Monday, August 27, 2012

August 27, 2012 – The Downside of Up Life-Expectancy

Here’s a jaw-dropping statistic: “Since 1900, the life expectancy of Americans has jumped to just shy of 80 from 47 years.”

Among so many significant developments of the 20th Century, this may be one of the most far-reaching: and it gets so little press, compared to advances in transportation, communications, electrical power, data-processing and all the rest.

Walk through any older graveyard, and take note of the lifespans cut into the 19th century headstones. Stroll over into the newer section, and do the same for the stones from the last decade or so.  Then, do the math.

You’ll experience your own little “Wow!” moment.

We’ve been making huge progress, as a society, fighting cancer – which partly explains the increase in life expectancy, of course. Yet, those numbers also do their part to blunt the remarkable gains in cancer prevention and treatment.  They make them seem less impressive than they really are.

Here’s why. 

We all know cancer is an old person’s disease.  Not every cancer, of course. Small numbers of the young can be afflicted as well, and it’s especially heartbreaking when that happens.  Yet, the chances of getting most cancers go up with each decade of life: way up, once you pass 60 or so.

In 1900, when people were dying at the age of 47, on the average, most of them were succumbing to other maladies before they even made it into the prime cancer years. So many cancers are influenced by genetics: at a certain age, some mysterious, pre-programmed switch in the DNA gets thrown into the “on” position. Then, some of our cells start morphing into predators and lunching on those around them.

Sometimes, I hear people of my generation comment with alarm on how many of their friends are getting moles cut off, or undergoing mastectomies, or following the same chemotherapy path I and a few others of us have unintentionally pioneered. The cancer rate must surely be going up, they exclaim!

It’s not – at least, not if the effects of aging are controlled for.  What’s going up is their age, and the age of their contemporaries.  That, in itself, accounts for a whole lot of cancers.

Want to know what the leading cause of cancer really is?  It’s getting old.

What a paradox! With each new advance in cancer treatment, average life expectancy goes up.  Yet, for all those cancers that are prevented or successfully treated, the chances of getting other cancers increase, due to the demographics.

You’ve really got to feel for the cancer researchers.  They work so hard, and they announce their latest successes in triumph, but their numbers don’t look nearly so good as they would, were the average lifespan not also increasing.  They’re walking up the down escalator.

In the August 25th New York Times, David Ewing Duncan poses the very reasonable, but creepy, question of whether some of these medical advances are really worth it. He says he’s in the habit of polling his lecture audiences, asking for a show of hands as to how long they truly want to live. “I provided,” he says, “four possible answers: 80 years, currently the average life span in the West; 120 years, close to the maximum anyone has lived; 150 years, which would require a biotech breakthrough; and forever, which rejects the idea that life span has to have any limit at all.”

Before voting, he tells his audiences, they should assume that aging, as we know it, would continue. His question is simply about longevity that could be gained through eliminating life-threatening illnesses, not a matter of freezing the normal aging process. He’s not offering the opportunity, in his thought-experiment, for people to remain forever 30, or 40, or whatever ideal degree of physical maturity they’d care to name.

The majority — 60% — say they don’t want to live past 80. Another 30% declare they’re willing to power on through all the usual infirmities of aging, finally dying at 120. Nearly another 10% want to boldly go where no one has gone before, and live to 150. Only a tiny fraction put up their hands to say they want to live longer than that.

Duncan goes on to report that medical researchers are on the verge of a number of breakthroughs that could push the average life expectancy up even higher. Among these are medications to reduce inflammation of the coronary arteries, as well as various stem-cell therapies. The growing field of bionics — developing replacement hardware for the body, like cardiac pacemakers, brain implants for Parkinson’s sufferers, even artificial hearts — offers to add even more years to the average age at death.

“Curiously,” Duncan goes on, “after learning about these possibilities, few people wanted to change their votes. Even if I asked them to imagine that a pill had been invented to slow aging down by one-half, allowing a person who is, say, 60 years old to have the body of a 30-year-old, only about 10 percent of audiences switched to favoring a life span of 150 years.”

For many of those who don’t want to change their vote, it’s the various infirmities of aging that scare them off.  For others, it’s concern for younger generations, who would find the staircases to so many joys and achievements blocked by their elders, shuffling around on the landings above them. For still others, it’s about worry for the environment — whether the earth can truly sustain very many more people than are already here.

