The Business of Hope

Who knows just when certain masses & ulcers were first noted to be markers of an untimely end? Whenever that may have been, the universal horror of these dreaded signs surely led to the lobby that hatched The Expert Cure.

Ancient Burr Hole

Its a safe bet that empirical wisdom and glib promise are ancient competitors in The Business of Hope…and, with both restrained & gung-ho operators catering to the desperate, regulatory entities weren’t far behind. Since antiquity, insiders like Hippocrates appealed for professional high-mindedness & discipline, while Big Brother legislated for consumer protection (just to be sure). Its less clear how the ancients dealt with organizations that offered premium mantras & herbs, oils & zaps, off-protocol cryosurgery & brachytherapy, infusions &  delusions– all in the name of superior enlightenment. The sick don’t always die on the table after all, not with Hammurabi’s minions so ready to cut surgeon’s hands off in observance of The Code. These days, most patients are discharged in fair condition, a few wads poorer perhaps, wistfully wishful in spirit, some of them seeding radioactive beads to mark their routes home. The Hansels & Gretels of modern fairy tales.

Why in heck do oncologists prescribe toxic therapies if an easier fix is truly available anyway? Why are they so sure that they’re the Good Guys? Even their clinical trials are fraught with possible side effects that they insist on detailing. Are they little more than a bunch of over-schooled sadists? Speaking for myself, I can see that telling patients only that which they wish to hear, using technology for uncharted indications, seeming pro-active or ”aggressive” in the face of severely limited benefits– these would all fatten my bank account, but… oh, well. If only embolization could eliminate my choke reflex…

OK, so I can’t say that mainstream medicine is the true fount of knowledge, much less of wisdom. (Didn’t the mainstream once proclaim that the world was flat?) Still, if I have to make sense of it all by subscribing to an underlying principle, the Scientific Method will just have to do.

We sure could use an independent cancer information agency at this technology- laden predatory time! Do we really expect the public to understand “Level 1, Level 2″ as they trawl nccn.org for their own edification? Note how the folks who endlessly agonize over the choice of a car can swiftly surrender their reason to panderers in their hope for miracle cures. This, despite all reproducible evidence to the contrary. Well, don’t you do it! If Fate has stolen away Good Health, don’t voluntarily bundle Logic into his loot bag. As with cars, ask for specs. Most basic questions can be answered by Yes and No (beware of Ifs and Buts). Does decreasing tumor bulk always translate into increased survival time or quality of life? Does tumor disappearance on a PET-CT scan mark a cure? If I go for “gene therapy”, is the production process or quality of the drug reliably checked by an independent party (can I be given plain old saline with no one the wiser)? Is the ultimate outcome of a treatment known for a reasonable period? If yes, were those outcomes vetted by the frequently dreaded but useful peer review process– or would personal endorsements do for those purposes?

Primum Non Nocere. Above all, do no harm. In Oncology, physician adherence to this dictum is critical but, I suspect, its Primum Utilis Esse that’s dead-on. “Above all, be useful.”

Lovely Bones

If you ever wondered what an experienced physician is thinking while examining your breasts, these pictures provide some hints.

EIZO, a Japan-based designer-manufacturer of professional display equipment, came out with a truly memorable calendar for 2010 through its European arm. I don’t know that their models were aware that this was to be their most revealing assignment, but there they were, in classic Playboy poses, wearing such flawless bones.  Which reminded me...

The first time that I’d had a notably attractive person in my office, we had literally bumped into each other in the elevator just a few minutes before, without knowing that we were destined to meet. After the shock of recognition on my part & some cursory apologies, I did the predictable thing and looked… hard, just like the rest of the folks in the elevator (which had become eerily quiet).  Walking a bit to the side of this surreal being in the corridor, I was busily in awe of long eyelashes and the perfect nose, thinking “Such killer abs!"  Then we both turned into my clinic. I had to quickly abandon furtive assessment for an overt clinical stance– “Did I miss something? What could be wrong with this one?”  

In such a reflexive manner is general fitness, a purposeful walk, and a fabulously toned behind transformed into mere clues to overall performance status in the continuing challenge presented by each patient. I don’t know if its dehumanizing, but each person across the clinic table intially presents a dominant agenda in the form of a challenge. A puzzle! Like the crosswords of The New York Times, they can then elicit excitement only in direct proportion to degree of difficulty and complexity of solution.

I can still spot great gluteals in the elevator, though.