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Patients wait as PET scans used in animal experiments

From Thursday's Globe and Mail

'This is absolutely the world upside down,' doctor says ...Read the full article

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  1. Scot Loucks from Pickering, Canada writes: My condolences to Mr. Graham on the loss of his courageous wife.

    This is an outrage and an example of why we need two tier health care in Ontario. Why aren't we buying more of these machines? Why aren't we buying the injection used in bulk to lower the costs? Why can't the beaureaucrats see that it will save us money and lives by treating an identifiable problem properly?

    And my health tax pays for what Mcsquinty?

    Letting private enterprise into health care will not only (eventually) lower the costs, but provide efficientcies that our provincial government aren't even capable of imagining.
  2. Alistair McLaughlin from Ottawa, Canada writes: Absolutely astounding. Rather than allow those who can afford it to pay for the $2500 procedure, the hospital allows the machine to be used for experiments on dogs and cats. I'm sure the person who came up with the PET acronym never considered the irony.
  3. Anton Berger from Kelowna, Canada writes: 'Dr. Prato stressed he did not want the public to think a clinical instrument that could be used on patients was instead being diverted to animal research. In fact, he said, empty patient slots are occasionally filled to do animal research so the machine does not go to waste.'

    my question is, if there are people waiting for PET scans why are there 'empty patient slots'? perhaps it's because we already have a two-tier system. animal testing pays better than people do.
  4. Rock n' the Boat from London, Canada writes: Do you still believe that we do not have 2 tier health care. It even runs cross/province. Do you know a Doctor personally or are you a high level civil servant. If you are just a regular Joe it's a roll of the dice.
  5. General Wolfe from Wolfe Island, Canada writes: I think that Scot Louks (1) and Alistair McLaughlin (2) should re-read the article. It seems that we already have two-tiered medical care with respect to PET scans. I believe that the article states that anyone who wishes to pay for the procedure can get it done at a private clinic in Mississauga. The reality of medical care in this country is that it is already two-tiered in that anyone with the cash and the need can avoid wait times by heading to a US or other offshore facility. What governments in this country must do is accept that two-tiered medical care is a reality and that its continued growth cannot be restrained. Those with money can always find what they need. When governments accept this fact and stop mouthing the platitudes about equality of access, perhaps we can develop a system that is less costly to the public purse, entails co-payment by those with resources, and allows for the expansion and overall improvement of the facilities and resources in the medical care system.
  6. Globular Cluster from Canada writes: The sad reality of our health care system: no heroics are used to save lives even though it IS possible. That said, the problem of using such expensive machines for experiments is widespread. For example, psychology departments routinely conduct MRI experiments on subjects to isolate the brain responses for various stimuli. If they find something strange (they are not physicians but they can still tell if something's wrong), they'll refer you to a physician. Sign up at your local university and get an MRI for free!!!
  7. Kirk . from Ajax, Canada writes: That ghostly image currently wandering the halls of Queens Park trying to kick people in the a$$ is Tommy Douglas.
  8. R DT from Burritt's Rapids, Ontario, Canada writes: This is an extremely disturbing article and has divulged a situation here in Ontario that should provoke an unprecedented attack on the provincial government, Premier McGuinty, the Ontario Health Ministry and to some extent the Canadian Cancer Society for not taking the lead in lobbying for consitent and increased use of this valuable diagnostic tool. The state of our health care re wait times and inequities is a shameful situation. For a government to allow our health system to deteriorate to the point where the largest demographic group (ie. the baby boomers) are at a stage in their lives where health care takes on an ever increasing level of importance is appaling. While the government has allowed such things as doctor and nursing shortages, increased hospital and doctor visit wait times and significant delays and inequities in critical care to become the norm, when they have known for decades that this group of baby boomers were going to need increased usage of the health system is beyond belief. If they are not prepared for this aging baby boomer situation when they have known that it was coming for decades then one must seriously doubt their ability to be properly prepared to handle something like a flu pandemic. The people of this province should have very little faith that when they require proper health care that they will get it. It is disgusting.
  9. Pat Gesner from Canada writes: So start new charities to pay for such medical treatments. Maybe thoses who benifited from two teir medical benifits would feel less guilt if they could have it asked at their funeral for donations to such a charity as compared to a general cancer, lung, etc, society donation. Then benifits can be spread out to include Canadians the without money to travel elsewhere. It can directly fund quick care elsewhere or can fund such technologies so that they become more widespread - either through direct purchase of new instruments, rental space, etc. or through training programs to have more staff able to run 24/7. Just make sure the money is spent in Canada -sending that person to Singapore,India or the US is a no, no - the airfare alone would pay for one scan.
  10. joe gortnar from Mississauga, Canada writes: PET scan is used world wide, only in Canada- Ontario our politicians and some doctors are oposed to it. Friend of mine was operated on Oct. 2003 to remove stomach because of stomach cancer. The operation was not posible but if he would have PET scan they would know that they can not remove the stomach. He sufferd for nothing. Went to Germany and first he had PET scan and doctors told him why did they operated on you. Did't YOU HAVE PET SCAN. The operation was done in London Ontario and as we later found out the doctor was aver of PET scan. One asks what should you do. What is the problem. Pet scan will change the way some cancers are treated. Some oncologiest DO NOT wont to hear abaut PET scan.
    News media should be after hospitals, doctors and goverments. Ask oncologist, Cancer Care Ontario........the list is long and the news media has them all as well as the names. This is the scan that cancer patients should have NO QUASTIONS ASKED.

