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“Too young to die, too old to worry”

An article with that title appeared in the New York Times. The premise is that, after a certain age, you should be able to do whatever you want. Why forego cigarettes? Leonard Cohen announces he is taking up smoking at age 81.

The truth is that there isn’t a lot of research about people who begin to let go after, say, age 65. From what I could find, late-onset diabetes doesn’t kill you.

I couldn’t find anything about resuming smoking in the last part of life. A doctor told me at most I’d get a lung infection that’s easily cured just by quitting for a few weeks.

The article suggested that one might avoid smoking because of potential harm to others due to secondhand smoke. A reader presented this article from a Forbes blog, showing that the dangers of second-hand smoke have been exaggerated.

It’s heartening to read the comments: so many of us are more concerned with living well than living long. And more people fear nursing homes than death.

I’d always planned to take up smoking again when I turned 50 or 60. I’d start now, except there’s no place left to enjoy smoking, even in your own home.

Lung cancer screenings in Medicare population? WSJ gets it wrong

“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.

Doctors are sick of their profession … and we’re sick of arrogant doctors.

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.

Single People Die Younger

Single people die younger. According to this article, the difference might be due to a spouse who nags you to eat better or see a doctor. I think it’s also likely that you’ll get better care from doctors when a family member can advocate for you. Read the article here.

And here’s another article about positive effects of marriage on men’s health. Click here.

One thing that gets ignored is the way the health care system views single versus married people. It’s assumed that you’ll have a family member pick you up after outpatient surgery. The Family Medical Leave provides only for care of a parent, spouse or child – not even a brother or niece, let alone a friend. People can’t get off work to drive a friend home from the hospital, especially in the middle of the day with short notice. Additionally, we keep hearing that it’s important to have family members with you if you’re in a hospital; otherwise you’re far more subject to medical errors, neglect and even outright abuse.

Some people genuinely enjoy their own solitude and single status. In terms of aging, that’s a plus, because we’re more independent and less likely to mourn. But getting care becomes a massive invasion of privacy, with limited options for support.

Marriage to cure heart disease? Gimme a break …

Recently I came across this article, allegedly reporting that being married confers health benefits: http://www.medicalnewstoday.com/articles/274828

Here’s my comment:

Being happily single and disgustingly healthy, I had a few concerns about this article.
Bella DePaulo’s book, Singled Out, provides a rigorous discussion of flaws in research comparing single and married people. For instance, often researchers lump together the “never-married,” divorced and widowed, without controlling for recency of divorce or widowhood. Those who never married actually have an advantage as they age because they are used to being alone.

As for cancer patients living longer, I’d want to know, “Are these people holding on longer, even living in pain, because they’re waiting to see a grandchild get married or graduate from college? Are their spouses and children reluctant to turn off life support, as compared to the more distantly related proxies of single people?”

Rather than emphasize the health benefits of marriage (which aren’t entirely clear), I’d like to see some focus on how the medical community treats married vs single people. Many singles find that getting an “approved” ride home from out-patient surgery has been so stressful, I will avoid having elective procedures that require a ride from a responsible adult. A woman with a tall husband or son at her side will be treated far more courteously than a single woman who shows up alone. There’s nothing wrong with solitary life (see Anthony Storr’s classic book, Solitude), yet the system discriminates against them. I’m pretty social, but if I choose to be a curmudgeonly hermit, why should I be denied access to quality health care? That’s the *real* question.

Patient satisfaction? Give me a car dealer any time.

In an article, “Patient satisfaction: Hospitals are not like car dealerships” (March 22, 2014) David Mokotoff
DAVID MOKOTOFF, MD | PHYSICIAN | MARCH 22, 2014
The article is here.
Mokotoff writes, “Here’s what I would like to ask the patients:

Did the condition for which you entered the hospital improve or go away?
Was the hospital bill clear and accurate and easy to understand?
Did a doctor explain procedures to you fully and in enough detail?
Was the food hot and edible?

Here’s how I commented:

Up to a point you are right. However, I am a super-healthy person who avoids doctors and declines tests. Recently I had cataract surgery as an outpatient in a top hospital. The surgery went well. My surgeon and anesthesiologist were superb once we got to the OR. To them, my case was boring because I’m so healthy.

For me, the whole experience was so stressful I developed physical symptoms. I was horrified by what I experienced: incorrect data entered in my records, repeated queries about irrelevant personal information; failure to note allergies on my chart till we got to the moment of entering the OR; required pre-op tests that are dismissed as useless in research published in leading medical journals (along with a scary high probability of false positives); inflexible requirements for finding a ride home when operations are scheduled at the last minute (hello – friends and even some relatives can’t get off from work); pre-op and post-op instructions presented in a disorganized, incomprehensible fashion (I have a Ph.D. and professional writing experience); stressful noisy waiting rooms with blaring TVs; rude nurses and technicians; and a lot more.

You may think it’s no big deal, but my relationship with the medical profession is more hostile than ever and it was pretty bad before. I was so traumatized that I’m refusing all future tests for cancer, heart disease or other illnesses. There’s no way I could handle the stresses of a major episode. I’m putting an advance directive in place and becoming an advocate for assisted dying, which I think should be made even easier.

After all, spy pilots used to get cyanide pills to avoid getting shot down in POW camps. Modern hospitals aren’t much different. You underestimate the impact of stress on otherwise healthy people.