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Sicko: Sad Commentary, Wrong Solution

Alright, I can’t help it – I just watched the new movie
Sicko, so I have to write about it.  Labeled a propagandist
by some, self-contradictory by others, the value of Michael Moore’s
work is in its ability to get the public talking about a critically important
subject.  And I must agree with the New York Times reviewer on this point – Sicko was the best
edited and most entertaining of Mr. Moore’s documentaries.

Socialized Medicine Won’t Work in the US (In My Humble Opinion)

was interesting for me because it compared the healthcare systems of the US, Canada,
France and Britain.  Moore’s whole thrust is that socialized medicine is the
potential cure for America’s
healthcare crisis.  I grew up in Canada,
spent summers in France,
trained in medicine in the US,
and my mom’s British – so I have a unique and very deep appreciation for the
cultural differences of these 4 countries.  And here’s what I see: the way
a country cares for the sick is a reflection of their shared cultural
values.  Each healthcare system has its own personality – like wine made
from grapes grown in the unique soil and climate of a specific region.
Even if you export the same vines to another place, the wine will never taste
the same.  Let’s take a look at a few of these cultures (and yes I am
using somewhat stereotypical language to clarify the differences):

are fiercely individualistic.  They are passionate, driven, and believe
that success is proportional to how hard you work.  They believe in
survival of the fittest – if you’re not doing well, it’s probably your own
fault.  Everything’s a competition, and capitalism spurs on a constant
parade of advertising, marketing, sales and consumerism, all orbiting the
almighty dollar and personal convenience.  It’s critical to them that
anyone can attain the American dream – if they work hard enough.  Fabulous
riches are within the grasp of any average Joe if he concocts a really good,
money-making business plan. Americans don’t have time for health prevention,
long vacations, taking care of others – no, they’re so busy working that only a
medical emergency will jar them out of their usual pursuits.

sort of healthcare system would grow out of this cultural milieu?  A
hurried, high stakes, emergency intervention focused, technology driven
grab-all ruled by any stakeholder who can outsmart the competition.
Forget the poor, they’re not productive and don’t deserve equal care
really.  But that financially successful “average Joe” will receive mind-blowing
technologically advanced care that costs hundreds of thousands of dollars and
can keep him alive long beyond any reasonable need to do so.  Joe has a
shot at immortality, and somehow that makes all the work worthwhile.  Yep,
that’s pretty much what the US
healthcare system is like.

are good natured and tolerant.  They put the needs of others first.
They will pull over in a snow storm to help you change a tire, and then they’ll
have a beer with you and talk about hockey at a local pub after towing your
vehicle out of the ditch.  They will also wait patiently and without
complaint for hours on end in a line for tickets or groceries, or whatever the
line is for.  There are so few people in Canada (compared to the land mass)
that nothing feels crowded or busy.  Their socio-political views lean
strongly toward socialism –almost no one is really rich or very poor in Canada.
Everyone is treated with the same friendly respect, living comfortably, no real
crime or racial tensions.  What sort of healthcare system would these
people invent?

socialized, government-run system that offers “free medical care” for all, with
insanely high taxes to cover it all.  There are long lines, competent
doctors, and moderately satisfied patients.

are argumentative and political.  They tend to value
leisure above work, they don’t like rules imposed on themselves, and believe
that their government’s purpose is to serve their needs at all times.
They protest regularly, everything is unionized and everyone is focused
on personal rights and liberties.  Employers are at the mercy of
government rules and employee whims.  They work very little and expect
extensive social services, smoking cigarettes and drinking coffee, watching the
world walk by from neighborhood cafes.  What sort of healthcare system
would these people want?

government-run, heavily social service oriented system that caters to a
leisurely lifestyle.  Spa treatments, alternative medicines, herbalism all
thrive, but in order to keep people from overburdening the spas, copays for
many basic services run as high as 40% of the total bill.

the question is this: how would Americans respond to these other brands of
If they were served up the Canadian system, they’d
scream at the tax rates, and become hysterical at the inability to trade up to
a platinum level of care for those who have “earned it.”  They would not
accept the long lines for care and would immediately start a scheme for
off-shoring medicine to circumvent the lines.

Americans were offered the French system, they’d be immediately annoyed by the
inconvenience of the office hours (months of vacation are taken at a time by
all members of society, including doctors), they’d never use the preventive
health measures (they don’t have time for that stuff), and although they’d be
glad to receive home health aides for no more excuse than  – “I just had a
baby and I’d like a government worker to clean my house” – when they saw the
tax rates it would take to make this available to all, they’d find it
unacceptable, especially with such high copays and out of pocket expenses..

socialized medicine will never work in the United States – not because it’s a
fundamentally flawed system, but because the American culture will not tolerate
it.  Healthcare solutions are not globally applicable – (though I’d say
that from an IT perspective, there is an information sharing system that is
needed equally badly by all countries).  Instead, systemic changes should
be personalized to the culture.  Looking to other countries for magical
fixes to healthcare woes is like expecting that all cancers will respond to the
same chemotherapy regimen.  Medical care is most effective when it is
customized to the individual, and healthcare reform will be most effective when
it takes into account the unique cultural values held by a country’s people.

In my next post, I’ll explain why health insurance companies
and big government health plans (Michael Moore’s solution to US healthcare
woes) share a common flaw.This post originally appeared on Dr. Val’s blog at

Yogurt Can Prevent Hospital-Acquired Diarrhea?

Well, having grown up on a yogurt farm – nothing delights me more than scientific evidence that this fine dairy treat is good for your health.  Hats off to my friends at the Imperial College, London who just published a study showing that elderly, hospitalized individuals may use yogurt  to avert nasty bacterial infections that cause explosive diarrhea.

