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Is this fair?


StrayCat 17 19.1k 3 Canada
17 Dec 2005 8:51AM
U.K. curbs care for fat people
Local health authority near London says obese can't have hip or knee replacements

Ipswich doctor cites financial constraints, says tight budget better spent on slimmer patients
Dec. 17, 2005. 01:00 AM
CAROLINE MALLAN
SPECIAL TO THE STAR


LondonBritain's cherished universal health-care system has started denying treatment to fat people.

The first official move to refuse surgery happened last month when a local health authority in Ipswich, northeast of London, announced that obese people would not be given hip and knee replacements.

The move, which has been met with both praise and condemnation, comes amid a story all too familiar to Canadians hospitals facing cash shortages at a time when the population is both growing and aging.

Dr. Brian Keeble, head of public health for Ipswich, acknowledged that while the added risks of hip and knee surgery on obese patients were a factor in the move, so was the reality of limited resources.

"We cannot pretend that this work wasn't stimulated by pressing financial problems," Keeble said in a statement of the list of services being reduced to save money, with joint replacements being the most controversial.

Keeble added that given the increased failure rate of the procedures on overweight people, the limited amount of money available is better spent on slimmer patients.

The Ipswich group has set a body mass index of 30 the World Health Organization's definition of clinical obesity as the threshold at which surgery will be denied.

Currently, one in five men and one in four women in the U.K. are obese.

Michael Summers, chair of Britain's Patients Association, a charitable advocacy group, said the move amounts to discrimination.

"Obese or large people are as entitled to these surgeries as anyone else because they pay for the NHS (National Health Service) just like everyone else does," he said of the taxpayer-funded health-care system set up in 1948. Along with social assistance, it's a key part of Britain's welfare state.

"It is meant to be available to all; that was the entire premise. And one might argue the elderly in need of hips and knees are even more deserving because they have been paying for it even longer," Summers said of the system.

The surgery limit has also ignited debate on whether or not smokers suffering from lung ailments will be the next group to be denied treatment if they refuse to kick the habit, and whether this trend amounts to an attack on the poor, who have rates of both smoking and obesity much higher than middle- and upper-class Britons.

"It's a slippery slope and it's not what doctors are supposed to be doing with their time," Summers said of putting physicians in the role of judge.

But Tony Harrison, of the independent London think tank the King's Fund, said the move amounts to a good dose of common sense given the reality of limited resources.

"Rationing is a reality when funding is limited," Harrison said, adding responsible health-service providers have an obligation to taxpayers to get the most benefit out of the money they're given.

Harrison said the lower success rates for hip and knee replacements in obese patients cannot be ignored.

"Ability to benefit is a key criteria. It is a valid point. If chances of successful outcomes go down, you are wasting money."

The move is also tacitly supported by the government body charged with giving guidance to local health authorities on what they should fund.

While stating in a new report that income, class or age should not be factors in deciding treatment, the body, known as NICE (National Institute for Health and Clinical Excellence), leaves room for doctors to deny treatment based on cost.

"If, however, self-inflicted cause/causes of the condition influence the clinical or cost effectiveness of the use of an intervention, it may be appropriate to take this into account," it states.

In a scenario mirrored in Ontario in recent years, the Labour government of Prime Minister Tony Blair has poured money raised through a dedicated tax into the health system amid election promises to dramatically reduce wait times for a host of procedures.

While most agree that the system has improved dramatically as a result, local hospitals say they are being forced to make cuts in some areas in order to deliver on wait time promises in others.

In Canada, federal Health Minister Ujjal Dosanjh hailed standardized wait times agreed upon last week, which sets 26 weeks as the maximum time a person should be expected to wait for a new hip or knee.

There are currently no formal weight restrictions for the procedure in Canada, although it is not unusual for a doctor to advise a patient to lose some weight before the surgery in order to reduce the risks associated with the anaesthetics used and to speed recovery.

Dr. Peter Schuringa, president of the Ontario Orthopedics Association, said Canada should not take any lessons from the British attempt to ration health care based on a patient's lifestyle.

"Before we start telling people they cannot have a procedure because of how much they weigh, we've got to find more creative ways to improve the system and to finance more procedures," he said in a telephone interview from Kitchener.

Schuringa stressed that finding new ways to fund more procedures in Ontario needs to happen without punishing patients for being overweight.

"That's a very complicated issue, in part because people's ability to exercise and lose weight is often severely compromised if they are suffering from arthritic knee or hip joints," he said. But he added that patients awaiting joint-replacement surgery are often advised to lose weight before their operations

Most doctors also believe that replacement joints last longer if patients are of normal weight. Schuringa noted that may reduce the need for future surgery, saving patients pain and stress and the health-care system money.

