Archive for October, 2010

The Stem Cell Facelift: Self-Delusional Surgery

Tuesday, October 26th, 2010

Recently ads for a stem cell facelift have been promising to enhance signs of facial aging by injecting stem cells derived from liposuction harvest into the face. This follows much of the minimally effective PRP injections for the same purpose. What makes the stem cell nonsense particularly vexing is that there is no evidence that the injected fat even has stem cells within the transplanted material. “Under Federal regulation 21 CFR 1271.3(d) “stem cell based products” are defined as tissue transplantations that may or may not contain stem cells and are used for a defined medical condition.” according to Spencer Brown PhD at the University of Texas Southwestern Medical Center in Dallas, Tx. In addition it is my observation that the public proponents of what appears to me to be a hoax are often well known physicians who have been paid by companies that either sell liposuction equipment or stem cell harvesting and infiltrating equipment.
As a child one of my favorite stories was “The Emperor and His New Clothes” and I never tired of re-reading it. I did not suspect that I would experience such overt deceptions in my adult life. As a child the story was an allegory describing self-indulgent pride and false self-importance. Now it is mostly about money. Noted physician-speakers parade around the country at medical society meetings promoting their quasi-scientific experience in return for financial remuneration from manufacturers. Marketing departments at manufacturers are given veto power over information dissemination by science and research laboratories. And a very gullible and superficial consumer population purchases these ruses in an attempt to impress their contemporaries by conquering aging.
Perhaps it is frightening to consumers to examine the changes of aging and to respond appropriately. I have spoken to numerous professional photographers and hair stylists who are able to take 10-20 years off someone’s face in 1 hour. But somehow that isn’t magical enough, isn’t cool enough for this particular population. For many women rather than reduce layers of caked make-up from their face they would rather purchase creams with secret formulations which can then be layered with gobs of make-up. For others, they would rather engage their fantasies of youthful long hair rather than cut their hair and wear it off their face and actually look more youthful. And for some, they would rather have a stem cell treatment that may contain no stem cells at all rather than use fillers that have proven efficacy. Again, according to Dr Brown, “Currently, there are no FDA approved ASC isolation devices, ASC procedures for use in medical conditions, or ASC stem cell clinics in the U.S.” (ASC-autologous stem cell). If Dr. Brown tells us that there is no assurance that stem cell materials contain stem cells and there are no devices to isolate stem cells, then I think this exciting technology should be placed in the hands of scientists for future development and removed from the purview of consumers.

Be a Skeptic and not a Cynic

Wednesday, October 20th, 2010

It is so easy and so logical to be jaded. 57% of the senate are lawyers and all are multimillionaires. Corporate America and possibly foreign interests are investing huge amounts of money in political campaigns designed to represent the citizens of the United States, not the Corporate entities of the world. Marketing campaigns obfuscate and dominate so that companies who sell everything from ice cream to cell phones overstate their efficacy and marketing departments of manufacturing giants have veto power over science and research departments. Religious intolerance is on the rise as is virtually every form of intolerance and political leaders speak at us and refuse to listen.
I feel the same way you do. I feel that way about medical practice where financial profits outweigh quality of care issues. I understand the pressures of overhead, of the constant threat of malpractice lawsuits, of government interference in administering a system they have little knowledge of, and ever escalating health care costs and insurance premiums out of proportion to our European brethren who often provide better care. I understand that patients are ever more hostile and willing to vilify and attack their physicians when they are not satisfied. I understand but I cannot justify the demise of medical care as I understood it because each of us physicians took an oath to serve our patients with honesty to the best of our ability, ideally with compassion. And I understand that many of us still adhere to our oath.
In spite of all of this I have a message; a conclusion for what I think must guide each of our survival and well being. I will speak of medical care, yet the philosophy extends to all decisions of welfare. Be skeptical! It is OK to question a diagnosis. It is OK to question a therapy. Get a second opinion. Obtain a copy of your records. Ask what the prognosis of your condition is and how long your doctor expects before your illness is under control or cured. And when your problem does not resolve in a reasonable amount of time leave for another evaluation and potential treatment. This is not a time to blame your doctor. This is not a time to argue with your doctor. Your doctor gets no pleasure out of you not getting well. Your doctor is human. Your doctor wishes for you to feel well and for the pride of doing a good job. Be skeptical of what you hear and seek further counsel when it is appropriate. Do not play the blame game. Do not become the know-it-all cynic. For then you have become exactly what you criticize.