Yes, it’s the battle of the bugs at its best – the most common yogurt bacteria: Lactobacillus casei, L. bulgaricus, and Streptococcus thermophilus work together as pretty effective colonic bouncers for enemy bug C. difficile.  In this study, elderly patients (n=57) at risk for hospital acquired diarrhea (due to antibiotic use) were given 2 small active culture yogurt drinks/day during the time they received antibiotics and for one week afterwards.  Another group (n=56) was given similar drinks, but the yogurt cultures had been sterilized with heat (so there were no actual live bacteria in the yogurt).

And guess what?  None of the patients who drank the live yogurt got C. difficile infections, while 9 in the other group did!  That means that for every 5 elderly people in the hospital (and taking antibiotics) you could potentially save one from getting a painful gut infection.

So if grandma’s in the hospital on antibiotics, you might want to ask her doctor if she can eat yogurt. It may make the difference between a short stay and a long and unpleasant healthcare experience.This post originally appeared on Dr. Val’s blog at

Chinese Toothpaste: Not Good

I’ve been expressing my concerns over the recent quality control issues in China – first the melamine in pet food, then the contaminated medicines, next the anti-freeze in toothpaste.  The New York Times has an interesting piece on the toothpaste scandal.  But they miss an interesting issue at play: cost cutting is the underlying cause of all this.

Antifreeze (diethylene glycol) is less expensive and mimicks the flavor of mouthwash.  Melamine (the poison recently found in pet food ingredients) is a cheap filler product that increases the apparent protein content of pet food.

So China was putting these cheaper imitation ingredients into their products to improve their bottom line, not because they were particularly interested in causing the death of people and pets.

And before we point a finger at them… let’s think about why the toxic toothpaste got into our hospital and prison systems: because the administrators were trying to buy the cheapest possible products to save on costs.  And the least expensive items are often from China.  This is a good example of how cost cutting can endanger lives – with both the US and ChinaThis post originally appeared on Dr. Val’s blog at

Chatty Doctors – Do They Waste YOUR Time?

Interesting article in the New York Times about doctors talking about themselves too much.  Apparently, some doctors spend precious patient interview time talking about unrelated personal information (recent vacation experiences, family members, etc.).  In fact, a recent study in the Archives of Internal Medicine suggests that physicians annoy patients with these misguided attempts at building rapport.

We physicians are trained in medical school to be more humanistic and compassionate towards our patients – but we are not given specific direction regarding how to achieve those goals.  And let’s face it, we’re kind of geeky in the first place, some of us lack social skills, and we’re under a lot of stress most of the time.  The result?  Awkward conversations about the most innocuous things we can think of to break the ice – vacations, daily routines, the weather… and perhaps a lot of wasted time.

The research study has its limitations, though.  First of all, it only studied physicians in Rochester, New York.  Now, my husband is from Rochester – so I dare not say anything unkind… but culturally speaking, the Rochester crew is a little more chatty and casual in their approach to conversations than folks in Manhattan or Boston for example.  So there may be a cultural bias at play here in the research.

Second, it’s unclear how much the personal commentary bothers real patients.  The conversations were judged by researchers listening to recordings of fake patients who had no previous relationship with the doctor.  It’s entirely possible that regular patients might enjoy the personal aspects of the dialogue and actually look forward to hearing how the doctor and his or her family is doing because they have a caring, friendly relationship.

And finally, the study doesn’t address the issue of how to improve the doctor-patient relationship if self-disclosure is so unsuccessful.  The poor docs in Rochester are going to be left with a self-conscious uneasiness about idle chatter – and will again not know exactly how to demonstrate humanism as recommended in their medical school training.

But, I must say – that if my doctor spent our entire session talking about herself, I sure would be annoyed, and rightly so.  Still, I think I’d like her more if she told me something personal about her own struggles.  There’s a balance here – and the complicated interplay of human relationships is hard to measure with standardized patients, audio tapes, and a small geographical location.  If your doctor is too chatty, just redirect him/her.  You know we do that to YOU all the time.  This post originally appeared on Dr. Val’s blog at

New FDA Rule Raises Bar for Supplement Industry

Well, hooray for the FDA.  On August 24th a new rule will be phased in, requiring all supplement manufacturers to demonstrate that their products contain the ingredients listed on their labels (nothing more, nothing less).  This rule will help to reduce contamination issues (some supplements have been found to contain dangerous levels of lead, bacteria, and other contaminants) and false advertising (some supplements don’t contain as much of an ingredient as the label claims).

This is really good news, and better late than never.  Although some manufacturers were already conforming to this rule (kudos to them), this will require compliance for the rest of the companies out there who have been misleading the public about the contents of their supplements.

Some say that this rule doesn’t go far enough to ensure the safety and efficacy of the contents of the supplements, and that these bio-active ingredients should undergo the same degree of testing as pharmaceutical products.  Unfortunately, studying all the supplements for efficacy would be an enormous and extremely expensive task that is totally cost-prohibitive.  At this point, the best we’ve got is NCCAM, and they are slowly grinding their way through a long list of supplements that are purported to be useful for the treatment of various conditions.  They are systematically reviewing them to see if indeed they produce the desired effect, without any undesired effects.

And so at this point, let the buyer beware – supplements may or may not be as helpful as the manufacturer claims, and they may not be as side-effect free as they suggest either.  But soon you’ll at least be able to know that they don’t contain toxic chemicals, heavy metals, or dangerous bacteria – and that’s a giant step in the right direction for public safety.This post originally appeared on Dr. Val’s blog at

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