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Rationing of Medical Resources or Medical Discrimination Against the Sick: 

Medical attitudes to the chronically ill

1.     Future Trends in Health Care and Health Expenditure

Although many would say it is the era of science, it is also unquestionably the era of chronic diseases (1,2,3,4,5: see also Health Trends, When Nutrition Became Quackery, Science or Progress?). The lucrative treatment of chronic disease represents the current “boom” area for technological and pharmacological “health” care treatments (5). While those who manufacture or supply such treatments are doing quite nicely, funding organisations on the other hand, are not quite so happy about current health trends.

An astonishing 75% of all health care expenditure is devoted to the care and treatment of the chronically ill or disabled (1,2), while such patients cost 3.5 times more to treat than other health care recipients (1). Treatment of chronic disease cost Americans two thirds of a trillion dollars in 1990 (3) and by 2001 total health care costs had blown out to $1.4 trillion (31) which represents "the fastest growth in a decade" (31). As has been noted by Booth and coworkers (3): 

These workers emphasise the fact that there has been (3):

In spite of these alarming facts, scientists, researchers, funding organizations, and governments continue to express little interest in preventative strategies (2,3), preferring instead to wait until these diseases become established and then utilize current symptomatic treatments (2,3). Preventative strategies are actively discouraged by a refusal to fund such research (3) and a refusal of health funds to cover such strategies(2). In fact, doctors who bill Medicare for the use of preventative strategies may even be charged with fraud (2).

It is abundantly clear that our current health care predicament is no accident. It is the result of a longstanding policy to encourage the use of lucrative symptomatic treatments which are known to offer no hope of cure or prevention. Indeed, the ineffectiveness of such treatments may account for their popularity amongst those with vested interests. The precise mechanisms underlying the failure of current treatment strategies are very well known, as I have considered elsewhere (see Holistic or Reductionist?) and will not be considered in any detail in the present discussion. Suffice to say that the entire practice of medicine is based upon a presumption of failure, that is, intervention only after a diagnosable disease has become established (3; see also When Nutrition Became Quackery). Medicine has never been interested in optimum functioning and the study of normality and prevention of disease (When Nutrition Became Quackery). In fact science and medicine have persistently and continually devoted precious little resources to defining and understanding optimal human functioning and freedom from disease.

For all the publicity given to the alleged scientific nature of modern medicine in the popular media, especially in view of recent allegations about the allegedly unscientific nature of alternative medicine, few mention the fact that the fundamental basis of medicine is grossly unscientific (see When Nutrition Became Quackery, Medical Evidence or Medical Ignorance?, Medical Bias). As long as the clinical trials are properly conducted and the statistics correctly tabulated it seems, we need not worry ourselves about causes, prevention, or optimal human functioning (see When Nutrition Became Quackery). Such matters become decidedly unscientific when profits are involved.

While some may consider, in the light of the above facts, that medicine has been an abject failure, this is not necessarily true. Clearly this is only true if the primary aim of medicine is to cure or prevent disease. Medicine of course, as I have already indicated, has never been structured in such a way as to maximize the chances of disease prevention. If medicine is judged by its ability to promote the use of rapid symptomatic treatments which produce highly lucrative pharmaceutical and para-medical industries then it has been an outstanding success.

Given this background, recent developments such as the corporatisation of medicine, medical rationing, medical discrimination or cherry picking, and futile medicine, are not too surprising. The structure of modern medicine continues to be shaped by a funding system which denies funding for preventative strategies (3). As has been emphasised by Booth and colleagues (3):

While funding continues to favour highly profitable symptomatic interventionist strategies it is clear that modern medicine intends to continue to discriminate against those patients who suffer from costly chronic diseases. Since symptomatic treatments are intended merely to conceal (ie. make the patient unaware of) any signs or symptoms of illness while permitting the underlying cause to continue (see Symptom Suppression), they are inherently expensive when used over the longer term. As is well known, short term suppression of symptoms frequently exacerbates the illness over the longer term (see Darwinian Medicine). Chronically ill patients are simply too sick and too costly to treat with ongoing symptomatic treatments, especially in the bold new world of medical rationing and corporatised medicine.

This article will focus upon some of the results of this deliberate bias against a preventative cause based scientific system of medicine.

2.     Medical Rationing, Cherry Picking, and Other Fruits of Medical Progress

a) Medicine Seeks to Avoid the Sick - Medical Rationing

While medicine has been busy avoiding any serious preventative or cause based approach to health care, the spiralling and inevitable increase in the incidence of chronic diseases finally attracted the attention of bureaucrats and those who are responsible for administering and funding medical expenditure. With health care costs approaching a trillion dollars it seems that it may have been the economists and bureaucrats who were first to realize there was something seriously wrong with our health care system. In view of the continually escalating costs of symptomatic or non-preventative forms of health care, costs that are the direct result of the ineffectiveness of medicine’s symptomatic interventionist approach, it is hardly surprising that health authorities now seek to ration medical resources. 

