A gut check in an acclaimed actor’s sad death and a leader’s abrupt resignation

abe-150x150Boseman-150x150The world has received painful reminders about the adage about decision making that also applies to digestive health: “Always listen to your gut.”

Movie fans are mourning the tragic and early death of the brilliant actor Chadwick Boseman. He was 43 and battled colon cancer with courage, including as he starred as the “trailblazing Marvel superhero ‘Black Panther,’ “as well as “real-life icons Jackie Robinson in ‘42,’ James Brown in ‘Get on Up’ and Thurgood Marshall in ‘Marshall,’” the Los Angeles Times reported.

The Japanese, in the meantime, dealt with sadness and uncertainty as Shinzo Abe, their nation’s longest serving prime minister, announced he would step down from office due to a relapse of ulcerative colitis, the bowel disease that led him to resign after just a year during his first stint in office, the New York Times reported.

As the American Cancer Society has noted:

“In the United States, colorectal cancer is the third leading cause of cancer-related deaths in men and in women, and the second most common cause of cancer deaths when men and women are combined. It’s expected to cause about 53,200 deaths during 2020.

“The death rate (the number of deaths per 100,000 people per year) from colorectal cancer has been dropping in both men and women for several decades. There are a number of likely reasons for this. One reason is that colorectal polyps are now being found more often by screening and removed before they can develop into cancers, or cancers are being found earlier when they are easier to treat. In addition, treatment for colorectal cancer has improved over the last few decades.”

As for debilitating ulcerative colitis, the federal Centers for Disease Control and Prevention says this:

“In 2015, an estimated 1.3% of U.S. adults (3 million) reported being diagnosed with inflammatory bowel disease or IBD (either Crohn’s disease or ulcerative colitis).1 This was a large increase from 1999 (0.9% or 2 million adults). Some people were more likely to report having IBD, including those: aged 45 years or older; Hispanic or non-Hispanic white; with less than a high school level of education; not currently employed … living in poverty; [and] living in suburban areas. This estimate does not include children younger than 18 years, who may also have IBD. Most people with IBD are diagnosed in their 20s and 30s.”

Ulcerative colitis — with its persistent and problematic diarrhea, weight loss, abdominal cramping, anemia, and blood or pus in bowel movements —  elevates patients’ risk for colon cancer.

With bowel conditions, correct diagnosis and early treatment can be key, and patients may need various screenings, included the invasive and dreaded (by many) colonoscopy. This procedure can be uncomfortable, stigmatized, costly, and over used. African Americans suffer higher rates of colorectal cancer and should discuss with their doctors the risks and benefits of colonoscopy, particularly if they have family history of the disease or symptoms of bowel problems. Although colon cancer typically afflicts older adults, younger people should not ignore this disease, as it is occurring more often in patients younger than 50.

Boseman chose not to make public his cancer diagnosis and colleagues have expressed surprise at how the South Carolina native and proud Howard University alumnus excelled in demanding roles while likely undergoing difficult treatment and suffering pain and discomfort.

As the Los Angeles Times reported of Boseman:

“Earlier this year, he earned critical raves for his riveting performance in Spike Lee’s Netflix drama ‘Da 5 Bloods’ as ‘Stormin’ Norman Earl Holloway, the fiery lost leader of a squad of Black soldiers in the Vietnam War … Boseman had completed filming on another Netflix project, the 1920s-set musical drama ‘Ma Rainey’s Black Bottom,’ adapted from the play by Wilson, with Viola Davis and Colman Domingo, due for release later this year … Boseman was set to star in and produce the samurai action story ‘Yasuke,’ set in 16th century Japan, for his own production banner, Xception Content, and was poised to reprise his Marvel role in ‘Black Panther 2,’ which has not begun production.”

He won raves, of course, in the path-breaking Panther film, of which the newspaper reported:

“As Black Panther, the Marvel Cinematic Universe’s first Black superhero, Boseman became the face of Wakanda to millions of fans around the world and helped usher in a new and inclusive era of superhero blockbusters. ‘Black Panther,’ directed by Ryan Coogler, was nominated for seven Academy Awards, including best picture. It earned more than $1 billion at the worldwide box office and remains the fourth-highest-grossing movie of all time in the U.S. (not adjusted for inflation).”

As for Abe, the New York Times reported this of his eight years as prime minister — the longest stint in his nation’s highest elected office:

“[H]e had overseen Japan’s recovery from a devastating earthquake, tsunami and nuclear disaster, restored the country to a semblance of economic health, and curried favor with an unpredictable American president, Donald J. Trump. Yet despite his long hold on power — it was his second stint as prime minister, having held the post from 2006 to 2007 — Mr. Abe fell short of his ultimate goal of revising the pacifist Constitution installed by the United States after World War II. He was also unable to secure the return of contested islands claimed by both Japan and Russia so that the two countries could sign a peace treaty to officially end the war.”

Abe might be considered a political natural, as he was the grandson of a prime minister (accused of war crimes) and the son of a former foreign minister. He also was haunted by illness, which combined with scandal to force him from politics before. Though he helped secure the Olympic Summer Games for Japan and held his own with high-profile global leaders, notably Trump, he lost popularity and struggled to deal with the Covid-19 pandemic and its economic shocks, as rumors swirled around him and his own health. He said he was losing the strength required for high office and will need extensive treatment. (By the way, Japan, with a population of 126 million, or roughly a third of the U.S., has recorded 1,226 Covid-19 deaths and almost 65,000 infections.)

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

Over testing, over diagnosing (and misdiagnoses), and over treatment can further add to patients’ costs and problems with the U.S. health care system, as can relentless, historic, and systemic inequities in medical care for African Americans. With all that said, patients can benefit themselves and their health by not — even with their Covid-19 pandemic worries at the fore — forgoing regular doctor visits and preventive and appropriate care, especially diagnosis and medical services for treatable illnesses and chronic conditions. It is tragic to see the loss of world class artistic and leadership talent due to disease, and we have much work to do to help do what we can to prevent its occurrence.

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