For the record, Covid vaccinations:
Also,
Still to come,
I give primary credit to President George W. Bush for helping end the culture war about HIV/AIDS. After a decade of hand painted “Thank God for AIDS” signs, President Bush showed how true Christians react to human suffering by creating PEPFAR [the President's Emergency Plan for AIDS Relief]. This remains the largest effort by any country in history to fight a single disease, and two of my Stanford colleagues recently calculated that it has already saved over a million lives. In one stroke, President Bush created humane policy and shattered the meme that there was something Christian about attacking people with AIDS.Bravo, W!
The soaring cost of health care is the greatest threat to the country’s long-term solvency, and the terminally ill account for a lot of it. Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.
Recently, while seeing a patient in an intensive-care unit at my hospital, I stopped to talk with the critical-care physician on duty, someone I’d known since college. “I’m running a warehouse for the dying,” she said bleakly. Out of the ten patients in her unit, she said, only two were likely to leave the hospital for any length of time. More typical was an almost eighty-year-old woman at the end of her life, with irreversible congestive heart failure, who was in the I.C.U. for the second time in three weeks, drugged to oblivion and tubed in most natural orifices and a few artificial ones. Or the seventy-year-old with a cancer that had metastasized to her lungs and bone, and a fungal pneumonia that arises only in the final phase of the illness. She had chosen to forgo treatment, but her oncologist pushed her to change her mind, and she was put on a ventilator and antibiotics. Another woman, in her eighties, with end-stage respiratory and kidney failure, had been in the unit for two weeks. Her husband had died after a long illness, with a feeding tube and a tracheotomy, and she had mentioned that she didn’t want to die that way. But her children couldn’t let her go, and asked to proceed with the placement of various devices: a permanent tracheotomy, a feeding tube, and a dialysis catheter. So now she just lay there tethered to her pumps, drifting in and out of consciousness.And, at the risk of violating the author's copyright, one more:
I confessed that I was confused by what Creed [, who is a hospice nurse,] was doing. A lot of it seemed to be about extending [her patient]’s life. Wasn’t the goal of hospice to let nature take its course?Read the whole thing!“That’s not the goal,” Creed said. The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.
Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months.
Studies show that between 30 and 40 percent of patients report feeling better after taking dummy pills for conditions ranging from depression to high blood pressure to Parkinson’s. Even sham surgery can work marvels. In a recent study, doctors at Houston’s Veterans Affairs Medical Center performed arthroscopic knee surgery on one group of patients with arthritis, scraping and rinsing their knee joints. On another group, the doctors made small cuts in the patients’ knees to mimic the incisions of a real operation and then bandaged them up. The pain relief reported by the two groups was identical.
A checklist for surgical teams that includes steps as basic as having the doctors and nurses introduce themselves can significantly lower the number of deaths and complications, researchers reported Wednesday.. . . the average patient death rate fell more than 40 percent and the rate of complications fell by about a third . . . ??!!'Surgical complications are a considerable cause of death and disability around the world,' the researchers wrote in the online edition of The New England Journal of Medicine. 'They are devastating to patients, costly to health care systems and often preventable.'
But a year after surgical teams at eight hospitals adopted a 19-item checklist, the average patient death rate fell more than 40 percent and the rate of complications fell by about a third, the researchers reported.
"Checklist Reduces Deaths in Surgery,"
New York Times
Studies have confirmed the common-sense notion that practice makes perfect, and the medical profession has known for at least 30 years that how well people fare after surgery often depends on where it was performed. For a given operation, outcomes are generally best at “high volume” hospitals, which perform it often. The difference between high- and low-volume centers is not just the surgeon’s skill, but also the level of expertise in other areas that are crucial after surgery, like nursing, intensive care, respiratory therapy and rehabilitation, Dr. Koniaris said. The same principles apply to treating cancer.[Write your own transition paragraph.]. . .(For people who want to find out how a specific hospital performs in treating certain illnesses and performing operations, the government Web site www.hospitalcompare.hhs.gov provides information. In addition, some states require that hospitals publish their infection rates; that information is at www.hospitalinfection.org.)New York Times, 1/6/09
Based on some of the evaluations you had as part of ClinSeq, such as your cholesterol level and blood pressure, we were able to calculate a Framingham risk score for you. This score calculates your risk to develop coronary artery disease in the next 10 years. You risk is 4 %[!]. This risk is below average [duh!] or someone of the same gender and similar age.
