Denby on Sicko

by Jon Mandle on July 12, 2007

David Denby didn’t like “Sicko” very much. In the New Yorker, he writes:

“Hauling off seriously ill people to a military base where they won’t receive treatment is a dumb prank.”

Okay – I’m not the biggest Michael Moore fan in the world, and I can see how this might rub some people the wrong way.

“Why not tell us what really happened on the trip – for instance, what part Cuban officials played in receiving the American patients?”

Actually, that might not be a bad idea.

“Moore winds up treating the audience the same way that, he says, powerful people treat the weak in America – as dopes easily satisfied with fairy tales and bland reassurances.”

Seems harsh – this is clearly supposed to be a piece of entertaining propaganda – but, again, I can see the point.

“A shift to the left, or, at least, to the center, has overtaken Michael Moore, yielding an irony more striking than any he turns up: the changes in political consciousness that Moore himself has helped produce have rendered his latest film almost superfluous.”

Er, how’s that again? In polls, a majority are in favor of universal health care, so there’s no need to build grass-roots pressure anymore? Same for getting out of Iraq, I suppose.

{ 51 comments }

1

derek 07.12.07 at 6:36 pm

Shorter Denby: Hey, you there! Stop moving that Overton Window!

2

Steve LaBonne 07.12.07 at 6:41 pm

Most of Denby’s comments are (predictably) really dumb, but I pretty much agree that it would be a stronger film without the Cuban segment.

3

abb1 07.12.07 at 7:07 pm

The AP reports:

…But did the American film crew get special treatment because they were, well, an American film crew? Moore and his producer, Meghan O’Hara, insist not. “We demanded that we be treated on the same floor as all Cubans, not the special floor for foreigners,” Moore told The AP. Still, the doctors obviously knew they were being filmed, so it’s hard to know — although Cervantes [former 9/11 “first responder”] said she went back alone with no cameras and was treated similarly.

4

artclone 07.12.07 at 7:21 pm

I haven’t been able to take Denby seriously since reading his Allan Bloomish “Great Books” memoir. Gimme A. O. Scott any day . . .

5

Jim S. 07.12.07 at 9:08 pm

Well, as a matter of fact, the American people have always favored national health insurance and universal social services in general (look at the support for Social Security). If the American Left would stop punishing and hating it’s own people by not advocating these programs-advocating, instead programs that benefit only the very poor and the discriminated-against groups-we would have these programs by now.

Not that a little agitation is bad.

6

CR 07.12.07 at 9:16 pm

I think most of us agree that Moore pushed it rather far with the Cuba segment. But I also think it is fairly clear that it served as (and was at least partially meant to serve as) a provocation to deliver media coverage (i.e. free marketing) of the film. The first I heard of it was during the week after Cannes when various CNN talking heads couldn’t stop discussing “Michael Moore’s illegal trip to Cuba and his potential incarceration.”

7

Emma 07.12.07 at 9:40 pm

If Mr. Moore had been treated in the same wing as “regular cubans” he would have had his family in Miami send blankets, bandages, and painkillers as we had to do when my 85 year old uncle entered hospital.

Having said that, that review is the biggest crock of condescending superiority I’ve encountered in a long time. What’s with the NYT reviews these days?

8

thag 07.12.07 at 9:48 pm

7:
New Yorker, not NYT.

But, yeah, this goes into the familiar genre of “since I agree with what he says, I’m going to slam him irrelevantly for saying it in a way that irritates me.”

Moore seems to get a lot of this. Never having seen any of his films, I can’t say why.

It’s particularly striking with e.g. Andrew Sullivan. By now, most of the criticisms that Moore made in Farenheit 911 (at least the ones I read references to back when it came out) are criticisms that Sullivan now accepts and agrees with.

So has Sullivan decided “hey, you know that Moore guy was actually right after all”? No, we still have to hate on Michael Moore.

Why, Andy: because he was right before you were?

