Stupid Reasons People Die
I want to recommend a book by John Corso, M.D., full title, Stupid Reasons People Die, An Ingenious Plot For Defusing Deadly Diseases.
Throughout the book, Corso cuts through common assumptions about health care and at the end, has a chapter on exactly what tests he thinks people need, and when and why, to avoid dying stupidly (i.e. when death could have been prevented but for a simple test).
Now, I'm not for hypochondria-based medicine (my recent experience with anesthesia has convinced me the way to stay healthy is to do whatever you can to avoid ever needing medical intervention) but Corso seems to take the prudent but necessary side of preventive care.
I haven't read the entire book, just read a bunch of it and skimmed a bunch more, but I did find one area where he fell down, which is in advising women to "know thy own breasts" -- in other words, through self-examination. Now, mine happen to be on the larger side, and I sometimes joke with the mammographer that there could be a bomb implanted in there and I wouldn't find it through self-examination. But, I think even women with smaller breasts feel a lot of lumps all the time or don't know what they really feel and don't have a good grasp on what's dangerous and what's not. A book I recently got in the mail that echoes that notion is Dr. Nieca Goldberg's Complete Guide to Women's Health. Goldberg writes:
If this book had been written ten years ago, it would say that the standard of care for examining your breasts would be a monthly self-examination. This has fallen out of favor because of a long-term recent study of women working in a Shanghai factory. Half the women were given instruction on self-examination of the breast; the other half received no instruction. After ten years, the researchers found that there was no reduction in the death rate from breast cancer in the women who performed self-examination. Therefore many concluded that self-examination is a waste of time.
I'm not a doctor, haven't read this study or any others, and maybe it's "better safe than sorry" -- but I think the real message here (and a message Corso does make as well at the end of his book) is to get regular mammograms and maybe ultrasound and/or MRI if you're a younger woman with large, dense breasts and a history of breast cancer in your family. Ashkenazi Jews with a history of breast cancer in the family might want to see if they can get the BRCA test.
"Now, mine happen to be on the larger side, and I sometimes joke with the mammographer that there could be a bomb implanted in there and I wouldn't find it through self-examination."
How fortunate, then, that you may enlist enthusiastic help for this arduous task!
"I'm from the TSA. This additional search will only take a few minutes. (Time passes.) OK. That's, umm, two... just a moment while we check for any others you may have hidden about your person... (More time passes) I'm sorry, Ms. Alkon, you don't have a permit, we cannot allow those on the plane unless we can be sure the search is complete."
/juvenile fun
Radwaste at January 20, 2008 5:03 AM
Heh heh...cheeky lad.
And actually, in The Netherlands and France, the screeners do feel you up. They have women do it.
Amy Alkon at January 20, 2008 6:07 AM
See also.
Crid at January 20, 2008 8:53 AM
Is the unself-examined life is not worth self-living. Or was that the unselfish life? The life of a shellfish?
Wait, were we talking about breasts or what? It would seem that I'm easily distracted.
BlogDog at January 20, 2008 3:59 PM
Amy, let me second you very loudly on encouraging women with a breast cancer family history on EITHER side of the family to try to get the BRCA1 and 2 tests! For many years GYNs pooh-poohed my concerns because the family history was on my father's side. EVERY female descendent of my paternal grandmother and her sister has had breast cancer. The ones who died, like my grandmother and aunt, died before the age of fifty. Those who didn't, my generation, have had recourences, resulting in two mastectomies. I tried for 10 years to get the BRCA tests, but insurance wouldn't cover it. I was fortunate that when I did find a lump (self-exam) it was very early stage. Once that lump was shown to be malignant, THEN insurance was more than happy to pony up the $3,500.00 for the testing. No surprise to me, I was BRCA1 positive, did the bi-lateral mastectomy and reconstruction in one surgery. Had the hysterectomy later (BRCA1 has major ovarian CA risk), and I am doing great! I was fortunate, as I had an AWESOME support system, and far more knowledge of the subject than did the "genetic counselor" with whom I had to deal. Ladies, do whatever it takes, and partners, let your ladies know you love them, and encourage them to take care of themselves.
adoringfan at January 20, 2008 6:41 PM
Thanks so much for posting that, and you have an amazing attitude.
I really have to emphasize, too, do not let your doctors be the last word in your health care. If you are not that able to research or reason, that's one thing - then get a second opinion, and maybe a third. But, otherwise, do your own homework and don't be afraid to ask lots of questions.
In my own recent experience with what they thought was some gastrointestinal problem, doctors were quick to offer me a prescription (drugs have side-effects, remember?)...and even before I was diagnosed. Just as a guess! Also, one of these doctors went straight for the most interventive test, when a less interventive test might've made it unnecessary. It was only by researching the issue fully and taking a skeptical approach to what's SUPPOSED to be prudent and evidence-based medicine that I was able to take a more prudent and actually-evidence-based approach to my care.
Amy Alkon at January 20, 2008 6:52 PM
"I really have to emphasize, too, do not let your doctors be the last word in your health care."
Amy I agree 100%. It can be intimidating to question what a doctor says. The label Dr. / patient, makes you feel like you are in an inferior position. It's easy to forget that they work for you and that you are paying for their service. Also, the big bad insurance company typically will not provide a clear answer on anything. Unfortunately, insurance co.'s are harder to replace than a doctor. People must remember that even with an HMO, you are entitled to change your primary care physician any time you want to (as long as they are a listed provider with your insurance co.) So it won't cost you any more to get a second or third opinion. Or to get a referal that you need to see a specialist, when your (current)doctor may not be taking you seriously.
Further, insurance co's are increasingly providing coverage for preventative, or health maintenance procedures that you must ask for. It will not be offered by your doctor (i.e. - appt. with a nutritionist).
dena at January 21, 2008 7:15 AM
I agree, always ask a lot of questions, do your own research, and don't let any doctor bully you into doing anything you don't want.
In Canada, where money is no object, they tend to think of patients as 'grist for the mill', just another warm body to process through whatever they think they can get away with, as long as it means they can charge the system for either their time, some medical procedure, and of course, prescription drugs (for the kickbacks).
The only way I'm going to remain healthy in the future is to stay out of doctors' offices. For the last 10 years or so, I've only gone it if I wanted her to run specific tests, or to fill my birth control prescription, and ignored the inevitable up-selling that she tried to do.
The best advice is to take very good care of your body through a healthy lifestyle, because there really are no miracle cures.
Chrissy at January 22, 2008 10:18 AM
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