The Healthy Barmaid, the New Minister of Health

Head Table Guests

William Whittaker, Q.C., Partner, Lette, Whittaker and an Honorary Director, The Empire Club of Canada; Peter Tun, OAC student, Northern Secondary School; The Rev. Kim Beard, Rector, St. Bede and St. Chrispin Anglican Churches; Peter Davis, National Executive Director, The Duke of Edinburgh Awards, Young Canadians Challenge; David Taller, Publisher, Canadian Association of Retired Persons Newspaper; Marilyn Linton, Lifestyle Editor, The Toronto Sun; Ramsay Fraser, retired Chartered Accountant; Diana Chant, C.A., Partner, Price Waterhouse and Treasurer, The Empire Club of Canada; Rolf Meyer, Managing Editor, Deutsche Press; Derek Cassels, Editor, The Medical Post; William Sommerville, Chairman, Ontario Pension Board and former Chairman, National Trust; and Rudy Fernandes, Vice-President, Ciba-Geigy.

Introduction by David Edmison

Last month we lost one of the greatest entertainment personalities of this century in the death of comedian George Burns at age 100.

Burns’ longevity may have had more to do with his attitude and outlook rather than his lifestyle. He was quoted as saying he drank four martinis and smoked 15 cigars each day. When asked what his doctor thought of this, he quipped: "My doctor is dead."

Sir Winston Churchill, another cigar smoker, who enjoyed the odd drink also lived a long and fulfilling life. He could hardly be classified as physically fit though, and when asked why he did not exercise, he said: "I get enough exercise being a pallbearer for those of my friends who believe in regular running and calisthenics."

Well, many of us will be lucky to retain good health as long as Burns and Churchill. In order to do so we may have to change some of our lifestyle habits. With us today as our special guest is Dr. Ken Walker who has been offering advice on preventative medicine to millions of people around the globe for over 30 years.

Dr. Walker is a prominent gynecologist and medical journalist. He writes his columns under the pseudonym W. Gifford Jones. His medical column, "The Doctors Game," is syndicated in 85 Canadian newspapers, the Chicago Sun-Times and 300 other U.S. newspapers. He is the author of six books; his latest, "The Healthy Barmaid," is set in a London pub surrounded by numerous medical school hospitals. His protagonist Ida, the healthy barmaid, listens to medical professors and practitioners and discusses how faulty lifestyle leads to a litany of problems.

In his book, Dr. Walker takes on the role of an insurance agent who gains valuable insight from the fictional Ida. If you are a moderate drinker, you will be encouraged by Ida’s advice. On the other hand, if you are a smoker, you will not care for her warnings; she quotes Mark Twain who said: "It’s easy to quit smoking, I’ve done it thousands of times." I’m sure many of you who smoke can relate to this. His book covers many other issues, ranging from heart disease to nutrition, which are discussed in a clinical, yet easy-to-read fashion.

Our guest is well qualified to offer his medical advice. He is a graduate of the University of Toronto and the Harvard Medical School and is a fellow of the Royal College of Surgeons. Dr. Walker has been practicing medicine for over 40 years, first in Niagara Falls and now in Toronto. He is President of the Gifford-Jones Foundation which is dedicated to fighting needless terminal cancer pain and for these efforts he has received a citation from the Governor General of Canada.

Dr. Walker is married to Susan Walker, who is also his editor and they have four children.

Our guest will address us on the importance of lifestyle in maintaining good health. He will tell us why his healthy barmaid would make a suitable candidate as the new Minister of Health.

Ladies and gentlemen, would you please welcome our distinguished guest, insurance agent, medical doctor, author and journalist, Dr. Ken Walker.

Kenneth Walker

My thanks to you, David, and the members of The Empire Club for asking me (and my healthy barmaid) to be a part of this medical series of talks.

Now before Ida, The Healthy Barmaid, discusses what she would do as Minister of Health let me answer a question that people always ask me.

What is it like being a syndicated medical journalist? This is a good question because the thoughts that my barmaid will pass along today stem more from my 35 years as a medical journalist than from what I learned at the Harvard Medical School. Medical journalism has added a huge dimension to my life.

Because of it I’ve been to the Pasteur Institute in Paris to interview the discoverer of the AIDS virus. I’ve talked to Linus Pauling on several occasions and many interviews with other distinguished researchers have been great learning experiences.