    Joe
  11. DCM DART from Montreal, Canada writes: REALITY CHECK fellow Canadians: this is but one example of how our governments RATION the delivery of health care while giving us the false impression that we are covered. The fact is: Too many Canadians in this country are dying waiting for medical treatment, or waiting in agonizing pain, because of either lack of access or restricted access based totally on budgetary and bureaucratic considerations, not MEDICAL NEED! This is proof of the need for ever greater involvement of private insurance and for-profit delivery of medical services, because NO government can provide everything we want, no matter how much we whine or bury our heads in the sand. I know many people (doctors, nurses, etc.) in our system who are beside themselves with anger and frustration at their inability to get timely treatment for people with serious life-threatening, or pain-causing conditions. Canadians have to stop letting ideology prevent us from opening up access to medical treatment. I can buy insurance for my DOG and get faster treatment for him than most Canadians can get for their own life threatening conditions! Does this make sense to you? I assure you that I will go into debt and pay for treatment wherever I can get it before I let the bureaucrats decide how long I'm going to live!
  12. Michele from the GTA from Canada writes: I agree with #5's assessment of the facts (PET scans are provided privately) but challenge the conclusion that a 2-tier system is therefore justified. Obviously, in this situation, the 2-tier system hasn't worked- the article describes situations where people did have the $$ for a private PET and the complaint is that they had to pay for it. Seems to me that the conclusion that should be reached from the article is that the goverment needs to alter its criteria for PET scans thereby allowing all citizens, whether rich or poor, access.
  13. Timothy Nessus from Somewhere..., Canada writes: OK, let's see... 2.000.000.000 (2 billion) dollars to fitght the Taliban in Afhanistan and 0.000.000.000 (ZERO billions) to fight Cancer in Canada... Yeah... that makes sense... IF YOU ARE HARPER!
  14. Arnie Aberman from Canada writes: The lack of outrage by hospitals and doctors is the result of our government monopoly health system. Hospital executuves have to agree not to criticize government policy in their accountability agreements. Doctors are paid by government so there is a chilling effect on their willingness to criticize.

    Do you think if newspapers got all their funding from the provincial government this article would have appeared.
  15. Dan Stevens from Winnipeg, Canada writes: #3, the point is that people are not waiting for PET scans. The restrictions that the Ontario government has put on the use of these machines assures that most cancer patients are ineligible. This is an unconscionable situation in Ontario.

