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Dr. Lisa Sanders: Medical Detective

If you follow me regularly, you know I enjoy watching the Fox television drama House M.D. on Monday nights (although I often watch the recording later in the week). Doctor Gregory House (Hugh Laurie) is a sorry character but a terrific diagnostician.  In almost every episode someone is on the brink of death from an elusive illness when House’s “light bulb” goes on and, in a flash, he saves the patient’s life by proving himself to being the world’s best medical detective.

Doc Hollywood

Doc Hollywood???

Dr. Lisa Sanders is watching 3,000 miles away in New Haven, Connecticut where she teaches first and second year med students at Yale how to learn to be House-type medical detectives – but much more respectful ones. She is like that herself. She’s so good at it she writes a medical column for The New York Times Magazine. That column was actually the inspiration for the television show. And it won Dr. Sanders a job as technical adviser on the medical drama. Read more »

*This blog post was originally published at Andrew's Blog*

A Nurse’s Guide To Heart Attacks

How do you know if you’re having a heart attack? Are you thinking about the classic Hollywood example?

Hollywood Loves Drama – Know the Signs of a Heart Attack

The classic example of a Hollywood heart attack is a person clutching their chest, gasping for a breath and falling to the ground.

After all, Hollywood is hot for drama, and when it comes to portraying a person having a heart attack, the exaggerated Hollywood version is far more riveting than a person sitting quietly wondering if their very slight arm discomfort is anything they should be concerned about.

The Hollywood version can be very misleading. Read more »

*This blog post was originally published at Health in 30*

Patrick Swayze Has Passed Away From Pancreatic Cancer

patrick-swayze-nowPatrick Swayze, the popular actor perhaps known best for his role in the 1987 hit movie “Dirty Dancing,” died today of pancreatic cancer. My thoughts are with his family in this time of grief.

Pancreatic cancer is among the more deadly forms of cancer. I asked GI oncologist, Heinz-Josef Lenz, M.D., professor of medicine and professor of preventive medicine in the Division of Medical Oncology at the Keck School of Medicine at the University of Southern California, to explain why that’s so.

Dr. Val: Why is pancreatic cancer so much more deadly (i.e. less treatable) than many other forms of cancer?

Dr. Lenz: Unfortunately we don’t have very effective drugs for pancreatic cancer, which makes it one of the deadliest cancers of all. The median survival is about 8 months with metastatic disease. Even when the tumor is successfully removed there is a very high risk for tumor recurrence. We need more funding to better understand the risk for pancreatic cancer and identify and develop more effective therapies.

Dr. Val: Can you describe the typical course of metastatic pancreatic cancer?

Dr. Lenz: Unfortunately, the 5 year survival rate for pancreatic cancer is only 15 to 20%. The average survival after diagnosis is 12 to 19 months. The best predictor of long term survival is if the tumor is found and removed before it reaches 3 cm in size. Patients with metastatic pancreatic cancer are usually treated with a combination chemotherapy consisting of gemcitabine, tarceva, xeloda or oxaliplatin. However the response rates are (despite using aggressive combination therapies) low. Large clinical trials recently did not show any benefit from erbitux or avastin, again demonstrating that pancreatic cancer therapy is a difficult clinical challenge.

Dr. Val: Are certain populations at higher risk than others for pancreatic cancer?

Dr. Lenz: Age is the most important risk factor for this cancer. It is most common in individuals over age 50 and increases in frequency with age. Black men and women are slightly more likely to get pancreatic cancer (though the reasons for this are unclear), and men are slightly more likely than women to get the cancer. Other risk factors are smoking, diabetes, and obesity.

Dr. Val: If you suspect that someone is “high risk” for pancreatic cancer, what tests should he/she have?

Dr. Lenz:  Patients with a genetic predisposition for breast cancer known as BRCA are also at higher risk for pancreatic cancer. There is also a familial form of pancreatic cancer. These high risk families are being followed up with specific screening plans. However there is not a reliable test for pancreatic cancer. Imaging with CT or MRI can miss pancreatic cancer and there is no reliable blood marker. The most common used is CA 19-9, which can be used for monitoring and diagnosis but is not elevated in all patients.

Dr. Val: What if the cancer is caught very early? Does that increase likelihood of survival?

Dr. Lenz: Absolutely. The best chance of survival is when the cancer is limited to the pancreas, and is surgically removed before it reaches a size of 3 centimeters. There are certainly people who have been cured this way, but unfortunately it’s very rare to catch the cancer at such an early stage since it usually has no symptoms until it’s quite advanced.


There is a wonderful advocacy group for those whose lives are touched by pancreatic cancer: PanCAN. One of PanCAN’s founders, Paula Kim, is a friend of mine and was inspired to create the organization after her dad was diagnosed with pancreatic cancer in 1999. At that time there was very little advocacy for this deadly disease. PanCAN helps people with pancreatic cancer find help and support.

Should Movies With Smoking In Them Receive An R-Rating?

As many of you may know, the famous tobacco control scientist and advocate, Professor Stan Glantz, has over the past few years been focusing on the issue of depictions of smoking in movies. Part of the concern stems from good evidence that young people are highly influenced by movies due to their cultural value and glamorous nature.

The other part stems from a history of use of “product placement” in movies. This refers to the movie producers agreeing to include a specific product in their movie in return for some incentive (typically money). A famous example of this is a letter from Sylvester Stallone agreeing to smoke particular brands of cigarettes in his movies for $500,000. So when one combines the financial power of the tobacco industry with product placement we end up with a hell of a lot more gratuitous smoking in movies than is necessary.

Of course the movie companies and many movie enthusiasts argue about the need for art to imitate life etc., etc. However numerous examples demonstrate that to be a lot of nonsense. Professor Glantz points to depictions of Marlboro cigarettes being dragged around or used by aliens in movies like Men In Black. Is it really true that those aliens prefer Marlboros and so showing the brand was necessary for the movie to be accurate? Mmm….I doubt it.

My favorite example comes from the film “A Beautiful Mind”. The movie stars Russell Crowe in the lead role portraying the (still living and working) Princeton University professor, John Nash. In real life, John Nash suffered from schizophrenia but did not smoke. In the movie he suffered from schizophrenia, but smoked. I’m not sure why the producers changed this aspect of reality or what it added to the movie.

But these are details. Professor Glantz’ main point is that movies made to be viewed by kids do not need to include smoking, and therefore should be given an R rating if they do, just as they are if they depict illicit drug use. Note that an R doesn’t stop people under 17 from seeing the movie in a movie theater. It just means they need to be accompanied by an adult. It also doesn’t ban smoking from movies, it just means that movies with smoking in them will receive an R rating, just as sex, drugs, cursing and certain types of violence will get a movie an R rating. Of course the movie industry is very clear that a large part of its audience is kids and particularly teens. The net effect of the rating changes professor Glantz is recommending would be that gratuitous smoking will be taken out of many movies and particularly those aimed at kids.

I must admit that I didn’t initially pay much attention to this proposal, and my natural inclination was to doubt whether it really was worth the effort. But while I was at the UK National Smoking Cessation Conference in London last week I heard Professor Glantz talk about this idea and I came around to thinking its maybe not as extreme as I first thought. In fact he convinced me that it’s a reasonably sensible idea that would likely result in thousands fewer teens taking up smoking. Sometime soon the full audio recording of Professor Glantz’ presentation will be posted on the conference website along with his slides. I’ll post the link when its available, but for now those interested in this subject may want to check out the following website:

This post, Should Movies With Smoking In Them Receive An R-Rating?, was originally published on by Jonathan Foulds, Ph.D..

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Latest Book Reviews

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

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