Blog | Thursday, November 6, 2014

Age is just a number, right?


In case you missed them, a couple of lay press articles hammered home the idea of our lifespans being finite.

First there was Zeke Emanuel’s provocatively titled “Why I Hope to Die at 75″ in the Atlantic.

The title was unnecessarily inflammatory. A lot of people saw that and thought “Health care rationing …” and “What a jerk!”

One of the core points of his article is well-taken: when we hit a certain age (75? 80? 85?), it no longer makes sense to “look for disease.”

Health care must continue improving and striving to reflect and honor the wishes of patients, but in addition, we should be more rational about whom we screen for disease and how often. It makes no sense to perform colonoscopies in octogenarians to screen for colon cancer. Even if they have it, the colonoscopy is unlikely to extend their life or improve its quality.

I think readers are right to quibble with Emanuel’s contention that at 75, creativity takes a nose dive. He was using that opinion, and the statistical evidence of age-related slowdown, in support of his point about the cutoff age for aggressive medical care. I hope sensible debate is not lost because of his tone and the fact that he’s seen as too political. He did work for the administration during President Obama’s first term, after all.

That same week, the New York Times published an opinion piece by Jason Karlawash of Penn, who wrote about musician Leonard Cohen’s decision to resume smoking (something he’d quit) upon turning 80. Titled “Too Young to Die, Too Old to Worry,” Karlawash examined how the 80+ population has grown from a 0.5% of the population to more than 3.5%. Doesn’t seem like a huge percentage, but it is certainly a significant increase and a huge demographic shift.

As Karlawash writes in the key paragraph of his piece: … Mr. Cohen’s plan presents a provocative question: When should we set aside a life lived for the future and, instead, embrace the pleasures of the present?

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.