On being treated to death – Part II

Is there a fate worse than death? Yes. In the U.S., often it is the fate of dying slowly: aggressively treated, over-treated and worn down by the system until that fate has made death truly a blessed relief.

Deborah Wright, an ordained Presbyterian minister and writer now working in secular fields while simultaneously serving as personal pastor to many, forwarded an article that proves out the fate-worse-than-death highlighted in this and recent other articles (see June 25 post below.) The fact that stands out, she comments, is that “the length of time we use palliative care services is growing shorter — because we start it too late.”

We start palliative care too late, we treat too aggressively and too long. The opening story in AP writer Marilynn Marchione’s thoughtful, poignant article just published in Daily Finance serves as a classic example:

The doctors finally let Rosaria Vandenberg go home.

For the first time in months, she was able to touch her 2-year-old daughter who had been afraid of the tubes and machines in the hospital. The little girl climbed up onto her mother’s bed, surrounded by family photos, toys and the comfort of home. They shared one last tender moment together before Vandenberg slipped back into unconsciousness.

Vandenberg, 32, died the next day.

That precious time at home could have come sooner if the family had known how to talk about alternatives to aggressive treatment, said Vandenberg’s sister-in-law, Alexandra Drane.

Instead, Vandenberg, a pharmacist in Franklin, Mass., had endured two surgeries, chemotherapy and radiation for an incurable brain tumor before she died in July 2004.

“We would have had a very different discussion about that second surgery and chemotherapy. We might have just taken her home and stuck her in a beautiful chair outside under the sun and let her gorgeous little daughter play around her — not just torture her” in the hospital, Drane said.

Marchione tells other stories of patients who might have had far more peaceful final days — and of patients who chose extensive, aggressive or experimental treatment for a variety of reasons. It should be the individual’s choice. But the reality is that discussion of palliative care or hospice care (there is a difference: hospice involves declining further treatment; with the newer “palliative care” concept some therapies may be continued) simply doesn’t happen until too late. If it happened sooner, many of us — likely including Rosaria Vandenberg — would choose hospice care over aggressive end-of-life treatment.  But physicians are too busy talking treatment, and patients have not considered their other choices. Comfort and peace lose to the system.

An article posted today on the website of the National Hospice and Palliative Care Organization points the finger in the right direction, right at you and me. If we took the time and energy to write our advance directives, and talk them over with family and friends, millions of days of suffering and millions of wasted dollars would be saved.

Recent media coverage on the challenges patients and families face with overtreatment of a life-limiting illness brings the issues of hospice and palliative care and advance care planning to public attention.

“It’s important to remember that quality of life and a patient’s personal wishes, beliefs and values must be a factor when making care decisions brought about by a serious or terminal illness,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

“Discussions helping patients and families understand the many benefits of hospice and palliative care must be more common and held long before a family faces a medical crisis,” Schumacher added.

Advance care planning—which includes completing a living will and appointing a healthcare proxy—is somewhat like planning a road trip to an unfamiliar destination.  Very few people would expect to get to a destination safely and comfortably without having a well-thought-out map in hand.   Yet, it’s estimated that 70 percent of Americans have not completed a living will.

  • A living will charts the course for your healthcare, letting your family and health care providers know what procedures and treatments you would want provided to you—and under what conditions.
  • A healthcare proxy or healthcare power of attorney form, allows you to choose someone you trust to take charge of your healthcare decisions in case you are unable to make those decisions yourself.
  • Advance directives can be changed as an individual’s situation or wishes change.

Still, you and I put it off. Or you may be putting it off, at least, and if so you are taking an absurdly unnecessary risk. You could, instead, download free forms, fill them out and avoid that risk.

Deborah Wright has shepherded countless friends and family members through their final days, and knows what a blessing hospice and palliative care can be. Problem is, though, “we start it too late.”

Americans are treated, and overtreated, to death – DailyFinance.

Dr Oz worries about cell phones too

More on cell phones and brain tumors: a reader yesterday sent along a link to an earlier commentary by Mehmet Oz, the cardiac surgeon/author/media guru who has also weighed in with advice that links between cell phone use and cancer are indicated.

We rely on them to connect us to the people we love, to help us stay organized, and, in an emergency, to keep us safe. But more and more experts are saying that cell phones may pose a very serious health risk – increasing your chance of developing a brain tumor.

That means that over 270 million Americans may be playing Russian roulette with their cell phones every day. Each year, more than 21,000 adults and 1,500 children are diagnosed with brain tumors, and researchers believe some of them may have been caused by talking on a mobile phone.

A new study examined a decade’s worth of research and concluded that people who use cell phones for more than 10 years are up to 30% more likely to develop brain tumors than people who rarely use them.

Nothing has shown proof — yet — that if you use a cell phone often enough, long enough, you’re going to get brain cancer. Dr. Oz lists ways to improve your chances — keep your phone in your pocket, use it on speaker (and Lord help us all when everyone’s not just on cell but on speaker…), use wired rather than wireless when possible. And however much some of us vow we’ll resist texting to the bitter end, atrophied thumbs might still be preferable to brain cancer.

