Map of life expectancy at birth from Global Education Project.

Monday, August 17, 2009

A few worthwhile links

I hope to have time to get back to the Comparative Effectiveness Analysis tomorrow. Meanwhile, you can bone up on some of the issues with the help of your corporate media.

My hometown fishwrapper discusses CEA with a big picture of Peter Neumann, who runs the Tufts center for study of same. This article is not extremely enlightening -- it's written by incompetent hack reporter Michael Kranish, who does his usual job of mangling the issues and mistaking "balance" for analysis -- but it will give you something to think about and some introduction to the issues.

Meantime, two op-eds in the NYT are more worth your while. Richard Dooling names the truth that shall not be named:

IN the 1980s, I worked as a respiratory therapist in intensive-care units in the Midwest, taking care of elderly, dying patients on ventilators. . . . When the insurance ran out, or Medicare stopped paying, patients and their families gave the hospital liens on their homes to pay for this care. Families spent their entire savings so Grandma could make yet another trip to the surgical suite on the slim-to-none chance that bypass surgery, a thoracotomy, an endoscopy or kidney dialysis might get her off the ventilator and out of the hospital in time for her 88th birthday. . . .With so much evidence of wasteful and even harmful treatment, shouldn’t we instantly cut some of the money spent on exorbitant intensive-care medicine for dying, elderly people and redirect it to pediatricians and obstetricians offering preventive care for children and mothers?

Note that today, I am not venturing and answer to the question. I am just observing that some has asked it, in public. No doubt a howling mob will show up outside his house, and pelt him to death with teabags.

As usual, Krugperson explains it in terms even a Republican ought to be able to understand, but probably can't.

So I'll pick up on all this shortly and give you my own arrogant, scientific take.

Meanwhile, please oh please oh please: Michelle Bachmann will run for president if God calls her. Okay big guy in the sky, make that call.

And one more: Idiotic statement of the day department: "'The microbes have hopes, dreams and aspirations just like human beings. In their case, it's to infect other people,' said Dr. Howard Markel, a pediatrician and medical historian at the University of Michigan." Give that man a seroquel.


C. Corax said...

Re: Bachmann, maybe we should send some fundie Christians up in an airplane to pray for God to call her.

Re: Dooling, perhaps that would happen less if more people had living wills. I can't object to how people spend their own money, but when grandma is on a ventilator, it's a bit late to ask her her wishes, isn't it?

kathy a. said...

that is hilarious, the "hopes and dreams" of microbes!

i agree with c. corax about the importance of advance planning. i also think that while there have been cultural changes the past few decades that make it easier for families to discuss care options and accept that the temporary "cure" can be worse than letting nature take its course at a certain point, the idea of a "good death" is still foreign to many.

i'm absolutely in favor of counseling about end of life decisions -- having a place to ask questions and hear options. bankrupting the family so granny can have all stops pulled out is generally something granny wouldn't choose herself -- particularly since heroic measures are horrible experiences for the patient.

i've had some great role models. my best friend's mother, a nurse, learned in 1976 that her cancer had returned and metastacized -- she chose to go home and live as normally as possible until her time was up a few months later.

when all treatments for my young [age 12] nephew's brain cancer had failed and the cancer was spreading through his brain, his pediatric oncologist called a meeting with his parents, me, and his entire treatment team [nurses, social workers, neurologist, family therapists, the works]. she very gently explained, "i promised i would tell you when there was no hope left." she talked about what would happen to him physically, and talked about family support. and she was straightforward about interventions and that those would not allow him to go gently -- that CPR might break his ribs; that supplemental food and fluids would only prolong his suffering. "and he has suffered a great deal," she said. this was such a brave, kind, caring meeting, even though the news was devastating; it has been years, and i am still in awe. [of course, his parents and i strongly suspected the bad news; we had no idea this wonderful doctor could present it in such a fundamentally decent way.]

a psychiatrist friend was beside himself a few years back, because his father's cardiologist wanted to major surgery. "i told them, he's 86 years old, what are you thinking? even if he survives the surgery, he will be in terrible pain and he will never recover the functioning he had at a younger age." a doctor himself, he flew across the country to make sure his dad wasn't put through any more suffering.

these are just a few stories. families deal with similar situations every single day. when i speak of cultural changes, i mean 2 things: [1] that it is OK to talk about what is really happening, even if it is the worst kind of news, and [2] it is really OK to choose less suffering when the end is near.