The tiny minority who do want to live longer speculate that we have no way of knowing what such super-centenarians could accomplish, with their added wisdom and life-experience. What new gizmo could a genius like Steve Jobs come out with, if he lived to 150?

We do know, Duncan concludes, that Albert Einstein was very clear about his own wishes, near the end of his life: “As he lay dying of an abdominal aortic aneurysm in 1955, he refused surgery, saying: ‘It is tasteless to prolong life artificially. I have done my share, it is time to go. I will do it elegantly.’”

Let’s hear it for everyone being given the opportunity to live long enough to still die elegantly!

Friday, August 24, 2012

August 24, 2012 – What Would Jesus Not Do?

One of the most brilliant things I’ve seen lately, related to the healthcare-funding debate, is this little satirical item that Rabbi Michael Lerner sent around in his latest Tikkun e-newsleter. (Same last name, but he’s no relation to my oncologist, as far as I know.)

The author is Fr. James Martin, S.J., and it was published today in the In All Things group blog on the website of America, the Roman Catholic weekly.

This item’s not even a day old, at least in its present iteration (I don’t know when Fr. Martin wrote it).  Yet, it’s already got quite an ecumenical life, it seems.  Written by a Jesuit, passed along by a Reform rabbi, and now picked up and republished by a Presbyterian.

Here it is, a very unauthorized translation of Luke 5:17-26.  Let those who have ears to hear, listen:

The Lazy Paralytic

1. When Jesus returned to Capernaum after some days, it was reported that he was at his home. 2. So many gathered around that there was no longer room for them, not even in front of the door; and he was speaking the word to them. 3. Then some people came, bringing to him a paralyzed man, carried by four of them.  4. And when they could not bring him to Jesus because of the crowd, they removed the roof above him; and after having dug through it, they let down the mat on which the paralytic lay. 5. When Jesus saw this he grew angry, "Why did you wreck my roof?  Do you have any idea how much that cost to install?  Do you know how many tables and chairs I had to make in my carpentry shop to pay for that roof?  The reeds alone cost five talents.  I had them carted in from Bethany."  6. The disciples had never seen Jesus so angry about his possessions.  He continued, "This house is my life.  And the roof is the best part."  The disciples fell silent.   7. "It's bad enough that you trash my private property, now you want me to heal you?" said Jesus, "And did you not see the stone walls around this house?"  "Yes," said the man's friends.  "Are these not the stone walls common to the towns and villages of Galilee?"  8. "No," Jesus answered.  "This is a gated community.  How did you get in?"  The man's friends grew silent.  9. Then Jesus turned and said to the paralytic, "Besides, can't you take care of your own health problems?  I'm sure that your family can care for you, or maybe the synagogue can help out."  10. "No, Lord," answered the man's friends.  "There is no one.  His injuries are too severe.  To whom else can we go?"  11. "Well, not me," said Jesus.  "What would happen if I provided access to free health care for everyone?  That would mean that people would not only get lazy and entitled, but they would take advantage of the system.  12. Besides, look at me: I'm healthy. And you know why?  Because I worked hard for my money, and took care of myself."  The paralyzed man then grew sad and he addressed Jesus.  "But I did work, Lord," said the paralytic.  "Until an accident rendered me paralyzed."  "Yes," said the man's friends. "He worked very hard."  13. "Well," said Jesus, "That's just part of life, isn't it?"  "Then what am I to do, Lord?" said the paralytic.  "I don't know.  Why don't you sell your mat?"  14. All in the crowd then grew sad.  "Actually, you know what you can do?" said Jesus. "You can reimburse me for my roof.  Or I'll sue you." And all were amazed.  15. "We have never seen anything like this," said the crowd.

Thursday, August 23, 2012

August 23, 2012 – You Takes Your Chances

Here’s an article that gives me pause. In the August 20 “Well” medical blog in the New York Times, Jane E. Brody comments on the possible overuse of medical diagnostic scans that could contribute to secondary cancers: perhaps as many as 1.5% of all the cancers that occur in the United States.

