Sunday, December 8, 2013

Take a few minutes for medical literacy

Last night when I was walking home from the LC holiday parade, I was reminded of the words of Stanford ageing specialist Dr. Walter Bortz"Old people don't need to take a pill - they need to take a walk." 
If you count the parade itself, the muster point for which was at Kilgore's Hardware, then my dog and I walked about two and a quarter miles - which is only about half as much as is considered a healthy daily amount.   If I had also walked to Kilgore's at the beginning of the evening, then I would have been closer to the ideal. 
I've come across a couple of related health perspectives lately and I thought I'd share those as a follow-on.

First, this piece called "How doctors die", which describes the fundamental differences that medical literacy can make in managing the dying process.  NYT did a shorter story with the same title about a year after the original was published.  

Second, this provocative piece by Sanjay Gupta in which he describes the substantial moral hazard created by health insurance, in that it furnishes a powerful disincentive to healthy living.  That one resonated deeply with me because I know from personal experience just how true it really is.  People often ask me how I'm able to muster the motivation and the discipline to keep eating well and exercising almost every single day of my life.  My reply: "Piece of cake.  I grew up in a country where it is difficult ranging into impossible to access socialized medical services.  I learned to take care of myself because I knew without question that nobody would be there to catch me if I voluntarily opted to fall on my own lazy ass."  Imagine where America could be today if its people had been given an opportunity to embrace such a valuable lesson.  Instead, they languish and pay out the nose for HMO coverage, the costs of which are not sustainable anyway

Third, I had an interesting conversation with a new doctor I recently decided to try out.  I did something that few health clients (I detest the word "patient") ever do - I asked for the best available definitive perspective on breast cancer risk in women of my age group so that I could make an informed personal decision about whether I want to follow current detection protocols or basically take my chances based on the statistics. 

Let me explain the basis for that question in more detail.  In the past number of years, I've watched a surprising number of female friends and associates get sucked into the industrial medical machine whereby they go through a living existential and financial hell of surgery only to find out that some entirely ambiguous speck on a mammogram was nothing more than an ambiguous speck. 

And each time one of them tearfully confesses their story to me, their astonishment is replicated when I tell them that X number of other women recently told me the exact same story, and every bit as tearfully.  That many women are getting shuttled through this process?!  It's hard to believe. 

It raises the question as to whether the implied chances of cancer are real or not - or even if they are, whether there's a significant risk even in many of those cases where certain indications of cancer are found.  In his essay "The Picture Problem", Malcolm Gladwell wrote (emphasis mine), "In 1987, pathologists in Denmark performed a series of autopsies of women in their forties who had not been known to have breast cancer when they died of other causes. The pathologists looked at an average of two hundred and seventy-five samples of breast tissue in each case, and found some evidence of cancer—usually DCIS—in nearly forty percent of the women. Since breast cancer accounts for less than four per cent of female deaths, clearly the overwhelming majority of these women, had they lived longer, would never have died of breast cancer."

Forty percent?!  The plot, like the breast tissue, thickens.  Something is clearly not adding up here. 

So anyway, I related these concerns to this new doctor.  I made the observation that I was no longer certain that what my previous health care providers had recommended was really in the best interest of my personal health.  I suspected instead that the protocols had more to do with minimizing liability throughout the entire medical supply chain than in minimizing the risks for me as an individual. 

In response to my question, the doctor directed me to the National Cancer Institute's Breast Cancer Risk Assessment Tool.
Pretty simple, isn't it??  I find it very telling that in the decade that I've been advised to follow standard cancer screening guidelines, not a single health care provider ever volunteered that this government-endorsed tool existed.  I had to ask for it. 

Screengrabbed from this page
That tool is definitely a start, but it's important to note how much personal information it does not capture and incorporate into its risk calculation.  There's no place for entering the amount of exercise a woman does per day, other lifestyle factors, diet, or her body fat percentage.  And in my case, all off those factors depart substantially from the unhealthy American average.  And they all influence the rate of cancer
Speaking of health, I've got a new cauliflower coming up this morning.  It's still a baby right now (and it's one of the green varieties, which I haven't tried to cultivate before).  I started planting my cruciferous crop earlier this year, hoping to extend the growing range.  So far I've harvested two broccolis, both of which were sweeter than average for reasons unknown to me.
Moral of that story:  Ask questions.  Assume nothing.  There is no substitute for good medical advice as it applies to your specific health situation, but there also is no substitute for your own brain in the process. 

I'll leave you with my favorite Dr. Bortz clip.  It's only three minutes long, and it's much more candid and unscripted than some of the other longevity-promoting material he has produced.  It is the clip in which he makes that memorable statement, "Old people don't need to take a pill - they need to take a walk."  Each one of us must make the best health management decisions we can in collaboration with our doctors, but I think that Dr. Bortz's message is worth contemplating within the greater context of our lives and our society.

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