"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Smallpox Update: Researchers are looking for ways to diagnose and treat the infection earlier. I don't hold much hope for the anti-viral therapy mentioned in the article. The anti-virals we do have never cure a person of the disease, they only decrease the amount of time the disease lasts, and sometimes they decrease the severity of the disease. It would be extremely uncharacteristic of anti-viral therapy as we know it to cure smallpox. posted by Sydney on
6/01/2002 04:41:00 PM
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Malpractice Nuance: If you ever wonder why doctors are reluctant to have information about malpractice lawsuits and settlements generally available for public consumption, just read this column by a California doctor.
He talks about being named in a suit in which he was not at fault. In fact, he was the one who diagnosed the patient's cancer, but he was named in the suit nonetheless because he had been involved in the patient's care. He was named and his name was never cleared because the case was settled. This is the problem with the system as it now exists. In malpractice lawsuits, the lawyers sue everyone who is connected with a case, no matter how remotely. They often will even name "Doctor John Does" in the suit if they can't read a signature on the chart. They do not make any effort to determine who was actually involved in a significant way with the case. I don't know if this is from genuine ignorance on their part or from laziness. I suspect the latter. Surely, even an attorney with no experience in medicine or malpractice would realize that a doctor who diagnosed a cancer was not responsible for the misdiagnosis of it two years before he ever laid eyes on the patient.
Microchip Medicine: Researchers are working on micro drug delivery systems. They sound promising, although still very experimental:
"MicroChips' product is probably too small for diabetes patients, who require huge does of insulin, Santini said. But the chip has 400 independent reservoirs that can store a variety of drugs in different forms. The chip holds promise for hormone therapy and treatment of cancer and central nervous systems disorders.
The technology has proved itself in tests with lab rats. Medication is released when a battery applies a volt of electrical current that together with a small amount of chloride ion helps dissolve tiny gold caps. The removal of the caps, which are half the size of a human hair, opens the reservoir, allowing the drug to be administered in short bursts if necessary.
``Imagine a situation where you want to place a small amount of a very potent drug or an anti-cancer compound, very precisely and very locally, instead of filling your whole body up with poison,'' said Paul Saffo, a technology forecaster with the Institute for the Future in Menlo Park. ``We can accomplish more and more with less and less, and for medicine that's a big deal."
Medical Antisemitism Continues: According to Israel's English language newspaper, Ha'aretz, Colin Powell has said that the International Red Cross is not discriminating against Israel, and so should continue to get US funds. The International Red Cross has long denied membership to Israel. Congress decided to take a stand on this issue earlier this year by decreeing that the International Red Cross can only receive American money if they stop discriminating against Israel. They included, however, a caveat:
"Attempting to prompt the ICRC to grant Israel membership, Congress ruled it could only get U.S. funds if "the secretary of state determines that the Magen David Adom Society of Israel is not being denied participation in the activities of the International Red Cross and Red Crescent Movement."
Powell, however, has decided there is no discrimination:
"I hereby determine that the Magen David Adom Society of Israel is not being denied participation in the activities of the International Red Cross and Red Crescent Movement," Powell was quoted as saying in a May 5 ruling published on Friday in the daily Federal Register of U.S. laws."
He thus frees up US money to be given to the International Red Cross, and from them to the Palestinian Red Crescent. Money that supposedly will be used to clean up the aftermath of the military attacks in Palestine. According to the Jerusalem Post, they are giving the Palestinians $30 million dollars for relief efforts. To avoid seeming to discriminate, they are giving the Israelis $300,000.
The real question is what will the Palestinians do with that money? Will they use it for legitimate relief, or to shore themselves up for making more attacks against Israel? As Best of the Web pointed out yesterday, the Palestinians have in the past even gone so far as to use ambulances to transport their bombs:
"Israel has indicted Islam Farhi Jibril of Gaza "for transporting an explosives belt in a Red Crescent ambulance," Arutz Sheva reports:
The charges state that on March 27, Jibril attempted to smuggle from Gaza to Ramallah an explosives belt of the type used by suicide bombers. He used his sister-in-law and her children to act as "emergency patients" on their way to the hospital. A collaborating dentist came along as the "doctor." Israeli checkpoint soldiers were suspicious, however, and upon inspecting the ambulance, they found the explosives hidden under a stretcher upon which laid Jihad's nephew. The driver had received the belt from al-Aqsa Martyrs Brigades terrorists."
International relief is all well and good, but when nations misuse relief equipment and money to perpetrate war, they should be smacked down quickly and definitively. The Palestinians should be dismissed from the International Red Cross for such behavior, and they certainly shouldn’t be given large sums of money with which to wage their war. If they want medical relief, it should be under the auspices of a completely independent organization, and not one entwined with the Palestinian government. It's to our shame that our secretary of state doesn't seem to realize this. posted by Sydney on
6/01/2002 09:03:00 AM
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Friday, May 31, 2002
Smallpox Update: Evidence that immunity has waned from old vaccinations more than experts think. This is important. The current strategy of "ring vaccination" and quarantine is based on the premise that a sufficient number of us are immune to prevent the virus from spreading quickly and easily. We are likely not as immune as the experts think, and thus much more susceptible to the contagion. Another argument for offering the vaccine to everyone. posted by Sydney on
5/31/2002 08:37:00 AM
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Pills and Profits: I didn’t see this ABC News report on the drug industry, but a lot of my patients did. They were to a man upset about the high profits of the drug companies for drugs that are not much better than older, cheaper ones. Each and every one of them mentioned Celebrex and Vioxx and the enormous sums spent on them every year. Each and every one of them are taking Celebrex and Vioxx. Ironically, these same patients had pressured me into giving them Vioxx and Celebrex after watching commercials for the drugs. I told them then that they were no more effective than older, cheaper drugs. I told them they were more expensive. They didn't listen. Television had told them otherwise. Now, thanks to television, they're finally listening. (But I’m still a little jealous that they value television's opinion more than they do mine.)
The story has this interesting little factoid tucked away at the very end:
"The pharmaceutical industry has more registered lobbyists than the number of senators and congressmen combined."
Remember that the next time you hear a Congressman or government body calling for widespread screening and treatment of a disease. Their motivations may not be so altruistic.
Meanwhile.... the FDA relaxes rules for testing drugs that can be used against bioterror attacks. In light of the above knowledge, it's hard to know whether this is a good thing or a bad. Overall, I think it’s probably good, if it will speed up the development of drugs that can be used against biological weapons. And as long as it isn’t used to sneak in other drugs without adequately testing them. posted by Sydney on
5/31/2002 05:14:00 AM
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It Would Make a Dead Man Laugh: I found this website of Codes of Ethics, via The Lancet. Hard to believe, but both trial lawyers and newspaper editors have codes of ethics. They don't appear to know that, however. Consider some excerpts, and some violations that came quickly to my mind:
No ATLA member shall personally, or through a representative, contact any party, or an aggrieved survivor in an attempt to solicit a potential client when there has been no request for such contact from the injured party, an aggrieved survivor, or a relative of either, or the injured parties' union representative. (My patients who have had accidents routinely get letters from attorneys without asking.)
No ATLA member shall personally, or through a representative, initiate personal contact with a potential client (who is not a client, former client, relative or close personal friend of the attorney) for the purpose of advising that individual of the possibility of an unrecognized legal claim for damages unless the member forgoes any financial interest in the compensation of the injured party. (Then why do I have people who have taken Redux in the past bringing in unsolicited letters from attorneys about the potential complications they may be suffering and aren't aware of?)
No ATLA member shall file or maintain a frivolous suit, issue, or position. However, no ATLA member should refrain from urging or arguing any suit, issue or position that he believes in good faith to have merit. (I think we can all think of plenty of examples that breach this one.)
Journalists must avoid impropriety and the appearance of impropriety as well as any conflict of interest or the appearance of conflict. They should neither accept anything nor pursue any activity that might compromise or seem to compromise their integrity. (Think Enron, think Krugman)
Good faith with the reader is the foundation of good journalism. Every effort must be made to assure that the news content is accurate, free from bias and in context, and that all sides are presented fairly. Editorials, analytical articles and commentary should be held to the same standards of accuracy with respect to facts as news reports. (Any New York Times story about politics or the Middle East, or just about anything.)
