Brave Man to question a near sacred-cow, the Breast Cancer patient. I applaud his concern that the big picture is what is paramount - the maximum quality of life for the most people who suffer. Just, humane care for those who suffer must not be tainted by Politics or go disproportionally to those who are the best marketers or storytellers, however emotionally compelling.

As propriety and policy intrude in every part of our lives, my feeling about this one is go ahead and do whatever you want.

Because—

• You can't fuck it up too badly, I promise: Death will find you.

• It'll find the rest of us too. And in our own last times, we'll probably have a proportionate appreciation for the skill by which it captured you.... And we may not, in that retrospection, be too impressed with your resistance.

And when we judge those two against each other, what we see is... Whatever. There's not a whole lot that's new under the sun at the end of life, but who cares? These men were journalists, but there's more to life than sharing.

(Perhaps some exception can be made for descriptions of disease; and I generally admire those who can remind us that, as Hitch said long before he fell ill, "This ends badly"… Stoicism is rarely seen in these years. But there's certainly no obligation for merely sick people to share their suffering. For the moment, I plan to hold my tongue.)

One of the great things about the internet is that this tremendously enriching new medium came to life within —and by the hand of— the United States of America. As recently noted, we're the country with the First Amendment. I haven't been looking for similar legal principles regarding free expression from elsewhere in the world, but none come readily to mind... The Botswanna Articulation Act or what-have-you.

The internet isn't about transmitter towers or editors or publishing inertia. If you've got something really great to say, it can carry your words as far as those from anyone on the planet.

It's wonderfully granular.

So's death; everyone gets precisely one.

You wanna chat like Oprah, go nuts. You wanna sit quietly, have at it. Thanks for showing up, either way.

Shux, I bungled the link. 1st Amendment comments here.

Metastatic cancer is a really selfish disease. No matter how you justify the battle, when it reoccurs, you dont have the time or energy for much else but keeping yourself alive.

My Cousin's wife went through a similar prognosis. The initial treatment bought her three good years. Once the cancer reoccured, the last three years were spent mostly in bed, and she slept away the rest of her life.

Staying alive for the kids can be a good motivator, if you are capeable of actually parenting, and participating in their lives, but if you are spending most of your time, at the hospital, sleeping, or tweeting, I doubt if you have much time or energy to be a parent.
This isn't a disease that you can cheer lead your way out of.

I am going to recommend "The Emperor of all Maladies" again.

My mother survived stage IIIb stomach cancer four years ago, and this book gave me the information I needed to make a good decision on how much treatment to allow.
In her case, surgery only, was the decision, as chemo has not even made a dent in the survival rate of stomach cancer.
I also got a lot of support and help from a doctor who posted on this web site.

So, thank you, Amy. You indirectly, saved my mothers life.

Apparently, Keller's wife just wrote a similar article for the Guardian. I wonder what bug got up their butts?

Apparently, Keller's wife just wrote a similar article for the Guardian. I wonder what bug got up their butts?

Posted by: Astra at January 13, 2014 6:36 AM

I think there is a bug up a lot of our butts, when we see people spending a million dollars of OPM on medical care, that many times yields a worse outcome than doing nothing.

Somebody needs to say it, and I am glad they did.

You will find that most doctors opt out of aggressive treatments of secondary malignancies for themselves for a reason. They have no interest in getting caught up a system, that will torture you to death, if you let it. Seeing it first hand from the other side gives them perspective on their own mortality.

So after years and years of promoting and celebrating the cancer walks and races for the cure, talk of survivor-this and hero-that, and the pink everything - including the friggin penalty flags in NFL games... now we're being told by the New York Times that we should make peace with the palliative care model.

It's almost as if a great hero of liberalism rammed through a law that isn't working out so well and might cause people to no longer get the medical care they otherwise would have expected and so the liberal voices in the media are lowering those expectations with a "it's okay if you all just die quietly" message.

But that could just be the conspiracy theorist in me.

Adams husband is at Morgan Stanley--I doubt taxpayer dollars are involved in her care. Personally, I don't care if she tweets or writes until her last breath, but there is a cultural meme that the sick can do no wrong. The late Cathy Seipp was brave to say that cancer hadn't made her a better person. Even her last month, she could be a jerk--and frankly that's what made her love able--she wasd't perfect and wasn't pretending to be. I miss her all the time.

