What happened to 'do no harm'?

This book sounds like it will give a pretty scary overview of medical treatment in the US. I will have to add it to the stack of intellectual books I am attempting to read 'The Emperor of All Maladies' and 'The Omnivores Dilemma' and others. But I really will read them all some day. 

Anyway back to the book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America. The title says it all. One example in the article talks about a woman who was treated with the standard of care for breast cancer in the early 1990s. Her treatment nearly killed her and she was hospitalized for nearly a year. And that was the standard of care. Her doctors probably knew about the side effects and yet prescribed it for her just as they probably did for many patients. After wards it was learned in clinical trials that the treatment probably did not good and may have done harm to her as well.

Medical practice in the US has a range of participants:

• FDA who approves treatments, medications, etc.
• Insurance companies who pay for these
• Patients who want the best available treatment
• Doctors who prescribe the treatments 

Then we add to the mix the availability of equal care to all and the patients who are willing to sue their insurance companies to get a new treatment covered. As you are aware I am not a fan of insurance companies but I find it silly for patients to sue for coverage of a treatment which is not FDA approved. I see this as interference in the medical system. (Yes, there really is a medical system in the US.) I am all for arguing with my insurance company (which I need to do this morning but that's another story) but I don't think I would sue them. Nor do I think I would want a treatment which is not FDA approved.
I am starting to digress here. Back to the subject of the book. It sounds pretty scary. I want my treatment to be FDA approved and I want it to be safe and effective. I do not want to be over treated and nor do I want to be under treated through unsafe medical treatments. I want my doctor to have my best interests at heart. 

Where I am treated, the hospital has set some relatively conservative protocols which give their doctors some leeway in treatment but provides a relatively high standard of care. I am comfortable with this. I do not want to be a guinea pig, I want to be healthy. I trust them. I don't want to end up in the next edition of this book.

What kind of patient am I?

I often wonder what my doctors think of me. I have been told I am a good patient in that I take my medications as prescribed and do as I am requested but what do they really think?

Am I a hypochondriac in their eyes? I mean I am at the damn doctor's office too damn often if you ask me. I had one appt in January and 2 appts and a scan in February. March has 5 dr appointments already scheduled. I can't remember any more at this point. Does this make me a hypochondriac? Most of them are follow ups or routine visits. I have only been to see my doctor once at my request in the past few months. I try to ignore symptoms for a week or two. If I have pain or something it needs to last long enough for me to be able to document it and give my doctor an idea of when it happens. But every time I am at a doctor, they look at my records and make some remark about how often I am there and seeing another doctor.

But then there are hateful patients. I really hope I am not one of these. I just learned about them in an article - these are the ones for whom nothing is good enough. The doctor is incompetent, inconvenient, blah, blah, blah. I really hope I am not one of these but I am not so perfect that I can't say I have never exhibited any of these traits. I am sure that under stress we all can show some traits of these demanders, clingers, help-rejecters, and deniers.

The hateful patients were diagnosed first in the 1970s:

"Hateful patients" are not those with whom the physician has an occasional personality clash. As defined here they are those whom most Physicians dread. The insatiable dependency of "hateful patients" leads to behaviors that group them into four stereotypes: dependent clingers, entitled demanders, manipulative help-rejecters and self-destructive deniers. The physician's negative reactions constitute important clinical data that should facilitate better understanding and more appropriate psychological management for each. Clingers evoke aversion; their care requires limits on expectations for an intense doctor-patient relationship. Demanders evoke a wish to counterattack; such patients need to have their feelings of total entitlement rechanneled into a partnership that acknowledges their entitlement — not to unrealistic demands but to good medical care. Help-rejecters evoke depression; "sharing" their pessimism diminishes their notion that losing the symptom implies losing the doctor. Self-destructive deniers evoke feelings of malice; their management requires the physician to lower Faustian expectations of delivering perfect care."

