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Archive 2009

Euthanasia (Part 3) Jim McVeagh Dec 26

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Quality of Life Issues (voluntary euthanasia)

In end-of-life euthanasia, there is, at least, some objective standards which we can use to determine whether a patient is truly dead. When the discussion moves to quality of life, the criteria are far more subjective. What, exactly, determines quality of life? Productivity? Mobility? Social Activity? Dignity? Any and all of these could be involved and would be given different weight by each person. This lack of objectivity is why I particularly dislike the ubiquitous measurement called Quality Adjusted Life Years or QALYs. QALYs are, of course, usually well-defined for the purpose of research. Unfortunately many people using that research to determine social policy forget that the QALY is there only to assist in comparing outcomes. It has no objective basis in reality.

It is this very lack of objective standards that makes it so hard to debate a topic like euthanasia, and almost impossible to work out ethical protocols for the practice – a fact that should warn us that we may be moving into ethically dangerous ground.

For instance, voluntary euthanasia has often been brought forward as a reasonable moral and ethical choice. After all, proponents of voluntary euthanasia propose, there is no-one better able to determine the worth of their life than the person who wishes to die. Surely, if a person of sound mind proposes to kill themselves, do they not have a perfect right to do so? And therein lies the dilemma.

These are the DSM IV criteria for diagnosing a depressive episode:

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Sadly, I have yet to meet a person who wishes to kill themselves who does not meet these criteria. I have been involved with terminal care of patients for nearly three decades and every single one of them who were suicidal met all of the DSM IV criteria for depression. I can only come to the conclusion that a person who wishes to end their life is likely to be clinically depressed and in need of treatment rather than death. I am well aware that there will be many people who do not agree with this viewpoint. Many of them will be able to tell me anecdotes of people they know, often their nearest and dearest, who suffered horribly and should have been put out of their misery.

Sadly, these tales are all too common. However, they do not represent an argument for euthanasia, but an argument for the improvement of palliative care training for doctors, particularly for GPs. I am extremely happy to see that the Goodfellow Institute’s annual conference this year has palliative care as its main them, and I encourage all of my colleagues to attend. The MacDoctor will certainly be there.

My point here is that, with proper treatment of depression and any symptoms that may be precipitating depression  (such as pain or shortness of breath), the person who is wishing to end his/her life usually finds that this last bit of life is actually worth living. It is very rare in my experience that patients find the additional weeks or months of reasonably good life a burden.

Things become a little more tricky when we move from the terminally ill to the severely disabled. Again, I think that people with suicidal ideation need to be treated for depression with medication and counseling. As my experience here is far more scanty, I cannot say with surety that all people who want to end their lives in this situation are depressed. Having said that, the literature suggests that all people who are disabled move through a similar process to the terminally ill and would therefore be almost certainly depressed at some point. The danger with liberal euthanasia laws is that people with eminently treatable depression are allowed to die. This seems like nothing less than discrimination against the disabled (and the elderly who often find themselves in similar straits). Any attempt at legislation for euthanasia would have to ensure that this concern is address in a far more precise way than the current way the abortion laws are interpreted.

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Euthanasia (Part 2) Jim McVeagh Dec 24

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End of Life Issues

I have blogged about these issues before, using the sad case of Eluana Englaro as an example, here and here.

For most of us, death comes as a discrete event. The doctor pokes your corpse a bit, listens for a heartbeat and breathing, finds none and writes out your death certificate. You are then officially an ex-person.

For some, things are not so cut and dried. Large strokes, poor resuscitations and serious head injuries make up the vast majority of these poor people. People who are most probably dead, but bits of their body are still functioning. In Englaro’s case, Silvio Berlusconi, the Italian Prime Minister once famously and bizarrely observed that she could still bear children. I do hope they are not taking him too seriously at Copenhagen…

Regardless of the functionality of our reproductive organs or our kidneys or our liver, or even our hearts, the accepted neurological definition of death is the cessation of all higher brain function, even when stimulated. This can usually be determined by an EEG, but an MRI is more accurate. Usually this is sufficient when the patient is being ventilated. I think that ventilation is so obviously artificial, that relatives are far more accepting of the decision to switch it off. After all, they are not “switching off” their loved one, just a machine that is aerating a corpse.

