Tuesday, November 05, 2013

"Money and Medicine": PBS film seems pertinent now given debate on entitlement reform, Obamacare; many patients get treatments that cripple them and that they may not "need"

Money and Medicine”, by Roger Weisberg, examines the problem of overly aggressive medical treatment of people, both in latter middle age (particularly in early breast and prostate cancers, as well as coronary artery disease) and at end of life.
   
The film compares the practices of the UCLA Medical Center with the Intermountain Medical Center in Utah.
  
The movie would appear to be timely given the public debate over “Obamacare” (the Patient Protection and Affordable Care Act of 2010) which is not directly mentioned by the film.  In fact, it may be even more timely in view of entitlement reform (especially for Medicare) that needs to be debated in Congress as part of urgent budget negotiations (right now, a deal is needed by Dec. 13, 2013).  
The early part of the film traces the end-of-life care of a few patients, and one or two want their loved ones to live as long as possible.  The family of one stroke patient is told that, were the patient to go into cardiac arrest and be rescued, he would probably never regain consciousness. The film tries to defuse the political canard of “death panels” and denies that euthanasia is ever practiced.  Of course, these issues become the other side of the abortion debate (the previous film).
  
The film then moves to the area of aggressive cancer treatment, especially the management of prostate cancer in men.  The movie maintains that of all men treated aggressively for prostate cancer, only 1 in 15 would die of the disease. The practical reality is that most men would die of something else first. However, the film presents two men who, with considerable spousal support, want aggressive treatment and don’t want to live the knowledge of an unpredictable tumor.  There is a problem of overtreatment, with the outcome of side effects (incontinence, impotence) but it is impossible to say definitively which patients really “needed “aggressive management, the newest of which is proton beam therapy.
  
The film also shows a heart stress test, with all the chest leads, and discusses some of the common tests for suspected heart disease. It leaves the impression that aggressive management, especially coronary bypass surgery, may not always be appropriate when it is practiced.
  
The film does not take up the issue of colonoscopy.   
  
My own father died of metastasized prostate cancer just before his 83rd birthday (on New Years Day 1986).  But his illness, with brain and lung tumors, was sudden and he was ill only four weeks.  At age 74, he had an aortic aneurysm resected.  My mother had triple coronary bypass surgery at age 85 in 1999, and lived to age 97, with eight years of good quality/
  
In my own case, I had an elevated PSA in 2010 (then at age 67) but it went down without treatment in 2011 and 2012.  I have always avoided aggressive testing and management, because I don’t have the social support system to deal with aggressive, disabling treatment.  Dr. Mehmet Oz says he doesn’t like to do aggressive surgery on an older patient without a spouse (and family) whom he or she loves, who will love him or her back, “in sickness and in health”.  I’ve always fount he expectation of such emotional loyalty perplexing, even disturbing.
  
  
The official site for the film is here.  It has been shown on PBS, with a production company of Public Policy Productions.
   
The film is also titled “Money & Medicine”. Pictures are mine (have many of LA, but not of UCLA specifically).  


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