Doctors have the very best medical care at their fingertips. They read journals that publish the latest medical findings; they know the most up-to-date treatments for various ailments and diseases; they might even play golf with a top surgeon or two. And yet, when faced with death, many physicians forgo intensive medical treatment.

Doctors “don’t die like the rest of us,” writes Ken Murray for Zócalo Public Square, primarily because “they know enough about modern medicine to know its limits.” Most medical professionals regularly see futile care in action—ineffective CPR attempts, unnecessary surgeries, and expensive drug treatments; patients hooked up to hospital IVs and machines for weeks or months before passing.

“I cannot count the number of times fellow physicians have told me, in words that vary only slightly, ‘Promise me if you find me like this that you’ll kill me’” says Murray, a clinical assistant professor of family medicine at USC. “They mean it. Some medical personnel wear medallions stamped ‘NO CODE’ to tell physicians not to perform CPR on them. I have even seen it as a tattoo.”

Our medical system certainly encourages doctors and staff to take exhaustive measures when a patient is dying. The fee-for-service model puts money in the pockets of medical professionals, and desperate relatives often push for recovery by any means necessary. But many doctors recognize there are more important things than the number of days we breathe on this earth. Murray offers one example:

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment.

At-home care can be an attractive, viable option, according to Murray:

Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures.

That doctors opt out of traditional end-of-life care might make us reconsider the measures we would take for our loved ones or ourselves. Read the moving story “When the Last Guest Leaves,” featured in our current issue, to see how one woman—with the help of her son—chooses a dignified death outside hospital walls.

Source: Zócalo Public Square 

Image by Truthout.org, licensed under Creative Commons. 

Imagine that you are nine months pregnant and have to drive seven hours to reach the nearest hospital. You have never seen an obstetrician or midwife for prenatal care and emergency health services are miles out of reach. This is the situation in parts of Afghanistan, where the maternal mortality rate is the highest in the world.

As of 2008, it was estimated that 1 in 11 Afghan women die in childbirth. (In Greece, the country with the lowest maternal mortality rate, the statistic is 1 in 31,800.) With a fertility rate of 6.62 children per mother, the life expectancy for women in Afghanistan—recently ranked “the most dangerous country for women” by the Thomson Reuters Foundation—is less than 48 years.

Now, a national midwifery program is one of several initiatives to drastically improve women’s maternal safety, report Isobel Coleman and Gayle Tzemach Lemmon in Ms. Magazine. Funded by organizations like the U.S. Agency for International Development, the United Nations, and the European Union, the program has trained more than 2,500 midwives. Coleman and Lemmon write:

For women in the country’s most remote provinces, who face the greatest challenge accessing health care in this overwhelmingly rural country, the midwives serve as a lifeline. Of the approximately 500 birth complications that occur daily in Afghanistan, 320 happen in those rural areas. Midwives are also active in cities, making home visits to women too poor or limited in mobility to seek help at clinics or hospitals.

The midwives can affect more than just the maternal mortality rate, they continue:

Along with saving mothers’ lives, the midwives serve as homegrown role models whose economic strength and earning power are changing their families’—and their communities’—views on women’s roles. Midwives can earn around $350 each month, a substantial salary in one of the world’s poorest countries and where per capita GDP is less than $500 per year. The money matters and is playing a role in shifting male attitudes toward women’s work outside the home…. When women begin contributing economically to the family, they also have a greater say in what happens to them and to their children.

 “Most people have a lot of respect for midwives because they need health care,” says Fatima, [a] student in the program. “Midwives save mothers’ lives and women’s lives.”

Source: Ms. Magazine (excerpt only available online)

Image by isafmedia, licensed under Creative Commons. 

Are our institutions of higher learning becoming dens of corporate complicity? That’s the thread running through a spate of recent stories that reveal how a trio of heavies—Big Oil, Big Agriculture, and Big Pharma—are pulling strings at U.S. universities. Each tale, on its own, is unsettling. Taken together, they paint a picture of collusion in which intellectual freedom and moral decency take a back seat to the mighty promise of profit:

• Oil giants spent $880 million over the last decade to support energy research at 10 large universities, according to a report covered by Kate Sheppard on the Mother Jones website. The report by the left-leaning Center for American Progress, “Big Oil Goes to College,” concludes that these ties constitute a threat to academic independence and good science.

• Mother Jones details in its Sept.-Oct. issue how a young man having psychotic episodes was coerced into a pharmaceutical industry study at the University of Minnesota—and ended up dead. The tragic tale, based on a great piece of newspaper reporting by Paul Tosto and Jeremy Olson of the St. Paul Pioneer Press, is a vivid glimpse into the dark side of market-driven drug trials.

• The Chronicle of Higher Education reports on “The Secret Lives of Big Pharma’s ‘Thought Leaders,’” also known as key opinion leaders, or KOLs: the influential academic physician-researchers who are paid by drug companies to basically shill for their brands—but not overtly, of course. That would be unseemly. Instead, they deftly blend their conflicting roles and realize substantial payouts for their credibility-lending efforts. “The KOL is a combination of celebrity spokesperson, neighborhood gossip, and the popular kid in high school,” writes Carl Elliott for The Chronicle. The piece makes me want to read Elliot’s new book, White Coat, Black Hat: Adventures on the Dark Side of Medicine (Beacon Press).

