Do Breast Tumours Go Away On Their Own?
November 25, 2008 at 7:26 pm | In BioMedicine, Modern Health-Care, Modern Research | Leave a CommentTags: Anomalous Data Point, Fear, RCT
The Archives of Internal Medicine published an article this week which challenges the conventional wisdom regarding the early detection of breast cancer.
This bit of research is an excellent example of what RCTs are good for: examination of apparently homogeneous populations to find indications of non-homogeneity.
Two groups were studied – women with frequent screening (and their cancer rates), and women with infrequent screening (and their cancer rates). The researchers were astounded to discover that, in these two large groups of people (approx 100,000 each), there was a twenty two percent greater incidence of cancer in the women who were screened frequently[1].
There are many explanations for this phenomena – the one that the authors advance is that a certain proportion of tumors go away “on their own” (although this author is certain it is not quite that random or mysterious).
If we read the USA Today article, we can find an interesting statement by the cancer society’s Robert Smith: “It’s important that people not wonder if women lost their breasts for no reason. That’s a reprehensible conjecture.”
Mr. Smith, medicine is not about feel-good. It’s about finding the correct way to maintain health and the correct way to resolve disease. Avoiding a conjecture because of a bad feeling is bad medicine. Conjectures should be based on the best available data and followed accordingly.
And, yes, unfortunately, human life does seem to have quite a bit of uncertainty and ignorance built-in.
From the study:
Conclusions Because the cumulative incidence among controls never reached that of the screened group, it appears that some breast cancers detected by repeated mammographic screening would not persist to be detectable by a single mammogram at the end of 6 years. This raises the possibility that the natural course of some screen-detected invasive breast cancers is to spontaneously regress.
Why the fear that cancer can be cured? Why not just write that the evidence indicates that the body is able to heal some cancers on its own some of the time?
The fear, in this case, doesn’t help us.
There is another possibility, which is the one that the spokesman for the cancer society immediately assailed: is it possible that the search and treatment for cancer causes more cancer?
It would seem that, if this is the case, the fear definitely doesn’t help us.
1.The natural history of invasive breast cancers detected by screening mammography. Arch Intern Med. 2008 Nov 24;168(21):2302-3.
CPR – Cardio Pulmonary Resuscitation
November 13, 2008 at 2:29 am | In Chinese Medicine, History Lesson, Modern Health-Care | Leave a CommentTags: CPR, History
I have something to say:
CPR saves lives. It is an excellent resuscitation technique:
Millions of people receive CPR training each year, and its use has been shown to increase the survival rate of people who are suffering from otherwise fatal conditions.
CPR is used in a variety of situations, including drug overdose, near drowning and electrical shock. It is also used when a person has entered cardiac arrest, or the heart has stopped beating (most often due to an abnormal heart rhythm called ventricular fibrillation). Patients may avoid sudden cardiac death if they receive CPR until emergency medical help arrives (who may use a defibrillator to restore a natural heart rhythm).
A Brief History of CPR
1891: The first external cardiac massage in the Western world was reported to be done successfully by Friedrich Maass.
1960: Kowenhoven and Knickerbocker reported their method in JAMA that chest compression was accepted as a method of resuscitation for cardiac arrest.
1966: The first guideline for CPR was published.
1970: Teaching the lay public to do CPR was started.
1974: American Heart Association (AHA) formally promoted the practice involving the combination of rescue breathing and external cardiac massage for cardiac arrest in a ratio of 2:15.
2005: Ewy in Arizona showed that hands-only CPR, at a rate of 100 per minute until the emergency crew armed with automated cardiac defibrillators arrive, was superior to the traditional method of CPR.
The AHA was hesitant to accept Ewy’s idea in their new guidelines for CPR in 2005, but as a compromise, recommended a ratio of 2 breaths to 30 chest compressions instead.
2007: In March The Lancet reported a Japanese study on a series of over 4000 cases in Tokyo, comparing traditional CPR to hands-only CPR by bystanders. The results showed that the latter was more successful in the resuscitation of cardiac arrest with preservation of neurological function.
2008: In April, the AHA finally gave its approval on hands-only CPR from bystanders.
Oh wait, I forgot something – Chinese Medicine has been practicing CPR since at least 403 BC:
A more complete History of CPR
403-221 BC: (Warring Kingdoms period) External cardiac massage was practised as a method of resuscitation for victims of suicide by hanging. Some credited this to Bian Que.
6 BC – 221 AD: (Eastern Han Dynasty) The first description of CPR for resuscitation of victims of hanging came from Zhang Zhongjing.
In his Essence of the Golden Chest, miscellaneous therapy #23, he described the method as follows: “Lower the victim gently, don’t just cut the rope, and lie him on the blankets. One person should put his feet against the shoulders of the victim and pull on his hair, rendering it taut (to open the airway). One person should put his hands on the victim’s chest and compress rhythmically (external cardiac massage). One person should flex and extend the victim’s limbs (to promote venous return). One person should press on the victim’s abdomen (to enhance intrathoracic pressure during external cardiac massage). ….This method is the best and usually successful.”
Zhang Zhongjing’s writings were handed down and read by Chinese physicians through the centuries.
1186-1249 AD: (Sung Dynasty) The above passage in Essence of the Golden Chest was cited by Sung Ci in his book on forensic medicine “Washing Away of Wrongs (Xi Yuan Ji Lu)”, which is recognized as the first book of forensic medicine in the world and has been translated into many languages both in Asia and Europe.
If you read the description of CM CPR carefully, you will see that there is no mention of rescue breathing.
CM has been teaching the better form of CPR for over 2400 years.
The above two histories are very slightly abridged and are courtesy of Am An Zhang, Child Psychiatrist and Author of “The Cockroach Catcher”, which is a very interesting book and available at online bookstores, including lulu.com.
Doctors Wanted
October 14, 2008 at 3:50 pm | In Modern Health-Care, Social Medicine | Leave a CommentTags: Choice, perception
Doctors Wanted
According to Eisenberg et al, [1] total visits to alternative healthcare practitioners exceeded total visits to primary care physicians in the US back in the 1990s.
If we can leave our notions of healthcare aside and look at the available evidence, it would likely become apparent that there already exists a “shadow system” of healthcare – effective, safe, and able to provide some of the very medicine we need.
More and more professionals are calling for interprofessional collaboration, including “emerging” healthcare systems like Chinese Medicine. [2] In the 21st century it won’t be possible to maintain the rigid hierarchical structure as it exists today.
1. Trends in Alternative Medicine Use in the United States, 1990-1997
David M. Eisenberg, MD; Roger B. Davis, ScD; Susan L. Ettner, PhD; Scott Appel, MS; Sonja Wilkey; Maria Van Rompay; Ronald C. Kessler, PhD
JAMA. 1998;280:1569-1575.
2. The Case for Interprofessional Collaboration
Geoffrey Meads; John Ashcroft; Hugh Barr; Rosalind Scott; Andrea Wild
Blackwell Publishing. 2005
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