(Again, I have to admit the possibility that Moore is just deeply annoying in ways I would only understand if I actually saw him on the screen. But I’m doubting that explains it.)

9

Sebastian Holsclaw 07.12.07 at 9:51 pm

“We demanded that we be treated on the same floor as all Cubans, not the special floor for foreigners”

Moore demands lots of things. Was he obeyed? Was he aware that there are whole separate hospitals for foreigners? Did he think about what it means that there are special treatment facilities for foreigners?

10

Seth Finkelstein 07.12.07 at 10:33 pm

The right-wing clearly hates Michael Moore because he’s one of the few people who has figured out how to do successful American left-wing entertainment. He’s taking all those deep-seated rants (“If you don’t like it, go to Cuba!” “Prisoners get treated better than real ‘muricans!”) and is turning them around for the opposite political purposes (went to Cuba, and did get treated better, after trying the prison).

It’s extremely clever, steals their thunder, and they don’t like it at all.

11

engels 07.12.07 at 10:48 pm

I haven’t seen this film and I probably won’t, so I don’t know what the problem is with Moore’s portrayal of Cuba although I’d be ready to admit there is one. It’s worth pointing out, though, that Moore is not the only person who thinks that the Cuban health system deserves extremely high praise.

If left-right prejudices really are as redundant as the prime minister reckons, his best-advised policy shift should be rather different. Within reason – and though hell will freeze over, while pigs cruise over Downing Street – he should go Cuban. John Harris, BBC Newsnight report

Cuba’s achievements in social development are impressive given the size of its gross domestic product per capita. As the human development index of the United Nations makes clear year after year, Cuba should be the envy of many other nations, ostensibly far richer. [Cuba] demonstrates how much nations can do with the resources they have if they focus on the right priorities – health, education, and literacy. Kofi Annan, Secretary General of the United Nations

Cuba has done a great job on education and health and it does not embarrass me to admit it. World Bank President James Wolfensohn

The health system in Cuba guarantees accessibility to the entire population, is free of charge, and covers the spectrum from vaccinations to sophisticated interventions. The results are impressive: Cuba’s health figures are on a par with developed countries that have 20 times the budget. The country is experiencing a difficult period because of the collapse and loss of support from the Soviet Union; over 30 years’ trade embargo by the United States; and the gradual change from a centrally planned economy towards more of a free market system. Shortages are experienced in every sector, and maintaining health care services at the current level is too expensive. Doctors and nurses continue to work towards the goal of health for all Cubans, even though their salaries are minimal. Signs of negligence or corruption, often seen in other socialist countries where incentives for output are lacking, are unknown. Topics such as family planning and AIDS deserve immediate attention. Hans Veeken, Letter from Cuba in the British Medical Journal

12

Uncle Kvetch 07.12.07 at 10:49 pm

But, yeah, this goes into the familiar genre of “since I agree with what he says, I’m going to slam him irrelevantly for saying it in a way that irritates me.”

Very nicely put.

13

thag 07.13.07 at 12:23 am

thanks, uncle kvetch.

14

Bruce Baugh 07.13.07 at 1:17 am

Thag, Moore uses a very working-class style in his documentaries. Which is to say that he’s louder, brasher, up closer, less polished, and otherwise not in his delivery as a typical maker of documentaries from the educated classes. He’s also extremely open about emotion, and completely uninterested in balance as a goal. A lot of the ire he gets is that he’s successful doing things and being ways that the journalistic establishment says you can’t and shouldn’t want.

15

Sebastian Holsclaw 07.13.07 at 1:20 am

And he doesn’t bother at all to make sure that his ‘facts’ give an accurate impression. So, for example, he thinks it is quite all right to use denial of experimental and unproven cancer treatment as an explanation of how the US system is inferior to other systems which would have also denied experimental and unproven cancer treatments on their dime.

16

Anderson 07.13.07 at 1:34 am

Denby is practically an anti-critic — if you see the movies he hates, & vice-versa, you will do all right.

