Friday, October 22, 2010

An Issue That Won’t Go Away

At the beginning of my hospital administration career some fifty-odd years ago, a cardinal principle of health care was that life was to be extended at all cost. If there were “hopeless cases” in which doctors did somewhat less than they might have (which there no doubt were), nobody talked about it.

Things are no longer that simple. I am reminded by an article appearing in the October 20 issue of The Boston Globe about the risk associated with the use of combined hormone therapy (estrogen plus progestin, sold as Prempro) for post-menopausal patients. The article reported a study that found that a group of 10,000 women taking that medication would experience two or three more deaths from breast cancer each year than a group of equal size that does not take it.

Other studies in the past have also found risks of heart disease associated with the drug. As a result, wife Marilyn was taken off it a few years ago and put on other medications that were supposed to achieve the same result. Well, they didn’t. Her hot flashes returned and her energy level was greatly reduced. Instead of being her upbeat, energetic self, she was struggling every day to make herself get on with doing the things that her life called for.

She finally decided that whatever longevity she might be earning wasn’t worth it and went back on Prempro. Within weeks, she was back to something more like normal.

In a historical sense, circumstances that raise the issue of whether life is worth extending are fairly new and as a society we have yet to become comfortable with them and the decisions they make necessary. The “death panel” brouhaha that arose during the recent health care reform debate is an example.

But it will not go away.

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