January 1, 2009

Can A Patient Postpone Their Own Death?

Why I hate.



There is a vague but popular assumption that some people close to death from disease can postpone their death in order to get to a special event.  Popular examples would be a cancer victim who makes it to his grandson's birth, etc, etc. 

History has examples where we assume as much.  Jefferson and Adams were in a coma, both until July 4, 1826, the 50th anniversary of the nation.  Then they woke up, looked around, and died.  "Did I make it?"  You made it.  Thanks.

Etc.

The authors of one large study discover it is not true.  Reviewing 300k cancer deaths in Ohio from 1989-2000, and looking to see mortality rates two weeks before or after Christmas, Thanksgiving, or the individual's birthday, they found no difference in mortality rates.

First, this study doesn't prove that people can't do it.  It doesn't even lend any support to the premise that they don't-- it is simply not a well thought out study.   Perhaps Christmas and Thanksgiving aren't a significant pull?  It would not have counted Jefferson or Adams as positives.  How do you know they didn't successfully postpone their death by a full year, but fall short by two weeks?  Perhaps Jews were not particularly motivated to stay alive to Christmas?  Etc.

More broadly, from the standpoint of epistemology, the study was flawed from the beginning.  You can't use an association study to deny a relationship, only to suggest that a relationship exists.  And, you can only do an association study on things you already know exist, to see what kind of association there is between them, not as evidence that one of the things themselves doesn't exist.  "According to a review of Chicago ER records, no relationship was found between lunar cycles and the treatment of alien life forms from 1980-2000, thus we conclude aliens do not exist."  You are looking to prove something doesn't exist by noting its absence in a few not particularly useful places.

Which brings us to the second point: why do it?  There is no information to be gained from this study.  Worse, its publication confuses people who think that information was discovered.

It takes away hope.  For what?  If you knew something for sure, well, then we can debate whether reality is a bitter medicine all must swallow, or not.  But this isn't reality, this is... a preliminary investigation designed to drive you crazy.  "We have reason to suspect your wife was really good at oral sex with other men prior to meeting you."  Now what?

I'm sure these authors are good people, I'm sure they think they have done nothing wrong, but they are not doctors, they have violated the very basis of their profession. 

There was no reason for this study at all, as far as studies go.  It's a violation of the principles of medicine.  It is not science, and it doesn't promote the treatment of patients.  It does not contribute to knowledge, it does not contribute to science, and, worst of all, it does not further humanity.  Yet here it is, not in some underground fanzine, but in JAMA.  Not slipped into JAMA, but past three peer reviewers and an editor into JAMA, not to mention 4 years of "readers."  For all their interference in social policy and contamination of medicine in order to further political agendas in the name of "humanity," they think nothing of this.

It is all ego, it is all done for the doctors, it is a study done not to inform medicine but solely  so they can say they did a study, "hey, you know the conventional wisdom, well, we just disproved it!"  Even though it isn't proof at all, but ha ha and they can gloat over drinks or at the conference and others will point and say, "XX's group at Ohio did a study and they found it wasn't true."

On the one hand, you exaggerate your power, dictate and interfere where you have no authority; on the other hand you pretend you're innocent observers to the freight train of truth, simply taking notes.  You violate the trust of humanity and hide behind the pretext of impartiality to the truth, when really you distort truth or invent pretexts for your own prejudices.

When a patient asks me if such is possible, I look them dead in the eyes and I say, "Of course it's possible."  I say it because the scope of my field does not have any information that allows me to answer any other way.  "Do aliens exist?" Being a doctor doesn't give me any insight into this answer, so you can't use your authority to promote one.

Your job, your obligation, is to serve humanity, if you can do it with science awesome and if there is no science for you then you come up with something else.  You don't leave them hanging, you don't leave them hanging.  And when all else fails you take out your stethoscope that you don't really know how to use, and you pretend to examine them, you pretend you're involved. 

I have no power to revoke your licenses, but if I had the power, if it was up to me, you would all be excommunicated.