Thank god for Anthony Lane.

17

Seth Finkelstein 07.13.07 at 2:14 am

Sebastian / #15: You’re demonstrating Moore’s cleverness perfectly. The right-wingers are now the ones playing catch-up and chase-the-story, sputtering it’s-a-misleading-anecdote.

You’re also missing the point. The insurance propaganda machine has been very successful at getting into the minds of average people that:

goverment health care == RATIONING! Bad bad bad.
for-profit insurance companies == TREATMENT! Good good good.

Now Moore comes along, and provokes _the other side_ into essentially saying, of course insurance companies have to ration health care, just like governments!

It’s a brilliant bit of rhetorical judo.

18

abb1 07.13.07 at 6:55 am

So, for example, he thinks it is quite all right to use denial of experimental and unproven cancer treatment as an explanation of how the US system is inferior to other systems which would have also denied experimental and unproven cancer treatments on their dime.

This particular treatment is “experimental and unproven” according to this particular insurance company. How do you know the other systems would’ve denied this particular treatment? Prove it, put up or shut up.

19

abb1 07.13.07 at 7:01 am

Was he aware that there are whole separate hospitals for foreigners?

Yes, he was. If you watched the film, you’d hear him saying: “we asked them to treat our patients exactly as they would the ordinary Cubans, no more, no less; and that’s what they did.”

20

SG 07.13.07 at 7:58 am

Sebastian, for the record, what were you saying and doing – and where were all the upright, virtuous defenders of truth on the American right – when Colin Powell lied to the UN and deceived your country into invading Iraq and murdering 600,000 people? I don`t seem to recall the American right`s love of truth and objectivity getting in the way of that good story. Would you like me to make a list of all the stupid, mendacious, lying, deceptive, slanderous, offensive, thuggish and disgusting things the American right trots out daily, weekly or monthly as part of their campaign to destroy your society? And, while they`re at it, to drag everyone else`s down with them?

No, if you want to see someone talking shit until it makes everyone else puke, just go and find yourself a conservative pundit complaining about how Michael Moore lied in Sicko (vs. the Iraq build up), did a hatchet job on Bush in Fahrenheit 911 (vs. outing Plame, for example) or setup Heston in Bowling for Columbine (vs. claiming Carson has killed more people than Hitler, for tobacco company money). These people wouldn`t know the truth if it bit them on the arse (which, incidentally it is). Why should I care if a fat hairy lefty does the same thing back to them? They deserve that and a whole lot more.

21

Sebastian Holsclaw 07.13.07 at 3:47 pm

“How do you know the other systems would’ve denied this particular treatment?”

Because a bone marrow transplant isn’t an indicated treatment for advanced kidney cancer even at the National Cancer Institute which is a touch on the liberal side (in the sense of listing treatments with marginal effectiveness).

“Prove it, put up or shut up.”

That is proof. Neither insurance companies nor national health care systems choose to pay for very expensive and very unlikely treatments. Contra seth above, this isn’t even rationing care. Rationing care involves restricting access to care that works or is likely to work. This is flat out ‘not wasting money’.

22

Sebastian Holsclaw 07.13.07 at 3:48 pm

“Would you like me to make a list of all the stupid, mendacious, lying, deceptive, slanderous, offensive, thuggish and disgusting things the American right trots out daily, weekly or monthly as part of their campaign to destroy your society?”

Sure, if the topic is “should we go to war with Iran” please feel free.

23

abb1 07.13.07 at 4:36 pm

Because a bone marrow transplant isn’t an indicated treatment for advanced kidney cancer even at the National Cancer Institute

It may be not indicated because it requires specific conditions, sibling with compatible cells or whatever it is. This is not a general treatment. I’m still not convinced that it would necessarily be rejected.

24

perianwyr 07.13.07 at 5:03 pm

Would the fact that the man died mere weeks later indicate, avulsive as it is, that the insurance company made the right call?

