Issue date: 11/15/07 Section: Arts and Culture

Media Credit: RandomHouse.ca Giller Prize Winning Author of Bloodletting & Miraculous Cures, Vincent Lam

To be honest with you, I didn't want to do this interview.

On the morning of, I had yet again fallen behind on my readings, nearly lost the battle with my body to pass the 36-hour stress marathon I subjected it to, and all the while trying to manage a small fundraiser I set up that was slowly coming to an end. Furthermore the interview, as far as I knew, was a no-go two days prior, as I was informed by a publicist for the Word on the Street Festival that Lam was waxing poetic with our neighbours down south. I was let down and had moved on to another author, who evidently was unavailable as well.

On the day of the initial interview date with Vincent said publicist informs the phone interview was still an option. I reluctantly took it, knowing I had about 30 minutes to come up with some decent questions. Armed with questions that either solicited answers too long for the allotted 20 minutes, or were completely irrelevant to his book, Bloodletting & Miraculous Cures and a vaguely-formed analysis of the novel this newbie journalist was ready to take on the Giller prize winner and biggest Canadian writer.

Since previous interviews all dealt with his process as a writer as well as Margaret Atwood's seminal role in helping getting the book published, I decided to delve deeper into the book's themes and today's pressing health care issues.

The Strand: Michael Moore's recent documentary, Sicko, seems to have brought the issue of private VS public health care in the limelight, both in the States and over here. There are a lot of private clinics popping up in Canada, providing treatments, such as orthopedic surgery, that Canadians usually have to endure long wait times to receive. I know there's one in British Columbia and a few in Quebec. Do you feel that we're edging towards a private health care system? If so, how will it affect the public sector?

Vincent Lam: I think that there is a very small group of physicians who are interested in private activities, and a certain split within the physician community and a minority of physicians who are interested in pursuing these other models of treatment . But I think that it's very telling that these things occurred in particular fields that offer specialized services, and the reason that it has come up is frankly because those are the types of services that can be offered and money can be made, but the health care system has a hole in terms of equality. Sure, doctors can do MRI scans and charge patients a large amount of money for them and make a profit but I'll argue that it's much more difficult to run an inner-city primary care clinic for disadvantaged people and make money. So I think that once the observations just from the type of services being offered which I would make should point out to us that for-profit care is not the best system as a whole. I just don't see someone opening up a for-profit clinic for disadvantaged immigrants in Canada.

TS: That makes sense. With the prospect of making more money, some doctors would eventually want to cross over to the private sector, causing a shortage in the public sector, and that would ultimately affect disadvantaged people, who can't afford the fees private doctors demand.

VL: Yeah, and I think there's a danger when the motivations in doing care change. For example, if someone is running a private CT, MRI or orthopaedic procedure clinic then of course, at least part of their motivation - and I'm not saying all of their motivation if they're responsible health care professionals - but part of their motivations is to get people in to generate profit. This is not necessarily in the best interest of the individual patient who's being cared for, it's one thing to say that we're going to get you the services faster, but the question is: Are these the right services for you?

Imaging is a good example because it's very easy to perform a scan. But if the results holds that scan are indeterminate - as they often are - if the results shows something that's X centimetres big and could represent any of five possibilities and we don't know what those five possibilities are then the information from the results leads to other procedures such as a biopsies - essentially a different set of imaging procedures - and all of these things carry their own complications with them and so it's a common conclusion that we find ourselves in even in our current system that we perform tests for good reason but we end up with results that are difficult to interpret. And end up with results that require additional procedures which may give additional risk of harm to patients. I'm using diagnostic imaging as an example just to illustrate this point but you know the example is prevalent in many types of patients and procedures but

I would rather go to a doctor whose ordering the tests just because they think it's the right test, and I would rather not be going to a doctor and have to think "gee, I know they're ordering it for me, but could they have more reasons to ordering this test? Is there some profit motive to this?"

As a patient I'd rather not think about that and just go to a doctor who's thinking only of my interests. And if that means that I live in a system where sometimes a CT scan is not available quite as quickly but nonetheless is available when it's needed then that to me, as a patient, that is a very worthy trade-off.

TS: I'm pretty aware of the flawed characteristics and bureacracy of the health care system. A minor health problem had me racing to several different doctors who gave varying diagnoses and occasionally directing contrasting opinions. It seems, and I'm not the only one to say this among those I know, that the more opinions you get the more it becomes fragmented and bewildering, because every body is coming from a different perspective. Of course the degree of discrepancy between opinions varies depending on the specific case in question. I'm a lot better off than I used to be, with no physical restrictions whatsoever, but it must be very frustrating for those who have it worse...

VL: It's very scary, in any health care system, to have a serious health problem. One thing that I would say about the Canadian health care system and I know it's true in the U.S. as well is that what we really need, more than any discussion of private health care, which I think is no direction to go in, is co-ordinated information systems.

One thing that I think is very inefficient in the health care system is the flow of information. We live in a world and society where people are mobile. People end up getting their health care in different hospitals and clinics and often we still have an information system that is more appropriate for a small-time hospital where you have one set of records and the clinical notes are tucked away somewhere in some section of a paper chart in medical records, and all these things can really really slow down care and very confusing if you are trying to get second opinions.

