In Thursday’s New York Times Andrew Pollack wrote a mostly unobjectionable, informative piece on an innovation in treatment for a variety of cancers. The trick he described involves attaching chemotherapeutic agents to antibodies that bind to specific markers on cancer cells — compounds dubbed antibody-drug conjugates. Such therapies aim at more precise targeting of cancer drugs, which researchers, drug companies and patients hope will yield more effective results with fewer side effects.
Pollack lays out the basic technology in the piece nicely, and he frames the science within the usual sorts of anecdotes about patients on some of the drugs under trial…all pretty bog-standard medical reporting.
So why am I pissed off?
By harnessing antibodies to deliver toxic payloads to cancer cells, while largely sparing healthy cells, the drugs are a step toward the “magic bullets” against cancer first envisioned by Paul Ehrlich, a German Nobel laureate, about 100 years ago.
Two thoughts: first, the lesser offense, the phrase “envisioned by Paul Ehrlich, a German Nobel laureate,” is an attempt to assert unearned authority. The dreamt-of “magic bullets” gain a quality of respectability from association with some long-dead smart guy.
That Nobel cover helps set up the second, greater claim, and the more damaging flaw in this piece: the implied outcome for someone actually receiving the hinted-at magic bullet.
Pollack, were he here, might try stop me at this point, noting that he only suggests “a step toward” the miraculous promise of a bullet to strike cancer down — and not that cure itself. And so he does.
But really, the whole framing of magic bullets is the problem. Pollack gives evidence of why this is so — at least by implication — later in the piece. The patient in his lede has breast cancer. for breast cancer. Much further down the piece we learn that the antibody-drug conjugate treatment she receives only applies to those 20% of breast cancers that express an excess of a particular protein. That speaks to one reason why magic bullets remain so elusive almost half a century into the “war on cancer:” cancer is not a disease. Rather it’s a family of illnesses that share the property of unconstrained cell division — but respond often very differently to given choices of treatment.
Again, there’s no doubt in my mind that Pollack knows of the real harm to be done by talk of cures for cancer; almost all of the article is sober enough about the gains achieved so far by this approach (real, but not curative) and of the limits the given therapies face.
But even good reporters can fall prey to the easy phrase or the inaccurate shorthand of the beat. Sometimes it doesn’t matter. No one cares if a football writer uses the phrase “smash mouth” in every piece about the Steelers-Ravens rivalry.
Cancer is different. The hunger for a cure is obviously and understandably overwhelming. But such hopes run straight into the basic science of cancer — which has undone seemingly imminent magic bullets time after time.
New hope, the prospect of more time, improved quality of life, and — with good fortune — increased remission rates. Those are all fine as ways to frame the real advances in cancer therapy. Present them with all the optimism one may reasonable feel. But to imply that we’ve moved meaningfully closer to what amounts to a cure? Until and unless that’s really true, it is beyond misleading to suggest that particular advances offer more than they do.
Instead, we move rapidly into the territory of the cruel.
So yeah, even as a throwaway. Even with the imprimatur of a Nobel laureate, alive or dead. Even with good intentions. This kind of carelessness bugs the living crap out of me.
No snark, no jokes, a dark subject, no fun. Nothing new here, either; I’m guessing everyone reading this has a pretty good idea that cancer is a bear of a disease(s).
What can I say? This one strikes close to home.
Image: Zacharias Wagner, Crab, from Thier Buch (Animal Book), 1641.
The main problem I had with the article was it failed to consult well known science and medical experts like Jenny McCarthy and Matt Taibbi.
a hip hop artist from Idaho (fka Bella Q)
I hear you, TL, and I agree. It’s careless cruelty, in the guise of reporting. Dipweed.
@David Koch: You mean Jenny McCarthy of her own personal body count?
Stuck in the Funhouse
I can see your point, of dishonesty and exaggeration for a topic so tender as cancer, and those afflicted with it. As well as for scientific sensibilities of caution, till proof is attained.
But for people who are dying, sometimes a little placebo effect, fluffed up some, can provide one of the best treatments there are for cancer, and that would be some sense of hope.
Cancer is so intractable at the cellular level, I wonder if there even is a cure that is physiological in nature, and lethal to abnormal cell division that you mention, that is so similar to normal life giving cell division. And I suspect as one factor that researchers can’t help themselves, but to juice up their theories and nascent studies and research. Maybe that is what is needed for them as well, to keep digging. But I get the loathing for leapfrogging too much in scientific research, especially concerning the killer of the ages that is cancer. As well.