We have come a long way indeed from the early days of medicine's drug paradigm of disease treatment when pharmaceutical drugs were claimed to be a panacea which would ultimately cure all man's health problems. Now we cannot afford either the drugs or the epidemic of iatrogenic diseases which they have caused (see Holistic Medicine Sets the Standard for Safety). 

It is claimed, because of the rate at which health care costs are escalating, that rationing is inevitable (17,18,19,20,31). Since rationing has apparently become an economic imperative, it is clearly the economists and the bureaucrats who will increasingly decide which patient gets what treatment (31). However the fact that medical rationing simply involves deliberate discrimination against those who are deemed to be too sick or costly to treat (6,7,8,9) has resulted in a tendency to avoid the term "rationing" in preference for more misleadingly soothing terms such as resource allocation. Rejection of patients suffering from expensive chronic illnesses in preference for more profitable and easily treated patients has also been termed “cherry picking” (6,7,8,10,11,15,26,27,28).

Regardless of which term is used to describe it, the tragic end result of such medical discrimination is highlighted by the case of the Port Macquarie woman who was sent home from hospital because she was too sick to treat (9). This incident occurred in an environment of medical corporatisation where concern about profits rather than the quality of health care has become the bottom line (7,8,14). In fact, the privatisation of Port Macquarie hospital was followed by numerous reports of a reduction in the quality and availability of health care resources (14). Not surprisingly, for profit hospitals have gained a reputation for providing a lower standard of health care and a preference for high profit rapid turnover procedures (15,16).

The point cannot be overemphasised that the push for medical rationing is a direct result of the ineffectiveness of medical therapies, particularly in regard to the treatment of chronic illnesses. The popular use of the term "futile care medicine" underlines this fact. If medical treatments had been demonstrated to be curative then the question of rationing surely would not have arisen. Although rationing therefore, is simply a confession as to the uselessness of medical treatments, it is curious that supporters of rationing seem to prefer to discriminate against patients rather than discriminate against  medical treatments. While there seems little point in administering useless treatments (although most doctors and scientists would probably disagree, citing the placebo effect) patients certainly should not be blamed for the determination with which doctors seek to avoid the use of other alternative therapies.

Discrimination against patients on the basis of the treatability or profitability of their illness however, is only the first step towards even more worrying types of discrimination. Once doctors and health authorities are given the power to decide who is “worth” treating then any type of excuse may be used to justify refusal of treatment. For instance, as long ago as 1993 the National Health and Medical Research Council (NH & MRC) endorsed the use of (12) “social worth criteria” such as “the patients lifestyle and personal morality and his or her value to the community” as grounds for assessing the suitability of patients for certain treatments. Apparently, if the doctor disagrees with the patient’s morality or lifestyle, or considers he/she is of little value to the community (value to family or relatives is apparently irrelevant), then the patient would be considered not worth treating. While there may be good arguments for treatment refusal in specific cases does this justify granting the power to doctors and health authorities to assess the worth of patients? Does the ineffectiveness and costliness of medical treatments justify giving doctors the power to decide a patient’s worth? In spite of these guidelines by the NH and MRC, according to the Minister for Health, Tony Abbott (13): “I’ve got to say that I am very uncomfortable with the concept of the deserving and undeserving sick.”  

Of course any decision to inform a specific patient that it has been decided that he/she is simply not worth treating is not likely to be very popular with the patient and his or her relatives. This is also clearly true of the wider community which would not easily accept such rationing decisions. Realisation of this fact has led to suggestions that rationing decisions should be made behind closed doors, remote from public scrutiny (31). The public it seems, should have little or no say in (or even knowledge of) rationing decisions (31) although it has been suggested that highly selected members of the public could be chosen to form a (31) "citizens jury" which could offer some token representation of community feelings. Rationing decisions are clearly made more easily by economists and bureaucrats who are most remote from the suffering of individual patients.

The potential unpopularity of rationing amongst the general community has led to moves to make rationing more invisible or “covert” (23,24), also known as (31) "implicit rationing". Covert rationing is the rationing you are having when you are having no rationing. It’s aim is to deceive and mislead. To politicians any mention of open medical rationing would be political suicide (23). However, while politicians may prefer covert medical rationing since this type of rationing places the medical profession in the front line when it comes to responsibility for rationing decisions (ie. denying treatment to the sick), it is for this very same reason that the profession undoubtedly prefers open rationing. The medical profession would no doubt prefer to offload responsibility for rationing decisions onto politicians by bringing the whole matter out into the open. The choice between open rationing and covert rationing simply boils down to whether the public should be told the truth or whether they should be deliberately deceived. The choice, it is claimed, is not between open rationing and no rationing, but rather between open rationing and covert rationing (25,31). This presupposes of course that rationing is inevitable due to the fact there is no hope that scientific medicine will ever cure or prevent most chronic diseases. 

