A few years ago, one of the Wizard of Oz comic strips showed a doctor standing outside his office glaring across the street at a vendor with a cart full of apples.
“Beat it!” yells the doctor. “I’m trying to make a living here!”
This was a funny twist on the old saying that “an apple a day keeps the doctor away.” From the doctor’s standpoint, however, it should say that “an apple a day keeps the patient away.”
Eating apples is obviously not enough in itself to ensure that you won’t need to see a doctor, but a diet rich in fruits and vegetables is certainly conducive to good health. And since doctors in our illness-dependent system don’t “make a living” from people who stay fit, the consumption of apples (or any other health-preservative food) is not conducive to a healthy medical practice.
An outbreak of general good health, of course, would not be financially bad just for doctors. It would be ruinous for all other sickness-treatment professionals, for private nursing homes, for the makers and sellers of crutches, wheelchairs, X-ray machines, and other medical devices – and absolutely disastrous for the pharmaceutical companies.
This explains why, out of all the billions of dollars spent in running and maintaining Medicare, only a little about 5% is devoted to prevention – to keeping people well.
The system is geared almost entirely to treating our ailments. It assumes (dare I say, hopes) we’ll get sick. In fact, it depends on our getting sick to justify all the billions spent on medical staff, technicians, high-tech gadgets, hospitals, clinics, pharmacies, and drugs – the whole immense panoply of a system that is not really about health care. It’s all about ill-health, about prescribing the drugs and the blood tests, or performing the surgeries that we’ll be told we need when our bodies succumb to some affliction.
As for trying to stay healthy, that responsibility is left almost solely to us. Granted, doctors do warn patients about obvious dangers to their health, such as overweight and smoking. But they’re ready and waiting for the many obese and tobacco-addicted patients who ignore these warnings and fall prey to heart disease or cancer as a result.
Even those of us who don’t smoke or overeat face serious difficulties staying healthy. We live in an increasingly toxic environment. Poisonous chemicals pollute the air and water. Many of the crops we rely on are dosed with carcinogenous pesticides and grown in soil bleached of nutrients. (A recent study found that most fruits and vegetables today contain much lower amounts of vitamins and minerals than plants grown 100 years ago.)
To compensate for these threats and deficiencies, our immune systems need a lot of extra bolstering. Wholesome organic foods, vitamin and mineral supplements, exercise and weight control – these are all much more vital for health protection today than they used to be in the past when we could safely rely on the grocery stores to meet our nutrition needs.
Such preventive measures, however, shouldn’t be an individual responsibility. We should have a genuine health care system that cares more about keeping us well than treating us after we fall ill. The Chinese used to have such a system a long time ago. Patients paid their doctors a modest monthly sum as long as they remained healthy. If they got sick – and for as long as the sickness lasted – the doctor’s payments stopped. So the doctor’s motivation was to preserve his patients’ well-being, not sit back and wait for them to get sick.
The closest approximation to that old Chinese health care approach today is being practised in Cuba. We got a glimpse of it several years ago in Michael Moore’s documentary Sicko, when the ailing Americans he took to Havana got prompt and effective treatment for their maladies, for little or no cost.
The emphasis Cuba’s system puts on prevention wasn’t depicted in Sicko, but it was fully described by reporters sent to Cuba by the U.K. Guardian newspaper. In their report they tell about the mandatory daily exercises, about the frequent regular check-ups, the attention to hygiene, and even the doctors’ annual visits to their patients’ homes. Posters displayed everywhere portray disease prevention as a patriotic duty.
The Cuban health care system is not perfect. The U.S. embargo occasionally leaves medical items in short supply. Doctors are paid such low salaries that they are tempted to accept “gifts” from patients for better service. But the people of Cuba still enjoy far more effective and reliable health care than do Americans – or even Canadians. Their system ranks among the best in the world, according to the UN – and, remarkably, it’s achieved by spending just $320 per capita per year (compared to the stupendous U.S. per capita expenditure of $6,600).
The neglect of a Cuban-style illness-preventive approach in Canada is a national disgrace. Not only does our system fail to stress the importance of prevention, but it also actively discourages people from taking pro-active steps themselves. Taking vitamin and mineral supplements is decried as unnecessary and even potentially harmful. Taking other herbal and antioxidant supplements – fish oil, flax-seed oil, ginseng, ginkgo biloba, garlic, even apple vinegar – is even more scathingly denounced.
Why? Is it because these supplements might just be keeping patients away, and thus keeping the drug companies’ profits and doctors’ bank accounts from rising even higher?
This is not to denigrate the dedication and integrity of the professionals who staff our health care system. In the “toxic-stew” environment we’re immersed in, their services are indispensable. Most of us, no matter how zealously we strive to preserve our health, will still catch an occasional bug that will necessitate a physician’s care. And some ills simply can’t be prevented, especially those that are congenital or associated with old age.
