Medicine and What Matters in the End

One of the great advantages of living in a university town is access to free lectures and discussions on campus.  On any given night, you can find an event going on at Stanford that will stimulate a new way of thinking about something.

Last night, we went over to the medical school to hear Atul Gawande talk about his book Being Mortal:  Medicine and What Matters in the End.  Gawande, a surgeon, researcher and writer for The New Yorker, has emerged as one of the country’s most articulate voices for a more humane and responsive system of health care and end-of-life care for an aging population.
 

His lecture, like his book, explains today’s “medicalization” of dying and of caring for the aging.  Our elder care facilities emphasize health and safety at the expense of personal autonomy and pleasure.  And, although people generally would prefer to die at home surrounded by family, most of us leave this world connected to hospital equipment at the end of a string of procedures that make us feel worse rather than better.

After his talk, Gawande was joined by an outstanding panel of experts, including the CEO of Kaiser Permanente, Berkshire Hathaway Vice-Chair Charlie Munger and Stanford doctors and researchers expert in health care, aging and dying.  Speaking to an overflow audience that included many from the medical school, the panel acknowledged that pressure from children and malpractice lawyers, coupled with the doctors’ own instinct to “fix,” not to mention financial incentives, all contributed to too much treatment too late in life.

 

There was also general agreement that we have too few general practitioners and too many specialists, thus encouraging more surgery, more chemotherapy and more specialized treatments.  But, until somebody figures out a way to give general practitioners competitive wages, young doctors who have to pay off mountains of debt from their years of training are necessarily going to choose the highly compensated specialties.

One thing is clear.  All of us should give serious thought to end of life decisions and, no matter how much the kids resist, talk to them now about your personal preferences.

Committee for Dish Access

Please join those of us from the Peninsula who want to continue to have access to Stanford’s Dish hiking trail.  As you may know (http://www.paloaltoonline.com/news/show_story.php?id=30977), Stanford is planning to eliminate over half the parking spots on Stanford Avenue and substitute parking on Coyote Hill Road, south of Page Mill and a good half mile from the Dish gate.

Two community meetings have been held on this subject, but few Dish walkers have shown up.  The audience consisted largely of Stanford neighbors who are tired of so much traffic on Stanford Avenue and on their streets.

Stanford Community Relations will take additional comments on this subject before it goes to County of Santa Clara for approval at communityrelations@Stanford.edu.  Please let them know that you care about access to the Dish and appreciate the health benefits of Stanford’s beneficence, but that Coyote Hill Road is too far from the gate and too cumbersome to cross busy Page Mill and walk so far along Junipero Serra before hitting the first hill.  You can ask Stanford Community Relations to be put on their mailing list for information about Dish parking.

Also we have formed a Committee for Dish Access and hope you will consent to joining our email list by sending an email to CommitteeforDishAccess@gmail.com.  This will not result in your name or email address being sent to anyone else without your consent.  It just enables us to keep you informed and to organize the community if future opportunities come up for your input.

If people who hike the Dish don’t speak up, we could find ourselves without access to this wonderful space.

PLEASE FORWARD THIS LINK TO FRIENDS WHO MAY BE INTERESTED IN DISH ACCESS.

Lance Armstrong and Doping

Coming on the heels of several Major League Baseball suspensions, Lance Armstrong’s tacit admission to use of performance enhancing drugs during his spectacular cycling career has led to a massive media condemnation of cheaters.

Use of terms like “cheaters” and “cheating” appears to be favored by the U.S. Anti-Doping Agency, which probably hired the same marketing experts who train our political candidates—experts in the use of inflammatory words to frame issues in a certain light in the public consciousness.

It’s hard to argue against the effort by professional sports organizations to do what they can to eliminate use of these steroids and hormones, which have serious health implications for the athletes later in life.  But the bitterness and acrimony towards these “cheaters” who are trying to get ahead at risk of their health strikes me as over the top.

In baseball, many of the players who have tested positive are young men from extremely poor families in Latin America who are risking everything for a chance to make enough money to help their families achieve some security.  And, it’s not as if these athletes haven’t continued to work hard to improve their natural talent.

The idea of a level playing field is a fantasy.  Most exceptional athletes had the good luck to be born with physical capabilities that permit them to excel at sports, probably including naturally high levels of testosterone.  We don’t penalize basketball players, after all, for their unfair advantage of being born tall.  Or the son of a professional athlete whose dad can afford to buy a batting cage for the backyard when the boy turns six.

What if we decided to level the playing field for college admission by prohibiting wealthy families from sending their kids to SAT prep classes or hiring consultants to work with them on their essays?

I’m not arguing against better and more frequent drug testing.  But I just don’t go along with subjecting these guys to public humiliation and shame for their bad judgment.

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One Possible Answer to "What's Ailing Google Chief?"

There are a number of possible causes of Larry Page’s hoarse, strained voice, some of them (like polyps or a paralyzed vocal cord) are physiological and some (like muscle tension dysphonia) can be caused by overuse or misuse of the voice.  Spasmodic dysphonia, an involuntary spasming of the vocal cords, causing speech to become effortful, strained or broken, is a neurological disorder of unknown cause that affects speech in mid-life.  See my Idea Box on "Living with a Broken Voice."