February 4, 2010 - A Double-Dog Dare

Today is World Cancer Day. One of the simple facts about cancer, as we all know, is that early diagnosis is tremendously important. Sometimes it can mean the difference between life and death.

Yet even so, there are many people who have noticed something unusual or out of the ordinary about their bodies, but procrastinate on going to the doctor. Of the lump or mole or recurring pain they say, “I’m sure it’s nothing,” then go back to business as usual – until the next time, when they’re just about as likely to repeat the process.

Although I had none of these symptoms, myself, I did have a recurring sense that something wasn’t quite right, and felt led to ask our family doctor to check me for an aneurysm (something my father had experienced, and nearly died from). It was that ultrasound scan that revealed the presence of the large abdominal mass that was later diagnosed as lymphoma.

An email that arrived today from Lance Armstrong’s Livestrong organization suggested I pass along a little reminder that, if you’re going to get checked for cancer, sooner is surely better than later. Here’s the message:

Know your risks. Call your doctor….What are you waiting for?

Learning about your family history and talking to a doctor about your daily habits can give you valuable insight into the steps you need to take, right now. It’s true – talking to your doctor about cancer can be scary, and many of us just forget to bring it up. But your health is important to me and that’s why I’m asking you to start the conversation now.

All of us can take some simple steps, like this one, to fight cancer. For help in taking that first step, go to livestrong .com and DARE TO CALL YOUR DOCTOR.

Want to nudge your friends to call their doctor? Drop the soda? Stop smoking? You can do it here.

So, I dare you. No – I double-dog dare you.

April 25, 2009 - Take a Little Wine

“No longer drink only water, but take a little wine for the sake of your stomach and your frequent ailments.” So says 1 Timothy 5:23 – a little practical advice, in the midst of some miscellaneous exhortations at the end of this New Testament letter.

Who woulda thunk it? Who could imagine this homey, first-century medical advice would surface at a 21st Century cancer research conference?

It has, though – at least, according to a recently-released research study. From a news article describing it:

“Pre-diagnostic wine consumption may reduce the risk of death and relapse among non-Hodgkin's lymphoma patients, according to an epidemiology study presented at the American Association for Cancer Research 100th Annual Meeting 2009.... [The researchers] analyzed data about 546 women with non-Hodgkin's lymphoma. They found that those who drank wine had a 76 percent five-year survival compared with 68 percent for non-wine drinkers. Further research found five-year, disease-free survival was 70 percent among those who drank wine compared with 65 percent among non-wine drinkers.” (“Drinking Wine May Increase Survival Among Non-Hodgkin's Lymphoma Patients,” ScienceDaily, April 24, 2009.)

Admittedly, those numbers aren’t all that startling. The wine-bibbers get a mild statistical bump, that’s all. Draining Bacchus’ cup is clearly no panacea, but it does seem that “a little wine,” as the author of 1 Timothy advises, can be good for what ails ya.

Not every tippler will be happy with the study’s results, though: “Beer and/or liquor consumption did not show a benefit,” the report soberly concludes.

It’s just the vino, folks.

According to the article, wine has certain anti-oxidants that tend to retard tumor growth. This is consistent with some earlier studies that show wine (especially red wine) has a mild positive effect on heart health. An occasional glass of Chianti or Lambrusco is part of the highly-touted “Mediterranean diet.” Now, it appears the fruit of the vine does a little something for lymphoma prevention as well.

The oncologists aren’t exactly advocating pub crawls. Far from it: “This conclusion is controversial, because excessive drinking has a negative social and health impact, and it is difficult to define what is moderate and what is excessive,” says one of the lead researchers, by way of a disclaimer.

(Nota bene: 1 Timothy does specify “a little wine.” All things in moderation.)

I’ve always thought an occasional glass of red wine to be one of life’s little pleasures. It’s nice when something that tastes so good turns out to be good for you, as well.

