Thursday, August 6, 2009

Alabama Surgical Case Reflects a Health-Care System in Disrepair

A 35-year-old Alabama woman underwent an extraordinarily rare surgical procedure four months ago in an effort to fight off advanced cervical cancer. She died last week, and her story reflects a malfunctioning health-care system as President Barack Obama fights gamely for reform.

Melissa McCutcheon was diagnosed with cervical cancer in 2002 after she had gone almost five years without a Pap smear in an effort to save money. The cancer, which has a high cure rate when caught early, was advanced at the time of discovery, and McCutcheon had been bedridden for most of the past four years.

In a last-gasp effort to fight off the disease, she had a hemicorporectomy in late March at the University of Alabama at Birmingham (UAB) medical center. The procedure involves amputation of the lower half of the body, including removal of the legs, genitals, pelvic bones, urinary system, rectum, and base of the spine.

McCutcheon, who lived in Lacey's Spring near Huntsville, never recovered from the radical surgery and died last Tuesday morning in a UAB intensive-care unit.

McCutcheon worked as an administrative manager for Lowe's before being disabled from her disease. After she was unable to withstand more radiation or chemotherapy, she proposed the hemicorporectomy to her oncologist.

The surgery was developed in the 1950s, based on advances from treating battlefield injuries in World War II. Only about 45 people worldwide have had the surgery since it was first performed successfully in 1961.

One online article describes hemicorporectomy as "probably the most mutilating operation ever to be described in surgical literature." The article outlines the possible complications from the procedure:

Hemicorporectomy results in a reduction of body weight by about 50%. The reduction in total vascular area reduces the ability to compensate for changes in circulating blood volume. Small losses may produce shock and intravenous transfusions can easily produce pulmonary oedema. The loss of normal abdominal wall function results in a reduction of lung vital capacity and functional residual capacity and a ventilation-perfusion mismatch with tidal volume diverted more to the lung apices.

News accounts of the McCutcheon story have focused on the human-interest angle. Numerous ethical, procedural, philosophical, and financial questions have gone unanswered. For example:

* Who at UAB made the decision to proceed with the surgery?

* Did any oversight body review the decision?

* Who were the doctors that made up the surgical team?

* How much did the procedure, and postoperative care, cost?

* Did McCutcheon's insurance cover the entire cost? If not, who covered the rest?

* Did UAB stand to benefit from performing the procedure, from publicity and perhaps opportunities to publish articles in medical journals?

Perhaps the biggest question is this: Was performing a hemicorporectomy on Melissa McCutcheon a wise use of our health-care dollars? And are decisions to go forward with high-risk/low-reward procedures one reason America's health-care system leaves so many citizens with no coverage at all?

How did our system work in the McCutcheon case? It provided a radical surgery at the end stage of her disease, when the chances of success were slim. But it failed in providing the simple, inexpensive test that probably would have helped cure the disease early on.

As for McCutcheon herself, it appears that she was a good-hearted, well-intentioned person who simply wanted to live in order to help raise her two teenage daughters. She was not the type to think only of herself, and she clearly thought about the bigger world around her.

Most cases of cervical cancer are caused by the human papillomavirus (HPV), which can be transmitted during sex. In a 2006 interview with the Decatur Daily, McCutcheon said she contracted HPV from a sexual encounter in her youth, and she became committed to helping girls learn from her experience:

Her face beams with joy, knowing she has outlived the few remaining days that doctors gave her in February 2005 and that she's using her time to help other girls avoid her mistakes. "I had no idea you could get cancer from a virus," McCutcheon said of human papillomavirus. "And if I would have gone to the doctors years earlier, we would have caught it, and it wouldn't have been a big problem." McCutcheon's big problem briefly describes about four years of repeated surgeries, radiation and chemotherapy treatments that resulted in a radical hysterectomy, removal of most of her colon and bladder, the loss of a kidney, and nerve damage that has left her unable to walk. A month after she lost 27 units of blood in January 2005, doctors gave her three days to live.

