Kool-aid urine and tinnitus acceptance.

As I finish Ironing my scrubs for another week, my head is full of thoughts and reflections.

Last week I saw one of my patients after chemo. One of the infusion nurses had said the patient was in pain, and also had the standard nausea that the harder core drugs often induces despite all the anti-nausea meds we pump them full of. We ushered the patient to a bathroom and acquired a urine sample. It looked like berry kool-aid or even beet juice. I was petrified, but smiled and stayed (on the surface) calm for the patient's sake as I ushered the patient to a room and laid him/her (I don't breach confidentiality) down on an exam table. I left him/her in the ultra capable hands of the infusion nurse and ran to the lab with sample in hand. Even the lab tech asked me to please tell her that the cup was anything other than urine. We rushed it over to the machines and I went back to tend my patient and continue patient flow for my Dr. once he had handled this crisis. We ended up admitting the patient to the hospital in the end.

This made me think about the drugs we use in my practice. There is BIG money in chemo drugs. We have one cabinet with a person's unused meds in it. There is a 10 month supply which translates to $55,000 worth of meds. That is only one person's drug. And that is a single drug. Many patients are on multi therapies. Or have even more expensive drugs. This is a burgeoning business of patents and promotion. All to treat the cancer. None of this cures cancer at all. The funding for research is given by those looking to make a profit. Curing is not really a goal. It is more cost effective for pharmaceutical companies to treat forever and accept pain and loss and damage than it is to cure. See a cure has a defined end point. A place where the $ stops coming in. It would not be viable for them to invest in unpatentable drugs either. So any and all research on unpatented drugs is left to researchers using indepenent funding. Now lets say an unpatented cure (Like the one covered in New Scientist last month) comes up. Who would fund the trials for that? Not the pharmaceutical companies. Without funding, the FDA won't even look at the viability of a trial much less approve the trials to start. It all seems very frustrating. Until we revamp the system enough that cure is more cost effective than treatment and acceptable loss there will be no funding for the right research.

This weekend I went to my husband's workplace and talked with a lady who works there. Her mom has had inner ear issues. The last doctor was willing to accept that hearing loss, loss of equilibrium, and lost mobility were totally acceptable because of her advanced age. I have encouraged the daughter to seek different medical care for her mother. Largely because I don't believe that accepting age as part of a debilitation process is reasonable. I think that the way we treat the elderly attests to our defeatism about the war on aging. So often doctors discount the realities because of aging. Well this lady's mother went from bedridden and hearing loss to regaining bits of her hearing (still a constant ringing in one ear) and regained mobility. All with the simple insertion of tubes. If they keep pushing they may even find some way to eliminate the ringing. I want to see wellness in the elderly. Not acceptable decrepitude.

Again there is not big money in improving quality of life. There is big money in end of life treatment, however. When health care as we know it collapses (and I truly believe it will, and hope it will) part of restructuring and values will be ethically driven cost effectiveness. Wellness over profit. It seems logical but I assure you in America the idea is still frighteningly novel.