Friday, November 23, 2012

The explosive topic...  

Of over-screening, especially for breast cancer, just got some more evidence of misuse.
The reason is that no other medical test has been as aggressively promoted as mammograms — efforts that have gone beyond persuasion to guilt and even coercion (“I can’t be your doctor if you don’t get one”). And proponents have used the most misleading screening statistic there is: survival rates. A recent Komen foundation campaign typifies the approach: “Early detection saves lives. The five-year survival rate for breast cancer when caught early is 98 percent. When it’s not? It decreases to 23 percent.”
Survival rates always go up with early diagnosis: people who get a diagnosis earlier in life will live longer with their diagnosis, even if it doesn’t change their time of death by one iota. And diagnosing cancer in people whose “cancer” was never destined to kill them will inflate survival rates — even if the number of deaths stays exactly the same. In short, tell everyone they have cancer, and survival will skyrocket.
Screening proponents have also encouraged the public to believe two things that are patently untrue. First, that every woman who has a cancer diagnosed by mammography has had her life saved (consider those “Mammograms save lives. I’m the proof” T-shirts for breast cancer survivors). The truth is, those survivors are much more likely to have been victims of overdiagnosis. Second, that a woman who died from breast cancer “could have been saved” had her cancer been detected early. The truth is, a few breast cancers are destined to kill no matter what we do. [More]
As we grapple with health care costs, over-screening must be tackled. I don't think individuals are prepared enough to objectively make these decisions (although that can change slowly, perhaps) and it isn't in the medical industry's interest to find ways to decrease services rendered yet. So despite all the railing about some government body deciding when and whether to treat, that seems the most practical method. We already are habitual bureaucrat haters, so not much to lose there.

The other minefield to be cleared is late-life care. With about 25% of all medial expense paid out in the last year, something has to change there as well. Feeding tubes are one example.
The benefits of a feeding tube -- helping elders who have forgotten how to eat -- seem so obvious that it is used on one-third of demented nursing home residents, contributing to a growing device market worth $1.64 billion annually.
Except it does little to help. And it can hurt.
Decades after the tube achieved widespread use for people with irreversible dementia, some families are beginning to say no to them, as emerging research shows that artificial feeding prolongs, complicates and isolates dying.
The tale of the feeding tube, known as percutaneous endoscopic gastrostomy (PEG), is the latest installment of "Cost of Dying," a series exploring how our technological ability to stave off death creates dilemmas unimaginable decades ago, when we died younger and more quickly.
Food is how we comfort those we love; when all other forms of communication have vanished, feeding remains a final act of devotion. So the easy availability of feeding tubes forces a wrenching choice upon families: Do we say yes, condemning a loved one to dependency on a small plastic tube in their stomach? Or do we say no, consenting to their death?  [More]
We are losing any familiarity with the death process, and our fears of death simply override reason. Too much medical treatment complicates impending death.

Almost all dying patients, even those who are hand-fed, lose their interest in eating and drinking; this is the body's signal that death is coming, according to palliative care providers. If food is not artificially provided, patients typically die within two weeks, although exceptions are common. Lack of food triggers a biochemical process called ketosis, which actually blunts hunger and eases discomfort due to the release of natural morphine-like agents.
"We are putting in feeding tubes much too quickly," concluded Dr. Joan M. Teno of the Center for Gerontology and Health Care Research at Brown University Medical School.
"We're thinking: It's nourishment," said Teno, author of some of the field's most influential studies. "We don't think of the myriad reasons they cause problems." [Same as above]

Updating our medical POA's is clearly a necessary process to make sure those who care for us have emotional backup to make seemingly harsh decisions. Telling our children/spouse/etc. exactly what we think about our death process may seem gruesome and awkward, but the alternatives keep getting grimmer.

No comments: