As Our Population Ages, This Is Important

 The Wall Street Journal posted an opinion piece this morning about the impact of doctor-assisted suicide on the practice of medicine. The author of the piece is Dr. William L. Toffler, national director of Physicians for Compassionate Care.

The article points out that in recent years, there have been about two dozen suicide bills introduced in legislatures in America. Dr. Toffler suggests that before we support these measures, we examine what has happened to the practice of medicine in Oregon, where assisted suicide was introduced 20 years ago.

The article details some of the impact of assisted-suicide laws:

In one case a patient with bladder cancer contacted me. She was concerned that an oncologist treating her might be one of the “death doctors,” and she questioned his motives. This was particularly worrying to her after she obtained a second opinion from another oncologist who was more positive about her prognosis and treatment options. Whichever of the consultants was correct, such fears were never an issue before.

Under Oregon’s law, a patient can request lethal drugs only if he has a terminal illness and less than six months to live. However, it is nearly impossible to predict the course of an illness six months out, and many patients given such prognoses live full, rewarding lives long past six months.

There is also the question as to whether cost enters into assisted-suicide decisions:

Also concerning are the regular notices I receive indicating that many important services and drugs for my patients—even some pain medications—will not be covered by the Oregon Health Plan, the state’s Medicaid program. Yet physician-assisted suicide is covered by the state and our collective tax dollars. Supporters claim physician-assisted suicide gives patients choice, but what sort of a choice is it when life is expensive but death is free?

It also appears that the statistics on physician-assisted suicide are being hidden:

A shroud of secrecy envelops the practice of assisted suicide. Doctors engaging in it do not accurately report the actual manner of death. Instead they are required by state law to fabricate the death certificate, stating that the cause is “natural” rather than suicide. In late 1997, right before assisted suicide was about to begin, the state legislature implemented a system of two different death certificates—one that is public and includes no medical information and another that is kept private by the state. As a result, no one outside of the Oregon Health Division knows precisely how many assisted suicides have taken place, because accurately tracking them has been made impossible.

Dr. Toffler shared his own experience with a patient afflicted with MS:

One inquiry came from a patient with a progressive form of multiple sclerosis. He was in a wheelchair yet lived an active life as a general contractor. I asked him how the disease affected his life. He acknowledged that MS was a major challenge and told me that if he got too much worse, he might want to “just end it.”

I told him I could understand his fear and frustration and even his belief that assisted suicide might be a good option. I also told him that should he become sicker or weaker, I would work to provide him the best care and support available. No matter how debilitated he might become, his life was, and would always be, inherently valuable. As such, I said that would I not recommend nor would I participate in his suicide. He simply replied: “Thank you.”

As our population ages, there will be an increase in the number of terminally ill patients. Most of us have watched a loved one struggle with terminal illness and wondered what in the world was being accomplished by their suffering. I suspect we will never know the answer to that question. However, we need to look at the impact of doctor-assisted suicide on the practice of medicine.

When researching this article, I discovered the following at Wikipedia:

It is a popular misconception that the phrase “First do no harm” (Latin: Primum non nocere) is a part of the Hippocratic oath. Strictly speaking, the phrase does not appear in the oath, though an equivalent phrase is found in Epidemics, Book I, of the Hippocratic school: “Practice two things in your dealings with disease: either help or do not harm the patient”.  The exact phrase is believed to have originated with the 19th-century surgeon Thomas Inman.

It seems to me that even if “First do no harm” does not appear in the Hippocratic oath, it is a really good idea. I have no answers as to why some people suffer through terminal illness, but I also do not feel that as mere human beings we have the right to decide when a person dies. I truly think that decision is above all of our pay grades.

Just as an aside, I recently attended my 50th High School Reunion. The person I sat next to at the reunion was told years ago that he would only live a few months (he had cancer). He was sitting next to me, cancer free, and fully alive. It would have been a shame if someone had wanted to ‘end his suffering,’ which I am sure he went through in fighting the disease.

What Happens When Government Interferes In Medicine

Ben Stein posted a story at the American Spectator about a recent visit to a dermatologist. The story reminds us of how much our society and the practice of medicine has changed over the past ten years.

While the doctor was out of the room, Mr. Stein checked the electronic tablet containing his medical records.

The story continues:

I’m a snoop, so while he was gone, I looked at his iPad-like device which he had left behind. It was a medical record keeping machine. It said my name (as “Benjamin,” not as “Ben” ) and then said that I had come in complaining of a rash and itching. It further said Dr. Wang has done a thorough full-scale examination of “all dermatological systems” or similar, had examined my whole body from ankles to scalp, especially my scalp. It also said I was to be charged as full exam, first time patient.

When, a minute later, Dr. Wang re-entered the room, I asked him, “I beg your pardon for snooping, but, sir, I would like to know why you said I had complained of an itchy rash. I don’t have an itchy rash and never did. I never complained about it. Why did you say you did a series of exams on me, not one of which you did? This is a medical record of things that did not happen. It is obviously a billing document.”

