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.


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.