I think that the real enhancement that we should be looking to in our health care system, is co-ordinating health care systems and frankly that is much easier to achieve on a national and provincial level than we have a single-payer co-ordinated health care system. I can't imagine the nightmare of trying to achieve that in a U.S. health care environment - with the multiple payers, various patient enrolls, and a jungle of different payment plans.

TS: On the subject of efficiency in health care, as I was reading I began to suspect that Ming and Sri's contrasting attitudes toward providing health and the field of medicine in general symbolically representing the two approaches to health care as we know it today - the Western, technologically-driven, objectively-determined health care that considers only the material aspects of a person's well-being as represented by Ming, with her cold and distinct demeanour, yet precise and calculating technical skill. On the other hand Sri - his Hindu background supporting the idea - takes a more sensitive and intimate approach when dealing with his 'patients' (I'm specifically referring to the cadaver scene where Sri's culturally-determined superstitions compel him, out of respect for the soul that once inhabited the body, to deviate from a surgeon's modus operandi and take a different approach to examining 'Murphy', as he calls him.), essentially reflecting Eastern medicine's consideration of a person's psychological and spiritual well-being. Alas, as I read on, you didn't seem to develop this undertone so I was probably off the mark. Nevertheless, this convergence of these approaches to healthcare is prevalent these days, with acupuncture and body works like Tai Chi and Yoga - with the basic tenet of "slowing down" - becoming mainstream.

VL: The first thing I'll say is I have a very close friends and relatives who are medical practitioners of Eastern and Western medicine, and if you're interested in this kind of thing you should look up the website of my uncle Dr. Paul Lam (http://www.taichiproductions.com/). He is a Western-trained family doctor in Australia and practices Acupuncture, runs a Tai Chi school and has written a series of Tai Chi books and videos. I mention him because his approach is the same view that I would take.

The Western tradition has gone through many cycles of treatments that we no longer do but the discipline is becoming quite rigourous, especially in the last hundred years. I don't think we should throw that out.

I think that in the past century we've actually reached a point where more and more Western medicine knows what it's doing and I think that the interesting thing is that many alternative practices may in terms of scientific rigorousness be where Eastern medicine was, say, three centuries ago in that there is an intellectual thought process there. There may be some good forms of alternative therapy but things also need to be looked at carefully, studied and regulated.

However, I think that there are many things that fall within what is often called "alternative therapy" which to me don't seem that "alternative" at all. Tai Chi, for example. Sure it's an Eastern tradition but is very much a form of gentle and healthy exercise about mobility. Something like massage therapy - how can anyone argue against that? It feels great!

There are practices that I would say are much more suspect and would treat with a lot of circumspection, [such as] any alternative therapies that involve putting pharmacologically active substances in the body - studies have shown that what is on the label is not necessarily what's in the bottle. People have this perception that it's harmless, because it's natural and herbal. That's a misconception, and I would seriously caution against putting into their body something of unknown constitution with questionable science behind it.

One of the things you mentioned was the Eastern concept of "slowing down," and really I think that at this stage the most important thing we can do in our society in terms of promoting health actually has very very little to with therapeutic health care. I think that the construction of modern cities seriously have to be reconsidered. Quite frankly the suburbs are an issue and the model of driving for an hour to commute from one place to another doesn't make a lot of sense really - it doesn't encourage activity, it doesn't encourage you to interact with your neighbour.

In a very basic way we understand that if people are more physically active and healthier, if people have more social connection with people around them, they're happier. The sensible thing to do for health has nothing to do with doctors. For example, I'm a big supporter of Bob Rae's "Rae Days". I thought it was a brilliant idea, give people a little bit of time off, have a little bit less money, wouldn't they be happier? Of course they weren't happier, and certainly afterwards the honourable Mr. Rae was no longer in office. That [i.e., people not content with Rae's plan and Rae's departure] to me is tragic, because that's the thing we should be thinking about in our society. Wouldn't we be happier if we worked a little bit less and spend more time walking?

TS: Going back to Tai Chi and Eastern practices in general. I think the fundamental thing that separates Tai Chi and, say, Yoga, from body-works like weightlifting are the effects upon human consciousness these practices have. The so-called expansion of the self or developing and maintaining feeling-attention in the entire body on a moment-to-moment basis. When it comes to Western medicine human subjective experience/awareness is often not taken seriously. Only recently have scientists begun to explore consciousness from a material standpoint - Running EEGs on meditators to examine changes in brain-waves that correspond to physiological changes. But, otherwise, that aspect of existence has largely been overlooked in medicine.

VL: You're absolutely right. I think what has happened in Western medicine for the past hundred years is that it's been successful in small questions, and in terms of posing small answerable questions and developing single useful drugs but the challenge for Western medicine - which has been reductionist for some time now - will be how to make it meaningful for people. How do we not lose sight of what we [doctors] are actually supposed to be about, and the ultimate challenge will be, how do we speak to human experience and consciousness? These are gigantic questions, but I think that if Western medicine doesn't embrace those questions over the next few decades, then the danger is us becoming more and more like tradespeople, more and more like mechanics and tinkerers. Yeah, we do need people who are specialized in things like joint replacements, but as a system, as an intellectual movement.

As a profession we are missing something if we think that all there is to medicine.

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