Canada’s federal election results had barely been counted when the Premiers resumed making their well-worn demands for more federal health care money. Instead of thanking Ottawa for the billions it has already provided for fighting COVID-19, or asking for short-term pandemic-related funding, the ritual chorus seeks ever-increasing amounts of money for decades to come.

Granted, the need for more money certainly feels urgent right now. Intensive care is on the brink of collapse in Alberta and Saskatchewan, with health officials preparing to make painful decisions around triaging patients as COVID-19 infections surge. A number of provinces are having difficulty even staffing their hospitals, after almost two years of burnout-inducing working conditions for front-line health care workers.

However, the premiers’ multibillion-dollar asks have been for unconditional long-term funding, well beyond the scope of the current crisis. But they have not been clear on how any new money would be used. It is entirely reasonable to ask them to explain themselves – especially since spending more on health care does not automatically mean better health outcomes.

In a recent study, CIBC economists Benjamin Tal and Andrew Grantham found that COVID-related hospitalizations per one million of the population were four times higher in the U.S. and five times higher in Britain than in Canada in early 2021. “Yet, as we all surely recall, the hospital system in Canada during the second wave was at its wits’ end,” they write. “Simply put, we reached capacity at levels that many other countries consider to be acceptable.” They conclude that Canada’s hospitals need more money.

But this is only part of the story. While the U.S. is well known for having much higher health care spending than any other country, both the U.K. and Israel spend significantly less than Canada – and yet neither came close to peaking on hospital capacity. The issue, then, cannot just be a lack of funding; how our health care dollars are being allocated must also be part of the conversation.

One reason provincial governments prefer hounding Ottawa, rather than focusing on more efficiently using the funding they do have, is that passing the buck is painless. As Canadian health economist Bob Evans says, “every health care cost is someone’s income” – that is, controlling or cutting health care costs means controlling or cutting the salaries of doctors and nurses, hospital budgets and pharmaceutical-firm profits. It is much easier politically for provinces to demand more funding than to get into conflicts with such concentrated and powerful interests.

But there is also a deeper reason. The provinces, and the federal government, simply may not have the data to evaluate their health care spending rigorously, even if they even wanted to. If they do have the data, they certainly keep their evaluations hidden.

This is not by accident. The savvier leaders among the key stakeholders have no interest in having such data exist, because they may fear it will lead to results that could embarrass them and turn public opinion against them, possibly in ways that would reduce their incomes or autonomy.

For decades, some of the most important data showing health care waste and inefficiency has looked at variations among small geographic areas – “postal code medicine.” These variations, which are the continuing subject of the Dartmouth Health Atlas, consistently show that while some parts of the U.S. spend two to three times as much on health care as others, key health indicators, such as primary care for diabetic patients and post-surgery complications, are not correlated.

One recent study by leading U.S. health economists concluded that these variations were not due to differences in patients’ needs; instead, they were most closely associated with physicians’ beliefs that were “unsupported by clinical evidence.” The specific examples they studied suggested that 12 to 35 per cent of this health care spending was unwarranted.

Canadians are rightly proud that our health care sector is nowhere near as expensive or inequitable as that of the U.S. But we are not immune. One decade-old study looked at heart attack treatments in Canada and found a threefold difference across health regions with no obvious difference in post-surgical 30-day mortality.

Sadly, no one has updated or extended this study, in part because the data needed are simply unavailable. We could get better value for our health care dollars if we knew more.

Before the federal government signs over any more multibillion-dollar cheques to the provinces with no strings attached, Canadians deserve to know why the additional investment is needed in the first place, how it will be spent – and whether, after all this time, our money has been well used.

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Lots of millivolts zipping and zapping from one neuron to the next neuron.

So can we, the medical doctors and medical researchers, figure out how to use electricity to tune up the brain?

That’s the BIG QUESTION.  

But the brain is the most complex structure in the universe aside from the universe itself.

But the work of using electricity to tune up the brain of those with mental health challenges is well underway.

Depression , for example, involves multiple neural circuits. This is different in different patients. So what is needed is a personalized approach to using electricity to treat depression.

The personalization is based on brain mapping of brain activity. EEG does that trick.

And then electrodes are programmed to target areas of the brain involved in creating depression.

This is like a pacemaker for the brain.  Deep brain stimulation with leads deep in the brain has been used for decades but it is very invasive and very expensive.

So transcranial brain stimulation using MRI targeting is a much less invasive and more accessible approach to treating depression and other conditions such as OCD.

Personalized brain stimulation requires accurate targeting of the right area of the brain but also the right rhythm. The neural code or the brain code is frequency dependent.  Like a song. Get the frequency wrong and Taylor Swift’s song is gaarbbage.

So the brain is and has been proven to be plastic. It can be rewired and using electricity in targeted and personalized methodologies will help humanity with the biggest illness of all – mental illness.

Raymond Rupert  health system disruptor and patient advocate.

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We have heard from our friends in Tel Aviv who have already received the vaccine.

Their process of vaccine distribution is very well orchestrated.  Our friends belong to one of 4 major HMOs ( health maintenance organizations) in Israel.

The HMOs are like OHIP. The big difference is that these 4 HMOs in Israel must compete for customers. OHIP is a monolithic monopolistic bureaucratic entity. Sometimes no one answers the phone.  Try it and you will see. Service levels are likely not even measured at OHIP.