Comments

"Your job, your obligation,... (Below threshold)

January 2, 2009 3:24 PM | Posted by Anonymous: | Reply

"Your job, your obligation, is to serve humanity."

I can't tell you how sweet it is to hear this argument reintroduced to the general discussion -- and by a doctor, an insider, someone other doctors might actually notice.

Happy New Year.

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My favorite blog. You mana... (Below threshold)

January 2, 2009 3:35 PM | Posted by ND: | Reply

My favorite blog. You manage to articulate so nicely the vague misgivings I have about the practice of medicine.

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I guess it would old-fashio... (Below threshold)

January 2, 2009 6:10 PM | Posted by Neuroskeptic: | Reply

I guess it would old-fashioned and sentimental of me to say that one of the virtues of humanity is the urge to know for the sake of knowing, whether we like the answers or not, and whether they are "useful" or not.

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SURE it's a virtue, but TLP... (Below threshold)

January 2, 2009 6:25 PM | Posted, in reply to Neuroskeptic's comment, by dES: | Reply

SURE it's a virtue, but TLP did not disagree, and "knowing for the sake of knowing" was not by any stretch of the imagination what the study was about. If you had gone and asked, patient by patient "is there something you're hanging on for," and then recorded whether or not they made it, THAT would be a study. Flawed, certainly, but better than this. The 19th century doctor who tried to weigh souls did a better study than this! This "study" was an absence of study, and by defending it and pseudo-studies like it, you ultimately attack the advancement of human knowledge itself.

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Actually I wasn't defending... (Below threshold)

January 2, 2009 8:24 PM | Posted by Neuroskeptic: | Reply

Actually I wasn't defending this study, which is clearly not perfect, although not meaningless either. But I think it's obvious that TLP wasn't primarily attacking the methdology of the study. This isn't about whether it's right to assume that Jews celebrate Christmas. Let's pretend the study was methdologically flawless - most of what he said would still stand. And I'd still stand by what I said even if I thought this particular study was rubbish.

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Cited in the Annals of Inte... (Below threshold)

January 3, 2009 1:05 AM | Posted by Dr Benway: | Reply

Cited in the Annals of Internal Medicine 2008 - did you check that link?

Tax incentives can provide a large financial impetus to change behavior. Current U.S. law establishes a substantial discontinuity in the amount of estate tax that many patients will have to pay in 2010: During this year only, the tax rate drops to zero. This article discusses concerns regarding the sharp change in tax rate and the incentives it creates for persons who are nearing the end of life and provides estimates of the number of people affected by this issue.

Planning on dying? Try to hang on until 1-1-2010. Your heirs will be appreciative.
/snark

Maybe no one is reading JAMA these days (or the Annals). That might explain the drop in editorial standards. No readers = no fear of public humiliation.

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I think you mean "epidemiol... (Below threshold)

January 3, 2009 10:04 AM | Posted by kristen: | Reply

I think you mean "epidemiology," not "epistemiology." And as a former epidemiologist, I've got a huge beef with the crap PhD epis put forth in order to pad their CV. They know better.

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The article title needs cor... (Below threshold)

January 3, 2009 12:55 PM | Posted by Anonymous: | Reply

The article title needs correcting. Reads awkwardly as "I can postpone my death because of cancer".

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It should be "Can a patient... (Below threshold)

January 3, 2009 3:10 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

It should be "Can a patient postpone his death due to cancer?" Or "her," if you're a feminist. Patient is singular and their is plural...there needs to be parallelism. But honestly, who gives a shit.

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No, I was right about th... (Below threshold)

January 3, 2009 9:23 PM | Posted, in reply to kristen's comment, by Alone: | Reply

No, I was right about that much-- epistemology-- as in the study of knowledge itself, what can we know and what is not possible to know? And this applies to Neuroskeptic's and dES's comments, the idea is not simply that the methodology is flawed, but that the question they are studying cannot be studied this way at all, because, essentially, you are looking to prove something doesn't exist by observing its absence in a couple of places.

