LETTERS FROM THE GLOBAL PROVINCE

GP 26 October 2005: The Medicine Men; the Cancer Paradox

Medicine Primeval.  Having worked around docs, and dietitians, and nurses all our life, we are ever surprised at how primitive the practice of medicine is, even in the 21st century.  All the pamphleteers trumpet the “miracles of modern medicine,” but it all still seems pretty pedestrian to us.  It’s an art form much closer to the chants of the medicine man, the leeches of the barber, and the witches’ bane of the apothecaries than all of us care to admit.  We want to believe it is better than it is: we need to be sold on it.  But, as often as not, we discover that the potentates of health are all just great until you really get sick.  At that point you had better get out your prayer beads.

Age of Specialization.  Somewhere along the line the economics of the health trade taught medical students that they had to become specialists to rake in the booty and rise to the top of the totem pole.  This is all for the worse.  At the point when specialists infected the health system in America, we started treating diseases instead of curing people.  The general practitioner or internist, the most vital link of all in the medical chain, went out the window: GPs today are largely referral agents who, contrary to the advice of Larry the Cable guy, no longer “git-r-done.”  When you call their offices with real problems, the answer machine tells you to go to the emergency room at the hospital.

The worst economic effect of this specialization, according to scientists who study such things, is that it has led to surgeries, medications, etc. that are of no value to the patient or even, in some instances, harmful.  It is estimated by very sober fellows that 1/3 of the stuff done to patients in this country is more or less worthless.

For instance, peruse our “Cutting Down on Cut Ups,” which suggests we would be better off without a lot of the heart surgery that is done these days at the drop of a hat in medical sawmills.  In fact, we are learning that inflammation and infection have a whole lot to do with heart disease which implies a far different regimen for those with faltering hearts. Moreover, even though the boys around Cambridge, Mass. and their brethren in the medical mafia fell deliriously in love with cholesterol numbers years ago and swear by the Framingham study, it has become abundantly clear that the story of what plugs your heart up in old age is terribly more complex than they thought and that you should be looking at homocysteines and many other factors that affect the coronary equation.

Stunted Research.  Possibly, too, this suggests that our research is not all that it should  be.  We are aware of promising lines of inquiry that have been shunted aside by those who control the pursestrings.  This is one of many predicaments we share in common with the Chinese.  Xu Tian, a leading developmental biologist at Yale and Fudan University in Shanghai, points out how science has gotten off the track lately in the People’s Republic.  “Materialism,” he is reputed to have said, “has fueled an overpowering urge to ‘get rich quickly,’ leaving few with the patience of pure inquiry”  (New York Times, October 22, 2005).  As well, he finds that the “system teaches people to follow the rules, not to be an innovator.”

Wellness.  As you have learned by now, the health nuts want you to exercise an hour a day, consume broccoli and fish and fruit or, better yet, eat nothing at all, avoid all stressful situations, take statins and aspirin,  etc., etc.  Such wellness campaigns don’t work.  To improve the health of large numbers of individuals, you must hit hard at all the behaviors of a community.  That’s what Dr. Pekka Pushka proved in the North Karelia Project and subsequently in the whole of Finland, employing aggressive public-health tactics that dramatically cut into cancer and heart disease rates.  It’s fair to say that we’re behind the eight ball here, not only in how we treat you when you get sick, but in how we work the clay to keep you from becoming a basket case in the first place.  Both medical failings are horribly expensive.

The Cancer Paradox.  Strangely enough, despite this quagmire, we appear to be making good progress with cancer, the most fearsome of diseases (and cancer itself is really a host of different diseases).  Bit by bit, we are pushing up survival rates.  In some cases we should shout for joy:  we have had lucky breakthroughs where our cure rates do approach the miraculous.  Not many years ago we could not do a whole lot for testicular cancer.  With the advent of Cisplatin, we have achieved cure rates in the 90% range, if the condition is caught reasonably early.  Lately, at least in the case of brain cancer, we are learning that a small percentage of cancerous cells account for the spread of the ailment, so we may in time become more precise in our treatments.

Cancer treatment, too, is still rather primitive.  We either cut it out (surgery), burn it (radiation), or try to poison it (chemotherapy).  Eventually we will use jujitsu on cancer when we get smart enough about the workings of cell mechanisms—we will be able to use the disease’s own energy to defeat it.  Nonetheless, even today, dedicated, ethical researchers and practitioners are winning a few rounds against the disease, even in cases that are supposedly hopeless.

Day by Day.  We publish this week the second installment in Ms. Stephanie Day’s huge battle against the most virulent breast cancer, a vivid example of medical progress.  The soothsayers would tell her that she only has a 45% chance to live.  But true grit keeps her going.

We have always been impressed by her anyway, having seen her turn out good work while serving bosses with defective DNA who made a lot of  bad moves.  Now, she is doing some golf, writing, paying court to her whole family, and, oh, by the way, keeping the cancer monster at bay.  We would judge that she is receiving informed, conscientious, high quality care, with a few minor caveats thrown in.  To read installments one and two, simply go to “My First Year of Cancer.” 

P.S.  By the way, there are some extraordinary doctors around.  Our favorite is a surgeon who is not only outrageously competent but who is very witty and very human.  He himself recently had a bout of heart surgery.  Afterwards, we called to check on him, first asking, “Had any good port lately?”  His response: “Well, yes I have.  I had the remains of a 1970 Dow sitting in the cabinet.  A few days before the surgery I had a contemplative moment and slowly finished off the bottle.  Why, I simply never would have forgiven myself if the surgery had gone South and I had let all that good port go to waste.”  We replied, “What a way to go—to surgery, that is!” 

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