Guinea Pig Medicine

by marosh

Recent articles in the press on the cost effectiveness of drugs and different medical procedures have refocused the discussion on what I am going to call guinea pig medicine. The general feeling is that none of the health care initiatives repeat NONE deal with this issue. They are too afraid of the political fallout. It was after all former Governor Lamm from Colorado who suggested that maybe the elderly have a duty to demand less health care and he was tarred and feathered. Now President Obama is telling us that maybe his grandmother shouldn’t have had a hip operation paid for by Medicare at age 85. Let the tarring begin.

In theory, yes we need to cut costs and care in the last year of life. But here is the reality: you or your child/parent/spouse displays all the signs of a life ending disease or accident, would you request that all be done to try to save that life? Remember this is your family we are talking about.

I know the issue is difficult because those who believe in doing everything haven’t really thought it through. My mother has it in writing do not intubate (DNI) and do not resuscitate (DNR). My father believes in doing everything. But he doesn’t want to feel pain. He also believes and has actually practiced putting horses and dogs to sleep when they get to a certain stage. My mother has made my sister her executor because she doesn’t believe her husband/my father will do what she wants. I believe like my mother for me and for her. The question is who will my father trust to do what he thinks he wants. I don’t think he even knows what he really wants.

Of course for those that clearly state: DNI and DNR things are much simpler. DNR is when the body stops breathing. DNI is when the body stops eating. What concerns me is that in this country the default is to do everything. If nothing else we need to change the default to DNI and DNR. Then if someone really believes to the contrary they can figure out a way to pay for it and add it to their will.

Now suppose that we are talking about a long expensive treatment process like Obama’s grandmother or as is common with cancer or Alzheimer’s, or say someone has heart problems that require lots of medical expenses over years. When do we cut expenses and say, as a society, you are too old or too sick to get additional treatment unless you pay for it yourself?

Clayton M. Christensen in his book “The Innovator’s Prescription” has identified two kinds of medicine on the one extreme precision medicine and on the other extreme intuitive medicine. I had struggled to somehow separate these two. Precision medicine is of course medicine where we as a society know what is wrong and what is needed to solve the problem for examples you need antibiotics for an ear infection. Intuitive medicine is where we as a society don’t know what is going on and a doctor is really experimenting trying to in some which way or form “intuit” what the solution is. This is what happens with various cancers and AIDS: doctors are constantly erring, re-diagnosing actually simply experimenting.

The deliverance of a treatment that does not have a known outcome is by definition an experiment. A participant in that experiment can be called a guinea pig. Understanding this, I realize that I do not believe in being a guinea pig. Effectively practicing as the above author euphemistically termed intuitive medicine is making me the patient a guinea pig. As a society we do not condone much less support Hitler’s World War II medical experiments on Jews. As a society now that we know the true nature of the US government 1932-1972 Tuskegee syphilis experiment we don’t support that either.

What is going on today is no different just not as centralized, a lot bigger and more profitable. When people finally realize that they are being charged exorbitant amounts of money for participating in medical experiments where they are effectively guinea pigs they will all of a sudden stop clamoring to receive the treatments involved. I, for one, have no desire to be a guinea pig for money or for free.