Observations on The Lancet, "Call the Midwife" and Global Healthcare

In various episodes of the British television series, “Call the Midwife”, the doctor’s teenage son refers to an article that he had just read in The Lancet.  Perhaps most Americans have heard of The Lancet, but the numbers who know what kind of medical journal it is, are much less.

There is nothing quite like the journal in the U.S.

I have an on-line subscription to The Lancet.  Why “The Lancet”?  Why not JAMA or The New England Journal of Medicine?  Because it is free and available in full text rather than just as abstracts.  U.S. journals are by subscription and are expensive.  I don’t get JAMA because I dropped my membership with the AMA about the same time and for a similar reason that I dropped my NRA membership.

Although I’ve been retired for 12 years now, I still like to keep up to some degree with medicine, and I like the scope of The Lancet.

 

I just looked at the latest issue of The Lancet, Vol.391 | Number 10130 | Apr 21, 2018.  In this issue there is an article summarizing the results of a 2015 study which gathered data on antimicrobial/antibiotic use in 53 countries according to UN defined zones.  North America includes two countries which I assume to be the U.S. and Canada.  It only looked at hospitalized patients, but it looked at the indications and what antimicrobials were used and the types of antibiotics prescribed.

A second article was titled, “Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40”.   The cost of medical care world-wide among countries with UHC (Universal Health Care) is expected to double from US$ 10 trillion to US$ 20 trillion by 2040.  The spending per capita in high income countries will be 45.6 times higher in high income countries versus low income countries.  In high income countries that cost will be about US$ 8,666 per capita per year by 2040.  By contrast, the annual per capita expenditure per person in the poorest countries was on the order of US$ 700 per year.  In the Seychelles that accounted for about 88% of their annual spending for all services and a larger percentage of their GDP than in high income countries.

But none of that concerns politicians and healthcare financing planners in the U.S. because we opted not to have UHC.  Except that it does.  Alternative scenarios to UHC were examined and systems calling for out-of-pocket and other methods of payment looked worse in terms of cost.

What should become obvious to anyone looking at The Lancet is that the scope of the magazine is global healthcare, and the editors don’t seem to back down from any topic.  One article is about the impact of sexual harassment and abuse, and intimidation of victims by the abusers.  One article examined Macrolide resistance in Yaws (a tropical disease).

U.S. medical journals are much more provincial in their scope.

The difference in scope may be the post-colonial nature of life in Great Britain.

“Call the Midwife” is based on the diary of a mid-wife in London’s East End during the 1950s and 1960s.  As the show progresses in time the complexions of the mid-wives and their patients change. By the early 1960s, one of the mid-wives is Jamaican and because the area of London served is very poor immigrants like Sikhs and Nigerians become some of the recipients of in-home obstetric care.

There are problems of poverty, language, culture, prejudice and class that are addressed.

The U.S. doesn’t know Britain’s reality, in part, because our colonies have been virtual colonies, and the residents of those colonies have had no faces.

Boy with Yaws

Yaws is an infectious disease spread by skin to skin contact

It usually begins in childhood

It is chronic, and untreated ends in skin and bone deformity.

Views: 58

Comment by J.P. Hart on April 20, 2018 at 6:04am

& America(s)
Puerto Rico IS NOT YOUR PETRI DISH!

Also, Rodney (lower right box, right now) queuing Four Strong Winds.

And all Madam Secretary had do is enjoy a cool bottle of water in Flint, MI.
Toasting the crowd, she should-dove said :
"...WE GOT 'EM ! ..
GO GET 'EM !...
LET MY PEOPLE GO!

Comment by koshersalaami on April 20, 2018 at 6:12am

Interesting

Comment by Jonathan Wolfman on April 20, 2018 at 7:55am

The BBC show is very good and your point abt the various kinds of imperialism are terrif.

Comment by mary gravitt on April 21, 2018 at 1:14pm

When I hear Iowa's Koch governor and Steve King damn Obamacare, it makes me sad at their ignorance.  The UK had to have socialized medicine when the upper classes who took in children from the inner-cites during WWI and WWII they found some deseases that gave them horrors.  Most people in the cities lived in such poverty that none knew what a sheet was.  Children has scabies and so forth.  So after WWII socialized medicine prevented Britain from falling to the Communists.  And if the US does not want to go that way, Obamacare will have to be fully funded and the lower classes will at least have a sickbed to fall into.

Comment by Rodney Roe on April 21, 2018 at 1:28pm

Mary that’s an interesting observation. Also, particularly after WWI, there was such disruption of the class system that society was shifted. In many cases lords fought in the trenches with their butler or footman, and the wealthy peers no longer were able to support large numbers of employees. 

After the second WW Britain was forced to rethink a lot of things. The property rebuilding was done under a new concept that prevented urban sprawl to preserve farmland, and there had to be community approval before any development. One of the things restructured was provision of healthcare.

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