@Tom Levenson: How dare you criticize the Huffington Post’s science editor!
Indeed. Thanks for this Tom. Even if my Mom has been healthy for over 5 years now every check up and mammogram is excruciating and nerve-wracking. The promise of cures always sticks in my craw.
As I understand it, the targeting of cell killing compounds is the issue. In an adult who is not growing beyond replacement levels or getting fat, recently divided cells should have effluent through the cell wall, which could be bound to using antibodies, and if you could use that feature to deliver the cell killing drug payload using that vector, you win. The selection for binding becomes much more targeted. The predicate is more precise, in CS terms.
I dunno, I can see how the term “magic bullet” would be useful to convey this understanding.
Also note that this is not remotely an “innovation”, in that it’s not a new idea. People have been trying to get this idea to work for at least twenty years that I know of offhand. Hopefully there have been significant advances, and this idea is much closer to coming to fruition than ever before. The people who are making the idea a reality are to be congratulated and indeed celebrated. But it’s irritating that the writer would claim it’s a new idea (and I’m sure it’s the writer’s doing – the scientists wouldn’t make an easily exposed false claim, because it would expose them to the derision of their peers).
Until we move beyond framing the battle as the War on Cancer, we have lost Unfortunately, framing it as the Battle on BRCA positive Hers negative ERPositive Breast Cancer and the Ambush on Large Cell non-Hodgkins Lymphoma and the Seige on Pancreatic Cancer and the Firebombing of Acute Myelogenous Leukemia is too difficult to report on. Let alone tweet.
I gave up on this years ago. Asking mainstream science reporters to discuss topics with any subtlety and sophistication is akin to asking water to not be wet. It’s all about writing something that will draw eyeballs and sell ads.
@Wag: How about the War on It’s Not Lupus?
CW in LA
Wait, I saw the title of this post and thought it was going to be about Funky Winkerbean.
Fun fact: the “magic bullet” that Dr. Ehrlich was seeking was needed to cure the most destructive disease of his day … syphilis. I’m not sure how accurate the Edward G. Robinson biopic is, but it’s still pretty entertaining, though the strict censorship of Breen meant they had to be very circumspect in describing what it is that Ehrlich is trying to cure and why even seeking a cure was controversial (God’s judgement, and all that).
Eh, I find it amazing that anyone would get so worked up over a random historical reference. It’s not like the guy started off with a claim that “we’ve cured cancer!” or anything. It may be sloppy, but hardly “cruelty”, which requires rather a deliberate callousness, if not positive malice.
But Paul Ehrlich is a fascinating character — there was a (fairly sanitized and complimentary) movie about his life in the 1940s. We watched it a lot as kids. His ideas about magic bullets to cure diseases were pretty crazy at the time – and there was a highly-publicized trial over several patient deaths.
@Warren Terra: I don’t see anywhere in the article where he says it’s a new idea. He does talk about new drugs that implement the idea, and more effectively than previous attempts. Actually getting something to work is an innovation, not just first thinking it might be possible.
Ladies and gentlemen, the Republican health care plan.
i so agree that “magic bullet” and “war on cancer” are destructive in the larger picture — even though i applaud further understandings of how particular cancers work and can be defeated. on the scientific end, as tom and wag point out, cancers are tremendously diverse and do/don’t respond to different things.
and on the human end — it creates stupidity.
exhibit A: all the pink shit that people want to sell you in breast cancer awareness month does not do squat to stop any cancer. the cancer just does not care what you buy.
exhibit B: someone with a minor, very treatable cancer is NOT in the same position as someone diagnosed terminal. a card saying “i’m sure you’ll get better!” is not the appropriate response to the latter; it just stresses a dying person and his/her loved ones the hell out, because now they have to be polite to someone oblivious.
exhibit C: those good buddies who sent those “you can beat it!” cards, but can’t bother to go visit because “it’s too stressful to see him/her this way,” but send really great flowers to the funeral? this set of messages does not only say that you are shallow and self-centered, but it lets those who were there know that the dead person did not “try” hard enough. thanks a fucking lot.
A few months ago there was a whole slew of articles breathlessly a new “miraculous” treatment for Cystic Fibrosis which made me very excited because a friend’s six-year old daughter has CF. Then I read the details and realized this near-cure did not apply to the most common Cystic Fibrosis mutations and would only help a tiny percentage of people suffering from this condition. The cruelty of these misleading headlines disgusted me. Yes, they got me to read the article, but I can imagine lots of people saw the headlines, got their hopes up only to have them dashed again.
