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The
Canadian Academic Health Mafia, or The Canadian Academic Health Establishment?
I wasn't sure if I
should use the term "Mafia" or "Establishment" in
the context of this section. Therefore, I consulted with my "token"
academic, Jim Cutt who passed on the following interpretation of the situation,
which made me choose the term "Mafia."
What I discovered
over the years in Canada -- I was away in Australia for most of the
70s-- from my return here in 1978, was that the academic establishment
in health care--concentrated in an axis of fellow-travellers at McMaster
and UBC--had made a major intellectual commitment to the sustainability
of Medicare, concretized in the Canada Health Act model, and would not
be discouraged by evidence to the contrary. They do this, first, by
strictly controlling the internal debate--those who agree get published,
get research grants, get promotion and tenure; those who disagree are
ostracized and demonized. Young faculty members, having an eye on survival
and progress, get in line by agreeing or avoiding the issue. What is
most criminal and irresponsible about the establishment is that they
deliberately ignore the one most important indicator of success--timely
effective care. The second avenue is to place all possible barriers
to examining evidence from other countries; if you search you can find
it, but its use is discouraged and any evidence derived there from considered
biased or culturally unsuitable. And this evidence is interesting. A
classic example is the WHO (where you would expect socialist bureaucratic
bullshit) survey that placed Canada 30th, after Morocco, by focusing
on timely effective care. So the sad news is that the system is imploding
while the academics travel to conferences congratulating themselves--on
their intellectual rigour AND superior morality. It is really a Soviet
model, and will unravel, is indeed unraveling, in just the same way.
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