Oops--I may be wrong. Adams is a research patient at Sloane Ketterling, somaybe tax dollars are somehow involved. The hospital also seems to be using her as their own social media cancer patient which seems sort of creepy. Keller doesn't seem to understand that Adams is pretty young--younger than his FIL in the UK. So what if she gets visits from dogs? How does that impact other patients in other parts of the world?

I don't care if she blogs, tweets, sculpts, writes poems, creates songs, or just sits on her ass while she deals with this, and I'm not sure why Mr. and Mrs. Keller do.

But they sure do.

The Guardian has pulled its story offline:

"Forget funeral selfies. What are the ethics of tweeting a terminal illness?"

--

"This post has been deleted with the agreement of the subject because it is inconsistent with the Guardian editorial code."

☑ Kevin at January 13, 2014 8:29 AM

+

Tweet.

Ah, that retraction is suh-weeeeeeeet.

Judging by the response to the 2nd comment, I'm (apparently) not dialed into the popular emotional response to this story any more than are the Guardian or the New York Times. But on the other hand, I'm not an editor for an international media colossus, either... Nobody cares if I'm an asshole.

Stories like this demonstrate that our media chokepoints are timidly pinched by witless, unprincipled doofusses. (Proper Latin: Dufi.)

This is the reason the L.A. Times is so robotic in its adherence to the lefty public line... Those boys are scared shitless that a waft of wind might one day lift their skirts to expose their naked cluelessness.

They don't know right from wrong. So they seek safety in numbers... They pander.

There will be many articles in the Progressive press about peacefully passing into death without expensive care. This is preparation for the screw up of ObamaCare, which makes all medical care more complicated, bureaucratic, and expensive. They don't want to give up on the mystical and religious value of socialized, "universal" health care. So, we will need to think differently about death and embrace it with less cost to the society.

Keller's article is in essence "why struggle so much, with so much expense (to the government)". Of course, this is only for the ObamaCare plans. Keller, politicians, and the unions will always have non-ObamaCare plans which fund the struggle to the last.

The Feds and the progressive states are building the progressive future. They will reduce health care costs, not by giving more care for the money, but by just paying less and delivering less.

online.wsj dot com/news/articles/SB10001424052702303393804579313021577450630
Maryland Caps Hospital Spending
=== ===
[edited] Maryland will cap spending on hospital care. Costs will rise no faster than economic growth [taxes -ag], an unusual experiment in government-imposed controls.

Eventually, residents with more expensive, complicated cases may be sent to hospitals in nearby states because Maryland hospitals will fill beds with less sick people who cost less to treat.
=== ===

This is Cuban style health care for the masses, available to all, and cheap. Remember that Cuba has a lower rate of infant mortality than the US! The open, free, and democratic Cuban government says so.
http://easyopinions.blogspot.com/2009/08/cuban-health-and-economic-news.html#leaks

opinionator.blogs.nytimes dot com/2014/01/04/can-upward-mobility-cost-you-your-health/ 01/04/14 Opinion at the NYTimes - Upward mobility can cost you your health

This is another preparation for the progressive life of the future. Back when there was freedom and opportunity, lack of upward mobility (achieving more income than your parents) was a failure of capitalism. Now that progressive policies are causing unemployment and reduced economic growth, we find (supposedly) that achievement reduces physical and mental health.

It isn't worth it. Take your government job or collect wellfare if you want to be healthy and happy. Achievement is a capitalist trick!

EasyOpinions.blogspot dot com

Medicine through a combination of huge government social programs, (medicaid, medicare, and Tricare), and of course state regulations governing what insurance "must pay for" has been socialized for years.

The only diference was the doctors and hospitals unloaded the losses from the socialized programs on to both those with good insurance, and the IRS in the form of tax deductions for paper losses.

Obamacare, just spreads the misery to small businesses and the self employed.

It made everything worse, certainly, but is far less transformational than people on both sides of the aisle believe.

The doctors and hospitals bear a large share of the blame for this debaucle. They have been pedeling the fantasy that they have a high sucess rate beating disease through a combinationtion of miracle drugs, and surgery, if you only throw enough money at them through both treatment, and early testing.

I agree that medical care in places like Britain is appaling, and they have lower "survival rates" but those numbers have been cooked also. Many studies seem to indicate that the higher five year survival rate for cancer in the US is almost totally due to early detection, and not to superior treatment. For those of you that understand statistics, that means if you die five years and one day after a cancer diagnosis, they get to pretend that you " survived" , no mater how wretched the last couple of years were for you.

Your doctor is not Jesus Christ. He is a businessman, adept at selling you a Mercedes Benz, in the name of safety, especially if he thinks you, or a third party is good for it.