I’ve had exciting moments such as flying onto the nuclear aircraft carrier, the USS Nimitz, while it was on manoeuvres with the U.S. 7th fleet. I’ve also received my share of criticism and spoofs. Medical students at Western University once wrote a series of articles for their newspaper using the pen name of W. Gizzard-Bones.

I’ve had moments of chagrin necessitating some quick thinking. Several years ago I wrote a column suggesting that Yves St. Laurent should design better panties for women. The current skin tight ones were causing gynaecological problems. One evening I arrived home from the office with a package and opened it in front of my wife while we were enjoying a drink before dinner. I pulled out a pair of women’s pink panties. I can tell you from experience this is not a good way to start the evening with your wife! During the next few weeks more panties arrived with design suggestions from readers. My wife finally concluded I might have one mistress but she knew I wasn’t capable of looking after 20!

I’ve had some frustrating and difficult times. In 1979 I proposed that the government legalise heroin for medical use to help terminal cancer patients in pain. I expected support from the Canadian Cancer Society. Instead it sent briefs to Ottawa claiming heroin wasn’t needed, because only a few patients suffered uncontrollable pain. The society didn’t say what to do about those few who might be helped and desperately needed this painkiller. Some cancer specialists labelled me an uninformed headline-seeking journalist. I began to wonder if I was terribly wrong. But then I received a letter in the mail from a convict in the Kingston jail. He wrote a 20-page letter telling me he had tried all the narcotics and heroin was the "Cadillac" of them all. He insisted that I was right and shouldn’t listen to my critics.

I receive tons of mail and some letters go on for 20 pages telling me about every ache and pain writers have had for 20 years. Some letters are very disturbing. Occasionally patients with terminal diseases write to me. They’ve been to the Mayo Clinic and other renowned centres without being helped and they write to me hoping I can solve their problems. It shows the power of the written word and this continues to astonish me.

If I had to pick one thing that has sharpened my wits and focussed my medical knowledge it’s been the fact of deadlines every week for the last 20 years. Samuel Johnson once remarked that "nothing sharpens the mind so much as the knowledge you’re going to be hanged in the morning." In one way weekly deadlines are a terrible curse. They’re like being married to a nymphomaniac. In fact, some weeks when I’m struggling with a column I’m convinced that would be the lesser evil! But deadlines not only focus your attention. They also help you to see the forest as well as the trees.

The longer I practice medicine the more I’m convinced there are two kinds of diseases–those we get and those we make. The secret is learning how to prevent the ones we make.

My father, who was a Scot, taught me my first lesson in prevention when I was a small boy. He told me about the Scot who saved for weeks to buy his favourite bottle of Johnnie Walker. He placed it in his back pocket convinced that God was in Heaven. As he left the store he fell and landed on his back. As a crowd gathered around him he slowly moved his hand around to his back. After a moment he said: "God, I hope that’s blood!" So if you learn nothing from my barmaid today I hope you will at least walk carefully after buying your favourite bottle of scotch.

Now, to get back to my barmaid, why do I propose that she should be appointed the new Minister of Health? Am I pulling your leg? Am I trying a journalist’s trick to keep you from falling asleep after a meal or does this suggestion have merit? I hope I can prove to you that my 85-year-old barmaid is a wise old owl who could prevent needless disease and even balance the health-care budget. What would be her first move?

The Healthy Barmaid as Minister of Health would tell them to buy a bottle of wine.

This would shock some Canadians, maybe even your president! There’s never been a time when everyone has been so uptight and there’s no better medicine to relax people than a glass of wine. For too many years its medical value has been swept under the rug for puritanical and dishonest reasons.

Why is it that Canada is so often behind the U.S. and other countries? Both the U.S. and U.K. governments announced weeks ago that moderate drinking helps to prevent heart attack. We haven’t heard a whisper from any Minister of Health in Canada!

People who wouldn’t say "damn" if they stubbed their toe at 2:00 in the morning would ask Ida, "How could you preach a healthy lifestyle when you’re a barmaid in a pub?" Ida, my barmaid, would bluntly tell them there are 20 studies from around the world which show that moderate drinkers live longer. Critics, of course, argue this message encourages people to drink and some drink to excess. The end result is cirrhosis of the liver, family and social strife and death from drunken drivers.

