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More on healthcare…the readers respond, and so do I

I wanted to share a response I got from my last blogpost  (which was on my thoughts on achieving a greater level of justice in healthcare) from a reader who brings up some very excellent points in regards to what some of the goals in healthcare, and in her case, the treatment of cancer, should be. She was very brave to share her story and her thoughts about what she would like from the healthcare system, which is unfortunately not always what the healthcare system provides. Why? Because it is too influenced by forces outside the needs of the patients, and the doctor serving the patient. I also added my response:

This is a great topic that needs to be discussed but seems taboo for some reason. I will give you my thoughts as a person who has stage IV cancer and lots of money has been spent on my behalf so far. The doctors tell me there is no cure for my condition and the cancer will return at some point. I figure they are saying eventually it will kill me. I’m glad I had insurance so far as medical treatment prolonged my life and right now I feel good! However, going through chemotherapy etc. to treat my cancer showed me how awful it feels to be sick. My greatest fear is not dying – it is suffering! It’s been stated that the last 6 months of one’s life is where most of the money gets spent. I imagine during my last 6 months will be plenty of suffering (as there was for my brother,and for my mother and for my father) as the medical profession/politicians don’t give me the option of opting out of this stage of my disease. WHY NOT??? Why can’t I, at my option, say when life gets too miserable to live, give me something to end it? This would save resources for someone else and I wouldn’t have to suffer. I’m not saying everyone needs to go this way. Some people may want to suffer to the bitter end no matter what. But some of us don’t, we should have a medically supervised better option and this would be much less expensive for society – a win win.

On a brighter note, I do think things may be changing. My oncologist told me that she believes cancer is being approached wrong, the emphasis should be on prevention. I think she watched “Forks Over Knives” (I know, it involves vegan propaganda) and it made her think. Hopefully this attitude spreads throughout medicine.

My response:

Johannah, thanks for sharing your story. I wish you the best in your cancer fight, and I can tell that you are both brave and honest. In regards to healthcare, and my thoughts for its future improvement, I think it really hinges on taking the heavy 3rd party payer influence out of it, whether it be the government or the private sector. The key is putting the power of choice in the hands of patients. This comes with certain responsibilities, which have to be fulfilled by both the patient and the doctor to work. A patient in your situation can be very desperate to try just about anything, and as a result, healthcare is not similar to other goods in a free market, because a person with stage IV cancer will spend and try just about anything because there is no penalty or harm fiscally to do so. I think to offset this condition, there have to be several things involved: (1) an agreed endpoint, which you say is to provide comfort and reduce suffering, not necessarily prolonging life. Unfortunately, most oncologists/cancer doctors measure the effect of drugs they use by how they prolong life, not by how they make you feel. After all, they use poisons, in essence, which make you feel terrible and sick. (2) Clear understanding of the what the drug or treatment does/how effective it really is. This is where doctors can exert the type of influence that actually helps people if they have the proper incentive to serve the patient’s interest only, and not any outside influence, eg hospitals or protect themselves from litigation, etc. If you are getting paid directly by the patient for the quality of the service that you provide, and not the quantity or the nature of that service, then you as doctor, will view expensive technology or medications in the same light as doing nothing, or providing comfort care, or placing someone on a lifestyle program to help them lose weight and gain metabolic health. We currently do not have that in the system, and rely heavily on technology, which people think is often more useful than lifestyle management, and is certainly more remunerative. It has created an overspecialization in my view, which has made a lot of doctor mere providers of technology. This is not only sad, but I think it’s harmful to health. The only was to really restore and revitalize medicine, in my view, is to give patients the power of choice (through economics and information) and give patient’s access to opinions while making doctors accountable and transparent in terms of both price and value of their treatments. That is, restore the central power of the doctor-patient relationship in health care. To me, that is the only way to make things work. I wish you the best for your health, Johannah, and once again thanks so much for sharing.

