April 30, 2007
Pap and HPV
Basically, HPV is a family of over 118 viruses. Some of the types are responsible for various genital diseases and cancers. Two particular types cause most genital warts and fifteen other types cause cervical (and other anogenital) cancers, with two (16/18) causing over 70%. A virus gets into the basal layer cells of certain types of skin and takes over, using the host cells’ replicating processes to replicate itself.
For about 20 years, we have known that HPV is a causative agent. For over ten years, research has conclusively demonstrated that infection with carcinogenic types of HPV represents a nearly universal event in cervical cancer development. (That means you have to have these particular infections to develop cervical cancer.) From the other direction, though, most HPV infections do not cause cancer.
It is estimated that over a quarter of all American women have had HPV infection. (There is a new study in JAMA quantifying women with high-risk HPV infection but I can’t put my hands on it at the moment. It doesn’t change the argument.) In many, the infection clears on its own. (In 90%, the infection is cleared within two years.)
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Posted by Robert Maddox at 02:06 PM | Comments (0)
iatrogenesis
Ivan Illich wrote Medical Nemesis in 1976, but he had already applied this concept to transportation, communications and education. Basically, the idea is that too much of something leads to it becoming harmful. Too much transportation ends up making us less mobile. Too much telecommunication decreases our ability to communicate. Too much formal education inhibits our ability to learn. Now it is not really the quantity of these things, but the quality that decreases as they become industrialized and centralized. A cell phone can be a great tool for communication but consider how much actual communication, edifying or necessary speech between people, occurs. The dumbing down of education is beyond question. Transportation, now that it is motorized and individualized, has consumed a huge portion of our production, and arguably limits our ability to transport ourselves, both because of the limiting infrastructure and the disabling immobility.
Illich identified three ways in which medicine has made us sicker, three forms, or levels, of iatrogenesis. These are clinical, social and cultural. Clinical iatrogenesis means that medicine is not only not responsible for the effective changes in life expectancy and health, but that it frequently causes more illness or death than it treats. Sometimes in the course of diagnosing a problem, sometimes in the treatment of it, illness or disability or death is actually caused by the doctor, or by the drug, or by the test. It is the case with overused antibiotics, that have led to MRSA and other very difficult to treat infections. It is the case with much of cancer care, with most of preventative medicine, with most of screening strategies.
Posted by Robert Maddox at 02:00 PM | Comments (0)
What is contranemesis?
In 1976, Ivan Illich wrote Medical Nemesis: The Expropriation of Health. The concept of iatrogenesis, in its clinical, social and cultural aspects, was instrumental in my medical education. I wanted to write a reply to Illich, offering better solutions. But I have been practicing medicine instead, frequently falling into the very behaviors condemned. The book has continued to haunt me through the decades. Recently, I have read it again and have more questions than answers.
This blog is an attempt at a conversation with myself and whomever else is interested. Along the way, I hope to discuss Medical Nemesis in detail, as well as other pertinent books, studies, articles and thoughts.
Posted by Robert Maddox at 11:21 AM | Comments (0)