Modern doctors are often deeply over-invested in the use of drugs, and amazingly ignorant of the power of the human immune system, when supported by a healthy diet and optimal nutrition, to defeat disease.
They sometimes exhaust their repertoire of drugs without ever considering using nutritional supplements to support the patient’s immune defense.
An extraordinary illustration comes from New Zealand. It began when Alan Smith, a New Zealand farmer, contracted swine flu:
He caught the Swine Flu (probably while on a fishing trip in Fiji), so badly that his lungs had “white out”, which is to say they were so full of fluid that they didn’t show up on an x-ray. The doctors also said he had got leukemia and he ended up being put on a life support machine.
The doctors told the family the machine should be turned off … [1]
The diagnosis of leukemia is suspicious. Both infections and leukemia lead to “leukocytosis” or a very high white blood cell count. In one case the white blood cells are multiplying to fight the infection, in the other a malignant population is multiplying. The difference is that in leukemia the population is monoclonal, i.e. all the new white blood cells are genetically identical, while in normal people with infections the white blood cells are created with genetic diversity. (Keywords for those who wish to investigate: T-cell antigen repertoire and B-cell immunoglobulin repertoire.)
As subsequent events showed, the leukemia “diagnosis” was mistaken. I wonder if it was made just for “family management” – in order to help persuade the family his case was hopeless and support the recommendation to end life support.
… but the family asked that he be given high dosages of Vitamin C. After a fight (one of many), one of the doctors agreed. Alan began getting better; his lungs showed pockets of air. Then he began to get worse and the family found out the doctors had stopped the Vit C.
Many more fights ensued, the patient getting better while having the Vit C, and getting worse when he was taken off. Alan’s wife describes one of the doctors sitting back in his chair, arms folded, rolling his eyes, looking at the ceiling, telling her that no way could the vitamin C be helping. The family hired a lawyer, forcing the doctors to continue the vit C treatment (albeit in slow dosage, until he got better enough to eat and his wife brought along sachets of large dosage herself for him to take).
Eventually Alan fully recovered, no trace of leukemia even. [1]
He should have been given high doses of vitamin D and iodine as well. Iodine supports leukocyte respiratory bursts of reactive oxygen species which destroy pathogens; vitamin C supports respiratory bursts by recycling glutathione and providing antioxidant protection for leukocytes against their own respiratory bursts, and also supports anti-viral immunity; vitamin D creates antimicrobial peptides that kill many pathogens.
Other possibly beneficial supplements in cases of elevated leukocyte counts due to infection: selenium, to support both glutathione and iodine/thyroid function; iron, for myeloperoxidase (respiratory burst enzyme) and catalase (antioxidant defense); N-acetyl cysteine (for glutathione production) and glutathione; zinc and copper (for the anti-oxidant zinc-copper superoxide dismutase).
Thank goodness the family had the sense to try vitamin C, and that that was enough for him to recover. It would have been a shame if he died for lack of vitamin D and iodine.
New Zealand was a pioneer of socialized medicine in the English-speaking world. Economists say that people respond to incentives; one wonders if the doctors were more motivated to tend to the interests of the bureaucrats who controlled their budgets, than to the health of the family and patient who weren’t paying them. Perhaps “free” medical care has unexpected costs.
References
[1] “Indictment of Our Medical Profession,” New Zealand Conservative, http://nzconservative.blogspot.com/2010/08/indictment-of-our-medical-profession.html; hat tip to Jewel at http://health.groups.yahoo.com/group/infection-cortisol/message/1760.
via this link:
wow, what a crazy story. linus pauling would be proud of this family heh.