My barmaid friend admits that can happen, but if we followed this reasoning, we should stop selling cars because some idiots drive at 140 miles at hour. As well, when scientific studies prove that alcohol in moderation is helpful to prevent coronary attack, it’s her opinion, and mine, that it is totally unethical to withhold this good news from moderate drinkers, particularly from elderly moderate drinkers when a happy hour at the end of the day can be of great psychological benefit as well.

Sir William Osler, one of Canada’s greatest physicians, knew the value of alcohol for seniors. He remarked that: "Wine is for the elderly what milk is for the young." I agree with Cardinal Richelieu who remarked in 1623: "If God forbade drinking would he have made wine so good?" None of us should forget that there are more old wine drinkers than old doctors!

Ida would stress we’re lucky to be living in Ontario. It’s "Resveratrol Country." Canadian wines contain greater concentrations of Resveratrol than most other wines in the world. It’s believed that Resveratrol helps to decrease the risk of atherosclerosis and heart attack. It’s an ingredient not found in other alcoholic beverages. In fact, apart from the small amount in peanuts, red wine is virtually the only source of Resveratrol in the human diet. To purchase wine with a higher Resveratrol content look for the three letters VQA (Vinters’ Quality Alliance) on the label. It’s a guarantee that the grapes used are 100-per-cent Canadian.

Wine also helps to dilate blood vessels. It makes blood platelets more slippery so less likely to stick together and form a blood clot. It decreases the amount of fibrinogen in the blood, a small particle also associated with the clotting mechanism. A glass of wine is a powerful antioxidant that helps to eliminate free radicals. Free radicals are believed to cause aging and degenerative problems such as heart disease and cancer. Flavonoids present in red wine are 20 times more numerous than those in white wine and their antioxidant effect is 10 to 20 times greater than vitamin E.

Moderate drinking also increases high-density lipoproteins (HDL), the good cholesterol, that removes excess cholesterol from the blood and never forget the relaxing effects of wine. In 1994 Drs. M.R. Lipp and D. Whitten estimated that if every North American adult drank two glasses of wine a day there would be a 40-per-cent decrease in cardiovascular disease and a saving of $40 billion a year. Isn’t it ironic that Ministers of Health support the tax on wine. Rather than being taxed, wine should be promoted to help decrease the risk of heart attack.

Apart from convincing Canadians to relax with a glass of wine each day what else would Ida do?

The Healthy Barmaid as Minister of Health would teach preventive medicine in the schools.

She would point out the horrendous track record of previous Ministers of Health in this area. Consider that one in three Canadians will have a heart attack by 60 years of age, that one in three will have lost not just some of their teeth, but all their teeth by age 60 and that a child born today has one chance in five of developing diabetes.

The first point she would hammer home to young people is that "good health works like compound interest." Start saving early, watch the compound interest grow and you end up wealthy. Einstein called compound interest one of the seven wonders of the world. If only I had learned this secret as a young boy I wouldn’t have to come to The Empire Club for a free meal today. Similarly, the sooner you follow a prudent lifestyle the greater the chance of living longer and healthier.

The great irony is that it’s easy to practice preventive medicine. There are no complex formulas. It’s like pulling teeth out of a bull to motivate people to follow a good lifestyle and it’s easy to identify the people headed for disaster.

Ida would tell the story about the boy who applied for a job at the railway station. He was asked this question: "Suppose you saw a train coming from the east and another coming from the west. They’re both on the same track travelling at 100 miles an hour and just a quarter of a mile apart, what would you do?" The boy scratched his head and said: "I’d run and get my brother." The station master asked: "Why, in the name of Heaven, would you do that at such a critical time?" The boy replied: "Because my brother has never seen a train wreck."

All too often I hear grieving relatives who have lost a loved one say: "Why did he or she have to die so young?" Sometimes you feel like saying: "It happened because your loved one was a damn fool." He or she was grossly overweight, smoked two packs of cigarettes a day, watched TV for hours on end every week while munching potato chips, and drove the car to the corner store. A small hole will sink a big ship and small faulty lifestyle habits add up to sink humans.

Every day I see people walking through Toronto’s underground who are intelligent people, but they still haven’t learned the ABCs of preventive medicine. Morning after morning 95 per cent of young, healthy workers take the escalator rather than walk up 25 steps, yet these people are going to sit at their desks most of the day. Ida, as Minister of Health, would put a sign at the bottom of every escalator in Toronto’s underground that reads: "This escalator is for the disabled. Take it if you want to become obese, have a premature coronary, develop brittle bones, arthritis and other degenerative problems that need not happen."