If you every see me being a hateful patient, feel free to smack me inthe head and say 'wake up, be nice'.   That 's one diagnosis, I do not want.

Colonoscopy Sweepstakes

Who would have thought that Ozzie Osbourne would become an advocate for colonoscopies? Well he has after one' saved his wife's, Sharon, life. He started a sweepstakes where the winner gets flown to New York and gets a free colonoscopy and three day stay in the city. Well if you have been putting off this potentially life saving procedure, I'm sorry but you are running out of excuses.  Dave Barry summed it up  in one of the funniest columns I have ever read - basically none of us want a camera up there. Go enter at CBS Cares - deadline is March 30.

Rock on Ozzie.

Yoo hoo, its about the patients

Its not about the money, its not about the money, its not about the money, its not about the money, its not about the money....

I can go on and on in an effort to pretend that all those cancer advances are about the patients and not about the money. But I know I am only pretending:

• I do realize that businesses are out to make money.
• I do believe that insurance was once intended to help people and not be about the money and people getting rich. 
• I do believe that medical advances can be very expensive to develop.
• I do try to believe that the health care industry - from doctors and nurses to health insurance to drug and device manufacturers - at some level does really care about the patients.

But I have a real problem when I read about people who:

• Can't afford their insurance premiums because they are so high due to their health issues
• Can't afford their co-payments because they are in the thousands for a single round of chemo
• Co-payments are so uneven that one patient pays a couple of dollars and another patient pays a few thousand for the same medication
• Hospitals look for ways to make more money and then claim its in the best interest of the patient - hospitals have patients come in for an injection because they can make more money than if they taught the patient how to self administer.
• Medical bills are a leading cause of bankruptcies.

"“Patients have to pay more for their premiums, more for their copayments, more for their deductibles. It’s become harder to afford what we have, and what we have is becoming not only more costly but also complex,’’ said Dr. Michael Hassett, a cancer specialist and policy researcher at Dana-Farber Cancer Institute in Boston.

Insurers also are being squeezed by laws that require coverage and restrict premiums. And the burden is growing on Medicare, which in some cases pays for treatments and tests not shown to benefit patients.

Why have costs escalated so much? To some extent, it is the price of success.

Cancer deaths have been declining in America since the early 1990s. Two out of 3 people now live at least five years after a cancer diagnosis, up from 1 of 2 in the ’70s, says the American Society of Clinical Oncology."

Sorry. I don't believe its the price of success. Yes I believe that medical advances probably do cost more but I also believe some people are getting really rich. And that some people are forced to make a decision between feeding themselves and their families and getting much needed medical treatment.

Putting a deadline on cancer

The government, in all its brilliance, has put a deadline on breast cancer. They want to make it go away by 2020. Seriously, they gave breast cancer a deadline to go away. How many smart politicians were involved in this bill (H.R. 3067?? There is even a non profit, Breast Cancer 2020 which is the National Breast Cancer Coalition's strategic arm, behind them urging them on, complete with a website counting down till Jan 1 2020. They state:

"NBCC's mission is to eradicate breast cancer by designing and acting on effective strategies addressed to the administration, Congress, research institutions and health care providers to end this disease. The Coalition informs, trains, and directs patients and others in effective advocacy efforts. Nationwide, the women and men we have trained are shaping breast cancer public policy by participating in legislative, scientific and regulatory decisions; promoting critical analysis of breast cancer information, media coverage and actively working to change all systems that affect our mission to eradicate breast cancer."

A friend, diagnosed with a later stage breast cancer, told me about the bill. I had already heard about the organization but I have thought they were a bit ridiculous. How did they pick this deadline? How do they plan to meet it? A congressional act will help but research breakthroughs don't happen on schedule, they happen when they happen. And if the FDA gets involved and anything has to go through the clinical trial process, according to BC2020's clock, we only have 7 years, 310 days, and 15+ hours to get approval.

