From The Cancer of Optimism [New York Times],
Physicians are thought to be the harbingers of bad tidings, the people who use cold words like “prognosis.” But studies show that they are just as capable of emotions as their patients are. According to a study published in 2000 in the British medical journal BMJ, about two-thirds of doctors overestimate the survival of terminally ill patients.
A study of cancer patients and their doctors in the Annals of Internal Medicine a year later found that many doctors didn’t quite tell patients the truth about their prognosis. Doctors were up front about their patients’ estimated survival 37 percent of the time; refused to give any estimate 23 percent of the time; and told patients something else 40 percent of the time. Around 70 percent of the discrepant estimates were overly optimistic.
This optimism is far from harmless. It drives doctors to endorse treatments that most likely won’t save patients’ lives, but may cause them unnecessary suffering and inch their families toward medical bankruptcy.One source of this optimism is pop culture, which frequently depicts heroic recoveries from seemingly life-threatening situations. Another is the medical school experience. What motivates weary medical students is the hope that one day interventions they perform will save lives, heal families and enact cosmic good.
“…the lack of predictability in genomic medicine is rather sobering. For certain genes and diseases, we can or will be able to make accurate and clinically useful predictions; but for many, we can’t and won’t.”
Caroline Wright lays out six reasons for the difficulties in genomic prediction. They’re all pretty obvious to me but the last reason may be a bit of a surprise.
Students Dissecting a Cadaver, c. 1900.
Standards for dissection have changed a bit in the past hundred years. From the photograph description:
The cadaver lies on a ceramic anatomy-table. A gas lamp is above the corpse. A student has placed a book on the cadaver’s forearm as if the cadaver were holding it for him. Two of the men are smoking pipes.
![Image: Christ Healing the Sick by John Friedrich Overback [link]
Blogger’s Note: You don’t need to agree with the discourse or how it’s presented because that’s not the point, these are the thoughts of a young lady who is living with three autoimmune disorders and they’re worth sharing incredible.
How to be a Person in the Age of Autoimmunity [The Cluster Mag]
Because of the rapid spread of autoimmune disease in industrialized nations, Nakazawa states, “Scientists the world over have dubbed it ‘the Western disease.’” The medical community remains unsure as to its origins, but often cites genetic factors. Others, unsatisfied with this weak causal explanation for these “Western” afflictions, have been exploring the environmental triggers of autoimmunity. One’s immune response is partially genetic. If you are not predisposed to autoimmunity, you are not likely to develop an autoimmune disease. Yet to not take into account environmental factors seems like a sanitization of a bizarre phenomenon, a reliance on the hermetic discourse of a medical field governed by specific protocols. I don’t mean to blame anyone specifically for the illnesses they have endured, but humans have likely participated in the creation of this situation. Our bodies have absorbed environmental degradation and the consequent chemical toxicity load.
There are currently no known cures for most autoimmune diseases. They are discussed as chronic conditions that must be in a lifelong process of mitigation through biomedical means. My doctors would plead with me, as I shuffled into their offices with my walker, to take Humira. Biologics are a new class of drugs, barely a decade old, used to treat a few autoimmune conditions. Humira, which carries a black box warning, is an exact clone of a human antibody. It’s a human protein cultivated in the bodies of mice. These biologics function as immune-suppressants, essentially shutting down the body’s immune system to prevent it from attacking itself.
But, left without its defenses, the body becomes vulnerable to fatal cancers, other autoimmune diseases, and opportunistic infections; Humira’s medicine-as-technology counteracted my body’s self-destructive but “natural” behavior. Forget the dualistic mode of thought, in which nothing was wrong with me, but something was wrong with my body. The idea is that I was deficient, and the only way to become the optimal version of myself was to embrace a drug that would make me do no more than function, all for $3,000 a month.
My doctors’ assurance was that I would get well. I would be able to get a job with benefits that would allow me to pay for insurance. Biomedical treatment operates on a capitalist understanding of time. Rather than embracing the regenerative powers of the body, the idea is to get back to work as quickly as possible. It is the body’s radical autonomy that resists commodification. To spite our optimal productivity, it gets sick. Sickness can be masked and treated but the body responds nonetheless. It reacts. It may take longer to recover than is convenient to your boss. We do not have time to get you better. We have time to make you functional.