The Case for Cancer Neurosis

Sunday, October 10th, 2010

The blessing and the curse of being a cancer patient is the very present knowledge that today may be one’s last on earth. The blessing is that God gives most of us some warning and we can plan the rest of our lives as we see fit. “Why me” makes no sense since we have not only lived the blessing of life, we are now given the privilege of enjoying what is a finite time left on earth. This is different than the person who’s sudden and untimely death occurs in an inopportune moment and there is no time to say good-bye, no time to make peace with the present and the past. It is the sense of knowing a recurrence of cancer can occur at any time just as it did the first time that gives us a sense of living in the present and the fear that we may have to leave.
This is the plight of the cancer patient. This is the cancer paranoia that each of us lives with in some degree of consciousness. A friend once said to me that only the paranoid Jews survived the Holocaust. The others blindly ignored their fate. So it is with the cancer patient. The subtle pain in the back, the indigestion following dinner, the recurrent cough – all may portend the recurrence that signal a resetting of priorities, a new allocation of time.
In 2002 I had pancreatic cancer and for reasons too ethereal for my understanding I survived. With due credit to my magnificent doctors there is some luck involved. The cancer was in the right spot to cause the jaundice to alarm my office manager who rushed me to the emergency room and on and on and the rest is my history. Several times in the past 8 years I have relived the fears and concerns as symptoms once considered inconsequential now become portents of my future. And so my indigestion and back pain led me to repeat my CAT scan 3 months ago with the disappointing news that there was a spot in my liver that could not be explained. What followed was the mandatory 3 month wait until I could repeat the scan to see if the lesion was real or ephemeral, was one that would realign my reality or would be followed by an all-clear signal. And so my wife and I waited and we waited and much of the time we put all of these thoughts out of our mind. But of a quiet moment, when we had time to reflect and to be thankful, the dark possibility always returned. Last week the repeat scan took place and to our relief and gratitude the “spot” was not present.
This is the fate of the cancer patient. This is our reality. We hope that groundless fears and neurotic pre-occupation will help protect us and at least serve as an early warning system. At worst it will give us time to share what is important and dispense with the rest. This hyperawareness is the domain of all who have brushed death and felt what might have been an imminent demise. This is the domain of all who are undergoing treatment or who support loved ones traversing the space of potential terminal illness.
I hope you will understand my sharing. I thought you might want to know.

Cancer Alert: “It’s Nothing” is not a diagnosis!

Monday, October 4th, 2010

No matter how loud the rejoinder, “it’s nothing” dismisses the content and reduces the listener to a passive, virtual inanimate object. For instance, Protagonist: “I am sorry I forgot your birthday”. Responder: “It’s nothing.” Translation: You blew it and I am not going to acknowledge my feelings.” Protagonist: “I should have paid more attention before I blurted out what I said.” Responder: “It’s nothing.” Translation: You are not important enough for your ill-gotten comments to matter to me.” And the worst by far is when your doctor does a biopsy and you are the Protagonist: “Doctor, you felt I needed a biopsy to protect my health. What was the result?” Doctor: “It’s nothing”. Translation: You are not intelligent enough to understand an explanation and I don’t want to waste my time with you.”
Dr Sanjay Gupta on CNN aired a report on a special unit of the National Institute of Health that investigates patients with previously un-diagnosable diseases. He was asked why the institute repeats tests and repeats biopsies that have already been performed. The gist of his answer is that when a biopsy is positive for a specific disease the diagnosis is established. But, when a biopsy does not diagnose a disease, it is a clue that more work needs to be done. It is not a diagnosis of “nothing”.
In an age of ever more impersonal health care you are the protector of your own health, you are the repository of your own information. It is your legal right to have a copy of your medical records at no charge to you and it is important to give each specialist the name of your referring doctor if there is one as well as your primary care doctor so the physicians can exchange information about you to arrive at the best care decisions possible. When you see a doctor for a health problem and you relate that a previous doctor did a test and said the results showed “it’s nothing” you are depriving yourself of the best care and at the least wasting valuable time.
One of my patients recently developed a brown streak in a toe nail. A podiatrist did a biopsy and did not find any pathology. He warned the patient that this could be a type of cancer. When I examined the toe I felt another biopsy was needed which would include removing the origin of the toe nail. I sent her to an orthopedic surgeon who promotes herself as an expert in hands and feet. For reasons I do not understand she refused to do the biopsy and sent the patient to another dermatologist. The dermatologist cancelled her biopsy because he said the first biopsy did not reveal cancer and that was most likely correct. There is a clear disconnect here between the problem the patient presented and the care she received. I called an associate at Northwestern Memorial Hospital and arranged for a second biopsy to be performed. “It’s nothing” “It’s OK” “It’s probably correct” are simply not good enough to practice good medical care. In an age where the single best weapon we have against cancer is early diagnosis you owe it to yourself to get a specific result for laboratory studies and biopsies, and to keep a copy of your own medical records.