The difficulty comes with a case like Englaro’s. Automaticity kicks in and the heart and lungs just keep going. If the unfortunate person is young, and feeding is maintained by nasogastric tube or stomach tube, then this half-life will persist, sometimes for decades. Even more complex are those who have some demonstrable, if inconsistent higher brain function, like Terry Schiavo, or have mostly normal brain function but are “locked in” – unable to initiate muscular action, including speech and eye movement.

In the second two cases, the discussion moves away from end-of-life to quality-of-life issues. These are not dead people, kept semi-alive by medical expertise. These are living, but severely disabled, people. There needs to be established brain death for this to be an end-of-life decision.

I am somewhat uncomfortable with the italian doctors decision to stop feeding Englaro. Although death by dehydration is not as uncomfortable as is sometimes made out, I have a problem with the assisted nature of this kind of death. It seems to me to be more ethical to continue feeding and nursing cares but to withdraw all medical interventions. After a month or two, she would have quietly succumbed to pneumonia or sepsis – a natural end for someone in a coma. Admittedly, it would be hard to question the ethics of even a lethal injection here, as Englaro had been technically dead for 17 years, but going against the Hippocratic oath so dramatically would not be a good thing.

While I think relatives have a perfect right to request that doctors do not intervene, the have no right to insist that we kill…

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Euthanasia (Part 1) Jim McVeagh Dec 23

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Euthanasia is a topic not unlike abortion, in that it generates a great deal of heat in a conversation and very little light. Like abortion, it is being practiced in New Zealand. Unlike abortion, there is no set of rules to guide it’s use and overt euthanasia often meets the business end of Law Enforcement – manslaughter and murder convictions being common sequelae. Unlike abortion, the issues involved are often far more complex and often involve decision processes from many different people at the same time. There are also multiple meanings for the word euthanasia which creates additional confusion in the debate.

Normally, I break up the term into three distinct groups:

  1. End of life issues. These are the debates about whether a patient is actually dead or not.
  2. Quality of life issues. These include the severely brain-damaged and the terminally ill who are in constant pain. Quality of life issues further sub-divide into voluntary – where the patient makes the choice to end their life – and involuntary – where the decision is made by an external agent such as a relative, friend or doctor.
  3. Quantity of life issues. Where treatment is withheld or active euthanasia is offered solely on the basis of a single criteria, without regard to quality of life. The commonest example here is ageism in medicine. Nasty things like eugenics come into this.

I will deal with each of these separately in other posts. For today, I want to look at another way that euthanasia is divided – into passive and active euthanasia. I am uncertain as to whether this is actually a real division. While there seems a clear distinction between, say, a doctor witholding futile treatment from a dying patient and the same doctor injecting an overdose of morphine into the same patient, the distinction becomes a bit fuzzier in the middle. If this same doctor witholds fluid from the same patient, is that passive or active euthanasia? Is the witholding of futile treatment euthanasia at all? After all, one is not killing the patient, simply not intervening in the dying process to extend life. Can that argument then apply to the witholding of food and fluids? I would say there is a difference between a futile medical intervention and the provision of the necessities of life and that difference is this: If I don’t give an antibiotic to a patient, then it is the infection that kills them; if I don’t give them food then I have killed them.

You might consider this reasoning sophistry, but I think it is a valid distinction. In the first, I am simply not intefering with the dying process. In the second, I am deliberately hastening the end. This would be my way of determining the difference between passive and active euthanasia or, as I prefer to term them – natural death and assisted death.

When we discuss euthanasia is further posts, I will be using the term to denote assisted death only.

