Think outside the box and we'll clean up D.C.

November 2, 2009
Eric Trefelner, MD

Volume 31, Issue 11

I would like to call to order these hearings of the Senate Medicare Oversight Subcommittee's investigation into death panels.”

I would like to call to order these hearings of the Senate Medicare Oversight Subcommittee's investigation into death panels.”

“Point of order, Senator. Due to our recent member losses, we currently do not have a quorum without Senator Dean West.”

“Well, we'll begin informally without him and go on the record once he shows up. Let's start with our first witness; good morning, Dr. Trefelner. We understand that you serve as chair of the local Washington, DC, death panel.”

“Senator, there is no such thing as a death panel.”

“What . . . ? Oh, I get it. What do you call them then, quality of life panels?”

“No. We don't need euphemisms. We simply strive to provide excellent medical care.”

“OK. But what do you call them?”

“Death committees.”

“Sorry to interrupt, Senator, but we just learned that Senator West was taken to the ER last night. We are trying to find out if he'll make it in this morning.”

“You might have a long wait.”

“Pardon me, did you say something, Dr. Trefelner?”

“Senator West was . . . let go . . . last night.”

“What?”

“It was a quality of life issue.”

“Quality of life?! He was only 42. He has a wonderful wife and three beautiful children.”

“Not his quality of life, ours. His votes in Congress were adversely affecting our quality of life.”

“Doctor, I'm 89 and falling apart, so I could understand it being my time, but Dean! Dean had everything to live for. I can't believe . . . Ahhh! My chest! . . . call an ambulance.”

“Don't bother. It won't make any difference.”

“Ack! . . . ”

I was on vacation in Budapest recently and stayed in a Soviet-era Hotel, in which I am convinced Stalin personally did the interior decorating. (Why does a hotel need rooms with a drain in the floor and easy-to-hose-down walls?) But Budapest in August is so hot and humid that even the granite statues of Lenin were sweating and my hotel's air conditioning wasn't working. Having seen the movie Hostel, I was unwilling to stay at the local one, so I opted for the only other rooms available at the peak of tourist season, at the Four Seasons' Gresham Palace.

I believe that snobs who think the more something costs the better it is are just chumps. A hotel room is just a hotel room, and you don't even spend that much time in it while on vacation. Right? WRONG! My new room had 14-foot ceilings, original Art Nouveau detailing, and French windows that opened onto a balcony overlooking the blue Danube. Sleeping in the bed was like dying and going to heaven. No wonder Julia Roberts and Oprah Winfrey say the beds at the Four Seasons are their favorites. The towels were so plush that I lost my keys in one of them and the hotel had to send the gardener up with a weed whacker to find them.

The staff treated me like a god and catered to every one of my unreasonable demands with glitteringly white, straight smiles (no small feat in Budapest). The chamber maid kept CIA-like track of my habits and anticipated what I would need/want next. No wonder Madonna was staying just down the hall. And the bathroom! The bathroom rivaled Rome's Baths of Caracalla when they were new. It was a symphony in polychromatic marble and glistening surfaces. A bathtub you could do laps in was capped by beautiful crown molding. A vast array of emollients, shampoos, moisturizers, lotions, scented soaps, and baths salts were there for sybaritic soaking. I realized I never wanted to leave. And if I couldn't live there forever, then I wanted at least to be buried in the bathroom when I died. So I immediately called down to the concierge's desk and asked if I could be buried in the bathroom. Without missing a beat he said they would send someone up immediately. After a particularly large tip to the bell boy to discourage him from offing me right then and there, I realized that if the Four Seasons can do it, then death panels just might be feasible.

Let's face facts: We are already killing people on a daily basis-though it is currently just random and takes too long-so the idea really wouldn't be anything new. Up to 40% of imaging studies are unnecessary, resulting in needless irradiation of patients. The New England Journal of Medicine has come out with yet another article about the risks of medical imaging, “Exposure to low-dose ionizing radiation from medical procedures,” and an accompanying editorial, “Elements of danger-the case of medical imaging,” in the Aug. 27th issue. The Journal of the American Board of Family Medicine recently ran an article called “Overtreating chronic back pain: time to back off,” (January) which noted how inappropriate medical imaging turning up irrelevant and incidental findings is a frequent starting point for a downward spiral into drug addiction. Not unexpectedly, the critics have come out attacking these articles and defending medical imaging. They argue that radiation, when used appropriately, is safe and essential to patient care. Where have we heard that before? Every day it seems a previously-deemed-safe-by-the-FDA drug or procedure is found to do more harm than good.

It is particularly ironic that this debate should be raging at the same time that the critically acclaimed, graphic memoir Stitches, by David Small, has come out. Contemporary experts are a little full of themselves and their “safe radiation” arguments. There was a time-not too long ago-when experts were advocating x-rays as treatment for acne, eczema, hypertrichosis, tinea capitis, pain control, tuberculosis, blindness, nymphomania, and even respiratory problems. Sadly for David Small, his father was a radiologist who followed these recommendations and bombarded his son with numerous x-ray treatments, which resulted in his developing thyroid cancer at age 14. The requisite surgery left him with only one vocal cord and no voice. I say, why not choose more appropriate targets?

I would rather use my talents for good, so as soon as I finished the book I faxed the Obama administration my CV. Soon afterward I got a very polite phone call from a very nice man, who informed me that the administration had no plans for death panels, but they would keep my CV on file and I could expect a call in six to eight weeks. Personally, I think they are overly optimistic, since the major problem with the Obama administration is that they have been marketing the death panels all wrong. I think if the average American knew that the primary targets would actually be politicians and lawyers, there wouldn't be any opposition. Actually, we would probably find the halls of Congress clogged with villagers brandishing pitchforks and torches. For myself, I would be happy at this point to settle for a more aggressive version of the ImageGently.org campaign so that 20 years from now we don't have any more David Smalls.

To be honest I had planned to make up a list of names for my first death panel-excuse me, death committee-meeting, but have actually been unable to come up with the name of a single politician I would actually want to . . . spare.