More Can Also Be Less: We Need A More Complete Public Discussion About Comparative Effectiveness Research
When the public turns its attention to medical effectiveness research, a discussion often follows about how this research might restrict access to new medical innovations. But this focus obscures the vital role that effectiveness research will play in evaluating current medical and surgical care.
I am now slogging through chemotherapy for stomach cancer, probably the result of high doses of radiation for Hodgkin lymphoma in the early 1970s, which was the standard treatment until long-term side effects (heart problems, additional cancers) emerged in the late 80s. So I am especially attuned to the need for research that tracks the short and long-term effectiveness — and dangers — of treatments.
Choosing a surgeon this September to remove my tumor shone a bright light for me on the need for research that evaluates current practices. Two of the three surgeons I consulted wanted to follow “standard treatment procedures” and leave a six-centimeter, cancer-free margin around my tumor. This would mean taking my whole stomach out, because of its anatomy and arterial supply.
The third surgeon began our consultation by stating that her aim would be to preserve as much of my stomach as possible because of the difference in quality of life between having even part of one’s stomach versus none. If at all possible, she wanted to spare me life without a stomach.
But what about the six-centimeter margin? “There isn’t really much evidence to support that standard,” she said. “This issue came up and was discussed at a national guidelines meeting earlier in the week. No one seemed to know where it came from. We have a gastric cancer registry at this hospital going back to the mid 1990s and we haven’t seen support for it there, either. A smaller margin is not associated with an increased risk of recurrence.” Read more »
Discover magazine had an article about Dr. Ben Goldacre, a British physician who writes for The Guardian, is the author of the new book “Bad Science: Quacks, Hacks, and Big Pharma Flacks,” and is considered a gift to skepticism. His column is also called “Bad Science,” and he recently gave a short and interesting talk about non-evidence-based medicine at the Pop!Tech conference held in Camden, Maine. Enjoy!
The BMJ’s statement this week that the 1998 article by Andrew Wakefield and 12 others “linking MMR vaccine and autism was fraudulent” demonstrates what a difference one journalist can make. Journalist Brian Deer played a key role in uncovering and dismantling the Wakefield story.
CNN’s Anderson Cooper had a segment worth watching, including a new interview Cooper conducted with Wakefield via Skype:
Unfortunately, journalism played a key role in promoting Wakefield’s claims. The “Respectful Insolence” blog referred to one journalist as “CBS’ resident anti-vaccine propagandist.” Around the world there were many other examples of journalists’ unquestioning acceptance of the vaccine scares.
The BMJ reminds us that “the damage to public health continues, fuelled by unbalanced media reporting and an ineffective response from government, researchers, journals, and the medical profession.”
A patient reading a copy of Prevention in the waiting room brought to my attention an interesting article entitled “7 Foods That Should Never Cross Your Plate.” I would have to agree that these seven commonly eaten foods should be avoided, so I’ll rehash them here, along with three more of my own choosing to flesh out a New Year’s 7 + 3 = Top 10 list.
The lead into the article implores the reader to recognize that “clean eating means choosing fruits, vegetables, and meats that are raised, grown, and sold with minimal processing.” Michael Pollan, the regarded author of The Omnivores Dilemma and In Defense of Food, puts it even more simply: “Eat food. Not too much. Mostly plants.”
So here are the food items to avoid, in no particular order:
1) Canned Tomatoes – The resin that lines the corners of tin cans usually contains bisphenol-A, a compound found to produce estrogenic effects in the body, linked to heart disease, diabetes, obesity, and possibly neuro-developmental problems like ADHD. Tomatoes get picked on because their acidity increases the leaching of BPA into the food. Perhaps citrus foods and other acidic canned goods would have the same concerns.
2) Corn-Fed Beef – If you’ve ever watched the documentary Food Inc., you’ve probably been disgusted and appalled by the supply chain that brings meat to our tables and fast food restaurants. Bloated cows are being fed corn and soybeans, heavily subsidized crops controlled by Monsanto, to the detriment of their health. Eating their meat passes on the lower nutritional value to us, and perpetuates an immoral system of CAFO’s and cow concentration camps. Grass-fed beef, especially free range, is higher in vitamins, minerals, and has a healthier fat profile (better omega-3 to omega-6 fatty acid ratios). Bison tends to be grass fed, free-range, and of a superior nutritional quality. Eat Wild can help you find local farms that raise animals properly and often need your support. Think of the higher cost returning dividends on your health and as a charitable support of a good cause. Read more »
Three recent stories lead me to my opening topic for the year: The value of open-mindedness. This characteristic — a state of receptiveness to new ideas — affects how we perceive and process information. It’s a quality I look for in my doctors, and which I admire especially in older people.
Piece #1 — On the brain’s maturity, flexibility and “cognitive fitness”
For the first piece, I’ll note a Dec 31 op-ed piece that appeared in the New YorkTimes: This Year, Change Your Mind, by Dr. Oliver Sacks, the neurologist and author. In this thoughtful essay, he considers the adult brain’s “mysterious and extraordinary” power to adapt and grow: “I have seen hundreds of patients with various deficits — strokes, Parkinson’s and even dementia — learn to do things in new ways, whether consciously or unconsciously, to work around those deficits.”
With appropriate and very-real respect, I question Sacks’ objectivity on this subject — he’s referred some of the most outstanding (i.e. exceptional) neurological cases in the world. And so it may be that his careful reports are perfectly valid but not representative; for most of us, the adult brain’s capacity to establish new circuitry for language learning or music appreciation may be limited. What his stories do show is that unimaginably strange things happen in our brains, at least occasionally. And maybe we should just accept that and take notes (as he does so carefully), and keep an open mind. Read more »
*This blog post was originally published at Medical Lessons*
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