Real Life Confessions of a Healthcare Addict

I have a personal confession to make. My father is a prostate cancer survivor. One month after he retired at the age of 68, he was diagnosed with advanced prostate cancer.  After undergoing radiation seed implants and hormonal therapy, he was in remission, until a couple of years ago. That’s when his addiction to health care began.

The Nightmare Begins

Starting a few years back, my father’s PSA would spike up all of a sudden.  When this happened, he underwent several rounds of bone scans, CTs, and blood tests. He ended up receiving cryotherapy, and later, stereotactic radiosurgery. More recently, he underwent chemotherapy. The problem is that his PSA is still very high, but his physicians have no idea where the cancer is hiding. There’s no obvious growth in his prostate, and his bone scans always come back normal. Still upon his physician’s recommendation, my father undergoes his CT, bone scans and blood tests every 6 months or so.

One day, as we were talking during dinner, my father mentioned that his doctors  billed his insurance company "a lot of money for the hormonal implants" as stated on his insurance claim’s Explanation of Benefits (EOB’s). He’d noticed that these claims were denied payment more often than not by his insurance carrier, which concerned him a great deal since he felt that this would sour his relationship with his doctor. He was just as surprised to find out many months later, that these claims would get paid, but after multiple claim submissions and denials, and at a much reduced, discounted rate. Suffice it to say that this experience rattled his illusion of me getting wealthy as a physician.

Seeing how expensive these tests were, my father also felt guilty for being such a burden to the health care system, undergoing test after test every 6 months, with no obvious origin of his cancer. Just the same, his doctors keep telling him that by all measures, his life expectancy looks grim as long as the numbers show evidence of cancer, and so still recommend testing as a precaution.

Healthcare Capitalism

One time, after seeing my father undergo an extensive battery of tests and radiation treatment that almost put him under, I tried using reverse psychology to get him to stop. Reasoning with him hadn’t worked until then, as what his doctors told him always trumped what I, or anyone else who loved him, said.  I sarcastically told my father that it’s his obligation as an American citizen to continue undergoing the testing and the treatments, as long as his physicians recommended it, since this is what drives our health care system. I added that massive consumption of healthcare is a major foundation of our economy. Without it, how else could we spend 17% of our GDP? Little did I realize at that time that he would take me seriously.

What More Could You Want?

A recent op-ed in the New York Times commented on using prostate cancer as a bell-weather for how we structure our healthcare system. Study after study has shown that overall, aggressive testing and treatment for prostate cancer doesn’t really change the overall life-expectancy compared with no treatment at all. Yes, there are some very aggressive tumors, but in comparison, there are much more incidental, benign-behaving growths that don’t grow or cause any problems. Just like thyroid cancer, prostate cancer is very common as men age. Only some behave aggressively.

The op-ed writer’s argument is that how we deal with similar medical conditions can make a major impact on not only cost containment issues, but also in many quality of life issues. He’s not saying we should just ignore it, but for most "routine" prostate cancers, follow it closely, but treat it very conservatively, intervening only when absolutely necessary. Since there’s no difference on life expectancy, what’s the point of spending millions or even billions on tests and treatment options that ultimately don’t make any difference in the long term?

I explained all of this to my father whose doctors recently recommended another round of radiation despite the fact that his stress test showed his cardiovascular functioning was that of someone 10 years younger. My father justifies continuing his current regimen for the following reason: Many of his close friends died of advanced metastatic prostate cancer, and clearly, doing something is better than not doing anything at all. When emotions are involved, logic, financial considerations and common sense all go out the window. It’s only natural, since it’s human nature. His doctors also feel compelled to do everything possible to give him and themselves peace of mind, in knowing every few months that that there’s no obvious return of the cancer.

Despite the cancer diagnosis, my father is healthier, more vibrant and youthful than many of his peers let alone his doctors. He takes undergraduate courses at Hunter College, plays a mean game of tennis, swims regularly, sings in his church choir, hikes on Hunter mountain with those that are 20 years his junior, and goes to the symphony and opera every chance he gets. He even played King Lear recently in a local theater production. Currently, he’s rehearsing for a role in The Fantastics. Although he’s living with a "life threatening" disease, this doesn’t prevent him from living the life he’s always dreamed of at the ripe old age of 78.

When More Is Not Always Better

According to Wikipedia, addiction is characterized as follows:  "the continued use of a substance despite its detrimental effects, impaired control over the use of a drug (compulsive behavior), and preoccupation with a drug’s use for non-therapeutic purposes (i.e. craving the drug)."

I’ll be the first to admit that I’m just as guilty in bringing about this healthcare crisis as anyone else. Up until a few years back, I was the same as anyone else-performing surgery, rendering treatment and dispensing medication according to the model standard of care. But over the last decade, the threshhold for what’s considered standard care has spiraled out of control.  In the case of my wife, for instance, who recently delivered our third child 10 years after our first, she had to undergo double the amount of tests and check ups, all the while spending countless hours negotiating multiple disruptions in her continuity of care (see the article Health Scare Crisis). Infant vaccinations have also doubled in the last 10 years, so if I choose to get just 1 shot rather than the recommended 2-3 shots per pediatric visit for Brennan, my newborn, I’d have to pay out of pocket for this expense since my insurance only covers for "routine visits".