“You are too young to live like this!”became my well-intentioned doctors’ refrain.“What a shame! We can get you back to work! You should be out living your life!”And so, they perpetuated the supposed narrative of health and death: illness is something which comes late in life, right before the end. They acted as if I was experiencing an inconvenience. As if I wasn’t living my life anyway. They didn’t understand that this experience had stripped and shed a light on me, making it simply impossible to carry on as before. There was no return to “normal.”
They often asked me about what I did before I became sick. As if that was me, and this a brief interlude of discomfort.In fact, most discussions in doctors’ offices are about pain or discomfort. These are important issues. Proust wrote, “Illness is the doctor to whom we pay most heed; to kindness, to knowledge, we make promise only; pain we obey.”
As my life came to be ruled by the sensation of pain, it became impossible to think about anything except the sensation of pain. But pain is only the partial story of the body, a symptom of an underlying problem, whether an injury or a systemic issue. Pain is the body calling out for your attention. I wanted to be healthy again, not simply living without pain. I wanted a medical practice that addresses the true health of the body.
I resisted starting Humira for this very reason. My doctor explained that the way to eliminate the pain and inflammation was to clamp down my overactive immune system. Doing this would prevent it from attacking my joints and my intestines, leaving me pain-free. But it didn’t take care of the underlying problem: my immune system is confused. Eliminating my immune system sounded like a bad—an incomplete—idea.
Most of my friends and family urged me to take what was offered. Even the people that I’d identified or had self-identified as radical or left-leaning were suspiciously unsuspicious of the biomedical industrial complex: that every other industrial complex demanded rigorous scrutiny, but in matters of health and the body, medicine was unmarked and depoliticized.
Here I was in the hospital, having my body completely compartmentalized— treated not as a living organism but as an alienated collection of symptoms. What I realized through these visits, and my increased aversion to biomedical intervention (even while it was keeping me alive) was a resistance to a cyborgian present. I was in a futuristic nightmare, watching my body change and having no control over it; getting post-industrial noise MRIs; having a blood transfusion and feeling two pints of someone else’s cold blood course through my veins; getting a colonoscopy, where I was knocked out and a fiberoptic camera was stuck up my ass and through my intestines. I asked for a copy of the video, a request they did not take seriously, nor find humorous.
I am not a neo-Luddite. I am wholly indebted to modern science and technology for keeping me alive and in little pain. I believe in the specificity of cases. Sometimes biomedical treatment is inevitable and sometimes it is not, but I find expressions of the body purity problematic. Our bodies are not discrete entities. They constantly interface with organisms and substances in our environment. Body modification and augmentation is an age-old human practice. We have always been cyborgs.
Intellectually, I embrace the idea of being a cyborg, but in the midst of my health crisis I became opposed to this new identification. Faced with feeling less and less human, I clung to a particular idea of humanity denied through current medical practices. My symptoms also made me feel human, in a particularly disagreeable way.
h/t: Wetware Ontologies](http://25.media.tumblr.com/8311a780109f2c9e03fe8957274a4d77/tumblr_mhs3ivnjCq1qzs6yjo1_1280.gif)
Image: Christ Healing the Sick by John Friedrich Overback [link]
Blogger’s Note: You don’t need to agree with the discourse or how it’s presented because that’s not the point, these are the thoughts of a young lady who is living with three autoimmune disorders and they’re worth sharing incredible.
How to be a Person in the Age of Autoimmunity [The Cluster Mag]
Because of the rapid spread of autoimmune disease in industrialized nations, Nakazawa states, “Scientists the world over have dubbed it ‘the Western disease.’” The medical community remains unsure as to its origins, but often cites genetic factors. Others, unsatisfied with this weak causal explanation for these “Western” afflictions, have been exploring the environmental triggers of autoimmunity. One’s immune response is partially genetic. If you are not predisposed to autoimmunity, you are not likely to develop an autoimmune disease. Yet to not take into account environmental factors seems like a sanitization of a bizarre phenomenon, a reliance on the hermetic discourse of a medical field governed by specific protocols. I don’t mean to blame anyone specifically for the illnesses they have endured, but humans have likely participated in the creation of this situation. Our bodies have absorbed environmental degradation and the consequent chemical toxicity load.