Since the essence of rationing is simply to avoid treating the sickest patients it is interesting to observe some of the covert means which may be employed by health maintenance organizations (HMO’s; see 29) to achieve this end. The first strategy they utilize it seems is to use cherry picking or “skimming” to establish disincentives to deter the sicker patients from signing up (28). This is claimed to increase profits for HMO’s in two ways (28): “once by enrolling only patients who would probably not need medical care; and again by driving the sick into high risk plans – causing the premiums of those plans to rise, and thus pulling up the HMO’s premiums automatically.” The point should be made most emphatically that  medical rationing is being justified here on the grounds of increasing profits, NOT reducing costs. The profit motive however ultimately drives up medical costs by encouraging the use of high profit rapid turnover procedures and discouraging cause based preventative treatments (14,15,16).

If all else fails and some patients with expensive chronic illnesses do manage to sign up with HMO’s then the next strategy is to ensure that their stay is as unpleasant as possible by (28) “allowing layers of obstacles to form between those patients and the care they want.” What is required is to (28) “let the system bog down in red tape for the ill.” This may be achieved by (28,30) “managing the information distributed to patients regarding services” and by deliberately imposed “lag periods”. In regard to lag periods, Australians will be very familiar with the blowout in public hospital waiting lists which has occurred during the push to promote privatisation of the health care system and increased use of private health funds.

There is no doubt that those responsible for covert rationing have turned deviousness and public deception into a highly developed art form. The devious means they have employed to falsely convince the public that chronically ill patients  are not seen simply as a negative influence upon their bank balance is amazing. 

Perhaps  the most visible form of medical rationing involves the elderly and the terminally ill. Denial of treatment or “do not resuscitate” (DNR) orders are part and parcel of modern scientific medicine. This has been termed “futile care medicine”.  

b) Medical Age Discrimination and Futile Care Medicine

Most people would probably expect that medicine has been deliberately structured in such a way as to favour treatment of those in greatest need and there is absolutely no doubt that, as a group, it is the elderly who most fall into this category. However the reverse is true. Modern health care actually seeks to discriminate against the elderly (32,33,34,35,36). Age limits have been placed on various types of treatments (32) and geriatric beds in hospitals are being reduced (32) even though chronic illnesses are increasing and the population is ageing (see Health Trends). Numerous patients have noticed that they are treated differently after they reach the age of fifty (32). Ageism is said to be (33) "pervasive in health care."

It is interesting to note that one significant area of age discrimination involves clinical trials for drugs - the elderly are consistently omitted from such trials (33,34,36). This is particularly odd given the fact that the elderly are the biggest users of prescription drugs (33) and they are also particularly susceptible to the side effects of drugs. This susceptibility to side effects would ensure of course that to include the elderly in drug trials would result in more negative trial outcomes and a negative effect also on the potential profits of drug companies.

Another area of discrimination involves the use of hazardous surgical procedures in already frail elderly patients. If the decision to refuse such procedures is based upon the perceived risk to the patient rather than age per se then clearly such decisions may be in the patient's best interests and would therefore be totally justified. However, denial of treatment because of the hazardous nature of modern medical treatments does raise an interesting issue since the aim of medicine is claimed to be to do no harm. If medical procedures have become so hazardous that they cannot be used on those most in need surely there should be medical discrimination against the treatment, not the patient. If treatments are so hazardous then surely medicine should be urgently restructured and undergo a fundamental change in direction and return to their basic aim of doing no harm. The urgency of such a move is highlighted by the fact that no one knows whether many modern medical techniques actually work and benefit patients since there is little interest in actual health outcomes (45). Even with cardiovascular treatments there is a lack of data on real life health outcomes (48). They just don't know if the therapy actually works. Medical procedures it seems, have traditionally been carried out on a geographical or class basis, irrespective of either need or outcome (45,49)

Considering the astonishing iatrogenic potential and ineffectiveness of modern medicine, combined with the current boom in knowledge confirming the importance of traditional holistic teachings regarding diet, nutrition, and lifestyle in prevention of many diseases ( see Nutrition & Megavitamins, Nutrition is for the Birds, B Vitamins), the incentives for a fundamental change in direction for modern medical science could not be greater. Indeed, the astonishing iatrogenic effects of modern medicine (see Holistic Medicine Sets the Standard for Safety), particularly involving the elderly (46; see also The New Paradigm), the total cost of which to all Americans is estimated at $29 billion annually (47), are cause for absolute alarm and immediate fundamental change to the direction of medicine. Fundamental change to medicine should not be driven by bureaucrats and economists however, but rather by the compassion and concern of all medical professionals. 

