Tuesday, October 30, 2012

CANCER SCREENING: BLESSING OR CURSE?


The good news is that breast cancer screening for women over fifty saves lives, an independent panel in Britain has concluded. This confirms other studies, including in the U.S.


The bad news is that for every life saved, roughly three other women were overdiagnosed, meaning they were unnecessarily treated for a cancer that would not have threatened their lives. The study reported that the British program annually saves about thirteen hundred women from dying of breast cancer while about four thousand are overdiagnosed. Overdiagnosis leads to unnecessary treatment such as chemotherapy, surgery and/or radiation for a breast cancer that while present, grows too slowly to be life-threatening.

Commenting on the study, Karsten Jorgensen, a researcher at the Nordic Cochrane Centre in Copenhagen who has previously published papers on overdiagnosis, said, “Cancer charities and public health authorities have been misleading women for the past two decades by giving too rosy a picture of the benefits [of mammograms].”

Maggie Wilcox, a breast cancer survivor and a member of the panel that published the report, said the current information on mammograms given to British women was inadequate. “I went into (screening) blindly without knowing about the possibility of overdiagnosis,” said Wilcox, 70, who had a mastectomy several years ago. “I just thought it's good for you, so you do it.”

So how does one navigate these confusing waters? Ms. Wilcox offers a clue, informed consent. Knowing what she knows now about overtreatment, she says she’d still have chosen to get screened. “But I would have wanted to know enough to make an informed choice for myself.”

Monday, October 29, 2012

THE D WORD


Healthcare is too expensive for a number of reasons. The leading one, by far, is that we overuse it.

Too many Americans behave in ways they know will eventually lead to illness (overeating, sedentary lifestyle, unmanaged stress, etc.), and then expect doctors to repair them. They demand the miracles they learned about in ads, often disguised as news—high-tech products and procedures pushed for their profit potential.

A parallel overuse occurs at the end of life. It’s estimated that a third of Medicare patients’ expenses occur during their final year. Attempts to stave off death, though, frequently amount to the prolongation of suffering. Most of us, I think, are aware of that fact now, yet when the event occurs, we tend to submit to futile intervention anyway. Our little inside-the-head voice says, “If you really love Dad, you’ll try to keep him alive.”

One task in authentic healthcare reform, then, is to develop a sense of peace with death. That’s not easy when many Americans fly into hysteria when the D word arises. An early version of the Affordable Care Act ("Obamacare") that recommended end-of-life conversations between families and docs was widely misinterpreted as “death panels” intent on pulling Dad’s plug. 

Tomorrow our local community will host its second annual public forum on healthcare reform. We’ll show a film comparing Canada’s healthcare system with ours, followed by a panel Q&A. Hopefully death-and-dying and other central issues will arise and be openly discussed. Taking such subjects out of the closet is the only way to illuminate them in order to address them intelligently.

Monday, October 22, 2012

IMAGINE YOUR DAUGHTER…


I wrote an article for Sisyphus magazine (http://www.hippocketpress.org/sisyphus) in 2011 which described an oft-neglected issue involving certain pregnant women. I’m republishing it here since it’s a high-profile issue in our upcoming election.

I was trained at Los Angeles County Hospital in the mid-1960s. In those days, if you decided to terminate your pregnancy and were well-off, your family flew you to Japan or Sweden. If you were poor, you sought a local abortionist.

Abortion being thoroughly illegal then, there were no professional standards. Abortionists didn’t need a degree, experience, or, for that matter, scruples. They did their work with whatever came to hand—kitchen tongs, harsh chemicals, even turkey quills. More often than not, their patients/victims developed bleeding, perforation, and infection. When I was on my Ob-Gyn rotation, we daily saw an average of eight to ten women with these complications. Many were as young as twelve, often hurriedly dropped off at the ER by frightened boyfriends or parties unknown. On the average, one died every day.

Imagine that: your daughter, who still keeps dolls in her bedroom, getting secretly pregnant, mutilated by a backstreet criminal, and shamefully dying alone. If abortion once again is declared illegal we’ll return to those days. As always, the wealthy will find little difficulty terminating pregnancies and the less affluent will risk death while their impregnators suffer no risk at all.

To say to these young women, “You should have thought of that before…” strikes me not only as inhumanly callous, but actually supportive of the taking of a human life.

