My friend was a member of the transplant team at Johns Hopkins. "They" said he was near multiple organ failure prior to the transplant. And he survived significantly longer than expected. Recovery under those circumstances was a very long shot already. Kudos to him for undergoing the procedure, and furthering the research. Condolences to he and his family.
I have an uncle in his sixties that has drank and smoked his whole life and he has been on heart and liver transplant list for about a year. Because he continued to live unhealthily his heart started failing this week with multiple heart attacks they moved him to level one priority and he will likely get his transplants this week. It feels weird that he is now ahead of others because they tried to be healthy and he did not.
Similarly a friend work for Alabamas football program and he couldn’t travel with the team to games in 2020 because he _hadn’t_ had Covid, while those who had gotten Covid could travel.
Basically… it’s hard to formulate rules for these sort of things and rarely are they “fair” to all involved.
It likely varies hospital to hospital and region to region. I would hope it's more often the case than not though. I'm an organ donor and I wouldn't be happy to find out that my liver went to an alcoholic that wasn't making a strong effort at sobriety.
Do you know how arrogant that is? Alcoholics aren't people who deserve to die because of some kind of moral failing. Very often they're alcoholic because of other mental health problems or abuse. Would you want to deny a clininically depressed person your liver because they might commit suicide?
Im a recovering alcoholic myself, don't lecture me. I didn't say they deserve to die. But if they can't stay sober they don't deserve a liver over someone else who may need it more.
You don't represent alcoholics. Personal experience gives you a bias, not a justification for being condescending. Medical decisions are not and should not be based on moral judgements of the patient's behavior.
You're now changing your idea to add "over someone who may need it more", which is different, and I'm not disagreeing with that. It's the same as favoring young or healthy people because they're likely to gain more life extension from a transplant when the rest of their body is working OK.
I assumed that was implicit given the context of the conversation (a comment up the chain discussing their uncle who got higher priority because he continued to make poor lifestyle choices). Obviously I'd still rather my liver go to the aforementioned alcoholic than into the ground, but they wouldn't be my first choice.
There was and is no condescension present. I don't look down on them just like I wouldn't look down on a 90 year old man whose liver is failing from natural causes. Neither would be my first choice for recipients of my liver.
Anecdotally, an ex-partner of mine here in Australia was denied a transplant for several years due to her heavy marijuana use, but was eventually allowed a transplant. Unfortunately her body rejected it and it had to be removed, and she passed away a year later.
He says he is committed to and I assume he has good intentions. He isn’t drinking or smoking, but water intake, salt intake, and red meat have been more challenging for his willpower/discipline.
Also, I have no idea if matters or not but he is wealthy (low eight digits) as well.
Honestly I can't find any fault here. Giving up the drinking and smoking has probably been monumentally difficult, and it's amazing that he's been able to do that. That alone tells me he is committed to getting healthier.
The diet stuff... honestly, nutrition "science" is full of contradictions. Sure, too much of anything is probably bad for you, but I don't think diet concerns should be a blocker for receiving a transplant.
At any rate, sorry you and your family has to go through this, and best wishes for your uncle's recovery.
The diet stuff is causing his body to fill with water. It isn’t just an eat healthier mandate. It is like becoming allergic to peanuts, but still eating them anyways when no one is looking.
Neither of those is a medical contradiction to receiving a transplant.
Smoking is the big no-no because it is fairly well proven to impair healing and increases chances of failure.
Evidence against red meat is very weak, and contradictory. Some studies show no harmful effects from non-processed red meat at all. In fact, there is just as much evidence against plant-based diets (they just aren't discussed widely due to the prevailing politics around CO2 etc), basically it's all just noise. Light alcohol use is absolutely fine in almost every case, and John Hopkins routinely does liver transplants for dependent alcoholics with an alcohol-related liver disease.
You should look up some centenarians cases, some lived on a diet of nothing but beer, waffles and blood sausages daily for several decades, and then had a nice healthy liver on autopsy at 100+ y.o., could've been from someone in their 20s.
Instead of contradiction, I believe you mean contraindication.
I'm also in agreement that cessation of alcohol and smoking are much more reasonable requirements for placement on the list than other dietary patterns that are highly individual regarding effects on overall health.
Sorry, I really don't mean to be a devil's advocate, but how do you know for sure that those others in the transplant line, also lived healthy lives w/ regular doctor visits.
Funny how having had COVID opens doors (eg. quarantine not required when traveling to some countries, and your example), but at the same time people are punished for not preventing it (vaccination, PPE). Talk about mixed incentives...
> (eg. quarantine not required when traveling to some countries, and your example)
For policies like quarantine following travel does it make any sense to distinguish anyone whether they have had covid, had a vaccine, had both a vaccine and covid, or had neither a vaccine or covid? Aren’t all of the above equally capable of carrying and transmitting the virus?
Yes, but measures like the policies in question encourage people to get infected with symptomatic COVID so that they could go to doctor and get that very useful piece of paper.
That's the point. If you wanted to ensure people to not get COVID, do not give those who have had COVID pleasant exemptions. They failed, they should not be rewarded.
If everyone will get it, then no one who gets it and does not die or become seriously inconvenienced has failed. Dying, of course, is usually a fail, but literally everyone will do that, too.
>Aren’t all of the above equally capable of carrying and transmitting the virus?
No. If I had Covid a month ago and recovered then baring a compromised immune system or new variant I am not going to get it again this month. So I am not "equally capable of carrying and transmitting the virus" compared to someone who "had neither a vaccine or covid".