In a 20 minute documentary video, The Story of Stuff, (www.storyofstuff.com), Annie Leonard details how as a society, we’ve become addicted to consumption. I highly recommend everyone watch this video. Similarly, we’ve also become addicted to consuming healthcare. It makes us feel good to have more tests, not because there’s any absolute proof it works, but "just because" it’s there. A day doesn’t go by when I don’t consult with a patient who’s on at least 10-20 different medications per day.  When I ask them if they think any of it is making a difference, they’ll say "not really, but at least it’s keeping the (i.e. cholesterol, blood sugar, PH etc) numbers down".  Despite dubious evidence that many pills or surgical procedures make any difference in the long run, doctors perform procedures or order more tests rather than spend time with patients or counseling them to help change their habits–especially when there’s zero compensation from insurance companies for doing the latter.

In another documentary, The Corporation (www.thecorporation.com) the narrator describes how a business entity that was created for the right economic reasons can morph into a paranoid schizophrenic monster. It’s not that the individuals within the corporation are malicious, greedy or even evil, but that the corporation itself takes on the personality traits of a greedy, delusional, psychopathic maniac. As I see it, this is what’s also happened to our health care system in the United States. Despite the good intentions we all had at the outset in providing affordable and accessible healthcare to Americans, our relationship to healthcare has morphed into a skewed dependency. Why should we eat right and exercise, which is so difficult to maintain, when there’s a pill for every ill imaginable and unimaginable?

The Only Thing To Fear is Fear Itself

Everywhere you look these days, there’s one fear mongering message after another being reeled into our consciousness. From the time you’re an infant to the time you’re old as my father, you’re told to protect yourself from encounter after near fatal encounter with every possible disease you can think of. At a picnic recently with some friends and family at a Westchester park about an hours drive from the city, a tiny tick barely the size of a pin-head was found on my friends’ young son. Instantly, everyone who attended was alerted to the possibility of Lyme disease and we begrudgingly woke up our three very sleepy children to comb through every nook and cranny despite the baths they took earlier. The thought going through my mind at the time was: you can never be too sure.

As such, healthcare is a major revenue generator, and as long as fear is what’s driving everyone, and as long as someone else (the government or your employer) is paying for to accommodate this fear, things are not looking too good for our future, despite all the proposed changes.

As for me, I’ve come to terms with my father’s illness. As long as my father continues to stay active and has a positive outlook on life, I’m not concerned about whether or not his cancer returns. My only fear is that if his cancer does return, the "prognosis" that he may be given by his doctors will ultimately come true as a self-fulfilling prophesy. In the meantime, I refrain all judgement of my father who now takes prides in the fact that he can continue to contribute to the health care system and to the economy by undergoing more tests.
 

Please note: I reserve the right to delete comments that are offensive or off-topic.

Leave a Reply

Your email address will not be published. Required fields are marked *

6 thoughts on “Real Life Confessions of a Healthcare Addict

  1. Brilliant! Absolutely brilliant and insightful. As one of those patients caught in the category of having excellent insurance, I find myself wondering how many of the tests I undergo from all my specialists are really necessary. Its often strikes me as to how much time I spend trying to understand the tests and results, rather than taking that time to enjoy the simpler pleasures of life. Thanks for giving me something to think about.

    my best to you and your father.

  2. Excellent! It’s great to see a physician with these insights.

    The flip side of all the testing, procedures, and spending is that we aren’t any healthier and sometimes even get worse from all the inappropriate treatment.

    In my own case, despite “excellent” health care and supposedly good health (I’m rarely ill), I have very thick medical file at my HMO network due to years of infertility, basal cell skin cancer, lipoma removal, tendonitis, arthritis, and many seemingly unrelated annoying health issues. Turns out I was hyperglycemic, hypothyroid, and am gluten -sensitive, and was Vitamin D deficient.

    I’ve given up wheat and other grains, all high sugar/high starch foods and as a a result, my insulin levels are kept normal and my BG remains in a very tight normal range throughout the day, instead of spiking high then low from roller coaster insulin production. That has improved every area of my life and my weight is normal and stable.

    I now take natural desiccated thyroid hormone, which has also improved my health tremendously. I had to go outside of my HMO network for the best care for my thyroid condition. Synthetic T4 alone did not improve my hypothyroid symptoms or quality of life enough; it merely returned my TSH to a place that pleased the endocrinologist.

    I supplement Vitamin D 5000iU a day now (despite living in So Cal) and am not only NOT deficient, but I keep my 25 (OH)D level in the higher end of the normal reference range (>60 ng/mL).

    My only regret is that I didn’t know enough about how to take charge of my health years ago, despite what many would consider a high degree of health-awareness. My years of infertility (not to mention the massive amount of money wasted during that time on fruitless tests and procedures) probably were due to mild hypothyroidism, but no one caught it, despite the many TSH tests (there was a definite slow rise in results over the years, always in the “high-normal” range which is now considered suspicious.