Wine has even found its way into religious poetry on occasion. I close with these lines from the medieval Persian poet, Rumi:

“The grapes of my body can only become wine
After the winemaker tramples me.
I surrender my spirit like grapes to his trampling
So my inmost heart can blaze and dance with joy.
Although the grapes go on weeping blood and sobbing
‘I cannot bear any more anguish, any more cruelty’
The trampler stuffs cotton in his ears: ‘I am not working in ignorance
You can deny me if you want, you have every excuse,
But it is I who am the Master of this Work.
And when through my Passion you reach Perfection,
You will never be done praising my name.’”

– Mevlana Jelaluddin Rumi (1207 - 1273)

Salut!

September 9, 2008 - Cancer Misinformation

OK, here’s a curious news item. Someone’s done a study of misinformation about cancer, and how spurious beliefs vary according to whether a person lives in the industrialized or the developing world:

“Researchers interviewed 29,925 people in 29 countries last year to compare data on perceptions about cancer risk factors among high-, middle-, and low-income countries.

Among their findings was the fact that people in high-income countries were least likely to believe that drinking alcohol increases the risk of cancer, when, in fact, cancer risk rises as alcohol intake increases. Specifically, 42 percent of the people in the high-income countries said alcohol does not increase the risk, compared with 26 percent of those in middle-income countries and 15 percent of those in low-income countries.”

So, first-world people insist on believing, despite the evidence, that they can tipple risk-free. They also choose to believe – again, contrary to evidence – that eating a diet high in fruits and vegetables will do more to lower their cancer risk than abstaining from alcohol. It won’t. Alcohol is a far bigger risk.

First-world people also believe exposure to air pollution is more carcinogenic than drinking. It’s not.

People in middle- and low-income countries tend to take a Que Sera, Sera attitude towards cancer, believing not much can be done to treat it. Folks in wealthier countries – evidently more used to seeing baldheaded cancer survivors walking around – believe that aggressive therapy can make a difference.

Generally speaking, “people in all countries were more ready to accept that things they could not control (e.g., air pollution) were risk factors than things they could control (e.g., overweight, which is an established cancer risk factor).”

I’m still processing these observations. I don’t quite know what to make of them. Of course, it’s humbling to be reminded, once again, of how cancer treatment is pretty much the preserve of the wealthy (with “wealthy” defined according to a global standard, to include pretty much everyone in Europe and North America). In many parts of the two-thirds world, a cancer diagnosis is still pretty much a death sentence.

Yet, from Basel to Bangladesh, there’s still a lot of unreasoning fear out there when it comes to cancer. It’s a better fit for our frame of reference, somehow, to see cancer as an unstoppable force that descends with devastating randomness (caused by something like air pollution that few of us can do anything to prevent), rather than as something that can be a consequence of our own lifestyle choices.

Cancer is a great drive-in movie screen, on which we tend to project our desires as well as our fears. No wonder it can be such a hard subject to talk about.

May 15, 2008 - Concierge Medicine?

A couple of nights ago, Claire and I attended an informational meeting put on by our family-practice physician, Dr. David Cheli. Starting this July, he’s associating himself with a nationwide group called MD-VIP. This decision will bring big changes for his patients.

For us patients, there’s some good news and some bad news.

The good news is, Dr. Cheli’s going to be focusing very intentionally on preventive medicine. Each patient will receive an elaborate annual physical, including a host of diagnostic tests. That physical exam takes about one and a half hours, and is – the company claims – comparable to the “executive physicals” long offered by world-class medical facilities like the Mayo Clinic. Each patient gets a personalized website with health-related resources, and a mini-CD-ROM containing personal medical history to carry around and present to emergency-room doctors, if necessary. Dr. Cheli also promises to be available 24/7 by cell phone, and further promises that no patient will ever have to wait longer than one day for an appointment. He’ll continue to take all medical-insurance plans for routine office visits – no change there, he assures us.