    Dr. Evans states that the 'clinical trials' being done in Ontario are of value, but his statements are demonstrably false. The medical literature is replete with well-conducted studies of PET scanning. The studies currently being done are redundant, and are done on the backs of Ontario cancer patients.
  16. Rich L. from Canada writes: well, the title of this article is certainly eye-catching (if a bit misleading). I read a similar story having to do with PET scans in the U.S., but haven't been able to find the article, so I don't have the specifics. The gist of it was the same as this story, and the speculation was that health insurance companies in the States were loathe to have PET scans recognized as an effective tool in diagnosing and treating cancer, for fear of having to pay for it. sounds about right.
  17. Maurice Coombs from Unionville, Canada writes: I don't think anyone should be surprised at the situation described in this article. It is the natural result of allowing Government to be involved in clinical decisions. Government's role should be limited to managing the funding for the medical system. We have more than enough evidence in this country that when bureaucrats become involved in medical decisions the result is confusion and chaos.
  18. Douglas Skinner from Kitchener, Canada writes: While we allow politicians to wallow in platitudes like 2 tier medicine doesn't exist we will continue to have a second rate medical system. The solution is so simple. If you were allowed to pay $2500.00 for a PET scan tthe London machine will be available for people who can't pay. The PET machine will operate 24 hours a day and save lives. Where's the problem? Medicine, tests and drugs are more and more expensive. Let those of us who can pay. Everyone will benefit.
  19. Wine Lover from Ottawa, Canada writes: General Wolfe (#5), you are right on target. I simply do not understand why our entire health system is set up on the model that no patient should pay any direct costs when they use health services. If we want to give free health care to people below a certain income threshold as a basic human right, that's fine and proper. But I'm sure that almost everyone else would be happy to pay a monthly premium and a copay IF it meant the system was better funded, more accessible and more timely. We're talking about people's lives and health here: no one with two dimes to rub together is going to accept that they can't have an effective test or treatment just because the government says it's not allowed. The Medicare plan Tommy Douglas set up never could have imagined the expensive, effective health care treatments that would be invented in the decades after he instituted free care for all. It's not sustainable. Instead of 'free' healthcare for all, let's have great healthcare for all. If that means most people pay a bit out of pocket, so be it. It's better than letting the entire system fall into disarray, which is what's happening now.
  20. P C from Canada writes: I guess it truly is a dog eat dog world after all. Especially in Ontario.
  21. James Marshall from Collingwood, Ont., Canada writes: After receiving 12 sessions of chemo for Hodgkins lymphoma, and feeling quite well, I was sent to London to see the radiation Oncologist to determine whether or not I should have radiation as a follow-up to my chemo. As I was feeling fine and getting my strength back after about 15 months of being totally fatigued, I asked if I really needed the radiation. The Dr. wasn't sure but he said there still seemed to be something showing on my lung. He finally suggested a Pet scan at the McMaster Hospital in Hamilton might be the best approach and this was arranged under a 'trial' arrangement. The Pet scan didn't reveal any cancer in my body but when I again saw my Chemo Oncologist some time later, he didn't seem to really 'believe' in Pet scans. I'm still feeling fine and it is now over 3 years since the Pet scan.
  22. Charles Wirrell from Cranbrook, B.C., Canada writes: This is totally unconscionable! Once the government pays for these expensive, hi tech devices they should be in operation 24/7. I am sure folks who need these scans would rather get up at 2 AM one day than wait 6-12 months and be in worse physical health but have a 10 AM appointment, I know I would!!
    For these machines to sit idle because the government could purchase them but is reluctant to fund the procedures to use them astounds me!
  23. J.C. Davies from Canada writes: Absolutely disgraceful. The ony answer is to allow private clinics. For those who are opposed to any private medicine please consider that people are free to pay for healthcare for their pets but not for their family members. This is ludicrous. You can spend money to to save your dog or cat's life but not yur spouse's, child's or parent's life.
  24. Gardiner Westbound from Canada writes: This is appalling! Taxpayers suffering and dying, doctors and technicians standing idle, while a $4-million life-saving PET scanner is used for animal diagnoses. Politicians and civil servants are making medical decisions and it's literally killing us.

    McGuinty's values and priorities are clear. He has wasted $50-million, enough for 20,000 PET scans at $2,500 each, masking his failure to effectively deal with the Caledonia Indian riots. He has to be thrown out of office at the next election.
  25. Jason Fournier from Acton, Canada writes: I'm not sure if #3 was critical of the hospital or the Ontario government, but if blame needs to be levelled, it has to be at our government. This is typical of governments (and insurance companies also) who claim they cover the costs of procedures, when in fact they will only pay a portion of it. Where do people think the rest of the money for treatment comes? The air? Queen's Park and insurance co's don't blink when they stick it to practitioners and everyone wonders why we can't get treatment. Dr. Urbain's comment about 'running a business without money' is right on the hammer. Until the Ontario government owns up to its own responsibility and also legislates insurance co's to do the same, we not see medical practitioners moving here to work (and be paid) or see proper medical technology used.
  26. Mike G from Toronto, Canada writes: This is deeply disturbing. There seems to be a contradiction in unused PET slots, and a registry that has people waiting to get the scan. In this light, it would appear that if I were put on the registry today, then I would get my scan next week. I'm not sure why, if the machines are not being used, that other types of cancer cannot be scanned for. Equally baffling is why the full cost of the procedure is not covered by the government. This leaves me with more questions than answers.
  27. Jonny Roo from Canada writes: # 1,

    Unfortunately you cannot buy the injection in bulk. As it is a short lived radioisotope it decays very quickly. Facilities that operate a PET scanner need to have a cyclotron nearby to produce the injection material. Thus, the dose per injection is more or less fixed.