The need to compete changes the entire service delivery experience for customers in Israel. If customers of the HMO do not get good service, then they can change to another HMO. The more customers, the more revenues and the more advances in technology and facilities that can be developed.

Competition amongst the HMOs forces them to up their game to the benefit of their customers.

Years ago, I toured the head office of Clalit, one of the HMOs. Their use of information technology (IT) at that time was light years ahead of the IT in Canada. Their managers manage service delivery and take pride in being excellent at it.

So when it came time to distribute the vaccine, the managers at Clalit pushed a few buttons and mobilized the effort. Somewhat like going to war. But this time, the enemy is a virus.

So the question for the political leaders and ministers of health in our provinces and territories is why don’t we use this model of competition to increase the service levels for Canadians. Lives depend on it.

Might be a useful thought exercise for our leaders to engage in, if their time permits.

All the best of luck with this initiative. I will be watching from the side lines.

Raymond Rupert patient advocate and part time health industry disruptor.

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I’m a clinical trials geek. I keep hearing people talk about the seven to 10 years it takes to make a vaccine and how dangerous speeding this up might be. The word that keeps popping up is “rushed”, and it is making the average person nervous about vaccine safety. So, as a clinical trials doctor, I am going to tell you what I do for most of those 10 years – and it is not very much.

I’m not lazy. I submit grants, have them rejected, resubmit them, wait for review, resubmit them somewhere else, sometimes in a loop of doom. When I am lucky enough to get trials funded, I then spend months on submitting to ethics boards. I wait for regulators, deal with personnel changes at the drugs company and a “change of focus” away from my trials, and eventually, if I am very lucky, I spend time setting up trials: finding sites, training sites, panicking because recruitment is poor, finding more sites. I then usually have more regulatory issues and, finally, if my big pot of luck is not used up, I might have a viable therapy – or not.

At this point, it might get delayed because of questions over profitability or any number of other obstacles. I’m not even going to go into the years it normally takes to get the “preclinical” studies, the ones before the human trials, done.

So next time somebody expresses concern at the astonishing speed the vaccine trials have happened at, point out to them that 10 years isn’t a good thing, it’s a bad thing. It’s not 10 years because that is safe, it’s 10 hard years of battling indifference, commercial imperatives, luck and red tape. It represents barriers in the process that we have now proved are “easy” to overcome. You just need unlimited cash, some clever and highly motivated people, all the world’s trial infrastructure, an almost unlimited pool of altruistic, wonderful trial volunteers and some sensible regulators.

With all of this and the clock ticking on a global pandemic killing people by the second, it turns out we can do amazing things. The vaccine trials have been nothing short of a miracle. A revolution in how we do trials that when you think about it is perhaps not that surprising given our ability to innovate when we really need to.

Three vaccines have already broken cover and demonstrated efficacy higher than we had hoped

And we really need to – necessity being the mother of invention. Safety has not been compromised. All trials have been through the correct “phases” or process of any normal drug or vaccine. Hundreds of thousands of the very best of us volunteered and had an experimental vaccine. The world watched so closely that when a single person fell ill, we were all debating it.

To date, there has not been a single associated death related to Covid vaccines and only a handful of potentially serious events. Just imagine watching everybody in a small city for six months and reporting every single heart attack, stroke, neurological condition or anything that might be judged serious. How astonishing is this? It has been a triumph of medical science.

I haven’t even touched on the lucky confluence of timing that meant this all happened at a time when sequencing all the genes in a person or virus is so routine nobody bats an eyelid. This turbocharged the early preclinical science needed as the foundation stone of several new technologies at the right point to be exploited.

At this time, three vaccines have already broken cover and demonstrated efficacy higher than we had ever hoped. The bar was set by regulators at around 50 per cent. Both Moderna and Pfizer reported 95 per cent efficacy, and Oxford University reported 90 per cent efficacy for a particular dosage regimen. Safety data is still to follow, but the track record of vaccines is excellent, and I am an optimist.

None of this is to downplay the challenges still ahead. It is also not to say vaccines are without safety questions still to be answered. It has been, however, a triumph of good process and great people. I am confident that when regulators pore over the safety and efficacy data, closely followed by every interested scientist in the world, that vaccines will only be used if their benefits clearly outweigh the risks – and you should be confident too.

Mark Toshner is a director of translational biomedical research at the University of Cambridge. This article first appeared on The Conversation

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But this is the most appropriate tool kit to bring to a system that does not work as a system.

A patient with severe facial pain from trigeminal neuralgia does not get a call back from the neurosurgeon for 8 months and then the doctor won’t see the patient until he has a MRI. The MRI is now booked for 5 months out. As I said, it is a non system. It does not work.

So what is needed is what Bruce Mau describes as MASSIVE CHANGE.

Bruce Mau, the author of MC24, outlines his approach to using design for change. As Bruce notes, government has never used design but uses a process that is hundreds of years old.

So with the healthcare system unravelling under the shocks of COVID, it might be the time for the healthcare leaders to invite designers into the conversation.

If we care about healing the healthcare ecosystem and advocating for patients, then we have to add DESIGN as a tool kit.

We need to visualize the future and it has to be life centred with the patient in the centre of the healthcare ecosystem.

That is the challenge for our healthcare leaders. And there is some urgency at this time.

Raymond Rupert patient advocate and healthcare consultant.

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