25

PJ 07.13.07 at 5:07 pm

Haven’t seen Sicko, but I believe that bone marrow transplants for (?metastatic) RCC are allogenic (graft versus host), but still need HLA compatibility. But I certainly don’t think it is a routine treatment, experimental as far as I’m aware (there are some clinical trials running).

26

PJ 07.13.07 at 5:14 pm

Sufficiently experimental that:

“A graft-versus-tumor effect through nonmyeloablative allogeneic stem cell transplantation (N-SCT) in metastatic renal cell carcinoma (RCC) has been reported. An Intergroup phase II trial was undertaken to define further the feasibility, toxicity and efficacy of this approach in a multi-institutional setting…A graft-versus-tumor effect was not observed in this study despite acute and chronic GVHD, thus highlighting the need for further understanding of this approach. Allogeneic SCT remains investigational in RCC.”

Adoptive immunotherapy by allogeneic stem cell transplantation for metastatic renal cell carcinoma: a CALGB intergroup phase II study.Rini BI, Halabi S, Barrier R, Margolin KA, Avigan D, Logan T, Stadler WM, McCarthy PL, Linker CA, Small EJ; Cancer and Leukemia Group B; Eastern Cooperative Oncology Group; Southwestern Oncology Group. Biol Blood Marrow Transplant. 2006 Jul;12(7):778-85

27

abb1 07.13.07 at 5:54 pm

I’m not denying that it’s experimental; all I’m saying is that it’s not at all obvious to me that if patient’s team of doctors recommended this treatment (as indeed they did), then under Canadian, British or French system it would’ve been denied by the administrators.

28

TomChicago 07.13.07 at 7:01 pm

Why not stop using the euphemism, “health” insurance? It is sickness insurance. We insure against fire, theft and floods, and call it that.

On a slightly different note, one criticism I’ve read is that MM does not distinguish between the for-profit and the non-profit insurers. While I haven’t seen the movie yet, this is a point that would be of interest to me. I have often thought for-profit insurers are related to vampires.

29

engels 07.13.07 at 7:14 pm

Why not stop using the euphemism, “health” insurance? It is sickness insurance.

Should we also abolish the “euphemisms” car insurance, house insurance and life insurance?

30

PJ 07.13.07 at 8:20 pm

abb1, at least in the UK they will not pay for experimental and unproven treatments – there are treatments that are proven but not cost effective that won’t be funded either but they certainly don’t go around paying for unlicenced unproven treatments outside of experimental trials.

Socialised medicine is not magic.

31

abb1 07.13.07 at 8:57 pm

at least in the UK they will not pay for experimental and unproven treatments

OK, in the UK the doctors are salaried employees; if they decide that this should be the treatment, how will “they will not pay” mechanism work, who doesn’t pay whom?

32

PJ 07.13.07 at 9:06 pm

abb1, the doctors just won’t decide it if the local policy is not to fund it – the reason being that at some point a doctor, pharmacist, or administrative worker will refuse the request. It is very common for a doctor to say that -ideally- the next move would be drug X (say thalidomide for myeloma), but if the NHS has a policy of not funding it (or rather their local health authority, PCT or whatever) then they just won’t prescribe it, even though the doctor would like to give it, and even though it has been proven to work (unlike in this case where it may not even have been licenced).

There has to be a system to control expenditure, you can’t just prescribe any old thing as the whim takes you, like I say, better than the US but not magic!

33

PJ 07.13.07 at 9:07 pm

that was _ideally_, rather than -ideally-.

34

Seth Finkelstein 07.13.07 at 9:47 pm

sebastian/#21 – Regarding “Contra seth above, this isn’t even rationing care.”, I’m willing to give the man’s doctors the benefit of any doubt, and assume that if they were willing to try the treatment, it was medically sensible. Sure, it might have been a heroic and desperate measure attempting to save his life – but that’s different from quackery. And now you tell us that it is absolutely necessary that some bean-counting bureaucrat in the national health service, I mean, the insurance company, must, absolutely must, make decisions against the medical judgment of those doctors, because there’s simply a limit – well, see the point?