    The PET and PET/CT (where you can overlay a PET image with a CT image) provide invaluable data to physicians and it's a shame they are being underutilized across the provice.
  28. Self confessed curmudgeon from Toronto, Canada writes: Supporting every special interest group in the province takes a lot of money. That means less is available for social services. Restricting spending to those issues that benefit all Ontarians would get programs like education and healthcare back up to a reasonable standard, but what of all those other great initiatives that might benefit a dozen or two people?
  29. james castle from Canada writes: Well, they're called pet scans. What do you expect?
  30. David More from Kingston, Canada writes: Privatize it entirely. ONLY people (and pet owners) who can afford it should be getting it. The rest are free-riders on us healthy, wealthy, hardworking taxpayers and should just be left to die.
  31. george moe from Algeria writes: To #1 and #2, you need a brain scan 2 tier health care is here and it is working for our elite. But I agree business management in our healthcare system is at kindergarten level because our md's consider themselves next to god and notice how poorly they can manage budgets, hospitals or a 4 million dollar machine.
  32. Dave Medich from Windsor, Canada writes: Some of you people are so 'intolerant'. As 'progressive' Canadians we must stand up for an animal's 'human rights'.
  33. Debirah Holland from Toronto, Canada writes: What a travesty! Politics and medicine simply don't mix. So many lives in the balance, waiting for tests and accurate treatments as time ticks on while essential equipment is underused/misused. What happened to triage? If people can be saved by effective use of this technology, Ontario has the equipment, then there is a responsibility to use it correctly and effectively. When every patient who can potentially be helped through this essential diagnostic test has been treated, then and only then should it be used for animal research. Since we in Ontario are paying for our healthcare through our tax dollars and have little recourse to treatment through private channels, it is critical that we demand transparency and effectiveness. This would never be tolerated in a private company, would it?
  34. David K from Guelph, Canada writes: My suggestion is that all Ontario readers should forward a copy of this article to their local MPP along with a message of dissatisfaction with the status quo. There is an election coming, soon.
  35. Rob Bairos from Toronto, Canada writes: Socialized programs are in the business of rationing, not producing.
    Anyone who still believes enforced equal access to health care is the moral
    route should give their heads a shake.
  36. Chris Edwards from Greater Sudbury, Canada writes: There is no money tree. Advocates of PET scanning see the issue as black and white - but it is not, as with almost all things in health care. Quebec has PET scanners? Good for them - they receive transfer money - Ontario pays it out. Maybe it is a travesty, maybe it isn't - this article was pretty one-sided. To those who can find a way to justify ANY cost when it comes to the health care system, I only ask you this - how much are you willing to pay in taxes? $2500 bucks a scan doesn't sound like much until you tally up all the cancer patients who will be clamouring for this test if it is available, whether they need it or not. Add to that the cost of the machine for every hospital who can put a proposal together to justify the price of one, and then you have to ask yourself how an already enormous and squeezed health care budget is going to rob Peter to pay Paul.
  37. Seb D from Ottawa, Canada writes: The problem seems to be that the Ontario government does not recognize the value of PET scans, not that private clinics need to step in. Yes, there are private clinics who will give you one for a fee, but any number of medical alternatives out there are available for any condition. For example, you can buy 'Miracle Tonic' from a quack for a fee if you want, but that is not two-tier health care. If the Ontario government decided to open up access, then presumably they would make more slots available instead of allowing the procedure to be done on animals where facilities exist.
  38. emilio D from Vancouver, Canada writes: If there are a lot of people in Canada who have the money to pay for PET SCAN privately, why not go to the U.S. and have these procedures done instantly. Why keep whining and clog up the system? Go now and don't destroy the public healthcare system with your private healthcare propaganda.
  39. Louis De Lange from Calgary, Canada writes: As far as I am concerned this is not an outrage about two tiered health care, rather one of mismanagement. Yes, we need more money for health care, but let's start by getting rid of the mismanagement that come up with these rules that allow diagnostic equipment to stand idle while people are dying around it.
  40. don gravenor from Memphis, United States writes: While PET scanning is useful, it doesn't pick up all types of cancer and also misses some very small ones. Dr. Evans is correct in properly trying to figure out who should have scans. This is not a trivial issue, even here in the US. There is not an unlimited source of funds to just do scans on anyone. The order to scan someone should ideally come from a cancer specialist.
    The main recurring cost of the scan is the reagent (FDG) that is injected. The capital cost of the machine is fixed. These are expensive technologies and financial resources are limited (even in the US !), so figuring out who, when, and how often to scan are not trivial questions.
  41. J Luft from Calgary, Canada writes: Canada's 'public' system absolutely ensures that people will die waiting in line. People with money (and even those who don't....or at least are willing to make the financial sacrifice) are already going out of the country altogether to get services faster and better then they can within Canada. But the left wing idealogues in this country supported by the useless health care unions are more worried about their failed system then they are about the health of Canadians.
  42. B Johnson from Halifax, Canada writes: #16 Rich L. is right. Having lived in the USA for 6.5 yrs. and watched both my in-laws die of cancer, they did not even have access to MRI's under their so-called insurance plan for which they paid very dearly. Anyone singing the praises of 2-tier medical plans should actually live in the states for a while and find out just how bad it is.
  43. The Philosopher King from True North, Canada writes: While I am against two tier healthcare, this is one of those cases where I believe a business model might actually make the scans cheaper. As long as those with money are not getting better medical treatment than those without, what's the harm? Ultimately though we must ensure equity. It is simply not humane to let some people go without medically neccesary scans simply because they cannot afford it, and it would be inconsionable to think that someone should get more timely treatment merely because they are rich.
  44. Diane Schweik from EDMONTON, Canada writes: #32 You should realise that these experiments that are done on animals are usually for the benefit of humans.Most of our medical treatments only become generally available after animal testing.
  45. R. B. from Toronto, Canada writes: Dave Medich (32) - the animals that are undergoing PET scans are part of research experiments - not pets that are being diagnosed. People complain that there is no cure for cancer, but they don't want to divert any funds or resources to research. It's as if they assume that the cure will just descend from the clouds. And doctors complaining about the scraps that researchers get - that's rich.
  46. The Philosopher King from True North, Canada writes: #35 Okay Rob, but what's the alternative? If we're going to talk morality, is it moral for someone to go without treatment because they are poor? Is it moral that someone with money should be able to get treatment faster than someone who is poor? I'm not suggesting this is your view point, but I wish to point out the difficulties we face in creating an equitable system. While I would certainly be one of those who would benefit from a payee system, I cannot in good conscience advocate my own health over someone else's. Not from a moral standpoint. It is a dangerous precedent to suggest that the value of a human life is relative to one's financial success. I am however open to any ideas you may have, as this is an important debate, and you are clearly very passionate about it.
  47. jorly fuster from Canada writes: When Tommy Douglas came up with the idea of universal healthcare, there weren't as many Canadians as there are today. We also didn't have overweight Canadians who eat crap food and gain massive amounts of weight and then get in a stitch when they can't find a hospital bed. We also didn't have nearly as much people smoking back then either. Let's face it, Candians are getting fatter, balder and uglier and it's not up to the Government to pick up the slack. Stop smoking, eat right and get regular exercise and you won't catch the bird flu.
  48. Pat Chen from Toronto, Canada writes: How ironic? Ontario gives money to other so called have-not provinces and they ended up having better heath care, day care? And now this?