There are currently no known cures for most autoimmune diseases. They are discussed as chronic conditions that must be in a lifelong process of mitigation through biomedical means. My doctors would plead with me, as I shuffled into their offices with my walker, to take Humira. Biologics are a new class of drugs, barely a decade old, used to treat a few autoimmune conditions. Humira, which carries a black box warning, is an exact clone of a human antibody. It’s a human protein cultivated in the bodies of mice. These biologics function as immune-suppressants, essentially shutting down the body’s immune system to prevent it from attacking itself.
But, left without its defenses, the body becomes vulnerable to fatal cancers, other autoimmune diseases, and opportunistic infections; Humira’s medicine-as-technology counteracted my body’s self-destructive but “natural” behavior. Forget the dualistic mode of thought, in which nothing was wrong with me, but something was wrong with my body. The idea is that I was deficient, and the only way to become the optimal version of myself was to embrace a drug that would make me do no more than function, all for $3,000 a month.
My doctors’ assurance was that I would get well. I would be able to get a job with benefits that would allow me to pay for insurance. Biomedical treatment operates on a capitalist understanding of time. Rather than embracing the regenerative powers of the body, the idea is to get back to work as quickly as possible. It is the body’s radical autonomy that resists commodification. To spite our optimal productivity, it gets sick. Sickness can be masked and treated but the body responds nonetheless. It reacts. It may take longer to recover than is convenient to your boss. We do not have time to get you better. We have time to make you functional.
“You are too young to live like this!”became my well-intentioned doctors’ refrain.“What a shame! We can get you back to work! You should be out living your life!”And so, they perpetuated the supposed narrative of health and death: illness is something which comes late in life, right before the end. They acted as if I was experiencing an inconvenience. As if I wasn’t living my life anyway. They didn’t understand that this experience had stripped and shed a light on me, making it simply impossible to carry on as before. There was no return to “normal.”
They often asked me about what I did before I became sick. As if that was me, and this a brief interlude of discomfort.In fact, most discussions in doctors’ offices are about pain or discomfort. These are important issues. Proust wrote, “Illness is the doctor to whom we pay most heed; to kindness, to knowledge, we make promise only; pain we obey.”
As my life came to be ruled by the sensation of pain, it became impossible to think about anything except the sensation of pain. But pain is only the partial story of the body, a symptom of an underlying problem, whether an injury or a systemic issue. Pain is the body calling out for your attention. I wanted to be healthy again, not simply living without pain. I wanted a medical practice that addresses the true health of the body.
I resisted starting Humira for this very reason. My doctor explained that the way to eliminate the pain and inflammation was to clamp down my overactive immune system. Doing this would prevent it from attacking my joints and my intestines, leaving me pain-free. But it didn’t take care of the underlying problem: my immune system is confused. Eliminating my immune system sounded like a bad—an incomplete—idea.
Most of my friends and family urged me to take what was offered. Even the people that I’d identified or had self-identified as radical or left-leaning were suspiciously unsuspicious of the biomedical industrial complex: that every other industrial complex demanded rigorous scrutiny, but in matters of health and the body, medicine was unmarked and depoliticized.
Here I was in the hospital, having my body completely compartmentalized— treated not as a living organism but as an alienated collection of symptoms. What I realized through these visits, and my increased aversion to biomedical intervention (even while it was keeping me alive) was a resistance to a cyborgian present. I was in a futuristic nightmare, watching my body change and having no control over it; getting post-industrial noise MRIs; having a blood transfusion and feeling two pints of someone else’s cold blood course through my veins; getting a colonoscopy, where I was knocked out and a fiberoptic camera was stuck up my ass and through my intestines. I asked for a copy of the video, a request they did not take seriously, nor find humorous.
