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    I was working the overnight shift in a remote hospital in the Rocky Mountains. Late in the evening, a young African teenager was brought into the emergency department. He lived at sea level and had never been in the mountains. After skiing all day, he felt really ill. Everyone assumed it was altitude sickness.

    He was sweating and had abdominal (腹部的) pain. His heart rate increased. We sent off his lab work, and his blood sugar came back at almost 600 — normal is less than 100. His platelets (血小板), necessary for stopping bleeding, came in at 10,000; they should have been over 150,000. I did an ultrasound of his abdomen, and it looked like his belly was full of blood. This wasn't altitude sickness. And in the short time I'd been trying to figure out what was wrong, he was getting sicker. The friends he was traveling with were terrified, and rightly so.

    The mystery was finally solved with an old-fashioned microscope. When we looked at his blood, we saw some sickled (镰形的) red blood cells. That's how we were able to diagnose sickle cell trait. If you have sickle cell trait — which means you got the sickle cell gene from just one parent instead of two — you have no symptoms at low altitude, but high altitude can sometimes cause the red blood cells to turn into sickle shapes and take oxygen from vital organs. This teenager didn't know he had it, but the effect of the altitude on his blood cells was so extreme that after just a short time in the mountains, he suffered great pain.

    He needed platelets immediately, but we didn't have enough at the remote hospital. And there was a snowstorm, so the medical helicopters couldn't fly. It was a scary night. Just as we were abandoning all hope, we met an ambulance that drove halfway up from the city with blood products and transferred him to the city hospital for emergency surgery. The story has a happy ending: He recovered fully.

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    Our risk of cancer rises dramatically as we age. So it makes sense that the elderly should be routinely screened for new tumors — or doesn't it?

    While such vigilant(警觉的) tracking of cancer is a good thing in general, researchers are increasingly questioning whether all of this testing is necessary for the elderly. With the percentage of people over age 65 expected to nearly double by 2050, it's important to weigh the health benefits of screening against the risks and costs of routine testing.

    In many cases, screening can lead to additional biopsies(活检) and surgeries to remove cancer, which can cause side effects, while the cancers themselves may be slow-growing and may not pose serious health problems in patients' remaining years. But the message that everyone must screen for cancer has become so ingrained(根深蒂固的) that when health care experts recommended that women under 50 and over 74 stop screening for breast cancer, it caused a riotous reaction among doctors, patients and advocacy groups.

    It's hard to uproot deeply held beliefs about cancer screening with scientific data. Certainly, there are people over age 75 who have had cancers detected by routine screening, and gained several extra years of life because of treatment. And clearly, people over age 75 who have other risk factors for cancer, such as a family history or prior personal experience with the disease, should continue to get screened regularly. But for the remainder, the risk of cancer, while increased at the end of life, must be balanced with other factors like remaining life expectancy(预期寿命).

    A recent study suggests that doctors start to make more objective decisions about who will truly benefit from screening—especially considering the explosion of the elderly that will soon swell our population.

    It's not an easy calculation to make, but one that make sense for the whole patient. Dr. Otis Brawley said, “Many doctors are ordering these tests purely to cover themselves. We need to think about the rational(合理的) use of health care and stop talking about the rationing of health care.”

    That means making some difficult decisions with elderly patients, and going against the misguided belief that when it comes to health care, more is always better.