In spite of all the evidence of ageism in health care, according to Gilhooly (36) there is little of what may be termed hard scientific evidence. Gilhooly points out for instance that under treatment of the elderly may not be because of age per se but rather because of the chronic nature of many elderly illnesses or the fact that such patients may be considered "vulnerable". This may well be true but does this make it acceptable? Surely we should not be seeking to justify or excuse medical discrimination. The seriously ill patient who is being under treated would no doubt express little interest in whether the discrimination was due to age, "vulnerability" or chronic illnesses.

Although Gilhooly (36) does concede that "there is some evidence that elderly people are routinely and systematically excluded from clinical research" she justifies this discrimination on the basis that the "co-morbidity" or various chronic illnesses which frequently afflict the elderly predispose them to adverse drug reactions and therefore increased liability to drug companies. Concern about liability to drug companies is commendable, but how about concern about harm to the health of patients? According to Gilhooly (36) drug companies may simply be trying to "protect patients from potential harm." They may also be trying to maximise profits. Gilhooly concludes (36): "perhaps it would be better to view exclusion of elderly people from clinical trials as evidence of positive age discrimination." In other words it seems, drugs are so hazardous to the elderly, the group that uses them the most, that these hazards should be reserved for the general community following marketing of the drug. Such is the nature of positive discrimination. Doesn't this positive discrimination also discriminate against the younger patients?

The reasoning here is indeed difficult for the layperson to follow. Drug trials it seems should be biased towards a positive outcome (see Medical Bias) so that adverse or toxic effects are reserved for the general community and not trial participants. The patients who are most likely to use the drug (ie. the elderly) should also be excluded from trials so that only those most unlikely to take the drug are actually included. In short, these much heralded scientific drug trials should apparently be constructed so as to depart as much as possible from reality. As I have noted elsewhere, deliberate medical bias is intended to deceive and mislead (see Medical Bias), a fact which  underlines just how unscientific and uncaring modern medicine has become. Far from disappearing from medicine, blatant commercial bias seems to be increasing (see Medical Bias). It is this type of attitude which has contributed to the current epidemic of iatrogenic diseases (see Holistic Medicine Sets the Standard for Safety).

Closely related to medical rationing due to age is the matter of "futile care medicine" or "end of life care" (37, 38, 39, 40, 41, 44). According to Smith (42): "Futile Care Theory is the bioethical maxim that gives doctors the right to refuse wanted life sustaining treatment based on their perception of the quality of the patient's life." In other words futile care medicine relates to (43) "the patient who is demanding care that the medical establishment has deemed futile." According to Smith (38) the definition of futile care is changing and it is now more "about subjective value judgements by medical professionals rather than physiological outcomes." Or, in the words of Barbara Simpson who has personally experienced the tragic consequences of medical futility (44):

The potential consequences of futile care medicine have also been noted by Smith who cites the case of a baby (38) and a teenager (41) who would have died if doctors had had their way.

Futile care medicine, which is introduced into hospitals rather covertly (39,41) by hospital ethics committees, as no doubt are other shameful health care reforms, involve making patients (41) "dehumanised and viewed as parasitic drains on limited health care resources." Medical bioethics committees it seems, have (39) "largely abandoned the sanctity of life ethic" so that now "a new medical hegemony is arising, one that proclaims the right to declare which of us have lives worth living and are therefore worth treating medically, and which of us do not." The futile care movement has been described as the beginning of a (40) "planned campaign among medical elites to impose health care rationing."

.The rationale commonly used to justify futile care decisions (ie. discrimination) is termed "distributive justice" (41,50). Distributive justice refers to the primacy of the group over the individual (41,50). Patients are seen collectively rather than as individuals so that treatments and costs must be shared and one patient is not entitled to a treatment if this would make the treatment unavailable to someone else who is considered to be of greater "worth" or have a greater need (41,50,51,52). Distributive justice seeks to abandon the primacy of the individual so that (51): 

As has been suggested by Hall and colleagues (52):

In a recent interview, Dr Bob Wright, of Sydney's St Vincent Hospital, agreed that chronically ill patients act as (13) "bed blockers" in the hospital system and prevent other patients from accessing much needed resources. According to Dr. Wright (13): 

Dr Wright noted that chronically ill people act as bed blockers (13) "because these people usually take a long time to die." He added that he didn't "think its good for anyone to live longer than they should." In stark contrast are the words of Franklin a decade earlier (53):

The demeaning term "bed blocker" is of course reserved for those patients whom doctors are unable to offer effective short term treatment and who therefore are seen as displacing other, perhaps more profitable patients, from acute care beds (117,118). The need to demean or blame certain patients for taking the beds of other patients is the result of bureaucratic attempts to restrict the number of hospital beds and therefore ensure there will be insufficient beds for everyone (117). In our modern scientific health care system however, there is more interest in 'sanitising' the term bed blocker to disguise its true meaning (118) rather than blame those who are really responsible for deliberately seeking to prevent patients from receiving treatment.