If they got a hundred people with cancer and asked them to try to postpone their own death until a randomly chosen date, that would at least be sound study; but even that, if negative, wouldn't necessarily negate the ability of others from doing it. "We asked three hundred people to try to bench press 275lbs, and none could do it." So? But again, that study would be a better one than this.

And it comes back, for me, to the purpose of studies in medicine-- either they are for science-- whatever it finds, even if we don't want to hear it-- or for "humanity" e.g. anything that makes suffering less. This does neither. It is for the authors' benefit ONLY. So much for the categorical imperative. (The what? Exactly.)

As for the title, yes, it is not really that good. Fixed. (I hope.)

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Yes, I did notice that, ... (Below threshold)

January 3, 2009 9:41 PM | Posted, in reply to Dr Benway's comment, by Alone: | Reply

Yes, I did notice that, pretty depressing. Depressing that no one else felt as I did (or, that the editors refused to print their letters), and even more depressed that anyone (e.g. insurers) could even attempt to use this pseudoscience as a way of setting rates. As for whether people even read the article at all, overall you're probably right, but this has a catchy title and is interesting enough that it could make the rounds. If anyone is so motivated, they can check the stats and see how many times that article was cited by other articles.

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Ditto on the "Can a Patient... (Below threshold)

January 5, 2009 10:45 AM | Posted by La BellaDonna: | Reply

Ditto on the "Can a Patient Postpone His/Her Own Death Due to Cancer?" - and the empirical answer, in my case, is yes; my own father, who had cancer, managed to hang on in order to say goodbye to all his children - one of whom had to sail back from Italy on compassionate leave from the Navy. But he managed.

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beautiful. thank you... (Below threshold)

January 7, 2009 7:22 AM | Posted by Trei: | Reply

beautiful.
thank you very much for saying it!

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let me suggest a new study.... (Below threshold)

May 22, 2010 1:31 AM | Posted by The (P)Irate Piper: | Reply

let me suggest a new study..

how many mentally stable people can postpone contracting cancer
n=1
n=me
i have not contracted cancer

>>>>if you're mentally stable, you shouldn't get cancer?

sigh >.>

http://theiratepiper.wordpress.com/

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Reading through the archive... (Below threshold)

November 27, 2010 12:44 AM | Posted by The Devastator: | Reply

Reading through the archives, glad I found this one; one of my favorites.

Your job, your obligation, is to serve humanity, if you can do it with science awesome and if there is no science for you then you come up with something else. You don't leave them hanging, you don't leave them hanging. And when all else fails you take out your stethoscope that you don't really know how to use, and you pretend to examine them, you pretend you're involved.

Hell, yeah.

Related question: how should I apply this idea to myself? Say I think that going to church would make me a better person, but I also think Christianity isn't true. Do I go anyway? Not going is more intellectually honest -- there's not enough proof of any religion to convince an ideal skeptic.

But is my primary obligation to be scrupulously intellectually honest about stuff no one knows the answers to anyway? Or is it to be a good person in ways that actually matter? The homeless guy at the parish soup kitchen doesn't care whether my philosophy was arrived at with rational rigor or not; he's just grateful that I'm there, making him a sandwich.

"You can be a good person no matter what philosophy you have."

Sure, today, while I'm thinking of it. How about next month? I'm not inherently such a good person. Maybe I need help.

You don't leave them hanging, you don't leave them hanging.

Does "them" include me?

(Used the first person because it was easier grammatically. This is not really about "me" though, it's a general question. Feel free to replace "I" with "one" where applicable).

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Why try to postpone Death? ... (Below threshold)

November 16, 2011 5:07 AM | Posted by Anonymous: | Reply

Why try to postpone Death? Unless you didn't live your life to the fullest when you had the opportunity?

Or worse, why wish to die in your sleep? Are you a coward, or what?

Afraid of the Big C? Does that mean you're afraid to face the legacy you leave behind?

Why all the fear of Death? It's a natural part of life.

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If you don't exert yourself... (Below threshold)

December 6, 2011 1:53 AM | Posted by MBT: | Reply

If you don't exert yourself in youth, you will regret it in old age.。

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