You Could Die Sitting Right There In That Chair
(January 9, 2018)
Conventional medicine has some very powerful tools. But regardless of how great a tool or technique is, whenever you have people around you get mistakes AND you get misapplications. There are your country types who absolutely insist on fishing with dynamite. There are cashiers who are convinced that they need a Humvee to get them to their job at Taco Bell. And there are doctors who will talk a patient into a treatment that they themselves know and love, but that is not right for the patient.
Today’s rant was prompted by an article on the side effects of a new cancer therapy I read recently on checkpoint inhibitors. “Checkpoint inhibitors” are drugs that work by persuading otherwise indifferent immune systems to go after cancer cells. They are being used in several types of cancer with very good results. The hyped-up immune systems, however, have a tendency to go after normal cells as well, producing unusual side effects that may not be recognized as such and are then treated improperly, putting the patient at serious risk. So far, so good, very interesting reading.
I tooled along, learning that up to 70% of patients treated with the checkpoint inhibitors have side effects of some kind. The common ones are mild and no worse than annoying. ... At this point I thought rather vaguely, what's "common" and why use a general term when we were just talking specific numbers? Well, I guess it doesn't matter if they are mild.
But THEN the article lets a rather largeish cat out of the bag and says, “Dangerous (side effects), such as the inflammation of the heart muscle, called myocarditis, are extremely rare.” That woke me up from my pleasant doze because even though we are now talking important stuff, we're still in general term territory. I mean, if you've ever been around people who order steak at restaurants, you know that one person’s “extremely rare” is another person’s “too well done”. So what does the writer think is “extremely rare”?
When you dig into the original reference article, which I had to do to get a proper answer, you find out that myocarditis has an incidence in this form of therapy of 0.09%. Ok, it is fair to call that “extremely rare". However, you also discover that immune-related side effects result in 40% of patients having their treatment discontinued.
Possibly this 40% is discontinuing their checkpoint inhibitor therapy because the side effects are unpleasant but not dangerous? You might quit your inhaler for that reason, but probably not your cancer therapy.
Returning to the original article, as one reads on, getting more annoyed by the minute (at least you do if you are me), you encounter a quote from a doctor who saw his patients developing diabetes type I in response to the therapy. (Diabetes type I is from destruction of cells in the pancreas and is permanent, folks.) Asked by the writer if this was a point against checkpoint inhibitors, this doctor responded, “If it’s a choice between staying alive and developing diabetes versus not, I’d always pick taking the drug and managing the diabetes.”
Well, me too, Doctor Smarty-Pants, but that is NOT necessarily the choice here. Your choice is between this particular form of immunotherapy AND ALL THE OTHER AVAILABLE FORMS OF CANCER THERAPY. You might still want to continue it. But you aren’t necessarily doomed if you don’t, and I think that implying otherwise is bordering on malpractice.
Once upon a time, my nervous and gullible father was told by his cardiologist that if he dared, DARED to try medication instead of the bypass surgery that the cardiologist wanted to perform, that he was putting himself in grave danger. That he “could die sitting right there in that chair”. Which was complete and utter balderdash. That is, unless his cardiologist was actually threatening to murder him unless he went along with the surgery. You never know about Brooklyn.
Anyway, my father suffered after effects from the surgery that pretty much ruined the remainder of his life, which is why I am still unhappy about the whole thing. Thank you so much, Doctor I-Have-Three-Kids-In-Harvard-And-A-Vacation-Home-In-St.-Moritz-To-Pay-For. Enjoy your life.
If you encounter a similar bit of medical salesmanship, because that is what it is, do not fall for it. Please take someone to the doctor with you any time you go where there’s any possibility at all that you might have to make a medical decision. Because in the shock and upset of finding out that you are diagnosed with something that sounds very nasty, your higher-paid specialists in particular may take the opportunity to push you into something that may not be right for YOU.
(This is why I mostly stopped showing my patients their x-rays unless they asked to see them. People get sort of hypnotized by staring at a picture of something that is inside of them, and while they are looking at it you can talk them into anything you want. If you do that kind of thing.)
Medical decision-making is now understood to include, if not to be completely determined by, what the patient is interested in doing. It’s not all about what your doctor thinks you should do anymore. This is partly because doctors finally recognized that patients are not chopped liver and have a right to be included in the decision-making about their own care. But it is also because, frankly, most medical treatments for most conditions don’t have stupendous results. Certainly not good enough to justify riding roughshod over the patient’s own preferences.
You can bet that if there is a 95%-plus successful treatment for something, too, your doctor is going to tell you that while he is trying to sandbag you into doing it. He is NOT going to indulge in biblical-sounding threats about what is going to happen to you if you don’t do what he says. If you hear such a thing, every alarm bell you have should go off.
Giving people a choice between what you want them to do, and what happens if you do nothing, is common in advertising of every kind of course. An ad for Red Bull is not going to tell you that you should treat your fatigue by getting more sleep, exercising, quit eating so much sugar, losing some weight, taking a nap, having your nutrient levels checked and corrected, drinking more water, stop working extra shifts, or any of the thousand other things that can cause fatigue. It’s going to tell you to go buy Red Bull.
But you know that that is what ads do. You’re not expecting it in your doctor. And you trust your doctor in a way you don’t trust Dietrich Mateschitz. Because you have to.
Certainly your doctor may think s/he is doing the best thing for you by steering you to their pet therapy. People always tell themselves that they are doing the right thing, and that their intentions are the best, and that they happen to be rich because God just wants them to be. Fat lot of good that is going to do YOU if you go down the wrong road.
So again, if you’re going to the doctor, bring someone you trust with you. They will be able to think at a time when maybe you can’t too well. And it could make a big difference in your health, short- or long-term.
dr. diane holmes, d.c., L.Ac., 615-385-3352
P.S. The article that prompted this newsletter is at https://www.washingtonpost.com/national/health-science/new-cancer-drugs-have-perplexing-side-effects/2018/01/02/9b84fa1e-d909-11e7-a841-2066faf731ef_story.html?nid&utm_term=.1b6662dc80a7
--dr. diane holmes
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