McCutcheon tried to use her remaining days wisely:

Though understandably scared, McCutcheon wasn't ready to give up hope. "That's when I decided if I'm going to stay, I need to be effective. There needs to be a reason why I'm here," McCutcheon said. "I asked God to at least let me be here till my youngest graduates high school." Her daughters, ages, 11 and 12, need her to stay active in their lives, she said, so they don't fall into the same lifestyle McCutcheon grew up in the small community of Woodville, between Huntsville and Scottsboro. The town offered teens little to do but get in trouble, she said, and sex was viewed as an easy diversion. Until she became a Christian in her mid-20s, she said, she, like all her friends, followed the view, "If you have a relationship, you have sex." And she added that she waited longer than most of her friends, losing her virginity as a high school senior. "The average age for most of my friends was 12 to 14," McCutcheon said. That's the age range of girls she wants to warn about the dangers of premarital sex, as well as the need to get vaccinated against HPV. "There's still going to be consequences. Maybe not a disease or pregnancy, but emotional ones," she said. Aided by a computer slide show, McCutcheon has spoken to girls at her church, Brindley Mountain Baptist, as well as a church in Hampton Cove. She tells them postponing sex till marriage is worth it so they'll have something special to share with their husbands for the first time. "You've probably already told someone that you love them or kissed them or gone to second base with them," she said. "You really want to have something that's special just between you and your husband." Her pastor, the Rev. Ken Galyean, said he was amazed at her effectiveness. "My daughter said it was the most holy time she had ever spent, and she just sensed the presence of God in a sweet and powerful way as Melissa humbly shared in open honesty of how she got cervical cancer from a promiscuous lifestyle."


Anonymous said...

Real Health Care Reform - Universal Single-Payer | by Stephen Lendman | Global Research, August 5, 2009

Organizations like Physicians for a National Health Program want Americans to have the same system in place in all other Western countries and elsewhere, including Venezuela, South Korea, Japan, Cuba, Brazil, Saudi Arabia, Costa Rica, Singapore, Taiwan, and Thailand. But not in America - the only industrialized country without it despite spending more than double per capita than the other 30 OECD countries and delivering less for it.

In a September 2007 report to Congress, the Congressional Research Service (CRS) compared 2004 US health care spending with other OECD countries:

-- America then averaged $6,102 per person, well over double the average $2,560 for OECD countries;

-- US health care spending was 15.3% of the economy compared to 8.9% on average for OECD countries; for Canada it was 9.9%; Germany - 10.6%; Great Britain - 8.1%; France - 10.5%; and Japan 8.0%;

-- "US prices for medical care commodities and services are significantly higher than in other countries (delivering comparable care) and serve as a key determinant of higher overall spending;" high insurance and drug costs are the most significant factors;

-- life expectancy in America is lower than in other OECD countries;

-- the US ranks 22nd on life expectancy at birth; post-65, it's 11th for men and 13th for women;

-- America has the third highest infant mortality rate after Turkey and Mexico;

-- heart disease, cancer, and respiratory diseases are the top OECD country causes of death; America ranks 17th for heart disease "despite (performing) substantially more invasive heart procedures than all the other (OECD) countries;"

-- quality of US health care isn't superior overall; nor do Americans "have substantially better access to health care resources, even putting aside the issue of the uninsured;" and

-- because of the cost, many Americans delay or forego treatment.

World Health Organization's (WHO) Ranking of World Health Systems

WHO ranks America 37th overall, behind Saudi Arabia, United Arab Emirates, Iceland, Malta, Colombia, Cyprus, Morocco and Costa Rica and about equal to Slovenia and Cuba.

In other measures, it has the US 24th on life expectancy, 72nd on level of health, 32nd in distribution of care, 54 - 55th in financial contribution fairness, 15th in overall goal attainment, and first in per capita amount spent. If Obamacare is adopted, it will drop America lower in world rankings by making its dysfunctional system worse.

In a 2007 Commonwealth Fund study comparing Australia, Canada, Germany, New Zealand, the UK and US, America ranks last as in its earlier studies on access, patient safety, efficiency, chronic care management, and equity. Most notable is its absence of universal coverage. Overall, the US ranks poorly on its ability to promote healthy lives through affordable, high quality care. Its for-profit system prevents it.

Anonymous said...

Ron Paul on the Obama administration’s healthcare proposals:

“It is nationalized healthcare, this pretence that it isn’t completely just means that there is some transition involved. Their goal is to have one party payer, which means that they control everything. And there’s a lot of other bad things in too like this effort to consult with anybody who’s over a certain age and talk to them about end of life type of procedures.”

“This bill is just such an outrage, the American people see it for what it is, it’s going to cost a lot of money, their care is not going to be improved, and special interests will be served.”