I understand that you would have antibodies and it be very unlikely if you carry the virus it would be unlikely to overwhelm your immune system in that time, but you can still carry/spread it right?
More directly related to the policy in question they can test you for antibodies, and maybe it is immaterial, but do they distinguish if you had covid 1 month ago vs 3 months vs 6 months? So does it work on the honor system or are they testing for antibodies, is it simply a matter of if you had covid at any point it doesn’t matter if you still carry antibodies you are not subject to quarantine?
From the article: “Doctors at the University of Maryland Medical Center were granted a special dispensation by the US medical regulator to carry out the procedure, on the basis that Mr Bennett—who was ineligible for a human transplant—would otherwise have died.”
He also basically murdered someone via stabbing so kudos for giving his body to science, but there's a case that he should have spent his life in prison.
> After Bennett got out of prison, she said, he “went on and lived a good life. Now he gets a second chance with a new heart — but I wish, in my opinion, it had gone to a deserving recipient.”
What makes him any less deserving? I don’t want to downplay the fact that he stabbed a guy, but the criminal justice system sentenced him and he, by all accounts, appears to have regretted his actions and reformed to be a good person. It seems like the system worked far better than it usually ever does. Once you’ve gone through the system and come out the other side rehabilitated, you’re done: continuing to deny random services, including in this case access to experimental surgery, is just cruel and seems really a desire for continued revenge against this person (which I definitely understand from a human perspective, but definitely does not belong in our social services scheduling).
> there's a case that he should have spent his life in prison.
Why? Normally you do this because you want people that cannot reform to stay away without resorting to murder. This person was gravely ill, which is it's own prison.
Why? If he had murdered Edward Shumaker (which seemed to have been what he intended to do), instead of merely stabbing him seven times, causing paralysis, and making him live the rest of his life in a wheelchair while in constant pain before ending his own life via a drug overdose of pain medication, a sentence of murder would be something the judge would have to consider. David Bennett Sr. got off pretty easy for ruining someone's life.
Well that really raises the question of what did he die from? If not from the heart, how do they proceed with the research? Gotta do the next one on a person whose not already nearly gone. That seems like a highly sensitive line, no doubt it's a big discussion to move it.
"What people die of" seems like the sort of question the medical community should be quite good at answering.
People are waiting for human heart transplants and dying from the wait. I don't think there will be a shortage of patients who we can ethically treat whilst researching this new technique. It certainly isn't binary with a hard "sensitive line".
> "What people die of" seems like the sort of question the medical community should be quite good at answering.
Does it? I'm definitely not a doctor, but it seems like a very difficult question to answer.
Even with perfect information, it seems unlikely there is always a simple/single answer. I would naively expect things like (and I'm making a bit up here, because I'm really not a doctor) "not enough oxygen reached his cells, because his lungs were bad at refreshing the air in them, his heart was bad at pumping blood in circles, his veins and arteries were in bad shape due to diet, and he wasn't moving around much because he had a cold further reducing circulation".
But also, we don't have perfect information. We have this set of measurements we could make without harming the patient, or consuming too much time on really expensive equipment like MRIs. Many of those measurements are no doubt themselves subject to some degree of interpretation error and confounding factors.
Maybe I underestimate our doctors, or overestimate the problem, but it doesn't sound easy to me.
One of Atul Gawande's books (Complications) mentions that amongst deaths where an autopsy is done, the cause of death was misdiagnosed by the doctor about 40% of the time. Quote from book [Page 197, Chapter name : "Final Cut"] ---
"How often do autopsies turn up a major misdiagnosis in the cause of death? I would have guessed this happened rarely, in 1 or 2 percent of cases at most. According to three studies done in 1998 and 1999, however, the figure is about 40 percent."
I think 100 years from now people will look back on our current medicine the same way we view medicine from 100 years ago. There is some impressive progress, but we know less than we think we do and conduct a lot of wasteful and harmful procedures.
It's disturbing to learn how thin the evidence is for a lot of modern medical operations. For example, the recommendations for certain cancer screenings have actually been reduced in recent years after it was found they were causing net harm.
It's a bit startling to realize just how young medical science is. I think it's not unreasonable to compare medicine (and a lot of biology) in the nineteenth century to the state of physics in the sixteenth century.
And certain major areas of medicine that people don't think about that much (outside of the field) such as medical informatics are younger still. This stuff has a huge impact on how medical care is actually delivered, but can be kind of left out of the broader public discussions around medicine due to the focus on the actual literal medicines.
You're not overestimating the problem - and it's not an easy one to solve. Cause specific mortality is hard, which is why measures like all-cause and excess mortality are often used. For example, the whole "With vs. From COVID?" question is, in the actual field, not actually a controversy because this is how we've measured all infectious disease deaths basically forever.
This is especially true for severe cases like this, people in the ICU, etc.
If someone is in the ICU for multi-system organ failure, gets an infection, and then dies of multi-system organ failure, did the infection kill them? Was it a contributory cause? The same sort of question arises as in this case.
That's why I'm noticing studies that use "all cause mortality". In other words, some people receive X treatment and a similar control group does not. Then you look at how many died in each group regardless of cause because it's just too difficult (and death is pretty much a binary measure). For example, cholesterol lowering drugs (I don't have a source) seem to have no impact on all-cause-mortality, suggesting a failure in our understanding.
Certain invasive cancer treatments can look a lot more effective than they really are, if all cause mortality isn't measured. It's possible to reduce the risk of a patient dying from the particular cancer they have while also lowering their overall life expectancy, since the procedure itself can be extremely harmful.
