Radio Interview - Dr Bill Glasson talks health with Jeremy Cordeaux, Radio 5DN

                                               Doctor, thanks for your time.

DR BILL GLASSON: Thanks Jeremy, thanks very much, and good morning to everybody listening this morning.

CORDEAUX:                         Mark Latham says that this election is a referendum on Medicare.  What do you think of that?

GLASSON:                            Well I think he's about right.  I think health and education, Jeremy, will be the two key issues, I think, that a lot of people ultimately judge the two major parties on.  Obviously security issues are important and there's other broader issues. 

                                               But I think at the end of the day the people that run the household budget, which generally are the females, the mums out there, really want to ensure that they can get the proper education for their children at the right price, and also that they have access to medical services at an affordable price as well.  And also that they have a doctor in the first place. 

                                               So, I think that education and health are the key issues, there's no two ways about it.

CORDEAUX:                         Would it matter - and this is the thing that rattles around in my mind when the health issue comes up, and I've never satisfied myself as to the answer - would it really matter if you threw tens of billions of dollars at health?  Would it not simply soak up all that money and there'd still be waiting queues for elective surgery and complaints and people in emergency wards and that kind of thing?

GLASSON:                            Jeremy, you're right, you could throw the whole GDP at health and you still would probably be able to throw more, particularly around preventative medicine.  And I suppose that's the area that we put very little money into, and it's probably where we should be targeting more funds to try and prevent diseases. 

                                               But we can become healthier and healthier and live longer and longer, but ultimately you have to die.  And it's the dying process that's often very expensive in the sense we spend a large part of our health budget in our last five years of life for obvious reasons. 

                                               And, but you say, it's a bottomless pit, it's... and therefore it's on us upon us to make sure the money we do spend, we spend appropriately, we target it at those that are most in need, and we try and ensure that there's equity of access across wherever you live in this country.  And that you and I can afford it. 

                                               I'd hate to think that, you know, I can't get the medical services that I require because I can't afford it.  I think the one great thing about the Australian system, as compared to, say, the American system where the large percent of patients over there just can't afford and don't have any access to medical services.

But we live in this country, you can get the best, highest quality medical service anywhere in the world.  And I think Australia should be proud of that and proud of the system we have.  We've got to make sure we don't throw the baby out with the bathwater here.  We identify where the pressures are and fund those pressure points to make sure that we continue to have a great system.

CORDEAUX:                         Technology is very expensive and we all want the most whiz-bang technology to further our lives and relieve our pain and suffering.

And drugs cost an awful lot to research.  I mean isn't there a limit beyond which medical science and the taxpayer should not go?

GLASSON:                            That's right.  I mean ultimately as we get smarter and smarter we can do things better and better.  We will be able to keep you not only alive longer, but you'll have much better quality of life. 

CORDEAUX:                         Yeah, but am I worth it?  Don't you think society has to say, now Jeremy's a nice bloke, but, you know, a little like the six million dollar man, we've got the technology, we've got the money, we'll save him.  I mean clearly they should have let him die.

GLASSON:                            That's the debate, I think, society has to have, Jeremy, that's absolutely right.  I've got my father in an aged care facility at the moment and he's a fantastic man.  He was really fit up until Easter when he had a stroke and then two weeks later another stroke.  And he's lying there in this body, he's frustrated, he doesn't particularly want to be there, to be honest with you. 

                                               And I suppose we have to ask the question, how aggressive do we get with his treatment if he develops, you know, a chest infection or whatever sort of illness it may be?

What does he want, I suppose, is what I ask myself, not what do I want.  And it's not a matter of deciding when he must or must not go, it's a matter of deciding how much further intervention we... or how many further dollars we're going to spend on keeping him alive for what quality.  And I think at the end of the day we've got to decide what quality of life we're giving people.

                                               Now people who have got quality, I don't care whether they're 120 or 130, if it requires a bit more money to keep them going, so be it.  As long as we're delivering quality, not delivering sort of somebody lying in a nursing home with really no future and frustrated with their position in life, I suppose.

CORDEAUX:                         Now what do I read into that answer though, who plays God?

GLASSON:                            Yeah, I think that's right and I think that's... at the end of the day it must never be the doctor, that's full stop, and that's why this whole debate, I say that that's not for the profession to have, it's for the community to have. 

                                               And I think that's... I'm a great believer in this... these advanced health directives.  And my father did... has filled out one of these, where in this form he clearly enunciates what he wants and what he doesn't want.  So we as a family can look at that and say, well listen, dad doesn't want to, you know, be fed by a tube and dad doesn't want to be... done X Y and Z to him if he's in his current level of health. 

