Now we have our own scare and 5,700 images are in question and nearly 5,000 people are involved.
Point #1 - Volume - But as I heard the story last night, I got to wondering - there are 47,000 households on PEI.
10% of Islanders are involved? Doesn't this sound odd to you too? What is going on that so many of us "need" imaging?
Point #2 - Volume - A huge challenge for all rural societies is to have skilled technicians locate in the hinterland. Realistically will PEI ever get a lot of technical talent here? When I say technical talent I mean the ability to interpret complex situations such as interpret pictures and to do complicated but routine operations such as knees. To be any good you have to have talent and you have to have lots of volume.
Why not have a strategy to define a sector of treatment that has to be done in a large centre and send the images there and send the patient there if necessary?
It will never happen that a place like PEI can have a critcal mass of such talent here.
Like many governments, the new PEI government now have access to the books and they are likely appalled at the trends behind the healthcare costs. These costs are growing exponentially and will in a few years, drain resources from all other sectors.
That is why they have hired a consultant to look for ways to save money. But I fear that at best, the will find peanuts.
The real issue is to ask the real question. The real question is this: What are the assumptions and hence drivers for the costs? Who are the groups that drive the costs? What are the results on the health of Islanders by what we do?
Here are some quick answers that in themselves offers a direction for policies that may have a chance of reducing the burden.
There are three groups of people that drive most of the costs and of course they are related.
About 30% of Islanders drive more than 60% of the costs. They drive costs all their lives and as they get older they drive even more
As we get to 65 our use of the system explodes
Finally the costs balloon for most Islanders in the last 2 years of life - often exceeding the entire prior lifetime cost per person
What is going on and what can we do about this?
The 30% - This is a modest estimate - are that group of people who also enter school at grade 1 unable to cope, behave and read. They have been wired for helplessness. The critical problem for them that causes a lifetime of health problems is their immune system. If you grow up believing that you have no control in your life, your flight or fight stress process works all the time flooding your body with cortisol. It is this that weakens and finally compromises your immune system.
This is true in all primates.
All of these people are likely to have heart heart disease, diabetes. They will tend to have addictions.
Lowered immunity and inflammatory responses in the body, slowed wound healing, and other health consequences
Increased abdominal fat, which is associated with a greater amount
of health problems than fat deposited in other areas of the body. Some
of the health problems associated with increased stomach fat are heart attacks, strokes, the development of ,
higher levels of “bad” cholesterol (LDL) and lower levels of “good”
cholesterol (HDL), which can lead to other health problems!
As this group get older, more and more breakdowns occur and the more ill they become. Their illnesses are chronic and drive huge amounts of healthcare costs.
These people cannot be "cured". The cannot be cured because the cause of their illness is not curable by a pill or by medical treatment. It is driven by their mindset and that is driven by their perceived place in the world. That was largely set in the first 3 years of life.
Everything we do today is "downstream" from the real causes of the problem. To have a chance at helping and also reducing our costs, we have to work in a new way. We have to make the early years a larger focus and we have to look at what does work to help people deal with the underlying cause of their problems.
As AA have shown, and as we are learning with PTSD in the military, the problem is spiritual and can only be remediated by peers acting in groups to provide the support that is required. The actual medication should only be a small part of this process. What works the best is when people are connected to others like them in a safe environment, where they are not judged and where they can help each other.
So what then about the inevitability about as we age, we use more healthcare resources?
Many seniors seem to be walking pharmacies. Are they ill and do all these pills work? What is going on?
First of all, a lot of the pill rolling is new and has been growing exponentially in the last decade. It is rooted in the system that we have. A doctor can only offer less that 10 minutes of her time to a patient. What many of the older patients need is attention. So to make them feel heard, they are given a prescription.
It will be vital to look at the reality of a doctor's world and the incentives that are part of it if we are to make a difference and to give the doctor a life too. They have had to disconnect from their patient and rely on the drug companies. Their costs are so high that they have no alternative.
If I was the Minister I would be making an analysis of the doctor's drivers a critical part of the work.
Secondly, the drug companies have made their fortune in lifestyle drugs. Most of this is based on a bogus idea that you ca cure high blood pressure, high levels of cholesterol etc that are all factors that increase the risk of us dying.
We all know that high levels of cholesterol are bad for us don't we? We in truth there is no correlation between these levels and death. You don't believe me - your doctor doesn't believe me.