I have a slide in a lecture somewhere noting that no one would ever die of a healthcare-associated infection if, when admitted to the hospital, they were put in a room full of ozone or hydrogen peroxide fog and intense UV light, while never being seen by a nurse or doctor.
Indeed. That's the point of the example. "You will almost certainly die in this room, but you won't die of an infection. So if we just look at infection-related mortality, everything is fine."
> "What people die of" seems like the sort of question the medical community should be quite good at answering.
Yes and no, I think.
Technically my dad died of asphyxia. His cancer had spread to his lungs, he'd gotten pneumonia and was in hospital on oxygen. The doctors were clear he wouldn't be going home in the months he potentially had left. So he asked to be disconnected from the oxygen and he died an hour later.
So did he really die of asphyxia? Was it pneumonia, or the cancer? Clearly they were contributing factors, but in the end it was his decision to stop the oxygen, so as such was it suicide?
To me it doesn't really matter. He's gone and I'm just glad he didn't have to hang on to the bitter end.
> In the United States it is estimated that the rate of major errors (eg, incorrect cause of death [CoD], incorrect manner of death) found on death certificates completed at academic institutions is approximately 33% to 40%. Internationally, this rate at some hospitals rises as high as 80%
> A wealth of literature is available highlighting the prevalence of death certificate inaccuracy seen at the national and international levels, as well as multiple studies that indicate lack of training as the root cause in the United States. Despite these noted errors, death certificate data continue to inform research pathways and drive medical practice.
> natural cause of death reports are known to have a 20 percent to 60 percent inaccuracy rate according to the peer-reviewed literature.
> The system isn’t built to allow for investigation. In fact, in the state where I worked, doctors are supposed to provide causes of death within 15 hours of the death
> 30 percent of doctors have reported being instructed by the coroner to put an inaccurate cause of death on purpose so the [coroner's] office won’t need to take the case.
> When I worked as a death certificate clerk, I occasionally would send death certificate worksheets to multiple doctors involved in a patient’s care if we had a rush to bury or cremate. In these situations we needed to cast a wider net to find a rapidly responding doctor to finish the record before final disposition. Many times each physician would report an entirely different cause of death.
Death certificates and cause-of-death attribution mainly exist to satisfy procedural requirements, not because they're supposed to be informative or helpful. Courts need to do cause-of-death attribution. It can't be done. So they solve their problem by the very simple method of pretending they can do it anyway. (Courts take this approach everywhere, not just in death certificates. Drug dogs, accounting errors, expert testimony...)
That was my biggest question too. patients die all the time after receiving a human organ transplant just due to the body being in a poor state and/or rejecting the organ. So it was either that case in which even if he received a human heart the same outcome of him dying would have happened. Or it was the pig heart that was the problem. Hopefully it can be determined which case happened, and I am glad he got to spend a few more months with his family.
I think that "Exactly what has happened since and the precise cause of Mr Bennett's death is not clear." indicates that the reporter is not clear, not the physicians. Other sources like https://www.wbaltv.com/article/man-received-historic-pig-hea... talk about infections and indicate his illnesses and treatment were well understood. Even though the patient was a public figure he has HIPAA rights and the hospital has obligations towards him. I don't doubt much more will come out in subsequent published research.
The chance they don't understand in great, great detail the cause of Mr. Bennett's death is nearly zero. The chance that IRBs aren't equipped to handle the ethics of this decision in the future are also very low.
If he had survived for a long time, we would have known that it worked. He didn't survive, so we didn't learn much.
If we try with enough people who are as critical as him, eventually one could survive and we would know that the procedure works for at least some people.
I believe he surpassed several important “milestones” for a transplant patient so his death doesn’t mean the surgery was unsuccessful by any means. And even if it was a total “failure” of a surgery and the patient died on the table that doesn’t mean the team “didn’t learn much”. Not by a long shot.
It's an amazing story of which your friend must be tremedously proud.
Now that it's been done, no doubt the results will improve. What an
amazing time to be alive seeing these leaps in medicine. I think the
pandemic has, in part, really made biology and medicine super cool
again.
Why, because Bennett couldn't be convicted of it? Bennett took decades off Shumaker's life. AFAICT it's for practical reasons that he got a lesser charge, not for philosophical reasons.
I think that particular exception to double jeopardy is unique to New York. It’s not my area of expertise so I could be wrong but I think most of the country still uses some version of the “year and a day” rule.
I do wonder, however, if there were potential patients available, who were near death solely due to the need for a heart transplant (and were near-certain not to get a conventional human transplant in time), and not also because of a host of other issues.
Given the complexities of the human body and how central strong circulation is to them, "Near death from heart failure, ineligible or outside the window for another transplant, but lacking any life-threatening non-cardiac comorbidities" is going to be a tough find.
Not sure about that aspect either. They invested a boatload of money into a guy that can't even make a 1-year follow-up. How are they supposed to observe the transplant long term?
Healthy people? Well, it's not like it's "raining organs" for people on a waiting list. Many of them will die waiting. There must be someone on a slight better shape and willing to take a chance.
It may not be ethical to do this under the guise of administering medical practice even if there is informed consent. Part of a doctors duty is to be the rational actor to say “you could have 6 months to live and this procedure has no evidence that you’ll live any longer, in fact, it could shorten your life to the time of your surgery”.
