June 26, 2007
yet more on mammograms
A very astute reader, one who has a dog in this fight, sent me a commentary that appeared in Lancet last year (Vol 368 p1854-6) (but still premium content which one must pay to read) which was basically a defense by Zahl etal of their study debunking the Swedish Two-County trial of screening mammography. There appears to be some significant editorial policy violation, in which their article was removed, contrary to accepted editorial and business policy. (Lancet was not the journal that removed their article.)
But more, it is evident that mammography is a third rail, the sacred cow, of medicine. There are many, of course, but this is a big one.
Posted by Robert Maddox at 01:37 PM | Comments (0)
June 07, 2007
Rivers North
I have finally starting reading The Rivers North of the Future: the Testament of Ivan Illich as told to David Cayley. It is fascinating, a conversation more than a treatise. There are some rather broad historical summaries, much like Rosenstock-Huessy. What follows are gross oversimplifications of his gross oversimplifications.
He states at one point that he did not go far enough in Medical Nemesis, that he missed the major point. The problem is not iatrogenesis as now commonly understood. It is rather that our bodies now are doctor-created. We think of ourselves in terms given to us by medicine. These great illustrations (that pretend they are depicting reality but are really artists’ renditions of various physico-chemical models) and the House animations of disease mechanisms give us a body that is very different from what our forebears were.
All of this comes from the change in the 12th century of the tool as an independent entity. It took doctors another 6-8 centuries to view disease as an independent entity. All of this is related to the change in understanding about the Real Presence of Christ in the supper.
Illich views all of this as a perversion of the Church, and of the Incarnation, that was built into it from the very beginning. He refers to this as the “mystery of evil,” using Paul’s phrase to the Thessalonians. So Western Civ, modernism, is not post-Christian or developed Christian thought, but anti-Christian thought that is built into the very fabric of the Church. He wonders why God would do this. It seems to me that it is to mature us as a people.
Posted by Robert Maddox at 08:11 AM | Comments (0)
May 22, 2007
Spirituality and Health
Over half of US doctors surveyed report believing that religion and spirituality have a significant influence on health and that a supernatural being intervenes at times. Sloan has tried to debunk the latter of these beliefs, if not the former. (more on that some other time)
What is interesting for the contranemesis is the recognition of cultural iatrogenesis that has occurred. Dr. Curlin, himself a practicing internist as well as ethicist, who has several related studies to his credit, distinguishes between areas where religion is more likely to affect decisions and where is does not.
In many cases, Curlin emphasizes, religion does not affect medical decisions. All emergency-room physicians treat broken legs and acute pneumonia using standard protocols. Religion comes into play at what he calls the “margins,” areas that until 50 or 60 years ago were not considered part of the medical profession: end-of-life issues, sexual and reproductive health, and mental health. As long as medicine continues to reach beyond broken bones and acute disease into “areas in which people disagree,” physicians will, he argues, make moral judgments. And those judgments will be colored by religious, spiritual, or secular beliefs.
The "margins" are areas that were "medicalized" by the hubris.
Posted by Robert Maddox at 06:42 PM | Comments (0)
May 10, 2007
Gattaca revisited
A study in JAMA April 11, 2007 (which I cannot link because it is subscription only) by Thomas Morgan, et al, entitled, Nonvalidation of Reported Genetic Risk Factors for Acute Coronary Syndrome in a Large-Scale Replication Study, had an unexpected result. The supposition is that we should be able to find the genetic defects that lead to heart disease (specifically that lump term ACS-which includes heart attacks that do and don't show on EKG, as well as chest pain thought to be from the heart and worse than your regular angina). This study attempted to validate the 85 genetic variants that previous studies have indicated may be associated with ACS.
They could not confirm any of them. The problem culturally, as the film Gattaca explored, is that many of these genetic variants can be tested for now, and that puts people with those variants in danger of social repercussions. It is ironic that this study focussed on the disease highlighted in Gattaca.
Further, it appears to call into question the whole "cure by genetics" approach that is becoming very popular since the Genome Projects. One of the major risk factors for heart disease is family history. But with all our recent hubris, we have not identified the genes responsible. Apparently there are many more factors involved. "There is no gene for the human spirit."
Posted by Robert Maddox at 05:33 PM | Comments (0)