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The Science and the Art of Exceptional Cancer Care

Not long ago, I read two articles, one by a cancer doctor and another by a journalist. They both left me steaming a bit.  In medicine, we talk about the science (the factual database and knowledge that we use) and the art of medicine (how we use and adapt that database to the benefit of individual and different patients). Both of these articles, the first overtly and the second more indirectly, suggested that the art of medicine is about hiding the science from the patient in order to provide hope, albeit false hope to the cancer victim. Let me state clearly, despite paternalistic instincts, dishonesty has no place in the practice of oncology.

Both of my grandmothers died from cancer. Grandma S. died of stomach cancer when I was in college. As far as I know, she was never told that her cancer had recurred after surgery. Her second husband and family wanted it that way. “Knowing that she has cancer will devastate her, let her have her hope,” we were told. When my cousins and I visited, we were under strict orders to not ask too many questions about her “gall stone” problems. She knew though. You could see it in Grandma’s eyes. But the web that had been woven kept her from being able to grieve and gave no opportunity for good byes. As she slipped away she became withdrawn and depressed.

Grandma B. was diagnosed with an aggressive lymphoma when I was just out of medical school and in my training. She was fully informed by her doctors. She had opportunity to seek second opinions. She conferenced with her children. When she chose to not leave her little ranch valley in Idaho for desperate treatments far from home, and to die in her own home, her family rallied around her in support. For six weeks, she narrated her life history, wrapping up a legacy of lasting value for her family. She was the recipient of an outpouring of love from her community and she died fulfilled, with a smile of satisfaction on her face.

The science and art of medicine are ...

Cold water immersion for cyclists- does it help or just hurt?

Two years in the life of the Swedish blog

For those of you who don't know, today is the official two year anniversary of the Swedish blog - this means Swedish has been blogging several times a week for two full years!

What have we been blogging about this year?

Who's been blogging?

We've had people from across Swedish blogging (more than 100 the last time we checked), including:

  • Surgeons

  • Nurses

  • Family Medicine and Primary Care Physicians

  • Dietitians

  • Educators

  • (And many others!)

Why are we blogging?

We started the blog as a way to connect with you (our community), whether you're a current patient, a past patient, a future patient…or just someone who stumbled across our site looking for health information. We believe our role is to be a resource of information, both online and off. Blogging gives us an easy way to keep you up to date, informed, and engaged on a number of health topics

New medication for MS, Tecfidera (BG-12), Approved by FDA

On March 27, the U.S. Food and Drug Administration approved the newest treatment in the increasing number of disease modifying therapies (DMTs) available to treat multiple sclerosis. Tecfidera (BG-12) is an oral capsule to treat adults with relapsing forms of MS. Research participants at the MS Center at Swedish participated in clinical trials for Tecfidera.

 

The trials reported that people taking Tecfidera had fewer relapses and less frequent worsening of disability compared to people taking a placebo. There were also fewer and less-severe side effects with Tecfidera than other treatments.

 

The studies found that ...

Clinical Trials and Personalized Medicine - Interpreting Studies

Medicine does not search for truth. It searches for cure. It does not look for the universal, it tries to create exceptions.

Medicine emerged from witchcraft. It has always utilized the most advanced technology of its day. Medical models and reasoning always evolve and that evolution makes the previous model obsolete. One of the foundation models of modern medicine is the randomized controlled clinical trial.

The principal of the randomized controlled clinical trial is that a single observation needs to be validated and reproduced. The clinical trial provides an estimate of how often a particular observation will occur. It tells us that chemotherapy improves survival for patients with non-small cell lung cancer at one year from 20% to 29%. It tells us that FOLFOX treatment for advanced colon cancer gives a median time to progression of 8.7 months, response rate of 45%, and median survival time of 19.5 Months. This is accurate information about populations. It's use for the individual is a difficult problem.

Every person is a unit, no one is 20% or 29% or 45%. The question is...

Some challenges in Targeted Therapy

What makes a target? Our understanding of disease is a model, an imagined defect in a fanciful machine. The workings of the intact organism are understood on the basis of the tools at hand and conform to the models of other world events and inventions. In the 19th century, the microscope became a useful tool and the cell was the agent of health and disease. DNA, the agents of heredity, became the basis of the most advanced therapy in the late 20th century. DNA was the target for chemotherapy, as soon as its importance in heredity was realized .

DNA as a target has fallen out of fashion. Now, we imagine the cell as a network of messages, an internet, with signals, noise and switches. These are the modern targets: growth factor receptors (and their mutations), kinases (and their mutations); the cellular equivalents of antennae and amplifiers.

This is the model that is generating today’s medicines (often ...

Hundreds of Swedish-Affiliated Providers Recognized as Part of Seattle and Seattle Met Magazines' Annual Top Doctors Surveys

SEATTLE, Sept. 11, 2012 - As they do each year, Seattle magazine and Seattle Met magazines published the results of their annual Top Doctors surveys in their July and August 2012 issues, respectively. To recognize the more than 300 Swedish-affiliated providers who were nominated by their peers for each survey, here is information about both efforts.

Results 1-7 of 15