To be impartial does not require the press to be unquestioning or to refrain from editorial expression. Sound practice, however, demands a clear distinction for the reader between news reports and opinion. Articles that contain opinion or personal interpretation should be clearly identified. (Just about any New York Times article.) posted by Sydney on
5/31/2002 05:08:00 AM
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Thursday, May 30, 2002
News from the Urology World: As promised, there are more stories this week from the urology conference in Florida. Click here and here for the most recent. posted by Sydney on
5/30/2002 08:32:00 AM
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Smallpox Vaccine Update: The CDC still hasn't added the promised public comment form on smallpox vaccine to its smallpox website, but here is a general form for sending them concerns and questions. posted by Sydney on
5/30/2002 08:21:00 AM
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Celebrity Medical News: Ken Caminiti admits to abusing steroids. To anyone out there tempted to use anabolic steroids to enhance muscle mass, just remember that one of the other things they do is shrink the testicles.
Both DB's Medical Rants and RangelMD have some good thoughts and observations about boutique medicine. Medrants asks how we got to this point and why, and RangelMD wonders what it all means for the future.
What I want to know is what's going on at the Cleveland Clinic?
"And at the Cleveland Clinic, the good life is symbolized by a simple golf shirt: Wearers never wait in line for an X-ray, EKG or blood work-up."
What happens if three guys wearing golf shirts show up at the same time? Who goes first then? The best looking one? posted by Sydney on
5/30/2002 08:15:00 AM
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Nurses Make a Difference: A study published this week in The New England Journal of Medicine suggests that more attention by nurses translates into better patient care. I hope hospital administrators out there are taking note. For too long, nurses have been replaced by nurses aids and licensed practical nurses, to the detriment of the patient. A well-trained nurse caring for the patient intimately and carefully is an invaluable part of hospital care, and one that should not be scrimped on. With all the talk that's bandied about concerning medical errors and how to decrease them, no one ever mentions the critical role of good nursing care.
Give This Woman a Medal: If I had the power, I would give the Presidential Medal of Freedom to the woman who wrote this memo to her FBI superiors. The criteria :
"The medal may be awarded only by a U.S. president to individuals who have made contributions especially meritorious to the security or national interests of the United States, to world peace or to cultural or other significant public or private endeavors."
I think she qualifies. She points out everything the FBI did wrong in the days leading up to Sept 11, and doesn't hesitate to point out what they are doing wrong now. If they listen to her, she very well could save our lives and our nation. It takes a fortitude of character seldom seen these days to risk all for the greater good. (She says in her letter that she's the sole bread winner for her family of six.) If she can't get the Medal of Freedom, maybe she could at least be given the job of heading the FBI. posted by Sydney on
5/30/2002 08:13:00 AM
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Wednesday, May 29, 2002
Much Ado About Nothing II:Andrew Sullivan is in a lather again over the issue of circumcision. (You have to scroll down to the "MGM and HIV" post.) He links to this story about the susceptibility of the foreskin to HIV infection. The skin lining the foreskin has a higher concentration of the type of cells that are particularly sensitive to the HIV virus compared to, say, the cervix or the outside of the foreskin. Sullivan is correct that the transmission of HIV from women to men isn't as common as the transmission from man to man or from man to woman, but that doesn't invalidate the study. Circumcision does seem to provide a protection against HIV infection, just as it also provides protection against other sexually transmitted diseases. The foreskin, even though it was put there by mother nature, is a fold of skin that provides nooks and crannies for viruses and bacteria to gather. That's just the way it is, like it or not. As to his claim that circumcised penises are at more risk for infection because they are "mutilated", that's just nonsense. The circumcised penis heals within a week of the procedure. There are no open sores or cuts or any other skin breakdown in the healthy circumcised adult penis. Sullivan has been down this road before. He has mentioned in the past that his mother told him he suffered a great deal after his own circumcision. The story seems to have influenced his feelings on the subject. These days, most doctors use a local anesthetic when performing circumcision and the babies do just fine. I am no circumcision advocate. I think of it as a cosmetic procedure, and as such a matter of personal choice. Sullivan, however, is passionately anti-circumcision. He too often allows that passion to cloud his usually level-headed logic. His posts on the subject remind me of the attitude of breastfeeding advocates toward infant formula. posted by Sydney on
5/29/2002 08:47:00 AM
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Clever Bacteria: There is evidence that bacteria can work together to form a film (otherwise known as slime) that makes them impervious to antibiotics and to our immune system. The process has been implicated in persistent ear infections and in dental plaque. For a picture of just such a film, click here. posted by Sydney on
5/29/2002 07:59:00 AM
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More Medical Conferences: Last week, it was the oncologists who were meeting in Florida. This week it's the urologists, from whence comes this story about a competitor for Viagra.
