Thursday, July 26, 2012

SCIENCE BASED MEDICINE; EVIDENCE BASED SCIENCE - SMOKE, MIRRORS & SNAKE OIL - NOT WELCOME HERE

VIDEO ALERT:  THE TIMES ARE ALL MESSED UP.... NOW, MATH BEING A HUGE CHEMOBRAIN ISSUE, I CAN'T SIMPLY JUST ADJUST THE NUMBERS!  I PROMISE TO FIX THIS.... MEANTIME, THE ENTIRE VIDEO IS NOW EMBEDDED IN ALL THREE SPOTS....  THE SHORTENED VERSIONS MAY BE EASILY FOUND BY CLICKING THROUGH THIS ONE.  IT WILL TAKE YOU TO THE MSK SITE.  MY APOLOGIES!  WHEN I EMBED A VIDEO, THERE'S NO WAY TO PLAY IT AND DOUBLE CHECK UNTIL THE POST GOES LIVE.  THIS WOULD BE AN UGH MOMENT SINCE I'D EXPECT NO ONE IS GOING TO SIT FOR AN HOUR AND LISTEN TO DR. NORTON ALTHOUGH, I WOULD SAY, HE IS QUITE ENGAGING!!!

I BELIEVE THE TIMES ARE NOW FIXED..... I HOPE SO.....  IF YOU GET THIS IN A FEED, IT SHOULD HAVE BEEN RESENT.

I'm going with Science Based Medicine.  And the science has to be based upon evidence.  Proven evidence or that which can be proven to a reasonable certainty when lives might be at risk.  Aha!  An angle.... a caveat... a way to backpedal....  I hear you.  But no.... what I mean is when the only way to truly prove something works would be to withhold it from people who might benefit.  Those are the circumstances under which I was listen to "observational" studies and give them due deference.

I wholeheartedly embrace integrative medicine.  I listen to alternatives but there is a difference between alternative and integrative.  I rely primarily upon Western medicine.  I appreciate the introduction of Eastern medicine into a holistic treatment approach.  I do not buy into things that I know to be harmful just because it's being repackaged or reworded. This goes back to the "getting vitamin D from the sun debate" and I'm firm in my belief.  Prolonged, repeated exposure to the sun places us at risk for developing skin cancer.  Tanning salons are not safe.  I'm still hearing from people who are trying to convince me I'm wrong.  They are entitled to their views.  I happen to disagree.

Despite all of the studies I've been fed,  I'm going with Dr. Larry Norton.  Memorial Sloan Kettering Rock Superstar. Entertaining.  Self deprecating.  Humorous.  Mostly.... just damn plain brilliant.  I mentioned I was at a presentation he gave back in March.  It was in a prior post somewhere.  Now, I am able to embed the videos.  They are neatly broken into three segments.  I HIGHLY recommend listening to the third one if you don't care to listen to any of the others.  He explains how to be a successful patient.  That's really excellent.

Under the first two, I am adding a bit of a guide indicating what is being discussed and the time point at which the topic may be found.  Bookmark the links.  They are well worth your time (when you have the time---IF you can find the time). He is brilliant.  He doesn't talk AT you.  He's not a doctor with a God complex although he surely has the smarts to sit on that high horse.  I suppose that's part of what makes him so spectacular.

Just as I was setting this up to post, something hit my medical news feed.... What appears below is information from Surgical Oncologists at a Symposium this past April..... Fits with my topic.  Real Science and Cold Hard Facts.  Evidence. Numbers don't lie.  Statistics can be skewed but Numbers.Never.Lie.

PART 1: INTRODUCTION AND DRAMATIC CHANGES IN THE UNDERSTANDING OF CANCER.


2:10  Science is evolving at a more rapid rate than ever before in history
5:00  Modern concepts of cancer understanding
9:30  What makes cancer cells go rogue


PART 2:  QUESTIONS AND ANSWERS


14:00    Tumor marker tests and some foreshadowing of what was to come with Choosing Wisely about these tests
17:30    Scanxiety.  Shouldn't the patient decide whether the anxiety of the test or the anxiety over NOT having the test will be worse?  Suffice to say, based upon his feelings and my knowledge, I will be insisting upon the tumor marker tests despite the guidelines of Choosing Wisely, specifically #4 on this list.  The example cited about early discovery of bone mets is enough for me.....
20:30    Not enough metastatic research and indicative of how little society values research in this area.  THAT is troubling to hear.
28:30  Mammography is ESSENTIAL but it's not "superlative" test.  MINIMIZE risk of dying of breast cancer.  No use of words prevent or cure anywhere to be found.
29:45  Possibility of "risk adjusted screening" based upon individual factors
31:00  Two most important things to reduce risk-No HRT and Good BMI.  "It's about how much fat is in your body, not how much fat is in your mouth."  Book recommendations, Michael Pollan's In Defense of Food and Rules for Eating.  No HRT and proper body weight can reduce risk by 1/3 in post menopausal women.
34:15  DCIS and treatment
34:15  Who has more estrogen in her breast: an 18 year old or an 81 year old?
40:15  Triple negative breast cancer
40:15  Two areas of research in TNB
48:00  How long should women stay on aromitase inhibitors
48:00  The tamoxifen story
48:00  Bone loss from aromitase inhibitors
51:00  Vitamin D3 and supplements.  D3 is not a supplement, it's a "substitution."  and.... "Obviously, you don't want to go to sun tanning parlors."  AHEM  and yes, that would be all about Bikini Wars where I am about to close the comments.  
58:30  Aspirin for cancer? 