There should be a special place in hell for the authors of intentionally misleading science writing.
Arlen Specter is a big proponent of “magic bullets”
Why don’t we all just come clean and admit that cancer is big business? Cancer is the cash cow of modern medicine. It’s the foundation of doctors’ and nurses’ and hospitals’ fortunes.
Cancer is what buys doctors their yachts and vacation homes in Maui. Cancer is what pays for that snazzy sports car the ICU nurse drives. Cancer is what lets that hospital administrator buy a penthouse in Zurich as well as his mansion in town.
Without cancer, American doctors and hospitals would be down in the weeds, shlepping around making $80,000 a year like German or French doctors and telling their patients, “Yeah, it’s fatal, we don’t have a cure, here’s a morphine pump, now go home and gather your loved ones around and say goodbye.”
Cancer is the single biggest scam in America. That’s why the reporter had to insert the obligatory “magic bullet” bullshit. Cancer is better than aluminum siding, it’s made more people richer than snake oil, it’s ripped off the life savings of more gullible dupes than all the Florida swampland in history.
You have to wonder why the reporters don’t just cut to the chase and shout “Hooray for cancer!” and show some pics of oncologists high-fiving each other when they diagnose a Grade IV astrocytoma while yelling “Vacation home in Malibu!” to one another…
A quick Google tells me that an “innovation” can indeed be a “new product” as you say. I’ve only ever seen it as being a new idea – not a more successful version or implementation of an old one. So: your position is the more supported, but I reject the evidence and maintain my position.
Villago Delenda Est
That’s the entire reason for it. If by some chance people are informed, well, that’s great, but it’s not the primary reason. If they’re misinformed, again, who cares, that’s not the primary reason.
@mclaren: Yes, it’s a conspiracy.
If you believe half what you write, you need either to meet some actual doctors, or perhaps some different ones, or you need to meet some actual psychiatrists – whom you will no doubt denounce as the cash cows of modern medicine.
All I can say is I just finished reading How We Do Harm by Otis Brawley and there is so much truth there it hurts.
Villago Delenda Est
Man, that explains all those nurses driving around in Bentleys. I was wondering what the deal was there.
I just bought 10,000 shares of Consolidated Cancer.
I just came from a memorial for a buddy that died of pancreatic cancer 5 months after diagnoses. This article about How Doctors Die sums up his approach.
About 20 years ago I worked for a pharmacy & home health care agency combo that was fabulous in many ways, but…
there was this one patient who spent tens of thousands of dollars, getting shots from a bitch of a nurse, supervised by the pharmacy owner (a pharmacist), of shark something-or-other. Remember back when that was the magic bullet?
The fabulous nurse/administrator that we had on the home health care side refused to give the shots, she got demoted, and we got the bitch as our new admin. Chaos ensued. Many people quit, including me, eventually. However, I’d uncovered, about a year earlier, some malfeasance by the billing group that had cost the company almost $500k, so I was golden… The bitch ended up out the door and I was back as a contractor, on my own terms, making lots more money.
So, there’s the issue of the magic bullets, and there’s the issue of shady people willing to push (or administer) the magic bullet to make money.
One of our local attorneys was on the golf course last week and had a tweek in his side. He was in a little pain, but nothing that really stopped him playing golf. He went for blood tests. As we speak he is in Duke Hospital on his death bed cause they are trying to put stents in his bowels because he has pancreatic cancer. If he had never gone for the tests he would be out on the golf course this week with a little pain. Right now he is in the hospital and they are merrily killing him. Nice to know.
Dead Earnest (a physician, btw)
Nice catch Tom,
It was subtle, just kinda slipped in, and one of the usual ‘harmonics’ that typically accompanies these stories, that I would have missed it.
And that right there Dear Fellow BJ’rs is Tom’s point. In the midst of an apparently (I’ve only read what got excerpted) adequate, if not better, article sits the standard mini-meme which reinforces a dumbed down picture of cancer.
I remain not only a fan of what (anyone can see that) you bring here; but despite the ploy of finally showing a picture of your creation ‘John Cole’, I remain a fan of the remarkable work you’ve created with Balloon Juice. Creating the characters: Cole, ABL, Mistermix, the one that is a guy pretending to be an old woman. It really is something to marvel at. Still, Kay and Laura and on occasion Dennis seem so real, that I sometimes wonder if you don’t have some other people working with you.
