Articles of Interest This Week

CBC

Cancer

In The simple act of truth in the face of incurable cancer, Elaine Waples speaks powerfully of what is important when faced with knowing that one will die. It all comes down to the people one loves. Quote:

The hard things that tug at the heart and create the pain are the unbearable truths to parents that they will lose a child; to siblings that the person they’ve known their entire lives will be gone; to children that they must overcome and move on. They convey a clear and undeniable message to doctors that they must relinquish the desire to salvage, fix and prolong.

In a similar vein, a doctor recalls how sharing his loss helped a patient come to terms with the terminal illness of her husband in Sharing my loss helped a patient’s loss.

This story surprised me: Suicide rates may be higher in stem cell transplant recipients, detailing the results of a massive European study of close to 300,000 stem cell recipients (both auto and allo). Delving into the details, some of the findings are more understandable: higher suicide rates among those suffering from GvHD, and higher relapse rates among those who have attempted suicide. But the overall findings still surprise me given the awe, wonder and gratitude that most of us feel when given another chance at life.

Hard to believe, but More Than a Quarter of Melanoma Survivors Skip Sunscreen, Study Finds. While the experts try to find excuses (more education needed, perhaps tanning is addictive), I am more drawn to a simpler explanation: human stupidity.

A good overview of progress in cancer research and treatment by Dr. Len Lichtenfeld of the American Cancer Society, more optimistic than usual, in Is Cancer Research and Treatment Moving From Evolution To Revolution?

A good piece in Le Devoir by Marika Audet-Lapointe, Libre-opinion – Cancer: abandonnons les métaphores guerrières:

Alors, s’il y a lieu de livrer un combat, d’accord, j’accepte, et je revendique le droit de la personne touchée par le cancer de choisir sa façon de composer avec le défi du cancer. Que chaque personne puisse vivre sa vie jusqu’au bout, comme il le souhaite. Qu’une fois rendu au bout du sursis que représente la vie, il puisse se tourner vers son miroir intérieur et se dire avec un grand sourire : « Combien de montagnes, de lac et de défis j’ai surmontés, et combien je suis heureux et fier de porter en moi la certitude d’avoir savouré la vie, ma vie, en harmonie avec mes valeurs et mes convictions. »

Jim Salwitz shares how he and other oncologists deliver bad news in How doctors give bad news, and puts it into perspective:

This takes us back the vital question asked by my friend; how does a doctor prepare emotionally to give bad news? I think the answer is that the physician prepares by getting ready to do his job well. If he does a good job delivering the bad news, than he has helped the patient and family move forward in a difficult time of their lives. Done well, this is satisfying and important work. While at times it can be sad and even tragic to work with patients who are experiencing overwhelming health events, if the doctor can guide them through such times, then some element of suffering can be avoided. The healing of suffering, giving the chance to cope and preserving hope, gives every doctor peace and solace.

Health and Wellness

Nearly 25% of nurses wouldn’t recommend their hospital reports on a survey of Canadian nurses. While the figure is alarming (somewhat attenuated that almost 90 percent think safety measures are adequate), I wonder whether if you asked nurses what alternative hospitals they would recommend if they would be able to come up with an answer (we generally know our own environment, strength and weaknesses, not other environments). It also tells me, which I already know, that nurses, like doctors, are always dissatisfied with the quality of care they can provide, a good sign as it helps prevent complacency and mistakes.

A more useful survey is CBC rates 10 hospitals best in Canada, as it provides hospital ratings. Of course, the rating system used can bias the results, but transparency does focus the mind on where improvements may be required. I checked out the ratings for The Ottawa Hospital (where I received my care) and it received a B. I would rate it higher for the cancer care I received; interestingly, it received highest ratings for being patient friendly.

Experts blast Health Canada’s approach to sodium reduction points out that voluntary guidelines without transparency and monitoring are likely to be little more than symbolic with little effectiveness. Another critique of government policy comes from André Picard in Tories deliver a hollow boast on health-care spending, noting how federal health policy has weakened a national healthcare consistency and delivery.

My Name is Roger, and I’m an alcoholic is about Roger Ebert’s experience with AA and how it helped him (and others) with his alcoholism, and a reminder of just how powerful support groups can be.

Lastly, Getting a Brain Boost Through Exercise reminds us of the importance of exercise to reducing memory loss and improve cognitive function, ideally through a mix of aerobics and strength training.

Other

A two-minute video of earth from space from a variety of perspectives.