This is advocating for civil engineers to willingly approve on a bridge they have no evidence won’t collapse, just because the current bridge needs serious replacement.
Define "slightly better shape". Because that's now your inclusion criteria. You have to be sick enough that "Or this might not work and kill you" seems like an acceptable risk, but not as sick as the guy they chose by arbitrary and hidden metrics primarily based on looking at the outcome retrospectively.
People needing an organ less urgently are going to be unlikely to take a huge risk on something unproven. People needing an organ urgently but with fewer red flags otherwise would similarly likely prefer the human organ they could get over the experimental one.
He lasted 2 months.
For reference, artificial hearts generally do 130 days -
(2018) https://syncardia.com/patients/media/blog/2018/08/seven-thin... with some notable outliers that live for years, and human to human transplant is about 9 years. Usually it's some related systemic problem that kills you under these conditions eg consistent brain clotting causing stroke or organ failure due to drug cocktails.
I found extra information for those curious about statistics involving human heart transplantation [1]:
"The most recent data of the registry of the International Society of Heart and Lung Transplantation indicates a current 1-year survival of 84.5% and a 5-year survival of 72.5%. This has significantly improved as compared to the 76.9% 1-year survival and 62.7% 5-year survival in the 1980s. The development of new immunosuppressive drugs which allow a variety of immunosuppressive regimens, tailored to the individual patient, has contributed to this success, since rejection and the adverse effects of immunosuppression could be better controlled. After 20 years, ca. 21% of patients are still alive, according to the international registry. In some experienced centers, long-term survival is reported to be even higher. The University Hospital Zurich has achieved a 20-year survival rate of 55.6%.
The improvement in outcome over the decades is related mainly to an increase in survival over the first year. After this period, the attrition rate of ca. 3-4% per year has remained similar over the different eras. This might be attributable to the fact that it was not possible to reduce the incidence of long-term complications after heart transplantation, such as chronic allograft vasculopathy (CAV) and malignancies, which account for ca. 35% of all deaths after 10 to 15 years."
The Wikipedia page cites a documentary as the source, which may be correct, but doesn't seem like an appropriate source. Here's a paper that I skimmed the abstract of claiming ~9 years:
Here's a 2015 article from the Journal of Thoratic Disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387387/.It doesn't calculate the exact average, but 21% of patients are alive after 20 years. Survival rates have definitely rapidly increased over the last two decades.
> Survival after heart transplantation is excellent, particularly if it is compared with the natural course of end-stage HF. The most recent data of the registry of the International Society of Heart and Lung Transplantation indicates a current 1-year survival of 84.5% and a 5-year survival of 72.5% (5). This has significantly improved as compared to the 76.9% 1-year survival and 62.7% 5-year survival in the 1980s. The development of new immunosuppressive drugs which allow a variety of immunosuppressive regimens, tailored to the individual patient, has contributed to this success, since rejection and the adverse effects of immunosuppression could be better controlled. After 20 years, ca. 21% of patients are still alive, according to the international registry (5). In some experienced centers, long-term survival is reported to be even higher (6-9). The University Hospital Zurich has achieved a 20-year survival rate of 55.6% (10).
>The improvement in outcome over the decades is related mainly to an increase in survival over the first year. After this period, the attrition rate of ca. 3-4% per year has remained similar over the different eras. This might be attributable to the fact that it was not possible to reduce the incidence of long-term complications after heart transplantation, such as chronic allograft vasculopathy (CAV) and malignancies, which account for ca. 35% of all deaths after 10 to 15 years (5).
To be honest, not sure why we spend so much resources on heart transplants. For the most part, the underlying condition that wrecked your old heart is probably still there. We should be putting more resources into preventative medicine.
This.
I know a doctor who was heading the liver transplant list.
Patients would come in, be diagnosed and told they need to live healthier, do this and do that as part of the preventative measures. Clear medical advice.
Habitual change is the hardest in my view and this is also how this story continues.
Over the course of time these patients will visit regularly. Their condition is worsening and the preventative medical advice will be stronger and more urgent.
In the end most still end in the transplant list. Most having exhibited little effort to turn their life around.
When it becomes evident that "clear medical advice" isn't working, then maybe we should dig another level deeper and find out WHY it isn't working. Shifting the blame to the patients when you have most that are failing is, in my opinion, bad medicine.
Artificial hearts are artificial hearts- mechanical plumbing. This is far more akin to human heart transplantation (which is a mature operation that has excellent outcomes).
It's still typically a massive change in quality of life. The left ventricle is what feeds your entire body blood; the right ventricle only feeds the lungs. When the left ventricle fails, blood backs up and starts overflowing into the lung space in addition to the rest of your body slowly suffocating. It's exceptionally unpleasant.
The right ventricle is usually in much better shape so an LVAD can be almost like having a functioning transplant, except that there's a big wire going out of your chest/neck (which is a constant infection risk and can't really get wet) and you're now battery-powered.
Any kind of heart transplant comes with huge problems, even besides the immunosupressants etc. The nerves don't reconnect, so the heart doesn't respond to commands to speed up. It makes any kind of exertion difficult and unpleasant. Diet is critical, clots are a constant fear, etc. By the time you get a transplant you've usually spent a while with insufficient bloodflow, and your organs have been slowly dying.
It's nothing short of incredible that people can get 20+ years out of transplants. The deck is stacked against us hard.
Artificial heart is kind of a non-specific term. It covers anything from LVAD, LBAD and RVAD together, ECMO or biventrivular vad. So depends on what you’re specifically referring to but lvad is the most common of those.