@Raven: Fuck. That reminds me, I’ve now lived to the same age my father attained. He died of pancreatic cancer. I feel older than dirt.
@Litlebritdifrnt: Gone for tests when?
@jeffreyw: He was about 67, flew P3 Orions and then became an ecology professor. Dude was serious about nature, very serious.
He was on the golf course last Wednesday (5/23), on Thursday he had blood tests, on Friday they did a biopsy on his liver, by the following week (5/30) he was in the hospital and basically told that if they could not get the stents in his bowels to hold then he was dead. They are basically killing him. They are sucking on those sweet sweet insurance company dollars to kill a man.
@Litlebritdifrnt: I’m sure the Bilderberger’s are involved
My sister lost her husband to cancer not long ago, and she gets really mad when the ads come on the tv for the Cancer Treatment Centers of America, due to this “not trying hard enough” bullshit.
Stuck in the Funhouse
Read this when you posted it earlier. I would hope to find that kind of strength, to accept the fate of one of the deadliest and painful cancers. Pancreatic. And his love of nature and ecology is right down my alley. Brave dude. We all die, just a matter of when and how.
@Stuck in the Funhouse: I can’t begin to tell you. I have been guilty for a couple of months because there was a gathering that got “postponed” and I didn’t get a chance to see him. I learned today he wanted none of it.
@I kathy a.: I agree, but I believe the drugs to cure were so damaging. It is hard to say hook me up. I saw my mom die and I am sure most people have not seen that, she had a plastic face mask, it was horrible. The cancer made her so weak. I do believe the drugs are killers. deb n
okay this thread is dead. No one wants to talk about it.
@beltane: I know the drug you’re referring to. Here’s the thing: CF is a rare disease, notable only for the fact that a lot of Caucasian’s are carriers for it. If we further divided it up into the 20 or so individual mutations it is, people would lose interest in it and research funding would dry up. That’s why I don’t mind the War on Cancer terminology – sure it gives the wrong impression, but at the end of the day, I’d much rather have people hear a lot of little stories about progress on “cancer” than no stories because nobody cares about what pancreatic neuroendocrine tumor is.
Also, it’s a sign of our progress that we have such individually targeted therapies for cancer now, and it’s only going to become more targeted (eg it’s only a matter of time before someone figures out how to train a patient’s lymphocytes to better fight cancer cells, then unleash them back into the body to do the job without having to use any drugs). Contrast this with Alzheimer’s, where basically we’re treating what is probably a lot of individual diseases as one big scary thing which we know little about and have few drugs available for.
If only it were that easy. One of the things that we’ve learned about cancer is that it (or at least many solid tumors- see that thing about cancer not being just one disease?) seems to work in part by subverting the immune system. The cancer cells trick immune cells into creating a local immunosuppresive environment, so lymphocytes that ought to be targeting the tumor get turned off when they get there. And, of course, that ignores cancers like lymphoma and lymphoblastic leukemia that affect the lymphocytes. There’s almost certainly substantial value to immunotherapies, but they’re no more a magic bullet than anything else that’s ever been proposed as a cancer treatment.
I think the most fascinating thing in your fact-free rant is that you actually believe the right-wing propaganda that claims doctors in Europe don’t treat cancer when a three-second Google visit could have fixed your ignorance.
They must think that there’s some hope of curing him (or at least slowing the cancer down) if they’re doing treatment that extreme. When my uncle was diagnosed with pancreatic cancer, they basically sent him home with painkillers because there was nothing they could do.
When he was diagnosed, he asked his doctor if he should stop smoking, and the doctor said, “Don’t bother.”
And, yes, like it or not, cancer treatment basically consists of getting as close to killing the patient as possible in the hope that the cancer will die before the patient does. It’s horrible and ugly, but it’s a horrible, ugly disease.
In general, if you think you see a simple solution to a big, tragic problem that has defied the efforts of tens of thousands of researchers for decades, despite (at least episodically) generous funding, there’s a pretty good chance the problem is harder than you give it credit for.