Now, I happen to know that medical conferences are held all year round and in all fifty states, but I can't help noticing that all the news stories from conferences come from those held in places like Florida and California. Could it be that health reporters only go to the meetings that are held in vacation venues? We can probably expect more news from the world of urology this week as the conference progresses, just as we saw a spate of oncology news last week. posted by Sydney on
5/29/2002 07:58:00 AM
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Profit vs. Non-Profit: A Canadian study of US hospitals claims that for-profit hospitals are more dangerous than non-profit ones. They used statistical methods to come to the conclusion that "roughly 2,000 people in the USA die each year simply because they were treated in for-profit hospitals." Of course, no one knows for sure if that many people actually died because they went to the for-profit hospitals, they just extrapolated that number from their gathered statistics. The actual increase in mortality was only 2%, not exactly an overwhelming increase. The article doesn't mention if the difference was statistically significant.
No doubt there is more pressure to exceed the bottom-line in a for-profit system, but non-profit hospitals are not oblivious to the bottom-line, either. As one adminstrator of a non-profit hospital I know is fond of saying: "No money, no mission." posted by Sydney on
5/29/2002 07:55:00 AM
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Food for Thought: "The story that follows is about Variola major, the virus that causes smallpox. From 1775 to 1782, Variola ravaged the greater part of North America, from Mexico to Massachusetts, from Pensacola to Puget Sound. For the virus, the great pestilence represented a phenomenal sucess: It found countless new hosts, it multiplied rapidly, and it traveled vast distances. But in its wake it left death and despair, killing more than a hundred thousand people and maiming many more. With no respect for boundaries of race, class, or nationality, the opportunistic microbe swept an astonishing array of people and events into its maelstrom: missionaries, mariners, fur traders, explorers, planters, fishermen, hunters, farmers, homemakers, warriors, neophytes, trappers, soldiers, prisoners, and runaway slaves. By the time the pestilence was over, it had reshaped human destinies across the continent." - the opening paragraph of Pox Americana : The Great Smallpox Epidemic of 1775-82, by Elizabeth A. Fenn.
I've only just begun the book, but one of the more striking facts she reveals is that the mortality was much higher in communities with no history of prior exposure to smallpox (and thus no immunity) than the thirty percent we assume it would be today. In some cases, as many as fifty percent of infected individuals died. posted by Sydney on
5/28/2002 08:36:00 AM
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Smallpox Vaccine Update: The CDC says that it will soon have a public comment forum available on its website so we the public can let them know how we feel about smallpox vaccine.( You have to scroll down a bit to the section on public forums to read about it.)They've been promising that for over a week, and still haven't added it. They are, however, doing an admirable job of educating us about the dangers of children who potty in the pool.
YET MORE: An interested reader wondered why professional medical organizations, like the AMA, haven't taken a more active and public roll in the smallpox vaccine debate. That's a good point, and quite frankly one I hadn't even entertained. The only place I have seen the issue debated is the pages of the New England Journal of Medicine. The AMA has been fairly quiet on the subject. The only public statement I could find was this article from their newspaper. It was written in November 2001, and their position is that it shouldn't be used since there is "no smallpox in the world." I obviously disagree with that statement. There is smallpox in the world, in labs, and perhaps in the hands of those who would use it to destroy us. That doesn't mean they aren't debating it, they probably are, and they probably haven't made up their minds yet on the subject. They also have a tendency to defer to the CDC regarding this sort of thing, so I expect them to follow what ever recommendations the CDC comes up with. posted by Sydney on
5/28/2002 08:19:00 AM
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"I will not give a fatal draught to anyone if I am asked, nor will I suggest such a thing."
