Pierre, 49 years old, has an appointment this morning at 11 a.m. for a coronary examination. This scanner is intended to clarify the general condition of the arterial circuit and detect possible areas of narrowing of the arteries. Pierre is resting. He is an airline pilot and takes the opportunity between two flights, one to New York and the next to Papeete, to take care of his health.
He is radiant, exudes vitality, has never smoked, does not drink, and it is to please his wife that he goes for this medical examination as he approaches fifty. His partner insists that he go see Dr Alexis Tubiana, a specialist in cardiac imaging in the Île-de-France region. Pierre goes there mainly focused on the birthday of his daughter Lola, 17, which he has to celebrate this evening.
Facility. Radio. Fifteen minutes. Report. And his life changes. The examination reveals that one of his coronaries is more than 95% blocked. Dr. Tubiana sends him urgently to the hospital to have an operation and insert a stent to prevent blockage of the artery. “In less than a year, I had to ban two long-haul pilots without symptoms from flying to have emergency stents inserted”, underlines the specialist. He adds that on average every day, two lives are saved following x-rays in his office.
Cardiac prevention, the big challenge
Cardiovascular diseases were responsible for more pathologies and mortality than all cancers combined until 2023 in France, according to the French Society of Cardiology. Women die six times more in France from cardiovascular diseases than from breast cancer. However, the country trains five times more radiologists subspecialized in women’s imaging than in cardiac imaging. Go figure…
Some voices are raised against ultra-prevention; we can hear them, but a happy medium would be necessary
However, screening by cardiac scanner is not widespread in France, although it has been recommended by all Western scientific societies since 2021. Our large metropolises do not have a scanner screening center dedicated to cardiac imaging. . When we consider that 59% of avoidable hospitalizations in France have a cardiac origin (Drees, April 2023), we wonder why resources are not put on the table for upstream prevention, in order to lighten our health system. downstream. Or simply our life.
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Who wouldn’t want to detect cancer, a blocked artery or a stroke early with the best diagnostic tools? Some voices are raised against ultra-prevention; we can hear them, but a happy medium would be necessary. In 2019, France had 18.2 scanners per million inhabitants compared to 25.9 for the rest of the OECD. Our country is essentially equipped with second generation scanners, which represent up to 90% of the devices installed in certain regions (Hauts-de-France Regional Health Agency survey 2020).
Fewer scanners in France than in the rest of the OECD
Radiologists therefore do not always have the most recent technological devices to provide appropriate care according to the latest advances in science, in accordance with the Hippocratic Oath. However, since 2021, a real revolution has been born with fifth generation devices on the market, I say fifth generation (hailed as the most significant innovation for medical imaging since the discovery of X-rays in the 19th century).
France currently has only four devices of this type. They make it possible to inject less iodinated contrast product, therefore less toxic to the kidneys, to obtain three times more information and to deliver up to three times fewer rays harmful to our health. At a time when all our neighboring countries are widely equipping themselves with this “latest addition” – Sweden, a country of 12 million inhabitants, has placed an order for nine of these devices in 2022 – the ARS in France widely recognize the usefulness of this fifth generation technology, and recommend equipping our country, but do not say how to finance it.
Prevention, to detect cancers, is our Achilles heel
The financing mechanism in France makes it impossible to allocate these expensive devices. The only solution is donation campaigns, used to obtain the device as in Brest, Lille, Pessac, Gustave-Roussy, soon Cochin, Necker and Pompidou… Surprising to have to appeal to the solidarity of the French. We who already finance our health system by contributions, now we must also move to the donation system. Double financing. We are there.
Cancer prevention, the great oversight
Prevention is also our Achilles heel in detecting cancer compared to our European neighbors, while we obtain good results in treating them. The European Cancer Organization published its report on May 13 to highlight that the breast cancer screening rate is 7 points lower than the European average (46.9% compared to 54% among our neighbors).
The European Cancer Organization says we have 1.52 oncologists compared to 3.76 in the European Union. “40% of them are avoidable if we reduce the consumption of alcohol, tobacco, sedentary lifestyle and excess weight”, recalls Alain Toledano, oncologist, founder of the Rafaël Institute, the first European center for integrative medicine which supports patients free of charge, during and after cancer. The daily fight against chronic diseases is at the origin of this institute. The number of patients affected by these pathologies currently stands at 20 million in France.
However, we would like to highlight the obsolete nature of our national care system, as well as the real possibility of rebuilding it. Indeed, the question arises for us to know what definition we wish to give to the notion of care. Do we want care to only designate the set of practices intended to fight against diseases?
Or do we believe, more broadly, that being cared for means, for everyone, in all territories, not only the possibility of receiving appropriate and necessary treatment, but also the possibility of preventing serious illnesses and staying healthy? a good state of physical, psychological and social health?
Conventional chemotherapy can cost from 5,200 to 31,200 euros depending on the product used. Treatments to treat cancer range from 80,000 to 116,000 euros. And we expect an increase of more than a billion euros in the cost of treatments each year due to the wave of innovations that is sweeping. To what extent will our social security system be able to cover this increasingly expensive care?
The welfare state is fading
At a time when the government wants to reduce expenses linked to long-term conditions covered 100% by social security, let’s ask ourselves the question of prevention. Patients from all over the world arrive in France in a brand new center specializing in prevention, around Dr Dalle. A completely private, luxurious center, between the Opera and Place Vendôme in Paris.
Prevention, neglected by the State, targeted by those who have the means.
The welfare state is fading.
