the company web site, a hip replacement will cost $28,457.95 (CA), including airfare for two, surgery, five or six days in a hospital, accommodations at a luxury hotel afterward (where a nurse will visit you regularly) and physiotherapy. So far, 29 Americans and one Canadian have signed up, according to the Post. The company expects to treat its first patient in late August, 69-year-old Eugene Horn, an Episcopal priest in Oregon.

Horn told the Post he wanted cheaper surgery than he could get in the U.S., and likes the idea of going to a developed country with an established public health system. Another patient, 54-year-old Marc Shaw of California, is also considering Medtral for his knee-replacement surgery.

That is exactly the type of patient, Day has told me, that Canada could attract if it got into the medical tourism market. There are a lot of Americans who want cheaper surgery, and would feel more comfortable getting the procedure done in a country similar to their own.

But the first step, Day says, is to get rid of the waiting lists here for surgery -- the primary reason Canadians go abroad for treatment.

It seems, however, that Canada has nothing to learn from New Zealanders on that score. As the Washington Post points out:

"The kind of timely response that Horn and Shaw describe is something many New Zealanders themselves have trouble accessing. The country has one of the world's oldest and most comprehensive public health systems, and few New Zealanders have private health insurance. They rely on a sometimes swamped public health system to deal with their complaints, and there are waiting lists for many procedures, including hip replacements and radiotherapy."

To many that sounds like Canada.

Who gets treatment?

There was good news for thousands of patients last week when the Ontario government announced it had earmarked $50 million to cover the costs of cancer treatment drugs Avastin, Sprycel and Alimta.

The announcement, however, raised important medical ethics issues: who gets treatment, and how do we decide?

“Governments are terrified of this stuff,” says Margaret Somerville, a medical ethicist at McGill University.

Dr. Brian Day, president of the Canadian Medical Association, warns that as the Canadian medical system moves away from hospital-based care to more drug-based treatments – plus gene therapy procedures and stem cell remedies just over the horizon – pressure on governments to fund ever-more expensive procedures will only build.

But providing every available procedure to every patient who might need it would bankrupt medicare, he warns. Better, he says, to figure out a way to ration treatment to ensure universal health care remains available to all.

To understand his point, try picturing a lifeboat. It holds 60 people, but there’s only 50 on board. Dozens of people are swimming just metres away, struggling to keep their heads above water. The question is, who do you bring on board, and why?

That, in overly simple terms, is the growing dilemma facing the medical profession, the governments that finance it and, ultimately, all of society. The people in the water represent cancer patients. The extra 10 seats on the lifeboat represent the ability to save only some of them.

Day would like to see a national body of experts set up that would make non-binding recommendations about who should be eligible to receive expensive new treatments and who shouldn't.

Somerville agrees that some sort of procedure might be needed, but points out that the essential ethical issues still need to be dealt with. She divides the issues into generally micro and macro categories.

On the micro level, she says, there are individual patients who need the treatments. It would be unethical, she says, to deny them. On the macro level, however, there's the question of whether the money spent to help such patients might be better used to help the overall medical system.

"You can get conflict over what's ethical at one level and what's ethical at another," she says. "That's when we end up in a knot about all this."

Day says that in the absence of a meaningful discussion about rationing, we end up with a "self-rationing" medical system of long waiting lists, crowded emergency rooms and patients with no family doctor.

Canadian Health Coalition director Michael McBane fears that decisions on who gets care depend more on the pressure applied to politicians than anything else.

"If they don't get embarrassed in the media, they don't move," he says.

Day says the issue will only get bigger in coming years as new treatments come available and baby boomers age, putting added strain on the medical system. At the same time, he says, the number of taxpayers left behind after the boomers retire may not be enough to maintain the system.

"In 20 years time, I am going to be in my early 80s and demanding more healthcare, but there won't be enough taxpayers to pay for it," he says.

"Society just isn't ready for this."