Double Mastectomies and Helpless Surgeons (May 27, 2014)
Women with breast cancer who receive double mastectomies were the subject of a recent study which found that 70% of these surgeries are NOT medically indicated. At the moment they are recommended (and presumably effective, although I won’t swear to that – there are fads in medicine just like there are in every other human activity) for only a very specific subset of breast cancer survivors who have certain major genetic risks. Despite this fact, these surgeries are being performed on many, many women for whom they are NOT medically indicated.
The news reports regarding this generally hasten to reassure the reader that this medical disaster is not the fault of the surgeons. Supposedly the women subjecting themselves to these worthless procedures are well aware that having a healthy breast removed is a very ineffective way for them to stave off a recurrence of breast cancer (except in the group of women I mentioned earlier, it rarely spreads to the other breast). Still, they are “freely choosing” to undergo a disfiguring painful procedure and their poor bullied surgeons of course have no choice but to comply? What a crock.
It happens that (except in school when we initially practiced on each other rather than an unsuspecting public) I have never manipulated the spine of, or “needled”, anyone whom I did not think that that procedure could benefit. And, personal ethics aside, I would be subject to professional disciplinary action if I did so. How is a surgery as drastic as a mastectomy different from that? why are these surgeons getting a pass?
There is an emotional component to ANY illness, even to a mild head cold. For any severe health problem, that component is profound -- people pass through the same stages of grief when they lose their health that they endure when they lose someone they love. Furthermore, it is not at all unusual for someone who has been very ill to be unable to successfully complete that grieving process. They frequently become stuck at one of the stages of grief and are unable to deal really effectively with their problem because of it. (For example, most of us by now have probably known a diabetic who was "stuck in denial", the first stage of grief, and refused to amend his/her diet.) For an illness like breast cancer, which is profoundly disruptive, disabling and life-threatening, the emotional aspects are, well, huge. So I certainly would not blame the patient if they “choose” a drastic but ineffective solution in an attempt to assert control over their illness. The only one to blame is their doctor, and s/he SHOULD be blamed, loudly and eloquently and repeatedly.
For a patient to choose a treatment that they know will not help them as some kind of magical gesture, in an attempt to alleviate their understandable fear and anxiety, is easy to understand. But it should be a bright red flashing light for his/her caregivers that that patient has emotional issues that are NOT being dealt with effectively, and it should also be a sign for the vast bureaucracy of medicine that is supposedly caring for this person to get them some good counseling and help them to deal with those issues -- rather than try to profit from them.
There are (finally, after many decades and many hundreds of billions of dollars) several lifestyle modifications, methods and treatments with good track records available for a breast cancer survivor that will assist them in avoiding cancer recurrence, and I find it very, very difficult to believe that any rational person will choose something s/he knows does not work over something that does. For this to be occurring on such a large scale is a huge and disgusting failure on the part of American medicine, and the "experts" who are overseeing it should be called to task.
--dr. diane holmes
Copyright © 2014
Women with breast cancer who receive double mastectomies were the subject of a recent study which found that 70% of these surgeries are NOT medically indicated. At the moment they are recommended (and presumably effective, although I won’t swear to that – there are fads in medicine just like there are in every other human activity) for only a very specific subset of breast cancer survivors who have certain major genetic risks. Despite this fact, these surgeries are being performed on many, many women for whom they are NOT medically indicated.
The news reports regarding this generally hasten to reassure the reader that this medical disaster is not the fault of the surgeons. Supposedly the women subjecting themselves to these worthless procedures are well aware that having a healthy breast removed is a very ineffective way for them to stave off a recurrence of breast cancer (except in the group of women I mentioned earlier, it rarely spreads to the other breast). Still, they are “freely choosing” to undergo a disfiguring painful procedure and their poor bullied surgeons of course have no choice but to comply? What a crock.
It happens that (except in school when we initially practiced on each other rather than an unsuspecting public) I have never manipulated the spine of, or “needled”, anyone whom I did not think that that procedure could benefit. And, personal ethics aside, I would be subject to professional disciplinary action if I did so. How is a surgery as drastic as a mastectomy different from that? why are these surgeons getting a pass?
There is an emotional component to ANY illness, even to a mild head cold. For any severe health problem, that component is profound -- people pass through the same stages of grief when they lose their health that they endure when they lose someone they love. Furthermore, it is not at all unusual for someone who has been very ill to be unable to successfully complete that grieving process. They frequently become stuck at one of the stages of grief and are unable to deal really effectively with their problem because of it. (For example, most of us by now have probably known a diabetic who was "stuck in denial", the first stage of grief, and refused to amend his/her diet.) For an illness like breast cancer, which is profoundly disruptive, disabling and life-threatening, the emotional aspects are, well, huge. So I certainly would not blame the patient if they “choose” a drastic but ineffective solution in an attempt to assert control over their illness. The only one to blame is their doctor, and s/he SHOULD be blamed, loudly and eloquently and repeatedly.
For a patient to choose a treatment that they know will not help them as some kind of magical gesture, in an attempt to alleviate their understandable fear and anxiety, is easy to understand. But it should be a bright red flashing light for his/her caregivers that that patient has emotional issues that are NOT being dealt with effectively, and it should also be a sign for the vast bureaucracy of medicine that is supposedly caring for this person to get them some good counseling and help them to deal with those issues -- rather than try to profit from them.
There are (finally, after many decades and many hundreds of billions of dollars) several lifestyle modifications, methods and treatments with good track records available for a breast cancer survivor that will assist them in avoiding cancer recurrence, and I find it very, very difficult to believe that any rational person will choose something s/he knows does not work over something that does. For this to be occurring on such a large scale is a huge and disgusting failure on the part of American medicine, and the "experts" who are overseeing it should be called to task.
--dr. diane holmes
Copyright © 2014