- from The Hippocratic Oath
Sherwin Nuland has a very good review in The New Republic of a book that makes the case against euthanasia, The Case Against Assisted Suicide: For the Right to End-of-Life Care. Even though he is an advocate of euthanasia, he treats the book evenhandedly and fairly. He even comes close to changing his mind about euthanasia, but pulls back in the end. This isn't surprising. Doctor Nuland is a surgeon by training. Surgeons are like action heroes. They attack disease with their hands. They stab it, rip it out, destroy it. They of all the specialists have the hardest time admitting defeat to the advance of a disease. They of all the specialists favor action over inaction. So, it's no shock that he clings to the idea that it is sometimes necessary to hasten death. It goes against the grain of a surgeon's nature to not take an active hand.
What is surprising is the approach he thinks we should take to facilitate this active hand :
"And here I offer a suggestion that may seem odd, superfluous, and even antiquated. It is that final consent should be in the hands of a kind of council of elders, people in a community or institution known for their probity, wisdom, and sense of civic responsibility. In some instances, a hospital's bioethics committee could fulfill the purpose, but there might be objection that it serves the interests of the institution. Instead, I would seek out representative members of the community who would convene on the rare occasions when such a thing is necessary. The limits of individual fallibility and the complexities of shared decision-making notwithstanding, such a council might constitute an influential forum deliberating on the moral principles of a period, a place, and a polity of reflective citizens."
His naive belief that a council of "sage citizens" could decide the fate of a terminally ill patient better than the patient and his doctor seems almost polyannish. Such a suggestion should give both proponents and opponents of euthanasia pause. People who are so wise that they can infallibly decide the fates others might exist in a perfect world, but they don't exist in our world. The very characteristics that he would choose for his committee members, "probity, wisdom, and civic responsibility", are highly subjective. Like all committees, member selection would end up being primarily political. It's the nature of the beast. Euthanasia by committee is nothing new, of course. It was, after all, the model once adopted by Germany's doctors. And look what happened to them. posted by Sydney on
5/28/2002 07:45:00 AM
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A Melancholy Screen:DB's Medical Rants took issue with my feelings about depressions screening, while RangelMD stands in the middle. My position isn't that we shouldn't be on the lookout for depression. We should. Emotional and physicial health are deeply intertwined. To ignore one is to imperil the other. My position is that we shouldn't be screening for it at every single visit in every single person.
An ideal screening test should meet several conditions. First of all, the disease or a precursor of it should be easily and clearly defined and diagnosed. It should exist in an asymptomatic state that can be found by the screening test. We should be able to effectively treat the condition at the stage we find it. Treating the condition in its presymptomatic state should make a difference in the patient's life expectancy. Treatment should not strain available resources, and most of all it should do no harm to the patient. Screening for cervical cancer is an example of a screening test that meets all of these criteria. The pap smear detects changes in cervical cells long before they become cancer. We can destroy the abnormal cells quite effectively, and in so doing prevent death from cervical cancer in the future. Both the screening and the treatment are readily available and relatively inexpensive. Neither involve any significant risk. Depression doesn't meet any of these criteria. It isn't always easily defined. Indeed, the current diagnostic criteria for depression are so broad as to include any pervasive unhappiness that has lasted for two weeks. It doesn't exist in an asymptomatic state, we can't treat it until it exists, and it is not always easily treatable. There aren't enough psychiatrists and psychologists in the world to treat everyone's unhappiness. There might be enough Prozac to do it, but is that really desirable?