It is clear that medical attitudes are changing dramatically and very quickly. Perhaps the matter is best summarised by Wesley Smith (41):

3.Terminating Futile Care and Rationing: solutions to the current health care crisis

It is abundantly clear that to rectify the current problems which plague our health care system and remove any need for rationing we must first identify and remove the underlying cause of the problem. Claims that rationing is inevitable, which emanate predominantly from economists and bureaucrats, certainly do not address the cause since they offer an economical solution for what is essentially a medical problem. Such suggestions are intended to conceal symptoms while permitting the underlying cause to continue.

It is clearly the proliferation of chronic illnesses and the ineffectiveness of medical therapies which is at the root of the current explosion in health care costs. The high cost of medical care today is not caused by "advancements" in health care techniques as is commonly suggested. If medical "advancements" are synonymous with increased rates of chronic disease and increased need for medical services then we need to progress in exactly the opposite direction if we are to address the current health care crisis. We must seek to reduce the NEED for medical services rather than continually seek to reduce the availability as the need increases.

As I have noted elsewhere (see Science or Progress?) the ineffectiveness of medicine is so consistent and predictable that economists can reliably predict increasing health care costs well into the future. In fact, such is the failure of medicine that even the rate at which costs will escalate can be reliably predicted (see Science or Progress?). In all such predictions it never seems to be asked; what if medicine cures heart disease? or what if medicine prevents cancer? or what if medicine conquers diabetes? or what if medicine eliminates iatrogenic diseases? Economists and bureaucrats know that these diseases will continue to proliferate and it is because of this realisation that they seek to reduce the availability of medical services. Even though iatrogenic illnesses alone are estimated to cost the US $29 billion annually (47) modern experts prefer to reduce treatment availability to the sick rather than confront the fundamentally dangerous and ineffective nature of modern medicine. Iatrogenic illness seems to attract a very low profile indeed amongst doctors, scientists and economists, regardless of cost.

Evidence of the dangerous (47; see also Holistic Medicine Sets the Standard for Safety) and ineffective nature (54,55, 56, 57,58,59,60; see also But What About efficacy?, Health Trends, Science or Progress?) of modern scientific medicine is indisputable. According to Doust and Del Mar for instance, in an interesting article entitled (54) “Why do Doctors use Treatments that do not Work:”

However, even in spite of all the available evidence there are still those who unquestioningly support the “wonderful advancements” of modern medical science. But on what evidence is this support based? Where is the evidence of the numerous chronic diseases which are disappearing from modern Western society? And where is the evidence that doctors and drug companies are becoming redundant as need for medical therapy diminishes? It is not necessary to conduct clinical trials to assess the effectiveness of modern medical techniques since the results of real life clinical trials conducted on billions of people throughout the world are abundantly clear. Yet, even in spite of all this there are many doctors and scientists who suggest we should discriminate against the sick rather than concern ourselves about the safety and effectiveness of modern medical methods.

To science it seems, the results of small scale highly selective short term trials are much more significant than real life trials carried out on billions of people for the past fifty years. Such is the nature of scientific evidence.

In all of the discussions and literature proclaiming the inevitability of medical rationing the fundamentally dangerous and ineffective nature (see Holistic Medicine Sets the Standard for Safety, Health Trends ) of medicine never seems to be mentioned, even in spite of the astronomical costs of iatrogenic illnesses. The fact that modern scientific treatments, far from actually curing patients, are actually causing an enormous burden to modern society, in costs suffering and deaths, is strictly avoided. This is all very surprising, especially given the fact that increasing scientific evidence indicates that alternative medicine therapies which offer more hope for the prevention of various chronic diseases (see Health Trends, Nutrition & Megavitamins, B Vitamins, But What About Efficacy?) are much safer and cheaper than the high tech gadgetry of modern medicine.

Using the principles of distributive justice where the sickest and costliest patient is the one who is penalized the most one would also think that the doctor or hospital causing the greatest financial burden to society from the use of costly treatments and resultant iatrogenic illnesses would also be the one which is penalised the most. Somehow however, a different sense of justice seems to apply in this case. While patients must carry the burden of the physiological cost of harmful or ineffective treatments, and they are discriminated against because of the financial cost of treatments, current “justice” determines that doctors, hospitals and treatment providers should suffer none of these penalties.

This type of health care policy creates a situation whereby a patient who develops an iatrogenic illness may ultimately be abandoned by doctors and hospitals because the cost of treatment is too expensive and the money could be better spent on other healthier (ie. patients who have not become ill from medical treatments) patients. According to the principles of medical rationing, a doctor who causes a patient to become chronically ill because of surgical complications or adverse drug reactions should then be able to use so called distributive justice to justify abandoning any further treatment of the patient. As a general rule, the sicker the doctor causes the patient to become, the more the doctor is required to abandon him/her and devote the resources to other healthier patients – unless and until they too fall victim to iatrogenic illnesses.