This chart is unambiguous. It shows the relative rates of death in the UK civil service for Coronary Heart Disease. On the left are the most senior people - on the right the least. See that there is a gradient. If you are a deputy minister, you will live much longer.
Look at the right hand column. You will see that there are levels of cholesterol, blood pressure, smoking etc but that the largest factor in "unexplained".
We it is unexplained no longer. Sir Michael Marmot's research is now well known in public health circles - but maybe not on PEI!
Here is Sir Michael in a 58 minute interview making all of this more clear than I ever could.
26.55 is where Marmot goes into detail of the Whitehall study - the most important experiment in health ever undertaken.
Again, it is a gradient of social hierarchy that drives health outcomes. The more control you have, the longer you will live. The traditional health markers are merely guides to the upstream issue of the immune system and how this is affected by the stress of having low control.
All the risk factors that the drug companies offer us solutions for are merely indicators of a deeper problem - lack of connection and meaning in our lives. These medications merely costs a lot.
The great malaise of getting older is the risk of losing our identity and meaning. This is especially true for men who have made their work their life.
As in the early years, the real "Cure" is re-connection with others and to being able to make a difference.
Finally we come to the hardest part of all. End of life.
What ever we spend in our lifetime, whether we have been a heavy or a light user of the system, we spend it twice in the last 2 years of life. This is where most of the cost of the system is to be found.
So if we are serious about reducing the trajectory of health costs - we have to look here as the population ages.
Why do we spend all this money in this fruitless exercise of trying to cure death itself?
I think it is because we have indeed made death an "illness" that we should be able to cure.
Again we have separated the spiritual from the physical as we have with all modern medicine. We deny our aging and we deny our death. Families with a dying parent often pretend that their dad will get better and so never talk about the things that they really need to. Their father, afraid and isolated because no one will be straight plays along and hangs on.
So the family and the doctors do anything and everything to keep dad alive a for a few more months. I recall sitting by the bed of an aunt. She was in a coma, two nurses were arguing about how best to attach yet more equipment to her. Her daughter had been creating scenes with the staff telling them that they had not done enough. So her mum died not being held by her daughter telling her how much she loved her but isolated in ICU connected not to the people she loved but to machines. The voices she heard were angry ones of strangers.
This kind of death happens all the time. We are too afraid to accept death - we have made death a failure when it is the inevitable. We have made it into a machine event, when it is surely the most spiritual event of our lives - it is when our lives should have the most meaning.
This is where Hospice enters the picture. Hospice is about dying well. Dying well for all involved. It is on the fringes of the system now but I think needs to be placed in the centre.
There is going to be a revolution in healthcare similar to the one that took place 140 years ago when we learned about germs.
We are learning that the key to most illness is not the disease itself but the immune system. A healthy immune system can fight off most things. A compromised immune system actually makes us ill.
The key to a healthy immune system is to live in a healthy environment. This means less one that is clean etc. Less that we eat the right things and take exercise.
This is a healthy environment. It is where the young are loved up and cared for by a trusting group. It is where the mothers are loved up and cared for a by a trusting group. It is where the adults care for each other.
We are primates. Our immune system is driven by our social environment.
What then could we do on PEI in practical terms to ensure that most Islanders had a healthy life and that this did not cost too much.
The first step for a province is to look not at individuals but to look at what affects populations. Policy can affect populations and groups. Therefore there is the potential of doing something if we take this view.
For the price of reading my blog - a lot less than $300,000 I will talk about this over the next few weeks.
But the one lesson for today - any savings you find by looking at how to make the current system more efficient are chicken shit and will do nothing to help us avoid the crisis that is coming.
When our son James was born nearly 30 years ago in England, we thought that circumcision would be a matter of routine. "Why don't you cut the whole thing off? " was one of the milder responses we got. Times had changed. We even went to a Jewish doctor and he sent us away with the advice that if there was not medical necessity, we should not have this done. Well there is more and more evidence that becoming a "Roundhead", as we called it at school when I was a boy (the other boys were of course Cavaliers) is not just a tribal relic but as Martha would say "A Good Thing". Here is the BBC today
Male circumcision could significantly reduce the burden of HIV in Africa, a study suggests.
It concluded that the operation could avert about six
million HIV infections and three million deaths in sub-Saharan Africa
over the next 20 years.
The findings build on research, published in 2005, that
suggested circumcision reduced HIV infection risk in heterosexual men
by about 60%.
The research is published in the journal PLoS Medicine.