I have featured earlier some of Christian Wyman’s reflections on religion and Christianity (see HERE), and Andrew Sullivan’s take on Wyman’s book On Christian Wiman’s “My Bright Abyss” captures the questioning better than some of the more secular reviews:

In short, Wiman’s book is the beginning of a conversation we very much need to have, and he clears away so much of the accumulated ridiculousness that has grown-up around discussions of religion in this country. He clarifies the questions we should be asking more than he offers “solutions.” Please read this book – for now, I only can urge that you approach this elegant, difficult testimony to what faith – always mingled with doubt, and always seeking to connect with lived experience – can mean in the modern world with honesty and an open heart. It truly is an essential book for our times.

Not sure whether I will read the book now, but one on my list.

A nice take on happiness in Happiness, Beyond the Data by Gary Cutting, in which he postulates four factors as being key to happiness: good luck, fulfilling work, the ‘proper pursuit’ of pleasure, and human love.

Articles of Interest This Week

Cancer

Not much new but Is the war on cancer an ‘utter failure’?: A sobering look at how billions in research money is spent provides a sobering look on cancer research and treatment, noting that most of the improvement has come from prevention (anti-smoking campaigns), with marginal improvements in most other outcomes. I do not think it is quite as bleak as all that; given the complexity of cancers, both at the individual and common levels, it was naive to expect early ‘cures.’ Managing cancer as a chronic disease does have real benefits to people such as myself. And the latest approach to cancer research, Cancer Dream Teams: Road to a Cure?, outlines how interdisciplinary teams, comprising researchers from a range of disciplines, recognize the complexity of cancers and will hopefully lead to promising results. Not sure how much is ‘repackaging’ of what was likely common practice already.

Much has been written about the links between environmental factors and cancer. Cancer Cluster or Chance? goes behind the science and uncertainty of accounts like Toms River: A Story of Science and Salvation, underlining the difference between correlation and causation, the wish to see patterns where they may be none, and how the politics plays itself out. I would still take a more ‘precautionary principle’ approach that the author, as I think the cumulative effects of our exposure to various chemicals and the like is not without impact, but important to understand the limits of what we know and don’t know. For the review of the book, more sympathetic than this piece, see Books: On the Trail of Cancer: A Review of ‘Toms River’ by Dan Fagin.

James Salwitz on The fine balance between hope and cope in cancer patients, reminds doctors and patients of the need for honesty in discussing the prognosis and usefulness or not of treatment. The rush to treatment, in some cases, can prevent a patient from doing more important things and enjoying life. In a related post, Oncologists vs Hospice, he comments on the need for oncologists to have earlier end-of-life discussions with patients to avoid unnecessary treatment and suffering. And Suleika Jaouad reminds us that not all of us make it through our journey, in A Friendship, Interrupted, about one of her friends who she met in the cancer ward.

The Semantics of Cancer, by Karin Diamond, is another in a series of reflections on the terminology of cancer, and the risk of insensitive comments. Some good examples of what not to say, could be strengthened by a stronger sense of grace and recognition that people, despite their best intentions, will sometimes say the wrong things, and one has to appreciate, in many cases, the intent behind the comment. But her closing remarks were spot-on:

Let’s turn up the love and respect and turn down the need to pounce with our own solutions to problems that may not even exist. The choices someone makes may be drastically different from how you’d approach a situation, but there is no single right way to survive and thrive in this wild and beautiful life. Let’s give each other the space and freedom to do that however we must, minus all the pressure and expectations.

And a reminder in Cancer patients who are positive in the face of terrible adversity that positive thinking doesn’t improve outcomes or survival. However, the article fails to acknowledge the importance that positive thinking can make to getting through cancer treatments, both for the patient and those close to them, and that it may help the patient be more active in their treatment, helping recovery time.

One of the cancer blogs I follow, Thinking Out Loud, has an all-so-true 10 Things I’ve Learned from Cancer. Conclusion says it all:

But to me, life isn’t about creating checklists to check off; to me, it’s about experiencing what you have, where you are, and who you’re with. …. Life’s a journey not a to-do list.

Health and Wellness

While I understand the need for ‘scripting’ in service and call centres, Scripting with patients is a silly game captures some of the absurdity in a healthcare setting.

A good reminder of Questions to ask before your CT scan, given the amount of radiation involved in CT (and PET) scans and how to minimize this over the long-term.