Fair enough. I'm in no way experienced in the medical field. I would have told you I thought an artificial heart was a complete heart replacement, just like a full transplant but with a mechanical device instead. TIL.
LVADs are implanted in your chest. Blood doesn't leave your body, but do they have external batteries. You have a wire coming out of your chest (or neck/head, sometimes) which is a constant infection worry. AFAIK the only external pumps are like, countertop kind of things.
They're ideally a stopgap, but even still it's typically a massive change in quality of life. The left ventricle is what feeds your entire body blood; the right ventricle only feeds the lungs. When the left ventricle fails, blood backs up and starts overflowing into the lung space. It's exceptionally unpleasant. The right ventricle is usually in much better shape so an LVAD can be almost like having a functioning transplant except for the risk of infection.
It is, and it has even been done. One large limitation is that it's not a great idea to have batteries inside the body. An LVAD is intrinsically liquid-cooled; batteries are not. Ruggedly encapsulating a battery means it is fairly well-insulated and can get warm. Batteries also fail pretty unpredictably- they're fundamentally dozens of square feet of very thin film, and it's very difficult to ensure that every battery is perfect. But again, it has been done.
Implanting a couple medium-size batteries and the circuitry+magnet for wireless charging is pretty robust to failure, but consider actually making that decision for yourself. You're already accepting huge restrictions, so is the wire that much of an extra burden?
Realistically, if the LVAD loses power, you're dead. It's not like suffocating; without bloodflow (even blood without oxygen!) your brain will die in about two minutes. Chest compressions probably won't even help. You got the LVAD because your heart couldn't pump, and chest compressions will not force blood through the LVAD. Even if this happens in the emergency room your odds are not good. Cutting open a chest to hand-crank a human is not easy. Pulling an ECMO machine and inserting the massive catheters is not easy. You might die while the machine is still rolling towards you.
... seems like a genetically-engineered pig's heart could avoid eventually be engineered to avoid some of those problems. It's science fiction, but quickly heading towards science, to engineer hearts which don't require quite the same cocktail of hearts. Cells would need to present the same way as the patient, so the engineering would need to be specific to each patient (which also means the patient needs to wait for the pig to grow old enough).
“Currently 17 people die every day in the US waiting for a transplant, with more than 100,000 reportedly on the waiting list.”
David Bennett was only 57. Heart disease, and related issues are a big problem.
While I’m hopeful for this technology, I wish there was a way for people to see heart issues coming much earlier in life so they can attempt to treat, or delay, the problem.
If you've not had a checkup in the last year go and get one! It'll be included on your health insurance and the blood draw will include things like if you have high cholesterol.
Meh. Might be an American thing, if you watch TV or news the images of persons will be constantly telling you to ask your doctor about this, consult a medical professional before this other activity they advertise, and oh you gotta see a dentist every six months. Just demand creation, better just to get a blood-pressure test when you do see a doctor and a cholesterol test based on the result.
To be fair, all the ad revenue for pharma products on American television networks whose parents happen to own a news network also do a great job of building leverage against the pharma companies ever being investigated too deeply.
You can go to quest diagnostics or labscorb and order yourself a test for under 200$ (no insurance needed) that would do an entire panel on you. I did this and then called a teledoc for like 40$ (copay) and had them go over hte results with me. It's pretty sweet.
If you make 100K a year in Canada you pay $29,986 in taxes of which about a third goes to healthcare, so $10000 annually and you still won't get tested preventatively.
The difference is that the US cost is true whether you're wealthy or poor (above a certain margin). In Canada, if you make the median household income of $35k, you presumably pay proportionally less (or even less than that; I can't be bothered to look up the progressive taxation margins) in taxes, so $3500 max.
You got a cholesterol test and only a cholesterol test? That was what the parent comment is about. Tests vary a lot by test. LabCorp states their prices very clearly.
Hundreds of different ones. Granted you still need some level of medical expertise to be able to accurately interpret results on a lot of them but a smart enough layman could probably self diagnose some illnesses with enough homework.
We even need a prescription for repeat labs. So if my doctor is away for personal reasons for a month and I need to have my [thing that I get tested every month] checked, I can't without having to navigate the entire healthcare system to find a workaround.
I would be easy for me to interpret the results as my doctor is clear that [number] should not fall under [threshold]. It even comes back highlighted in red on the result sheet if it falls under that number. And I have clear instruction on what to do if that happens.
There is no real medical need for an ‘annual physical’ it is a creation of the American medical-industrial complex and creates more problems than it solves.
Having said that seeing a doctor occasionally for blood pressure etc is useful, but the interval for someone young and otherwise not experiencing any symptoms doesn’t need to be annually
Isn't there catch-it-early type diseases? Like breast cancer, testicular cancer, colon cancer, etc... that prove this wrong?
The funny thing is, the older you get, you are likely to have some sort of symptom. Such is life.
For blood pressure, I would expand and add general bloodwork for health conscious individuals or people with a family history for certain issues -- diabetes, liver, androgen, heart health markers.. Here in Canada you just need to mention you are interested for health reasons and a doctor refers you -- not sure how costly it is in USA -- but apparently private clinics are a choice to build custom panels.
For ‘catch it early’ you are talking screening. That’s why there’s cervical cancer screening (pap smear/the new cytology test), mammograms, faecal occult blood tests, in australia skin cancer screening, etc.
And that’s why people should have a regular doctor and that’s why as you get older you see your doctor more frequently. But for young(ish) otherwise healthy people, the whole concept of something ther occurs annually doesnt make sense.