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On the Turning Away Jim McVeagh Dec 15

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The news that Timaru Emergency Department is “turning away” patients (actually, sending them to their GPs) is exciting Labour’s health spokesperson, the barely noticeable Ruth Dyson.

Labour MP and health spokesperson Ruth Dyson believes essential frontline health services are being cut.

“You can’t get much more frontline than the emergency department. The Government promised there would be no cuts to frontline health services but I think Timaru is seeing the knife-edge of cuts to essential services.

Codswallop, Ms. Dyson. Had you known anything at all about emergency departments you would have know that they have always encouraged patients, who present to the emergency department with a problem that could be tackled by their GP, to go to the person most suitable – their GP. EDs have done this in a number of ways. Some have had a community campaign to discourage minor problems from attending the ED, but all have had some way of moving minor ailments out of the ED and back into general practice where they belong. The bigger EDs practice “attrition by waiting times” with nurses politely suggesting that a trip to the GP or the local A&M would be substantially faster than the four hour wait (on a good day) to see a harassed junior doctor. The smaller EDs, like Timaru, have lower waiting times in general and have to be more overt in their redirection. Note that nurses NEVER turn people away. They are redirected to their GP, with the nurse often making the appointment for them. They are also redirected only according to carefully worked out protocols. I should know, because I worked out one of the first sets of those protocols for Invercargill ED. And they were very, very conservative. In three years of use we had only one person return immediately from the GP (a man with appendicitis). He was inconvenienced rather than medically disadvantaged and the nurse had not followed the protocol properly.

Ms Dyson goes on:

Sure there will be some people that might be going to the emergency department that should be going somewhere else but they are going there because they need help. A lot of people can’t afford after-hours care.

Labour really should get themselves a new health spokesperson because this remark is just a confused, addled mess. Timaru has just negotiated the closure of their GP after hours service, so there is nowhere else except the ED. After hours is the only time the ED does not redirect patients. And if they need help during hours but are in the wrong place, surely it is better that they get help in the right place? Emergency departments are deplorably bad at managing chronic disease processes such as hypertension, sciatica and poorly-controlled diabetes (as opposed to diabetic emergencies). And if Ms. Dyson actually means that some people can’t afford a normal GP consultation, then that is an issue to be addressed in some way other than inundating expensive ED facilities with trivia.

Frankly, I find it fairly unbelievable that people say they have no money to pay their doctor but plenty to buy smokes and alcohol and play the ponies. But even should they be in the unfortunate position of truly not being able to afford the absurdly cheap medical care that New Zealand GPs provide, there is always WINZ, who are only too willing to provide. If all else fails, they only have to wait until the GPs have closed and then the ED has no choice but to see them. And yes, this is exactly what some do – even though they know they have a GP treatable condition. There; I feel better after my little rant.

This will not cure the enormous over-usage of emergency departments in New Zealand brought about by the abandonment of the part charge for ED visits. But it will at least remove some of the more egregious examples and allow the ED to be used for its original purpose – the provision of emergency treatment.

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The Pen is Mightier Than the Jab Jim McVeagh Dec 14

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Pharmac is almost universally hated by GPs. The incomprehensible funding decisions. The endless “special authorities” designed only to stop you prescribing a drug. The sudden unexpected loss of control of a patient’s disease because of a change to a cheaper brand. The dwindling choice of drugs which becomes horribly apparent when you try to prescribe drugs for overseas visitors (I have managed to find only four exact equivalents of the last 20 drugs from lists overseas patients have brought me). All of these things combine to make the average GP seriously homicidal about Pharmac decision makers.

None of this is very surprising. Pharmac simply does not have the same philosophy as mainstream medicine. Doctors are thinking “what can I prescribe to my patient that will give the best result?” Pharmac is thinking “What is the cheapest drug I can use for this condition?” Admittedly, doctors are notorious for being lead around by drug reps who are adept at persuading us that their drug is the best, with the lowest side effects and the strongest action. Pharmac is not so easily persuaded, needing hard evidence to convince them.

