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Cancer's Invasion Equation

10/10/2017

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We Can Detect Tumors
Earlier Than Ever Before.

Can we predict whether they’re going to be dangerous?


By Siddhartha Mukherjee (September 11, 2017, The New Yorker)



Read article

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 Additional thoughts from Dr. Goldman:

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”
William Osler, MD 1849-1919

William Osler, MD, was one of the founders of American Medicine at Johns Hopkins, and his quote seems particularly appropriate after reviewing the September 2017 article in The New Yorker. The subject is about cancer, its diagnosis, treatment and what doctors are really doing for their patients.

Mukherjee mentions Occam’s razor twice in the article. Occam’s principle states that among competing hypotheses, the one with the fewest assumptions should be selected. Simple answers are better than complicated ones. This has been a driving principle of science for the last few centuries, but I think the tide is changing. Over the last fifty years of following the advances in science and medicine, it is amazing to me how many things have swung from the simple to the complex.

The science of evolution of our solar system grows more complex every year. Copernicus made things much simpler by proposing that the sun was at the center of the solar system, not earth. It was all simple clockwork. Jupiter is now thought to have started out further from the sun then it is now — to have actually moved much closer to the sun, scattering small objects (and even planets) out into space, and then moved back to where it now resides. No one theorized this complex movement fifty years ago.

Research involved with the AIDS epidemic showed that the immune system is far more complex and has many more moving and changing parts than anyone had dreamed. In the 1970s there was a simple idea — if we could detect cancer earlier and declare war on it, we could save a lot of lives. Unfortunately, that has not worked out. Screening programs for breast, prostate, thyroid cancer and melanoma have resulted in a huge increase in the number of patients treated with almost no reduction in the death rates from these diseases.

On page two, Dr. Daniel Hayes talks about breast cancer and says, “Only some fraction of the patients who receive toxic chemotherapy will really benefit from it, but we don’t know which fraction. And so, unable to say whether any particular patient will benefit, we have no choice but to overtreat.” I disagree. Dr. Hayes and his patients do have a choice. The number of patients that benefit may be as low as 3%. The other 97% will develop damage from chemotherapy treatments and will either live or die anyway, but will not have received any benefit. Mukerjee does not address money in the article, but the entire medical system is making a huge amount by implementing these testing programs and therapies. Whenever a more careful consideration of screening and therapy programs is suggested, the medical companies scream bloody murder about restricting medical care, and could result in a large amount of dying patients.


Mark Twain was known to have said, “It is difficult for a man to see the truth when his income depends on not seeing the truth.”

 
In the article, the theory of the spread of cancer is discussed and states, “This theory would form the intellectual basis for William Halsted’s “radical mastectomy.” Halsted and William Osler were colleagues at Johns Hopkins. A study published in 1971 proved that radical mastectomy had the same breast cancer death rates versus simply removing the lump and giving local radiation. There was no added benefit for performing the more radical surgery. Radical mastectomy rates plummeted in the 1970s but are now rising again, with no proof it saves lives. Numerous surgeons have told me that many of their patients insist on getting the mastectomies. That may be true, but surgeons could still refuse to perform a surgery that may cause more harm than benefit. I am sure they could convince a patient that no benefit would be gained by removing their breasts — but that may not be in the best interest of the surgeon. There are also more lawsuits for patients dying after too little treatment than too much.

On page four, Mukherjee talks about a meeting he had with Gilbert Welch, MD. I have read Welch’s book, Overdiagnosis, and I highly recommend it. Welch talks about a thyroid cancer screening program in South Korea that resulted in a huge increase in thyroid cancer diagnosis and treatment but no reduction in cancer deaths. The basic reason is that, as with breast and prostate cancer, a lot of people have slow moving tumors that would never kill them. The screening uncovers many more tumors that would otherwise remain hidden. On the other hand, when the screening program finds aggressive tumors, it is often already too late. They may have already sent metastasis all over the body. Even when the thyroid, breast or prostate is removed, it may already be too late to prevent the cancer spreading. The distant disease may still be hidden, but it is already there.

Again, quoting Dr. Daniel Hayes, he says, “The early detection of breast cancer via mammograms saves women’s lives although the benefit is modest.” He doesn’t say how modest. In fact, the total death rate for breast cancer continues to rise. In 1975, 70,000 women were diagnosed and treated for breast cancer – average deaths were about 35,000. In recent years, around 285,000 women are treated yearly for new breast cancer diagnosis and the deaths are around 39,000 a year. It may have seemed like a good idea to set up these screening programs to make more cancer diagnoses. As it turns out, this has resulted in a huge increase in patients being treated for breast, prostate, and thyroid cancers as well as melanoma type skin cancer. The death rates, despite so many more patients undergoing major treatments, has remained about the same. Mukherjee says, “ For Welch, the fact that diagnoses of thyroid cancer or prostate cancer could soar without a corresponding effect on mortality rates was a warning, a little knowledge had turned out to be a dangerous thing.”

