Wednesday, August 11, 2010

MS's controversial "liberation procedure" provides a lesson in obesity bias.


I opened up the paper yesterday morning to see dueling columns discussing the controversial and currently highly experimental liberation procedure for multiple sclerosis.

The columns came one day after a front page City section story detailing one individual's anecdotally positive experiences having paid for the procedure himself overseas.

The first column, penned by Paula Simons, calls on provincial health plans to only fund proven therapies.

The second, penned by a gentleman named Bart Bakker who himself suffers with MS, calls on the provinces to follow Saskatchewan's lead in that according to Premiere Brad Wall, they plan on funding trials of the procedure.

The trials are likely to be exceedingly expensive and while as an evidence based clinician I welcome them, given the research that's already been published on the procedure, I wonder whether that'll be money well spent or whether Saskatchewan will be just funding hope. I also wonder whether there are proven treatments for other conditions that Saskatchewan's doing a poor job of funding where that money might be better spent.

The reason Saskatchewan's premiere Brad Wall gave for the funding?

"I think it's incumbent on us to explore what hope exists around this and to answer as many questions as we can"
So what does this have to do with obesity?

Well far from an experimental procedure, obesity has a proven surgical treatment. Studies have demonstrated that gastric bypass surgery increases longevity and decreases morbidity, curing many chronic conditions in the process, while markedly improving quality of life.

Saskatchewan's gastric bypass surgery program?

There's a single bariatric assessment centre in Saskatchewan and it's located in Regina. That's a single centre for a province that's 588,276 square kilometres (277,100 square miles), an area slightly larger than the great State of Texas. That's one single, solitary assessment centre for a population of just over a million people, roughly 30,000 of whom would meet the surgical criteria for bariatric surgery.

Oh, and for icing on the proverbial cake, Saskatchewan boasts Canada's second highest provincial rate of obesity.

I called Saskatchewan's lone bariatric surgical centre yesterday. I was told that if I sent in a referral that, "it would be at least 2 years" before my patient would get seen and then they'd need to complete a 6 month pre-surgical program which would involve a minimum of 6 visits. I was also told that the province won't pay for any travel expenses incurred for non Regina residents trying to get surgery and that once the pre-surgical program was completed there'd be an additional wait of many months before the surgery because currently they're only performing one a week.

Putting that math to play, at one surgery a week, if even 10% of Saskatchewan's surgically eligible folks wanted to consider surgery it would take the province roughly 58 years to meet the demand. Good news though, the very kind person I spoke with on the phone mentioned they're hoping to soon be able to do 2 a week so that'll bring the wait down to 29 years.

So to recap. On the one hand, a procedure that's experimental at best has the Premiere of Saskatchewan crowing about hope and wanting to spend money funding its research. On the other hand his province has a woefully underfunded bariatric surgery program for a proven procedure that not only increases both quality and quantity of life but also simultaneously decreases health care costs and in the long run would save the province money.

So has Brad Wall ever said anything about bariatric surgery?

If he has, I certainly couldn't any find mention of it.

So why not?

As far as the world goes, obesity is still a disease of willpower. Premieres and the public simply want to blame individuals for their weight, whereas MS is not something that a person is generally blamed for contracting.

Though of course in our socialized medical system, even if it were a disease of willpower, given that bariatric surgery has been proven to save health care dollars, Premieres should be busting down doors trying to get the job done.

So have people really changed over the course of this past 30 years? Is there really an epidemic lack of willpower?

I guess that's what's causing early puberty in increasingly obese 7 year old girls. These 7 year olds nowadays. No willpower.

Bookmark and Share

10 comments:

  1. Wait, what? You're saying that obese individuals should get bariatric surgery, despite the countless records of failures, complications, and individuals finding ways to keep their calorie intake up (vs. starving themselves through decreased stomach capacity)?

    How about, instead of supporting the extension of fix-it surgeries, you consider the prevention method? Educate people about the problems with sugar- and grain-based carbohydrates. Stop sending the low-fat message. Get people off "healthy whole grains" since they spike blood sugar higher than the average chocolate bar.

    Don't give obese people the pity party and shuffle them off to surgery. Nip the problem in the bud before those kids reach their 7th birthday.

    Bariatric surgery is not a cure. I'm glad access is limited - maybe it will force governments to push for food education; perhaps they'll even follow in the footsteps of Sweden. THAT will save tax-payer dollars!

