The United States of America is addicted to narcotics. I do not mean the millions of individuals who are hooked. I mean the whole nation is jonesing for the stuff. I also do not mean the junk that slips into our nation in coffee cans or across midnight borders. I mean the billions of pills pouring off assembly lines. I could blame pharma or the FDA, but the truth is …
It’s time for doctors to say no to drugs
When doctors tweet about oncology, they tweet about breast cancer. A lot. Last year, about 4,000 doctors tweeted about cancer generating somewhere in excess of 80,000 tweets. And more than one in four — a whopping 26 percent — mentioned breast cancer, according to an analysis of physician tweets that we conducted for the American Society of Clinical Oncology meeting.
That doctors talk overwhelmingly about breast cancer is either a ho-hum …
What doctors tweet about when they tweet about cancer
An excerpt from A Breast Cancer Alphabet.
There is a hushed reverence in the waiting area outside the Oval Office. After all those years of The West Wing, one might think there would be a bustle of activity — a swirl of smart, earnest people walking and talking at the same time. Perhaps I would …
You can never be prepared for a diagnosis of breast cancer
Three months ago, Anne finished chemotherapy. She is tired, overweight, anxious and her feet burn. Anne sleeps poorly, cannot concentrate at work and her relationship with her husband is distant, let alone intimate. In my office for a “survivor’s” visit, Anne asked the glaring question. “Will I recover? Will I ever be the same?” After a moment of thought I answer, “I hope not.”
Okay, I was not really that cold. …
Cancer takes so much, but can its passage give back anything good?
A few days ago I decided that since I have been officially retired for two months, it was time to change my profile on the LinkedIn social network. After all, the purpose of that network is to link business and professional people to potential opportunities and ideas. I needed to let contacts know that I am no longer with the university where I practiced for the last seven years, while …
Keys to creating a community cancer center
Last summer I met with a patient in my clinic who had come to the hospital with leg weakness and his CT scans showed widespread cancer. His type of cancer is rare and treatable with a pill, which he had been taking for about a month. He was tolerating it without too much trouble.
During our first visit, he was insightful but overwhelmed. “I know how sick I am — just …
The cancer journey well-traveled
Heisenberg uncertainty principle: A principle in quantum mechanics holding that increasing the accuracy of measurement of one observable quantity increases the uncertainty with which another conjugate quantity may be known.
Perhaps it is because I just got back from Albuquerque, a city which has become like a second home to me, that I have Heisenberg on my mind. For the one or two of you out there who are not Breaking …
The uncertainty of monitoring prostate cancer post-prostatectomy
“The plastic surgeons tell me that women who like to swim do much better with reconstruction than with prostheses,” says a young breast surgeon at our weekly breast cancer tumor board, the working conference where we discuss every new breast cancer patient before starting treatment.
There’s a slight note of surprise in her voice; to her, it’s simply another consideration when advising women before mastectomy.
For decades, the only option after a …
Responding to cancer as the surgeon or the survivor
His wife thinks he looks like Tom Cruise. There is a resemblance, I can see him riding a motorcycle off the side of a burning building, jaw fixed, eyes on fire, ready to save the damsel … only he is not so short. Funny, brilliant and genuine, we have known each other for exactly two decades, sharing the growth of our families, the anxieties of middle age, and the vicissitudes …
About 25km outside of Sao Paulo, Brasil, in a small city called Barueri, lies the grave of my mother’s cousin. Henrique was the Brasilian version of Mr. T — a larger than life character, he spent his days on the pitch as the starting goalie of a local football club. “Senhor Henrique” was well known. He had three major trademarks:
The complex interplay between masculinity and health care
The American Cancer Society recently released important new data showing that the rate at which people are diagnosed with colon cancer in the U.S. has dropped 30% in the last ten years for those aged 50 and older. Much of this decline was attributed to the widespread uptake of colonoscopy screening. Colonoscopy is the only screening test that examines the entire colon and allows removal of precancerous polyps in the …
A patient’s role in ensuring high quality colonoscopy
The myth that bras cause breast cancer is apparently coming ‘round the barn again. The latest scare-you-out-of-your-brassiere “article” claims there are “five research studies” that show a strong correlation between bra wearing and breast cancer. Well, that certainly sounds all scientific.
Why the bra hullabaloo? A couple of anthropologists wrote a whole book about their incorrect theory back in 1995, Dressed to kill: The link between breast cancer and bras. …
No, bras do not cause breast cancer
Martha (name changed) had recurred yet again — her third in as many years. Despite our best attempts, remission proved fleeting. Fortunately, she had few (if any) symptoms of the cancer in her abdomen; no bloating, no nausea, no difficulty moving her bowels. Her concerns were more psychological — anxiety and frustration because her cancer refused to go away, and indeed, …
Treating cancer should not be paved in our patients’ financial despair
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From a philosophical standpoint, one of the things I hate most about cancer is the use of “war” analogies. The “battle” may mobilize patients and families, but it may also interfere with education and informed decision making. And both patients and clinicians often take recurrence or disease progression personally as a failure. Even when everything is done perfectly, the outcomes aren’t. Why …
7 steps to eliminating the war analogy in cancer care
I recently spoke to a class of undergraduates about the benefits, harms and politics of screening smokers for lung cancer using low-dose CT scans. Afterwards, a student asked how I felt about the Affordable Care Act’s requirement that Medicare and private insurers cover U.S. Preventive Services Task Force “A” and “B” recommended screening tests and other preventive services without co-payments or deductibles, making them free at the point of care.
I admitted that …
When free preventive screening tests aren’t really free
Hegira: To take flight to escape. To travel from a place of danger to a place of safety.
“You have cancer.”
You hear the words. Your mind does not understand.
“You have cancer.”
Shock. Distance. Isolation. Someone else. A mistake. A lie. Bizarre, strange, you float above the room. Everyone speaks; nothing is said.
“You have cancer.”
A fog-like curse, a venomous reality, a phantom idea. A cold ghost foreign to the soul. I must run. …
To emotionally survive cancer, we must create perspective
It was only a matter of time before the name Dr. Stanislaw Burzynski would grab the attention of the family of McKenzie Lowe, a 12-year-old from Hudson, N.H., with that most damning of diagnoses, a diffuse intrinsic pontine glioma, an inoperable brain tumor with a median survival of less than a year.
Like McKenzie, my own daughter was 12-years-old with a recurring brain tumor that had started to metastasize and …
Should doctors tell parents of terminal children to quit pursuing quackery?
Sometimes it seems that life is unfair and the odds are stacked incredibly against us. More than 1 in 3 persons will get cancer. The chance of survival if you get lung, pancreatic or brain tumors is pathetically small. The most common cancer in 20 to 30-year-olds is the deadly beast melanoma. We have no easy or effective early detection for most cancers.
However, there are remarkable stories of hope. Here …
A cancer story that defied the odds
As characterized by Dr. Rita Charon in her JAMA article almost 15 years ago, narrative medicine is “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” It is the recognition that scientific knowledge alone is not enough — not enough for our patients, for ourselves, and for society. It stresses the importance of not only hearing what our …
Can narrative medicine inform quality of care?
I had the opportunity recently to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called “80 by 2018” designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence and deaths …
Don’t forget those where cancer screening didn’t make a difference
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