    Perhaps we in Ontario should stop being working so hard and we can end up having less income and thus better benefits!
  49. N. C. from Canada writes: I don't believe the editors even allowed comment #30 to be posted. I can't express how deeply offended I am by it. It might do you well to remember that any one of us in this country (unless you are unspeakably rich, in which case, why don't you just take your private jet somewhere else, or bribe doctors to save your pathetic life) is one or two paychecks away from being a 'free-rider that should be left to die.' Your callous words make me ashamed to be a member of the same species as you.
  50. Andrew Pearson from Montreal, Canada writes: I had a dog for fifteen years and it always amazed me that good medical care was always available promptly and at a reasonable cost - for the dog but not for me.
  51. Terry Johnson from Burlington, Canada writes: I too am upset by this situation and will email Mr. McGuinty immediately. Everyone should do the same! I lost my sister to cancer six years ago and my aunt had breast cancer but survived. I know too many people who have died and/or suffered for years enduring treatments that may have been needless. That this asset is being wasted is an abomination!!! This is just another example of how the wealthy can disparage higher taxes because they can always pay for these types of services while the rest of us have to endure and suffer needlessly. I just think the provincial government's policy is so shortsighted. For example, how much of our tax dollars go towards patients who receive the wrong treatments? Any party who asks me for their vote in the next election better include changing this policy. I just hope someone wants my vote bad enough. (Maybe I will a copy of this to John Tory too!).
    And to #36, I wouldn't demand a scan if my oncologist told me it wasn't necessary although I might ask for a second opinion. I would assume that a family doctor would not be able to request a scan and would have to refer a patient to a specialist first. Additionally, the more frequently we can diagnose cancer in its early stages the more likely we can deal with if more efficiently and save healthcare dollars and your taxes. And if I have to pay more taxes, I am ok with that. I can't begin to tell you how much I would pay to have my sister back!
  52. Dave C from Toronto, Canada writes: Ummm... so where exactly is that Ontario Health Premium tax going to?
  53. The Philosopher King from True North, Canada writes: #47 Sorry Jorly but the number of smokers in Canada has dropped by over 50% since 1960. Additionally, you are not taking into account that our per capita GDP is considerably higher than in Tommy's day. In other words, with the notable exception of expensive new technologies, healthcare should be cheaper now not more expensive.