My barmaid would tell you that one of the best examples of the failure of preventive medicine can be seen aboard the nuclear aircraft carrier the USS Nimitz. It’s the most powerful ship in the world and loaded with electronic equipment that boggles the imagination.

The Nimitz has 6,000 sailors on board with an average age of 19 years, but seven dentists working seven days a week cannot keep up with the dental cavities. It’s ironic that you can teach these young men to manage complicated technology, but you can’t teach them sound dental hygiene! If you lose your teeth it’s not going to kill you, but you can eat a steak better with them. Henry Ford once offered a million dollars to anyone who could give him a good set of false teeth. He never had to pay the million! George Washington always looks tight lipped and never smiled. He had wooden dentures and they had a habit of falling out. The point is that if people can’t learn to brush their teeth and floss three times a day, small wonder they commit other more serious lifestyle errors.

The Healthy Barmaid as Minister of Health would stress that obesity is the number-one killer.

Ida’s most important message as Minister of Health would be a very basic one. It’s not the CAT scans, MRIs that are the most important pieces of medical equipment in 1996. It’s the bathroom scale. Obesity kills more people than heart disease and cancer. Today our medical system is in a financial mess, but if people could maintain a weight they would never go over, the Minister of Health could fire half the doctors and close half the hospitals. He could also inform you when he addresses The Empire Club in a couple of weeks that he will be able to balance the health budget. To be obese is to be ill. Obesity sets the stage for a variety of problems. For some it triggers sore backs, varicose veins, arthritis and surgical and obstetrical complications. Others develop coronary heart disease and hypertension.

The most devastating complication is diabetes and 90 per cent of the time it shouldn’t happen. The facts are appalling. Every 45 seconds a new diabetic is diagnosed in North America. It’s estimated between two and five per cent of the population are diabetic. Diabetics are 25 times more likely to lose their sight and they’re 17 times more likely to die from kidney disease. Diabetes is the most common cause of blindness between 22 and 65 years of age. Forty years ago 90 per cent of diabetes was due to bad luck, inheriting bad genes. Today 90 per cent is due to obesity and for reasons that are in part puzzling, this epidemic has been swept under the rug. My barmaid would wonder why there hasn’t been a royal commission to look into this epidemic. Can you imagine how many royal commissions the Minister of Health would appoint if we had a new case of polio, measles or legionnaires disease every 45 seconds!

The future looks grim. Since 1960 obesity among adults has increased 15 per cent. During the same time teenage obesity has increased 39 per cent, but for the 6 to 11 year age group it has increased a staggering 54 per cent. Neither my barmaid nor the MOH has to be a genius to know why this is happening. Children and others are getting 75 per cent less exercise than in 1960 and eating habits have changed. Consider that one potato contains 160 calories; the same amount of French fries, 700 calories; and a comparable amount of potato chips, 1,200 calories. Soft drinks contain eight teaspoonfuls of sugar.

People are also confused about nutrition. For instance, consumers today are being told to buy low-fat and fat-free products. Just because a product is fat-free doesn’t mean it’s calorie-free! What’s happened is that as people have tried to decrease their fat intake they’ve increased their consumption of sugar. For parents Ida would have this advice. Some breakfast cereals are 50 to 60-per-cent sugar, so loaded that it’s safer for children to eat the box! Her advice? No one, including corporations, the medical profession or the Minister of Health, is going to protect you from diabetes. You have only one good choice. Buy a scale and step on it every day.

The Healthy Barmaid as Minister of Health would defend Canadian farmers.

My barmaid is tired of hearing that it’s Canadian farmers who are responsible for the epidemic of heart disease. She would tell Canadians they must rid themselves of a new disease "cholesterolphobia." She has an open mind on cholesterol, but not so open her brains fall out. She would explain that blaming the farmers, hens and cows for making CHD the number-one killer is like blaming the iceberg for sinking the Titanic. It was a foolish captain who sank this ship and it’s foolish people who usually die from CHD.

What a shame that the only thing we learn from history is that we don’t learn from history. Farmers have been around for hundreds of years. They’ve eaten an awful lot of butter and other dairy products while working on the farm and haven’t died in large numbers from CHD.