PART 3:  HOW TO BE A SUCCESSFUL PATIENT


1:00:30  Twelve minutes of pure genius interspersed with humor and tragedy.  Listen to it all.  In its entirety.  Trust me on this: You will not be sorry.  It's a guide book for the ages.  VHI Behind the Music, Sloan Style.  It's MSK: Behind The Treatment .... Pure, uncut and pitch perfect.


AND NOW....The final word on tanning salons (for now):


April 18, 2012 (Orlando, Florida) — Although the dangers of indoor tanning beds and melanoma risk are strongly buttressed by scientific data, public recognition of the danger remains low. The Society of Surgical Oncology (SSO) is the latest organization to push for an end to the cosmetic use of tanning beds.
A session here at SSO 65th Annual Cancer Symposium constitutes a step toward what is expected to culminate in a position statement expressing the society's strident opposition to the use of tanning beds.
The session was moderated by Jonathan Zager, MD, from the Moffitt Cancer Center in Tampa, Florida.
Cancers of the skin make up nearly half of all new cancers in the United States, with more than 3.5 million cases diagnosed annually. In the past 3 decades, melanoma-related mortality has risen in the United States by 690%.
The scientific case against tanning beds is strong. Of note, a recent study linked tanning-bed use during adolescence and early adulthood to a sharp increase in the risk for melanoma (Int J Cancer. 2011;128:2425-2435). Another study, of nearly 1200 melanoma patients, presented at the 2012 American Academy of Dermatology annual meeting, provided even more convincing evidence linking indoor tanning to invasive cutaneous melanoma.
Debunked but still popularly accepted benefits of tanning beds include increased sex hormones, dental cavity prevention, promotion of bone regeneration and repair, reduction in breast and colon cancer, and prevention of diabetes.
The dangers of tanning-bed use have largely gone unrecognized by the general public and by legislators. Legislated banning of the cosmetic use of tanning beds exists only in Brazil and, as of 2014, New South Wales, Australia.
In the United States, the tanning industry has lobbied aggressively to prevent legislation to curb tanning businesses and tanning-bed use. In 2012 alone, 26 bills intended to curb tanning-bed use were introduced at the state level. Nearly all were defeated.
The push to change public opinion concerning the use of indoor tanning beds faces a formidable battle. The indoor tanning business is a $2.6 billion industry in the United States, according to Dr. Zager.
Each year, 30 million Americans acquire or enhance their tans using ultraviolet (UV) tanning beds. The majority are teenaged girls, who visit tanning salons 20 times or more per year, on average.
In a 2009 study of the 116 most populous cities in the United States, tanning businesses consistently outnumbered Starbucks and McDonald's nearly 2 to 1.
Legions of tanning-bed users are motivated by the belief that a tanned body is a healthy body. This belief stems back almost a century. "Much of the blame goes to Coco Chanel, who made the tanned body a fashion desire," Vernon Sondak, MD, from the Moffitt Cancer Center, told meeting attendees.
The use of UV radiation in the pursuit of health is regrettably paradoxical, according to Samantha Guild, from the AIM at Melanoma Foundation in Richmond, California. She pointed out that UVA, UVB, and UVC are class I carcinogens, along with tobacco, arsenic, asbestos, mustard gas, and plutonium.
As a first step in crafting a position statement, the SSO has begun to gather comments from its membership concerning the action points and wording of the statement. The goal is to develop a position statement based on science, directed particularly at people younger than 18 years of age, that can be drafted within the year.
"We are not talking about living in a cave. We can enjoy the sun and still be sun smart," said Dr. Sondak.
Position statements against tanning-bed use have already been issued by the American Academy of Dermatology, the American Medical Association, and the American Academy of Pediatrics.
Dr. Zager and Dr. Sondak have disclosed no relevant financial relationships.
Society of Surgical Oncology (SSO) 65th Annual Cancer Symposium. Presented March 9, 2012.




    6 comments:

    1. AnnMarie,
      Wow, thanks for all this info. I hope I find time somewhere down the line to watch and listen to the videos. I must make time. I completely agree, we must stick to the science. My friend Rachel used to remind me of this too - just deal with the facts we know, she'd say. And of course, some of these facts do speak directly about the dangers of tanning beds. How can the tanning industry have such powerful lobbyists? It's incredible really, the outside influences that exist. Hmmm. Very timely with my bikini parade post today. Thank you!

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      1. Yes! Very timely... and thanks for jumping into THAT commotion with me, my friend!!!

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    2. You really know your shit lady, and you are a beautiful light in the dark. Thanks for being here. Awesome informational post. Thanks.

      My latest post is online now: www.donttouchthese.wordpress.com

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      1. I saw your post. I hate that you are so down. I'm glad you got some info from this post. I try to balance out being angry with sharing what I've learned... Mostly, it seems, I'm angry. Gotta work on that....

        xoxox

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    3. I have started to watch the videos, this will be my weekend project. It is so important we stick to the facts based on Scientific evidence. We can't deviate from fact. It's that simple...
      Thanks AnneMarie
      Love Alli xx

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      1. Alli,

        It's one video here but on the MSKCC website, they are broken into three different videos. Truthfully, however, Dr. Norton is quite witty and I think a couple of his "wise cracks" may have been edited out of the shorter videos. Connecting the dots backwards, I remember the whole conversation about tumor markers when I was in the audience. He said to be on the lookout for information about new guidelines. Those guidelines were released between his talk and my routine oncology visit (very loosely using the word "routine" since there is NOTHING routine about an oncology appointment). After listening to Dr. Norton and knowing one of our blog buddies was in the EXACT situation he uses as an example IN FAVOR of a test they want to eliminate, I am insisting on the test regardless of the guidelines.

        xoxo

        PS-you scared the daylights out of me.....I'm so glad you are ok....

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