“Ask a stupid question…”
Image by Nick Fewings on Unsplash.
Why you must second-guess doctors and google everything in your medical chart
Image by Public Domain Pictures on Pixabay.
Can I grow older without becoming holier?
Image from an unidentified artist on Pixabay
The Great Bone Density Myth
There’s very little evidence that “preventive” actions make a difference, especially in those over 65.
Bone density scans also are highly recommended but other measures (e.g., muscle tone, ability to rise from a chair) predict fractures more and bone density doesn’t predict hip fractures, as discussed here. I’d like to see references to articles showing that people on meds for cholesterol, high blood pressure, etc., actually experience different end points than those who are not screened. Often when you actually read those articles you find the relative differences are huge but the actual differences are barely noticeable. When you start quoting journal articles to doctors the conversation changes.
Worried unwell (or potentially unwell)
Responding to Abigail Zuger’s column in the New York Times. Zuger notes that today doctors spend most time prescribing for pre-illness, which means they try to predict the future.
I am amused by, “For people who feel fine… It is the patient … firmly planted in the here and now, while medical personnel spin wild tales of coming catastrophe…”
and
“In fact, our future of treating pre-illness will simply catapult us right back to a priestly past, as we offer up misty visions of the future and encourage the masses to see with us and act accordingly.”
Zuger’s image – emotional doctors versus patients demanding evidence – captures my experience perfectly. When I declined a mammogram, citing research in top journals, the doctor responded emotionally, literally throwing up her hands: “It must be better than nothing.”
Urging a bone density scan, she cited relative risk (50%) rather than absolute risk (3%). Outpatient surgical clinics require pre-op tests for despite published research consistently showing no difference in outcomes. Most doctors don’t know the Society for General Internal Medicine’s guidelines limit testing for asymptomatic adults.
Doctors eagerly embrace studies questioning the value of herbal or alternative options, but shrug off equally credible reports showing the low value of mainstream “preventive” medicine. In fact “preventive” really means “risk reduction” and often the reduction is so low as to be meaningless. Thus the line between science and magic become blurred, educated skeptics resist medical advice, and most doctors hate patients who know how to read statistics in the medical journals.
“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.