The solution is much more likely to be in a holistic approach that involves the patient and their resistance to the spread of cancer, rather than just focusing on the cancer itself. Cancer researcher D.W. Smithers is quoted, “Cancer is no more a disease of cells than a traffic jam is a disease of cars.” This is where Occam’s razor comes in again. Oncologists, like everyone else, want simple solutions. They don’t want to multiply the factors that they have to consider.

More is not necessarily better. On page eight, Mukherjee says, “We err toward risk aversion, even at the cost of bodily damage; we don’t learn what would happen if we did nothing.” He was counseling one of his patients that had undergone a hysterectomy — when her newly removed uterus was examined, doctors
found a rare, malignant sarcoma lodged in the tissue — a tumor so small that it could not be detected on any of her preoperative scans. Both her gynecologist and surgeon had recommended an aggressive procedure to remove the ovaries and surrounding tissue. Mukerjee explained that her circumstances were completely different, as the tumor was detected incidentally, with no signs or symptoms of the cancer (and was contained in the uterus, which no longer inhabited her body). She looked at me as if I were mad and asked, “Would you sit and do nothing if someone found this tumor in you?” She decided to go ahead with the surgery.” I have been in this position myself. It is very difficult to say no to a therapy that is proposed. There is an ad for Houston’s MD Anderson Cancer Hospital that says, “They will never give up on your cancer.” Maybe many of their patients would be better off with less therapy, rather than more.

In conclusion, Mukherjee states, “It would return us to the true meaning of Holistic: to take the body, the organism, its anatomy, its physiology -- this infuriatingly intricate web -- as a whole. Such an approach would help us understand the phenomenon in all its vexing diversity; it would help us understand when you have cancer and when cancer has you. It would encourage doctors to ask not just what you have but what you are.” I started medical school in 1967— everyone in my class would know that Dr. Mukherjee was simply paraphrasing William Osler. Treating this particular individual patient was important in the late 1800s but seems to have been forgotten in 2017. Mukherjee doesn't seem to know that he is just resurrecting an old idea from Osler.


“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” 
William Osler, MD 1849-1919


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With Cancer Screening, Better Safe Than Sorry?

8/10/2017

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With Cancer Screening, Better Safe Than Sorry?click on image to read article
Here is the link to the NY Times article published last month.  


Additional thoughts from Dr. Goldman:
Breast Cancer: In Europe, routine screening starts at the age of 50, is done every other year, but ends when the patient turns 65. Then mammograms are only done if the doctor or patient finds a mass or has other issues. Routine screening in patients with no symptoms is not performed.

Prostate Cancer: The chances that a man is carrying a quiet prostate cancer is about equal to his age. For instance, a 60-year-old man has a 60% chance that prostate cancer will be found (if enough biopsies are done). So it seems that an elevated PSA is mostly an excuse to perform a biopsy. 

In 2014, about 210,000 men were treated for prostate cancer and about 30,000 died of the disease. F
or most of the last 30 years, the number of yearly deaths has remained at approximately 30,000 a year. During this time the number of men treated has grown from 30,000 annually to about 210,000. That is a lot of men treated with very little effect on the death rate. There are a lot of side effects from prostate cancer treatment. Thousands of men are becoming impotent, leaking urine or having their testosterone surgically or chemically eliminated with very little change in the death rate. 

I heard a radio report in February stating that in 2016 half the men diagnosed with prostate cancer had decided not to receive any treatment. Here is my question: If you are going to refuse treatment, why get the biopsy? If you are going to refuse the biopsy, why get the PSA test?

The official United States Preventive Services Task Force says
to start examinations at the age of 55 and to stop PSA testing when the male reaches 69. Was it even helping those men during the 14 years of exam recommendations? Many primary care doctors are still doing PSA tests on patients well into their 80s. Word of the new guidelines does not seem to be getting out. 

Colorectal Cancer: Much better results. I agree with the guidelines.
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It looks like the Susan G. Komen organization is losing ground. It’s about time.

