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Mind-Over-Matter In Medicine

[Recently] I came upon a Jan 24 op-ed, “A Fighting Spirit Won’t Change Your Life” by Richard Sloan, Ph.D., of Columbia University’s psychiatry department. Somehow I’d missed this worthwhile piece on the sometimes-trendy notion of mind-over-matter in healing and medicine.

Sloan opens with aftermath of the Tucson shootings:

…Representative Giffords’s husband describes her as a “fighter,” and no doubt she is one. Whether her recovery has anything to do with a fighting spirit, however, is another matter entirely.

He jumps quickly through a history of the mind cure movement in America: From Phineas Quimby’s concept of illness as a product of mistaken beliefs — to William James and “New Thought” ideas — to Norman Vincent Peale’s 1952 “Power of Positive Thinking” — to more current takes on the matter. These ideas, while popular, are not reality-based.

In his words:

But there’s no evidence to back up the idea that an upbeat attitude can prevent any illness or help someone recover from one more readily. On the contrary, a recently completed study* of nearly 60,000 people in Finland and Sweden who were followed for almost 30 years found no significant association between personality traits and the likelihood of developing or surviving cancer. Cancer doesn’t care if we’re good or bad, virtuous or vicious, compassionate or inconsiderate. Neither does heart disease or AIDS or any other illness or injury.

*Am. J. Epidemiol. (2010) 172 (4): 377–385.

The New York Times printed several letters in response, most of which point to pseudo-evidence on the matter. All the more reason to bolster public education in the U.S. — people won’t be persuaded by charismatic, wishful thinking about healthcare.

It happens I’m a fan of Joan Didion’s. I was so taken by the “Year of Magical Thinking,” in fact, that I read it twice. Irrational responses — and hope — are normal human responses to illness, disappointment, and personal loss. But they’re not science. It’s important to keep it straight.

*This blog post was originally published at Medical Lessons*

FDA Reports On Association Of Breast Implants And A Rare Form Of Cancer

The FDA [has] issued an alert about a pos­sible link between breast implants — saline or sil­icone — and a rare form of lym­phoma called anaplastic large cell lym­phoma (ALCL). These lym­phoma cases are exceed­ingly rare, but the asso­ci­ation appears to be significant.

The FDA iden­tified a total of approx­i­mately 60 ALCL cases in asso­ci­ation with implants, worldwide. Of these, 34 were iden­tified by review of pub­lished medical lit­er­ature from 1997 to May, 2010; the others were reported by implant man­u­fac­turers and other sources. The agency esti­mates the number of women worldwide with breast implants is between five and 10 million. These numbers translate to between six and 12 ALCL cases in the breast, per million women with breast implants, assessed over 13 years or so.

In women who don’t have implants, ALCL is an infre­quent tumor, affecting approx­i­mately one in 500,000 women is the U.S. per year. This form of lym­phoma — a malig­nancy of lym­pho­cytes, a kind of white blood cell — can arise almost any­where in the body. But ALCL cases arising in the breast are unusual. The FDA reports that roughly three in 100,000,000 women are diag­nosed with ALCL in the breast per year in the U.S.

These are very small numbers. Still, the finding of ALCL tumors by the implant cap­sules is highly sug­gestive. Almost all of the implant-associated ALCL cases were T-cell type, whereas most breast lym­phomas are of B-cell type. The lym­phomas arose in women with both sil­icone and saline-type implants, and in women with implants placed for pur­poses or aug­men­tation and for recon­struction after mastectomy. Read more »

*This blog post was originally published at Medical Lessons*

A Second Opinion Is Good, But A Third Or Fourth?

A few years ago I started writing a book on what it was like to be a cancer patient and an oncologist. This morning I came upon this section on second opinions:

Is It OK To Get A Second Opinion?

