Articles of Interest This Week

Gubar Birds

Cancer

Somewhat less encouraging, an update on some of the problems encountered getting cancer vaccines to be more effective in Cancer vaccines self-sabotage, channel immune attack to injection site. However, getting a better understanding of why should help find ways to make vaccines more effective.

From Cancerwise, comes 4 common myths about cancer doctors, which I think is pretty universal, at least based upon my experience here in Ottawa and other readings. The list: small stuff is important, collaboration is practiced, doctors care about their patients’ time, and no issues with getting a second opinion.

A summary of academic literature on the benefits of exercise post-cancer treatment, noting the uncertainty about what approaches work best, including long-term motivation in More Studies Support Exercise During and After Cancer. In the end, motivation has to come from the individual, although support structures (family, friends, support groups, exercise classes, activity trackers) can help strengthen this.

A new initiative from the American Cancer Society, “WhatNext”, another portal, similar to PatientsLikeMe, about sharing patient experiences, but with a cancer focus. Described in For Cancer Patients, It’s Not Just About What’s Now But Also What’s Next–And We Can Help Answer That Question, and in my initial exploration, seems like a well designed portal and tool.

Susan Gubar, an a somewhat amusing piece, tries to categorize the various types of people who comment on her cancer by bird companions in Living With Cancer: For the Birds. Doesn’t completely work but captures some of the awkwardness on both sides:

At times, I have to admit, there is absolutely no response to my cancer that seems acceptable to me, probably because the cancer isn’t. Chirping about other subjects can seem evasive or boring. Chatter about it casts a confining net. Apparently I’m the only one with the right tweets. Should I be left alone to brood in my bristly nest?

But happily I don’t have to choose between exasperation and isolation, given my dear friends near and far: the homing pigeons bearing their quotidian comforts, the perching owls with their phlegmatic wisdom. How splendid to be under their wing! Surely even a lame duck like me shouldn’t go on categorizing and castigating while delighted by the dappled plumage of their numbers: a host of sparrows, a convocation of eagles, a cast of hawks, a charm of finches.

An interesting detail about former Canadian Prime Minister Trudeau, who chose not to treat his metastasized prostate cancer given his also being diagnosed with early dementia, an eminently rational decision in keeping with his motto, ‘la raison avant la passion’, in Faced with dementia diagnosis, Pierre Trudeau rejected cancer treatment.

A lung oncologist throws some cold water on IBM’s Watson for cancer diagnosis in Is IBM’s Watson in Jeopardy? This Oncologist Thinks So!, noting that:

Knowing how much of what I and so many other thoughtful oncologists do, integrating principles and conclusions from one population with judgments and principles to help guide us through cases with many unknowns, I find it very difficult to envision that any algorithm could be complex enough to mimic that thought process that so many of my patients and colleagues value in my perspective.

Watson will likely be invaluable for integrating new medical data and published content in the medical literature. But it is simply a fool’s errand to distill a “best workup” or “best treatment” for the more complex cancer cases.  The medical recommendations it creates based on a learning process of digesting case histories from Memorial Sloan-Kettering Cancer Center (MSKCC), Cleveland Clinic, and other institutions can only be as good as the data that are input and the decision-making processes it is charged to recreate. Not to slight the excellent physicians whose views shaped the algorithms developed, but those algorithms are still the product of human minds and their own subjective interpretations of limited data, laced with significant biases. 

Needless to say, IBM’s CEO has a different view in IBM CEO Ginni Rometty Crowns Data As The Globe’s Next Natural Resource.

Lastly, Leading scientists sign up to global cancer manifesto captures the need for greater cooperation among cancer research organizations worldwide, and greater attention to cancer prevention, particularly in developing countries.

Health and Wellness

To reduce smoking rates further (from the current 20 percent to less than 10 percent), Richard Daynard, in Op-Ed ContributorTwo Paths to the Gradual Abolition of Smoking, suggests regulations to reduce nicotine levels in cigarettes to below addictive levels and prohibit selling cigarettes to anyone born after 2000. And Sugar industry’s secret documents echo tobacco tactics documents early efforts by the sugar industry in the 1970s to discourage public discussion of links between sugar consumption and health.

Some ongoing debate on US health care costs from the Time story featured last week (The Great Healthcare Scam (And The Future Of Journalism)). From Forbes, a detailed analysis of some of the statistics used that suggest the case may be overstated but is not fully convincing to me (5 Myths in Steven Brill’s Opus on Health Costs–Part 1). A more balanced debate can be found in The Great Healthcare Scam, Ctd, including some policy prescriptions. Always strange as a Canadian, given single payer and medicare, to see these variances in pricing.