7/18/2017

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I received this email from founder, Annie Brandt, and wanted to share.  Dr. Robert Goldman  
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Some Interesting News!
I ran across a very interesting piece of news recently that I want to share with you. The Susan G. Komen organization is pulling out of Arizona. Mary Budinger, an Advisory Board member who lives in Arizona, sent me two articles from the Arizona Republic newspaper which says SGK:
 
“will close in July because of dwindling donations and event participation … 7,500 people ran in the 2016 Race for the Cure, a number significantly lower than in previous years, which at one time saw upward of 30,000 participants.”
 
Lower participation and donations are attributed to the fact that Arizona’s weather permits many organizations to hold races and outdoor fundraising events. The executive director suggests there is simply too much competition.
 
Nice try, but there is much more to it than that. I’ll let Wikipedia hit some of the high points:
 
“In 2012, Komen's controversial attempt to withdraw funding for mammogram referrals provided by Planned Parenthood caused a significant decline in donations, event participation and public trust. The organization was further criticized for its use of donor funds, the CEO's 64% pay raise after the significant drop in donations, its administration costs, its choice of sponsor affiliations, its role in commercial cause marketing, and its use of misleading statistics in advertising. In March 2013, Komen dropped from Charity Navigator's highest rating of four stars down to three stars and then to two stars in 2014.”
 
I still remember when SGK slathered their pink on M&M candies and buckets of fried chicken—foods no cancer patient should touch—in return for sponsorship money. The organization chooses to beat the drum for annual mammograms, despite a mountain of evidence that they represent a poor early detection technology. Why not make the choice to promote some form of thermography? Why not wage a war on sugar, cancer’s favorite food? Why not come out against trans fats which we’ve known for decades to be carcinogenic? Why not give voice to the 2005 research by Environmental Working Group which detected 287 chemicals in umbilical cord blood, of which 180 are known to cause cancer in humans or animals? Or give voice to the more recent work of Dr. Thomas Seyfried? You get the idea.
 
Seems the American public is getting the same idea. 
 
SGK, founded in 1982, started out with a promise to find a cure for cancer. In 2016, SGK announced their “Bold Goal to reduce the current number of breast cancer deaths by 50% in the U.S. by 2026.” Given how they choose to operate, it is hard to imagine SGK could even make a small dent in the coming fatalities.  
 
It is my opinion that so many people have had cancer now, or known family members and friends who have had cancer, that they have glimpsed the harsh realities of the cancer industry’s machinery. And SGK, advocating for the status quo, is part of that machinery. Increasingly, the public is rejecting the status quo.
 
So to all of you on the front lines of innovative, integrative care—keep it up. The public is waking up and rejecting the status quo. Yes, many still fall for the mainstream marketing because getting the diagnosis of cancer can scare the living daylights out you. Having some good survival statistics for alternative therapies can help people look at the options that are available.

I strongly encourage all of you to participate in one of our clinical studies to get quotable survival stats for alternative medical therapies. Write me and I'll tell you how.

I also encourage us all to amplify our messaging and let people know good options exist.

Our efforts ARE making a difference! Change IS happening!

Thank you for all you do,
Annie 

 
annie@bestanswerforcancer.org
bestanswerforcancer.org

Copyright © 2017 Best Answer for Cancer Foundation, All rights reserved.
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Functional Medicine Means Figuring Out “Why?”

7/1/2016

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Why Functional Medicine?

Functional Medicine means taking the extra time to figure out, “Why?”
At Georgia Hormones, we practice Functional Medicine and it means taking the extra time and effort to figure out why a problem is happening to you — we don’t just treat the symptoms.
 
Is Functional Medicine really different from seeing my regular doctor? Yes!
Your regular doctor most likely practices what is called “standard Allopathic medicine.”  “Allo” means against; “pathic” means disease. Allopathic medicine attempts to just stop whatever disease the patient has. If you tell your regular Allopathic doctor you have migraines, you will be given drugs that only treat the pain of migraines. Allopathic medicine will then send you out the door. It’s known as, “Got an ill? Take a pill.” For many patients, a pill is not enough. A pill can cover up a problem, rather than fix it. That’s where Functional Medicine is different — we keep digging. American Allopathic doctors are simply taught how to paper over the problems, mainly with pharmaceuticals, surgery and radiation. They are not taught to dig down to discover the cause of the problem.
 
How does standard American Allopathic medicine work?
Allopathic means against disease. If someone has high blood pressure, doctors are taught to just prescribe an anti-high blood pressure drug. If they have a migraine headache, they are given an anti-migraine medication. An osteoporosis diagnosis will usually have the physician prescribing an anti-osteoporosis drug. And on and on and on.
 