An international team of researchers used data on HIV
infection rates and the prevalence of male circumcision across Africa
to predict the potential impact.
Using mathematical modelling, they looked at what would
happen if, over the next 10 years, all men in sub-Saharan Africa were
circumcised.
They calculated that within a decade some two million
new HIV infections and 300,000 deaths could be prevented. And in the
ten years after that, a further 3.7 million infections and 2.7 million
deaths could be avoided - with one in four of the deaths prevented
being in South Africa.
There is also a growing debate as to whether women's risks in getting cervical cancer are reduced if their partner is circumcised. It may be that fears of the small risk attendant on circumcising are overblown when compared to the overall health benefits.
So what to do? It is unlikely that asking an adult male to go through this, or even a small boy, will get a big take up. For any male other than an infant, who if my experience means anything, can't remember it happening, this is quite traumatic. Not the small incision that any anesthetic can mask, but the healing period afterwards. It is why St Paul insisted that converts to Christianity did not have to go through it to become Christians.
So what to do? If you are a concerned parent and have a baby boy, maybe you should consider it.
When I see all those ads for big Pharma telling me how much they care - I want to vomit.
Today there is an announcement that a drug that has been known about for many years called DCA, has signs of being a breakthrough. It is simple to take, in pill form, and shrinks many tumours without side effects.
BUT - because it cannot be patented, BIg Pharma won't touch it and do trials. OK, they are a business. BUT don't talk about how much you care then. Let's be straight - theyr care only about one thing - themselves.
What about an Open Source kind of approach to trials instead?
At the height of the middle ages the issue that really tipped the west into the Reformation was the sale of Indulgences. This was the process where the Church raised enormous sums of money by claiming that you did not have to live a good life to go to heaven and avoid hell - all you had to do was to buy a pass from the Pope.
We all can laugh at how silly people must have been to believe that how you lived your life could be canceled out by a piece of paper from the Pope. But are we not as silly?
Do we not as a matter of routine absolve ourselves from living a good life and instead take a pill from Big Pharma that has been dispensed by its sales force know colloquially as our Doctors?
Just as we are seeing signs that global warming is real, are we not seeing cracks in the unlimited confidence that we have placed in the idea that drugs are the way to health?
Who is to blame for all of this? Aren't we the user at the heart of the
matter. We have given up our responsibility to take charge of our
health and to challenge the system foir information. The Web gives us
the tools to do both.
Signs are emerging of "Trusted Spaces" where those with problems can share with others - support each other in making the life changes that they need to and also to follow the research more closely than the doctors. The Social Web will transform healthcare as it is all parts of life and will give back responsibility and control to us the patients.
In the follow on I have added some detail on 3 major situations where the system has been exposed.
Will obesity bankrupt the health system? This is what the BMA fear and I wonder what will be the result in Canada and on PEI (We are the nation's fattest).
Simply talking about this and hoping that individuals will take action is not working.- The follow on has more ideas about where to look for real answers
Time to look at the core reasons - our food industry, early eating habits at home that solidify into lifetime habits and at the few ways that we can turn the corner and lose weight permanently once we have gained it. I am at least 20 pounds overweight myself!
By chance, as I was looking for more material on Romanian Orphans, I came across this outstanding series on relationships, parenting and the complex outcomes on children of what they experience. It is Called the Science of Mother's day
Apart from the insight that it provides as to why so many kids do so badly at school, the issues related to daycare etc. It also provokes my thoughts about how we are organized for work.
I hear all the time about Stress in the workplace but see little evidence of the tasks themselves being stressful. Compared to say warfare or a dealing room, most jobs are exceptionally routine and require little skill or effort for a well rounded person. But the stress is real and we see its evidence in an ever increasing spiral of health care costs. The workplace drives much of our adult illness today. This slide taken from the Whitehall Study in the link shows that in the British Civil Service that you are 4 times more likely to die early of Heart Disease than the people at the top.
The further down you are in the modern hierarchy, the less long you will live and be healthy.
So here is the link - if you have a workplace where you neglect the needs for real relationship you will get an unhealthy and acting out workforce.
If you have a home life where this is also true, then your kids are in trouble. If there is no loving person in a child's life then later there will be little chance that he will be able to cope with life and little chance that any remedial action will turn this around. What is behind this bold statement?
The connection between neglect and abuse and a primate's ability to thrive or cope is the hormone called Cortisol. Neglect and abuse, drive the production of Cortisol.