Dr. Paul Dudley White, Harvard’s internationally renowned cardiologist, treated President Eisenhower when he suffered a heart attack. He once told Ida that when he was an intern at the Massachusetts General Hospital it was rare to see a patient with a heart attack, in fact so rare that when someone was admitted to emergency with a coronary all the young doctors were called to see the patient.

Whether or not you die from a heart attack depends on genetics, obesity, diabetes, smoking, lack of exercise, lack of antioxidant vitamins, whether postmenopausal women are taking estrogen replacement therapy, and blood cholesterol. TV ads never tell consumers that cholesterol is a very important substance for the body. The body manufactures more than three times the cholesterol consumed in the diet. It’s a major component of the wall of each individual cell. We need cholesterol to make sex hormones and it’s used in a number of other metabolic processes. Without cholesterol we would die. Of course cholesterol plays a role in CHD. But it’s only responsible for about 15 per cent of the cases of CHD.

One problem today is that too many people are sure that dairy products cause cardiovascular disease. As Josh Billings wrote 150 years ago: "It’s not the things you don’t know that get you into trouble, it’s the things you know for sure that ain’t so." My barmaid would explain that foolishly saying "no" to dairy products, means many people are not getting enough calcium and setting themselves up for a broken hip, severe disability or death. And women who say "no" to both dairy products and "no" to postmenopausal estrogen are in deeper trouble. It’s the combination of calcium and estrogen that keeps bone strong. Estrogen is the hammer that pounds calcium into the bones.

In Canada there are one million people with osteoporosis and every year 25,000 people fracture their hips due to it. It’s estimated that the complications of osteoporosis cost this country $1.3 billion a year.

The Healthy Barmaid as Minister of Health would stress that humans deserve the same nutritional treatment as gorillas!

Ida, being a very inquisitive woman, would ask this simple question: "Why do gorillas in captivity get better nutrition than humans? Why do they receive 5,000 mg. of vitamin C a day and yet the Health Protection Branch in Ottawa claims humans only need 45 mg.?" Humans and gorillas can’t manufacture their own vitamin C. Most animals produce it themselves. That’s why sailors died on long sailing trips to the new world, but the ship’s cat always survived.

Ida would point to studies showing that people taking both vitamin C and E have less chance of developing heart disease and cataracts. She would argue that taking these vitamins and preventing these problems would again save this country millions of dollars.

Vitamin E has several functions. One is to increase the oxygen-carrying capacity of the blood. To emphasise the importance of E she would tell this story.

An 82-year-old man had to stop playing tennis. His arteries were unable to carry enough oxygen to the muscles. The result? He could only walk a few steps before developing leg cramps. He had three operations for blocked arteries to try to unblock the arteries yet he still could only walk a short distance. He then read a column on vitamin E, started taking it and in a few months was back to playing tennis! Now at 85 years of age Ramsey Fraser is still playing tennis. If he keeps up with his E and that glass of wine he’ll be on the courts at 95.

The Healthy Barmaid as Minister of Health would have this message about cancer patients.

My barmaid has heard doctors telling tales in her London pub for the last 40 years. It’s made her a bit sceptical of how doctors treat patients. Ida would agree doctors do much more good than harm, but in some instances it’s better to run for the woods than accept medical care and she would tell this story.

A married couple had a rather bad altercation. The husband accused his wife of a variety of imperfections. Finally as he stormed out of the house he said: "And, in addition, you are a lousy lover." A few nights later he returned home, walked into the bedroom and found his wife in bed with another man. She calmly looked up at him and said: "I decided to get a second opinion."

Every year I receive letters from readers who have had radical cancer operations and who wished they had asked for a second opinion. All too often they complain that they would not have agreed to the operation if they had been advised of all the complications. There’s a great tendency for surgeons to underestimate the after-effects of radical surgery. I’m convinced that some surgeons suggest operations to patients that they would never submit to themselves. There’s no better example than subjecting elderly males to radial prostatectomy. This always leaves many incontinent and there’s no quality of life if you end it in diapers. The great tragedy is that, for elderly males who develop cancer of the prostate gland, the prognosis is the same whether they have radical surgery, radiation, chemotherapy, a combination of all three or do nothing, since it is a very slow-growing malignancy.

Ida would advise it’s often better to live with the devil you know than the devil you don’t.

