Comments on GeriPal - Geriatrics and Palliative Care Blog: Cheating Death: A Book Lost in Definitions

Anyone know how to do things like this?

2010-02-15T10:47:49.067-08:00

Anyone know how to do things like this?

Hi, Thanks for writing the review of the book. Wh...

2010-01-01T16:49:52.404-08:00

Hi,
Thanks for writing the review of the book. When I saw the title "cheating" death, I knew the book wasn't for me.

I have a terminal degenerative brain disease and I consider death a process not to be feared but as a part of life.

Also there is life then there is just hanging on in limbo between life and death. When I get to that point of limbo, my personal option is to go ahead and cross on over to the other side.

Dying is teaching me so much about living.

Thanks for the comments. I actually thought this...

2009-12-31T11:15:38.409-08:00

Thanks for the comments. I actually thought this book had some potential. Dr. Gupta does have a good writing style that is very accessible to the general public (something that is very hard for doctors to do). He also does a good job of presenting his case that the medical profession is making great strides in prolonging lives of those critically ill.

What is lacking though is any relevance to what occurs in the day to day work in a medical ICU or in working with patients who are chronically ill. As a neurosurgeon Dr. Gupta may not have a lot of experience with this population, but in writing this book he should at least acknowledge that most people now a days die of chronic progressive diseases rather than falling through the ice in a Scandinavian glacier.

Mike - I am not knowledgeable about Dr. Gupta's previous work to know whether his blurring of "brain death" and PVS is a common theme. I would like for him to set the record straight though considering that he is the chief medical correspondent to CNN (or at least move over to Fox News)

So, would any of his peers (physicians, surgeons, ...

2009-12-23T19:30:59.096-08:00

So, would any of his peers (physicians, surgeons, neurosurgeons) consider this book an example of malpractice?

A question for laypeople, or for non-physicians, might be - what purpose or benefit is served with this book?

Personally, I see the book as yet another example of how members of the corporate media act to protect or advance their own material interests.

Gupta sure couldn't pull off this deceit if he was a blogger.

I'm really disagree that "You're not ...

2009-12-23T14:09:36.587-08:00

I'm really disagree that "You're not dead until Sanjay Gupta says you're dead" . cos I'm not a "MD" . I just believe that it's same other perspective that human kind think "I'm a God".

Thank you, thank you, thank you for writing this c...

2009-12-22T20:28:17.856-08:00

Thank you, thank you, thank you for writing this criticism. It has been extraordinarily frustrating these last few months since "Cheating Death" has been published to see so little criticism of Gupta's obvious misinformaton concerning brain death. His co-author (ghost writer?) Caleb Hellerman in the Amazon reviews, and whoever supervises the CNN comments pages, have actively obfuscated and stonewalled criticism. Comments critical of Dr. Gupta are cencored on CNN. BTW, there are only 3 critical views with low votes to the 9 praising reviews on Amazon. It would be worth your time to post there.

I can add two things. This isn't something new for Gupta. He's been misinforming about brain death for years, and has been criticized for it before. See Truog RD. Brain death – too flawed to endure, too ingrained to abandon. Journal of Law, Medicine, and Ethics 2007; 35(2):273-281. For those that doubt the criticism is justified, see the white paper from the President's Counsel on Bioethics from this year: http://www.bioethics.gov/reports/death/index.html
The current professional discussion about brain death is about improving the definition of death and the protocol for determining irreversible upper brain function, not about a supposed failure of brain death.

The other thing is that I've come to believe that Gupta's motivation for doing it is right there in the book. Against any evidence he actually does believe that a surgeon could reverse brain death, and that brain death is just a variation on vegetative state. The surgeon as god, in other words. You're not dead until Sanjay Gupta says you're dead. In interviews promoting the book he claims that he has personally seen the charts of patients who were declared brain dead but survived. This is deceitful in that he has not published anything about this in the peer reviewed liturature. In other words, he's delusional. He prefers his own subjective misunderstanding of brain death to the objective consensus understanding because it serves him better. Its more sensational.

This reminds me of that old rumor that if you chec...

2009-12-21T08:33:21.073-08:00

This reminds me of that old rumor that if you check the box on the back of your driver's license to be an organ donor, the EMTs won't try as hard to save you. Very responsible, Dr. Gupta. Not.

Fascinating review. I did not read the book, and ...

2009-12-20T21:38:42.222-08:00

Fascinating review. I did not read the book, and based on this review probably won't. I did see parts of the related special hosted by Dr. Gupta on CNN. Some of the stories of survival were certainly inspiring.

That said, the stories tended towards the sensationalistic, particularly the contention that one can "cheat death" if one just tries hard enough.

It does sounds like the book creates some confusion around the issue of brain death. I dont recall this being an issue on the CNN special, though I could have missed this. The components I saw on CNN convey the sense that medical technology can now save some people on the brink of death, who probably would not have survived in the past. That is all fine, and there is nothing wrong per se with conveying this or describing these interesting stories. The problem is that these cases are vastly different from most of the patients in ICUs, in whom aggressive of medical care decisions will need to be made. Most of the stories I saw portrayed on CNN apply to generally well, high functional status people who have a catastrophic event.

In some ways, these issues reminds me of a NEJM paper that described CPR as portrayed on television--which was wildly optimistic in terms of outcomes and survival (http://content.nejm.org/cgi/content/abstract/334/24/1578). There was nothing wrong per se with each of these TV shows---it is certainly there purview to be dramatic. However, collectively, these shows were probably damaging to the public by creating an untrue sense of the outcomes of CPR.

I don't really have a problem with Dr. Gupta choosing to write a book about dramatic cases. These cases are not typical, and the book may not create a correct image about what medical care can offer to most people. It is important that this be made clear to the public.

Perhaps one of the problems is that Dr. Gupta's responsibilities as CNN's chief medical correspondent is different than his responsibility as an author. I am not sure how these roles should be balanced. I am not sure an author has a responsibility to present a balanced perspective. However, in his CNN role, objectivity and balance are important. While it is certainly fine to present compelling human interest stories, they should be presented in proper perspective. Perhaps the CNN coverage needed to take a different perspective from that of the book.

Thanks, Eric. I could tell this wasn't a book ...

2009-12-19T15:29:07.352-08:00

Thanks, Eric. I could tell this wasn't a book for me as soon as I got it home from the library.

I wanted to share this end-of-life decision from a NYT op-ed today: http://www.nytimes.com/2009/12/19/opinion/19sat4.html?th&emc=th

"Which means that now is the time for a hard decision. According to the vet, there are no signs of disease, other than the disease of age — nothing to force our hand. When Tavish died, four years ago, his liver was failing, and there was no choice but to sit on the floor and hold him while the vet inserted the final needle. It’s somehow not surprising that Darcy raises the matter of our responsibility in its purest form.

"I’ve known too many owners who waited far too long to put their dogs to sleep, and I’ve always hated the sentimentality and the selfishness in their hesitation. Last week, watching Darcy out in the sun, it felt as though I was trying to decide just when most of the life — the good life, that is — inside her has been used up. Is it conscionable to wait until it’s plainly gone? Or is it better to err on the side of saying goodbye while she’s still discernibly Darcy, while she seems, as she nearly always does, to be without pain?"

great summary Eric

2009-12-19T08:55:03.437-08:00

great summary Eric