How a Healthy Heart Can Lower Risk of Cancer reminds us that healthy living, whether to reduce the risk of heart disease or cancer, comes down to the same general things: exercise, nutrition, avoid smoking.

The ultimate in online doctoring in The Doctor is In (Well, Logged In) strikes me more as hucksterism than quality medical care but others may disagree.

Mark Bittman, on Banning the Big Gulp Ban, provides his assessment of the court decision striking down the Bloomberg ban of large-size soda drinks. Good piece.

Other

Bruce Feiler’s The Stories That Bind Us details how family histories and stories, through their ups and downs, provide a solid grounding that life has its good and bad moments, and in telling these stories, we can increase resilience in kids.

And more from Evgeny Morozov, Open and Closed, on how online transparency may not be so transparent and helpful as thought. I particularly liked this comment (which applies in many countries):

Likewise, “open government” — a term once reserved for discussing accountability — today is used mostly to describe how easy it is to access, manipulate and “remix” chunks of government information. “Openness” here doesn’t measure whether such data increase accountability, only how many apps can be built on top of it, even if those apps pursue trivial goals. This ambiguity of “openness” allows British Prime Minister David Cameron to champion open government while also complaining that freedom of information laws are “furring up the arteries of government.”

Articles of Interest This Week

Cancer

More of an overview of trends and issues than specific suggestions, Two New Reports From eHealth Initiative Provide Valuable Information On eHealth Tools For Cancer Patients is worth reading for those interested in eHealth issues and some of the challenges that make health applications, beyond fitness trackers and the like, more challenging.

Painkillers Could Prove Helpful in Stem-Cell Transplants provides some early evidence that common painkillers could help patients generate more stem cells for autologous stem cell transplants (the ‘harvesting’ phase). To be tested in clinical trials. Autologous stem cell transplantation improved follicular lymphoma outcomes highlights a recent study showing better results for auto SCTs and Rituximab compared to allo SCTs for follicular lymphomas.

Caring for the emotional needs of a cancer patient captures well the ‘post-cancer treatment blues’ that many of us have to varying degrees, once the immediate focus on our treatment is over. I never had anything as dramatic as the case outlined in this article, but there was some withdrawal symptoms as my follow-up clinic visited decreased in frequency, as they were a comforting routine.

A good reminder on the importance of the quality of life, and how framing a prognosis and end-of-life discussion can make a difference in Sunshine Rounds’ Celebration:

The lung cancer did not stop.  Nevertheless, in those four years since the diagnosis, Sue rejoiced.  She celebrated daily smiles, family travails, dry Thanksgiving turkeys, the moon on Caribbean waters, 43 books, long walks with blisters, bad April fool jokes and two grandchild births.

The medicine that kept Sue alive was not in a bottle. It was an elixir from her soul. She learned that those last years were not a part of death.  Sue healed and gained strength because she decided to live.  Whatever tomorrow might bring, sunrise or sunset, this moment, right now, is infused with the glory of life.

And Valerie Harper, being open about death and living in the moment, provides another good example as in this short video (2 minutes): Harper on living with cancer diagnosis. And from Don Dizon, an oncologist, the importance of saying goodbye, or closure, when their efforts have not succeeded and their patient is terminal in The importance of saying goodbye at the end of life:

“It was the greatest honor of my life to be here for you and to get to know you and your family… thank you for the letting me be your doctor; I don’t know if we will see each other again, but let me tell you now because I can, and because you are here—goodbye; I will always be here for whatever comes to you and your family—but I just needed to say this to you now.”

Health and Wellness

The Disease Lobbies, not surprisingly, shows how lobbying can increase the amount of government funding for research into different types of diseases. This is in addition, of course, to the various public and private fundraising campaigns where some cancers (e.g., breast cancer) receive more attention and funding than others (e.g., lung cancer).

The White Coat Ceremony by Dr. Phil Gold provides a touching and pointed address to second year medical students with 10 suggestions. My favourites are : there are no stupid questions and to manifest your humanity, encompassing altruism, compassion, and commitment. A somewhat different take is “Good patients” cover their emotional cracks, on how patients ‘self-discipline’ themselves in their conversations with their doctors, and how doctors manage their emotional pressures. Always a fine line, and more clinics and hospitals are better at handling the socio-psychological side of treatment, but none of us our perfect in how we handle raw emotion.

