Baby’s got back (problems)

Apologies in advance – this is going to be a long post that doesn’t mention Macs, digital downloads or murdering cartoon characters. Apart from that sentence, heh.

Just over ten years ago, I had a disagreement with a bit of gym equipment and ended up with a slipped disc. Ever since then, I’ve knocked my back out with alarming regularity, and it doesn’t take much: a few years back I managed to slip a disc picking up a piece of paper, which was rather embarrassing. So when I knocked it out yet again fitting an oven, I wasn’t particularly surprised. Here we go again, I thought. Painkillers, physio and a good bit of self-pity for a few months.

Unfortunately, the problem didn’t go away after a few months – painkillers and physiotherapy helped a little bit, but whatever the underlying problem was this time, it didn’t respond to treatment. Falling down a set of concrete stairs soon afterwards didn’t exactly help, either.

The current back problems started in April, and after the usual physio and painkillers I was discharged in September on the grounds that the NHS had done as much as it could. They’d given me some exercises that helped a bit, but it was pretty obvious that the underlying problem hadn’t been addressed. I spoke about it with my GP a few times and he agreed that the only way forward was for me to get an MRI scan to find out exactly what was knackered; unfortunately, tight cost control by the local NHS funding body meant that an MRI was out of the question. Too expensive. As my GP explained, if I had lost all sensation in my feet and all control of my bowels, then he could get me an MRI within a few months; otherwise, a scan was out of the question.

I’m the first to admit that my back problems aren’t that serious: while I can’t lift weights or do DIY, I’m still mobile. But it’s still debilitating, because I can’t sit still for more than a few minutes before my back goes crazy. The biggest problem for me is sleep, or lack of it: I can’t sleep for long periods without waking up in pain. To put it simply: I’m bloody knackered.

By November I was starting to think I’d never get better. I did find one source of help, though: Squander Two recommended a chiropractor called Ian Dingwall and described him as a miracle worker, and he was right. Half an hour of being beaten senseless by Ian doesn’t fix the back problems, but it does make them much more bearable for a few days. Best of all, Ian has seen the film Jacob’s Ladder and understands my fear that if he cracked my bones too hard, I’d end up having Vietnam flashbacks (if you haven’t seen the film, that won’t make a great deal of sense. Heh).

In January, it became obvious that there was a pattern developing: Ian would throw me around the room every week, and after two or three sessions there’d be an improvement in my overall situation; on the fourth or fifth week, I’d be right back to square one. Both Ian and my GP agreed: something needed to be done.

Of course, an MRI was still out of the question: my doctor was sympathetic and frustrated, because he reckoned I needed a scan but couldn’t refer me for one. We discussed seeing a neurosurgeon, but the waiting lists were very long just to get an initial appointment – so I decided to go private.

I was already getting private medical treatment to some extent – Ian’s services weren’t through the NHS, so I was paying £30 a week for treatment – so I had some idea of the speed at which things happen. But I was still surprised when I called to make an appointment with a neurosurgeon and saw him within four days. Of course, such a service comes at a price: £130 for a 20-minute chat. During that chat we discussed various options, and agreed that an MRI was an essential next step.

MRIs aren’t cheap, but it seems that they’re cheaper in the private sector than they are in the NHS. Whenever I discussed MRIs with my GP, the figure of £1,000 was bandied about; Glasgow’s private hospitals – Ross Hall and Nuffield – do them for £450 and £350 respectively. As with the neurosurgical consultation, they happen quickly too: four days between phone call and scan, and another two days to get the scan results.

Incidentally, MRI scans are bloody terrifying. They manage to combine every bloke’s fear of hospitals with every person’s fear of being buried alive; according to the nurses at the hospital, the majority of people who’ve had an MRI scan vow never, ever to have one again.

The other thing about MRI scans is the “black dog” problem: if someone says “don’t think about a black dog”, you immediately think of a black dog. With an MRI, you’re told not to move a muscle – which means that your body immediately wants to start disco dancing. It isn’t helped by the noise the MRI scanner makes, which is a rhythmic, electronic pulse that sounds like a Kylie Minogue backing track.

Thanks to the MRI scan, I know exactly what the problem is – two prolapsed discs, pressing against nerves and generally making me grumpy – and what my options are. Some form of back surgery is almost inevitable, and while I’m scared to speculate on how much it will cost I know that by going private it’ll be over and done with quickly.

There is a point to this, honest.