That last sentence is not quite true. Pharmac seem extremely easy to persuade that a cheaper drug is the exact equivalent of a more expensive one or, worse still, that a cheaper drug does “as good a job” as the more expensive one. Part of the reason for this is the division between itself and Medsafe – the body that approves drugs. Medsafe is only concerned with the safety of drugs, not their bio-equivalence (whether the drug is absorbed in the same way). Consequently, Medsafe will declare a drug “the same” without ever testing whether it is absorbed at all, let alone absorbed at the same rate as another brand. Pharmac will then buy the brand because it is cheaper, without testing its efficacy. Small wonder that sometimes the new drug is simply not bio-equivalent. Small wonder that Mrs. B’s blood pressure suddenly goes through the roof after ten years of stable readings.

Perhaps the most overtly ridiculous example of Pharmac’s idea of equivalence is their steadfast refusal to fund the EpiPen. The Herald today carries two articles – one on a little boy called Finn who carries an EpiPen with him everywhere and one on the renewed call for funding for EpiPens following the death of an 8-year-old boy from an acute allergic reaction to cashew nuts. It is highly likely that an EpiPen could have saved his life. Pharmac believes that providing a patient with a syringe, needle and ampoule of adrenaline is the equivalent of an EpiPen – an auto-injection device that contains the exact amount of adrenaline needed. Adrenaline injected at the earliest opportunity in anaphylaxis (collapse from allergy) is a life-saving action. Pharmac thinks that:

  1. carrying around a syringe, needle and glass vial, breaking the vial and drawing up the required dose; then plunging the needle into your leg and pressing the plunger; is the equivalent of
  2. carrying around a neat pen, taking the cap off, putting it against your leg and pushing the button.

You might think this madness is purely temporary while Pharmac is struggling a little for funds, but you would be wrong. Pharmac have stuck to this position since 2005. Here is the New Zealand Medical Journal article that pleads for full funding of the EpiPen. Here is the reply from Pharmac in the NZMJ. For those of you who like summaries, the gist of Pharmac’s argument goes ” People don’t know how to use the EpiPen properly and don’t carry it with them – so we will only fund an “equivalent” that is more difficult to use and harder to carry around”.

Yeah. I can’t follow their logic either.

Apparently, it does not occur to Pharmac that the simple solution to the poor use statistics of the EpiPen (which is still 10 times better than the syringe/vial combo) is to ensure that people are trained properly in its use.

  • Provide it only to GP practices.
  • Fund a nurse consultation to ensure that holders of the EpiPen and parents can use it properly (this does not add a lot to the overall cost of the EpiPen).
  • Have a recall system in place so that people come in and replace their Epipen at no charge – and get another “refresher” from the practice nurse.
  • Add training in the use of the EpiPen to all the first aid courses.

I am willing to bet within a couple of years at least 50% of all episodes of anaphylaxis will get treated with an EpiPen in the community. And we won’t have 8-year-old boys dying from an eminently treatable condition because Pharmac is too busy funding chocolate flavour condoms.

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First Aid Jim McVeagh Dec 13

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A recent high quality study in the Journal of the American Medical Association shows that the use of intravenous drugs in out-of-hospital resuscitation does not lead to better survival rates – just more admissions to hospital. This is a significant finding for two reasons. First, it emphasises that good quality CPR and early access to a defibrillator are the only things that make any difference to cardiac arrest survival in the community. And the evidence is that good quality CPR, administered as soon as possible, is more effective than standing with your hands in your pockets and waiting for the guys with the heart rebooter. You can’t do any serious damage doing CPR, even if you have never done it in your life. Middle of the chest; press hard; press fast. Simple as that. Oh, and keep your elbows straight and use your weight, otherwise you will get tired real fast.