I am not a neo-Luddite. I am wholly indebted to modern science and technology for keeping me alive and in little pain. I believe in the specificity of cases. Sometimes biomedical treatment is inevitable and sometimes it is not, but I find expressions of the body purity problematic. Our bodies are not discrete entities. They constantly interface with organisms and substances in our environment. Body modification and augmentation is an age-old human practice. We have always been cyborgs.
Intellectually, I embrace the idea of being a cyborg, but in the midst of my health crisis I became opposed to this new identification. Faced with feeling less and less human, I clung to a particular idea of humanity denied through current medical practices. My symptoms also made me feel human, in a particularly disagreeable way.
h/t: Wetware Ontologies
Could we clone our organs to be used in a transplant?
How would you like a clone of yourself stowed away somewhere in case you need a new heart or liver, like a spare tire in the trunk of a car? That, in a nutshell, was the plot of the 2005 high-dollar, low-attendance sci-fi movie, “The Island.” Hollywood heartthrobs Scarlett Johansson and Ewan McGregor play dual roles portraying the rich and famous — and their genetically identical clones. In an appropriate Orwellian twist, doctors must murder the “spare” clones in order to harvest needed body parts.
Chances are, “The Island” isn’t a glimpse into the future. Nevertheless, it brings up a relevant point about the potential uses for human reproductive cloning. Organ transplants are difficult undertakings for two major reasons. First, you have to find a donor, and second, there’s no guarantee that your body will accept the new organ. Statistically, organ demand far outweighs current supply. According to the Organ Procurement and Transplantation Network, 28,356 Americans received organ transplants in 2007 — around 78 percent of those came from deceased people. Yet as of August 2008, more than 99,000 people in the United States were on the national waiting list for organs [source: OPTN].
What if you could eliminate the wait time and risky odds with traditional organ transplants by creating custom, cloned organs from your own cells that your body would recognize?
There’s a difference between inquiring about the feasibility of constructing “custom, cloned organs from your own cells” and the systematic murder of “spare clones in order to harvest needed body parts.” For starters, the latter is illegal and the former is not. Why would one harvest needed body parts from expensive clones (complete with ethical, sprititual issues, etc…) when you may one day be able to affordably print, grow, xenotransplant organs, or my favorite, entirely replace those problematic organs with their superior artificial counterparts?
There’s also all sorts of potential anti-aging, gene therapy, genetic engineering solutions that are promising.
Just in case you needed your morning dose of cells that fold into beautiful geometric shapes or for what I suspect is a majority, a hint at a way to make money from the origami skills you perfected in health class during your freshman year of high school. It’s Science, haters to the left.
Cells cultured along origami seams, prodded to self assemble into 3D shapes. Future applications include organ growth and drug delivery.
Technology will replace 80% of what doctors do [CNN Money]
Here’s the story from dailymedical:
Human Cloning Will Be Possible Within 50 Years, Nobel Prize-Winning Scientist ClaimsSir John Gurdon, the British developmental biologist whose research cloning frogs in the 1950s and 60s led to the later creation of Dolly the sheep in 1996, believes that human cloning could happen within the next 50 years.
He said that parents who lose their children to tragic accidents might be able to clone replacements in the next few decades.
Gurdon, who won this year’s Nobel Prize for Physiology or Medicine, said that while any attempts to clone a human would likely raise complex ethical issues, he believes that in the near future people would overcome their concerns if cloning became medically useful.
And here is the actual quote from Sir John Gurdon,
“When my first frog experiments were done an eminent American reporter came down and said ‘How long will it be before these things can be done in mammals or humans?’” Gurdon said in the interview.
“I said: ‘Well, it could be anywhere between 10 years and 100 years - how about 50 years?’ It turned out that wasn’t far off the mark as far as Dolly was concerned. Maybe the same answer is appropriate,” he said.
There’s a lot of room to negotiate between the maybe in the quote and the will in the title, there are also a lot of questions about the sources of funding and these things called laws.
With that point made, the better question to ask the public is, would you clone Beyonce if you could?
Don’t answer, we call that a rhetorical question.