So far the combination of chiropractic treatment, consultations and scans has cost a few thousand quid – while waiting on physiotherapy last summer, I spent hundreds on osteopaths and other alternative treatments – and by the time I get surgery (and follow-up treatment) the whole bill is likely to be several thousand pounds. Private medical insurance would have cost me a fraction of that amount but like many people, I assumed that if I had a problem the NHS would be able to accommodate me.

I was wrong, of course. The problem is one of money: there’s only so much money kicking around the NHS, and we’re placing more demands on it by the year as we live longer, as we find new ways to treat people, as medical advances enable us to do things we’ve previously been unable to do. While politicians fiddle with the NHS every few years, they’re not fixing the fundamental problem: the NHS can’t do everything.

No politician in their right mind would suggest this – it’s a guaranteed vote-loser – but one of the obvious ways to solve the NHS problem is to tell people like me, “you’re working, so you should have health insurance”. That would return the NHS to its original role as a safety net for people who can’t afford private treatment, and as a provider of accident and emergency care. For everything else, you’d need medical insurance.

Whenever such a thing is suggested, there are howls of protest. Do we want an American-style system? I used to think the same, but there was a fascinating article in last week’s Spectator that made me rethink my attitude. The US healthcare system is regularly used as an example of what we don’t want in the UK, but as the Spectator article pointed out, in many respects it’s superior to the NHS. In almost every conceivable area, waiting lists are much shorter, treatment is more effective and in the case of potentially fatal illnesses, survival rates are considerably higher than they are in the UK.

Suppose you come down with one of the big killer illnesses like cancer. Where do you want to be — London or New York? In Lincoln, Nebraska or Lincoln, Lincolnshire? Forget the money — we will come back to that — where do you have the best chance of staying alive?

The answer is clear. If you are a woman with breast cancer in Britain, you have (or at least a few years ago you had, since all medical statistics are a few years old) a 46 per cent chance of dying from it. In America, your chances of dying are far lower — only 25 per cent. Britain has one of the worst survival rates in the advanced world and America has the best.

If you are a man and you are diagnosed as having cancer of the prostate in Britain, you are more likely to die of it than not. You have a 57 per cent chance of departing this life. But in America you are likely to live. Your chances of dying from the disease are only 19 per cent. Once again, Britain is at the bottom of the class and America at the top.

How about colon cancer? In Britain, 40 per cent survive for five years after diagnosis. In America, 60 per cent do. With cancer of the oesophagus, survival rates are low all round the world. In Britain, a mere 7 per cent of patients live for five years after diagnosis. In America, the survival rate is still low, but much better at 12 per cent.

…Look at any proper measure of the capacity or success of a medical service and one finds, again and again, that America comes out better. In Britain 36 per cent of patients have to wait more than four months for non-emergency surgery. In the US a mere 5 per cent do. While in Britain the government celebrates if the waiting times get a bit lower, in America they don’t do waiting.

There are more American doctors per patient so, not surprisingly, patients have more time with their doctors. American patients also get to see specialists as a matter of routine whereas in Britain 40 per cent of cancer patients, for example, don’t see a cancer consultant. There are shortages of specialists in many areas of medicine in Britain.

The article points out that in the US there are more doctors per patient, more MRI scanners (and crucially, the scanners work around the clock; in the UK, they run during office hours), more surgical consultations, and so on. It also demolishes the myth that poor people are ignored, while accepting that the US system is far from perfect (US healthcare is ruinously expensive and leads to a huge numbers of bankruptcies, but there’s a safety net for the poor; the problems tend to affect people in lower-paid jobs or temporary unemployment).

The full article is now behind the Spectator’s pay-to-read barrier, but if you Google for “Die in Britain. Survive in the US” you’ll find the text on the web (I won’t link directly as it’s infringing the Spectator’s copyright). It’s fascinating stuff and while I’m sure some of it is flawed – articles that rely on statistics usually are – it’s still very interesting.

We’re weeks away from a general election, and as ever the various political parties will be claiming that health is their number one priority – but no matter what party you listen to, you won’t hear anyone suggesting a major revamp of UK healthcare; instead, you’ll be presented with various different versions of the same approach. The politicians are running around with sticking plasters when what the NHS needs is major surgery.

Update, 10 March

If anyone’s interested, my neurosurgeon has ruled out back surgery because the potential benefits don’t outweigh the risks. So it’s drugs, drugs, drugs from now on.