Monday Evening News Roundup

Monday Evening News Roundup

My good friend, Blake Butler, announced that he is leaving 880 The Revolution at the end of this year. Blake has been behind the mic for four years. He has been a great progressive voice for Asheville. He will be missed.

Over the last several days, there have been many blog posts and news articles (here, here, here and here) regarding the death of a woman in Ireland. Savita Halappanavar was a 31-year-old dentist who presented to the hospital with abdominal pain. The patient was pregnant. Reportedly, the doctor said that her baby would not live. Now, exactly what happened next is unclear. All that I know is that for some reason the baby was not removed from the uterus. Dr. Savita Halappanavar got sicker and sicker. The exact reason for this is also unclear. Unfortunately, the baby died and shortly thereafter the mother died from sepsis. Some have pointed to the restrictive abortion laws in Ireland as the reason for the mother’s death. In the year 2012, there is no reason to sit around and wait for the inevitable. If the fetus was dead or dying, it is imperative for the physician to save the mother’s life. Now, before I slam the physicians for being a totally unethical, spineless subhumans, I must say we do not have all the facts. I simply hope and pray that this woman was not allowed to die because doctors were afraid to do the right thing. (As a Christian, I feel very comfortable in saying that the right thing to do when there is nothing that you can do for the fetus is to save the mother.)

Continuing on my medical theme, the New York Times had an editorial titled, “Care at the End of Life.” I think the editorial was good. I think it is something that everyone should read. Unfortunately, as a country, we Americans don’t like to talk about death. We hate it. We avoid the subject. It is almost as if by ignoring death we can somehow put off the inevitable. It was not so long ago when we were all familiar with death. 70 or 80 years ago, people didn’t go to hospitals; physicians came to your house. Often, there was nothing the physician could do. The family member would die at home. Now, many of us are shielded from death. Family members die in hospitals. In my opinion, it is actually important that we in the medical profession figure out what it is that patients truly want at the end of life. The only way for us to truly know is for us to open up a dialogue with our patients. As a trauma surgeon, by the time I’m discussing end-of-life issues, things have gone terribly wrong. The patient has been in a terrible car crash and there is nothing more that we can do. In general, it is up to primary care physicians to sit down and chat with their patients. This simple task mistakenly sounds easy, but it is not. Some patients will become offended when approached about end-of-life issues. Some of them believe that their physician has “given up” on them. Some patients will simply go to another physician because they are so upset. We, as a country, have to fix this. Doctors need to become more skilled at discussing end-of-life issues. Patients need to understand that they are in charge of their own medical care. Therefore, the only way that they were in charge is to have this discussion.

Mammogram

Arguably, the New England Journal of Medicine is the most prestigious medical journal in the world. When they publish an article, everybody listens. Last week, they published an article titled, Effect of Three Decades Screening Mammography On Breast Cancer Incidence (abstract here). The conclusions of the article are somewhat startling. The authors estimated that 1.3 million US women were over diagnosed with breast cancer over the past 30 years. They estimated that in 2008 over 70,000 women were over diagnosed. I do not blame the authors but I do blame the mainstream media for over hyping this article. Let’s just think about this for a second – suppose a development test that will diagnose bad breath. No matter what test I have developed, the test will never be perfect. There has to be, therefore, a false positive rate and a false negative rate. There are some people I’m going to diagnose with bad breath who don’t have bad breath. On the other hand, there are some people who will take the test and the test will determine that they don’t have bad breath, when in fact they actually do. Now, back to breast cancer. How do you want to err in the diagnosis of breast cancer? Is it better to over diagnose breast cancer, meaning you told the patient that she has breast cancer and she gets appropriate therapy (excisional biopsy) and she finds out she doesn’t have cancer? Or is it better to under diagnose breast cancer, which will lead to the disease being detected at a later stage? I can tell you that early in my career I worked with a surgical oncologist. We stared at mammograms with radiologists. We did as many as 10-12 excisional breast biopsies in a single day. We went down to pathology and looked at frozen sections of breast tissue searching for breast cancer. Breast cancer is simply a disease that you do not want to under diagnose. Finally, I must add that this is an extremely complex subject. It requires more thoughtful study and less overheated rhetoric from talking heads in the mainstream media.

The Supreme Court has agreed to hear a challenge to the Affordable Care Act by Liberty University. Basically, the University is arguing that the requirement that large organizations provide employees health insurance could lead to the university funding abortions. This would violate the First Amendment right. I would argue that organizations don’t enjoy the rights granted to individuals in the Bill of Rights.

I saw an interesting story the other day suggesting that national polling was actually skewed toward Mitt Romney. Almost all the national polls had a error range which was usually approximately 2%, plus or minus. Only eight of the 130 polls taken in the final month of the election showed President Obama with a lead of three or more points. During the final week, only three out of 30 polls showed President Obama by over three points – Democracy Corps (founded by James Carville and Stan Greenberg), Google and the RAND Corporation. The RAND Corporation’s polling was incredibly interesting. They polled the exact same group of Americans every single time they did the polling. They asked those people how likely they were to vote and how likely they were to vote for their particular candidate. I’ve never heard of this polling method. It appears to be extremely accurate. At least it was this year.