And why is this of such concern to me?  To anyone who knows my medical history, it should be obvious.  Ever since my non-Hodgkin lymphoma diagnosis in late 2005, I’ve received somewhere between two and five radiation-based scans a year: some of them CT scans, others CT scans combined with a PET scan. I had the greatest number of these during and just after my chemotherapy. In recent years, the number of scans has decreased: first, to about three a year, and now, two.  With my indolent lymphoma continuing to snooze away, I seem, now, to have settled into a pattern of two alternating scans a year: one CT, the other PET/CT.

These are not quite full-body scans, but are pretty close to it: neck, chest, abdomen and pelvis.  Everything but the arms, leg and head, in other words.

I’ve had so many scans, I’ve lost count. Really. I probably should have kept a central log of all my scans, but I haven’t – although I suppose that information could easily be mined from my thick file at Dr. Lerner’s office.

Now, here’s the kicker. Just over a year ago, I had surgery to remove my cancerous thyroid gland.  Was the thyroid cancer merely a matter of bad luck – a disorder I was destined to develop anyway, independent of the lymphoma? Or was it caused by something related to my previous cancer treatment - like radiation from all those diagnostic tests?

A CT scan delivers a relatively modest, measurable amount of radiation.  In and of itself, one scan doesn’t amount to much. The question no one really knows the answer to is whether or not there’s a cumulative effect.

A PET scan is a whole other matter. With respect to radiation, PET scans are to CT scans as a double vodka is to a thimbleful of beer. They involve getting injected with a radioactive-glucose solution that courses throughout the body, carried by the blood.

Ever since getting diagnosed with thyroid cancer, I’ve wondered about the secondary-cancer thing - but reading this article brings that worry home once again. I know that, after a nuclear disaster like Chernobyl or Fukushima, the first thing people in the affected geographic region are supposed to do is swallow potassium iodide pills to protect their thyroids. The thyroid, it seems, is the organ in the body most susceptible to radiation.

It's like the canary in the coal mine.  Or, the uranium mine.

This next bit of information is, of course, anecdotal, but it gives me something more to think about.  Last fall, when I went for my post-thyroidectomy radioactive-iodine treatment, I shared the treatment room that afternoon with a young Hodgkin lymphoma survivor who had undergone her chemotherapy at exactly the same time I’d had mine.  She had Hodgkins and I non-Hodgkins, so our chemo regimens were naturally different, but presumably, in the years that followed, she received roughly the same series of diagnostic scans as I did – to make sure her cancer was gone, and stayed gone.

Two blood-cancer patients. Both treated for their cancer at the same time. Both develop thyroid cancer and have thyroidectomies at about the same time. Coincidence?

Maybe.  Like I said, the “evidence,” such as it is, is purely anecdotal.  Two cases do not a medical trend make.

But, still... it does make you think.

Of course, the radioactive-iodine treatments she and I both received – swallowing those hot pills, in order to fry any leftover thyroid tissue still floating around in our bodies – was a way-bigger jolt than anything delivered by a diagnostic scan.  She and I ingested so much radioactive material, we had to keep our distance from our loved ones for several days afterwards.  Granted, thyroid cancer was no longer an issue for either of us - we no longer had thyroid glands. But, what about our other organs?

Don’t get me wrong.  I dutifully submitted to all those diagnostic scans and will continue to do so, because it’s important to keep a vigilant eye on my lymph nodes. Six years ago, I let my medical bartenders drip six highly-toxic chemo cocktails into my veins, knowing that at least one of the ingredients in those concotions, adriamycin - the one they call “the red death” - burns the skin on contact and is strongly suspected to cause secondary cancers in a small, but measurable percentage of patients.

If my lymphoma ever yawns, throws off the bedclothes and gets up to stumble around like Frankenstein's monster, one of the treatment options I'll want at the top of my list is radioimmunotherapy (Bexxar or Zevalin), which involves an injection of Rituxan bonded to radioactive material.

It’s all about the odds. We cancer patients say “bottoms up” to the chemo bartender.  We shoot up with radioactive glucose like some oncological junkie.  We smile and say “cheese” to the PET-scan photographer.  And all because we know our odds are better with those interventions than without them. The oncological Russian-roulette revolver may hold considerably more than the traditional six rounds, but even if its rotating cylinder’s chambers are numbered in the hundreds, one of them does still hold a bullet.

We pays our money (or, our insurance companies do).  And, we takes our chances.

