The XX Factor: What women really think.

A Guest Post on Socialized Medicine, CT Scans, and Natasha Richardson

This post comes from Tim Noah, a Slate-ster of the XY variety who has written extensively on health care in the United States, in response to our conversation about Natasha Richardson and socialized medicine:

The Great Debate about whether socialism (in the form of Canada's single-payer health care system) killed actress Natasha Richardson turns largely on the availability of CT scans. In the March 26 New York Post, a stateside physician named Cory Franklin wrote:

Richardson's evaluation required an immediate CT scan for diagnosis-followed by either a complete removal of accumulated blood by a neurosurgeon or a procedure by a trauma surgeon or emergency physician to relieve the pressure and allow her to be transported.

But Sainte-Agathe-des-Monts is a town of 9,000 people. Its hospital doesn't have specialized neurology or trauma services. It hasn't been reported whether the hospital has a CT scanner, but CT scanners are less common in Canada.

Two days later Max Harrold, a reporter for the Vancouver Sun, acting on a hunch that at the very least Sainte-Agathe-des-Monts has telephones, phoned the radiology department of the hospital in that remote town to which the actress was taken after she complained of a headache. Do they have a CT scanner? They do.

I take Rachael's point that the United States has almost five times as many MRI machines per person as Canada, and about 1.5 times as many CT scanners. But this is not an unmixed blessing. In her excellent book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, Shannon Brownlee writes, "In cases involving a head injury, giving a patient an unnecessary CT can be almost as bad as not ordering a test and missing a brain bleed" because a CT scan can render a false negative and/or cause unnecessary delay in treatment. A common complaint about contemporary medicine is that doctors are so fretful about malpractice lawsuits and so enamored of medical technology generally that they over-rely on high-tech imaging at the expense of more reliable diagnostic methods. British doctor/blogger John Crippen writes:

These days, and particularly in the medico-legal climate prevalent in North America, it would be a brave doctor indeed who did not wait for the CT scan before drilling the burr holes. It would be a career making or career breaking decision. Few American doctors are brave. Defensive medicine is the order of the day. You cannot have a migraine in the USA without someone ordering an MRI scan.

Had this accident happened at base camp on Everest in a helicopter-blocking snowstorm, a doctor would likely have drilled. Had this accident happened in a ski resort forty years ago, before CT Scanners had been invented, a doctor would likely have drilled. Then a subdural/epidural haemorrhage was a clinical diagnosis. Apparently minor head injury, lucid interval, headache, sudden deterioration in consciousness, a dilated pupil ... all adds up to an obvious diagnosis.

Medical technology has deskilled doctors.

Also, she really should have worn a helmet.

Socialized Medicine and Natasha Richardson

It makes me uncomfortable when individual medical cases become fodder for national debate, from Terri Schiavo to Natasha Richardson. It seems macabre to turn a family's private grief into a public debate. But since you brought it up ...

You make a valid point about helicopters: They are perhaps overused here. I certainly wouldn't want to use one in the event of non-life-threatening injuries.

But I had a different takeaway about what makes Natasha Richardson's death the fault of socialized medicine. The New York Post's article on this matter suggested that the first hospital that Richardson went to might not have had a CT scanner and that by the time she got to a hospital with one, it was too late. This blog post says that she did have a CT scan at the local hospital, but that she wasn't transferred to a larger hospital with a trauma center for another three hours.

Either way, it sent me a-Googling for numbers comparing the United States with Canada. During a conversation with a friend who'd just had an MRI, my friend told me that the MRI tech had told her there are more MRI scanners in Orange County, Calif., than there are in Canada. If that's inadmissible as hearsay, there is this: Canada in 2007 had 419 CT scanners and 222 MRI scanners. We have more than 10,000 MRI scanners in the United States and more than 6,000  CT scanners. Even if you account for the population difference (33 million people in Canada vs. 300 million in the United States), this country is outfitted better with high-tech life-saving medical equipment.

Did socialized medicine kill Natasha Richardson? I don't think we can say one way or the other, and I hope that her family is able to ignore the hubbub and grieve in peace. Health care in this country is far from perfect. But even with all the problems we have, this is just one reason that I'll take my chances in the United States over Canada any day.

Did Socialized Medicine Kill Natasha Richardson?

Has anybody else been picking up on the effort to create a comparative health care storyline out of the Natasha Richardson tragedy? A friend mentioned a couple of days ago that she wondered if Richardson's death from "talk and die" syndrome would have been prevented had she fallen sick in the United States, and then today, this PR e-mail from a think tank that promotes health savings accounts arrived in my inbox:

NEWS REPORTS REVEAL NATASHA RICHARDSON’S DEATH MAY HAVE BEEN PREVENTED WITH U.S. HEALTHCARE

Lack of Equipment Under Government-Run System Delayed Lifesaving Measures

Washington, DC – News reports of the skiing accident, medical treatment and eventual death of actress Natasha Richardson last week shed new light on the limits of the Canadian health care. The timeline of the afternoon’s events indicate that the lack of medical equipment—a trauma helicopter and basic CT scanning equipment at the local hospital—delayed the treatment that may have saved her life.

Well, it's certainly possible. But I'd hope the Natasha Richardson Proof—the Canadian health care system didn't work perfectly for Richardson, ergo it sucks—doesn't become some major PR tactic during a health care debate, because it's a serious case of missing the forest for one tree.

A trauma helicopter might have helped Richardson, but on the flip side, in the United States such helicopters are generally way overused, in part because they're profit makers and because the burden of their costs is distributed in such a way that it isn't appropriately felt: This past September, a Medevac chopper crashed in Maryland, killing three personnel (including one ambulance volunteer, a gig I've done) and one of the two wounded girls it was transporting from the scene of a car crash. Both girls originally had non-life-threatening injuries. "We've just gotten into a situation here in the United States where we think that the helicopters are a panacea," an emergency medicine researcher told the press after the accident. The September crash, sort of the reverse image of the Richardson incident, could be considered an event in which the overabundance of medical equipment killed.