    ReplyDelete
  2. Amazing post Dr. Freedhoff. Did you cc it to Premier Wall? I wonder what he would think of your insight?

    I bet Dr. Sharma has a smile on his face today as well.

    As a RD who sees countless people struggle with diabetes/obesity/hypertension/hypercholesterolemia and simply cannot change themselves enough to meet health goals, I applaud all practitioners who are warming up to the idea that becoming healthy isn't all about willpower. Come on people, if it was that easy, we'd all be thin and rich.

    ReplyDelete
  3. Thank you Dr. Freedoff!!
    Jezwyn, I don't think you should judge someone until you have walked a mile in their shoes. Believe me, I know ALL of the research, information and education of healthy eating. I tried for 20 YEARS to lose weight and I finally asked for a consult for bariatric surgery and had surgery last Feb. My procedure was vertical sleeve gastrectomy and to date I am down 66 lbs. I have roughly 90 lbs to go. I think you best look at the success stories of bariatric surgery rather than the failures before you go judging the treatment.

    ReplyDelete
  4. Gastric surgery is all the rage in California with no rules or barriers. Many suffer needlessly and the results are often disappointing. Individual responsibility and accountability along with education and social support are not a part of the surgery. I spoke at USC in the Bariatric ward three months ago and they were serving pudding, juice, cured meats and tapioca.

    ReplyDelete
  5. Anonymous10:55 am

    "As far as the world goes, obesity is still a disease of willpower."

    Many people who are unfortunately enough to wake up to extra weight merely from something going wrong inside them know that, at a certain point, they will feel so out of control and so defeated, they will just go out and eat the doughnut. And they also know that that will be the day skinny people will see them and say some very harsh, judgmental things to them or behind their backs. It hurts.

    Obesity is evil, and not just for the skinny people to look at. *eye rolling*

    @Stacerella

    ReplyDelete
  6. Anonymous3:26 pm

    Great post, especially the closing sentence!

    ReplyDelete
  7. In Canada, too much science is micromanaged by politicians and career bureaucrats. It's a bit of an unseen problem that is getting worse.

    Ideally, in science, you'd want politicians to decide the level of funding, and then let a peer-reviewed process dole out the money to researchers. A process like that should decide what medical trials to fund. Preferably there would be inter-provicial and federal cooperation. Medical studies ought to fall into those categories. Canada already has granting agencies that should handle these things (but they've also become more politicized and bureaucratized).

    Only for the largest ticket science projects should politicians be very directly involved at the early stages. And what to study ought not to originate with politicians: it would be better if they okayed proposals. NOTHING exists in Canada to advise government on Large Science (to this country's detriment). I don't think clinical studies qualify as large science.

    Wall's decision is playing politics trying to gain sympathy with the public by cosying up to MS patients. MS patients do deserve sympathy, no doubt. But Canada has finite health dollars, and needs to be sure they are spent properly. Other pressure groups will now lobby directly for funding. Peer review will be irrelevant, and selling your science to the general public will become a priority. Politicians going above peer reviewed granting agencies will assure nothing but bad medicine and bad science.

    ReplyDelete
  8. Anonymous8:48 pm

    Excellent post. I don't think Dr. Freedhoff is saying that prevention efforts should not be supported. But, when we have 60% of the population being overweight and obese (26% obese), prevention is no longer the main point of action. We need to support obesity management programs (evidence-based) and at the same time increase public health efforts to change the environments in order to prevent the remaining 40% of the population from becoming overweight and obese.


    I am all for preventing diseases but when the disease is already an epidemic, how can you not support treatment approached?

    We need to change our society's attitudes about obesity. Patient responsibility is key but we cannot keep discriminating against 60% of our population. How would people react if we denied access to chemotherapy to patients who have smoked most of their lives?

    ReplyDelete
  9. As a 49-year-old Saskatchewan resident who was faced with the daunting task of losing 140 pounds (BMI 45) and who didn't want to die waiting 29 years to get bariatric surgery, I chose "self-pay" and had a Vertical Sleeve Gastrectomy in March 2010 (I'm now down 58 pounds).

    The benefits are too numerous to mention here but the number one benefit is an unbelievably high increase in the quality of my life.

    I have an incredible (private) support group and I, along with the 100+ people from the support group who also chose self-pay, have said many times that we would make the exact same decision in a micro-second.

    Yes I have one regret (and only one): that I didn't do it years ago.

    ReplyDelete
    Replies
    1. Anonymous12:57 pm

      self pay? In Canada?

      Delete