Regarding capital punishment, Samuel Johnson once observed that the prospect of being hanged concentrates the mind wonderfully. I have always suspected that he was right, but I can only offer myself as evidence – for, in the course of the last few months, the prospect of mortality has repeatedly reminded me just how lucky I am to be alive.
About twenty-one months ago, I took a PSA test. The previous year, my score had been 1.27 (a low level). On this occasion, it was 2.07 (also quite low). Percentage-wise, however, the jump was considerable, and I was on track to have doubled my PSA in the course of eighteen months. This, because my brother had been diagnosed with aggressive prostate cancer when he was in his early sixties, I took as a warning, and I called an old friend, a physician who worked at the National Institutes of Health (NIH), for advice. Had I not been so wary, had I waited another year, as my local physician advised, I would have found it consoling when my PSA score dropped back from 2.07 to 1.77.
As it happened, however, my friend drew my attention to an experimental program in diagnosing prostate cancer then underway at NIH, and I signed up to be a guinea pig. As I spelled out in detail in an earlier post, in March 2011, at the Clinical Research Center, I underwent a trans-rectal MRI, and, with the help of the images thereby produced, I had a targeted (as well as the standard scattershot) biopsy. Because the biopsy was targeted, the surgeon in charge, Dr. Peter Pinto in the Department of Urology at NIH, was able to sample the lesions revealed by the MRI. On this occasion, Pinto and his team found cancer, but only 2% of the tissue gathered was cancerous, and it was graded in the laboratory report as Gleason 6 (not especially aggressive).
A year later, both procedures were repeated. The MRI suggested that nothing much had changed, but, on this occasion, the samples taken were 50% cancerous. Although they were once again graded Gleason 6, Dr. Pinto told me that intervention was advisable; and, being not so terribly old and otherwise healthy, I opted for surgery, and Dr. Pinto did the job on 25 June.. I have, in previous posts, described the surgery and the immediate aftermath. It should suffice to say that it was no picnic but that the effort was successful, that my prostate was removed, that the surgical reconstruction of my urethra was successful, that I am neither incontinent nor impotent, that the cancer was in fact Gleason 7, rather than Gleason 6, and much more aggressive than previously thought, and that it had not spread to the lymph nodes nearby. My PSA is now zero, and there is every reason to suppose that I am cancer-free.
There was, to be sure, a complication. To sample the lymph nodes in the immediate vicinity of the prostate, Dr. Pinto cut into them, and in the aftermath of the operation the lymph nodes that remained bled fluid in considerable amounts. This collected in the cavity near my left kidney and formed a lymphocele (not a lymphedema, as I erroneously reported in an earlier post). This collection of fluid pressed hard on the muscles controlling axial motion in my left leg, and in late July I experienced considerable pain. In consequence of this, I returned to NIH on 24 July; a catheter was inserted into my lower back to drain the fluids, and, in the period stretching from that date to 21 August, various attempts (mainly via sclerotherapy) to reduce the flow.
While in the Clinical Research Center, about a week after my return, I came down with pneumonia. This raised on the part of the staff a level of concern that, initially, I did not understand. Their worry was that I had what they called “hospital pneumonia” and not the more ordinary “community pneumonia.” The former was said to be resistant to antibiotics, and, on the off-chance that I had it, I was put on a cocktail of antibiotics, delivered intravenously, that I had never heard of. They were harsh and corrosive, and, after a day or so, the vein into which they had been introduced would collapse. In time, the staff in the Department of Infectious Diseases, managed to grow a culture on my sputum, and from this they learned that I had “community pneumonia.” When the word came through, I was put on Amoxycylin, and I recovered with reasonable alacrity.
What I did not know the time was that the previous summer a woman with an antibiotic-resistant strain of Klebsiella pneumoniae, who was in desperate straits, had been brought from another hospital to the Clinical Research Center at NIH; that the antibiotics given her had failed to do the job; that, in the six or seven months that followed, the disease had spread to seventeen other patients at NIH; and that five of these had, as a consequence, died. The “hospital pneumonia” that the staff feared that I had contracted was the so-called superbug; and, as they almost certainly knew when they treated me, another patient – a boy who had had arrived in April – had been diagnosed with the disease on 25 July, the day after my return to the facility. He died this past week.
That I am now cancer-free and that I did not contract the superbug is a matter of dumb luck, and it gives one an appreciation for what modern science can do and for what it cannot do. It should also give one pause.
The particular superbug that ended the life of my fellow patient at NIH is found today in only 6% of American hospitals, but there are other antibiotic-resistant diseases lurking in other hospitals, such as Staphylococcus aureus, MRSA, E. coli, and Clostridium difficile, to mention just a few. In the years to come, their number will grow, and in the pipeline, I am told, there are almost no new antibiotics. If nothing is done, our children may live in a world akin to that of our forebears – in which there are no antibiotics capable of being deployed against the most common diseases.
Just how this situation is to be headed off is unclear. The physicians I spoke with blamed the pharmaceutical industry, which is not investing the requisite sums in research. This may well have to do, however, with the fact that the scientists have reached a dead-end and that no breakthrough is on the horizon. It may also have to do with the way we fund medical care both in this country and abroad. Socialized medicine of one sort or another is the norm – even in the United States where Medicare and Medicaid rule the roost. The cost of developing new antibiotics and of shepherding them past the Food and Drug Administration is immense. The risk of failure is great, and the likelihood of generous recompense is small. Wherever there are monopsonies – single buyers – the cost of an item or service may easily be forced down – but at the price of suppressing innovation.
It is not enough that we repeal Obamacare. If we do not reform Medicare and Medicaid, if we do not return to the free market, we will in all likelihood be sacrificing the prospects of our progeny.
-- If you liked this post and want to join the conversation on it, click here to sign up for a One-Month Free Trial Offer. --