ALAN CASSELS -- MEME'S THE WORD@Arts & Opinion

health scare tactics
MEME'S THE WORD

by
ALAN CASSELS

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Alan Cassels is a pharmaceutical policy researcher at the University of Victoria and frequent commentator on prescription drug issues. He is author of The ABCs of Disease Mongering: An Epidemic in 26 Letters (Emdash, 2007). For more, visit his website: www.alancassels.com

Then take some comfort in knowing that your anxiety may not be due to your genes, but your memes. What’s a meme, you say? British scientist Richard Dawkins defined it as a unit of cultural transmission, analogous to a gene. Genes transmit biological information, whereas memes are ideas that transmit cultural information. Malcolm Gladwell said that a meme “behaves like a virus that moves through a population, taking hold in each person it infects.” Just as some people blame their ill health on bad genes, it’s time we blame the poor health of some of our public institutions on bad memes.

Memes transmit current notions and ideas about health care and they can be highly communicable, spread pandemic-like, and infect quickly and broadly. They can also be extremely virulent and hard to subdue, even when patently false. They can be destructive by raising unnecessary panic and fear, and fuel irresponsible political responses. “The aging of the population will destroy public health care” is a pernicious meme invoked by demographers, politicians, economic pundits, media columnists and others. Wielding stark demographics, they say baby boomers will soon launch a terrifying tsunami-like assault on our public health care system. Call it demographic demagoguery, but the implications are clear: prepare for disaster.

But before you go scurrying for higher ground, you’ll want to know, is the “greying tsunami” meme even true? The answer in a nutshell: not really. Statistically, health care spending has risen quite a lot in the last few decades, and the key culprits are general population growth (there are more of us), inflation (things cost more as time goes by), aging (as we get older we use more medical services) and utilization (we are all using more health care stuff, including drugs, doctor visits, screening and diagnostic tests and hospitals).

The aging population might be causing health care costs to rise, but by how much? Independent researchers and economists conclude that about 1% of the annual increase in health care spending is due to aging. Which is to say if overall health spending grows at an annual rate of 5%, about one-fifth of that is because more of us are getting old. In fact, numerous studies indicate that the aging of the population is too gradual to rank as a major cost driver in health care, that it’s more a glacier than a tsunami. Others say the current generation of seniors is extraordinarily healthy, so it’s difficult to predict their health burden in the future. A BC study found that over the past 30 years population growth accounted for 7% of growth in health care spending, aging 14%, inflation 19% and increased utilization 59%.

While the aging population is contributing to increases in health care spending, increased utilization (more drugs, doctor visits, surgeries and diagnostic/screening tests) contributed about four times as much. Maybe the greying tsunami should be rewritten as the tsunami of overmedicalization. Do these other contributors get reflected in the media’s often-repeated memes around aging and health care sustainability?

Colleague Jaclyn Morrison and I conducted a media database study to get some answers. We searched two large media databases containing all of Canada’s major daily newspapers for the phrase “the aging of the population” and found 1,364 stories (over the last two decades). We eliminated duplicate articles and those that focused on pensions, the labour force, investments and general demographic issues etc. Isolating only those addressing the aging of the population and the sustainability of health care left 132 articles, which became our ’data.’ Of this narrowed body of literature we asked: Did the article provide an alternative hypothesis for the rising costs of health care? In other words, did the article suggest other reasons besides aging for the growth in health care spending?

About 57% (75/132) of the articles offered alternative hypotheses to the greying tsunami meme and three-quarters of those articles focused on utilization: more drugs, physicians, surgery, technology and specialized care all took some of the blame for increased health care costs. So not all media commentators are purveyors of the greying tsunami argument and at least some serious attempts were made to debunk the meme. But almost half (44%) the coverage reinforced this meme by failing to offer alternative explanations for the growth in health care costs. Although demographics tell us that a cohort of people born between 1947 and 1966 in Canada constituted a baby boom, Dr. Réjean Hébert, Scientific Director at the Canadian Institute of Health Research’s Institute of Aging, is encouraging: “Baby boomers, including myself, can take comfort in the realization that there will be no health care apocalypse on the horizon.” A 2001 Saskatchewan-based public inquiry into medicare headed by Commissioner Kenneth Fyke said of the greying tsunami: “That gloomy prediction persists in the face of increasingly persuasive evidence that aging has never been and is not likely to be the ruin of the system.”

Clearly there were many attempts to scare people into thinking the sky is falling with such terms as “the looming elderquake” and the “nemesis of medicare.” While we’ve got more analysis to do, we see that politicians and right-wing commentators are among the biggest promoters of the meme. BC’s Health Minister Colin Hansen, for example, used the term “the aging tsunami” in the context of the future of health care spending in BC, and Liberal MP Keith Martin refers to the “demographic time bomb” and concludes that we will inevitably need two-tier health care. In a study of health care costs, UBC’s Bob Evans puts much of the blame on utilization. He points to more doctor visits, more complicated medical procedures and more expensive drugs used by everyone, not just seniors.

Some increased utilization might be appropriate, yet we know a lot is wasted. It is intolerable that we continue to waste public money on unnecessary, useless or harmful procedures/products while effective alternative therapies remain unfunded. Consider these statistics. In 1994, Alberta Health paid for 2,500 bone density tests, which grew to 13,000 by 1996 – after the launch of a new osteoporosis drug – and to 90,000 in 2000. All this for a dubious procedure that has not been proven to prevent osteoporotic fractures.

In 2009, there were 266 MRI and 465 CT scanners in Canada, representing an increase of 70% and 36% respectively since 2004. More scanners means more scans, not all of which are being done appropriately. Between 1982 and 1992, the proportion of seniors in Quebec grew from 8.9% to 11.2%, while their costs of physician services more than doubled. Why? Ever wonder why your doctor doesn’t refill a routine prescription over the phone any more?

Of 23 countries in the OECD, Canada has the second-highest per capita drug spending and our drug bill grows by $2 billion per year. Ever wonder what value we’re getting for that extra money every year? The greying tsunami meme is clearly alive and well, but to blame the increase in health care costs solely on old people is unjustified. All of us – the young, the middle-aged and the old – are all using health care services more and more. So now what?

Not only do we need to start understanding why our use of health care services is growing so rapidly, but we also need to counter misleading memes that are promoted by the media. Politicians, media spokespeople and columnists who continue to lay sole blame on the elderly deserve a public spanking. Since bad memes can affect the public’s perceptions of future health policy options and stifle true debate, we need an unbiased assessment of the facts. A decade ago, former BC premier Dave Barrett wrote in theToronto Star, “We wish to refute the Chicken Little doomsday scenarios that publicly financed health expenditures are going to bankrupt provinces, if not now, then in the future.” He added that there “appears to be a well-orchestrated war on Canada’s public health care system by a number of provincial governments, representatives of national and provincial physician organizations, and right-wing research institutes such as the Fraser Institute and the C.D. Howe Institute.” Our analysis of the Canadian media indicates that there is a war of sorts going on: a war of memes. There is much to do to improve the public health care system in Canada, so why not immunize ourselves from bad memes so we can debate things with a correct assessment of the facts?