Why? Functional Medicine
At Georgia Hormones we take the time to figure out “why?” Why? is the key word because it makes a difference! With Functional Medicine we don’t send you out the door. We talk it out. We dig down. We individualize. Why is this symptom happening in the first place? Let’s fix the cause, not just patch the damage. American doctors are taught how to treat problems. For every ill there is a pill. Jeffrey Bland, PhD, is one of the founders of Functional Medicine. In his book, The Disease Delusion, Dr. Bland explains that we must investigate and treat the underlying cause of disease, not just paper over the symptoms with a pharmaceutical drug.
 
How do engineers approach problems or failures?
I have a patient who is a network engineer. His job is to investigate failures in the system, fix them, and reduce the chance that this failure will occur again. He told me that the key is to ask Why five times. Why was there a failure? What were the conditions leading to and allowing the problem? Why did they occur? What allowed that to happen and Why did it happen?
 
To truly fix the issue and ensure robust health of the system we have to keep asking Why? until we get down to the basis for the failure.
 
OK, but what really changes for me, the patient?
Fixing an underlying problem is often harder than just taking a pill, but it works better and longer. We are not against pills, but we work along with the whole body and lifestyle. This means we may work with a personalized approach to change diet or exercise patterns. We may guide you to specific supplements, to furnish what a patient individually needs. We may reduce or eliminate certain toxins (which your body may be poorly reacting to). It’s about working with a patient to figure out why the symptoms are happening and to change your life and medicine to fix the cause.
 
In Functional Medicine, We Ask Why?
Why is this person gaining weight?
Why does this person have high blood pressure or high blood sugar?
Why does menopause cause hot flashes?
Why does menopause cause osteoporosis?
Why does this man have erectile difficulties?  
Why do people get Alzheimer’s disease?

 
How does this change the treatment?
When we shift from asking How? to asking Why? we treat the underlying problem, not just the symptoms of the problem. This often involves changing diet or exercise patterns. A patient may need additional supplements or might need to reduce or eliminate toxins (including environmental), excess sugar, salt, alcohol, or even pharmaceutical drugs.
 
Functional Medicine is about fixing the underlying problem.  We must keep asking, Why, Why, Why, Why, Why.
 
Additional Resources
Read Dr. Goldman’s review of Dr. Bland’s book: http://bit.ly/2920wZh

Watch video of Dr. Bland's book presentation
: http://bit.ly/298j4sw 

​Buy the book, The Disease Delusion:
http://amzn.to/295j10c
 
For an appointment, just call 770.475.0077.


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Are we Being Overtreated And Overdiagnosed?

11/17/2015

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I purchased Overdiagnosed along with Overtreated (written by Shannon Brownlee). Brownlee’s book was published in 2007 and Dr. Welch’s book in 2011. Both books discuss similar issues. Americans are in love with testing and screening. Originally, the intent was to detect diseases faster and prevent deaths with earlier treatment. It may have seemed to be a good idea at the time, but things haven’t actually worked out well.

Both authors review our massive screening programs. One man’s expense is another man’s income — and a huge income it is. Americans are spending hundreds of billions of dollars yearly. Treatments are not without risks and potential damage to the patient — it is common that some patients do not gain any additional health benefits.  

Overtreated begins with the work of John Wennberg at Dartmouth Medical School. He studied national statistics and found that some areas of the U.S. have conducted a greater number of particular medical procedures, even though the incidence of disease was about the same. How much surgery was done seemed to be a way of local life. Patients were undergoing many procedures with little, if any benefit and often much harm.  

Both books talk about back surgery, prostate cancer, breast cancer, and genetic screening. Overtreated also discusses overtreatment of thyroid cancer — interestingly, it holds as a shining solution, the VA’s system of enforcing the use of Electronic Medical Records (EMR). Since 2006 (when the research was initially conducted), the VA has been overwhelmed with disabled veterans from Iraq and Afghanistan, old and sick Vietnam era veterans — the VA is severely underfunded to treat all of them. The system is now falling apart. I wonder what Shannon Brownlee thinks of the VA now?

Having read and reviewed How We Do Harm by Dr. Otis Brawley and The Great Prostate Hoax by Richard Albin, Amazon had also suggested these two books — they are older and the information is not new. The problem has been growing for a long time and both Brownlee and Welch have warned America for at least a decade. In the last few months (2015), it is amazing that some of the issues concerning over diagnosing breast and prostate cancer (along with recommended treatments) have begun hitting the news. If you want to protect yourself from unneeded, dangerous tests and treatments, Overdiagnosed and Overtreated are good reference books.
 

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    Robert P. Goldman, M.D.

    Dr. Robert P. Goldman provides guidance for female and male hormone balance, menopause management, holistic therapies and routine gynecological care.

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