But shouldn’t doctors and hospitals have to clean up their own mess? Why is there such a push to make doctors and hospitals so unaccountable? Should doctors and hospitals that deal with human lives be less accountable for the problems they create than plumbers or mechanics? Where is the incentive to produce a safe health care system free of iatrogenic illnesses when there is such a determination to ensure that doctors and hospitals are unaccountable?

Acceptance of responsibility is one of the absolute foundations of a safe, successful and orderly society. Especially when we are dealing with human lives, denial of responsibility is a recipe for chaos. Modern medical science has created an enormous iatrogenic mess and they should be compelled to clean it up (if they do not wish to do so voluntarily) before there is the slightest mention of discriminating against the sick.  How much more illness should medicine be permitted to create before accountability is enforced? If medicine were required to clean up their iatrogenic mess, and required to research the underlying reason/s why iatrogenic illness is one of the fastest growing types of illness in modern society, then the key to a cost effective safe health care system may become obvious.  

One of the most tragic examples of iatrogenic diseases may well be the current epidemics of heart disease, syndrome X, diabetes, adrenal disorders, and respiratory diseases (see Health Trends) which may all share a common cause. According to increasing scientific evidence all these diseases may result from low birth weight caused by inadequate nutrition during pregnancy (96,97,98,99, 100,101,102,103, 104,105,106,107). But 50 years ago modern medical science was advising women to deliberately practice semi-starvation during pregnancy to ensure they would give birth to a smaller baby and hence have an easier delivery (108,109). And medical experts continue to wonder why there has been such an epidemic of chronic diseases in the latter half of the 20th century. And medical bioethicists, bureaucrats, and economists seek to withdraw treatment from the chronically ill because of costs.

There is no better example of the possible tragic consequences of medicine's short sighted symptomatic approach to "health care". The fact that deliberate iatrogenic foetal malnutrition may be a significant factor in the current epidemic of chronic diseases should be headline material, but yet it rarely receives any mention whatsoever. The "costs" of this irresponsible nutritional advice would be expected to be most prominent in those who are now 50 years of age or older. Unfortunately we must all pay the price for the disruption of the learning process which occurs when health authorities seek to deny or conceal the truth.

According to the available scientific evidence alternative medicine offers a very practical means of significantly reducing two of the costliest aspects of health care, namely chronic illnesses and iatrogenic illnesses, and yet it never seems to be mentioned by those who seek to reduce costs by introducing medical rationing. This is indeed difficult to understand unless of course promoters of rationing are more interested in maximizing profits rather than reducing costs. One would think that doctors, scientist, bureaucrats, and economists would be pushing for an urgent and fundamental restructuring of modern medicine, particularly education and training, aimed at emphasizing the importance of safe preventative alternative medicine techniques and discouraging the use of costly and dangerous medical drugs and surgery. Of course preventative techniques will not only reduce costs but ultimately they will also reduce profits and this may be a considerable disincentive for those whose interests are not consistent with patient welfare.

In all these decisions about health care of course, it is the patients, the recipients of  health care services, who have the least say. The only vested interests of patients is towards elimination of disease and restoration of health and, ultimately therefore, a consequent reduction in the size of the health care industry. The health care industry on the other hand, those who are actively involved in making decisions about the direction of health care, have a vested interest in ever increasing use of highly profitable symptomatic medical procedures and a reduction in the use of more costly less profitable procedures. To them, profit is the bottom line. Their livelihood will be threatened by effective preventative techniques which reduce the total burden of human suffering.

What is clearly needed is more patient input into the decision making process. If the ultimate aim of health care is to conquer disease and eliminate human suffering then patients are the only group with a vested interest in a totally positive outcome. Unless our prime consideration is profits it makes no sense at all for the primary decision makers to be those who have a vested interest in illness and perpetuation of human suffering. They cannot afford to be successful. It should be noted here that the current success of alternative medicine is in fact due to consumers, certainly not doctors and scientists who have traditionally adopted a very negative and antagonistic approach to such therapies and all who support or use them. In spite of the medical opposition to alternative medicine however, continued public use of such therapies has resulted in scientists increasingly, if not reluctantly, confirming their effectiveness.  

It is clear from the above facts that the logic used by those who seek to reshape our health care system goes something along the following lines.

The evidence is clear. The first step to reducing costs and creating a more cost effective health care system is to focus increasingly upon the use of natural preventative treatments and actively discourage the use of harmful surgical and drug band-aid therapies. The answer is NOT to seek to discriminate against the sick as orthodox medical therapies continue to fail, but rather to discriminate against the use of such treatments by changing to safe cause based preventative therapies.

b) When Caring Stops - whistleblowers incorporated

One of the primary reasons that our health care system is in the deplorable state that it is is because of the culture of silence, mateship, and cover-ups which are so prominent within the medical profession (62,63,64,65,66,67,68,69; see also Holistic Medicine Sets the Standard for Safety). Deliberate medical bias is another way in which doctors and scientists seek to deceive the public and conceal the truth (see Medical Bias). The primary purpose of this culture of deceit is to prevent accountability and to conceal the mistakes, hazards and ineffectiveness of medical treatments. This culture of silence has two vitally important side effects. Firstly, it interferes with, or totally destroys, the capacity of the system to learn and benefit from medical mishaps and shortcomings. Secondly, when problems do occur the refusal to formally acknowledge these problems prevents the system from responding appropriately and introducing effective corrective measures. We should be seeking to learn from our experiences not simply denying that they occurred.