    Incidentally, what's with the 'balder and uglier' comment? How is that relevant to health outcomes?
  54. Chris Edwards from Greater Sudbury, Canada writes: #51 - Right. Or my mother. You don't have a monopoly on grief. Kudos to you for being a reasonable person. Most aren't, and if a test if free, most doctors are more than willing to give in to a patient's demands. You are correct that early detection ultimately saves money, but there are effective means for early detection of most cancers that already exist. PET scans are not a panacea or a magic bullet, as many here seem to believe. Good for you that you are willing to fork over as much of your paycheque as the government would like. Health care, unfortunately, is a beast that grows bigger as you feed it, and it is insatiable, so dollars must be carefully spent and difficult ethical matters must be discussed, and pragmatic decisions must occasionally be made. If it sounds heartless - sorry.
  55. Terry Horton from toronto, Canada writes: 'Those who can afford it should be made to chip in.' Only a few days ago only 37% of the Globe responders agreed with this statement regarding cancer health care. Is it working for you? This is what happens when you rely on the government for total care. Let those of us willing to pay for it -- pay for it!
  56. The Philosopher King from True North, Canada writes: #49 Pat I think David is being facetious. He is taking the extreme opposite view to make a point. At the heart of the argument of those who promote a two tier system is the right of influential individuals to have their needs cared for ahead of others or through more timely means others do not have. If this were not true they would suggest fixing the system, not changing it. That many of these advocates quote the 'cost to tax payers' suggests they don't mind paying for what their taxes already cover. Somehow I don't buy this from a group with a huge political lobby dedicated to cutting their taxes. The 'cost to tax payers' angle seems to me a devious way to reduce funding to public healthcare without reducing the health outcomes for the rich. I suspect they would quickly start whining for tax breaks to 'cover the costs' soon after such a change took place, entrenching an insurance system that has led to an average increase of healthcosts in the US of up to 50%. That Microsoft and GM have both been lobbying the US government to take on a system similar to ours should be proof enough of the costs to business. I don't think David himself actually advocates this, so I hope he replies to your comment.
  57. Gary Dare from Portland, Oregon, Canada, writes: I only caught the earlier postings but someone raised the issue of having the 'private sector' provide the service and another pointed out that in our de factor 2-3 tiered system, you can get a private scan in Mississauga. The practice of leasing facilities off-hours to vets is a common practice in the (mostly) private care US and probably adopted from there. My last stop was Chicago and in the suburbs, you can't get a scan 24/7. You had to go all the way downtown to Northwestern Memorial or U Chicago. This was true in the far NW suburbs, it was even true in Evanston just off of Chicago's far north side! That said, an official 2-3 tier system would allow for a larger set of facilities from the additional private spending and generate the extra capacity that we now seem to lack when demand peaks.
  58. PETER TOFT from Canada writes: It is interesting to see how PET has been treated differently from CT and MRI. The province continues to throw money at CT and MRI centres. To my knowledge CT and MRI have never had to undergo clinical trials and registry studies to justify their utilization. I am sure that often the CT and MRI are unnecessary. My wife had knee surgery. In spite of the fact that she had had an MRI, the orthopedic surgeon examined the knee and said I do not need the MRI. Perhaps, if an appropriate exam had been performed of the knee, an unnecessary MRI would not have been performed. I have had a friend have CT, MRI, and ultrasound for a lump. They still don't know what it is so the next step is for him to go for a biopsy. Could his doctors not have done only the most appropriate test and then decide to biopsy? For one patient it may not appear costly to have addititional tests which do not give any additional information. When the same scenario is repeated for many patients this must become very costly. We could save money by ensuring that all tests done are required be it CT, MRI, or PET scanning.
  59. Rob Bairos from Toronto, Canada writes: #46 The Philosopher King '#35 Okay Rob, but what's the alternative? If we're going to talk morality, is it moral for someone to go without treatment because they are poor? Is it moral that someone with money should be able to get treatment faster than someone who is poor? I'm not suggesting this is your view point'

    Actually it is exactly my viewpoint. If you have something of value that you can trade for someone elses services than by all means do it. Be it love, money, loyalty or even chocolate cupcakes.

