The culture in the practice of medicine today in general has been assailed by two new studies that highlighted “over diagnosis and over treatment for ailments that might never seriously impact a person’s health.” TIME reported that these are big problems worldwide.
The researches, which were published in The British Medical Journal, consider this “a public conundrum, where current screening guidelines lead to an over diagnosis and over treatment.” Some of the diseases they listed are hypertension, breast cancer, and heart diseases.
About 40 percent of adults worldwide have high blood pressure and 50 percent of those are mild, but even the mild hypertension is being treated with drugs, which is not necessary because most of these could be managed by lifestyle modification (diet and exercise), which also precludes having side-effects like erectile dysfunction in men. Unless drugs are strictly medically indicated, the less we resort to drugs, the better and the safer. This overtreatment costs about $32 billion annually in the United States alone, not to mention the expenses incurred in the diagnosis with high tech tests.
The onus is on the hospitals and physicians to safeguard against this abuse of the system and to protect the patients, whose tests and treatment should be tailored individually and strictly in accordance with medical science, where expediency and extra financial gains for the institutions and the practitioners are not the overriding considerations.
22 suicides a day
Twenty-two American veterans commit suicide each day, according to the US Department of Veterans Affairs. Starting in 2005, suicide within the military, especially in the Army, continues to increase annually, and seemed to have reached its highest level in 2012 at 164 casualties. Among those Army active-duty soldiers, 185 killed themselves in 2012, a rate of 30 in 100,000, which is 3 times more than in 2004.
In the Army National Guard, the rate was 32.4 per 1100,000 that year. Among civilians in the United States, the rate is about per 20 per 100,000. The first and most recent comprehensive study to understand suicides among soldiers during and after their deployments in the wars in Iraq and Afghanistan was done by a former Army research director and his cohort, who stated that “the high rates of depression or post-traumatic stress disorder flowing out of the combat experience can lead to suicidal behavior.”
“The illnesses can lead to a sense of burdening others and social isolation. Add to this loss of personal relationships a familiarity with firearms, and the resulting toxic stew can drive suicides among troops and veterans,” reports the study, which was published in Current Psychiatrics Reports.
The research also pointed out that “the high rates of depression or post-traumatic stress disorder and the sense of hopelessness and being a burden, plus the loss or straining of relationships that occurs during crucial life transitions, such as returning from combat, leaving the military, or growing old,” can trigger suicide.
“The illnesses can lead to a sense of burdening others and social isolation. Add to this loss of personal relationships a familiarity with firearms, and the resulting toxic stew can drive suicides among troops and veterans,” reports the study, which was published in Current Psychiatrics Reports.
The research also pointed out the “sense of hopelessness and being a burden, plus the loss or straining of relationships that occurs during crucial life transitions, such as returning from combat. leaving the military, or growing old,” can trigger suicide. The Journal of the American Medical Association posted online 3 separate studies that are ongoing, with a cost of $65 million.
Among the recent findings reveled lower suicide rates and women in the military and that about a third of those soldiers who had committed suicide had mental disorders before they joined the Army. Twenty five percent of soldiers were found to have at least one psychiatric problem and 10 percent have multiple disorders.
The US government and socio-civic support groups for the military, those in active duty and those who have returned home from war torn foreign lands, have some programs in operation to aid these servicemen, but they are far from adequate and being effective. These soldiers and their loved ones have suffered enough in the service of their country, risking their lives for freedom and democracy. They certainly deserve better.
“Stealth” ovarian cancer
While breast cancer detection is very popular, which has saved the lives of countless women around the globe, about 80 percent of ovarian cancer are discovered only at a late stage, where the cancer has spread, making the prognosis dismal. Every year about 22,000 women in the United States are diagnosed with ovarian cancer and more than 14,000 (about 64 percent of them) die annually. A woman has about 1.4 percent (one in 70) risk of being diagnosed with ovarian cancer in her lifetime.
Unfortunately, in spite of the advances in medicine, there is no effective surveillance technique for detecting ovarian cancer in its early stage. The fact that the ovaries are inside the abdomen, deep in the pelvis, they are invariably discovered already in their advanced stage.
Clinicians are now exploring the genetic predisposition of women to this particular cancer, in the hope of predicting who might be more vulnerable to develop ovarian cancer. BRCA1 and BRCA2 mutations are well known hereditary factors that increase risk for breast cancer and ovarian cancer.
Oscar-winning actress Angelina Jolie helped spotlight this when she underwent her double mastectomy in 2013 when she tested positive for BRCA1, which increased her risk for breast cancer by 87 to 90 percent. About 1 in 8 American women develops breast cancer during their lifetime. This same mutation elevates the risk for ovarian cancer by 50 percent. There appears to be a connection between breast cancer and ovarian cancer, which makes family history a very important information.
A biomarker has been identified that could be used for screening and early detection of ovarian cancer. The study is ongoing. In the meantime, a new treatment for ovarian cancer called hyperthermic intraperitonial chemotherapy (HIPEC) is on its initial trials, where the solution is given directly into the abdomen, to avoid the side effects of intravenous administration of the anti-cancer agent.
Ovarian cancer is one disease where living a healthy lifestyle is essential to protect the integrity of the DNA and prevent of the development of this difficult-to-detect cancer, other cancers, and majority of the common ailments that afflict us today. That’s how powerful a healthy lifestyle is.
***
Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
