The Ghost Ranch in the Carson National Forest in New Mexico provided a fitting backdrop for a discussion on justice and health care. The seminar was attended by consumers and health professionals, and focused on creating a health-care system that is medically, economically and ethically acceptable. The questions raised were universal.
Do ethics and resources have anything to do with each other? Do health resources determine ethics? Do ethics determine resources? Is there any ethical basis for denying treatment to someone solely on the basis of age?
Finally, we got to the question of what is health care. Is it a basic human right for everyone (old people, infants, the homeless and unemployed), an investment in our collective humanity or another consumer good available only to those who can afford it? Will we have to choose the use to which limited resources will be put? Within the health-care budget, what choice will society make between research and treatment? Between restorative therapy for those already ill and preventive measures for those at risk? Among different age groups? Among different diseases? Between humanistic care and high technology, if such a choice needs to be made?
The discussion raised more questions than it answered, perhaps because ethical questions never have definitive answers. However, such difficult questions will have to be faced. The answers to these resource-, ethical- and value-laden questions will determine the future of program development for the frail elderly.
Question: My daughter (age 43) and I (age 75) were both diagnosed as having breast cancer within seven months of each other. I've heard that older women do better than younger women. Is this true?
Answer: Recent research from Sweden on the relationship between survival and age at diagnosis of breast cancer indicates that older patients having a more favorable outlook is not necessarily true.
The Swedish researchers' analysis of 57,000 patient records found that women ages 45 to 49 had the best prognosis, with survival rates exceeding those under age 30 by 7% to 13%. Survival declined after age 49, and women above 75 had the lowest rate of survival.
These statistics are extrapolations from research and cannot be universally applied. How long you and your daughter will live depends on a range of considerations. Speak with your physician about your concerns and perhaps join a breast-cancer support group.
Q: I am a 61-year-old man. I play tennis weekly and am still active in a law practice. Several months ago I noticed a small lump in my breast that hasn't gone away. Is it possible for men to get breast cancer?
A: Yes, men do get breast cancer. Although it is rare, breast cancer is now diagnosed in one in 1,000 men per year, as opposed to one of every 15 women in the United States.
Signs of the disease include a lump (usually painless) near the nipple area, or a sore on the skin. Unfortunately, because most men are embarrassed or think they can't get breast cancer, they delay seeking medical treatment. When the disease goes unrecognized until in advanced stages, treatment results are poor. Male breast cancer is more likely to occur in someone age 60 or older.
Another condition that men may experience is enlarged breast tissue. The enlargement is most commonly caused by medications, including digoxin, some tranquilizers and antidepressants, and drugs used for hypertension.
Like women, men should pay attention to changes in their breasts and seek medical care. In most cases the problem is likely to be minor, but if you are the rare man who has breast cancer, the sooner you seek treatment, the better the outcome.
Q: I take the drug Feldene for rheumatoid arthritis. I heard that Ralph Nader wants to ban its use by elderly people. Is this so? Why?
A: Feldene is the brand name for piroxicam, a widely prescribed anti-inflammatory arthritis medication. The Health Research Group, a consumer-protection organization founded by Ralph Nader, asked the government last January to declare piroxicam an "imminent hazard" to health in the elderly and ban its use in people over age 60. The recommendation was based on reported deaths, gastrointestinal bleeding and perforated ulcers associated with the drug's use in the United States and Great Britain.
The Food and Drug Administration held hearings and recommended to the Department of Health and Human Services that the petition be denied. Research found no basis for concluding that piroxicam is more likely to cause gastrointestinal toxicity in the elderly than other similar products. Health and Human Services Secretary Otis Bowen ruled in favor of the FDA's recommendation.