To his credit, Dr. Wang looked suitably embarrassed. “Oh, this is just boilerplate,” he said (or something similar). “At the end of the day I would have edited it to show I didn’t do anything much.”

“A full exam, first time patient billing under Medicare?”

“Oh, don’t mind that.” he said.

The doctor said that he would edit the report and it is assumed that he will not be billing Medicare for a full exam that he did not perform. Please follow the link above to read the entire story–it got very interesting when Ben Stein explained to the doctor who he was.

The article concludes:

I went away angry. I am sure Dr. Wang is a fine fellow. Yes, very sure. But… There are hundreds of thousands of doctors in this country and millions of appointments with patients every day. How many of them involve billing for exams that never happened? How many of them serve only the purpose of ginning up revenue for the doctors? Mr. Obama wants to consider how to lower health care costs and he’s right. But what a staggering moral-ethical-criminal problem there is in medical care today. And with what sickening contempt these medical office personnel treat us patients. It was a maddening day.

I would add that most of the doctors I see treat me extremely well. Better than I deserve. But what about the doctors who see their license to heal as a license to steal? Who watches them?

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Thumbs

Some recent observations about thumbs. I was recently forced to realize the usefulness of thumbs due to some surgery on my thumb. The surgery was on my left hand; and as I am right-handed, I didn’t think it would be any big deal. The surgery went well and my thumb is healing nicely. In that sense, it was no big deal. Now for the educational part of the experience.

People are born with two opposing thumbs. They don’t seem too important–after all, there are eight other fingers. However, there are some things that thumbs are very useful for–opening jars, buttoning buttons, tying shoelaces, etc. You get the picture. Thumbs (opposing thumbs) are useful.

When America was founded, three branches of government were established–the Executive, the Judiciary, and the Legislature. The idea was that if one branch overreached its power, the other two would bring balance to whatever was happening. This was a really good plan, and it generally works. It means that Congress controls the debt ceiling so that there is some control over the amount of money the President can spend. It means that the President can veto a law that he feels is not good for the country and that law will not go into effect unless the Congress overrides his veto by a two-thirds margin. It means that the courts can rule when the other branches of government overstep their bounds. Just as opposing thumbs help us do useful tasks, opposing branches of government strive to keep us a representative republic.

Sometime today, take time to be grateful for things that oppose–thumbs, Congressmen and Congresswomen, Judges, and sometimes, Presidents.

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Medical Expenses Of The Elderly

Friday’s Wall Street Journal (I am not linking to the article because it is subscribers only) contained an article entitled, “Commonly Used Medicines Send Seniors to Hospitals.”  The article reports on a study done by the Centers for Disease Control and Prevention that found that an estimated 99,628 hospitalizations every year of people 65 years and older are linked to adverse drug events such as allergies and unintentional overdoses. It further reports that nearly half of those hospitalized were age 80 or older. The drugs responsible were not high-risk medications–they were commonly used diabetes pills and blood thinners.

Maybe we need to rethink the way we handle medical care for seniors. Is there a way to make the commonly used drugs safer, for example bottles that somehow remind the person to take their medicine and let them know if they have already taken their dose for the day? I have no idea if that is possible or already in existence, but certainly drug safety might be one way to seriously cut medical expenses for everyone.

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Unintended Consequences Of Changes In Food And Drug Administration Policies

The American Spectator reported today that there is a shortage of essential cancer drugs due to some changes in policy at the Food and Drug Administration (FDA).

The article reports:

The shortfall is the result of stricter FDA regulation, government price controls on already discounted but complex drugs, and policies that discourage the use of new medications. Companies, facing lower prices, tighter regulation and increasing government control over what drugs will be used and when, are exiting the U.S. market and investing in product development in China and India where, sadly, it is easier and cheaper to produce next-generation medicines.

As usual, government interference in the free marked is having a negative impact on the lives of Americans.

The article further points out::

Provenge, the first cancer vaccine, stalled at the FDA for years. Once approved, it faced 18 months of additional delay while the Obama administration figured out whether to pay for it. The gauntlet cancer patients face with Provenge is being extended to everyone waiting for a medical breakthrough under Obamacare. Before a medical innovation can be used or paid for, the government will now demand additional research demonstrating that a new product will be more effective and cheaper than existing technologies. Since most new products come from small start-ups with limited cash, such a requirement means life-saving innovations will not be available at all.

There will always be some risk associated with a new drug, but is it better to let people die than to take a reasonable risk?

This is the same government that decided that in order to save money, women under the age of fifty should not get mammograms. Since breast cancer can occur at any time and tends to be more aggressive in women in their thirties, this is the kind of decision that will result in women dying. I know a number of women who had breast cancer in their thirties and forties. They would never have discovered the cancer in time if the government policies of no mammograms until age fifty had been in effect.

Let the government do government things and the medical community do medical things. All Americans are negatively impacted when the government attempts to micromanage healthcare.

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