Couldn’t agree more with this post, up until the one paragraph musing about “socialised medicine.” Even the briefest of comparisons of the UK versus the US model would suggest that this sort of decision (with costs having disproportionate weight over patient care) are far more common in a marketised rather than public system. It’s also difficult to see how the ‘bureaucrats’ would actually benefit. Unlike in a profit-driven system, here the doctors actually are incentivised to produce the best total health gains with the resources they have. The problem is that due to the current medical culture, vitamin C and other nutritional interventions are viewed as tantamount to voodoo, compared to pharmaceuticals. If you (incorrectly) believe that there’s “no way could the vitamin C be helping,” then the medical decision makes perfect sense.
Hi David,
Thanks for your comment.
I would agree that most doctors throughout the world, private or public, would not have thought of giving vitamin C. In the US, if they thought of it, the hospital may have forbidden it out of fear of lawsuits over unconventional care. So you are right that the primary medical issue is not one of socialized vs private medicine.
That said, I think it is clear that we have come a long way from the Hippocratic Oath when doctors are urging euthanasia (cessation of life support) and withholding of care (vitamin C) even after the therapy has been shown effective, and even in the face of vigorous opposition from the family, and supporting their anti-Hippocratic behavior with a “diagnosis” they must have known was probably false.
Why has this culture change among doctors happened? Is not one factor the shift of funding from patients to third parties? “No [doctor] can serve two masters,” St Paul said.
Regarding incentives, we have to look not only at doctors’ incentives to provide care “with the resources they have,” but also the incentives others have to provide doctors with resources. An oft-cited statistic is that US spending on health care is 16% of GDP vs 8% of GDP in the UK. On its face, it would seem from that statistic that the incentives to provide doctors with resources for care are stronger in the US.
Perhaps questions of incentives facing doctors, the third parties who pay them, and the regulators who supervise them should be beyond the scope of this blog … But it looks like these questions may become more and more central to the practice of medicine and, if some who wish to more tightly regulate food and supplements get their way, even issues of diet and nutrition.
Best, Paul
Thanks for the reply Paul.
I think euthanasia and witholding of care for patients who are deemed beyond hope are separate issues to this case (though fascinating ones, speaking as one with research interests in bioethics). In this case the doctors would have viewed vitamin C as comparable to, say, homeopathy (and so utterly futile), so in their view they weren’t “withdrawing care” by denying vitamin C, the choice presented to them was maintaining a [seemingly] hopeless case indefinitely or not.
One could of course favour maintaining all life indefinitely, were it not for the question of other costs. It would be tempting to say “If such and such can pay to prolong life in this case, they should be permitted.” This benefit of private medicine comes with the cost of precluding a far greater number of individuals (those who can’t afford it) to receive the same medical treatment. Were doctors to serve those who could pay, those who can’t would lose out. It’s a fact of any triage situation, not just socialised medicine, that treatment should be denied ‘hopeless’ patients, in favour of those who could benefit. I don’t think there’s anything fundamentally different going on in this scenario, so I’m not sure I’d look for any negative change in culture.
Keep up the excellent work with this blog anyway, I flew through the entire archives just a couple of days ago.
Thanks, David. I am glad you liked the archives.
The triage logic is the central issue. In the NZ case, probably the doctors were concerned that resources devoted to Adam Smith’s artificial respiration might deprive other patients of care later in the fiscal year.
As a former business executive and entrepreneur, I never thought of having a fixed budget for capital investments (and saving a life is a sort of investment in human capital). Instead, if a project had a highly positive ROI, we would go out and raise capital to fund it. If it made sense to save Adam Smith’s life, it shouldn’t be necessary to deprive others of care in order to do it. It should be possible for the family to raise funds to give him the care that makes sense for him.
I don’t agree that allowing doctors to serve those who can pay implies that they must not serve those who can’t. There are ways to deliver care to the needy without depriving others of the ability to make investments in their health.
As a bioethicist, you surely must be concerned about a system that pits patients against one another in a fight for fixed resources. I’m reminded of this Onion video: http://www.theonion.com/video/autoworkers-compete-to-keep-jobs-livelihoods-on-ne,14331/. I’d hate to see a hospital equivalent!