What sort of response are you looking for? Cancer is a horrible, awful disease, and many of the treatments are highly imperfect, too often ineffective and too often exacting a terrible toll on the patient. That is a spur to develop better treatments and to continually reassess existing treatments – not necessarily a reason to denounce the existing treatments as poison. Doctors dealing with terminal conditions or potentially terminal conditions always face a choice to be handled with the patient and their family about the cost of the treatment – and I’m using a word that deliberately combines issues of monetary expense and the burden borne by the person undergoing treatment. The choices are often bad ones, either way. But you don’t need to slander either of the choices, any more than McLaren needs to slander the doctors helping the patients to face them.
It’s not sloppy writing. It’s sloppy thinking. The words are just the medium.
Fine, I’m insane and deluded. Take a look at what treatments doctors accept when they get diagnosed with cancer, and the treatments the general public get when they get diagnosed with cancer.
Doctors know the score. A doctor gets diagnosed with cancer, and he takes some pain meds, quits his practice, wraps up his life, and goes home to die. Members of the general public, by contrast, piss away three quarters of a million dollars on worthless chemo and radiation and other horseshit that serves mainly to prolong their already agonizing process of dying from cancer, while draining not only their insurance company’s coffers, but, after they hit that magic “lifetime cap” on their insurance, their life savings as well.
Source: “Why Doctors Die Differently: Careers in medicine have taught them the limits of treatment and the need to plan for the end,” Wall Street Journal, Ken Murray, 25 February 2012.
Of course the doctor who wrote that is lying or insane. And the statistics showing that doctors as a group typically refuse the ridiculously expensive end-of-life nostrums and palliatives, the hyper-expensive radiation therapies and chemo treatments, the quality-of-life-destroying but fantastically lucrative oncology surgeries and steroid treatments that produce even worse symptoms than the disease itself…? Why, those statistics are all lies.
Yes, everyone is insane and deluded — the doctors, the reporter, the statistics are all lies…everyone is deluded except you, Warren Terra.
On the other hand, I nursed two parents who both died slowly while doctors fumbled and stumbled and bumbled and tried whatever came to mind, as long as it cost plenty of cash — and in the end produced absolutely nothing other than to prolong the death of people already deathly ill. Moreover, I watched quite a few other people died slowly in agony in the cancer ward during my visits there — people too weak to press the nurse’s call button and whose eyes pleaded for death while no one paid the slightest attention to them.
Stretching out a terminally ill patient’s end like that, in an environment as cold and soulless as a modern hospital, is frankly something I consider a form of torture. If doctors had even an inkling of conscience, they’d explain how it’s going to end to their cancer patients, advise ’em to hold back a few of those pain pills every day to stockpile ’em, and go home and spend the rest of their time with their family. And when the pains gets too bad, take all the pills at once.
But of course that wouldn’t be profitable for American doctors. That kind of concern for the patient would reduce American doctors’ incomes from an average of $230,000 a year for general M.D.s to the $80,000 a year that doctors in Europe get paid.
@mclaren: Doctors in Europe make more than $80,000 per year (unless you’re talking Southern/Eastern Europe, in which case that kind of money is worth about three times that in real terms).
Also, among American docs, oncologists are hardly raking it in. If you want to make money, you go into plastics, radiology, orthopedics, anesthesiology, or derm, not anything having to do with internal medicine (except cardio). That tells you a lot about where society’s priorities are.
And the reason docs make as much money as they do is because they spend over a decade of their lives in medical school/training.
It’s easy to rant about how expensive our end of life care is… but everyone has a right to go out however they want, even if that means exhausting every option known to man. None of the doctors I work with would ever tell a patient there’s no point to a certain treatment and they should just go home and die, but if the patient asks what they would recommend if it was them or their child who had the disease, they’re honest.
And yet, as I proved to you above without a doubt, European doctors do treat cancer.
So your theory is that European doctors are basically serial killers who slowly torture their cancer patients to death for no reason, but American doctors are worse because they get paid better?
Ilia bangs her little spoon on her tiny highchair and shrieks:
Everyone “has a right” to piss away hundreds of thousands of dollars for no reason? Spoken like someone who has no concept of how the real economy in the real world works.
Your bizarre attitude explains superbly why America spends twice as much of its GDP on medical treatments for worse results than Europe/Japan and the rest of the developed world.
As for your assertion that “the reason docs make as much money as they do is because they spend over a decade of their lives in medical school/training,” that’s obvious and foolishly false nonsense, and the evidence proves it.
The reason American doctors make as much as they do is because the AMA acts as a cartel to artificially restrict the number of doctors in America and thus artificially raise their income two nearly 300% what doctors in Europe and Asia and the rest of the developed world make.