High Cortisol levels are at the foundation of the behavioral and health problems of the modern age. What drives them is that we have dropped the ball on the reality that for humans, legitimate relationships are the holy grail for a good life and a healthy society.
I will come back soon to this and point out the dollar costs to the workplace and to the healthcare system. But in the follow on you can see the costs of abuse and neglect on PEI's Children.
It's not school per se that I object to - it is its increasingly machine process that deadens the spirit, the mind and the body. Is there a way back? Am I just complaining? Where is Rob's patch?
Well here it is (an old post of mine)
Yes the one room school house. Is this, I ask the Natural Space for "School". Look at the interactions in the picture - is everyone in lockstep? Who is dominant? Think of what you cannot see - where is the school - far away from the community? What else do the kids do during the rest of the day? Think of the numbers - remind you of anything? Could there be a lot of bullying here?
Here is my old post that says more -
None of these schools had more than 50 students. Most had closer to
30. They had a wide range of ages and abilities. In practice, the
teacher acted as a learning facilitator. Much of the teaching was done
by the older students who helped the younger ones. So while the teacher
was an authority figure, she was not the sole talker. Most of the
teaching was in the form of a series of conversations between the
students themselves. She did not claim to know everything either and
called on the wider resources and knowledge in the community to help if
needed or pointed the child to the library.
School was integrated into the full life of the community. All the
students lived in their community and walked to school. The teacher
lived in the community. Marion Reid had
retired from teaching when she started her family. A group of parents
came to her house one day and made her a deal - they would baby sit her
younger children if she would return to teaching their children.
School was augmented by work and life in the community. Children
were not excluded from work or their full responsibility for the
community in which they lived. All the children had work to do at home
or on the farm and learned a great deal of practical things about how
the world worked from all the other adults in the community. They were
not apart from the work of their families or the community. While there
were always naughty kids - they were naughty in the context of a
community that had their eye upon them and where the consequences of
doing the wrong thing were immediate and powerful.
Very clever kids found that the community got behind them in their
efforts to do well - this is part of the story of Anne and Gilbert of
Green Gables.
But you say - this was not a very effective school. That is why we
needed to consolidate. The kids need the physical resources that come
with scale. Not effective?
The kids were fully engaged in their learning and in their full
community. Literacy was very high. Now nearly 40% of Islanders cannot
read with comprehension. Next time you watch Ken Burns' film on the US Civil
War, think of the literacy of the private soldiers whose letters are
featured.
I am sure there was bullying of a sort at times but not what we see so often today. It is inconceivable that a community would suffer the mindless vandalism that we see so often today. By walking to school and by participating in the work of the community, kids were in much better shape than today.
The one room school house was an "Emergent Design" that fitted
naturally the formal learning needed by children into the life of their
community. Being emergent, the design, like a good local fishing boat,
emerged over time to best suit the real conditions. Being emergent, it
had a scale that fitted the Magic Numbers of our natural organization.
By fitting into that scale, it created by design the optimal social
conditions for learning and social engagement. It was also very
inexpensive and depended on few outside resources.
By linking so
tightly physically to the community, it also reduced the real childcare
issues and cost that face every family through all the ages. As with
Marion Reid, the community could organize to deal with these issues.
We have replaced this system with an industrial model that violates
most of the conditions of natural organization. It is no wonder for me
now that learning engagement is low and that we see kids estranged from
their families and their community.
A typical PEI school breaches the overall size needed to have as the basis of a community that polices itself - 150. There are no subunits of 8 - 15 or 35 that
could reduce the stress of an organization that breaches this
condition. So gangs emerge instead. Gangs are the feature of a society
with low social capital. Without a formal structure, theses self
defense structures emerge and prey on the weak and the different. You
see this in prison, in the Soviet Union and in Sicily. they are a
product of an authoritarian response to poor community. Bullying is
endemic. Learning is reduced to speeches and bribery.
Busing kids all over the Island will soon not be affordable as oil prices will make this process too expensive.
We have isolated our children from a social environment where
learning happens as a result of conversation. We have isolated them
from those other children who are both younger and older than them. We
have isolated them socially from their families and from their
communities. We have isolated them from the work of their households
and their communities. We have isolated them from adult life. We have
isolated them from their bodies. And this is better?
Could we not experiment with a few new/old one room schools again.
Imagine what they could be like - especially in an internet world.
With a shrinking population of children, the pressure will be the
opposite. The pressure will be to consolidate even further. Yet in our
heart we know that smaller and more local is better. If we look at this
more carefully, I bet that we will find that lots of very small local
schools will be both better and cheaper.