Any way you slice it, that’s rationing.

35

abb1 07.13.07 at 10:03 pm

PJ, if you know that this how the NHS works, that’s fine. I would imagine, though, that ‘expenditure’ there should mean something totally different from what it means in the American ‘fee for service’ environment. If a salaried employee has time, it seems it would make more sense to have him administer experimental treatment than twiddle his thumbs. Different ways to control expenditure.

36

theo 07.13.07 at 11:15 pm

I also think it is fairly clear that it served as (and was at least partially meant to serve as) a provocation to deliver media coverage (i.e. free marketing) of the film.

Second this. The most provocative documentaries are the ones you hear about 6 months before the release date, because the filmmaker is under investigation by the US Treasury/has started a riot at a rodeo and had to flee town.

37

Sebastian Holsclaw 07.14.07 at 3:11 am

“If a salaried employee has time, it seems it would make more sense to have him administer experimental treatment than twiddle his thumbs.”

I don’t think you understand what a bone marrow transplant is.

38

SG 07.14.07 at 5:47 am

Abb1, I think Sebastian is right in general about this. One of the ways in which socialised medical systems keep costs down is by always going for the cheaper proven treatment, rather than the new expensive unproven one. Private health insurance systems tend to err on the side of the newer and better, even when they don’t have to, as a function of their business model. I don’t think that this is the main reason for the US’s inflated prices, btw.

I grabbed this off a random website which gives an introduction to the UK’s private health insurance system:

Unless the drug has been approved for use by the NHS in England and Wales, by the Institute for Health and Clinical Excellence, your insurer is unlikely to approve its use. The problem is that the Institute’s brief is not simply to decide whether a drug works, but to carry out a cost/benefit analysis to ensure that the benefits to the nation outweigh the financial costs of using it in the NHS. Not an easy brief – and one that has placed the Institute under scrutiny for the extended delays in drug approval.

(In this quote I think “insurer” means private insurer, and “drug” can also mean “treatment”). so the upshot is that if the NHS won’t treat you for it for free, no-one will. The UK private health system has essentially incorporated the NHS’s cost-control system in order to keep its own costs down.

(However, having said that – if the NHS was funded at twice it’s current level, I reckon it would be able to afford almost any treatment. So probably if the NHS was receiving as much money as is pumped into the US system, England would be a much prettier place – all those dolly-birds would be getting face transplants on the NHS!)

39

abb1 07.14.07 at 10:05 am

I don’t understand what a bone marrow transplant is. But I do understand how government agencies work.

40

PJ 07.14.07 at 10:23 am

abb1, there are not just doctors sitting around waiting to do bone marrow transplants who would otherwise be unoccupied. It is an expensive and time consuming procedure requiring specialists, with very high mortality and unproven benefits.

For a start (although even if this were not the case they still would not do a BMT) the NHS is organised along a sort of internal market with a purchaser/provider split.

41

engels 07.14.07 at 12:16 pm

I’m afraid you don’t appear to, abb1, as they do not have large numbers of surgeons sitting around “twiddling their thumbs” so they frequently have to make decisions about how to allocate their scarce resources. In practice they do so according to policies which are informed by cost-benefit considerations. So I don’t think there is the big difference you think there is with how insurance companies operate.

42

abb1 07.14.07 at 2:45 pm

I worked for a state department of mental retardation for several years. They had caseworkers, they had budgets, they hired contractors. Caseworkers had a lot of discretion, and they did experiment. Sometimes their workload was heavy and their budget was low, sometimes it was the opposite and then they were looking for ways to spend more and take more cases. Anything was possible.