    In recent years I have saved my HMO insurer many thousands by not seeing the HMO docs because they often can’t see the forest for the trees.

  3. Thanks, Anna for your insightful comment.

    It’s a sad statement to make, but our health care system can definitely make you sick. The one exception is after you suffer from major physical trauma. But this is the system what we have, and we have to make the best of it. What’s most important is that you take responsibility for your own health, just like what you did. I agree with your philosophy that ultimately, what we eat (along with stress management, moderate exercise, and proper sunlight exposure) makes a huge impact on our health. Your hypothyroid situation is not too uncommon. It’s important to replenish nutrients and vitamins that you’re deficient in, but it’s more important to ask why is the deficiency happening in the first place.

    If you follow Weston Price’s work, take a look at pictures in his book of the native’s teeth when they ate completely off the land, and compare against those that ate processed, Western diets. Smaller jaw and more dental crowding also means a smaller airway to breathe through, especially when on our backs and in deep sleep.

    My wife and I are going through another dilemma with vaccinations for our 8 month old son—we’re torn between going with the flow (conventional Western medicine) or following our gut instincts (that there’s something not right with vaccinating against everything just because it’s possible). In the end, we’ll probably go ahead with the shots, since many are required for schools. I have a feeling that decades down the road, we’re going to regret it.

  4. I’m quite familiar with Weston A. Price’s work and for the last 5- years or so have been increasingly influenced by what I have learned. I am more choosy about sourcing my family’s food directly from small local farmers who raise animals in more biologically appropriate way (on pasture instead of confined and eating grain rations) and our produce is mostly seasonal and grown within our county via a farm subscription program (CSA).

    I’ve very pleased to learn you are also familiar with Price. I meet so few in the medical profession who have even heard of him.

    I understand your dilemma with the infant vaccines. My husband is a research scientist in biochemistry and even with his knowledge we often are on the fence about how to proceed with some of these decisions. We followed the suggested vaccine protocol for our 11 yo son but I didn’t question very much when he was an infant. Now I seem to want to turn every decision inside out to make sure I have considered all the options ;-).

    If I had to do it now, I would probably choose to space the vaccines out more, even if it is less convenient and more costly to our own pockets, and perhaps I’d opt out of some vaccines.

    Currently, my husband and I are discussing the H1N1 flu shots (he’s the only one who usually gets a flu shot annually). I don’t see a benefit, but his infectious disease colleague recommended it for our son, but didn’t say why (his school aged sons got the shot). I suggested we gather some more information about the vaccine so we can make an informed decision, not a knee-jerk reaction. We’ve seen such a huge increase in resistance to cold viruses in the past few years with our Vitamin D supplementation that I’m inclined to instead make sure we suort our immune system instead of resorting to iffy shots (and I’ve never had a true flu).

  5. For now, we’re spacing our son’s shots further apart. As for the flu shots, I have my reservations too, but now it’s a moot point. It’s mandated for hospital staff.

  6. Dear Dr. Park,
    Thanks for your thoughtful insights into a number of topics. First, on your father’s case, Please consider having his blood tested for XMRV virus, a newly discovered human retrovirus, only the third known to man. please check on Dr. Judy Mikovits at the Whittemore Peterson Institute. WPinstitute.org. the Cleveland Clinic’s Dr. Silverman and Dr. Klein discovered this XMRV virus in prostate cancer patients just 3 years ago. they have some videos on YOU TUBE.com, but the nursing home i am stuck in down here in Florida has blocked the use of youtube by patients because of some of their staff wasting time on the internet while at work…(ridiculous) or i would have looked up the videos to save you time.
    i have very crooked lower teeth, my mother did not breast feed me as a baby. i am 56. i have been bedbound for 23 years with chronic Lyme, Fibromyalgia and EBV, and more. it is a HORRIBLE disease. i have been diagnosed with three kinds of apnea, obstructive, central and mixed hypopnea. and tried a cpap on and off for 11 years of my 23 years bed bound with NO benefit at all. i have tried 5 different kinds of cpap masks. one place recommended a BIpap machine, but the sleep doc i was seeing said that medicare probably didn’t want to pay for it. so i don’t know if bipap is any better than cpap. I was so happy to hear you say how awful cpap is..i just hate it! But, i have HORRIBLE quality sleep. never get to deep sleep. severe dental problems. my sinuses are so blocked that a tech for an MRI posted back in 1989 that “sinuses of patient are blocked like concrete”. I saw a very nice doctor named Dr. Alec Chester in D.C. who suggested i get sinus surgery for my poor nasal quality breathing. often if i block one side of my nose, i can’t even breathe out of the other. it is awful. and i have really high BP. often up to 170/112. not good!
    and on your last son, i would DEFINITELY spread out those vaccines as long as possible even if you have to pay extra. with autism striking something like 107 boys, i don’t trust the medical establishment AT ALL!
    Best of luck with your business, you are obviously a smart guy. my life was been RUINED by lack of decent sleep. just destroyed. and though i would hate to have surgery, i don’t know what else to do. ciao for now. TMH