A spirited attack on a society that places many unnecessary demands on Canada's health care system was the focus of the showcase lecture during the May annual meeting of the Canadian Health Economics Research Association.
In delivering the Justice Emmett Hall Lecture, Dr. Charles Wright contended that the demand side of the health care equation has been ignored in recent reviews and critiques of medicare because all attention has been focused on the supply of medical and health services. Wright, a professor of health care and epidemiology at UBC, said Hall could not have foreseen how the scope of and demand for services would grow as he helped create Canada's medicare system in the 1960s.
He said current popular thinking that medicare can publicly fund all medical services that all people might want and demand is “completely ridiculous.” He pointed to the growth of elective medical services and the waiting lists for them. “We're not talking about gunshot wounds to the belly,” he said, but about surgical procedures, the need and timing of which are largely a judgement call on the part of the physician.
Wright listed a growing number of medical procedures that have not been proved clinically necessary, ranging from the use of antibiotics for minor childhood infections to mammography and prostate specific antigen screening. And he was applauded when he attacked direct-to-consumer advertising for prescription drugs. “Good morning! used to be a greeting between friends,” he said, referring to an ad for sildenafil.
He then turned to the “medicalization” of life, with a special focus on conditions such as complicated grief disorder and generalized anxiety disorder. “Unhappiness is now a serious condition,” he noted, adding that “we have narrowed the bandwidth of normal behaviour” so that many more behaviours now are targets for medical intervention. He called for education blitzes to challenge ad campaigns and the inappropriate prescribing pressures they create.
He said there is a need to change medical culture and foster more consideration of the appropriateness of medical interventions, and that physicians must reconsider the notion that just because something can be done, it should be done.
Wright admitted that all attempts to correct the problem face an uphill battle because of politicians and health care providers who are unwilling or unable to act. “Politicians are terrified about this stuff,” he said, noting the unwillingness of any politician to tell the public that access to all the medical services they want may be impossible.
Wright, a frequent contributor to CMAJ, is a member of the Clinical Epidemiology and Evaluation Centre at the Vancouver Hospital and Health Sciences Centre. — Pat Rich, CMAJ