Thursday, October 11, 2012

MEDICATION UBER ALLES!!



CANTON, Ga. — When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall. [The article says all four kids in one of Dr. Anderson’s patient families are treated with Adderall or an antipsychotic, Risperdal, and the sleep aid Clonidine to counteract the nocturnal stimulation caused by the other drugs.]

The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.

“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Dr. Anderson has nailed a problem responsible for much of healthcare’s incredible cost—our tendency to treat social disorders with medications. When kids don’t focus well in school, it’s hardly ever because of a brain dysfunction. It’s because they’re hypersugared, underexcercised, and overexposed to a TV culture that reinforces short attention spans. A pediatrician I know treats ADHD by teaching the parents meditation.

We’re becoming a society bent on medicating virtually all behavior, either to minimize deficits or maximize performance. Last year a National Heart, Lung, and Blood Institute panel, concerned about the increasing rate of type two diabetes in young people, recommended that all kids over the age of nine have their serum tested for cholesterol levels, and those above normal take agents like Lipitor. To repeat Dr. Anderson’s conclusion, “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

This sort of strategy isn’t just ridiculously expensive; it’s expensively ridiculous. A deeper disorder than ADHD or youthful type two diabetes is our bovine submission to the medical-industrial complex. If we gave it any thought, we’d be outraged…but maybe that would require a longer attention span.

Wednesday, October 10, 2012

PAY TO MAKE YOURSELF SICK?


Many corporations are now offering financial rewards to employees who demonstrate better health practices. Get a “wellness screening,” for example, and you get a $50 bonus. General Mills offers a monthly $10 to tobacco-free employees. Conversely, Walmart deducts $10 each pay period from employees who smoke. The rationale is that people with unhealthy habits (smokers on average consume twenty-five percent more healthcare services than non-smokers) ought to co-pay.

This has come about because of the huge and ever-increasing cost of medical insurance. Employers are expected to spend $11,664 per employee on healthcare in 2012, up from $10,982 last year. That's expected to rise in 2013 by seven percent, according to a Kaiser Family Foundation survey.

Some unhealthiness, such as familial hypercholesterolemia, is beyond people’s capacity to correct. But most is chosen, and costs everyone plenty. If we had to pay to smoke, overeat, remain sedentary, and ignore stress, would we continue to do it? Interestingly, that’s exactly the way things were before the advent of medical insurance: you got sick, you paid for treatment. We’ve come almost full circle. 

Tuesday, October 9, 2012

LORI HOPE, PEACE TO YOU


If you look at the bottom of this webpage, you’ll see my recommendation to check out my friend Lori Hope’s blog, http://carepages.com/blogs/helpshurtsheals/posts.

Lori died on September 27 from lung cancer. She lived with it all the time I knew her, at least ten years. Along the way, she devoted much of her time to helping others deal with their cancers. In 2005, she published her first book on the subject, Help Me Live: 20 Things People With Cancer Want You To Know. It was so useful and popular that she published a second edition in 2011. 

Lori was as articulate as she was compassionate, and will be sorely missed and forever loved and respected by the rest of us who deal, in one way or another, with cancer.

WANT TO READ YOUR MEDICAL RECORDS?


In recent research published in the Annals of Internal Medicine (http://annals.org/article.aspx?articleid=1363511), over thirteen thousand patients in a hundred medical practices—in Massachusetts, Pennsylvania, and Washington—were given easy access to their records. More than three-quarters reported that this not only helped them feel more in control of their care, but increased their medication compliance. As for their physicians, they reported little effect on their practices. Almost none reported longer visits or more time addressing patients' questions outside of visits.

When I was a kid, open records would have been unthinkable. You couldn’t even get a practitioner to tell you your blood pressure. Medical records were written in professional shorthand (“38 y/o SWM c/o SOB”) not only to save time, but to obstruct lay access. Prescriptions were written in Latin. It would never have occurred to patients to ask to see their chart.

The law—now and even then—never supported that secrecy. Medical information about you is your property. A practice can charge you reasonably for making copies, but must convey your records upon request. 

That being the case, one wonders about the source of traditional resistance. Is it that whoever has the knowledge has the power? Do open records, then, signify a shift in power? In any case, open records is an idea whose time has come, and hopefully will lead to closer patient-doctor relationships.