                                               And so it helps me, I suppose, guide, not as a doctor, as a family member, to tell the doctor what we as a family would like for dad.  And so I think that's why it's not for the profession, it's for the community to talk about this, debate it.

And as I said, it should be in the form of an advanced health directive where we know what our loved ones would like if they end up in a position where they can't make a decision for themselves.

CORDEAUX:                         You see, I would rather the doctor made the decision.  I think doctors have been making those tough decisions forever, they've been doing it quietly, and I believe, by and large, they've been doing it correctly.

GLASSON:                            You're right, Jeremy, I admit that, I admit the fact that as a doctor we have to make decisions all the time about what is in the best interests of that patient.  It's not... it doesn't come down to saying, well look, we'll just spend a whole lot of money, it comes down to what quality of life am I delivering that patient. 

                                               And if it means keeping the patient alive for another, you know, six months with no quality, or, having them pass away with the family around in peaceful, painless conditions, then, you know, you can withdraw treatment.  I'm not saying you are exacerbating the cause to death, but you withdraw treatment or don't intervene with treatment that will just prolong a patient's life for a smaller period with no quality, I think, that's all about.

CORDEAUX:                         We've done lots of programs and segments on transplant, the miracle of it, the need for it.  Seldom do we talk about the expense of it.  What's it cost to have a heart transplant?

GLASSON:                            Oh look, it's a very expense... I can't tell you off the top of my head what it would cost.

CORDEAUX:                         It would be hundreds of thousands of dollars.

GLASSON:                            Absolutely. I mean basically when you talk about the technology required, the staff, resources required, the nursing, intensive care resources required, it is, it's a huge, huge amount, it'd be hundreds and thousand of dollars, et cetera.

CORDEAUX:                         But don't we have to ask then, you know, Jeremy unfortunately, genetically he just drew a bad hand when it came to his heart.  Now that's... why don't we just accept that, you know, Jeremy has got a heart problem and he's going to push off considerably earlier than he otherwise would?  Why should I put my hand up and say, I want someone to pay hundreds of thousands of dollars and give me a new heart?

GLASSON:                            I think if Jeremy has been born into this life with unfortunately weak heart...

CORDEAUX:                         Don't I accept that?

GLASSON:                            Well, I think you can accept that.  But the reality is that we do have technology there to try and help you, and I think that in that situation where the rest of you is fit and healthy, and you've got a very sound mind, then I don't mind spending my taxes to ensure that you have some sort of quality of life.  If you're a young man with a young family and responsibilities, I think it is upon us as a society to ensure that you get the appropriate care, what... to be honest with you, whatever it costs.  

                                               I think the doctors have to say, this is what you require, and ultimately the system will say we can afford it or we can't afford it.

But, I think the good thing about it is that we get... out of all these transplants, we get advances all the time, Jeremy, we actually learn things, we can actually get better technology, we can actually get, you know, ultimately either see mechanical hearts, and we can actually do it cheaper and in a much more effective way. 

                                               So though the technology is expensive, and the operation is expensive, and the drugs that they're on in the long-term are expensive, I think that obviously for that particular person concerned it is a lifesaving operation.  And the fact they can go on and live, and love their family, and work, and be a contributor to society, that's what it should all be about.

CORDEAUX:                         And how do you feel, as a doctor, if I'm a smoker and you lavish all of those extraordinary heroic efforts on me, and I go right back and say, I'm going to continue smoking?  How do you feel about that?

GLASSON:                            Look Jeremy, you've hit one of my sort of, I suppose, very biased points.  I think if in a situation where people smoke and they have a medical problem as a consequence, then I think if we're going to spend a whole lot of money on them it beholds upon them to, first of all, stop smoking.  And I'm a firm believer that if a doctor says, I'm not going to operate on you until you stop smoking, then that's the doctor's right because you are putting yourself at huge risk by continuing to smoke. 

                                               But if you went through an expensive operation, then take up smoking again, then that is just totally irresponsible and unacceptable.  And so I think the patient has a responsibility here and that responsibility need to be laid out very clearly prior to embarking on one of these expensive processes or procedures.  And that if, you know, if they turn around and decide they want to smoke further, well I think that you don't withdraw treatment, but I think that it beholds upon them to, I suppose, accept the consequences, and that is that they're going to obviously, you know, make them more at risk of all sorts of complications as a consequence of that, full stop.

Ends