As for ‘Forks over Knives,’ I did see the movie, and to be clear, I don’t think a vegan diet is particularly healthy versus an omnivorous diet that is based in whole foods, but they do get the refined sugar and processed food thing right. In my opinion, refined sugar and processed food (and to a great extent grains and the overconsumption of starch) are the key factors in the development of the the diseases that are responsible for the skyrocketing cost in the health care system, ie metabolic syndrome, obesity –>arthritis, diabetes, cardiovascular disease & stroke, cancer, and end of life care. The more I study it, sugar and processed food are the culprits, and so in this sense, the vegans are right. I am willing to acknowledge that. But to say that meat is dangerous and unhealthy, or that an omnivorous diet is not good for you, is something I think the vegans are wrong about.

5 Responses to More on healthcare…the readers respond, and so do I

  1. Johannah says:

    Dr. O,
    I agree people should have some skin in the game to eliminate wasteful and frivolous spending. However, you said, “A patient in your situation can be very desperate to try just about anything, and as a result, healthcare is not similar to other goods in a free market, because a person with stage IV cancer will spend and try just about anything because there is no penalty or harm fiscally to do so.” That doesn’t apply to everybody – I paid private health insurance premiums 100% out of my own pocket for the last 25 years. They have gotten so high that my savings are almost gone especially coupled with the drain of deductibles and co-pays. This is why in America, bankruptcy happens in spite of having health insurance. So, I have the choice of spending all my family’s money on my healthcare and leaving nothing for their future or security or doing nothing and seeing how that goes. This has been a heavy issue weighing on my mind. So, what do you do with people like me? Tell them, “Sorry, you have no money left – you’ll just have to die”.

    There is no doubt that the way healthcare is done in this country has to change. There are a few groups of people who are delusional enough to think we have the best health care in the world thanks to a free market system and except for letting those poor leaches at the bottom suck the government teat (because they won’t get a job or don’t work hard enough), our system is perfect. At the other end there are groups of people who think everyone is entitled to healthcare and no cost is too high to treat, spare or prolong a life.

    My insurance company has decided that the lowest deductible that they offer annually will be $2500 with a $7500 co-pay 70/30. They are eliminating vision care and radiation is 50/50. Anyone on this plan will have skin in the game if they get sick. Anyone with a serious chronic illness will be broke unless they have a very large bank account.

    I think people need to realize that health is everything and to be able to keep the fruits of their labor in the future, they need to start watching their lifestyle starting when they are young. The government and all the alphabet agencies need to get off their corporate-owned butts and start really looking at the science for their dietary and other guidelines. The doctors need to do the same. This is a huge problem and thank you for starting to address it.

    • Johanna, once again thanks for your very open and thoughtful responses. I think you make some excellent points and bring up some very important issues as they regard to 2 particular issues in health care: (1) the expense of care that may not be successful, or leave you permanently disabled or impaired and (2) end of life issues. These need to be addressed, and it won’t be easy. Expensive care is profitable and end of life issue bring out some very deep passions. They are hard to even discuss in an open fashion.

      That is why I feel accountability, transparency, and information as such important core values. These are the avenues that people in health care can express their compassion, honor, and integrity.

      Likewise, in terms of restructuring a better system, you have to start not at the beginning but before the beginning, that is before you walk into a doctors office or a hospital. That is what prevention is all about, and like I said, that begins with patients having the power–patients like you.

      After all, health care, I feel, really about the patient’s voice, and as you know, it’s getting lost or drowned out or ignored and that is not a good thing. Good doctoring is essentially about really listening to patients. You have expressed some excellent ideas and points, and it only reinforces to me that patient’s are always the doctor’s best teacher, and voices like yours need to direct the conversation.

      I wish you well.

    • Margaretrc says:

      Joannah, Please do one thing for yourself. Try a ketogenic diet (if you haven’t already)along with whatever therapy you are getting. Studies done recently in Germany indicate that literally starving cancer cells of the glucose they require can help and certainly won’t hurt. I believe this is the link to a PDF of the study and the background/rationale: http://www.communityoncology.net/co/journal/articles/0501022.pdf Anyway, good luck–you are a brave soul.

      • Johannah says:

        Thank you Margaretrc. I have been doing low carb but I don’t think I got it low enough to be ketogenic at least all the time. I do fasting which is supposed to mimic calorie restriction which is supposed to be good to fight cancer. Thank you for the study reference, I can’t wait to read it.

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