This addresses a number of things I think about. I’m only 31, but maybe I’ll write and sign an advance directive. Maybe NO CODE will be the next tattoo I get. CPR and respirators sound horrific to me.
In the past 30 years, an estimated 1.3 million American women had breast cancers that were "overdiagnosed," which means their screening-detected tumors would never have led to clinical symptoms, according to a study published in the November 22 issue of the New England Journal of Medicine.
I stand by what I said in a previous post about cancer screening’s shortfall not in finding small not-yet-significant cancers that may or may not be serious, but in the black and white treatment options for people with diagnosed cancers. Overdiagnosis is a problem because it leads to harmful unnecessary interventions. What if a diagnosis of a small cancer led not to watch-and-wait OR chemo/radiation but instead led to lifestyle changes and gentle non-invasive treatments? ….Treatments such as those a licensed Naturopath provides.
I just read a great little introductory article about myths that prevent parents from talking with their children about sex and values. It is a PDF entitled “The 3 Biggest Myths Even Smart Moms Believe That Get in the Way of The Sex Talks”. Check it out here.
Girls who understand their own sexual response are less likely to rely on another person for their sexual gratification. Perhaps if they know they can do it themselves they will be less likely to engage in risky sexual behavior because it feels so good.
I think so too. That’s why I plan to have regularly offered age-appropriate sexuality & reproduction education classes at my clinic, once I’m a doctor.
More on the influenza vaccine:
Looking at the policy around it points to the difficulties of evidence-based medicine.
In 1960, the surgeon general, Leroy E. Burney recommended vaccinating three high-risk groups [with the flu vaccine]: pregnant women, the chronically ill and people 65 and over, Dr. Osterholm said. Once that recommendation was made, scientists felt that it would be unethical to run a trial that would essentially deny a recommended vaccine to participants assigned to the placebo group.
In other words, because Standard Of Care mandates that elderly people receive the flu vaccine, no research trial looking at the efficacy in the elderly can not provide the vaccine to its subjects. I.E. There cannot be a placebo-controlled group, so it can’t truly be a randomized placebo-controlled study. Reminder: RTCs are the penultimate pinnacle of support in evidence-based medicine. (The ultimate type of supportive study is the meta-analysis of many RTCs.)
C.D.C. officials say population-based studies show that elderly people who get flu shots are less likely to die of any cause than elderly people who do not get them. Critics say these studies suffer from what’s called the healthy vaccine recipient effect and prove only that older people who are in good health and take care of themselves go to the doctor regularly — and get flu shots.
In other words, if you take care of yourself to the extent that you get a flu shot, you’re already healthier than someone who doesn’t, and so because you take care of yourself in general, you’re less likely to die of any cause.
Now I grant you, that’s why observational studies (which yield results like the one above) are not as valued as RCTs. In the end, correlation between Factor A and Outcome Z cannot account for Factors B, C, D, E, F, and G which all go along with Factor A. Which one (if only one) actually led to Outcome Z? We can only make educated guesses.
If we want to provide evidence-based medicine, the ideal thing would be to do a large scale randomized placebo-controlled study (= randomly giving half of the subjects the flu vaccine and giving the other half a shot of saline plus the vaccine’s adjuvants) of those who have been recommended to get the vaccine. But we can’t, because it’s been decided, without much evidence, that Standard Of Care is to give the vaccine.
This post is not for or against vaccinations. See my previous post about that. This post is to point out the failings of our culture’s attempts to provide only Evidence-Based Medicine.
Finally, since I’m not technically allowed to give medical advice, I’ll let the NYTimes author do it for me with Point 3:
Another option for those who want to reduce their risk of influenza and flulike infections may be simply this: Wash your hands more often. There is good evidence this works.
Nope, can’t resist. Also must recommend going home and resting if you get flu-like symptoms!
I recently noted on LinkedIn and Twitter that I’ve been vaccinated — as I am every year — and recommend this year’s vaccine, which appears to match the prevailing viral strain quite well, to everyone else. I promptly got comments back from naysayers, including at least one self-identified microbiologist, who noted he never got vaccinated, and had “never gotten the flu.”
I do understand the reasons for reticence about immunization in general, and flu immunization in particular.
So, I am unimpressed and unpersuaded by those who argue against flu vaccination because they have avoided the flu without it.
You presumably know the expression — unless, that is, you are George W. Bush — “Fool me once, shame on you, fool me twice — shame on me.” If you are George W. Bush: Thank you, Mr. President, for reading my column — no offense — hope those English lessons are coming along, and please get a flu shot.
For everyone else, the relevant point is this: Influenza unashamedly kills tens of thousands of us ever year. Being fooled by it even once could be one time too many.