    One day I will die. If I'm at all savable I hope that I can persuade someone
    to provide me that service for something they find of value.
    Forcing someone to spend their resources on me when they would
    spend them on another patient, endeavour, etc is wrong.

    It may not sound pretty and sentimental, but its how we all live our lives,
    no matter how much we pretend otherwise.
  60. J Kay from Canada writes: I suspect most of the people complaining herein about either the government trials for PET or the use of it as a research device right now have little if any knowledge or understanding of PET or I suspect any other imaging modalities. PET is not perfect, it is useful for certain things but it produces images which are fuzzier than CT or MRI. SPECT and fMRI can produce some if not all of the benefits of PET and in general at a lower cost, so it makes sense that the government is investigating the efficacy and cost/benefit of adding PET scanning to the health care system.

    As others have noted the equipment requirements and other add on requirements (eg: cyclotron, specialist phamacologists, etc) are not small and if the benefit is tiny over existing modalities, then it's reasonable for the government to try to determine that. That absense of PET scanners does not mean that people are going undiagnosed or that there is no way to detect diseases (cancer) which may have a metabolic signature. fMRI and SPECT are both used for metabolic studies and can detect similar things to PET, as opposed to MRI and CT (X-ray) which are used for anatomical imaging. Since the images from PET are relatively poor compared to MRI and CT in resolution, they are usually overlaid with CT or MRI images, though this is not without technical issues. While PET may prove to have benefits which cannot be obtained with the other imaging modalities that question is not closed.
  61. pat rooney from Canada writes: 70,000 Canadians will die this year from cancer. 19,000 of them of lung cancer. That's 27%. A clinical study in the NEJOM on Oct26,2006 demonstrated that 80% of lung cancer could be cured after CT followed by a PETSCAN finds lung nodules in STAGE 1 cancer. Arithmetic: only 55,000 Canadians would have died of cancer, year to year statistic down 21%. There are 13 million smokers/ex-smokers of which 6.5 million are 'heavy smokers-at risk'. If we screened with a CT and confirmed with a PET and only then did a biopsy it would cost $2 billion but we would save 90,000 persons who today have stage 1 lung cancer but don't know it. The Canadian health system will find them in Stage 3B and 4 and they will die on average in 1 year and cost the health system $4 billion. With a statistical certainty we can cure 90,000 Canadians defined as not dying on average of lung cancer for at least 10 years. If those 90,000 pay at least $10,000 in taxes for 10 additional years they will have contributed $9 billion to the system. $9B $4B= $13B less the $2B cost of the 'screening' with CT and PET just saved us $11B and gave Canada the best cancer statistics on the planet. The USA has 2000 PET locations. The 1 for 10 rule dictates that Canada should have 200 PET scanners at $2 million each =$400 million. At 200 PET's Canada is best on the planet in that category also and all Cancers are served. The G&M article is just talking about 'full body' PET. Canada doesn't have this 'latest and Greatest' PET technology yet. Well the world is talking about 'organ-specific ' PET. We are doing mammography which is inadequate while the USA has 'PET mammography' which is 91% accurate for 'early breast cancer'detection. We do PSA tests while the world is developing 'prostate specific PET'. Canada can fix its problem when we put someone with vision in charge. Japan spends 30% more on technology then us but has 10% less overall healthcare costs. And less cancer. Somebody must do due diligence. THX.
  62. S W from Canada writes: Aside from the core issue of this article, I am still a bit disturbed by humans having a treatment in this machine after it has been used by animals. I guess their must be some kind of sterilization done, but, would you crawl onto a bed in a hotel that was also being used routinely by sick animals? To me, it seems a bit odd that it was ever allowed in a medical facility. I think that tells as hideous an underfunding story then the waiting lists. How clean is that machine? LOVE TO know why sick animals are allowed in a hosiptal setting AT ALL, they aren't allowed up in the wards when they are well!
  63. Emma Hawthorne from Canada writes: Congrats to the Globe for such a great investigation and story. One can't but surmise that the only way each additional scan 'costs' medicare more is because the scanners are privately owned. I would like to see those incorporation documents and contracts! Clearly when you own something, each additional use is less expensive not more expensive. It's important to look at the actual technology and equipment needed for such machines. I cannot seek the need for elaborate exensive mechanically rising and falling tables, for example, when using more practial equipment means dollars can be focused on technology, which should also be rapidly dropping in price. The Globe has unearthed a prime example of rampant financial and diagnostic mismanagement.