Ideally the virtues of caring and compassion and the desire to minimise suffering and prevent deaths should ensure that health care professionals have the best interests of patients at heart and therefore have every incentive to report medical errors and mishaps which they cause or which they witness. However, in reality this is not so since many in the health care industry give a much higher priority to "mateship" and the reputation of themselves and their colleagues rather than the welfare or even the lives of their patients. 

The tragic consequences of medicine's cloak of secrecy and cover ups has recently been brought to light again as a result of the use of the ineffective anti-miscarriage drug Stilboestrol or DES (112). In spite of the fact that this drug was ineffective and was found to cause cancer in the daughters of the women who used it, doctors continued to prescribe it for nearly 50 years after its introduction in 1938 (113,114,115,116). The tragic consequences of DES use draw attention yet again to both the inability of clinical trials to detect the real life consequences of drugs as well as the determination with which the medical profession will attempt to conceal the truth about the hazards of medical therapies. It also emphasises again just how long doctors may continue to use therapies which are ineffective.

According to Dunlevy (113) the use of DES was a "case study in medical arrogance and bureaucratic timidity." According to Dunlevy (113):

A further tragic example of this culture of secrecy and deceit which exists within medicine concerns the deaths of two patients in a Sydney hospital following operations which were carried out with the assistance of a drug addicted anaesthetist who sometimes needed to excuse himself from the operation so that he could satisfy his urgent need for drugs (70,71,72). The problems surrounding this case related to the medical secrecy which was involved. Medical authorities and hospital staff who worked with the anaesthetist and were aware of his drug addiction refused to reveal this information (70,71). Even when the police proceeded with a manslaughter charge medical staff refused to tell the truth and thereby prevented his conviction (71,72). Alan White, a policeman involved in the case commented (71):

When Sergeant White was asked if the medical profession had adopted random drug tests which he recommended in his report he responded thus (71):

Further evidence of the refusal of health authorities to confront this culture of secrecy and deceit is clear from the New South Wales Health Department's response to the above matter (73). Many questions put to the Health Department by the Sunday program (74) were avoided and remained unanswered (73). And so the culture of secrecy and cover ups continues.

Then there is the widespread negligence and mistreatment of hospital patients in the Camden-Campbelltown area to the south west of Sydney, negligence which was only exposed by the persistence and determination of a group of whistleblower nurses (75,76,77,78,79). Although various authorities allegedly attempted to prevent exposure of these matters and the 20 deaths which resulted (65,66,67,76,80,81,82), even to the point of intimidating the whistleblower nurses who all lost their jobs (80,81,82), one inquiry even concluded there was no cover up in spite of the fact that the cause of the 20 deaths was still being investigated by the coroner (83,84). This was also in spite of the fact that the Commissioner who conducted the inquiry noting that the whistleblower nurses had been vindicated (83) "in their claim that they raised matters which should have been investigated and which were not investigated." The Commissioner also criticised a previous investigation which, although substantiating the allegations, found that (83) "no individuals were accountable."

The most disturbing aspect of this whole matter is the systematic and callous way in which the whistleblower nurses were allegedly bullied, harassed and victimised by colleagues and medical authorities (80,81,82), actions which would suggest there was a determination to punish any nurse who told the truth. Any attempt to prevent the truth from being publicised clearly suggests there was more concern about the reputation of medical staff, and/or the reputation of the hospital, than there was about the lives of dying patients. An investigation revealed that the hospitals involved (80) "had a culture in which the nurses who complained of poor care were investigated, bullied and, in some cases, sacked." As was also reported by Paola Totaro and Ruth Pollard (82):

Even management was involved in this apparent conspiracy of silence, deceit, and intimidation with the chairman of the South Western Sydney Area Health Service apparently attempting to silence a politician (82) while also claiming that whistleblower nurses had (82) "psychiatric problems." So severe was this victimisation that both the Minister for Health and the Premier of New South Wales were ultimately forced to apologise (77,81).