Why not try a few? After all - we know that they work and they could not be worse that what we have now.
The human diet today is vastly different from that of our ancestors. For early mankind, hunting, fishing and food gathering were a survival imperative and as a consequence human beings evolved on 'natural' foods supplying a diet that was low in total fat and saturated fat, but contained a balance of omega-6 and omega-3 essential fatty acids.
For most of the time humans have been on earth we have eaten foods containing omega-6s and omega-3s in a ratio of about 2:1 In recent centuries, the emphasis gradually moved away from hunting/gathering towards cultivating the land, but the greatest diet changes have occurred in the past 50 or so years.
As a result of our increasing reliance on cereals, processed foods and, most significantly, vegetable oils and spreads, compounded by a decreased consumption of oily fish and grass-fed meat, today this ratio is about 10-20:1. Modern Western diets are therefore deficient in omega-3 fatty acids compared with the diet on which humans evolved and their genetic patterns were established.
When I was a boy, I was given Cod Liver oil at school every week. In addition, I regularly ate sardines, kippers, herring roe and mackerel. Fish that had Omega 3 fatty acids were an essential part of most people's diet then. None of these may seem like a great food choice to you and most people today hardly have any Omega 3 in their diet. A few may take Omega 3 pills
I no longer eat many sardines - but I do eat a lot - a lot of smoked salmon. I eat only the very best Smoked Salmon which is produced locally on PEI by Kim Dormaar.
For me Kim's salmon is my special treat for myself - it's my personal luxury. I also find that salmon makes a great gift for the friend who is impossible to buy for. So what is good smoked salmon and why should you believe me?
Now Kim and his team have a blog. Here you can find out all about how he handles and sources his fish. You can find great recipes. You can follow the year long ritual of the smokehouse. You can buy his salmon and many other smoked fish delicacies.
Apple is a great organization because of the energy and drive of Steve Jobs.
About 3 years ago a dear friend of ours was diagnosed with a rare form of Cancer of the islets of the Pancreas. Our devastation was reduced when she learned that this type of cancer can be cured. For 2 years, she was fine. But then she weakened and died very quickly.
I mention this because Steve Jobs was diagnosed with the same type of cancer and he and all of us were similarly relieved that he could be cured and that he looked as if this had happened.
Then I caught this report from Wired by Leander Kahney today about how he looked and performed yesterday. I know nothing really and all I do know is what I read below. But as Jobs put in his moving Address - life is uncertain and sometimes shorter than we think.
"Jobs is so charismatic, his talks are usually mesmerizing. I've seen
almost every one he's given in the last 10 years, and he effortlessly
sucks the audience into his famous "reality distortion field," a state
of suspended disbelief that makes even mundane products seem like
miracles of technology.
In the past, I've found myself clapping wildly at the most mundane
product features, or the tiniest increase in market share, despite
trying to maintain a steely, Zen-like editorial impartiality.
But on Monday, the yo-yoing of alternating presenters utterly broke
the spell. Mundane product details were revealed for what they were --
mundane product details.
Looking very thin, almost gaunt, Jobs used the 90-minute presentation to introduce a new desktop Mac and preview the next version of Apple's operating system, code-named Leopard......
I wondered if Jobs, who was treated for cancer last year, was sick.
Was he sharing presentation duties to save energy? When I saw Jobs
introducing the iPod Hi-Fi at Apple's headquarters in late February,
about five months ago, it looked to me like he was tiring quickly and
was glad to get it over.
But a couple of people I canvassed after Monday's keynote thought he looked fine.
I also wondered if he were testing -- or grooming -- possible
successors if he should decide take a back seat, or step down, or worse."
Here is SJ on how death can help you to see the truth about life -
No one wants to die. Even people who want to go to heaven don't want to
die to get there. And yet death is the destination we all share. No one
has ever escaped it. And that is as it should be, because Death is very
likely the single best invention of Life. It is Life's change agent. It
clears out the old to make way for the new. Right now the new is you,
but someday not too long from now, you will gradually become the old
and be cleared away. Sorry to be so dramatic, but it is quite true.
Your time is limited, so don't waste it living someone else's
life. Don't be trapped by dogma — which is living with the results of
other people's thinking. Don't let the noise of others' opinions drown
out your own inner voice. And most important, have the courage to
follow your heart and intuition. They somehow already know what you
truly want to become. Everything else is secondary.
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