I understand reasons for reticence, too. For an immunization to work correctly, the body has to respond to it as if it’s the real deal infection. If you’re not in particularly good health, being hit with a needle stick and an infection –even a staged, hobbled one– can cause some deleterious or obstructive symptoms.
However I’m not against immunization. So, my personal thought about immunization is that they should be coupled with health-boosts in general. Even Dr. Katz agrees:
For any vaccine to do us any good, we need to get it while feeling fine.
If you’re worried about your personal response to being immunized but would like to participate in herd immunity to protect our vulnerable population, consider* planning a month-long health-boost prior to and following your immunization shots. Eat healthy foods (vegetables especially). Get enough Vitamin D (a hormone involved in the immune system) through 15 minute bursts of sun exposure or supplements. Get all your anti-oxidants up to levels (green tea, colorful fruits and veggies, even some dark chocolate). Find some immune-modulating supplements such as Reishi mushrooms, or Astragalus or Licorice root, which have polysaccharides that train the immune system to hunt for invaders, and take according to your doctor’s instructions or the recommended dose on the bottle. Find and ingest appropriate probiotic strains to push a Th1 response (against bacterial and viruses; rather than Th2: against parasites and allergens, or Th3: immune modulating and quieting). Consider taking along a homeopathic remedy that both matches your general somatic/mental/emotional state and is also useful for countering negative effects from vaccines, needle sticks, bruises, or infections. If you’ve been vaccinated before, you can use your historical reaction to predict how you might react presently, or you can look at the typical symptoms/reactions other folks experience for the vaccine you’re getting.
Etc. Etc. Etc. There are lots of ways to rev up your body and psyche to face the affront that is the fake invasion of a vaccine.
*Consider also working with a licensed naturopathic physician or another functional medicine practitioner for help in your decisions. They can evaluate your current state of health and limitation, and help you find quality resources.
This also goes for getting travel vaccines.
Also, whether or not you are vaccinated, if you do end up getting the flu, another way to promote herd immunity is to GO HOME AND REST until you’re feeling better.
To whatever extent the oft-troubled waters of breast cancer screening had cleared since the last salient controversy, they have been stirred up again by a study just published in the New England Journal of Medicine. The paper, which has received widespread media attention, suggests in essence that mammography routinely finds cancers that would be better left unfound — cancers that would not progress, and do not need treatment.
Definitely read the rest of the article to gain a better understanding of diagnostic tests.
I think the other part of this issue, not mentioned by Dr. Katz, is that the standard of care for treating cancer is extremely aggressive. As in, Is Cancer Present? Y / N. If Y, proceed with chemotherapy (poison that hopefully kills cancer before it kills you) or radiation (energy that messes up DNA so that replicating things will critically fail) or surgery for resection. So what happens if the cancer is one which that patient’s body is capable of handling? The cancer is found, now. Simple Y/N question with 3 options.
If doctors (MDs, DOs, and probably Physician’s Assistants and Nurses) are bound by standard of care, it means that they don’t have room for nuance, unless the patient adamantly refuses and documents refusal. People are scared of cancer. We’re right to be cautious and vigilant, because they might end up being “large, obvious masses eroding through other body parts” (as Dr. Katz described it). But we are having normal cells turn into cancerous ones all the time, and a healthy immune system takes them out without our ever knowing.
So what if, coupled with scaling back or acknowledging the limitations of screening diagnostic tools, we also allow for nuanced and patient-specific therapies coupled with vigilance of the discovered tissue-gone-wrong? What if we treat low-grade non-invasive yet (prematurely) discovered cancers with gentle immune boosts from diet, minimally processed supplementation, botanical medicines, and exercise? Take the burden off the body so it can turn its attention to that pesky misbehaving cell line.
Just thinking out loud….
I feel genuinely sorry for any child I might have who ever asks me for anything for Christmas, only to be informed that every time a "Place Order" button rings, a poor person takes four Advil and gets told they suck at their job.
Hey Portlanders, check out Supportland and Chinook Book to get discounts or reward yourself for buying local! Supportland is free to start, and Chinook Book (especially the smartphone apps) pay for themselves in a few uses!
At nearly 14 weeks pregnant, Bauer, who also suffered from fetal alcohol syndrome and life threatening seizures, had become the subject of a court room case when her doctor grew concerned that continuing the pregnancy could jeopardize her life and health. Bauer originally saw the physician when her guardians brought her to have her epilepsy medication adjusted so as reduce the risks for the developing fetus, which the guardians said would be adopted by one of six potential couples they had lined up once they learned Bauer was pregnant.
So, it’s totally fine to use a mentally disabled woman and put her at risk for seizures in order to provide a baby to someone who wants to adopt?
*fighting nausea of disgust with humanity*
Let’s replace the term “guardian” with “user” then.