43

PJ 07.14.07 at 3:10 pm

This article on the topic:

http://washingtontimes.com/article/20070630/COMMENTARY/106300004/1012

reminded me of aspects of this debate that I find odd. In the article he talks as if the US is the only place to do clinical trials, which is bizarely shortsighted given the number of European clinical trials, admittedly there is a lot of good quality medical research done in the US, but that is due to generous US _government_ (NIH) funding to a large extent.

A idea is that US drug costs fund all pharmaceutical research, again partly driven by the bizarre view that all big pharmaceutical companies are American (obviously false), and the more difficult to disprove view that somehow the US healthcare consumer is paying for global drug R&D through their high costs, and everyone else is free-riding on the back. I don’t know whether this is true, I doubt it, and I’m surprised that rightwing low tax types don’t want to redistribute some of these healthcare costs back to the Europeans and their socialised medicine if this is really the case – very altruistic of them.

44

PJ 07.14.07 at 3:13 pm

abb1, larger organisations like the NHS (one of the world’s biggest employers) have rather more division of labour, with, as I said, purchaser/provider split and internal markets. There is room for discretion over little things (e.g. thrombolysis in stroke patients over 80yrs), but not over whether people get unproven bone marrow transplants.

45

abb1 07.14.07 at 4:03 pm

Fair enough.

46

abb1 07.14.07 at 5:36 pm

Btw, here’s what happened when I worked at the Mass. DMR. There was a provider there, certified by the state, that was using electroshock therapy (very controversial, obviously, behavior modification technique, illegal in some states) on mentally retarded. The DMR commissioner Mr. Campbell tried to decertify the place and shut it down, the provider sued, won and Campbell had to resign. This is just to give you an idea of how much leeway components of these agencies are given sometimes. In the US, at least.

47

Seth Finkelstein 07.14.07 at 9:54 pm

FYI:

http://oracknows.blogspot.com/2005/12/when-is-cancer-care-futile.html

“Part of the problem is, of course, that there are limited resources, and the public health question is whether we should be putting so many resources into “hopeless” cases. The reality is that Sontag underwent a bone marrow transplant only because she had the money to pay for it if her insurance company didn’t come through. She had to put up a $256,000 deposit before the Fred Hutchinson Cancer Center would proceed to treat her. Only a small percentage of the population could afford that; anyone of lesser means would have had to fight his insurance company while precious time ticked away, making a tiny chance infitessimal.

But the real problem here is that the areas where advances are most needed are exactly in these “futile” cases. Advances are made when doctors and their patients push the envelope and try to cure diseases that, at the time, have a very low (or seemingly nonexistent) chance of cure, sometimes at high cost, both in money and in risk. …”

48

PJ 07.14.07 at 10:15 pm

I disagree, the advances are made when they push the envelope and try and cure a disease as part of a clinical trial – anything else is just pissing in the wind.

49

glenn 07.16.07 at 1:12 pm

One certainly doesn’t have to be a right winger to dislike Michael Moore and/or his movies. Part of it is his ‘tude, the condescension, the smarter/better/holier and more righteous than thou, and patronizing attitude.

There are those on the left, or at least agrees with much of MM is trying to accomplish, who believe his sledgehammer-and-smirk is probably more counter-productive since he’s sooooo willing to offend the mighty (to afflict the comfortable —- which is his #1 modus operandi), rather than comfort the afflicted, which is what his guise it. Whether it’s true or not, he certainly comes across as having much more fun throwing the stones than picking up the downtrodden.

And I’ve made these similar comments on other blogs, so some will recognize them … but two hours with coke and a popcorn is really the only and appropriate venue for MM.

50

Pete 07.16.07 at 4:56 pm

Google “nhs herceptin” for a good example of the controversy over

Also, http://randomreality.blogware.com/ and the NHS blog doctor for what the NHS looks like from the inside. It’s an organisation that provides excellent medical care – when it is allowed to do so, and when it’s not having its time wasted by the public.

51

Pete 07.16.07 at 4:57 pm

Oops – “controversy over what treatments will be paid for”, I should have said.

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