In the other hand, since most screening and medical engagement is with females, you are left with lots of men who get into their 40s without ever having seen a doctor.
So - if thats you - go and see one, build a relationship, and if everything is good ask when you need to come back for prostate screening, FOBT, cholesterol or anything else. All across the board is unnecessary.
With regards to your last point, I’m all for devolving autonomy and power to the patient, but frankly across the board wide ranging blood testing (especially regularly) just doesn’t make sense for a significant percentage of people, unless there is a high pre test probability or a significant family history. All blood results are managed at the 95% CI so if you go in and have 20+ blood tests then more than likely at least one is going to be out of order. All you need to do is visit the askdocs subreddit to see the immense anxiety and flow down effects that has on a population who have absolutely no way of understanding a slightly out of bounds result. Those private clinics trying to spin up and do ‘wellness checks’ are frankly in my opinion, and until the evidence proves otherwise, a parasite on the worried well
If a person is otherwise healthy, no. Or at least, there is no medical indication to do so. But a person with pre diabetes is not generally otherwise healthy. T2DM is not a condition of a healthy person, it is a lifestyle disease caused by lack of exercise, poor diet and obesity. This person should see a doctor, but they’re not a healthy person. They should be aiming to exercise and reduce body mass.
I've heard many experts talk about issues with "catching disease early", one being that what doctors find might have never developed far enough to cause harm and so the treatment might actually be more harmful.
I don't want to risk trying to explain it from memory since I have zero medical knowledge, but there's a YouTube video by "MedlifeCrisis" about this that also has sources cited in the description. The title is something like "the problem with screening".
> one being that what doctors find might have never developed far enough to cause harm and so the treatment might actually be more harmful.
This is not a reason to not screen regularly. If treating very early is the problem then you should still aim to detect it early and then closely monitor it until you have enough information to decide whether to act or not. There are many people that will simply not go in for testing until there is a major problem if you advise against regular testing. A close family member of mine just passed away recently because he didn't go in for regular testing and they caught the cancer way too late.
> There is no real medical need for an ‘annual physical’ it is a creation of the American medical-industrial complex and creates more problems than it solves.
What problems does it create? Isn't preventive care a good thing? Also Japan does annual physicals much more rigorous that in the US. I wish what is done in the US was more rigorous because it would have caught the autoimmune disease that caused my kidney failure. Unfortunately by the time there are visible symptoms, the damage cannot be reversed.
Medicine can hurt as well as heal. A concrete example. Many doctors will advise you not to get a full body MRI scan. You can pretty easily buy such a service, and hire some radiologists to pour over every cubic millimetre of your body. But it's a really bad idea.
Because they will almost certainly find something ambiguous or troubling. And they're gonna biopsy. And then, well, maybe that's ambiguous. Another biopsy. You're terrified, the doctor's now worried about something they would never have known about otherwise, and maybe you have surgery to get it early. In the end the complications of all that quite potentially add up to a shorter life expectancy than simply not getting scanned in the first place. On average. Though of course, if you had a giant treatable tumour that shows up, well, you'd want the scan. But most people don't have one, and all those interventions can cause harm.
I agree in principle, but health literacy is so appallingly low - globally - that more often than not people are not equipped to deal with this information. As I said in an earlier post on this thread, look at the askdocs subreddit. 90% of the posts there are worried well asking for clarification of some unnecessary test they went and specifically asked a doctor for, the result of which they don’t understand and which is causing a cascade of health anxiety.
If every person understood enough to realise how many ‘abnormalities’ enough investigations would show up, and how in 99% of people they mean absolutely nothing, then it would be fine. But that’s not our current situation. And if you’re one of those people who are capable of parsing the dense health literature and understanding the implications (or not) of ‘normal abnormal’ findings, then go for it. But for the population as a whole? It’s not viable or helpful
Preventative care is different from the concept of all round comprehensive annual physical as it has been propagated through the culture from the American experience (I practice in Australia, so am talking from what I see from time working there, and the trickle through effect culturally of Australians thinking this is something they ‘have’ to have).
Preventative care consists of positive health messages (smoking cessation, moderate alcohol consumption, healthy diet, exercise), early identification of at risk individuals through family history, obesity, and then population wide cancer screening. Preventative care does not mean take a dozen tubes of blood and a pot of urine on every person every year.
I’m really sorry to hear about your kidney failure
Annual checkups are just that.
1) Body weight measurements.
2) The doctor talking to you about whether you have any medical or life concerns.
3) The doctor sharing advice on diet improvements, smoking improvements, exercise plans, including providing resources for them.
4) Recommended screenings based on age.
5) 1-2 vials of blood to get basic health information such as glucose levels, vitamin levels, etc.
6) Urine samples are only required if you're sexually active with multiple partners to screen for STDs and is completely optional.
That's been my experience. Through the annual physical I've been able to handle several minor issues, which have materially improved my life, and identified a major diagnosis that goes undiagnosed in the majority of people throughout their lives, and leads to them living significantly worse lives than they would have otherwise. By identifying it early, I have a chance for a much better lifestyle, and reducing the odds of an early death greatly.
Let me be really clear, everyone should have a doctor. But the concept of an annual checkup, as though there is a process to it and if you haven’t been to the doctor in the last 12 months is something you have to go through, is not part of general medical care. For the average under 30, and even under 40 male, with no family history, you are literally just pissing money away ordering annual vitamin, hormone and at some level lipid levels (although occasional checks are definitely useful).