Like all mental illnesses, depression exists across a wide spectrum of symptoms, from a withdrawn, catatonic state to a mild funk. It is something that we all experience at some time, albeit to different extents and in different circumstances. It has even served as the muse for some of our greatest composers, authors, and artists. So, when is it worthy of treatment? The USPSTF wants us to treat depression no matter how mild if it has been present for two weeks. Severe depression, the kind that takes away the will to live and the ability to function certainly deserves treatment. No one would deny that. But what about mild depression, the kind of sadness that puts you in a fidget, makes you lose sleep, dulls your appetite and your wit, and saps your energy? What if you've only felt that way for the past two weeks? Furthermore, what if it's caused by something you did or something that happened to you? Is it better to dull your emotions with Prozac, or is it better to draw on your inner strengths to surmount those difficulties?
To illustrate, I’ll share with you a vignette from my own practice. It's the story of two men who saw me within a couple of months of each other. They both had symptoms of mild depression. They were both laboring under a burden of guilt brought about by cheating on their wives. The first man was distraught to the point of tears when he saw me. I treated him with drugs and sent him for counseling. He never went for the counseling. He said the drugs took care of his sadness. Unfortunately, they also took care of his conscience. He left his wife and kids for his mistress. He told me his Prozac made it possible. The second man came to see me shortly after this. I listened to his story, all the while thinking of the first man and his Prozac. When he was done, I put my prescription pad away and did something I never do with my patients. I issued a moral judgement and said, "What you need to do is behave yourself." He seemed taken aback at the time, but when I saw him for a check up a few months later, he had given up the mistress, reconciled with his wife, and was feeling completely better. He continues to do well. I wish I could say the same for the first patient, but I can't. He's still depressed. Despite his drugs. Despite the counseling he now gets. He still hasn't come to terms with the choice he made. He hasn't gotten any worse, but neither has he gotten better. Medicine is a poor substitute for honest introspection.
I would argue that in the case of a mild and brief depression, Prozac and even counseling are not always desirable; that in fact we may do more harm than good when we treat people at this stage. By taking the approach recommended by the USPSTF, we are basically saying, here, take this pill so you don’t have to grapple with your conscience or learn to adapt to changing circumstances. Go see this counselor so they can tell you how best to handle life. Let us, the medical professionals, lift your burdens and your sorrows from you. Let us be your Jesus.
There are also times when despite our best efforts, depression just is not easily treatable. Again, I don't mean severe, disabling, endogenous depression. I mean a pervasive melancholy spirit that stems from someone’s life circumstances, that does not disable but only leaves one perpetually sad. The lady in Dr. Certo's example is such a patient. She has no fun, because she's no longer physically able. We can dull her sadness with drugs but we won't take it away. We can try to get her to restructure her thinking and deal with her illness in positive ways with counseling, but it's been my experience that this is rarely successful. No amount of counseling or anti-depressants is going to restore the functioning of her joints. Neither is any arthritis medicine. This is the depression that is rooted in unchangeable circumstances, and the kind that is seen most frequently in the elderly. This is the depression caused by lost loves and lost opportunities, by bodily deterioration as a result of aging or illness, by loneliness, or by grief over lost youth. I can think of scores of people like this in my practice. Most of them are on anti-depressants. Many of them even see psychiatrists, but to no avail. Despite all of my best efforts and the efforts of several others, they remain depressed. No one can bring back their dead spouse or make their bodies behave as they did twenty years ago. No one can give them back their health or their dead friends, or give them back their independence. No one can take away their sadness. Medicine can not be their Jesus.
Screening a patient for an illness carries with it the implicit promise that we can make a difference by treating the illness. We can't say that about all forms of depression. By calling for us to screen all comers in such a broad manner the USPSTF sets up an unreasonable expectation in the public that we can eliminate all their unhappiness. We can't. Even God hasn’t been able to do that. posted by Sydney on
5/27/2002 08:35:00 AM
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In honor of those who serve, a poem by Carl Sandburg:
"At first I said it in anger as one who clenches his fist in wrath to fling his knuckles into the face of some one taunting;
Now I say it calmly as one who has thought it over and over again at night, among the mountains, by the seacombers in storm.
I say now, by God, only fighters to-day will save the world, nothing but fighters will keep alive the names of those who left red prints of bleeding feet at Valley Forge in Christmas snow.
