Cancer and Halloween

I don't have much to add to this. Dana Jennings, a reporter for The New York Times, has chronicled his life with prostate cancer for the NYT Well blog. This week, he wrote about Halloween and the ghosts of cancer. You can find his eloquent post here.

Being a doctor and a patient

As part of their ongoing series on the 40 year war on cancer, The New York Times did a profile on the M.D. Anderson Cancer Center in Houston, Texas. Among the stories were the unique perspectives of both a nurse and a physician who faced a cancer diagnosis and treatment in the place where they have cared for so many patients.

The article touched on how being a patient might affect a physician's perspective:

“A common question people would ask is ‘Are you a better doctor since
you’ve been sick?’ ” Dr. [Martin] Raber said. “My first answer is that I
thought I was a good doctor before. I was worried about being a worse doctor.
Having lived through these biopsies and all these tests, would I be hesitant to
order all these things patients need because I had experienced them and knew
they were not pleasant?

“Then I realized I am not better, but I am a different doctor,” he said. “I
talk to patients differently. I understand more of what their situation might
be.

“My life was very different than it was before that day in the CT scanner,”
Dr. Raber said. “It’s not the life I thought I would have. But my life is still
really good."

Communication about cancer screening

Yesterday, the American Cancer Society announced a shift on their position on certain cancer screenings. The Cancer Society said that American medicine has over-promised on the benefits of screening and some screenings over-diagnosis disease while missing other deadly diagnoses.

While there is healthy debate about the Society's decision itself, from a health communication perspective it reinforces that medical professionals need to take time to engage in discussion with their patients about the real risks and benefits of screening exams. Many patients expect medicine to be certain, where in reality uncertainties abound and not every decision is as simple as "You should get this test when you reach this age." Clinicians need to understand how each individual patient understands and assess risk and other health information. There is a growing body of research examining both how individuals understand numbers (numeracy) and how they assess risks and benefits. But the research is meaningless unless physicians and patients engage in continued dialogue and education about the goals of care, treatment and screening. Continued conversations won't necessarily make the decisions about screening quicker or easier, but they have the potential to ensure that individual doctors and patients the decision that is right for them.

How do food companies define health food?

The Food and Drug Administration has sent a warning to food manufacturers about the criteria they are using to label foods "healthy." The FDA is concerned that too many healthy labels without clear criteria for defining what is healthy may confuse consumers. And some obviously unhealthy foods have been defined as a healthy using the manufacturers own standards.

The article about the warning made me chuckle, if only because I immediately thought of my least favorite commercial on television right now. I yelled at the television the first time I saw this commercial. Something to the effect of "You've got to be kidding me!" That's right, Kellogg's is trying to market Froot Loops as a healthy food. "They make your tummy happy." Sure, fiber is good, but I don't think health is Froot Loops best selling point.




What do you think? Does the FDA need to step in and set standards for what manufacturers call healthy food?

Fellow inmates provide hospice care in prisons

The New York Times had a compelling article about the growing geriatric prison population and how some prisons are starting hospice programs to provide care for the aging population. Some of the programs use prison volunteers, other prisoners to visit and provide comfort to the dying prisoners, who may not have family members who will visit in their dying days. The programs appear to have a dual benefit, both for the dying prisoners and for the prison volunteers. The dying receive some comfort at the end of life; the volunteers make a human connection with another person and learn to express empathy and emotions many have buried for a long time.

There are some challenges with programs like this, especially the risk that dying prisoners will pass pain medications the volunteers, who can sell them to the general prison population. But the prison volunteers can provide a compassionate ear in a way that a guard or nurse simply cannot.

What parents can learn from the books their children read

The New York Times Well column had an article today about what parents can learn about the lives and thoughts of their children from a popular book series. The article highlights the series Diary of a Wimpy Kid. The books talk about the regular struggles of a regular kid, a kid to whom readers can relate. The stories give insight into how a child struggles internally with issues of fairness and ethics and relates how a child works through these dilemmas, not how an adult thinks a child should work through them.

For many families, the books are serving as a catalyst of discussion between parents and children. What other books might help spur family communication?

Public health reading list

The Web site RNcentral.com has published a list of 50 excellent public health blogs. I am not familiar with all the blogs on the list, but I am looking forward to doing some reading.

Ongoing debate regarding physician's speaking fees at University of Wisconsin

The Milwaukee Journal-Sentinel had a story today about the ongoing debate at University of Wisconsin about the speaking fees UW physicians can receive from pharmaceutical and medical device companies. Earlier this year a new conflict of interest policy was proposed which would ban UW physicians from giving presentations paid for by pharmaceutical and medical device companies. But uproar from orthopedic physicians has meant an exemption for presentations about medical devices but maintains the ban for drug talks. The proposed policy has raised debates about ethics in medicine, conflicts of interest, and power and influence in medical schools. Some physicians are concerned about their own autonomy to conduct their medical practices and supplement their incomes as they see fit. Others are concerned about how one group of physicians was able to influence the policy in their favor.

Whatever the outcomes, it seems that these debates are only beginning, as medical schools and physicians continue to consider the interaction between pharmaceutical and medical device companies and medical practitioners.

Doctors in distress

Dr. Pauline Chen outlines the dangers of doctors under stress in her column this week. Personal, fundamental stress, beyond the normal stresses of the job, can cause as much harm and as many errors as a physicians who is sleep-deprived.

But I think what is most compelling about this column and Dr. Chen's other columns are the personal stories and anecdotes about physicians and the difficulties they face on the job. It is one thing to see your physician and think "Hey, he seems stressed." But it is another thing to hear firsthand from real physicians about their occupation and the stresses and insecurities that accompany it. Being able to empathize with the person on the other side of the exam table can be a valuable part of fostering trust and building a communication relationship between physicians and patients.