Source: “The Medical Cartel: Why are MD Salaries So High?” Mark J. Perry, 24 June 2009.
As of 1996, the average general MD in America made $199,000 — compare that to $104,000 for the same general MD in Germany, $100,000 for the general MD in Canada, $62,000 for the general MD in France and Japan, $58,000 for the general MD in Australia, $52,000 for the general MD in Britain, and $41,000 for the general MD in Sweden.
An American doctors is 5 times better than a Swedish doctor? Really? So why, Ilia, pray tell, canyou explain to me why in the world America’s infant mortality rate is double that of Sweden?
Source: “Beyond the mandate: Improving America’s health will take more than universal insurance,” The Economist, 7 April 2012.
And all that impressive education of doctors (which you claim comes to 10 years: in fact, it’s closer to 5 years post-baccalaureate, less postgraduate education than a typical PhD gets) you claim so airily doesn’t seem to have resulted in developing the ability for analytic thought or critical thinking in doctors.
If American doctors boast such a superbly impressive education, perhaps you can explain why they can’t manage to stop prescribing treatments that study after study has shown don’t work, and in fact hurt the patients…?
Riddle me that, Batman.
I keep hearing about how impressively educated doctors are. It’s a crock of shit. Every time I meet a doctor, I swing the conversation around to Bayes’ Theorem. Naturally, they’ve never heard of it. “Oh?” I essay. “That’s interesting. So if a patient goes to you and you perform a medical test on her that’s 99% reliable, if the patient tests positive, what are the chances that the patient is actually sick?”
The doctor invariably hems and haws and spews vacuous bullshit. At which point, I hit ’em with the simple calculation required for answering that question — and invariably, the goddamn ignorant incompetent undereducated doctors don’t know the first thing about Bayes’ theorem, and have never in their entire time in medical school done a single calculation using it.
The intuitive answer is 99 percent, and that’s the answer the ignorant incompetent doctors invariably give. Which explains a whole goddamn lot about why America’s health care system is as badly fucked up and costs as much as it does. Our doctors have shit for brains, haven’t been trained for spit in basic rudimentary diagnostic statitics, but American doctors have an overweening god complex and think they’re the greatest and smartest and most impressive gift to the world since Leonardo da Vinci when they’re actually a bunch of undertrained narrowly educated egotistical rule-of-thumb drones.
The correct answer turns out to be 50 percent, and, boy, when you hit a doctor with that one, watch the deer-in-the-headlights stare as his eyes widen and his mouth opens and closes like a guppy in a pet store fish tank.
Source: “What is Bayes’s theorem, and how can it be used to assign probabilities to questions such as the existence of God? What scientific value does it have?” Scientific American, 4 December 2005.
As for Mnemosyne…a piece of advice, kiddo: don’t post when you’ve been drinking. It shows.
Mnemosyne offers this magnificent gem of analytical reasoning:
Great thinking. How does the fact that European doctors by and large shunt terminal cancer patients into hospice treatmeant rather than providing fabulously expensive heroic and largely pointless end-of-life treatments make European doctors into “serial killers”?
You really don’t get it, do you? When people are diagnosed with a cancer with a high mortality rate and low life expectancy, that person is basically going to die. The chance that such a person will experience a spontaneous remission exists, and it’s about on the same level of likelihood as surviving a skydiving accident where your parachute doesn’t open. It happens, but very rarely.
So my “theory” is that American doctors are trained for heroic intervention rather than preventive medicine or hospice-style end-of-life treatment that focuses more of quality of life than massively expensive technologically impressive surgical extravaganzas. Moreover, the hard cold facts of American end-of-life care compared to European end-of-life care bear out my claims.
On the other than, the hard cold fact that the terminal cancer patients we’re talking about are going to die no matter what anyone does makes nonsense of your claims that either American or European doctors are “basically serial killers.” That doesn’t even make sense. How does artificially and painfully extending the suffering of a dying person by a few weeks or months make a doctor a “serial killer”? Did someone slip LSD into your coffee, Mnemosyne? You sound like you’re on goof gas.
But let’s let an American doctor untangle Mnemosyne’s scrambled logic and garbled reasoning for himself:
Source: “How Doctors Choose To Die,” The Guardian, 8 February, 2012.
You really shouldn’t post after you’ve been drinking, Mnemosyne. It’s embarrassing. Go home and sleep it off. You’ll make sense in the morning. Right now…not so much.
