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‘The Operation Was a Success, but the Patient Died’

When the cure is worse than the disease.

by
Theodore Dalrymple

Bio

September 4, 2013 - 5:00 pm
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The diagnosis was very uncertain. She had been given steroids on the supposition that the skin condition was a severe form of psoriasis. The latter is a common skin condition, and it is another old saying that common diseases occur commonly. But she continued to be ill and eventually was admitted to the Massachusetts General, as law cases are taken finally to the Supreme Court.

The patient underwent an immense number of tests of enormous sophistication, among them repeated skin and lymph node biopsies. Immunological and genetic tests were likewise performed. Eventually a diagnosis was reached: she had a cutaneous kind of lymphoma that has a bad prognosis.

The case report discusses the various possibilities for treatment, none of them guaranteed to work and all of them with serious side effects. The best option seemed to be pegylated liposomal doxorubicin, which had a cure rate between 20 and 60 percent, though it can cause serious damage to the heart. “This agent,” said the report, “was considered but could not be obtained because of a national drug shortage.” Other drug treatments could produce remissions, but short-lasting and at the potential cost of severe complications.

In the end, the patient “received alemtuzumab followed by total-skin electron-beam therapy and a reduced-intensity-regimen stem-cell transplant.” The dermatologist adds that the patient “is currently doing well, 1 year after the transplantation.”

A triumph, then, you might think! But in the next paragraph the pathologist says, “Unfortunately, she died approximately 1 year later of transplant-related coronary artery disease, with the lymphoma in complete remission.”

This rather peculiar juxtaposition of the patient doing well, in the present tense, and of having died at the same time, rather casts doubt on the way in which such case histories are constructed or redacted. The patient is cured, but the patient died. However, it is by such contradictions that medicine makes its strides.

******

images courtesy shutterstock / Johan Swanepoel / Roblan

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Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute. His new book is Second Opinion: A Doctor's Notes from the Inner City.

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Top Rated Comments   
When I hear the litany of side effects accompanying drug ads on tee vee (drug ads didn't used to even be on tee vee which was appropriate)...I often think a variation on your headline...

"The treatment worked but the patient was really messed up as a result"
45 weeks ago
45 weeks ago Link To Comment
I've come to the conclusion that death is a side effect of life.
45 weeks ago
45 weeks ago Link To Comment
Of course the final bill was handed to her surviving family: $14,345,560.67, of which $145.67 would have been covered by Obamacare.
45 weeks ago
45 weeks ago Link To Comment
All Comments   (22)
All Comments   (22)
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They made the symptoms go away, but who can say they ever really figured out what the cause was. Sometimes the operations fails but the patient lives.
45 weeks ago
45 weeks ago Link To Comment
▬▬▬▬▬▬▬▬▬▬▬~ஜ۩۞۩ஜ~▬▬▬▬▬▬▬▬▬▬▬▬­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­▬
my buddy's step-sister makes $72 an hour on the computer. She has been laid off for 8 months but last month her payment was $12918 just working on the computer for a few hours. Here's the site to read more......

------------------->http://www.Rush60.com

▬▬▬▬▬▬▬▬▬▬▬~ஜ۩۞۩ஜ~▬▬▬▬▬▬▬▬▬▬▬▬­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­▬
45 weeks ago
45 weeks ago Link To Comment
I had a painful cyst in an unmentionable place. The doctor who saw me for about two minutes said surgery was required. Skeptical I got a second opinion, that doctor suggested warm, soapy baths and don't rush it. In about three days the cyst disappeared. About two years later I sat on a empaneling process for a malpractice case. When the doctors name was mentioned it was the one who wanted to operate on me. About 1/5th of the people in the room were excused and left, as I did.
The same doctor amputated a friends leg much later, when I found out it was he I had to wonder.
45 weeks ago
45 weeks ago Link To Comment
I thought by your description, you were referring to Obama.
45 weeks ago
45 weeks ago Link To Comment
The painful cyst in an unmentionable place?
45 weeks ago
45 weeks ago Link To Comment
One of my close friends just passed away last Sunday. He had inoperable cancer. His doctors were recommending that they surgically remove his soft-palate, insert a feeding tube, and stick him in a managed-care facility. With no other benefit, no prolongation of life.

He told them to shove off, as there was not only no benefit, his remaining quality of life would have been ruined.
45 weeks ago
45 weeks ago Link To Comment
When I hear the litany of side effects accompanying drug ads on tee vee (drug ads didn't used to even be on tee vee which was appropriate)...I often think a variation on your headline...

"The treatment worked but the patient was really messed up as a result"
45 weeks ago
45 weeks ago Link To Comment
I've come to the conclusion that death is a side effect of life.
45 weeks ago
45 weeks ago Link To Comment
Yeah! Let's all sue our parents!
45 weeks ago
45 weeks ago Link To Comment
I believe our friend the Doc is doing us a great favor with his honest articles. Many Docs are so busy they are hard to see, hard to understand, hard to believe, and hard to please. But when one gets relief, it's like heaven.
45 weeks ago
45 weeks ago Link To Comment
I went to several doctors over a ten year period about some problems I had. I got all sorts of diagnoses, usually allergies. The last doctor I went to spent about two minutes looking at me, came up with some off the wall diagnosis about a low grade infection, gave me a prescription, and sent me on my way. I tried his prescription, exactly as he said to follow it. He was dead on. Sometimes doctors do get it right. Heart and blood pressure problems went away. Migraines gone. I still have a few minor problems, like sniffles, but they are just because I was sick and untreated for 10 years. My body is still trying to cope with a problem that is cured and gone now.
45 weeks ago
45 weeks ago Link To Comment
So many things that go can go wrong that are described to us in polysyllabic esoteric language but have quite banal origins.

Ulcers were finally discovered to be bacteria related. There may even be a connection between healthy flora in the gut and mood disorders/dopamine imbalances. (I read that in the Daily Mail, so I know it's true...kidding )

Inflammation is another common phenomenon at the origin of sundry dis-eases.

Anyway, eat broccoli (the wonder veg of the month) and yogurt to keep those little critters in the intestines civilized.
45 weeks ago
45 weeks ago Link To Comment
"First, do no harm....." is a precept often ignored by physicians when considering treatment.
45 weeks ago
45 weeks ago Link To Comment
Of course the final bill was handed to her surviving family: $14,345,560.67, of which $145.67 would have been covered by Obamacare.
45 weeks ago
45 weeks ago Link To Comment
Priceless!
45 weeks ago
45 weeks ago Link To Comment
A triumph, then, you might think! But in the next paragraph the pathologist says, “Unfortunately, she died approximately 1 year later of transplant-related coronary artery disease, with the lymphoma in complete remission.”

They had to destroy the village in order to save it.
45 weeks ago
45 weeks ago Link To Comment
When what she really had was a allergic reaction to something in her diet.

Well I suppose that is why they call it a practice...
46 weeks ago
46 weeks ago Link To Comment
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