Saturday, February 21, 2015

Last Resorts - The California Sunday Magazine

The charter bus leaves Los Angeles for Tijuana at the height of morning rush hour. Frank Cousineau does his best to keep his three dozen or so passengers entertained as they inch down the I-110. "On your left is the Staples Center," he says over the scratchy P.A. system, "and all of downtown Los Angeles." A few miles later, Cousineau, a 68-year-old grandfather with a light drawl and a thick mustache, hands out bran muffins and tucks into a topic closer to his audience's interests: the supposed cancer-curing powers of hydrazine sulfate, a semitoxic chemical compound used to prevent corrosion in industrial processes.

For $100 a person, Cousineau, who runs a nonprofit advocacy group called the Cancer Control Society (ccs), is leading a tour of four alternative cancer clinics in Tijuana. My seatmate, a friendly and devout dentist named Nate Liu, has been on the tour before, after his wife developed breast cancer five years ago. She's currently taking an herbal regimen she obtained domestically, but Liu is curious about new treatments in Mexico. "Half the people on this bus are here for research, to bring help back to the U.S.," Liu tells me. "The other half are looking for a miracle cure."

"I just can't tell you how many people have recovered using hydrazine sulfate," Cousineau says as we hit cruising speed in Orange County. Since American distributors have been "persecuted by the fda," he adds, the treatment is now only available outside of the U.S.

There is no hard data on the number of Americans who seek alternative cancer treatment at Tijuana's 20-some-odd clinics (though there is data showing that most of that treatment doesn't work), but it's high enough to support a cottage industry of entrepreneurs who offer consultation, transportation, housing, and even funding to desperate patients. Cousineau first learned about this world in the 1970s, when his mother was diagnosed with colon cancer. After she finished several punishing bouts of chemotherapy, Cousineau took her to a clinic known today as Oasis of Hope, in the Playas neighborhood of Tijuana. During one of their stays, he met Rosario de los Ríos, nicknamed "Chayo," a secretary at the clinic whom he eventually married. His mother succumbed to the cancer, but Cousineau believes her death was more comfortable because of her time in Tijuana.

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Wednesday, February 18, 2015

Doctors Strive to Do Less Harm by Inattentive Care -

Suffering. The very word made doctors uncomfortable. Medical journals avoided it, instructing authors to say that patients " 'have' a disease or complications or side effects rather than 'suffer' or 'suffer from' them," said Dr. Thomas H. Lee, the chief medical officer of Press Ganey, a company that surveys hospital patients.

But now, reducing patient suffering — the kind caused not by disease but by medical care itself — has become a medical goal. The effort is driven partly by competition and partly by a realization that suffering, whether from long waits, inadequate explanations or feeling lost in the shuffle, is a real and pressing issue. It is as important, says Dr. Kenneth Sands, the chief quality officer at Harvard's Beth Israel Deaconess Medical Center in Boston, as injuries, like medication errors or falls, or infections acquired in a hospital.

The problem is how to measure it and what to do about it.

Dr. Sands and his colleagues decided to start by asking their own patients what made them suffer.

They found several categories. Communications — for example, a doctor blurting out, "Oh, it looks like you have cancer." Or losing a valuable, like a wedding ring. Or loss of privacy — a doctor discussing a patient's medical condition where an adjacent patient could hear.

"These are harms," Dr. Sands said. "They elicit suffering. They can be long lasting, and they currently are largely unquantified, uncounted, unrecorded."

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