McLaren, some of the things you say are true, but most of the conclusions you draw are flat wrong. American doctors are paid better than others in part because they pay massive tuition, plus living expenses, for years of medical education, then are worked like a dog for laughable pay during their residency. After passing one of the most selective barriers our country has and getting accepted into medical school, they assume hundreds of thousands in debt and delay earning while studying and working their asses off for at least six years, and often more. Add that to the general stratification of pay in our society and you have a big part of why fully trained American doctors earn more than their counterparts elsewhere.
Also, the limits on the numbers of doctors trained are set in essence not by the AMA but by the taxpayer: training each doctor is far more expensive than even the huge debts American medical students reflect,a difference largely borne by government subsidies to medical schools.
A lot of the rest of your screed – and for gods sake seek brevity (not that I am a model); no one can hope to address everything when you vomit forth two thousand words, and most won’t even read it all – consists of failing to understand the differences between decisions made by doctors who’ve internalized the facts and are inured to death versus families desperately seeking any thin reed of hope available; the difference between medicine on the one hand and public health and the social safety net on the other; and the difference between a rationally acting single payer system that can ration care and issue verdicts on effectiveness, and a horde of customers screaming for the treatment they demand.
Are there villainous American doctors? Undoubtedly. And there genuinely are doctors conspiring to take excessive profits from the system; see Gawande on McLaren, Texas, a story that given your handle I suspect you already know. But while a lot of the issues you raise reflect real problems to be addressed, you direct your anger in the wrong directions and wind up slandering a lot of dedicated servants of their fellow man.
Someone here has been drinking too heavily, but it ain’t me.
So if cancer is all a scam and a cash cow, why do they have cancer hospitals in Europe? Note that you never specified “terminal” cancer until your very last post.
If you want to talk specifically about how we treat end-of-life care and terminal patients, we can do that, but ranting about how all cancer is a scam and doctors in Europe don’t even bother to treat it is not how you get to that conversation, because it makes you look like a fucking idiot from the very beginning.
You may be surprised to hear this, but different cancers have different prognoses. Was my mother-in-law supposed to refuse treatment for her thyroid cancer that had a 98% survival rate with treatment because her doctor just wanted to make a buck from her?
They don’t have the kind of heroic intervention no-expenses-spared massive technological cancer treatment as the basic standard for care of cancer patients that we do here in America. That’s why. The American kinds of cancer hospitals, where no expense is too much even if it only extends a cancer patient’s life by a week, do not exist in Europe.
You keep claiming things are facts when they aren’t. A “cancer hospital” in Europe is a very different thing than a cancer hospital in America. They offer different amounts of treatment, they triage patients differently, and they don’t engage in bizarre no-holds-barred efforts to extend all paitents’ lives regardless of cost.
There is a difference between the US and overseas in terms of the lengths and expense people will go to to minimally extend life, or the extent to which doctors will perform questionable procedures to answer the demands of desperate patients, though I suspect the difference is not as great as you portray. Where you err (or rather, your greatest error) is in thinking that this difference betrays villainy and greed on the part of American (cancer) doctors, rather than a cultural difference and a difference in how medical care is funded.
Living in Britain here, and my mother-in-law was diagnosed with pancreatic cancer late last year. Trust me, she’s getting big-guns treatment on the NHS, and unlike what would be the case in the States, they aren’t going to be bankrupted by the treatment. (She’s doing remarkably well at the moment.) And thanks for this post; the goddamn Daily Mail and Express have this habit of frequently posting SIMPLE CURE FOR CANCER FOREVER-style headlines, when they aren’t running through the usual collection of xenophobic hate headlines, and that shit just breaks my heart. We’re not going to get a magic bullet cure; the best we’re going to get is some more time. We hope most of that time is pretty good, but that’s it.
It’s true. I’m sorry Tom, but the term “magic bullet” is used all the time. And Ehrlich was the first to propose that such a “cure” may exist. The problem may be that it is spoken of in the media in the terms of a cure. Cure is not what the magic bullet hypothesis is about. Cancer isn’t just one disease, but many. Even breast cancer comes in dozens of flavors. And each needs its own “magic bullet”.
I’m a cancer researcher. And I’ve worked with dozens of these magic bullets over the years. Some work well, some less so.