If you ever find yourself in that very frightening situation, have a go. Neither of you have anything to lose.

The other thing about this study is that it tells us that all the fancy drugs we give in community resuscitation serve only to waste hospital resources, not save lives. This result needs to be confirmed by at least one more study as soon as possible. If it is verified by another study, then all resuscitation drugs should be abandoned in the out-of-hospital situation (I can hear the paramedics complaining already!). The extra 15% of people who survive to hospital admission are consuming expensive hospital ICU resources to no avail. Frankly, if I’m not going to survive anyway, I would much prefer a quick, drop-in-the-street death to a lingering week in ICU having my near-corpse poked and prodded. I suspect most of us feel that way.

As an ED trained doctor, I am enthusiastic about doing your absolute best in a resuscitation situation. But pointless interventions are not only pointless, they are cruel.

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Demand Driven Jim McVeagh Dec 12

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The Abortion Supervisory Committee are pushing for more use of the abortifacient, RU486. They say that it is being used in only 6% of abortions while the “standard” overseas is 20 – 30%.

Now I don’t have a problem with RU486 being used instead of a surgical termination of pregnancy (leaving aside the whole abortion issue and why the ToP is being done). It is certainly safer than a surgical procedure and, if done before 9 weeks, just as effective (if effective is the right word in this context). However, I do wonder if the ASCs interest in RU486 use is not being driven by the desire of the Abortion Law Reform group to institute true “abortion on demand” in New Zealand, without the attendant debate that should go with it. This quote from Abortion Law Reform Association president, Dame Margaret Sparrow, is quite revealing:

Sparrow wanted GPs to be able to prescribe the abortion pill, as they could in other countries.

These “other countries” all have abortion on demand. There is, in fact, no other way effectively to give GPs prescription rights to RU486 except by allowing abortion on demand. There is no way a GP is qualified to make the decision as to whether continuing the pregnancy is a serious mental health risk (the “criterion” for most abortion approvals). Of course, it could be argued that the current abortion clinics are not exactly applying strict professional judgement in most cases, so why not let the GPs make the same inadequate judgement call? But that is a ridiculous argument akin to “it’s broken already, so why don’t we break it some more?” I’m traveling at 120kph in this 100 zone; why don’t I travel at 160?

Sparrow is also asserting that the reason why the change from surgical to medical procedures is taking so long is because:

it [medical abortion] required the approval of two certified consultants and two trips to the clinic for the patient.

This clearly cannot be the reason why there has not been a shift to medical abortions. Surgical abortions also require two certified consultants and two trips to the clinic. While the procedure for medical abortions could be streamlined a little, the reason for the lack of use of RU486 is the lack of experience with it in this country, not how hard it is to get hold of.

It is for this reason that I am dubious about Family planning clinics holding stocks of RU486. It is not as if this is like the Morning After Pill, where timing is critical. I see no need for it to be available from Family Planning Clinics at all. I have no difficulty with the second consultant dispensing it from his/her own stock but family planning clinic stock can only be a prelude to demanding GP-initiated prescription rights again.

Consider these facts at the end of the article:

* 53 per cent of women who had abortions last year were not using contraception.

So the real problem here is not the ease of abortion, but the lack of contraception – contraception that is freely available and costs little or nothing except the will to use it. If family planning were actually doing their job of properly promoting contraception, instead of rooting for abortion (sorry – unfortunate turn of phrase there!) then the need for “one stop shop” abortions would be greatly diminished.

* 98.7 per cent of abortions were carried out on mental health grounds.

Which tells us that the vast majority of abortions are procured under extremely dubious circumstances. All these proposals are doing is making the grounds even shakier.

* 196 certifying consultants were paid nearly $5 million in fees for abortions last year.

