Comparing five-year survival rates for the US and England is fundamentally misleading. Prostate cancer is overdiagnosed in the US. Many men who receive a diagnosis do not have cancer or will never develop symptoms, let alone die from the disease. The estimate for the US is that 48% of men diagnosed with prostate cancer do not have a progressive form of the disease. In England, on the other hand, testing is performed after symptoms appear, so a diagnosis is much more significant and meaningful.
In a perfect world, doctors would not prescribe – and patients would not take – drugs that do more harm than good. But it’s complicated. The benefits and harms of drugs are determined in randomized, controlled clinical trials. For many reasons, the outcomes of such trials may not provide doctors with the information they need to decide who should take what.
Despite the increasing understanding that clinicians routinely ignore alarms due to noise fatigue and their perceived nuisance, more vendors of monitoring equipment have responded by making their alarms louder or more irksome, hoping to out-compete related equipment by ensuring their alarm gets attention. Yet equipment alarms are not equally important and there is currently no system that prioritizes disparate alarms. Additionally, there is no incentive for a given vendor to work with its peers on this problem. The result is an “arms race” mentality that is fundamentally detrimental to the quality of patient care.
The University of California, San Francisco (UCSF) has a team of robots that fills prescriptions for its medical center. Orders are submitted electronically. The drugs are retrieved from a secure, sterile environment. The dosage is as exact as a computer is logical. Medications are packaged for each patient – even assembled into 12-hour packets for the day. It eliminates possible errors by both pharmacists and nurses.
The lackeys of capitalism compete to become employee of the month, just as the donors of Never Let Me Go take a pride in their donations. In both cases, the system has indoctrinated them so successfully that they’ve ended up perfectly willing to accept their part in an apparently unalterable scheme of things.
In part one of this post I explained how a new anatomical understanding of disease in the 19th century changed the practice of medicine. Prior to this insight, there was no need to expose the body to observation or to touch parts of the body that were normally clothed. The anatomical theory sent doctors on a search to discover what was happening inside the body. The new physical exam required much greater exposure and invasion of the body, a significant change for the patient experience.
The need to reveal private and intimate parts of our bodies is a routine occurrence in medical practice today. Though it may offend our modesty, we take it for granted that the embarrassing moments of a colonoscopy, a Pap test, or a prostate exam are necessary for our health. Has it always been so? Have doctors always expected patients to disrobe? Have young male technicians always exposed the chests of female patients in need of a routine EKG? Have patients always been willing to allow doctors and their staff to view parts of the body normally seen by only the most intimate of partners? The answer is a resounding no.
Common sense tells us that early detection of breast cancer is good, and most screening programs have been successful in reducing breast cancer deaths. … However, while some women truly benefit from early detection, others experience harm and unnecessary anxiety. The women who received false-positives in our study experienced a significant reduction in their quality of life, especially if they were prone to anxiety, and the effects of this lasted at least a year.
A world in which cancer is normalized as a manageable chronic condition would be a wonderful thing, but a risk-factor world in which we all think of ourselves as precancerous would not. It might decrease the incidence of some forms of malignancy while hugely increasing the numbers of healthy people under medical treatment. It would be a strange victory in which the price to be paid for checking the spread of cancer through the body is its uncontrolled spread through the culture.
Earlier this month scientists announced a test that can detect a single cancer cell in a blood sample. Although some news reports were realistic – BusinessWeek commented that “researchers still aren’t sure what these circulating tumor cells (CTCs) actually mean” – most greeted the news as a revolution in the fight against cancer, promising early, non-invasive detection.
What’s not widely known, however, is that this is not the first time the physical exam has gone into decline. We know from surviving medical treatises that the exam was an integral part of a physician’s practice in ancient Greece and Rome. This continued to be true until the late Middle Ages (1300-1500). The hands-on exam then disappeared for hundreds of years, reemerging gradually in the late 18th century.
A more nuanced translation of Hippocrates’ original Greek text might read: Life is too short; the task is huge; the right time is like a razor blade; the road to experience is fraught with hazards; to continuously accept reality and critical thought over hope and prejudice is taxing.
Source: Wunderground When did we start calling the whole day before Christmas “Christmas Eve?” I thought Christmas Eve was the evening before Christmas. But no. Senators voted on health care reform at 1:00 AM on Thursday December 24th. To me, that’s still Wednesday night, but it was widely reported as happening on Christmas Eve. Perhaps…
Additional stories related to health. Categories include: More articles on Health Care Reform, History of Medicine, Medical Journalism, Medical Technology, Medical News, Pharmaceuticals, Pop Culture, Social Media and the Internet, and The So-Called Obesity “Epidemic.” HEALTH CARE REFORM A ‘Common Sense’ American Health Reform Plan (The New York Times – Uwe Reinhardt) After studying this…
My mother was decidedly vain her whole life. She’d been exceptionally good looking in her youth, which made it especially difficult to accept the slow physical decay of aging.
Surely it must be easier in our culture to accept the wrinkles, sags and bulges that come with advancing age if one has never thought of oneself as particularly attractive. Or if one has cared little about appearances. Admittedly, this is an increasingly rare point of view in contemporary Western societies.
Source: Americais As we get into the nitty-gritty of health care reform, critcs from both left and right are asking whether current proposals will reduce costs. Here we have a historic opportunity to make major changes in health care, but it appears no one is willing to address the problem of escalating costs. The public…
