Following on the strong NY Times medical-related stories of Lawrence K. Altman (here, here and here) over the holiday season, Drs. H. Gilbert Welch, Lisa Schwartz and Steven Woloshin contribute this op-ed to the Times in which they make the salient point that the American health care system is a hypochondriac’s dream:

For most Americans, the biggest health threat is not avian flu, West Nile or mad cow disease. Itís our health-care system.
. . . The larger threat posed by American medicine is that more and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses.
Americans live longer than ever, yet more of us are told we are sick.
How can this be? One reason is that we devote more resources to medical care than any other country. Some of this investment is productive, curing disease and alleviating suffering. But it also leads to more diagnoses, a trend that has become an epidemic.[ . . .]
. . . the real problem with the epidemic of diagnoses is that it leads to an epidemic of treatments. Not all treatments have important benefits, but almost all can have harms. Sometimes the harms are known, but often the harms of new therapies take years to emerge ó after many have been exposed. For the severely ill, these harms generally pale relative to the potential benefits. But for those experiencing mild symptoms, the harms become much more relevant. And for the many labeled as having predisease or as being ìat riskî but destined to remain healthy, treatment can only cause harm.

Read the entire article. Then take a chill pill! ;^)

Fresh off his fascinating article on Dr. Michael DeBakey’s confrontation with death (here and here), the NY Times’ Lawrence K. Altman reminds us in this article that — despite the dysfunctional U.S. health care finance system — medical advances are continuing at an increasing rate:

As a reporter for The New York Times for 37 years, I have witnessed many important medical events, from new treatments to new diseases. In reflecting on that panorama, it is clear that technology has accounted for the greatest changes in medicine. Technology has improved laboratory testing; allowed for the development of CT scans, magnetic resonance imaging exams and positron emission tomography, or PET, imaging to improve diagnostic accuracy; and produced new drugs and devices. Basic science, too, has deepened our understanding of disease, and much of that work depends on technology.
At the same time, the care for many ailments has been greatly improved by ancillary developments like better nursing care, newer antibiotics, transfusions of platelets to prevent bleeding, the insertion of monitoring tubes in major veins, and better organization of some services. [. . .]
Few people appreciate that medicine has advanced more since World War II than in all of earlier history. Newer drugs and devices and better understanding of disease mechanisms have vastly improved the care of patients. For male babies born in this country in 1960, the life expectancy was 66.6 years; for female babies, it was 73.1 years. In 2004, the figures, respectively, were 75.2 and 80.4. Medical advances account for much, though not all, of the gain.

Altman’s point regarding the importance of medical advances reminds me of a similar one that Donald J. DiPette, the chairman of the Texas A&M Internal Medicine Department, made while giving the Walter M. Kirkendall Lecture at the University of Texas Health Science Center this past spring. Given the advances in treatment of hypertension over the past 60 years, Dr. DiPette noted that President Franklin D. Roosevelt would have never been allowed to participate in the Yalta Conference at the end of World War II had his doctors known then what doctors knew a decade later about the traumatic implications of acute hypertension. In short, a better understanding of hypertension at the time of Yalta almost certainly would have changed the course of human history.

Following on a trend noted in previous posts here and here, this NY Times article (see also here) reports that findings from a major new study suggest that noninvasive treatment with beta-blockers and other heart drugs turns out to be at least as good as angioplasty for patients whose arteries remain blocked at least three days after a heart attack. The findings — which were presented earlier this week at the annual scientific meeting of the American Heart Association and published simultaneously online by the New England Journal of Medicine — supplement an increasing body of research that is indicating that heart-attack patients whose disease is stable and whose symptoms are under control should be wary of taking the risk of invasive treatment, which can result in infection and bleeding.
Over the past 20 years or so, treatment of heart attacks has been transformed by the ability of doctors to break up blood clots that cause the heart attacks with clot-busting drugs and angioplasty procedures. By quickly restoring blood flow to the heart muscle following an attack, doctors have been able to save lives and minimize damage that can lead to total heart failure. However, a nagging problem has been that about a third of the million or so Amerians who suffer a heart attack each year do not arrive at a hospital within the 12-hour window after the attack during which the patients are most likely to benefit from these techniques. In those patients who stabilize on their own after an attack and then are not diagnosed with blocked arteries until days after the attack, the conventional wisdom has been to go ahead and perform the angioplasty, anyway.

Continue reading →

All the rage these days in longevity circles is calorie restriction, so this Julian Dibbell/New Yorker article reports on Dibbell’s two-month test on the the ultra-extreme Calorie Restriction Diet — an 1,800 calorie daily diet:

Iíve been starving for the past two months, actually, and thatís precisely what the party is about: My dinner guestsófive successful urban professionals who for years have subsisted on a caloric intake the average sub-Saharan African would find austereóhave been at it much, much longer, and Iíve invited them here to show me how itís done. They are master practitioners of Calorie Restriction, a diet whose central, radical premise is that the less you eat, the longer youíll live. Having taken this diet for a nine-week test drive, Iím hoping now for an up-close glimpse of what it means to go all the way. I want to find out what it looks, feels, and tastes like to commit to the ultimate in dietary trade-offs: a lifetime lived as close to the brink of starvation as your body can stand, in exchange for the promise of a life span longer than any human has ever known.
Seat belts, vaccines, clean tap water, and other modern miracles have dramatically boosted average life expectancies, to be sureóreducing annually the percentage of people who die before reaching the maximum life spanóbut CR alone demonstrably raises the maximum itself. In lab studies going back to the thirties, mice on severely limited diets have consistently lived as much as 50 percent longer than the oldest of their well-fed peersóthe rodent equivalent of a human life stretched past the age of 160. And it isnít just a mouse thing: Yeast cells, spiders, vinegar worms, rhesus monkeysóby now a veritable menagerie of species has been shown to benefit from CRís life-extending effects.

The WSJ chimes in with this article ($), which focuses on a group of scientists who are attempting to mimic calorie restriction’s antiaging effects with medicines. At the same time, this NY Times article reports on a Wisconsin-based research project that indicates that rhesus monkeys on a calorie restricted diet are much healthier than their counterparts that are eating a normal diet. Meanwhile, this NY Times article reports on a researcher’s work that indicates that the 65% or so of Americans who are overweight or obese got that way, in part, because they didnít realize how much they were eating.
After all this, please excuse me while I go get a gelato. ;^)