  64. bill johnson from Quebec, Canada writes: What we need is value for our money. Right now we don't get it. Let's take the average wait time for the OECD group of countries for all major cancers treatment, diagnostic tests etc. That would become the Canadian standard. If the government was unable to meet that timeframe, you could have it done anywhere and billed directly to government. Once govt sees the high out-of-province bills, they will increase training and deployment of equipment. I personally need a toe operation and was given a 9 month delay for it. Dalty promised health care would get better but it has not; force them to diagnose and treat promptly or get the hell out of the way of those who will. Notice the person who got the treatment was a Liberal premier's wife. No delay.
  65. R B from Ottawa, Canada writes: I'm a breast cancer patient in Ontario. I had surgery followed by chemotherapy and radiation last year, and surgery and chemotherapy this year for a second tumour identified by MRI. I had very minimal lymph node involvement.
    I'm shocked to read that for my situation this test isn't even an option. No wonder my radiation oncologist just started to mumble when I asked him about the use of a PET scan to determine if I had any invasive involvement from my recent breast cancer to lymph nodes not tested at the time of my surgery.
    All he did was suggest that I might want to have radiation again. I cannot understand why the Ontario system would want to spend all the money on radiation treatment without determining if there are any cancer cells 'out there' to kill with it.
    To say I'm appalled that this is a policy not a medical decision is very much an understatement.
    Thank you for a great series of articles -- my eyes have been opened.
    cheers,
  66. harry carnie from Telkwa, British Columbia, Canada writes: Well...if Canadian Health care is mismanaged enough ,the public will lose faith in public health care. Then the large U.S. Health Companies can come in , take over and make a bundle. If you do not think this senario(with the help of high level political leaders) is not already in the process...'you gots you head in the sand'
  67. carol c. from kingston, Canada writes: Universal healthcare is a wonderful ideal. Unfortunately, if everyone got the healthcare that they think they deserve, the system would be bankrupt in very short order. This necessitates some kind of triage. Perhaps the rules for the PET scan are too strict and should be reviewed. However, the review should be done by medical personnel and NOT politicians. Furthermore, there should be some kind of central registry for ALL medical care. I required surgery a little while ago. In my town the appointment for the consult with the surgeon was to take 6 months. Upon asking if travelling to another center would help, my doctor found a surgeon 40 minutes away from my home that could do the consult in 1 week and the surgery in 8 weeks. However, I had to push for this solution and my doctor had to waste time calling around. A central registry would have saved time and reduced waiting lists.
  68. liz fox from nanaimo, Canada writes: Just today Finance Minister Flaherty announced 'we all want tax cuts'. Maybe thats true but if we have the choice between tax cuts and losing health care what would the majority decision be? Most would choose to keep their healthcare system. If you're sick and able to pay the $2000-$3000 for a privately run scan why would you not be willing to pay a lower amount as your proportion of taxes to maintain and fully fund a public health care system that works far more efficiently than a private system with all its extra administrative overheads and profit? paying taxes that go towards maintaining an all inclusive publicly funded health system is like paying house insurance; nobody likes actually paying the premium but its a lot cheaper than losing your house; same with taxes; nobody likes paying them but if your family member gets cancer its a lot cheaper amd more efficient to fight it together than weaning out the poor people and leaving them to suffer and die. And no; rich people paying for their own care does not help the poor access the system' it merely leads to further erosion of support for the public care for those who could not otherwise afford it. Where is our society heading people or is this the logical extension of the ideology of self interest?
  69. Scot Affleck from Prince George, Canada writes: # 22 Charles Wirrell states, ' these PET scans should be run 24/7 to get the most benefit.' If I was a radiologist, (which I aint), I doubt I would like to be assigned the midnight shift at a hospital reading X-rays. Especially after my theoretical expensive education. Maybe they should dumb down these PET scanners. Just pop in a token ( like a Coke machine) and you get your x-ray delivered below and then pick up a pamphlet on how to interpret it. Radiology fer Dummies book, maybe. Ever so simple the solutions, eh?
  70. R DT from Burritt's Rapids, Ontario, Canada writes: I wonder why we have not heard any comment(s) from key individuals representing the Canadian Cancer Society and other special interest groups that supposedly represent the interests of people that this technology can surely benefit. If they want to continue to receive vast donations from the public, then they, at times like this, should first of all realize that those donors are not satisfied with the status quo and that they would want the recipients of their donations to stand up and lobby the government(s) to be aware of the 'peoples' concerns and to do something about it. It is fine for these charities to continue to seek donations but they have a moral duty to take an active and aggressive role in areas like this when it is clear that the 'people' are very dissatisfied. It is much more than just asking for donations - stand up and be heard.

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