Letters 22 December 2012by Morgan.J
Christmas; over-diagnosis; and defibrillators.
STUFF AND NONSENSE
I heard preschoolers being interviewed by Radio New Zealand about their Christmas wish lists; iPads, etc, were very popular. Cute? Maybe. In reality, it’s scarily depressing. Encouraging our kids to be self-centred little consumers isn’t going to help the planet. When I was teaching, I eschewed the boringly predictable end-of-year essay topic of “What do you want for Christmas?” and opted for “What will you do for someone?” It would be wonderful to have our children feeling just as excited about, for example, giving to other children, such as those in Haiti who are still in tents in winter, or helping a frail family member or needy neighbour. Children’s minds and lives are being cluttered with too much frivolous stuff. With all that trash, how will they find the voice and clarity of vision to design a better future?
A wrong diagnosis (“When caring is dangerous”, December 8) can endanger not only one’s health but one’s purse. On two occasions I have been sent to specialists, I believe unnecessarily. One was recommended by my dentist, the other by an optician. The dentist claimed to have seen “striations” inside my mouth, which could have been cancerous. The optician, on the basis of the air-puff measurement on the eyeball, thought I might have glaucoma. I had neither, but I paid a substantial amount of money to find out. I recognise the need for caution, but I question whether sufficient attention is being paid to informed discipline in a situation where the mutual supply of clients to each other is perhaps a more important issue among certain professional groups.
“If you think you are well, you haven’t had enough tests” was a notice on the waiting-room wall of a Jewish doctor’s clinic in the Bronx. It humorously epitomised what has become the norm over past decades, with the proliferation of tests and subsequent medicalisation of humanity’s imperfections and a pill for every perceived ill. Notably, the human carcass is unique, being the only one with a commercial value when identified as diseased. There’s no profit in health. It is therefore refreshing to see the media finally permitting itself to expose the skeletons in the allopathic medical cupboard. Fortunately, there also now appears to be a well-overdue ground swell of young doctors challenging the dictates of so-called best medical practice, even though it takes much longer (and is less profitable) to listen to a patient’s problems instead of providing a quick-fix for the prevailing symptom. The psychosocial and chemical environments appear to be far more relevant than lab results and a sympathetic ear more therapeutic, even though the doctor risks being disparaged as “fringe”. However, the “quackery” of today has a sneaky habit of becoming the science of tomorrow. Long
may this last.
The article on over-diagnosis paid insufficient attention to the fact that money spent on over-diagnosis or over-investigation is money that is not available for other health interventions that would be more effective. If you spend $1000 on a scan that is not really needed, that’s $1000 that can’t go somewhere else. Health Care Aotearoa represents community-controlled practices, many of which serve “underserved populations”. Two-thirds of its practices are working to deficit budgets. Newtown Union Health Service had its budget cut by 6.9% and Hutt Union Health has lost $500,000 in the past two years, so on current funding can only keep going for a couple more years. A third of Samoan women do not access lead maternity carer services. The middle classes are being harmed by over-diagnosis, but the poor are being harmed by inadequate access to services. A one-in-four “number needed to treat to achieve benefit” is pretty impressive. But why would we look to introduce a bowel-cancer-screening programme when 25% of children are living in poverty and their lives are blighted by a poor start to life? If we thought of child poverty as a health diagnosis, a screening programme to “detect cases” is already in place. “Treatment” (a universal child benefit for under-fives) has a cost benefit that has proved to be much higher than many other screening programmes and the side effects of “unnecessary treatment” (giving money to people with children not in poverty) are limited to the cost to the Government. Our policy response is lagging behind our change in circumstances. The health and pharmaceutical industries continue to come up with more ways to postpone dying that are increasingly expensive. The death rate over the next 30 years is projected to nearly double (as baby boomers die). We spend seven times as much in the last year of life than we do in any other year, so if we change nothing, the health services are going to be under severe strain. If we provided equitable access to health services and reversed the current inequitable health outcomes without doing anything new, the health system wouldn’t cope. It would be a good start if we stopped over-diagnosis, but if we are going to provide an adequate standard of care for everyone, we need to stop doing some of the marginally beneficial things, too.
Further to “In for a shock” (December 8) on automated external defibrillators (AEDs), Auckland Airport can confirm that unlike most public buildings and venues, we have an Airport Emergency Service (AES) operating 24/7. Two medical crews operate 24 hours a day, 365 days a year, responding to all medical emergencies in the terminal buildings. These crews are committed, highly trained paramedics who carry sufficient medical equipment (including AEDs) to deal with most medical emergencies. So far, our response rate for medical emergencies remains high. However, we are always considering ways of improving the service, so to complement (but not replace) the service already provided, we recently installed 12 AEDs in strategic locations throughout the international and domestic terminal buildings. There are three in the domestic terminal and nine in the international terminal, located so anyone using the terminals is no more than two minutes away from any unit. The AEDs are stored in highly visible cabinets that are set up to transmit a signal to the Incident Control Room whenever the cabinet door is opened. This will confirm the incident’s location and automatically alert the AES of any emergency involving these devices. Training courses are held regularly, although little training is required, as the AEDs were selected for their simplicity of use and delivery of clear voice prompts to lead the user through the rescue process. We have also offered training airport-wide to anyone who wishes to attend.
Corporate relations manager,
FLOATING AN IDEA
Recently I attended a Ministry of Education consultation on the Canterbury Schools Renewal Plan. In the ministry’s view, consultation consisted of an official talking to us for over an hour and telling me not one new piece of information. Everything he said I had already read in the media. He invited written questions, so I posed the following: “Has the ministry taken into consideration the effects of climate change and possible sea level rises in regard to its school merger and rebuild plans, particularly in eastern Christchurch?” His reply was prefaced by a nervous laugh, then he said, “We’ll build you a school on pontoons.” This is perhaps sadly indicative of the developing fiasco that surrounds this issue and lack of any real foresight or future proofing on the part of the Government.
FRONTING THE ISSUE
One hesitates to take issue with Douglas Lloyd Jenkins’s entertaining and informative guide to developments in the male underwear industry (“We have uplift”, December 1). After all, what self-respecting male would wish to claim expertise on the subject? In the article, Lloyd Jenkins says, “The mismatching of low-ride trousers and high-rise underwear has been the most abhorred male-fashion crime of recent times”, but this is not borne out by my observations of the young and trendy in European cities where, as recently as 2010, young males could be observed deliberately and proudly high-rising their (presumably expensive) designer-label briefs well above their fashionably leg-clinging, low-slung jeans. Those of us over 35 can only conclude this new aesthetic low in men’s fashion is presumably part and parcel of the culture of cool youth irony, intended to flag the wearer’s hip affluence rather than flaunt any physical attributes. A significant byproduct of this fashion seems to have been the “free” advertising enjoyed by the Calvin Klein empire. All this is not to be confused, of course, with the largely inadvertent phenomenon encountered in less-fashionable circumstances and sometimes referred to as “labourer’s crack”. With the new developments mentioned by Lloyd Jenkins, it will be interesting to see whether fashion-conscious youth or humble labourers will be more persuaded by the benefits of “uplift”.
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