The hard reality, however, is that most kinds of illness can be prevented, or at least mitigated or extensively delayed. Take Vitamin D, for example. Most people don’t get enough of it from exposure to the sun, so they need supplementation to build up a resistance to cancers and other serious ailments. But their doctors don’t stress this basic need, or test them for Vitamin D levels when they come for their annual checkup.
Some people, even when they become aware of their Vitamin D deficiency, have such low incomes that even a $10 bottle of 100 pills is beyond their reach. Vitamins are not ordinarily covered by either public or private drug plans, so many people go without. When they get sick as a result, however, their medical, hospital, and drug costs add up to a lot more than $10 – but such a huge and easily avoidable expense is an integral part of a system that favours treatment over prevention.
The same point can be made about inadequate nutrition. One-and-a-half million children in Canada are undernourished, and will therefore grow up to be much more vulnerable to bacterial and viral infections than they would be if their immune systems had been strengthened by nutritional food in their youth. The newly-born infants of poorly nourished mothers are especially susceptible to disease in later life. The cost of preventing the malnourishment of poor children and pregnant women would be a small fraction of the billions now being spent to treat their frailties.
It would be much less costly, in the long run, to eliminate hunger in this country, along with poverty and squalor which also undermine health, than to try to cope medically with their debilitating effects. But we have a “health care” system that is designed to serve the drug-makers and drug-pushers who profit from illness, not the people whose health it allegedly is supposed to protect. The actual role people are expected to play in this system is to become patients. Otherwise there’s a danger the profits will stop flowing.
In a previous column I wrote about health care, I said I had stopped sending money to the Canadian Cancer Society because of a missing word in its name. In its present form, it should be called the Canadian Cancer Treatment Society, since almost all of the money it collects goes to support either efforts to help people suffering from cancer or efforts to find “cures” for the dozens of different kinds of cancer. I said I would resume my financial contributions to a Canadian Cancer Prevention Society, if that were to become its primary purpose.
A doctor then e-mailed me to ask if I was opposed to further cancer research. I assured him I wasn’t, because, even if only one in a dozen cancers was genetic in origin, it would affect many thousands of people, who deserve to have some hope of a cure. But most cancers are caused by the malignant mutation of our own cells, which in turn is caused by carcinogens in our air, water, and food, and the inability of people with weak immune systems to protect themselves. What I disagree with -- along with millions of other Canadians -- is the inordinate imbalance between health spending on research and treatment (95%) and spending on preventive efforts (5%). I’m not saying that this ratio should be reversed, but that at least 50% of the money raised to fight cancer be devoted to measures to help people stay healthy.
Surely, if a disease is largely preventable, the main emphasis should be on preventing it. It’s hard to escape the suspicion that most of the money donated to fight cancer is for the benefit of the big pharmaceutical companies, whose profits keep rising no matter how ineffectual their research.
The fixation on finding a cancer cure contrasts sharply with the treatment of allergies, another immune-system breakdown that now afflicts millions. My wife is one of them. Her allergy to peanuts is so sensitive that even a whiff of peanut butter from 10 feet away can cause her throat to close. So why no well-funded campaign to find a cure for peanut allergy? Why no Canadian Peanut Allergy Society to bombard us with appeals for donations? The answer is simple: it’s easier – and a lot less costly – for people with this allergy to stay away from peanuts and peanut butter than it would be to spend billions trying to find a cure.
Carcinogenic chemicals, however, can’t be evaded, no matter how hard we try. They are spilled and spewed into the environment in such quantities that their ingestion is unavoidable. The cancers they cause could theoretically be prevented if we could avoid exposure – just as the ill-effects of peanuts can be prevented – but with cancer we can’t protect ourselves by individual effort alone unless our immune systems are as strong as they can possibly be. But to maximize the strength of our internal defences requires a sizeable financial outlay on the proper nutrition, on the necessary food supplements, and probably on homeopathic treatments. Many people, however, can’t afford such self-protective measures. They need government programs that will assure them access to adequate food, shelter, and incomes. Even more urgently, we all need government action to stop industries from clogging our arteries with carcinogenic chemicals.
I’m writing this column in the middle of a federal election campaign in which the problem of chemical-caused cancer has not been raised as a serious issue. General health care problems have been addressed, but only in the context of long waiting-times, understaffing, and privatization. The neglect of preventive programs – for cancer and other preventable maladies – doesn’t even seem to be on the political radar-screens. Instead, the politicians keep wringing their hands over the rising costs of Medicare, which they claim are insupportable. Some even warn that it could collapse if costs are not curbed. The only way they can envisage to do this, of course, is to cut staff and services, or make patients pay for more treatments. They ignore the preventive solution, even though it would cost much less to keep people healthy than to treat them for the many ills that could be prevented – many billions of dollars a year less.
Clearly, we’ll be stuck with an unnecessarily high-cost sickness-treatment system until governments are elected that have the courage to replace it with a sickness-prevention system. Sadly, I’m not expecting such a government to emerge from the most recent election results.
Ed Finn is the CCPA’s Senior Editor.