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  • Volume Eight, Number Five: July 2003


    Well what did you expect?

    Dr. Diane Forbes, DC

    This past week it was hard to not have noted the story of Ladan and Laleh Bijani, the 29-year-old conjoined (a.k.a. Siamese) twins from Iran who requested a risky surgery to separate them. They opted to undergo a multiple day surgical procedure that had been untried on adults in order to attempt to live more normal lives. Reports state that they were given a 50-50 chance that one or both of them would die during the operation. As we now know, neither sister survived the operation.

    What interests me about this report is that if they had been born only 20 years earlier they would never have faced the possibility of separation through a surgical intervention.

    But today many things are conceivable that would never have been possible in earlier days. The Bijani twins would have never dreamed of separation, and would have never considered the possibility that they could live healthy and separate lives. They did however dream these dreams, because they held some expectation that one if not both of them could live out this dream.

    The practical thinking about a 50-50 chance is that if Ladan had died, then Laleh would have lived and vice versa. However this belief is unfounded. What their 50-50 chance represents is a possibility that over many of these procedures about half of the patients would survive. Unfortunately this means that there could be very many failures in a row resulting in many deaths before there are an equally large number of survivors. It could be another decade or more before both twins could be expected to survive such a procedure, and possibly longer to ensure that the survival leads to a full and meaningful life. Maybe there would be such limited interest from consenting adults that we never learn enough to ensure the survival of both twins.

    In today’s medical environment we are constantly faced with odds of getting some disease and or chances of cures from ailments. We are all familiar with the sense of impending doom that a five per cent death rate from SARS (Severe Acute Respiratory Syndrome) gives us. We also worry about increased risks of death from eating peanuts to our children, accidental death to our teens and from smoking to our friends and ourselves. But we rarely flip this sense of odds awareness on our likely success of getting over some illness or injury.

    When we arrive for treatment at the clinics of our health providers we often hold the sense that every ailment is curable, that we should be able to resume our prior activities without inconvenience or delay. And this is often not the case. Two per cent of back injuries never go away, becoming chronic. The failure rate from breast cancer treatment is around 19 per cent. Almost seven per cent of patients have negative reactions to prescribed medications. Often what we hope will be the outcome of medical treatment is not what results.

    When we approach the practitioner’s office we need to have realistic expectations about what can be accomplished through treatment. Not everything goes away, in a short time, by taking a pill. Some conditions become issues that can only be managed over the long term. Your health care provider is by oath making every attempt to provide you with the best care they can. And often you are not served better by attempting experimental therapies that are read about online or in the paper. Odds chances provided for these therapies are just guesses until true measures can be made by providing treatment to many patients, some who have very unsuccessful outcomes and others who have no success at all.

    Every one needs to talk to their care providers to make sure that their expectations are realistic. Maybe your expected outcome and the true success rate of care are really far apart. Even the most commonly employed treatments have failure rates for therapy. Unfortunately some of us have to make up the proportion of patients who end up with outcomes that less than satisfy our expectations. Our prior good health helps us to overcome illness and injury, but it does not guarantee our success in treatment. Sometimes the outcome is less than hoped for, just as the Bijani sister’s case has reminded us.


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