On the cross of Jesus, the sword of Napoleon, the skull of Shakespeare, the pen of Tom Jefferson, the ashes of Abraham Lincoln, or any sign of the red and running life poured out by the mothers of the world,
By the God of morning glories climbing blue the doors of quiet homes, by the God of tall hollyhocks laughing glad to children in peaceful valleys, by the God of new mothers wishing peace to sit at windows nursing babies,
I swear only reckless men, ready to throw away their lives by hunger, deprivation, desperate clinging to a single purpose imperturbable and undaunted, men with the primitive guts of rebellion,
Only fighters gaunt with the red brand of labor's sorrow on their brows and labor's terrible pride in their blood, men with souls asking danger - only these will save and keep the four big brothers."
-from Four Brothers posted by Sydney on
5/27/2002 07:39:00 AM
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Sunday, May 26, 2002
Australian “Suicide”:Tim Blair has more on the woman who committed “suicide” with the help of familiy, friends, and euthanasia advocates, then turned out not to have cancer after all. He's wondering about the coroner's diagnosis of "twisted bowel" and why it couldn't be corrected surgically. I e-mailed a reply, but since I'm not sure if my e-mail is working properly, I'll post some thoughts on it here, too.
The story I linked to above says the woman had three abdominal surgeries since the diagnosis of her cancer. The first one was presumably to remove the bowel cancer. The second two were probably done to try to break up what the story refers to as "adhesions". Adhesions are scarring in the abdomen outside the bowels that result when one has abdominal surgery. The more abdominal surgeries you've had, the more adhesions you are likely to develop. They can choke the bowel and cause obstruction. If there are only a few problem adhesions, they can be broken up with surgery. The problem is, more adhesions may form as result of that surgery, too. After three surgeries, her doctors probably thought they would be doing more harm than good by going in a fourth time. The question is, did they think she was terminal as a result of the obstruction, or did they think the obstruction was manageable medically. If they thought she was terminal, they would have treated her pain and enrolled her in hospice, I'm sure.
Descriptions of the woman, even by her family and the euthanasia advocates give a hint that there was a lot more going on with her than her bowel problems. I suspect her doctors did not consider her terminal. Her family is shocked. They thought she had cancer. No doubt their only source of that information was her. The euthanasia advocate says he knew she didn't have cancer of the bowel any longer, but he also states that she claimed to have breast cancer, too, which he says there was no record of. The coroner says she had a multitude of "minor ills". Her own adviser stated she "had a multitude of problems."
Therein lies the greatest problem with this case and with assisted suicide in general. Illness , and pain in particular, is rarely straightforward. Here is a woman who, like many of Dr. Kevorkian's victims, did not have a terminal illness, but instead had pain from a multitude of ills. One has to wonder about her state of mind. A lot of that pain may have had its roots in depression and anxiety. It may have had what we call a "strong psychosocial component", which means that it was rooted more in her response to the pain, and the response of others to her complaints than in the severity of its physical cause. Her doctors, bound by their commitment to patient-doctor confidentiality were helpless in preventing her from being publicly manipulated by the euthanasia advocates. They couldn't divulge her condition to her family or the public without her permission as long as she was legally competent. She clearly wasn't forthright with her family, and it sounds as if she wasn't so honest about her condition to the right-to-die movement, either. Perhaps what she really hoped to gain the most was attention. This she got, but at a very steep price.
posted by Sydney on
5/26/2002 06:04:00 PM
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E-mail: I just found out I'm having some e-mail problems. I've added an optional e-mail address to the listing at the left. Try that if the first one doesn't work. posted by Sydney on
5/26/2002 04:29:00 PM
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Fear and Loathing: Tipper Gore, mental health advocate, says the terror warnings are turning us all into basketcases:
"Americans want the information. We want to know what's going on. But then we want to be told what to do. And if you frighten someone, but you don't give them a solution to that frightened state, then you leave them anxious, frightened, wondering what to do, pulling on their inner reserves of resilience and resolve and being strong and united."
Thinking with Their Gonads: There's been a lot of batting around the blogosphere on the subject of teen sex this past week. The only sensible one I've read so far is this one by Moira Breen. posted by Sydney on
5/26/2002 08:10:00 AM
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