The most invasive part is that they send the results to your employer. I initially balked at this, but you effectively don't have a choice if you want to work at a big company in Japan, although it's worth noting the legal requirement is on the employer to get the tests done, not on the employee to do it.
Having trouble taking satisfactory breaths while laying flat? See a doctor. Feeling out of breath abnormally while working out? See a doctor. Got an Apple Watch? Just for kicks take your ekg. It is crude but can detect abnormal heart rhythms.
You probably know this, but for anyone else reading - I have an Apple watch that has the EKG. It is a two-contact EKG, so it's limited in what it can see. It also requires you to actively look at it (you have to touch the crown while it's reading).
It did successfully diagnose a bout of bigeminy that I had, but unfortunately my cardiologist didn't think it was important, and I ended up having a heart attack anyway. But I lived, and now I have a new cardiologist, so there's that.
Not a lawyer so this is only anecdotal but It is actually very hard to sue a doctor unless its egregious to my understanding and your rewards are limited to the point where most lawyers are hesitant to take the case due to that. Have a family member that got a colonoscopy and the doctor commented after that there was a bit of a tough time getting it in but he just pushed a little harder and all was fine. That push actually perforated the bowel and he got sepsis and spent 3 weeks in the hospital and many months with a coloscopy bag. No lawyer would take the case.
Maybe in the US, probably not anywhere else. You'd have to prove actual negligence, and in this case, it's quite possible the doctor's decision was reasonable. Benign abnormal heart behavior is pretty common.
I’m not american and thought this would be a good generic word to convey “getting some answers/justice”.
I’ve had so many infuriating encounters with dismissive doctors, that I fear I’ll get into a similar situation.
The healthcare system is really strained, but does it have to give them the right to not take your “only annoying, not life threatening” level of simptoms seriously?
I do not have the resources to go for three different doctors to really make sure they are right about telling me “just don’t worry about it..”
How would you apply this to a child, or convey it to their parents?
The procedure has a profound effect on the family that receives the heart and on the donor family. Hearing donor family members describe what it’s like knowing their child’s heart is still beating somewhere is something you don’t forget.
I don't mean to be callous by this comment but if you mean "live differently" as living unhealthy well I have a problem with this. People that live in unhealthy ways cause all sorts of grief to others as well as financial loss. It is not right that I have to pay for people that decide to essentially eat themselves to death; it is not right that my wife and I had to care for my mother for months because she decided to eat herself to death. Heart disease and diabetes are all too common "paid" for by others - they should choose differently and while we can't make them choose differently we should for sure tell them that their choices are not "o.k.".
There are a whole host of heart diseases not spurred on by unhealthy living. Particularly diseases affecting younger folk who would inordinately benefit from a longer lifespan if we got better at transplanting.
As a selfish example, I have ARVC. I was diagnosed at 24 while training for my first marathon. Lifestyle treatments for my disease are to explicitly avoid exercise as it exacerbates the deterioration of my heart muscle. As I age, I expect to be at a much greater risk for the heart diseases that you would recommend "healthy living" for, as I will be categorically barred from one of the most important pillars of that, exercise.
I realize we're talking about the margins here, but as a margin, I would love more advancement in transplants.
Living is unhealthy. It’s universally fatal. In a free society we (should) retain autonomy over our bodies. This isn’t purely philosophical, it is practical. Who decides what is healthy? What if they are wrong?
How many eggs should I eat today to meet your personal definition of healthy living? And what do I do when it differs from someone else?
This is kinda an extremist straw man, though. I don't think anyone is claiming that the fields of nutrition and physical fitness are settled and that we know everything about what people need to do to be healthy.
But if you're obese and eat junk food all day, or if you just sit around on your couch and never get any exercise, and then end up with (for example) heart disease, that is something that was likely preventable, and we have a pretty good idea why and what could have been done differently. I'm force to subsidize these people's health care to some extent, and I think that's unfair.
The whole autonomy thing is tricky. We live in a society where we "care" for each other in collective ways (taxes etc.). People who want to live in that society lose some autonomy as a part of the bargain. I don't think this means we should legally force people not to eat or drink certain things. But I do think that (for example) denying people liver transplants when they won't stop drinking excess amounts of alcohol is fine. They can have their autonomy, but then they have to live with the consequences of their choices.
In all seriousness, I think there's obvious medical definitions for unhealthy in regards to addictions, weight, etc. Let's not philosophize some libertarian defense of something that obviously restricts and constricts one's freedom -- the ability to move an inch without your joints buckling.
I can sympathise with you if you have suffered from anti-fat bullying and adopt defensive attitudes in reaction -- but what the hell am I reading.
I agree - people need to be able to be called out when they are making bad decisions - especially w/regards to their health, and they especially should be called out by their health care providers - many doctors these days won't even broach the subject of a patient's weight, for fear of offending them - and I have seen patients file formal complaints against doctors when the doctor notes in their chart that the patient 'is obese'. It is right to tell them they are obese and it is right to encourage people to live healthier - how can you be a health care provider and not be allowed to call out people who are eating themselves to death?
Welcome to being an adult. People will do all sorts of things you think are not "OK", including people you're attached to. If you have kids, they will, too.
How we choose to deal with watching people do things we think they shouldn't is a matter of character.
I will say that I try hard to listen to people's criticism with an open mind, but people who badger me when they know I have considered their position, well, we tend to spend progressively less time together the more it happens. There's a difference between sharing information and punishing people for not complying, and I see no reason to accept punishment for something I don't intend to change about myself. A second-best fix for the problem, but better for everyone concerned.