Dr. Cheli will continue to have a solo practice, but he’s cutting his roll of patients from 2,700 to 600. That’s what makes the more personal attention possible.

OK, that’s the good news. Now for the bad news. Each patient must pay an up-front fee of $1,500 a year – which (except for, perhaps, a small portion) is not covered by insurance.

Do the math. 600 patients times $1,500. That’s 900 grand. Dr. Cheli doesn’t get all of it, of course. MD-VIP gets their cut, and those elaborate tests associated with the annual physical do cost something. Yet, what he does receive from these annual fees is evidently enough to cut his patient roll by more than three-quarters.

I can understand what’s in it for him. As he explained the other night at the public meeting, he’s been practicing medicine for 31 years. Along with many of his colleagues, he’s feeling increasingly frustrated with a health-care system that forces him to rush through patient appointments so he can spend hours on the phone arguing with insurance adjusters. He knows the type of medicine the system forces him to practice isn’t as good for his patients as the type of medical care he was trained to deliver.

MD-VIP claims their patients’ hospitalization rates are just 65% of the general population. They attribute this to two causes: better prevention, and same-day or next-day appointments (which allow MD-VIP doctors to identify and treat serious conditions in the office, keeping their patients out of the emergency room).

That may be part of it, but I’d be willing to bet that a significant portion of this favorable statistic can be explained by the fact that patients willing to pony up the $1,500 fee are younger and healthier to begin with.

Why do I say that? Several reasons. First of all, MD-VIP relies heavily on the internet. Patients have to be familiar enough with computers to derive the full advantage from this service. While some senior citizens have taken to the internet with a vengeance, a great many still don’t know the difference between hypertext and hyperactive. Second, chronically sick people are more likely to have burned through their financial resources and would have a harder time coming up with the $1,500 annual fee. Third, patients who see the value of preventive medicine, and are willing to pay for it, are more likely to have already adopted positive lifestyle habits. (How many chain smokers or alcoholics are willing to go for this?) Fourth, those who simply have an aversion to going to the doctor are not likely to pay top dollar for the privilege of spending more time doing the thing they hate.

So, Claire and I have a tough decision to make. We both really like Dr. Cheli. He’s been our family doctor for 17 years. He diagnosed my cancer before I was displaying any obvious symptoms. He’s a got a caring bedside manner, and he’s always been responsive to our needs. But, can we find the $3,000 a year to keep going to him?

My medical insurance, provided by the Presbyterian Church (U.S.A.), has a preventive health benefit that reimburses 100% of the cost of an annual physical, independent of deductibles and co-payments. That benefit’s got a cap on it, though, that falls way short of $1,500 for each of us. Most of the MD-VIP fee we’d have to pay out of pocket.

If Dr. Cheli will be able to work with me to overcome my #1 preventive-medicine challenge – losing weight – it will be money well spent. But, will the MD-VIP philosophy really give him the time and resources to do that? Is it really as good as the rosy description on the website claims?

They call this “concierge medicine” (although MD-VIP's website disavows this label, saying they’re “beyond concierge healthcare”). As with any pricey “concierge floor” in a hotel, the question is, “will we get our money’s worth out of the enhanced service?”

Or, is this one of those situations where, as they say, “if you have to ask the price, you can’t afford it”?

December 1, 2007 - Secrets of the Pyramid

Today I come across a helpful and attractive website, belonging to a group called the Cancer Recovery Foundation of America. It’s got a lot of useful information for cancer survivors.

The thing that’s most intriguing to me is a rather simple teaching tool called the Cancer Recovery Pyramid. It’s modeled, I’m sure, after the nutritional pyramid used by the Federal government.

I like several things about this model. First, spirituality is foundational. It’s the broad base on which everything else rests.

Second, the next level pairs attitude and support, which are indispensable both to recovery and to each other. Keeping a positive attitude is central to cancer recovery, but it’s not everything. Those who are successful at living with cancer, in my experience, are those who also reach out and build connections with others. They know the importance of both nurturing their existing intimate relationships and establishing new ones with fellow cancer survivors.

