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.