Sunrise Rounds has a good post on the teaching culture of medicine in The doctor will teach you now, and how this also applies to patients:

The best doctors remember that their calling is not only to teach practitioners of the health sciences; it is their duty to teach their patients.   Every patient can identify physicians whom have the patience and skill to explain the complex in clear language, allowing the patient to make better decisions and have better control of life.  Knowledge is to fear, as water is to fire or as oil spread on a turbulent sea, brings calm.  Patients are the greatest benefactors of a deep educational culture connecting the centuries and ending at individual bedsides.

While not intended to be morbid, This test may offers clues on whether you’ll live beyond 10 years is an interesting way to look at risk factors. Unfortunately, I have not been able to find the direct link to the test, as all the articles I have seen do not seem to have a direct link.

Some nice reflections by Robert Abramson on the ‘follow-up’ culture, where watchful waiting and six month recalls are part of our new reality in Our Wait-and-See Medical Culture. We cancer patients have been aware of this for some time, given fear of relapse, but this also applies to potential cancers or comparable issues

Welcome to the “follow-up culture.” The danger here is that we will always be living in the future: the scan was O.K., but what about in a year? No advances in medicine, as remarkable as they may be, will ever provide us solace for this predicament.

And yet, as disturbing as it is, it also provides an opportunity to live our lives to the fullest each day. As some Eastern philosophies tell us, life is like a river, in perpetual motion, and when we flow with it we attain a level of tranquillity. My patients and I will never know what the future holds for us in this new medical calendar, but my hope is that we can come to terms with the river, make friends with it, and allow it to teach us to be present in the here and now.

And one of the latest developments in reading the body, the following short video shows how magnification of body movements can be used to good effect (i.e., monitoring breathing of babies), but doesn’t go into how it could be used for less worthy aims (e.g., gambling in combination with Google glasses):

Other

A nice summary in The Ethical Nag about changing behaviour, and some tips on how to do so in The three triggers that can change behavior (the elements are motivation, ability and trigger, to which I would add support from others).

A fun collection of quotes by writers on criticism in Cultural Icons on Criticism. My favourite is Joan Didion’s:

A certain amount of resistance is good for anybody. It keeps you awake.

TED tipsBill Keller on the The Bullying Pulpit, or how social media tends, ironically, to be less social and more shouting or talking past one another on any number of issues. A reminder to all of us of the role we can play in making discourse and debate more courteous. His reflections:

  • Social media rewards partisanship. It is the nature of the medium that like-minded people talk to one another and reinforce one another. It is easy to dismiss any aliens who challenge your prejudices. Unquestioned prejudices shrivel into slogans and labels.
  • Immediacy encourages snap judgments, and once you have voiced your judgment to the wide world it is more difficult to retreat from it. Sree Sreenivasan, the chief digital officer at Columbia University, has said he spends an average of three to five minutes composing every tweet he sends. But that goes against the Twitter grain, where I suspect most tweets take three to five seconds.
  • In a crowd – and the Internet is the ultimate crowd – there is a temptation to SHOUT to be heard. This is especially true when comments are unfiltered, and the crowd noise consists in large part of nips and jibes and sneers.
  • Anonymity – and much of social media still permits anonymity – is license to be vicious.
  • The Web culture is simultaneously elitist and anti-authoritarian, as you might expect from a universe that (for now) skews young, educated and attentive to fashions. The technology is open to all; the ambience is more clubby.
  • It is always on, and it gets inside your head. If you are a kid hounded by the class nasties, or an adult being punished for an unpopular view, there is no escape.

Evgeny Morozov is getting a lot of airplay on his new book, To Save Everything, Click Here: The Folly of Technological Solutionism, casting doubt on technology as a solution to all our problems. Well worth reading his piece in the New York Times, The Perils of Perfection, and his interview in The Globe and Mail, Why the Internet isn’t the solution to everything. This graphic provides a funny way to structure a TED talk, and fits into the Morozov critique.

Favourite quote:

The ideology of solutionism is thus essential to helping Silicon Valley maintain its image. The technology press — along with the meme-hustlers at the TED conference — are only happy to play up any solutionist undertakings. “Africa? There’s an app for that,” reads a real (!) headline on the Web site of the British edition of Wired. Could someone lend that app to the World Bank, please?

Shockingly, saving the world usually involves using Silicon Valley’s own services. As Mr. Zuckerberg put it in 2009, “the world will be better if you share more.” Why doubt his sincerity on this one?

Whenever technology companies complain that our broken world must be fixed, our initial impulse should be to ask: how do we know our world is broken in exactly the same way that Silicon Valley claims it is? What if the engineers are wrong and frustration, inconsistency, forgetting, perhaps even partisanship, are the very features that allow us to morph into the complex social actors that we are?

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