Physician and wife face future -- with advance directives in hand
Regarding "Bringing light to dying" (Article, Sept. 11): I look forward to watching "On Our Own Terms: Moyers on Dying," which you reported on. Now that my wife and I are in our 70s, we have both written advance directives with the advice of our attorney and family doctor. We have watched too many friends and patients die over the years with excessive interventions that made the final months living hell.
Although there is evidence that some chemotherapy works, there is a lot of evidence that other chemotherapy and surgery, while statistically lengthening life, do so at great emotional cost to patients and their families. Even for those with chronic diseases other than cancer, such as chronic liver, lung and renal diseases, physicians should discuss future outlook with greater reality than is often done today.
There needs to be more choices for terminal events than currently given. My wife and I have given clear directions to keep us out of nursing homes, although a hospice might be used, and at an appropriate time to provide pain control if necessary, but not to lengthen a deteriorating capability when there is no good evidence of benefit from therapy.
I realize that our choices may not be those others might make, based on personal philosophy and religion, but all of us should be given better data about options when we start approaching a terminal event. I am concerned that so-called "ethical" advice may prevent us from receiving care that we believe is appropriate.
--Christopher M. Buttery, MD
Urbana, Va.
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No sleep lost over a schmoozing, lobbying pharmaceutical industry
I was annoyed with the article by Scott Gottlieb, MD, "Bashing drug industry hazardous to our future health" (Street Smarts, Aug. 14).
Although I agree that the cost of developing new drugs is staggering, Dr. Gottlieb fails to mention the great deal of money spent by drug companies schmoozing doctors, lobbying for political favors and exploiting the newly created frontier of television advertising. These costs to maximize profits are passed along to the patient.
Even more infuriating was Dr. Gottlieb's inexcusable quip that today's seniors would benefit from legislation to lower drug prices by getting "a break on their Viagra next year." As someone who cares for a low-income patient population, I found this remark especially insulting. Often my patients need to make the difficult choice between buying medications such as insulin and antihypertensive drugs, or paying their rent.
Since Dr. Gottlieb is himself a product of Wall Street and has just begun his medical training, I can forgive him for his insensitive attitude. I hope he can forgive me for not losing any sleep over the "failing" pharmaceutical industry.
--Richard P. Graham, MD
Toppenish, Wash.
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Don't scapegoat drug companies
The comments and insights provided by Dr. Gottlieb (Street Smarts, Aug. 14) represented one of the lone voices of reason that I have heard on this topic.
At a recent session discussing this issue at the National Conference of State Legislatures, the room was overflowing and the atmosphere was electric. This is the type of emotionally charged issue that can easily be lost in political rhetoric, and as Dr. Gottlieb pointed out, can lead to shortsighted actions. The battle cry "We have to do something!" was heard very frequently that day. One must ask, what else is at stake in this effort? Is it legitimate at any level?
It is clear that state legislators are being faced with increasing costs in providing medication benefits to their Medicaid population. This pressure cannot be underestimated as a fiscal emergency from their viewpoint. It is one additional reason that there is such a strong movement to regulate this industry.
On a superficial level, this again illustrates another opportunity to place blame on one sector of the health care system for accelerating cost. As physicians, we can easily recognize this position as a target.
As in all things, this is not quite so simple as greedy drug companies ripping off citizens and is indicative of much bigger problems with coverage of pharmaceuticals in general. It is more important than ever that we push this discussion to a higher level.
When will all the players in the health care industry realize that this issue is bigger than all our own turf issues? We as physicians must stand up and say that health care is indeed expensive and challenge our patients and our society to undertake a dialogue on the true value of "health."
If this is not on the political agenda, we can be assured that no one will have access to acute health care services when they are sick, to the current explosion in new pharmaceutical products or to future innovations. If these decisions continue to be controlled by the political process, we will all suffer with the solutions.
We must advise elected leaders and regulators to act in a well-thought-out manner. We must remind them of the statement, "Be careful what you ask for, because you just might get it." The far-reaching effects of such action on our economy, our investments, our practices and our health as a society may be devastating.
--Susan M. Nedza, MD
Hinsdale, Ill.
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