Which is an average of $25,500 per consultant. That is not an insignificant sum, especially when you consider that many of these consultants see very few “clients”, so that some doctors are earning very much more than this. The question that always crosses my mind is, when one makes a significant portion of one’s living approving abortions, how much pressure is one under to approve the abortion, regardless of merit or criteria? And how much interest does one take in promoting contraception, knowing that it will certainly reduce your income? (and yes, I am aware that that same motivation could be ascribed to all of us doctors – and probably with some justification)

Quite frankly, I think that the last thing New Zealand needs at the moment is for abortion to be made easier. Safer – most certainly; easier – no. Abortion is a decision that needs to be considered carefully and fully. It should not be a quick-fix you can obtain on the spur of the moment from your corner dairy (7-11 for my US readers).

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Correct Diagnosis Jim McVeagh Dec 12

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It is always a tragedy when a young life is lost, but it is especially heart-wrenching when a young man dies from something you would not normally expect such a person to die from. Such is the case of Dean Carroll, the 22 year old who presented to an emergency department and left with a script for pain-killers, only to die from a spinal abscess the next day.

Unfortunately, his death was inevitable, according to the testimony of the three expert witnesses at the inquest. I agree with them. Dean not only had a rare condition, he was unusually young for an epidural abscess and had no unusual signs or symptoms at the time that might have warned his doctor. Coupled with a late night presentation to a busy ED and his demise was a forgone conclusion. Even if he had had suspicious symptoms, it is highly unlikely he would have had the MRI that would have made the diagnosis.

This is why the headline is inaccurate – “Correct diagnosis may not have altered outcome” is not precisely true. A correct diagnosis would have saved his life. The point the experts are making is that a correct diagnosis in this case is essentially impossible. Impossible for the young doctor who had the misfortune to be the one to examine Mr Carroll and impossible also for the senior doctor on that night. Literally, the only thing that would have produced a correct diagnosis and saved Mr. Carroll’s life, would be if we had a protocol to do an MRI on everyone who presents to the ED with back pain. This is simply not possible.

The dilemma of high tech medicine is that the pool of resources available to us is always finite. This is true even in the US, where they spend five times as much on health care as we do. Consequently, regardless of the system of care, doctors wind up making sub-optimal decisions, not because they are bad doctors, but because we simply can’t justify the expense. Mr Carroll might have been saved – but only at the expense of hundreds, if not thousands, of other lives elsewhere in the health system.

Consequently, and much as I respect Mike Ardagh, I cannot agree with his statement that “Dean Carroll’s care “was not good enough””. While there is always room for improvement in any situation, the reality was that Dean Carroll would certainly have died, even if the ED was quiet and the senior doctor had seen him and admitted him. As the outcome would have been unchanged, I submit that, by definition, the care must have been adequate. One can only consider care inadequate when the outcome could have been different. In the real, constrained world in which we live, Mr Carroll’s care was perfectly adequate – it was simply not enough to save him.

To suggest otherwise is to invoke the “rule of rescue”. Not a good idea in medicine.

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Spam Journalism #65 Jim McVeagh Dec 11

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Spam Journalism: The spurious use of sensational headlines to add spice to an otherwise pointless article.

There is always plenty of spam to go around in health reporting. Journalists just love to sensationalise anything to do with medicine, preferably putting it in the worst light possible:

Seeing red over high health costs

Cataract surgery for Christchurch woman Glennis Lane would have taken a “huge chunk” of a small retirement fund.

When her GP told her this year that she needed another operation, the $4000 cost was daunting.

Lane said she was angry that she could not use the public system as she and family members had worked in public hospitals. “My husband was pretty angry too, but it’s just life,” she said.

You might be forgiven if you thought the headline indicated that this article was going to be something about the Health budget or ACC costs. You would also be wrong. This article is about the costs of private cataract surgery.

Surprise, surprise. Private surgery is expensive. Who would have thought it?