• The Chronicle of Higher Education also recently reported on an incident in which Big Ag seemed to be calling shots at the University of Iowa: A shoo-in candidate for a sustainability program position was brushed off after he suggested that cows eat grass—not a message that sits well with the factory-farm titans who are entwined with the university.

• Finally, a recent blowup at the University of Minnesota carried another strong whiff of Big Ag influence. An environmental documentary film, Troubled Waters, that ascribed water pollution in part to farming practices was pulled from a public television broadcast amid criticism from a university dean that it “vilified agriculture.” Ultimately, the film was reinstated after a public backlash to the move—and the university vice president who canceled it publicly apologized. Paula Crossfield covered the controversy at the blog Civil Eats (later reposted at Grist and Huffington Post), although Twin Cities Daily Planet reporter Molly Priesmeyer broke the story and stayed on it.

It’s not lost on me that several of these conflicts of interest occurred at my alma mater, the University of Minnesota. If I were the type of person who displayed my degrees on the wall, my B.A. from the university would be losing a bit of its luster right now. University of Minnesota President Robert Bruininks said after the film imbroglio that academic freedom is the “cornerstone of all great American universities.” I see signs of that cornerstone crumbling—and I hope that hard-working journalists keep drawing attention to it before there’s a complete structural failure.

Sources: Mother Jones, Chronicle of Higher Education, Civil Eats, Grist, Huffington Post, Twin Cities Daily Planet  

Image by minnemom, licensed under Creative Commons. 

Too often, scientists today rely on statistics that they don’t understand. As a result, “there are more false claims made in medical literature than anyone appreciates,” biostatistician Steven Goodman told Science News. In fact, the entire system of how scientists use statistics to draw conclusions is being called into question. Science News quotes statistician David Salsburg who wrote, “This problem is still unsolved, and… if it remains unsolved, the whole of the statistical approach to science may come crashing down on its own inconsistencies.”

Science News explains the problem:

It’s science’s dirtiest secret: The “scientific method” of testing hypotheses by statistical analysis stands on a flimsy foundation. Statistical tests are supposed to guide scientists in judging whether an experimental result reflects some real effect or is merely a random fluke, but the standard methods mix mutually inconsistent philosophies and offer no meaningful basis for making such decisions. Even when performed correctly, statistical tests are widely misunderstood and frequently misinterpreted. As a result, countless conclusions in the scientific literature are erroneous, and tests of medical dangers or treatments are often contradictory and confusing.

Source: Science News 

A California hospital has banned midwives from delivering babies, saying they must deliver at a larger facility 11 miles away that has a neonatal intensive care unit. The Ventura County Star reports on the controversy and the midwives’ reaction to the decision in Camarillo, California:

The two midwives who deliver at least 60 babies a year at the Camarillo hospital said they don’t understand the reasoning because they rarely have complications. …

Midwives said they’re worried that patients who want to deliver their babies at a Camarillo obstetrics unit they described as quiet and homey may not want to go a busy, much larger hospital. They also questioned why hospital leaders decided midwives need immediate access to the intensive care unit but obstetricians-gynecologists who routinely handle high-risk births do not.

Feministing suggests an answer, writing, “It’s hard to view this decision as being motivated by anything but a distrust of midwives, especially when OB/GYNs who deal with higher-risk pregnancies are still able to use the smaller facility.”

The blog On Birthing pins the midwife ban on fallout from the hospital’s contentious relationship with a doctor who assists in home births and is affiliated with the midwives. He and the hospital have disagreed over some of his methods. “So for his non-compliance with such ‘suggestions’ on how he ought to practice, they now take it out on midwives?” writes On Birthing. “This is a travesty.”

Feministing reports that the advocacy group the Birth Action Coalition is protesting the hospital’s decision.

Source: Ventura County Star, Feministing, On Birthing

Every year, pharmaceutical companies spend some $23 billion trying to convince doctors to prescribe their drugs. The industry employs about 90,000 drug reps, also known as “detailers,” to make friends with the doctors, dole out gifts, and make the case for drugs personally. Some drug companies even engage in data-mining to target specific doctors who might be susceptible to marketing efforts. 

To combat drug company bias, states have begun employing “academic detailers,” according to John Buntin in Governing, providing “independent, evidence-based information on how best to treat complex medical conditions.” Pennsylvania, a state that spent $2.5 billion last year filling prescriptions, hired the first academic detailers, and South Carolina, Massachusetts, and Washington D.C. quickly followed suit. 

Other states have gone further, forcing drug companies to disclose gifts to doctors. Others have tried to ban data-mining, and some doctors aren't happy. “The government is saying that you can have a license to prescribe narcotics, but we can’t trust you with gifts of pens and paper,” Dr. David Stein of Primary Care Associates told Governing. “That’s the way we’re being treated. The best term I can use is we’re being treated like whores.”