The abuse of psychiatric assessments to discredit and silence whistleblowers who merely wish to tell the truth is unfortunately a popular practice by those whose shame or guilt results in deviousness and dishonesty and a determination to conceal the truth (87):

Similarly, according to a parliamentary address by Senator Murray (88):

De Maria has also noted the trials and tribulations of whistleblowers (110):

It is noteworthy that in spite of the numerous instances of neglect or incompetence and the tragic loss of human lives that occurred as a result of the Camden - Campbelltown fiasco there was a determination amongst those conducting the inquiries not to hold individuals accountable but rather to blame the system instead (80,82). According to an editorial in the Sydney Morning Herald (80):

According to the Australian (94):

Or, in the words of Paola Totaro and Ruth Pollard (82):

Similarly, according to Martyn Goddard of the Australian Consumers Association (95):

It seems that according to Martyn Goddard the reasons for the 10000-20000 annual Australian deaths from medical mishaps (see Holistic Medicine Sets the Standard for Safety) are "overwhelmingly" clear. Furthermore, it would also seem that the current system of avoiding individual accountability is having the desired effect and there is no need for change. While patients who kill no one but themselves, and plumbers and mechanics who kill no one at all, must be made accountable, this is certainly not so with doctors and medical staff who deal with peoples lives everyday.  

You never know, in future when you return your motor vehicle to the mechanic for that expensive but faulty repair job he may simply respond; "it was nothing to do with me - it was the fault of the system. It was a systems failure." And this would probably win the support of the Australian Consumers Association also!

It seems that when medical costs are excessive individual patients must be blamed and must be discriminated against - there never seems to be the slightest suggestion that it is the fundamental nature of the medical system itself which should be changed. On the other hand, when suffering and deaths are involved rather than costs, it seems we must avoid at all costs any discrimination or penalty imposed on any individual, no matter how guilty he/she is. And the cover-ups continue and the experts wonder why the cost of "health care" is out of control.

The implications of this desire of medical staff to regard their professional reputation and that of their colleagues as being more important than the welfare or even the lives of their patients, are most grave indeed. Health care will have a disastrous future while this attitude prevails, irrespective of how many inquiries or reforms are carried out.

In view of the culture of secrecy, deceit and mateship which exists in health care today what is needed, in addition to more patient input into the decision making process and a fundamental change of direction in the nature of medicine and medical research, are more safeguards and more checks and balances to enable a rapid and appropriate response when things do go wrong. I refer here especially to whistleblowers, whistleblowers such as the nurses that brought to light the tragic events in South Western Sydney. Whistleblowers tend to be conscientious individuals who are not moulded, suppressed, or intimidated by the system, but rather are motivated by a deep sense of social conscience, justice and morality (61). Their commitment to honesty, decency, and justice is such that they frequently pay an extraordinarily high personal price. 

In the words of De Maria (110):

De Maria has compiled a detailed bibliography of literature concerning whistleblowing (111).

As a society we need to decide which values to support and which direction we are going to take. At present there is an emphasis upon team players who condemn individualism and whistleblowing. There is little or no sense of conscience and there is a callous determination to silence anyone who is perceived as threatening the team. There is no significant allegiance to truth and decency. The only allegiance is to the team. As a result, anyone who seeks to expose medical neglect or mishaps is victimised ruthlessly - the worse the reported neglect, the more ruthlessly the whistleblowers will be condemned and the more vigorously the truth will be concealed. In the still continuing Camden - Campbelltown fiasco, medical authorities, bureaucrats and politicians were dragged kicking and screaming into various inquiries aimed at determining the truthfulness of the nurse's allegations. Eagerness to learn the truth was apparent only amongst those affected and the general public.

Although Australia does have some so called "Whistleblower Legislation", in reality Australian governments have made only a token effort to provide legislative protection to whistleblowers since current laws (89,90,91) are largely ineffective and no one has yet been prosecuted for victimising whistleblowers (88,92). As has been noted by Sawyer in an article entitled "Let's Encourage Whistleblowers" (92):

Unlike Australia, America has introduced effective whistleblower legislation which has enabled the recovery of billions of dollars in medical fraud (61,92,93).

At present Australian whistleblowers are harassed, intimidated, bullied and victimised for daring to tell the truth while frequently those responsible for concealing the truth and harassing whistleblowers are rewarded or perhaps even promoted. While we reward deceit and victimisation the future is bleak indeed. Whistleblowers are the ones who should be handsomely rewarded, encouraged and promoted if we are to have a decent society and an effective health care system (80). Whistleblowers should receive effective legislative protection in line with the vitally important role they play in upholding decent values and just standards and saving human lives (61,85,86,92). Victimisation of whistleblowers should be severely penalised. 

Conclusion

The case in support of medical rationing and discrimination against the sick is short sighted and inconsistent with the traditional healing basis of medicine. It requires an abandonment of the caring and compassionate basis of the health care profession. Since it is an economic ‘solution’ to what is a medical problem it ignores the primary causes of escalating health care costs.

While the incidence of iatrogenic diseases spiral out of control, suggestions that the inefficiencies and failings of medicine should be ignored while chronically ill patients are discriminated against on the basis of cost represents a shameful abandonment of the fundamental principles of medicine. When such a massive part of health c