It has ever been so, in Cancerworld.

Tuesday, August 21, 2012

August 21, 2012 – Our Hidden 30% Tax

Here are a couple of figures related to our dysfunctional healthcare system that made me sit up and take notice, when I saw them recently. Both are mentioned in the short video below (sorry for the annoying commercial that precedes it, but that’s what you get with CNN).

The first statistic is that 137,000 Americans died over a 7-year period due to lack of insurance.

I've known some of those people. I’ve heard their firsthand stories in the course of my ministry: people who delayed getting medical treatment because they were uninsured, only to find out that – once they either got insurance, or pain finally drove them into the emergency room – it was too late, and the doctors could do little for them. These are heartbreaking stories, especially when you’re looking into the faces of the people telling them, as I have done.

Lack of insurance can literally be a matter of life and death.

Actually, I think that 137,000 figure is probably low.  Lots of people are filled with shame about their uninsured status, and hesitate to speak of it, even to a pollster promising anonymity. Some of these premature deaths-by-insurance (or lack of it) no one will ever know about.

Second is the statistic that we have a de facto 30% tax on every healthcare dollar spent in the U.S.

“What kind of a crazy tax is that?” you may ask. “Healthcare is expensive enough.  That’s one tax we’ve got to dump right away!”

It’s not so simple as that.  This is not the sort of tax you can complain to your Senators and Representative about, asking for a repeal.  It’s the largely unnecessary administrative costs related to health-insurance coverage and billing.

We’ve got a massive industry in this country that siphons money out of the healthcare system for private gain. These are very large, publicly-traded companies, whose executives earn multi-million dollar bonuses and that make huge campaign contributions to politicians and Super PACs. Not all of that 30% is shareholder profit, to be sure.  Most of it is the “overhead” cost of a bloated industry that exists for one purpose only: to allow those profits to be earned.

Countries with single-payer healthcare systems – that’s virtually every other developed country in the world, except for ours, as you’ll see from the World Health Organization statistics in the chart below  – avoid most of this 30% “tax,” simply by eliminating medical billing altogether and picking up the tab for all medical care. We're not exactly getting good value for our money, according to several significant benchmarks:
Of course, as the video makes clear, real taxes would have to be increased to pay for the somewhat lower actual cost – as opposed to the insurance-inflated cost – of medical services delivered to everyone. But at least these new taxes would pay for something real and useful, and not simply subsidize an industry that doesn’t actually produce anything.

The current presidential-election debate is cast in terms of “Obamacare” vs. free-market care. What’s seldom mentioned is that Obamacare is a watered-down compromise (based, ironically, on the system Governor Romney established in Massachusetts, although he furiously denies it).  Obamacare still includes the wasteful 30% “tax,” because it continues to protect and coddle private insurers.

Obamacare is a weak political compromise, the only thing the President and his supporters could sell to the few members of the obstructionist opposition party willing to reach across the aisle. Although Obamacare shakes up the inner machinery of the present medical-insurance system a good bit, it doesn’t tinker with the feature that allows all those for-profit companies to tap into the flow of dollars and siphon off one out of every three, for their operating expenses and profits.  A true single-payer system – one that would begin with the relatively simple reform of extending Medicare to everyone – isn’t even on the table in this election campaign.

“But we must have competition!” cry the free-marketeers. “Only competition can keep costs down!”

Oh, really?  Enough to offset the cost of the one-out-of-every-three healthcare dollars presently circling the drain?

Those are the costs we need to eliminate.

“But that’s socialism!” cry the wild-eyed Tea Partiers.

OK, by some definitions of the word - but not most - it is.  But no more than Medicare is socialism. Or Social Security. Or taxpayer-funded police and fire departments, or just about any other government service you’d care to name. I don’t think anyone but the lunatic fringe has the slightest fear that government-funded services such as these shove us onto some imagined slippery slope that ends up with jackbooted soldiers parading before the Capitol and brainwashed schoolchildren singing Marxist labor anthems. That hasn't happened in Britain, or France, or Australia - or Canada, for crying out loud! So, why should taxpayer-funded medical care be any different here?

Every other developed nation in the world looks on, dumbfounded, unable to figure out why the United States of America allows such blatant waste to continue – and why we allow so many of our citizens to die unnecessarily.