When Mrs. Lane says that “she was angry that she could not use the public system”, what she really meant is that she was angry that it was going to take such a long time to get her surgery in the public health system. There is no question that she could have got her cataract surgery eventually, but she would have had to wait until she was nearly blind (in that eye) before she “qualified”. This is the main way the system keeps its waiting times looking reasonable – by denying service until you have enough “points” – like some sort of bizarre Fly Buys scheme (Die Buys?). The real wait for Mrs. Lane is not 6 weeks or even 6 months. It is more like 6 years.

So there is an actual story there. One that would have been worthwhile reporting. But the journalist has opted for a bit of sensationalist spam instead.

How sad.

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Death on Ice Jim McVeagh Dec 10

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Remember the oft repeated picture of the two polar bears forlornly stuck on an ice floe in the middle of nowhere? Turns out that the photographer who took the picture was more interested in the interesting shape of the ice floe and the picture was taken within a couple of hundred meters of the arctic shore line. The bears were in no danger at all.

Enter Polar bear panic picture Mark II…

Polar Bear

Now this is not as cute are the previous picture. And the headlines…

Polar bears’ fate worsens

New pictures show that polar bears are beginning to cannibalise each other as global warming destroys hunting grounds.

The images, taken in Hudson Bay, Canada, around 321km north of Churchill, Manitoba, show a male polar bear carrying the bloodied head of a polar bear cub it has killed for food.

Polar bears usually subsist on seals, which they hunt from a platform of sea ice.

But the melting of sea ice as a result of rising global temperatures has made it more difficult for polar bears to hunt seals at sea, confining the bears to land.

This has led to malnourishment and starvation as polar bears are unable to build sufficient fat reserves for winter.

Drowning is also more common as bears are forced to swim further out to sea to find food.

That is the entire Herald article but there are many similar ones floating round the international media. The Herald does not carry the picture – I had to go and find it

I was curious when I saw that the Herald had not included a nice, gory picture – normally the staple of newspapers. When I found it, I understood why.

Does this look like a starving bear to you? Yeah, me neither. Makes me want to ask questions like:

QUESTION: Is it normal behaviour for adult bears to kill and eat their young? (I know male lions do this when taking over a pride – it brings the females into heat immediately)

ANSWER: Yes, This is normal behaviour according to the Inuit and the experts. There is no evidence that this is on the increase, only speculation.

QUESTION: Is there any evidence that polar bears are finding it harder to hunt?

ANSWER: No, but they may hunt less at sea and substitute land-based food sources. For instance polar bears have been known to hunt bird eggs. They are perfectly happy to eat carrion. Clearly, they are very adaptable creatures. Even if sea ice completely disappears, the chances are that polar bears will survive. Although they may come into more contact with humans and that is far more likely to render them extinct!

QUESTION: Is there any evidence that polar bears are malnourished?

ANSWER: Well they did find a Mother and her cub starved to death in 2007. A mother. And a cub. Inuits say that the polar bear population in Alaska has grown immensely, which may explain any signs of starvation in the local alaskan population.  I did manage to locate one piece of research that thought the bears in their local study area were “nutritionally stressed” (though they did not report cannibalism!) – but they were unable to say whether this was due to poor seal numbers or deficient sea ice. (Stirling, I, Richardson, E. , Thiemann, G.W. , Derocher, A.E  Unusual predation attempts of polar bears on ringed seals in the Southern Beaufort Sea: Possible significance of changing spring ice conditions Arctic 61: 1; 2008; 14-22).

QUESTION: Is there any evidence that polar bears are drowning?

ANSWER: Again, four polar bears were found drowned in 2004 but nil since – except for a couple of bears that were tranquillized and drowned, proving once again that humans are considerably better at direct means of extinction than all this mucking about with carbon dioxide.

It does appear that, once again, the current meme of dying polar bears needs no facts to bolster it, just hysterical assertions.

I welcome actual evidence to the contrary. I have searched the Auckland University databases with no luck and I find the lack of real evidence appalling, considering the emotive mileage being made out of it by environmentalists.

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