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Demystifying Medicine One Week at a Time

Category: advocacy (page 1 of 15)

How Treating Cancer is All About Playing the Odds

The following is a guest post by Dr. Andrew Howard:

Like many Americans, I was sad to hear about Senator John McCain’s recent cancer diagnosis. Though I don’t always agree with his political stances, I greatly admire many things about him, including his service during the Vietnam war.

Senator McCain has a type of malignant brain tumor called a glioblastoma multiforme (also called a GBM). This is the same sort of tumor that Ted Kennedy, Beau Biden, and Ethel Merman had. Since the news about the senator’s diagnosis came out, a lot has been written about the fact that GBMs are associated with a poor prognosis. This has made me think about the term “prognosis.” In my experience, patients and their families often misunderstand how doctors think about that term.

Prognosis is all about trying to answer the question, “What’s going to happen to this person?” It’s not always easy to tell. However, early in my training, my mentors taught me that all cancer patients can be divided into two groups, which they called “curative” and “palliative.”

If a patient was palliative, that meant that there was no real chance for curing their cancer. Treatments may still be helpful for slowing the cancer’s growth and reducing symptoms. But we knew from the beginning that the cancer would eventually cause the patient’s death.

Curative patients, on the other hand, had cancers that were potentially…well, curable. The goal of their treatment was to entirely eliminate their cancer. I often imagined those patients finishing their cancer therapy and going on to live long and healthy life. Eventually, I hoped, the cancer would just be a faded, bad memory in their past.

Even in cases where the goal is curative, there is still no guarantee that treatments will cure the cancer. Instead, treatments are intended to make it as likely as possible that the patient will be cured. Curative treatments are all about playing the odds. It’s like we’re at a casino in Las Vegas, and we’re trying to maximize our chances of winning at the blackjack table. With curative treatments, we’re doing everything we can to stack the deck in our favor.

Here’s another analogy: Imagine you’re out for a walk, and your goal is to cross a busy street. You could just step blindly out into traffic, but your risk of not making it to the other side would be high. There are some simple things you can take to make it more likely that you will make it across. You could:

  • Look to your left before you start to cross
  • Look to your right before you start to cross
  • Cross at a crosswalk
  • Wait for a walk signal from a traffic light

Doing any one of those alone would increase your odds of making it across the street alive. Doing two of them would improve your odds even more. Doing all four would give you the best shot. However, even if you do all four of them, your likelihood of making it still isn’t 100 percent. A speeding truck could come out of nowhere, or you could be hit by lightning, or you could have a heart attack when you’re halfway across. Also, even if you don’t do any of them, there’s still a chance you could, by pure luck, make it across the street alive. However, no one would ever recommend you try that!

Your cancer treatments are like these things you do to improve your likelihood of making it across the street. They are each intended to improve your chances of achieving a cure. They can’t make it absolutely certain you’ll be cured. What they do is shift the odds in your favor.

I’m sure Senator McCain’s doctors will do all that they can to stack the deck in his favor. Glioblastoma is usually treated with a combination of surgery, radiation, and chemotherapy. Though the odds aren’t great, a small minority of patients do achieve full cure, and go on to live years and years after their diagnosis. I certainly hope that for Senator McCain.

Andrew Howard, MD, is an Assistant Professor of Radiation & Cellular Oncology at the University of Chicago. He has written a new book for cancer patients and their families titled So You’ve Got Cancer: A Super Patient’s Guide to Diagnosis, Treatment, and Beyond. You can find it here.

“Crowding,” and Other Items

The stock market is up. But the economy sputters along–it grows, but only slowly.

The health care sector has been an exception to the trend of slow growth. It continues to employ more Americans than ever before, without much sign of slowing down.

[Correction. Here’s a sign of some slowing.]

The health care industry has become so huge that it comprises nearly 1/5 of the economy. Now 1/9 American workers are somehow in health care (think medical coders, billing specialists, and various administrators). It’s astonishing. Whole cities (Hello Cleveland, Pittsburgh, etc., etc.) rely on health care as their #1 sources of jobs/income/investment.

[For a superb treatment of this phenomenon, read Chad Terhune’s piece here.]

A while back I read a great essay by a health care pundit who talked of health care spending “crowding out” other forms of public investment.

Think of it this way: a government collects taxes. If it spends an increasing amount on health care goods and services each year, there is less available for education, roads, infrastructure, etc.

It may not quite be a zero sum game, but it’s darn close.


Don’t You Just Love Those Drug Ads on TV?

I wrote new essay for NPR’s health blog, Shots, in honor of the 20th anniversary of drug ads appearing on TV in the U.S.

You can click on the box below to have a look. It ran with more great collage art by @KatStreeter.

How to Age Better: Live somewhere that combats Loneliness, Helplessness, and Boredom

At GlassHospital we strive to bring you interesting ideas about improving health and health care from places far and wide:

An article in the Saskatoon (Saskatchewan) StarPhoenix features Suellen Beatty, CEO of the Sherbrooke Community Centre in Canada.

Sherbrooke is a community centre, but it also is home to more than 250 residents — the kind of place we might call a ‘nursing home’ in the U.S. I love that in Canada they’re called Community Centres. That’s what any facility or neighborhood should strive for.

Suellen Beatty rejects the idea that nursing homes are places where people go to await death. Her team’s philosophy is to make old age more fun. Sherbrooke readily acknowledges the big three elements that compound the infirmities of aging: Loneliness, helplessness, and BOREDOM.

By loading up the day with activities, by listening to their residents and families, and by hosting hundreds of volunteers who see their job as providing fun and emotional sustenance to resident and day-visitor elders, Sherbrooke attracts visitors from all over the world who marvel at its success.

It reminds me a of a piece we ran a few years ago about a pretty special elder care facility in Arizona–one that put its residents’ happiness and comfort above all else — even when it means deviating from ‘standard’ protocols of elder care like eating bland food.

Take a look at what’s going on in Saskatchewan. We can all learn.

Marching for Science

Another piece I recommend: This time from Vox, in their First Person section.

It’s an essay by someone close to me who appreciates the scientific advancements which will help her survive the breast cancer she’s just been diagnosed with.

The ‘One Stop Shop’

“How can you expect patients to look after their health, when they don’t know where they will be living next week? You can not separate people’s physical health from their psychological, social and spiritual health.”

So asked community health nurse Ruth Chorley, in an article by Rachel Pugh in the Guardian.

The story reported on a local program in Oldham, one of the UK’s National Health Service districts, in which nurse specialists work to help people whose social and economic problems prevent them from managing their health.

From the story:

Chorley is a focused care practitioner – one of four employed by Hope Citadel Healthcare, a not-for-profit community interest company, to lead a pioneering approach to delivering healthcare to the most needy families in its four Greater Manchester NHS GP practices, by filling in the gaps between health and social care.

I think this small scale NHS experiment is one right way to truly improve a  community’s health.

Match Day 2017

Click on the link below to see an essay from NPR on learning from and working with foreign medical graduates.

All in honor of St. Patrick’s Day, which this year is also Match Day — when medical students learn where they will match for residency — the next chapter in their training.

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