My barmaid is a very compassionate woman with very specific ideas about cancer pain. She would tell you this story. A friend once asked a widow: "Did your husband die a natural easy death?" The women replied: "Oh no, he had a doctor"!

She would find it intolerable that in Canada 50 per cent of cancer patients die in pain. She would urge doctors to use heroin which was legalised for medical use in 1984. If they refused to do so when other painkillers had failed, families should sue both the doctor and the hospital. Malpractice occurs when a surgeon amputates the wrong leg. It’s also malpractice when patients are allowed to die in severe pain when it can be prevented.

She would also urge other Ministers to allow Canadians riddled with cancer or other frightful diseases, such as Lou Gehrig’s disease, to be treated as one would treat a loving dog, to have the right to end their lives in peace with assisted euthanasia.

The Healthy Barmaid as Minister of Health would have a message for the deans of Canada’s medical schools.

There is a cartoon hanging on the wall of The Red Lion pub. It depicts a doctor saying to a patient: "Of course you don’t understand what I’m saying. You’re not supposed to!" My barmaid would tell the deans we’re graduating too many doctors who are book-smart in mathematics and chemistry, but some can’t talk to a wall. If you can’t communicate you cannot sell used cars or relieve patients of their worries. She would urge deans of medical schools to place more emphasis on communication skills when selecting students and on family doctors who are still the backbone of medicine.

She would tell them this true story about a patient who had just had his gallbladder removed and was in the recovery room. The surgeon was worried about the man’s breathing so he called in an ENT specialist who was also concerned about his breathing. Finally he decided the patient needed an emergency tracheotomy or he would die. Just as the patient was being wheeled back to surgery the family doctor arrived. The surgeons explained the problem. He too listened to the man’s breathing. He merely looked up at these two specialists and said: "Hell, George is OK. He’s always breathed that way!" End of operation.

The Healthy Barmaid wouldn’t mince words about our troubled health-care system.

She would remind the public and her fellow politicians that no country has enough money to give everyone all the health care he or she demands. Any fool could have seen that our open-ended health-care system would collapse, but previous Ministers of Health had for years been blind to this fact.

She would tell the story about a U.S. economist who likened our health system to giving his daughter an American Express card on graduation and then saying to her: "Darling, go out and buy anything you want." He added: "If that doesn’t scare you, I’ll lend you my daughter!"

My barmaid would urge the public not to run to the doctor for every ache and pain. Ontario spends $100 million a year treating the common cold. This money could be saved if people with a cold considered Jewish chicken soup. She would suggest there are also times when Sir William Osler’s remedy made sense. He suggested that the best way to treat a cold was to "put your hat on the bedpost and start drinking whisky; Stop when you see two hats!"

My barmaid would have harsh words for lawyers for the way they have abused the health-care system. She would agree with Shakespeare when he wrote: "Let’s first shoot all the lawyers," but she would suggest that enough bullets should be saved for the politicians–politicians who have done nothing to tighten laws that allow frivolous malpractice actions demanding millions of dollars. Laws must be enacted to stop this trend. If not, doctors will continue to practice defensive medicine spending millions on tests that are not needed. Funds could be better used elsewhere.

In one particular area, my Barmaid as Minister of Health, would make Margaret Thatcher look like Joan of Arc. She would urge that laws should be enacted similar to those in Singapore on the use of illegal drugs. Her reasoning is simple. Easy laws on drug pushers are costing millions of dollars in medical treatment. Every day you can see the cost in our hospital emergency departments–drug addicts being treated for overdoses; pregnant women on crack cocaine giving birth to brain-injured children; and surgery to treat gunshot wounds. There are also the costs of psychiatrists and social workers, not to mention the costs of stolen cars and home break-ins to provide funds to purchase these drugs.

She would stress that Aristotle was right when he preached 2,000 years ago that "punishment is a form of medicine" and that all those who think otherwise should have been with her in Singapore when she talked to government officials. If punishment doesn’t work, how does one explain that Singapore has not needed to increase its police force for 27 years; that you can walk around that city at 3:00 in the morning without worrying about being robbed or mugged; that there hasn’t been a bank robbery for 10 years; and that everyone knows what happens to those who push illegal drugs? Singapore officials aptly describe our western society as being "irresponsibly permissive"–two words that none of us should forget.

We need more than money to save what we have left of our fractured health-care system. Last year the