Best, Paul
Hi Paul,
Under a socialised system, private care isn’t banned, so the family could have gone and taken out a loan for $2,920,000 and had life support for another year (ignoring all the other costs), they just presumably weren’t able to. The family would doubtless see a good return from saving his life (since they value it very highly) but why should this view be shared by the market from which they’d be raising capital?
“Going out and raising capital” if returns are good enough makes more sense in a socialised system. Let’s say the doctors assess returns solely by QALYS (quality adjusted life years) and every treatment that returns 1QALY/$10,000 is ranked as a good investment. (By comparison basic life support costs $9900 per QALY). So for every patient who could be treated in this way, we’d just need to go out and find the money somewhere? This might be the right ethical response, but if the money isn’t just to be drawn from general taxation (with society funding any treatment that is efficient enough), then where would the money come from? There’s certainly no reason to think that the family should be able to find it.
When I say that if doctors treat those who can pay, those who can’t lose out, I’m assuming a system of fixed resources, where ability to pay determines whether one is treated. Without drawing ever more on taxation, there’s no way to avoid that ethical dilemma. Similarly, wherever you have fixed resources, you will have patients pitted against each other to gain those resources; the only question is what factor determines resource allocation.
N.B. Great video!
Hi David,
Private care is banned in some countries, such as Canada. In any case distortion of the private insurance market, and having to seek private care when you are already sick, may render it unaffordable.
People have a great ability to adjust their expenditures and plans to meet unexpected health care expenses. In the case we are talking about, an acute infection, the situation was likely to be resolved one way or another in weeks. I found on this site (http://www.drbrantigan.com/physician/costeffective.htm) that an artificial respirator rents for $286/day. I think the family could have managed to scrounge up $2860 to give the man a few more weeks without too much strain on the capital markets or their credit rating.
I think the empirical experience is that quality and quantity of care are generally lower under a socialized system — as is quality and quantity of output in other socialized industries. Ultimately, however, I think the issue is less one of efficiency than of morality. To deprive consumers of choice and providers of the opportunity to innovate and compete, and to concentrate decision-making in a few hands, is immoral and unjust. Human relationships should be voluntary and cooperative, not coerced and choiceless. They should be expressions of love.
People can find creative solutions to misfortune, but not if patients are pitted against each other for fixed resources. Resources are not in fact fixed, but can be created to meet new needs. The US system is deeply flawed, but at least it does not hinder such additional investment in care where the parties involved believe that is warranted.
Addressing some of these questions would take us off the original question about whether the doctors acted badly in this case because of the socialised structure of NZ healthcare and take us way beyond the scope of a series of blog comments.
In NZ private insurance payment or pure private healthcare is available. The average cost of even a hip replacement is just under 1/3rd the median NZ income so still beyond the means of most. In any case, establishing that the family could have paid for their father to receive the life-saving treatment they wished seems to undermine the argument. If they could have easily met the costs and it was a worthwhile investment, then why didn’t they? Given that the socialised system was not forcing them not to do so, the opportunity you demand is clearly present. The socialised system ought to be viewed simply as a choice: the state will pay for *this* healthcare treatment for you, take it or leave it.
Resources will always be fixed at some level of analysis, given the fundamental scarcity of resources (but I hardly need to tell you that, as an economist!). It is difficult to see from the above either how socialised provision “hinders additional investment” or what “creative solutions” could bypass the dilemma I set out above. By definition, additional resources will have to come either from the taxation or private wealth. Patients are equally “pitted against each other” in the market and socialised systems. There’s therefore no reason to suspect that this sort of behaviour is a result of the socialised system. Of course, you might believe that non-market systems retard care by being generally less efficient at mobilising resources, but that’s a much wider and distinct question.