@Mardam: Without going into a long thesis now, I’d say you’ve just expressed my point. I will say that my students have recently completed a short film on work in the lab of a top cancer researcher, and in that telling, modern molecular approaches to cancer confound rather than smooth the way towards magic bulletry. IOW — it’s a problem even in professional research thinking, and not just in media transduction.
Don’t forget the organization’s PR office. I don’t know about cancer research, but in other fields of science, the press release is shamefully often where the exaggerated, messianic nonsense gets in.
I tend to side with @mclaren here. I went through an unsuccessful three year cancer battle with my wife, and a couple of things became clear to me as I researched as much as I could: 1. Doctors know what they are taught by the AMA. Most do not spend their free waking hours studying outside the box treatments or questioning the policies of the AMA; 2. In the 50 – 60 year American war on cancer, the AMA refuses to look into anything other than improvements in surgery, chemotherapy and radiotherapy. Are we to believe that during all of this time the original three treatments are still the only three worth considering? Nothing new has shown an inkling of promise during this time? Is it overly cynical to think that the big three treatments all coincidentally happen to cost vast sums of money?; 3. European hospitals seem to be more open to new ideas, and some, if not many, provide alternative treatments like oxygen therapy and heat therapy; 4. There is a history in America of respected doctors dropping out of the mainstream medical industry in America to pursue their ideas for alternative cancer cures. There are some interesting ideas floating around in the alt-cancer universe. Almost certainly none of these alternative ideas/treatments will see the light of day due to exorbitant costs related to FDA testing.
It’s common on threads like this to drown out people who talk about the medical industry in America in a conspiratorial tone. I find it strange that it happens on web sites like this one, where informed people rightly speak cynically and conspiratorially about politics but have trouble fathoming that the same might be true of the medical establishment. A look at the dollars involved should dispel any notions that the medical industry is somehow above ordinary politics.
@muddy: I’m so sorry about the loss of your brother-in-law.
my dad had a metastatic cancer. i could find absolutely nothing suggesting any hope of cure (or long-term survival) for someone in his position.
the treatments slowed things down for a while, but at some point it was clear that they were not working, and were making what was left of his life very miserable. my dad kept going back for more — which really upset me at the time. i was furious with his oncologist for offering one wrenching experimental treatment after another. (by “experimental,” i do not mean my dad was part of a scientific research project, but that his doctor was pulling up chemo agents and throwing them against the wall of this cancer to see if any stuck.)
in retrospect, i’m convinced that my father was responding to the “war on cancer” messages — that he had to go down fighting; that maybe the next treatment would be a “magic bullet.” he was getting those messages not only from his buddies — the ones who hated to see him like that, but sent great flowers to the funeral — but also on a constant basis from one of my siblings.
I’ve been reading BJ for years but have never commented, until today.
I was diagnosed with Stage III NH lymphoma about 3 weeks ago, so maybe I’m a little raw and over sensitive about this “Cancer” thing.
But I’ve been driven out of the shadows just to say:
F**k you, @mclaren, you pompous, long-winded douchebag. Who the hell do you think you are to tell ME or anyone else with cancer how we should choose to spend our last days on earth?
I fell asleep halfway through your treatise, but I got the drift.
If the medical industrial complex can give me an extra 3 months, or 6 months or a year of life, well, I’ll take it. It might mean I get to see one of my kids graduate from college, or get married, or see a grandchild born.
And yeah, that’s just one reason why our healthcare system sucks, cause I get to make that decision.
BTW, I’ve dealt with end of life care, my mother died last year at 84. She didn’t want any heroic interventions and she didn’t get any. That was HER wish. We got zero pushback from doctors or anyone else.
@Mnemosyne: When addressing mclaren,
should just be copy/pasted in response to anything of his. That simple statement has a 80% or better chance of being correct, as-is, without any changes.
@mclaren: I just got to reading this. Wow, this person is a moron.
Tell you what Mclaren, I’ll tell you what Bayes’ theory is as soon as you tell me how to work up patient for stroke and the different options available based on time of onset of symptoms.
You say I have no concept of the economy, I say you have no concept of PEOPLE. I have many, many patients who are willing to sell the clothes off their backs to get the best health care for themselves and their children. THAT is why our health care system is so expensive, not because greedy docs are sucking up the money. I don’t know a single person in my medical school class who couldn’t have gone to Wall Street and spent their whole life scamming other people for cash. Although, in retrospect, that might have been the better route to go, because unlike with docs, there’s no chance of the government ever taking those guys’ reimbursements from them.