He also operates under the threat of being sued if he doesnt try everything insurance will pay for, regardless of how ineffective it might be in your particular case.

Your doctor is not Jesus Christ. He is a businessman, adept at selling you a Mercedes Benz, in the name of safety, especially if he thinks you, or a third party is good for it. -- Isab at January 13, 2014 6:19 PM

Does anyone remember Laetrile from the 80's.

Quackery has been going on for years since the snake oil in the the 1800's.

The site also has a bunch of other good articles. Maybe it would be a good guy for Amy to interview some Sunday night.

The Nation piece had a link to the Guardian piece via Wayback.

…Which is weird, because I thought newspapers didn't allow such caching.

The Kellers casual energy for their belief about this is strange.

You know, in a sane world, I would pay more to take my kids to the pediatrician, and no one would be wailing about having insurance cover IVF, but cancer patients wouldn't worry about getting treatments covered. Do I think a lot of money is being spent on this woman? Yes. But you know what? Most research that leads to breakthroughs is pretty damn expensive on the front end, and relies on having people participate who fear for their lives.

And yes, I also think a disproportionate amount of attention is paid to breast cancer, and I actively avoid buying products that flaunt a pink ribbon. But I also think it's likely that any research involving this woman has the potential to help with other, less visible types of cancer.

And one more thing…if Bill Keller's father-in-law had decided that, actually, he didn't want to go gentle into that good night, would he have had the option to do otherwise? I have a really hard time believing that the NHS would pay significantly for anything but palliative care for someone in his situation. There is private care available in England, but maybe he just didn't want to bankrupt his family after a life that could not by any means be said to have been cut tragically short.

And yes, I also think a disproportionate amount of attention is paid to breast cancer, and I actively avoid buying products that flaunt a pink ribbon. But I also think it's likely that any research involving this woman has the potential to help with other, less visible types of cancer. -- marion at January 13, 2014 8:12 PM

At my last job I was talking to an accountant during the Yoplait "Save the pink lids" campaign because I saw them on her desk. It took 15 minutes to get it through to her that she could buy the store's brand at 79¢ per container and send the Susan G. Komen® 30¢ per container compared to paying $1.27 per container and donating the 10¢ and matching 10¢ from Yoplait and still save money. I don't think she ever really got it.

Or am I not making any sense?

> Most research that leads to breakthroughs
> is pretty damn expensive on the front end,
> and relies on having people participate who
> fear for their lives.

Exactly. We missed you while you were away, Marion.

Fear for their lives, or for their careers, or for the well-being of those they love.

There are breakthroughs that never get old; if your 9-year-old wears a cast for two months instead of losing the use of an arm for a lifetime, you'll always think of the removal of the cast as a freaking breakthrough. And if you live in the poorer part of town and have less faith in the orthopedist who sets the break, you might break the piggy bank for one who looks like less of a drinker.

What I mean is: Medicine costs so much because it means so much to us.

Civilization had well-internalized this unpleasant truth when the idiot Obama and his zombie associates arrived on our planet.

Marion, please...

…Please read this:

These are the people who love Freakonomics, who enjoy all sorts of mental puzzles, who like to see an idea turned on its head, but who couldn't fix a toaster.

The ObamaCare website is the natural spawn of that technocracy who love the idea of using modernity to make things faster and easier, but have no idea what anything costs or how it works.

[…T]his is a Bloombergian technocracy of billionaires and activists, of people who think that "progress" makes things work, rather than things working leading to progress.

The idea that “failure is not an option” is a fantasy version of how non-engineers should motivate engineers. That sentiment was invented by a screenwriter, riffing on an after-the-fact observation about Apollo 13; no one said it at the time. (If you ever say it, wash your mouth out with soap. If anyone ever says it to you, run.) Even NASA’s vaunted moonshot, so often referred to as the best of government innovation, tested with dozens of unmanned missions first, several of which failed outright.

Failure is always an option. Engineers work as hard as they do because they understand the risk of failure. And for anything it might have meant in its screenplay version, here that sentiment means the opposite; the unnamed executives were saying “Addressing the possibility of failure is not an option.”

Your comment catches the eye because many don't recognize that civilization leverages distasteful truths to make things better: When they see that needful desperation is used to propel scientific progress, they assume that no one theretofore had noticed that needful desperation is unpleasant.

Yes; they are that arrogant. They think the rest of us never noticed that poor people need care, too.

Plus, if "needful desperation" is redundant, I expect to be forgiven, just as I would if it were also repetitive.