Alzheimer's discussion shouldn't focus on number of deaths, and other letters

Regarding the article “Alzheimer's may be leading cause of death after heart disease, cancer,”, it is my experience that Alzheimer's disease claims more lives than are reported on death certificates that spell out pneumonia or urosepsis instead of the underlying cause. But people who write articles such as this forget that death is one of the few zero-sum games—the denominator is always 100% of humans. Humans have to die of something, and if we reduce the number of people dying of Alzheimer's, it will increase the portion of people dying of something else.

Nobody wants to see their parents or themselves suffer from the loss of their minds and memories—that's the reason to look for treatments, not that the disease produces death. Before we spend more money looking for ways to live longer, maybe we should concentrate some money on making old age worth living. The number of elders who would prefer a quick, peaceful death to waking up the next day is higher than you think.

Dr. Lou Lukas

Regarding the recent article “Mammography debate heats up with new study”, when I was a young physician (I am now 71), many women had metastatic breast cancer at diagnosis or soon thereafter. I had the sad duty to sit at the bedside of many women dying of breast cancer. This changed with the introduction of mammography in my community in the early 1980s and may have been complemented by tamoxifen (introduced in the late 1970s), but surely is not because of tamoxifen alone. Only a very small percentage of women in my practice were ever treated with tamoxifen, and the decrease in metastatic breast cancer was in the order of 80%.

Mortality from breast cancer in women having regular mammograms has gratifyingly decreased substantially, and it defies logic to ascribe this to anything other than mammography. Ditto for the use of PSA (prostate-specific antigen) in detecting early and curable prostate cancer.

We do need further scientific study to reduce overtreatment of breast and prostate cancer, but certainly not a movement away from early diagnosis of lethal cancers. No one can assert that all of the cancers diagnosed early by mammography and PSA are nonlethal. This is where research should be focused. Not on nonblinded studies that cloud the debate more than clarifying it.

Dr. Abe Levy

I applaud Modern Healthcare for highlighting the important issue of patient blood management in the article “Time to transfuse best blood practices at hospitals". The decision of whether to transfuse blood products is gaining significant attention. Clinical studies have shown that evidenced-based transfusion practices are generally associated with better patient outcomes, as well as reduced resource utilization.

A growing number of institutions are turning to patient blood management—the evidence-based, multidisciplinary approach to optimizing the care of patients who might need a transfusion—as an important component of their care-planning decisions. Yet more needs to be accomplished within individual hospitals, health systems and medical societies to promote greater awareness of this approach among clinicians, including increased education and expert advice.

Lance Trewhella