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Oh and if I may address the ethical question briefly (since it is my area!), there’s no validity to the view that a non-market system involves less voluntary choice morally. Any distribution of resources or institutional arrangement enforces and precludes certain sets of choices, so the market cannot be said to be more free a priori. Also, as noted above, most socialised healthcare systems don’t outright ban private healthcare, so by your ‘pro-choice’ lights, a system where socialised healthcare makes private healthcare unafforable still allows it as a choice.
Best,
David
David, thanks for sharing your point of view. I don’t agree that a socialist system is as free as a market system, but I think we’ve probably exhausted the interest of our audience, so I’ll stop the debate. It’s been a pleasure though. Hope you find the blog useful.
Best, Paul
Good debate and one which many need to listen to as we seem to be moving more in the socialist direction. I come down on Paul’s side of the argument and think the poor ultimately are much better served in a free market system with “good” government regulation, ah therein lies the rub! I don’t understand why so many people are willing to cede so much control to government – had any dealings with the IRS, DMV or the PO lately??!! Healthcare is next!
One last thought: the more centralized any activity, whether it’s medical care, the public schools or anything else, the more of the budget goes towards administrative costs.
FYI to your older readers. In order to divide and conquer us more efficiently, the federal government/Medicare is requiring that patients “update” their records using a new form they’ve provided. On these forms is a space where we are to fill in our “race.”
I hope everyone will do as we did, write the word, human, in the appropriate box.
I am not sure that the conclusion has anything to do with the information in the article. I’ve experienced similar eye-rolling and hurdles from my “excellent” HMO. Socialized or for profit, if the motives aren’t to patient care, they aren’t to patient care.
After being on antibiotics over and over again on a reoccuring urinary tract infection, I ended up in hospital on a drip fighting for my life and kidneys (drinking lots of cranberry juice which had more sugar than cranberry concentrate didn’t help).
I was put through courses and courses of intravenous antibiotics. It cleared the infection but made my body resistant to the antibiotics used. Which scared me because if the infection comes back, I’m really screwed.
Then my wonderful doctor (J. Son) told me to try high dose cranberry capsules (sugar free). And it worked even better than all the antibiotics I’ve used. Since that time in hospital (almost 3 years ago) I’ve haven’t had any urinary infection at all! In the old days, the infection would come back every 3-6 months.
Sometimes vitamin supplements can help. It’s not going to work for everyone but it’s a definite must try if conventional medicine isn’t working. I’m so glad that my doctor recommended me to go on cranberry capsules. And she’s a conventional doctor too – not a naturopath!
Hi Chloe,
That’s a great story. Cranberries have a strong anti-biofilm action and are a great way to address persistent infections. I’m recommending them to simona today.
Many doctors are learning, that’s heartening!
Re. the statement that “Private care is banned in some countries, such as Canada” is apparently incorrect, at least in the case of Canada:
“…about 30% of Canadian health expenditures come from private sources….Private clinics are therefore permitted…”
However (and this confuses me, even as a single instance):
“In 2006, the Government of British Columbia threatened to shut down one private clinic because it was planning to start accepting private payments from patients.”
Of more direct significance, consider the statistics on the (minute) fraction of Canadians who seek medical care in the U.S.:
“In a Canadian National Population Health Survey of 17,276 Canadian residents, it was reported that only 0.5% sought medical care in the US in the previous year. Of these, less than a quarter had traveled to the U.S. expressly to get that care [e.g., they became ill while in the U.S.].”
There’s been a lot of propaganda in circulation on this topic. Beware!
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All quoted text from an apparently well-sourced Wikipedia article:
http://en.wikipedia.org/wiki/Health_care_in_Canada
I read about Primal Panacea by Allan Smith “Back from the Dead” offering a book plus a CD. I wanted to order but did not know where to go. Please advise.
How can I order the book about Primal Panacea and CD. I came upon the article when I saw a small insert on Max Health/News Friday 30/12/11. Please advise. M. Gay
Hi Maria,
I have no knowledge of that book. Try google.