The more I think about it, the dumber I think it is:

• A Congressional act and media coverage will greatly help in eradicating breast cancer - NOT.
• They want to eradicate what part of breast cancer? The cause, find a cure, or what?  They talk about getting everyone to work together but to what end?
• And if this is all about ending breast cancer, what about curing those of us who have already had it? Especially all the women who have late stage disease? 
• What about other types of cancer? I think there are over 1.6 million cancer diagnoses in the US each year of which 220,000 are breast cancer but what about the 1.38 million people facing other cancer diagnoses.

I am not impressed. This strategy is too focused and doesn't account for too many issues. If I could give it a rating, I would give it 5 stars for effort, 3 stars for strategy, and 1 star for brilliance.

My body, my choices

May no politics or religion touch my body, thank you. I do not want politics or religion anywhere near my body. Its no one's business but my own what my medical choices are for my body. I really don't care what you think about birth control, surgery options, life prognosis, flabby status, overall health, and my multiple ailments. Its none of your damn business. The only people who are allowed to be concerned about my body are me, my doctor, my husband, and me again (and my parents because they are, well, my parents). Its all about me.

So get the politics and religion out of health care please. Whatever happened to the separation of Church and State? Doesn't the Constitution and the Bill of Rights allow us to make our own decisions? So why are politicians and religious leaders allowed to interfere in medical coverage? They are making decisions about my body and I find that wrong.

I want a level playing field regarding my medical choices. I should be able to look at a range of options available and make decisions based on what I believe, what I want, and what my doctor recommends. I should not have to worry about what is covered in my health insurance or what some politician, religious leader, or other blabbermouths think about what is 'right' in their eyes. Their eyes are not in my body, my eyes are in my body so get your big fat snoopy nose out of my decisions.

I can understand people don't believe in abortion, Viagra (don't get me started on the fact that Viagra is covered by health insurance but birth control is not), antibiotics, modern medicine, voodoo, Obeah, Wicca, Catholicism, Islam, Judaism, Taoism, Democratic party, Republic Party, Green Party, Communism, the rights of free range chickens, and the possibility that moral and ethical politicians actually exist. But we are all allowed to have our own opinions.

Politics and religion should not be creating barriers to medical treatment. There are enough other socioeconomic barriers in place for many people. So please just shut up about religion, politics, and health care.

It sounded like a good idea at the time

Just because something sounded like a good idea at the time, doesn't meant in the long run it will be. I am sure we can all think of many of these in our lives - we have all done them and then after said to ourselves 'Doh! What was I thinking?'

Here is a prime example, and explains something to me that I never understood (I'm claiming chemo brain here as I think everyone else probably already knew this): Where did MRSA come from? As we should know MRSA is a nasty anbiobiotic resistant form of staph infection that can easily be fatal. It started in humans and was treatable but now can kill us off:

"The strain, Staphylococcus aureus CC398 started in humans and was still treatable with antibiotics, said Lance Price, director of the Center for Food Microbiology and Environmental Health Translational Genomics Research Institute in Arizona.

It  spread to livestock, which are usually pumped with antibiotics, to keep them healthy. “The lineage appears to have undergone a rapid radiation in conjunction with the jump from humans to livestock, where it subsequently acquired tetracycline and methicillin resistance,” according to the study.

Methicillin and tetracycline are among the most common antibiotics used to treat staph infections.

The problem is in the way animals are raised and pumped with antibiotics, said Price, the lead author of the study.  He said that farmers and ranchers give millions of pounds of antibiotics to farm animals to make them grow faster and to prevent - rather than treat - diseases."

Well, doh! If the meat we eat is full of antibiotics its no wonder that the infections have become resistant to it as they are already over exposed. Okay, now I want organic meat. I also don't want antibiotics unless I really need them. Icky poo. Just because it helps farmers grow healthier, fatter beef faster, it doesn't mean there won't be problems done the road for other people. Just another idea which sounded like a good idea at the time.