Third, the pyramid emphasizes nutrition and exercise. If there’s any part of the pyramid that’s my personal weak point, it’s this level. I do know, though, that when I eat right and get to the gym regularly, I feel better.

Finally, medical treatment is at the top of the pyramid. This is where it should be. There are some who emphasize alternative therapies to the point where they’re neglecting, or even contravening, medical advice. These are the people who are inclined, by nature, to jump on the bandwagon of each new bit of wacky, word-of-mouth advice that comes their way. They are constantly getting their hopes up and seeing them dashed just as quickly. It’s better to think not of alternative therapies, but of complementary therapies – those pursued in coordination with the best medical advice.

At the same time, it’s worth noting that the area occupied by medical treatment is the smallest of all. As vital as medicine is (symbolized by its position at the top of the pyramid), it’s a paltry response indeed if the other areas are not also in place, forming a solid foundation. Patients who walk into the doctor’s office spiritually grounded, supported by healthy self-esteem and by their families and communities, and taking good care of their bodies are best-equipped to live with cancer.

These are some things I see in the Cancer Recovery Pyramid. Whether all these observations were intended by the pyramid’s creators to be there, I don’t know. But that’s what it says to me.

Now, if I could only do better with that diet and exercise thing...

August 31, 2007 - Another Risk Factor for Cancer

Today's New York Times contains an article reporting on a dramatic change of strategy for the American Cancer Society. They've decided to dedicate $15 million – their entire advertising budget for next year – to a series of ads dramatizing the plight of the uninsured.

Some are charging that this strategy is too political – although the Society's leadership is quick to point out that the ads are non-partisan, and don't call for any single solution to the crisis of the uninsured (such as universal health care coverage). They are, however, going to be spending heavily for ads in states with early Presidential primaries, in an effort to influence the direction of the debate.

I can see why the Society would want to do this. They spend millions every year encouraging people to get early-screening tests for cancer. These tests save lives, no doubt about it. Yet, the uninsured are much less likely to go for these tests. Who's going to go out and get a colonoscopy for routine cancer screening, if it means paying the full cost of $3,000 or more out of pocket? People without medical insurance are highly unlikely to have this kind of money just sitting in a bank account somewhere (if they did, they would probably have used it to buy insurance).

"I believe, if we don't fix the health care system, that lack of access will be a bigger cancer killer than tobacco," says John R. Seffrin, chief executive of the Cancer Society. "The ultimate control of cancer is as much a public policy issue as it is a medical and scientific issue."

Here are some eye-opening statistics from the article:

• According to the U.S. Census, the number and percentage of people in the United States without health insurance is on the rise. Last year, 47 million people – 15.8 percent of the population – lacked medical insurance. That's one in seven people who are at a higher risk for cancer, because they probably won't be going for screenings.

• One out of every 10 cancer patients is uninsured. I can't imagine trying to pursue the costly treatments for lymphoma without insurance. It's hard enough affording them with insurance! It's also hard enough managing the paperwork, keeping track of appointments, and all the rest. If I had to do that as a charity-care patient – filling out endless forms for financial assistance, and having to endure long waits for scarce appointments – obtaining treatment would seem like a full-time job in itself.

• One out of every four families affected by cancer will be impoverished as a result of the disease – including one out of every five who do have medical insurance.

• Uninsured breast cancer patients are more than twice as likely to have their cancer diagnosed in late stages as those with private insurance. The same is true of those suffering from cancers of the larynx and mouth.

• This advertising expense, large as it is, is just a drop in the bucket, compared to commercial advertisers. The American Cancer Society's planned expenditure of $15 million on this campaign in the next year is just a quarter of what just one auto-insurance company, Geico, is spending on its "caveman" series of ads.


People are literally dying because they lack health insurance. When is the nation going to wake up and realize that – voting only for politicians who have a concrete plan for doing something about it?