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10 Controversial Medical Questions Answered by Dr. Dalrymple

Where do you stand on these challenging ethical and scientific debates?

by
Theodore Dalrymple

Bio

March 15, 2014 - 8:00 am
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From November 2012:

5. As life expectancy increases will the elderly become too much of a burden on society?

Eighty really is the new 70…

At dinner the other night, a cardiologist spoke of the economic burden on modern society of the elderly. This, he said, could only increase as life expectancy improved.

I was not sure that he was right, and not merely because I am now fast approaching old age and do not like to consider myself (yet) a burden on or to society. A very large percentage of a person’s lifetime medical costs arise in the last six years of his life; and, after all, a person only dies once. Besides, and more importantly, it is clear that active old age is much more common than it once was. Eighty really is the new seventy, seventy the new sixty, and so forth. It is far from clear that the number of years of disabled or dependent life are increasing just because life expectancy is increasing.

There used to be a similar pessimism about cardiopulmonary resuscitation. What was the point of trying to restart the heart of someone whose heart had stopped if a) the chances of success were not very great, b) they were likely soon to have another cardiac arrest and so their long-term survival rate was low and c) even when restarted, the person whose heart it was would live burdened with neurological deficits caused by a period of hypoxia (low oxygen)?

A paper in the New England Journal of Medicine examines the question of whether rates of survival of cardiopulmonary resuscitation have improved over the last years and, if so, whether the patients who are resuscitated have a better neurological outcome.

The authors entered 84,625 episodes of cardiac arrest (either complete asystole or ventricular tachycardia) among in-patients in 374 hospitals in their study, which covered the years 2000 to 2009. They found that, between those two years, the rate of survival to discharge from the hospital for patients who had been resuscitated increased from 13.7 to 22.3 percent. This improvement was very unlikely to have been by chance alone. Moreover, the percentage of those who left the hospital with clinically significant neurological impairment as a result of their cardiac arrest decreased from 32.9 percent in 2000 to 28.1 percent in 2009. Extrapolating to figures in the United States as a whole, where there are about 200,000 cardiac arrests per year among hospital in-patients, the authors estimate that 17,200 extra patients survived to discharge in 2009 compared to 2000, and 13,000 extra with no significant neurological disability – if, that is, the 384 hospitals were representative of U.S. hospitals as a whole, which they may not have been.

Of course, it is usually possible to extract pessimistic data from the most optimistic data. The study could have emphasized that, thanks to improvement in cardiopulmonary resuscitation, 4,200 extra patients with significant neurological disability were being discharged from hospitals annually, a burden, as the dinner guest would have put it, on society.

In addition, only 22.3 percent of patients given CPR survived to discharge while 54.1 percent responded initially to it. This means that in 2009, 31.8 percent of patients resuscitated died in the hospital after initial success; in 2000, the figure had been only 29.0 percent. Presumably patients who responded initially to resuscitation but subsequently died used up a lot of expensive resources in the meantime.

The authors are cautiously optimistic. They admit that the improvement might have been due to something other than better technique of CPR: a change in the nature of the patients having it, for example. Nevertheless, these results are more encouraging than those of a previous study, which showed no improvement in survival of CPR patients in the Medicare system between 1992 and 2005.

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All Comments   (9)
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More than half of these questions would simply go away if everyone (or their family or close friends as needed) paid for their own health care. For the remainder - perhaps excerpting parental responsibility for an obese child - it is sufficient for everyone to have their own opinion and act accordingly.
27 weeks ago
27 weeks ago Link To Comment
There's so much PC BS on most topics that it's startling to hear or read TS, "true speak." Thanks, Doc.
27 weeks ago
27 weeks ago Link To Comment
RE: Obesity & RE:Healthy Diet. I know 17 people with Hypo-Throidism, & most continue to gain weight eating healthy low cal diets with lots of aerobic exercise. I doubt most overweight people have this, but some do have a medical reason for obesity, likely a small minority. Those who simply choose a poor diet likely fall into one of these categories...1) I will eat what I want (needs immediate & constant gratification). 2) Too uninformed (or ill informed) to make intelligent choices. 3) Too poor to buy healthy food (the price, per calorie, of junk food has dropped, while the cost of real food has skyrocketed). If most people would eliminate all processed foods made with white flour & white sugar, & replace that with a MUCH SMALLER amount of whole grains than the food pyramid recommends & eat mostly lean sources of protein + lots of organic produce, they would naturally loose weight. For weight loss to be permanent, you have to make permanent changes!! "Let thy food be medicine & let thy medicine be food"...Hippocrates
27 weeks ago
27 weeks ago Link To Comment
Here in NV our absurd Medical Marijuana laws require a patient to break the law BEFORE they can comply with it. First, you have to break the law & illegally obtain the seeds. Then you apply for a Medical Marijuana card ($50.00), then pay another $50.00 for an "Illegal Contraband Tax Stamp", (no I'm NOT making that up). Then you have to "grow your own". Once "your crop comes in"...you FINALLY have your medicine. As a patient who laid in bed CRYING AND SCREAMING IN AGONIZING PAIN FOR MONTHS ON END, because pain pills don't work on me, NOT opiates & NOT NSAIDS, I can tell you that "witch hunt" leveled against Medical Marijuana is merely "cover" to TORTURE cancer patients like me. I choose not to break the law, because there's no telling when/who the Fed. Gov't. will turn on next & my Hubby is a legal immigrant, here on a Green Card from Canada...so I SUFFERED!! The freely available (by RX) dangerous, highly addictive, toxic narcotics & their horrific side-effects they "experimented on me with" are what we should be worried about...NOT a plant that grows out of the ground!!
27 weeks ago
27 weeks ago Link To Comment
With the understanding that people should be free to obtain help for obesity, addiction, and all health issues at any age, but cannot demand that others pay for this treatment (Charity given by others is ok and encouraged), my take is as follows. Let the debate begin.

1. Obesity is neither a disease nor a moral failing
2. Alcoholics should not be denied available medical care
3. Psychiatric illnesses merit treatment as much as physical illnesses
4. Doctors sometimes are guilty of giving pain killers to addicts who con them
5. Elderly should not be denied available medical care
6. Marijuana can be a medicine, with side effects
7. Nutrition is important to health
8. Drug addiction is not like non-addiction illnesses but addicts should be treated
9. Obese children are not victims of child abuse
10. Parents should vaccinate their children
27 weeks ago
27 weeks ago Link To Comment
Interesting that the author chose only one vaccine to discuss pros and cons.
27 weeks ago
27 weeks ago Link To Comment
He must be in on the CONSPIRACY!!!!!!!
27 weeks ago
27 weeks ago Link To Comment
A government funded psychiatrist on an NHS pension in on 'the conspiracy'? No. Not possible.
27 weeks ago
27 weeks ago Link To Comment
Thank you, Doctor, for this thoughtful and objective article. These are two qualities that in tandem are virtuous but rarely encountered today.
27 weeks ago
27 weeks ago Link To Comment
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