Dr. Andy

Reflections on medicine and biology among other things

Friday, December 16, 2005

Socialized medicine and free speech

A Norwegian doctor is the subject of an ethics complaint for publically objecting to rationing of medical care. The doctor, Sverre Kjeldsen, disagreed witht the government dictating that cheap diuretics had to be used as the first line agents in patients with hypertension.
The news report that provoked the case was a front page news story in a Norwegian national newspaper, Dagbladet, published on 11 February 2004. In the report Sverre Kjeldsen, professor of cardiology at the University of Oslo, was quoted as saying that “the authorities urge us to kill the patients with pure rat poison,” in an article that suggested that high doses of cheap thiazides worked in a similar way to rat poison.

The news story came after a change in drug regulations made by the Norwegian parliament in 2004, making low dosage thiazides the treatment of first choice for the management of hypertension. Doctors have to prescribe them unless they can give an explicit medical reason for making another choice
The journalist got the story badly wrong as thiazides do not work like rat poison; instead, a common medication to prevent clots (aka "thin the blood") called warfarin (or coumadin) is also used as a rat poison (more here).

I don't have an informed opinion on what medicine should be used first for hypertension, but I find it troubling that critics of government dictated health care decisions face "ethics" charges for speaking out.


At 8:01 PM, Anonymous Anonymous said...

I supose it is the mild irritation of seeing, yet again, the expression "socialised medicine" used to suggest that such systems are the ONLY ones that ration medicine that makes me want to comment.

No country in the world can afford to provide the "ulimate" in health care to all its citizens. It can be rationed by government policy, by waiting lists, or by front end cost as in the USA.

Compare the general medical care given in downtown Detroit or the South Side of Chicago to what is routinely available in Beverly Hills or the Hamptons.

The problems of insatiable demand and finite resources are universal; the way we all deal with them is different, but no one country or system has a monopoly of wisedom. If it did, we would all be copying it. But we can learn from each other.
Low dose thiazides may not be perfect, but it is a reasonable starting point, and no physician in Norway is compelled to use them, he/she merely has to justify why she is not using them.

I would like to see every physician in the USA give written justification for his/her use of ciprofloxacin which in the USA is currently grossly and inappropriately overprescribed for relatively trivial conditions.


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