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How do we know whether screening for something like cervical cancer is effective at saving women's lives? Two ongoing studies conducted in India (one funded by the National Cancer Institute and the other by The Gates Foundation) are aimed at answering that question — but their methods are under fire by critics.
It works like this. Say you want to test the effectiveness of a new screening method. You recruit a large group of women and you split them into two groups. One group gets the screening regularly. The other, the control group, doesn't get the screening. Then you follow them over time and track how many women in both groups died of cancer. That's a pretty basic scientific method. It's also something that prompts big questions about the treatment of women in the control group.
The people conducting the study say women in the control group were told they could seek out screening on their own. Critics argue that point (and the way the study worked) wasn't clearly explained, and that those alterante options weren't as available to the women as researchers imply. The majority of the women participating in the studies are poor and have very little formal education.
There are some important differences between this and the infamous Tuskegee syphilis experiment. In that case, researchers identified men with syphilis and neither told them about their disease nor offered them treatment — just monitored the deadly disease's progress. Here, there's clearly an attempt (however poorly executed) at being open with the women about what the study is and what is being done. And nobody is intentionally trying to prevent sick women from being treated. But the study definitely exists in an uncomfortable space and could reasonably be called unethical. Is it ever okay to not screen people for a disease that are pretty sure some of them have? If not, how do we figure out whether potentially life-saving screening methods are actually useful? How do you do statistics ethically when people are the numbers? I don't have good answers for these questions.
Here's what we do know. There are 76,000 women enrolled in the National Cancer Institute study, and another 31,000 in The Gates Foundation study. So far, they've been tracked for 12 years and at least 79 of the women in the control groups have died of cervical cancer.
Federal data to be released this week through the Journal of the American Medical Association shows that drug overdose deaths rose for the 11th year in a row. Most were accidents involving prescription painkillers: specifically, opioids like OxyContin and Vicodin which are commonly prescribed for pain management, and are widely abused. Those two drugs contributed to 3 out of 4 medication overdose deaths, according to the report.
Not one single death in the Centers for Disease Control and Prevention data set was due to overdosing on marijuana.
A post on Dr. Roni Zeiger's blog (it's a few months old, but new food for thought for me) explores models for shared intelligence in health care.
"We’ve heard a lot about crowdsourcing, or outsourcing work that one person would normally do to a large and often distributed crowd. There is a related and I think even more important idea of a network of microexperts and how they amplify the collective intelligence of their members," Zeiger writes.
My friend Lisa Adams, who coached me through so much of my treatment for breast cancer, recently learned that her breast cancer returned as metastatic disease. She has been writing about cancer eloquently and beautifully since she was diagnosed, and so much of what she's published since her disease advanced has been powerful, brutal, essential reading. Her most recent post, which appears on HuffPo, is about an hour-long talk with her daughter that started with her first question, "Are you scared?"
She asked questions about genetics and risks of getting cancer to what kind of treatments I might need. She asked me again, as if to confirm for herself, "It's not curable, right?" We talked about my writing, about being public with my health status, about being open and honest with her and her brothers.
I told her that yes, I was scared. I explained that my fear usually comes from the unknown, in this case just how I will respond to treatments. I told her it was okay to be scared. That it's normal. That sometimes that fear makes you brave enough to do things you don't think you can otherwise do.
I told her that I understood that sickness could be scary, that I didn't want her to be afraid of me as I got sicker someday. "I would never be afraid of you, Mom. I'm only afraid of cancer," she said. My heart squeezed and thrashed and the tears flowed.
Ken Murray, Clinical Assistant Professor of Family Medicine at USC, writes about his experience of how his peers in medicine tend to handle end-of-life issues.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.Zócalo Public Square :: How Doctors Die.
She wrote the post a week after the episode, and two weeks before having brain surgery to remove the tumor that caused it.
"At the time I was still having seizures every few days, and just the act of writing about the first seizure in such detail almost brought on another one," Jess explains. "I initially planned to keep this account private, but after two months, I’ve decided to share it, if only for the fact that it might be useful to others who have had or will have a similar experience."
It happened when she was in transit via plane from Yemen to Beirut.
There are three things very wrong in this article at Livestrong.com, which my friend Meredith Yayanos pointed me to just now via Twitter. One, "nutrition" and "Velveeta" used in the same sentence at a website associated with cancer prevention and treatment. Two, the message in the yellow band—probably something they want to downplay right now, but no-one has gotten around to updating on the site. And the third is the real kicker, but you'll have to read the copy closely to find it.
The Livestrong dot-com site is basically a content farm populated with Turked-out SEO-bait by Demand Media; the dot-org is where the cancer advocacy organization does its thing.
Anti-cancer-quackery blogger Robert Blaskiewicz has a blog post up that details how Houston-based "alternative cancer treatment" practitioner Stanislaw Burzynski (photo at left) whom many reasoned minds in the oncology field would describe as a quack, has crossed a new line in his ongoing awfulness.
The latest: Burzynski's rep threatened one of his own patients, Wayne Merritt who had advanced pancreatic cancer, after Wayne (right) and his wife Lisa published a website detailing how they'd been duped.
That site, burzynskiscam.com, is still up, despite the nastygram threatening "to file a legal lawsuit" for its purportedly "defamatory" contents.
Threatening bloggers is nothing new for Burzynski, but threatening cancer patients is, as far as I can tell.
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Space is full of radiation. It's impossible to escape. Imagine standing in the middle of a dust storm, with bits of gravel constantly swirling around you, whizzing by, pinging against your skin. That's what radiation is like in space. The problem is that, unlike a pebble or a speck of dirt, ionizing radiation doesn't bounce off human flesh. It goes right through, like a cannonball through the side of the building, leaving damage behind.
Last week, researchers at the University of Rochester Medical Center published a study that suggests long exposures to galactic cosmic radiation — like the kind astronauts might experience on a trip to Mars — could increase the risk of developing Alzheimer’s disease.
Reading stories about that paper made me curious. We've now been sending people into space for more than 50 years. We've been able to track a generation of astronauts as they aged and died and we're constantly monitoring the people who travel in space today. Research like what was done at the University of Rochester is conducted on lab animals, mice and rats. It's meant to help us prepare for the future. But what do we know about the past? How has radiation affected the people who have already been to space? How is it affecting the people who are there now?
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