A nightmare that doctors overwhelmingly choose to avoid when they die themselves

[HiPointDem]

99. and now that i've tracked down a couple of the sources, here's some information.

Last edited Fri Mar 8, 2013, 06:43 AM - Edit history (3)

The source of part of this claim is from this paper:

"Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?"

http://www.ncbi.nlm.nih.gov/pubmed/12834516

There were 765 respondents.

The question about CPR was in the context of having irreversible brain damage.

However, the comparison group of "ordinary people" did not come from this scientific paper.

The survey of 'ordinary people' was done by the staff of a radio show:

http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/

We don't know how many people they talked to or what exactly they asked them. They don't say, and we never hear them asking the entire question to anyone.

So I call bullshit on this part.


Here's some more info:

The paper cited for the CPR claim is this one (none of the others have anything to do with CPR survival rates):

Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.

http://www.ncbi.nlm.nih.gov/pubmed/22436956

It's a study done in Japan comparing use of ephinephrine v. no epinephrine in "out of hospital" cardiac arrest treated by EMTs.

I can't even figure out where the numbers in the graphic come from. It claims the study was of 95,072 subjects with 3% surviving with a good outcome and 3% surviving 'in a vegetative state'.

But the total number of subjects was 417,159 of which 402158 were in the 'no epinephrine' group.

The only thing close to the "3.0%" is the finding that in the no epinephrine group, 3.1% survived with "good or moderate cerebral performance" (Cerebral Performance Score of 1 or 2) and 3.1% survived with "no, mild, or moderate neurological disability" (Overall Performance Score of 1 or 2).

Neither of these categories equals "vegetative state".

So this claim just seems false.

The other part of it is that this surveyed a large group of subjects treated by EMTs outside hospitals (which can mean in the street, in a nursing home, in a public place or in someone's home), and includes people treated with varying time lags between the cardiac event and treatment (i.e. some may have been treated within minutes, some may have gone for a hour before getting CPR).

So it's one measure of the efficacy of CPR, but a pretty broad one.


Here's some more information:

The graphic highlights the point that $50 Billion (!!!) is spent yearly by Medicare on patients in the last 2 months of life. Wow, that sounds horrible!!

But about 2.5 million people die every year. Over 1.8 million of them are 65 and over; about 75%.

http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf

So that's about 26K/person. It includes all Medicare costs, including pharmaceuticals, hospice, and regular outpatient doctor or clinic visits.

1/3 of Medicare recipients die at home.
1/4 die in a hospital.
Average length of hospitalization is 10.9 days.
42% of Medicare recipients are on hospice care at time of death.

30% of Medicare recipients have an ICU stay during the last two months of life.

I'm not finding any good stats for average Medicare ICU stay in last months of life. However, for advanced lung cancer patients over 66:

22% have an ICU stay in the last 6 months of life.
87% of that 22% have only one ICU stay.
only 1/4 of that 22% is mechanically ventilated.
average stay = 5.9 days.
median = 4 days

http://www.medscape.com/viewarticle/576083_3


To me this suggests more that medical care is very expensive, not that people are getting too much hospital/ICU care. It also doesn't suggest that there's a large percent of the elderly population that's dying after being "hooked up to a ventilator & tubes" for a long time -- or even a short time.


But the main target seems to be getting people to use less care, not examining why the care costs so much.