by CathyG | Sep 9, 2014 | medical care
“Nearly 70% of lung cancer occurs in the Medicare population.” That’s the scare statistic the authors of this article use to incite fear and indignation: “Oh no, they’re killing Granny.”
The statistic is probably accurate. But some of these people are in their 80s and 90s. Lung cancer screening makes sense, at best, till age 74. Some elderly folks have other medical conditions that would preclude treatment, regardless of screening outcomes. And when you’re in your 80s and 90s, you could be treated for lung cancer only to end up with some form of cognitive impairment and/or incarceration (I use that word advisedly) in a nursing home with a loss of dignity and independence.
The article reports, “From 2002 to 2010, the NLST evaluated the impact of low-dose computed tomography—or CT—scans in more than 53,000 individuals and demonstrated a 20% reduction in lung-cancer mortality.”
That number is meaningless. We need to know the number of survivors in the screened group vs the number in the non-screened group. If these groups are self-selected the results will be muddled even further because there are differences in people who successfully seek screening vs. those who don’t seek screening or don’t have access.
It’s hard to trust any screening recommendations from radiologists and cancer centers, who stand to profit from screening and from investigating false positive. Here are links to published research studies showing far less impressive results. If newer research is available, let’s see the links.
“Cumulative lung cancer incidence rates through 13 years of follow-up were 20.1 per 10,000 person-years in the intervention group and 19.2 per 10,000 person-years in the usual care group (rate ratio [RR] …” In other words, intervention – presumably this screening – saved less than one person-year.
http://www.ncbi.nlm.nih.gov/pubmed/22031728
“Overdiagnosis is of particular concern in lung cancer screening because newer screening modalities can identify small nodules of unknown clinical significance. Previously published analyses of data from the Mayo Lung Project, a large randomized controlled trial conducted among 9211 male cigarette smokers in the 1970s and early 1980s indicated that overdiagnosis might exist in lung cancer screening…”
http://www.ncbi.nlm.nih.gov/pubmed/16757699
Let’s forget about lung cancer screening and use the money for massage.
by CathyG | Sep 7, 2014 | pollyanna views of aging
I’m tired of hearing that 50 is the new 30 and 60 is the new 40. Here’s what’s different as you get to the 60 mark and beyond.
1 – It’s harder to predict where you’ll be 5 or 10 years from now – sometimes even one year.
When you’re 40 or 50, if you’re healthy, the odds are very high that you’ll be the same for another five to ten years. You can make plans. It makes sense to invest in long-term growth stocks and your new business.
When you’re in your sixties, with each year, you’re less sure. Sure, some 70-year-olds and 75-year-olds are running marathons and businesses. But it’t not unheard of to keel over with a completely unexpected stroke or heart attack. Often, says a cardiologist I know, the first symptom of heart disease is a fatal heart attack.
2 – You stop saying, “Never say never.” Some things just won’t happen. You don’t have enough time.
3 – You realize you won’t outlive everything you own. Why buy more clothes? The t-shirts I have now will last another 10-15 years.
4 – You become comfortable with the idea of dying. It’s gonna happen. It’s more about dying a good death than living a long time. I’m more scared of going into a nursing home than I am of dying.
5 – You realize your days are limited and you want to make each one count. So you resent sitting around in waiting rooms or wasting your time on things that don’t contribute to your welfare or anybody else’s. You don’t have time to suffer fools gladly.
And, if you’re like me, you don’t hesitate to tell them, using language as colorful as possible.
by CathyG | Sep 3, 2014 | stereotypes of aging
Cartoon circling around Facebook, suggesting that people get all saggy and baggy as they age.
First of all, a lot of the time you can prevent sags and bags with exercise, if you start early enough.
And second, there’s not much you can do about sagging and bagging, in some cases. It goes with the territory. Even if you’re totally fit your skin won’t hang the same way as you age.
We don’t make fun of disabled people. Why is this funny?
by CathyG | Aug 31, 2014 | medical care
Today’s Wall Street Journal had yet another story by a disillusioned doctor: Why doctors are sick of their profession
Jauhar actually offers a balanced view. He points out that doctors were warned they would kill the goose that laid the golden eggs; many doctors still perform unnecessary surgery. I am healthy and rarely see doctors, yet when I had a small ovarian cyst, a doctor tried to persuade me to undergo a complete hysterectomy! I switched doctors and had an outpatient procedure in just a few hours.
The irony is that managed care often doesn’t prevent unnecessary or wasteful treatment. The term “preventive care” should be replaced with “risk reduction medicine.” Much of a primary care doctor’s work involves screenings of perfectly healthy, asymptomatic people that cannot be justified by research findings.
Doctors are still trained to memorize molecular structures but they need courses in statistics and decision making. Recently the WSJ published a review by a cardiologist who insisted that deaths from heart disease were down by 60%. I looked up the numbers: the reduction was 172/100,000 and that doesn’t account for things like errors in coding causes of death.
And while doctors complain bitterly about lack of respect, many of them persist in making elderly patients (and those close to end of life) suffer with unnecessary treatment. Just read any list of comments in a NYT article. I’ve heard first-hand accounts of 90-year-olds given colonoscopies, paid by Medicare; a doctor writes about aging Alzheimer’s patients getting painful needle tests for diabetes, ordered by a doctor, who can’t be stopped. yet few insurance companies give them what they need – massage, good food and privacy. I’ve heard even more horror stories of doctors who disregard DNR orders and who think they’re doing a service by keeping someone alive for a meaningless, drugged-up existence in a nursing home.
Finally, doctors have limited accountability. It is very, very hard to sue a doctor. Doctors make claims on their websites (and in practice) without disclaimers and disclosures of conflict of interest. Eye doctors actually place ads in their office magazines (“Want great vision? Talk to us about …”) without warning that these procedures do not always turn out well and sometimes make vision worse.
by CathyG | Aug 12, 2014 | health care waste
The New York Times article (Unkind Life For Young and Old, Aug 7) highlights yet another way the US wastes money. It costs $100,000 a year to maintain an aging prisoner, and prisons aren’t exactly geared for “aging in place.” They have unsafe stairwells, a ban on canes and of course no geriatricians on staff.
Geriatric prisoners rarely pose a threat to society so there’s little reason to keep them.
Jamie Fellner, author of a Human Rights Watch, was quoted in another article as saying, “Age should not be a get-out-of-jail-free card.” But why not? In some countries, people over 70 do not go to prison, period. I doubt that we’d see many people over 70 suddenly going on crime sprees; the rare cases of white collar crime, like Madoff, could be handled with supervised probation or fines.