Still, the cell phone industry is not going to issue credible warnings. The FCC should do so.

Is your cell phone frying your brain?

OK, if you think it’s all just a lot of hysterical hooey about cell phones & radiation, you can click on to another page. But this op ed piece by public health expert Joel Moskowitz (with Diana McDonnell and Gene Kazinets) in the San Francisco Chronicle got my attention. Moskowitz is the Director of U.C. Berkeley’s Center for Family and Community Health.

A huge, 30-year study called COSMOS has been launched in Europe to determine whether cell phones cause cancer and other health problems. Meanwhile, policymakers in Sacramento are considering legislation to ensure people know how much radiation their cell phones emit. The wireless industry vigorously opposes such legislation. It argues that its phones comply with regulations, and there is no consensus about risks so people don’t need to know this. Our research review published in the Journal of Clinical Oncology found alarming results to the contrary.

We reviewed 23 case-control studies that examined tumor risk due to cell phone use. Although as a whole the data varied, among the 10 higher quality studies, we found a harmful association between phone use and tumor risk. The lower quality studies, which failed to meet scientific best practices, were primarily industry funded.

The 13 studies that investigated cell phone use for 10 or more years found a significant harmful association with tumor risk, especially for brain tumors, giving us ample reason for concern about long-term use.

Do federal regulations adequately protect the public? The 1996 Federal Communications Commission regulations are based upon the Specific Absorption Rate (SAR), a measure of heat generated by six minutes of cell phone exposure in an artificial model that represents a 200-pound man’s brain. Although every cell phone model has a SAR, the industry doesn’t make it easy to find it. Moreover, children, and adults who weigh less than 200 pounds, are exposed to more radiation than our government deems “safe.”

So just for fun, I got out the 107-page User Guide that came with my cell phone. Full disclosure: my cell phone is turned off unless I’m out walking or traveling; it takes pictures but it doesn’t do apps. Still, those 107 pages say it can do all the fancy Stuff.

On page 81 I found the SAR data. Even if I wanted to decipher the very small print, there is no way any of it would be meaningful to a lay reader. It does say that “Your wireless phone is a radio transmitter and receiver. It is designed and manufactured not to exceed limits for exposure to radio frequency (RF) energy set by the Federal Communications Commission (FCC) of the U.S. Government.”

I do try to trust the U.S. Government. But since they once sent my then-Marine husband double-timing out of a foxhole toward an A-bomb blast with a radiation tag hung around his neck in the ’50s, it would appear we have long been open to experimentation about radiation damage. (He survived. The animals positioned closer to the blast site did not. No one will ever be certain how much damage was sustained by those Marines wearing radiation tags… but then, who knew we’d keep right on storing bombs and fighting senseless wars anyway?)

Another what-can-you-believe? comes from CNN’s medical guru Sanjay Gupta in this line from a two-year-old commentary on potential cell phone radiation damage still up on his blog:

Over the last year, I have reviewed nearly a hundred studies on this topic, including the 19 large epidemiological studies. I urge you to do the same and read carefully to see what you think. Here is an example from a Swedish paper showing no increased risk of a brain tumor, known as acoustic neuroma. (see study) As you read the paper, you will find they defined a “regular” cell phone user as someone who uses a cell phone once per week during six months or more.

Once a week? Hello? Even in Sweden, even a decade ago, did anyone with a cell phone not use it at least once an hour? This very old study did have a timeless conclusion: “Our findings do not indicate an increased risk of acoustic neuroma related to short-term mobile phone use after a short latency period. However, our data suggest an increased risk of acoustic neuroma associated with mobile phone use of at least 10 years’ duration.”

Moskowitz argues that it’s time to revamp FCC regulations, pointing out that it is not just heat transfer but also variations in frequencies emitted that could cause damage.

Most of us know something about potential damage lurking in our Stuff. But we tend to be slow learners, and our regulatory agencies tend to be even slower. Having just lost a greatly loved sister, a long-time smoker, to pulmonary failure, Moskowitz’ concluding paragraphs hit home:

We should address this issue proactively even if we do not fully understand its magnitude. Our government has faced similar public health threats in the past. In 1965, although there was no scientific consensus about the harmful effects of cigarettes, Congress required a precautionary warning label on cigarette packages: “Cigarette Smoking May Be Hazardous to Your Health.” More specific warnings were not required until 1984: “Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy.”

Should we have waited 19 years until absolutely certain before we informed the public about these risks?

Although more research on cell phone radiation is needed, we cannot afford to wait. There are 285 million cell phones in use in this country, and two-thirds of children over the age of seven use them. Manufacturers bury the SAR within their owner’s manuals, along with safety instructions to keep your phone up to an inch away from your body.

Nine nations have issued precautionary warnings. It is time for our government to require health warnings and publicize simple steps to reduce the health risks of cell phone use.

Why not?

Government must inform us of cell phone risk.