Definitely. And there’s no need to be secretive about it, or to worry about hurting the doctor’s feelings. Second opinions are routine in fields like oncology, and are often covered by insurance. Be up-front: Any decent oncologist can understand a cancer patient’s need to find a doctor who’s right for them, with whom they’re comfortable making important decisions. And in difficult cases, some specialists appreciate the chance to discuss the situation with another expert. So a second opinion can be beneficial to patients and physicians alike.

When things can get out of hand, though, is when patients start “doctor shopping.” For example, I’ve cared for some patients with leukemia who’ve been to see over 10 oncol­o­gists. If you’re acutely sick, this sort of approach to illness can be coun­ter­pro­ductive — it can delay needed therapy. From the physician’s per­spective, it’s alien­ating: Who wants to invest her time, intel­lectual effort, and feelings for a patient who’s unlikely to follow up? Besides, oncology is the sort of field where each con­sulting doctor may have a dis­tinct opinion. (If you see 10 oncol­o­gists, you may get 10 opinions.) Beyond a certain point, it may not help to get more input, but instead will cloud the issue. Read more »

*This blog post was originally published at Medical Lessons*

Synthetic Blood Via Artificial Cells And Platelets From Stem Cells

There’s hema­tology news, times two (at least):

1. Progress in devel­oping syn­thetic red blood cells

A University of North Carolina-Chapel Hill research group has created hydrogel par­ticles that mimic the size, shape and flex­i­bility of red blood cells (RBCs). The researchers used PRINT® (Particle Replication in Non-wetting Templates) tech­nology to gen­erate the fake RBCs, which are said to have a rel­a­tively long half-life. The findings were reported on-line yes­terday in the Proceedings of the National Academy of Sciences (PNAS) (abstract available, sub­scription required for full text). According to a PR-ish but inter­esting post on Futurity, a website put forth by a con­sortium of major research uni­ver­sities, tests of the par­ticles’ ability to perform func­tions such as trans­porting oxygen or car­rying ther­a­peutic drugs have not yet been conducted.

Developing com­petent, arti­ficial RBCs is a hematologist’s holy grail of sorts, because with that you might alle­viate anemia without the risks of transfusion.

2. Progress in using human stem cells to gen­erate lots of platelets

In an exciting paper pub­lished today in Cell Research, inves­ti­gators stim­u­lated human embryonic stem cells to become platelet-producing cells, called megakary­ocytes. According to the article (open-text at Nature PG), the platelets were pro­duced in abun­dance, appeared typical and clotted appro­pri­ately in response to stimuli in vitro. The researchers injected them into mice, used high-speed video microscopy for imaging, and demon­strated that the stem cell-derived human platelets con­tributed to clot for­mation in mice, in vivo (i.e., they seem to work). Read more »

*This blog post was originally published at Medical Lessons*

Why The Term “Patient” Is So Important In Healthcare

An online friend, col­league, and out­spoken patient advocate, Trisha Torrey, has an ongoing e-vote about whether people prefer to be called a “patient,” a “con­sumer,” a “cus­tomer,” or some other noun to describe a person who receives healthcare.

My vote is: PATIENT. Here’s why:

Providing medical care is or should be unlike other com­mercial trans­ac­tions. The doctor, or other person who gives medical treatment, has a special pro­fes­sional and moral oblig­ation to help the person who’s receiving his or her treatment. This respon­si­bility — to heal, hon­estly and to the best of one’s ability — over­rides any other com­mit­ments, or con­flicts, between the two. The term “patient” con­stantly reminds the doctor of the spe­cialness of the rela­tionship. If a person with illness or medical need became a con­sumer like any other, the rela­tionship — and the doctor’s oblig­ation — would be lessened.

Some might argue that the term “patient” somehow demeans the healthcare receiver. But I don’t agree: From the prac­ticing physician’s per­spective, it’s a priv­ilege to have someone trust you with their health, espe­cially if they’re seri­ously ill. In this context, the term “patient” can reflect a physician’s respect for the person’s integrity, humanity and needs.

*This blog post was originally published at Medical Lessons*

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