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Saturday, May 18, 2013

Cargo Cult Cancer

In the Cargo Cults, authority is the truth. In real science the truth the authority. The documentary Money and Medicine highlighted many examples of our medical authorities working in cargo cult mode and real science. The authority becomes the truth when we just do not know something. We don't know of any way of dealing with Alzheimer's but we have doctors who still have to treat patients. They even have pills approved by the FDA. That seems to make people feel better, just as a religion. Science, on the other hand, offers up what some would consider confusion. By admitting that we do not know something we run the risk of losing our credibility with the masses. The minority, those who think scientifically, run towards the unknown with a much different attitude. The truth is our authority. If we can reign it in we can harness some of that authority/power.

In the Money and Medicine documentary the authority take a real science view of what a hospital can and cannot do for end of life situations. We can keep people alive, for example, but in ways that do not bring them back to any semblance of a healthy human being. Death is an option that most would prefer. Yet a hospital must offer the option of keeping a patient alive if they can, even when it is merely a technical version of life. To the healthy person looking in from the outside, life is life. They imagine the dying individual being happy and content to lie in their bed looking out from the inside. The healthy person does not imagine what it is like on the inside, laying in bed as your body tries to expire. We simply don't want to accept the fate that awaits us all.

Cancer may very well await us all, if we live long enough.  If we were to study cancer, and not just single genes or other single causes, we could study dormant cancers we all live with. What cancer precursors dwell within our bodies that never progress to the point of taking our lives. In Money and Medicine was pointed out that autopsies on a group of men, post 70 years of age who died of something other than prostate cancer, showed that around 80% had what doctors would call prostate cancer. The advent of the prostate specific antigen (PSA) test has led to an increase in diagnosis yet dubious evidence of having an impact on mortality. The same can be said for mammography and breast cancer. Men and women have separate but equal cancer precursors that may exist as one of many possible expiration devices placed in our bodies to ensure we don't live too long. When it comes to medical science however, the authority can fancy itself to be the truth. They will find these ticking time bombs and zap them with medicine. As we can see with breast and prostate cancer testing, early detection has not provided the doctors with the authority to hand over new leases on life. They do however offer up treatments that enrich big pharma and the hospitals.

We are humans and humans seek patterns. If we can find patterns in those who die from cancers we believe we can prevent cancer from happening. The news of Angelina Jolies double mastectomy is an extreme example of using the patterns we think we see and following up with another pattern we think we see, that of surgery leading to extended life. Angelina Jolies mother died in her fifties thus Angelina is taking a preventative measure to avoid the same fate. The medical authority has given her a new lease on life, but no guarantees that it makes a difference. We can see how the Hippocratic Oath, "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone", is subjective. 

This all leads me to an article published by the New York Times last month.  Peggy Orenstein wrote this piece, "Our Feel-Good War on Breast Cancer". She points out that early detection may not provide the benefits that have been touted. Younger women have more density in the breasts thus there are more false positives and false negatives in mammograms.  The question of just how many lives are being saved is itself taboo among breast cancer advocates. Their answer is that early detection works. They have what they want, never mind the statistics. It feels good to believe that what we are doing is working. So why the inconvenient negative data?

From the documentary Money and Medicine:
A number of recent studies estimate that a third of all health care expenditures are unnecessary and that eliminating wasteful spending would save over 800 billion dollars a year. 
Why is that? I continue to think about these things. What have I come up with here today? What is my point? Conclusions? After 7 years on this blog I see only one solution. Keep the negative and inconvenient information flowing. To a true scientific mind, the state of not-knowing is like the state of hunger to a person walking into a restaurant filled with the aroma of delicious food. To the cargo cult scientist, the state of not-knowing is shameful. The cult must turn to the authority who will make the claim that they do know something, it's just that a little more research is needed. Research becomes mere tweaking the old ways that aren't working. My conclusion today is to simply stay thirsty my friends. Remain a skeptic. The state of not-knowing is good. Authority does not represent the truth... the truth is the authority.

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