Distinguished Professor Gordon Guyatt on Equity and Autonomy in Medical Care
Author(s): Scott Douglas Jacobsen
Publication (Outlet/Website): The Good Men Project
Publication Date (yyyy/mm/dd): 2018/06/05
Professor Gordon Guyatt, MD, MSc, FRCP, OC is a Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact and Medicine at McMaster University. He is a Fellow of the Canadian Academy of Health Sciences.
Here we talk about equity and autonomy values around the world in medical care. This amounts to part of the evidence-based medicine model with values and preferences considered in medical care within the context of technological advances.
Guyatt, when asked about the aging populations of North America and Europe, responded on the valuation of equity over autonomy, and vice versa. The value judgment depends on values of preferences.
Those values and preferences come from culture. These influence individual and societal medical care decisions. Guyatt included Japan in with the Western world in terms of the aging population, which amounts to a significant problem in the demographics.
“Most of the Western world in terms of the aging population, and also Japan, are substantially ahead of North America. A big thing that people do not realize in terms of healthcare for populations and the aging of the population is that the huge bulk of expenditures comes in the last year of life,” Guyatt explained.
People live longer. Whether we die at 100 or 60, the largest bulk of healthcare expenses come from the last year of life. We get sick. We age. Sooner or later, we die. Guyatt said there has been a good job in the constraining of costs.
The technological advances, according to Guyatt, have raised the costs of healthcare. However, this depends on the costs people feel willing to pay out. The advances in technology can be drugs, surgical devices, and other things.
These improve health outcomes but cost more than before. Guyatt stated, “We live longer, longer, and longer. Yes, we may have to, if we want to take advantage of all of the technological advances that are going to continue even though the last 7 years it has not gone up, spend more of our GDP on healthcare.”
If done efficiently, according to Guyatt, then this will be public expenditures rather than private expenditures. He argues, in the next 100 years, that Canada, as an example, will get close to what the United States spends as a portion of its GDP on healthcare.
The US spends about 18% at the moment. However, I am aware of Moore’s Law in information technologies and the Law of Accelerating Returns. This brought a question to mind for me. I stated, “Technology becomes cheaper over time. Phones were for the rich decades ago. They were not good. But they became better. The poorer were able to afford them and the phones were far better.”
“It is a great point. 50 years ago, everybody had to live with their debilitating hip osteoarthritis or knee osteoarthritis. Now, hundreds of thousands of people are getting their hips and knees replaced,” Guyatt responded, “That ended up costing money for years. The hip and knee replacements have become much more efficient. People used to stay in the hospital a week after the hip replacement. Now, it can be the same day. It is a good point.”
He surmised that this may be the reason for the stagnation in the increase in health care cost as a percentage of the GDP in Canada. Potentially, this may extend to other nations as well. Some of the advances can raise costs. Other can decrease them.
In the end analysis, the increase in efficiency may balance out with the increase in costs due to more advanced technology introduced into the global medical care market.
Guyatt, in a final example, concluded, “Another huge example of that is it used to be 45% of our healthcare expenditures were spent in the hospital. Now, it is 30%. There has been a gigantic shift to doing things as an outpatient, which is a much more efficient way of operating.”
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The British Medical Journal or BMJ had a list of 117 nominees in 2010 for the Lifetime Achievement Award. Guyatt was short-listed and came in second-place in the end. He earned the title of an Officer of the Order of Canada based on contributions from evidence-based medicine and its teaching.
He was elected a Fellow of the Royal Society of Canada in 2012 and a Member of the Canadian Medical Hall of Fame in 2015. He lectured on public vs. private healthcare funding in March of 2017, which seemed like a valuable conversation to publish in order to have this in the internet’s digital repository with one of Canada’s foremost academics.
For those with an interest in standardized metrics or academic rankings, he is the 14th most cited academic in the world in terms of H-Index at 222 and has a total citation count of more than 200,000. That is, he has the highest H-Index, likely, of any Canadian academic living or dead.
He talks here with Scott Douglas Jacobsen who founded In-Sight Publishing and In-Sight: Independent Interview-Based Journal. We conducted an extensive interview before: here, here, here, here, here, and here. We have other interviews in Canadian Atheist (here and here), Canadian Students for Sensible Drug Policy, Humanist Voices, and The Good Men Project (here, here, here, here, here, here, here, here, and here).
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