A Bumpy Road to a Soda Ban summarizes the initial reaction to the court defeat of Mayor Bloomberg’s ban on large size soda, noting correctly this is more of a ‘nudge’ to change behaviour than an outright ban. Unfortunately, the editorial writers of The Globe and Mail, despite their in-depth reporting on health and obesity issues, wrote a silly editorial on individual ‘freedom and responsibility,’ ignoring the supply-side marketing and engineering that breeds over-consumption. Even their ever-reliable Margaret Wente, normally against excessive government, has come out in favour of some forms of regulation to address the temptations engineered by the ‘food’ scientists (Is it time to ban junk food?). A more nuanced view, on the challenges of getting public acceptance of ‘nudge’ approaches, can be found in the Christian Science Monitor’s Sugary-drink bans and other fads: When pols try to nudge good behavior.

A powerful video on empathy by the Cleveland Clinic. While set in a hospital, its message on understanding and empathy apply to any number of situations. 4 minutes, well worth watching:

Other

Nick Bilton’s Digital Era Redefining Etiquette provides a provocative take of what is proper etiquette in today’s world. Voice mail no, thank you messages or emails no, twitter to communicate with your mother (!). It has provoked a fair amount of comment, one of the better ones, from the Atlantic, This Is Not the End of Email Etiquette:

But, okay, even if you assume that everyone reads and cares deeply about email send offs, there is still room for kindness. On the one hand, you risks offending Slate writers, who will harshly judge anyone who writes “my very best” before signing her name. Far more likely, should you follow his mean advice and abruptly terminate your email, is that the recipient of your email will notice theabsence of a sign-off, and think: “This looks naked. How rude!” Which person would you rather antagonize: The jerk getting pissy over everyone following the presumed standards of human communication, or someone who actually cares about the email you’re sending her? Ideally, neither kind of person would get all worked up and everyone could go on emailing as they please. 

Like a Dagger to Bloggers’ Hearts, Google Just Killed Google Reader (effective July 1) is bad news, as I rely on Google Reader for my article search. I expect alternatives will emerge and should readers know of any good ones, please share (this article in The Atlantic gives some suggestions A Guide to Life After Google Reader: I will try NewsBlur).

And in more Google-related news, The Eyes Have It: Google Glass and the Myth of Multitasking, points out the other major risk in addition to privacy concerns (see also The Plan to Make Google Glass Seem Totally Normal Is Backfiring, which is somewhat encouraging):

Multiple studies have actually shown that it’s actually a myth that our brain can juggle two things simultaneously. In actuality, the brain is designed to only process one piece of information at a time. Cognitive capacity models of attention, memory and processing explain that our brain has a limited amount of resources it can use to deal with new pieces of information it gets to process. The more difficult a task is, the more resources the brain will need to put on the job. But the more resources we use for one job, the less we have to apply toward another. Doing two things at once stretches our brain’s capacity thin, making it so we aren’t able to perform either task without sacrificing some time or performance quality. In other words, while we can certainly try to do more than one thing at a time, reading text messages on our Google Glass screen and cooking, for example, something has got to give. Either we’ll be reading our texts at an incredibly slow pace, or that soufflé we’re supposed to be watching is in big trouble.

Survey Shows How Employers Are Dealing With Rising Health Care Costs

While much of this survey, of large employees by the National Business Group on Health, pertains to the US private insurance approach and how costs are increasingly passed on to employees, some elements of increased emphasis on wellness are particularly interesting:

1. About half of companies surveyed use incentives to encourage participation in wellness programs
2. More than 40 percent provide an incentive for not using tobacco
3. Just under 25 percent have chosen a more punitive approach (surcharges for non-participation)

In the public system in Canada, no such programs that I am aware of, but some of the additional health costs from tobacco and alcohol are picked up in the form of higher taxes on these items.

Survey Shows How Employers Are Dealing With Rising Health Care Costs.

Smokers Penalized With Health Insurance Premiums – NYTimes.com

I have posted a number of articles on making people more responsible for their health plan costs. This practice appears more widespread than I was aware, as this article indicates. Private employers (e.g., Wal-Mart) and their plans are increasingly using premium incentives (more co-pay for smokers and the obese) to help encourage wellness. And the new healthcare law provides employers greater latitude to adjust the co-pay amount (e.g., from 20 to 30 percent).

While I appreciate the public policy issues involved regarding the difficulty some people have with making lifestyle changes, it is hard to argue that financial incentives, correctly applied, and ideally with complementary support measures to assist lifestyle changes (as in the case of the Cleveland Clinic), are not part of a wellness approach.

Smokers Penalized With Health Insurance Premiums – NYTimes.com.