In Britain, the debate over how much patients can reasonably expect of a taxpayer-funded health-care system has been raging in recent weeks over both the joint-replacement issue and the death of soccer legend George Best. An alcoholic, he received a liver transplant in 2002, but fell off the wagon after his surgery and his health declined, leading to rejection of the liver.
tepot 16 4.4k United Kingdom
17 Dec 2005 8:55AM
it's the same issue as "should we give livers and kidneys to alcoholics" or "should we give new lungs to smokers", in my opinion, NO we should not!
keithh 17 25.8k 33 Wallis And Futuna
17 Dec 2005 9:00AM
On the other hand should smokers fund the tax man and inevitably the NHS to the tune they do? Perhaps we should withdraw treatment to anyone who inadvertantly steps out into the path of a car...children included.
mdpontin 17 6.0k Scotland
17 Dec 2005 9:07AM
My opinion? As it says above - it's a slippery slope. I don't agree with this approach.

Doug
Boyd 17 11.2k 11 Wales
17 Dec 2005 9:10AM
Tepot I'm tired of your liberal attitude. We should round up booze drinkers and smokers and put them to work cleaning the streets and helping old age pensioners keep warm. If they refuse, we shoot them as examples to the other reprobates of our society.

Good grief, where's your compassion?
elikag 16 749
17 Dec 2005 9:12AM
OMG!!!......

Just O-h, m-y G-o-d!!!

I'm speechless.

Ilia Kagan.
elikag 16 749
17 Dec 2005 9:16AM

Quote:It's the same issue as "should we give livers and kidneys to alcoholics" or "should we give new lungs to smokers", in my opinion, NO we should not!


And while we're at it, we should round all HIV carriers on a remote island and nuke the b*stards!

Come-on, isn't there any sensetivity left???

Ilia Kagan.
Carabosse 18 41.6k 270 England
17 Dec 2005 9:17AM

Quote:Local health authority near London says obese can't have hip or knee replacements

Ipswich doctor cites financial constraints, says tight budget better spent on slimmer patients



Bet they've got shares in Weight Watchers! Wink

It has always been true though that some types of surgery have been refused to the (seriously) overweight.
mdpontin 17 6.0k Scotland
17 Dec 2005 9:21AM
I can accept a case for refusal of treatment on clinical grounds, but what's being described here is motivated by financial, not clinical criteria.

Doug
Ade_Osman 18 4.5k 36 England
17 Dec 2005 9:21AM
Well that's me stuffed then isn't it?......I'm fat and I'm a smoker, but am I bothered....Nope!
What concerns me more is the fact I'll have to sit here most of the night, looking at another thread that has the possibily on descending into total chaos and abuse!.....Grrrr
Dunno if my ticker can take it!

Ade
Boyd 17 11.2k 11 Wales
17 Dec 2005 9:23AM
BOO!

;o)
mdpontin 17 6.0k Scotland
17 Dec 2005 9:23AM

Quote:Dunno if my ticker can take it!


That'll be the next thing - denial of heart treatment to ePz moderators! Wink

Doug
Ade_Osman 18 4.5k 36 England
17 Dec 2005 9:24AM
I thought most members wanted that anyway :-((
twordley 15 360 England
17 Dec 2005 9:27AM
while we're at it, lets round up all the crackheads and junkies and nuke those, this will have the added effect of reducing crime so we can save even more money by cutting the police force.........
SuziBlue 18 16.2k 10 Scotland
17 Dec 2005 9:30AM
Interesting. I notice it's the Health Authority who are refusing treatment and not the hospital consultants. Health Authorities across the country are already limiting what surgery people can have and what they can't have - in my current field (plastics & reconstruction) funding is denied for a lot of procedures (many of which to be fair are simply cosmetic which accounts for 10% of plastic & reconstructive surgery and which isn't done on the NHS).

I can understand why you would want to delay elective surgery on an obese patient in order to help them reduce their weight - the anaesthetic risk is much higher and your recovery progress is likely to be difficult if you are severely overweight. And yes the strain on the skeletal and muscular systems is compromised by being overweight. Far better I think to help and encourage a reduction in weight and to help instil a healthier lifestyle in order to keep the weight off in the long term. Bear in mind that many people with a number of conditions contributing to their extra weight will not find it easy to lose weight and will be in pain from knee / hip problems for much longer especially if they can't take exercise. But to refuse altogether? If this is what is being suggested then I'd agree that this is discrimination.

I heard (ahem) of one consultant who had been treating a patient since infancy for congenital problems and whose plan, once her last operation had settled down, was to tidy things up and do the finishing touches and help her on to the road to a liveable existence. The Health Authority turned down the operation saying that it was cosmetic. Quite rightly he appealed on her behalf and finally after a lot of wrangling and their finally being convinced that this wasn't 'just' cosmetic surgery, she was granted funding for the procedure.

It's one of the reasons I'm moving out of this particular job because I just can't bear the fact that desperate and deserving people are being refused surgery because it's considered at a remote meeting to be cosmetic and therefore not fundable.

It's happening across the board. I won't go into the reasons why money is becoming more and more scarce for treating patients and yet available money is being wasted in hospital trusts on things which have nothing to do with real patient care. (There are quite a few of us NHS people on epz - some of us will differ in opinion!)

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