It's only one self that can determine if one self is in balance or not. Just like we can lie to ourselves telling "everything is alright" while in truth it's not really the case.
But yes, as adults we can determine for ourselves. But it's a poor character trait not to be responsible for how you feel.
Well, we certainly do set up people for [heart] failure in our culture. Standard American diet is atrocious and I often day-dream about what it might take to transition to a culture around healthy, whole foods.
It's hard to imagine. And looking at the westernizing diet of the rest of the world, maybe that's a ship that never sails back. Maybe tech breakthroughs are the only hope we have if major cultural reform around health and food never arrives.
I wish the effect smoking has on the heart was advertised more.
People are terrified of cancer and that's all they think about with smoking, but actually far more people die from heart and stroke related illness after smoking than from cancer. I don't know the exact number, but it's a multitude.
>Bennett’s doctors said he had heart failure and an irregular heartbeat, plus a history of not complying with medical instructions.
>Patients may see Bennett’s death as suggesting a short life-expectancy from xenotransplantation, but the experience of one desperately ill person cannot predict how well this procedure ultimately will work, said ethics expert Karen Maschke of The Hastings Center. That will require careful studies of multiple patients with similar medical histories.
> Exactly what has happened since and the precise cause of Mr Bennett's death is not clear.
Which is the most useful information (next to the actual end of a human life here).
Did he die because the heart was ultimately rejected, or did he die from underlying complications that had made him ineligible for a human heart transplant in the first place?
If the latter, I'd still call this whole story a significant success and a possible step on the road to providing more transplants for people worldwide who won't survive without a new heart.
The most most interesting part of this story is they needed to delete the porcine endogenous retroviruses from the pig dna before the heart could be transplanted since that can infect humans. Next step is to use Crispr to kosher bacon.
May he rest in peace - he had some additional happy days from what it looks like, and he helped science advance a bit, kudos to him.
What worried me was when I read he was "not eligible" to be a recipient of a human heart; I hope this is not just because he had a bad (or no) insurance.
My recollection is that his general health was quite poor and he also had a documented history of not following doctors' orders.
Of course it's also probably not unrelated that he paralyzed someone for life in a stabbing attack many years ago, but I believe the official story at least was that this didn't enter into the calculus.
If you're not likely to survive very long with an organ transplant, you're not going to get one. Organs don't grow on trees.
Underlying medical conditions, refusal to follow medical orders, an unhealthy lifestyle (smoking, alcoholism, drug abuse) are all reasons to pass you over for someone more likely to survive with a transplant.
Medical resources aren't infinite, even when money isn't an issue.
Could they actually enhance the heart to be 10x stronger than a normal human. Giving the recipient superpowers.
I'm imagining the movie now BearMan, of course, we're still in the early stages, but I can imagine in 50 or 60 years being able to pick out all types of super enhanced implants.
All jokes aside, this man is a hero for trying such a crazy experiment, may he be the first but not the last. If this technology is perfected, no one will ever die waiting for a transplant again.
Not that it should detract from the main story, but the man who received the heart isn’t a hero at all… he stabbed a man multiple times leaving him paralyzed to die a slow death. Better to reserve the title “hero” to someone more deserving.
You seem to be missing the point - his repayment to society was being the guinea pig for a medical experiment, which would have been unethical to do on somebody in nearly any other circumstance.
Another comment points out that his crime was not taken into account, only the fact that he had no other medical procedures as options due to his ill health and history of not following doctor's orders.
Why should a persons crime be taken into account? If the person served their time in prison or did their community service or probation or whatever, they’ve done their sentence, and we should try to incorporate them back to being free people.
However, if it had been a dog's heart that was used, there'd be without a doubt at least one comment - probably several - expressing either kudos or sympathy to the "donor" dog.
I love dogs (especially mine), but there's no objective reason a pig's life has to be worth less than a dog's.
Why would the reason have to be objective? It's perfectly fine that the reasons are subjective. We're talking about people's emotional responses afterall.
Sadly, speciesism relies on the same foundational arguments that were prevalent when slavery was also still prevalent (in the west, at least) - which is why slavery was so prevalent. I'm sure those having their organs harvested in China are the subject of similar specious (ha) reasoning, which humans are all to ready to accept uncritically, as it benefits us too much.
If it’s specifically pigs up for discussion, vegan and vegetarian are the same, and vegetarian is easier — I’m vegetarian, and AFAIK there’s no food made from pig’s milk (certainly nothing I’ve seen in the local supermarket).
But as for healthy? That’s the easy part, there are so many healthy vegan options it’s silly. Food cravings however, that’s hard (and also why I’m only vegetarian, not vegan — I’m looking forward to improvements to vegan cheese[0] in particular given everything else on sale around here now has good enough non-dairy alternatives — though the other part is that I’m not hugely concerned about the ethics of free-range no-kill eggs).
[0] smoked tofu slices is good for sandwiches, but it doesn’t melt nicely on pasta
I tried vegetarian for a year and it was hard (this was 30+ years ago, and so much has improved!), but my current flexitarian diet is easy to maintain and a healthy option.
If you genetically engineer a pig to more like a human.
When does it stop being a pig and start being a human and given the rights of a person
If you genetically engineer a human to be more like a pig, at what point does it stop being a human.
I see a future where genetically modified humans grown in tanks raised for their organs, different enough were they are not legally classes as humans and you can farm them.
