Science Ain't So Bad

LOOKING FOR THE BAD THING

GOOD

What if doctors could always find cancer before it starts to spread? When they could still remove it and send you home?  No chemo. No radiation. See ya.

Here’s a blood test for cancer that gives a warning early enough to avoid big trouble. The test tells what type of cancer and may give inferential information about where it is located. Devin Koestler, Margaret Karagas and Jason Moore  (Geisel School of Medicine) did the work. Their test could spare you a biopsy as well as save you from metastatic cancer.

NOT PERFECT 

It’s only a test. You still have to get rid of the tumor, okay? And, yes, you still have to pay the bill.  But, if this preliminary research does pan out,  the term cancer won’t have the same punch. Most cancers would be nipped in the bud and wouldn’t be such a durn big deal. Worse than a hair cut. But much much better than looking up through the dew covered sod.

ScienceAintSoBad Rating = 5. The science seems okay  but hold on to your war hoops. Preliminary.

DR. KNOW-IT-ALL

What if your doctor knew everything?

Instead of just acting like he did.

I mean what if your physician ACTUALLY had all those studies and papers – all the latest stuff – in his.her head?

Nobody’s saying doctors aren’t smart but they can’t be up on every possible disease or every possible drug. Nobody could keep all that information “upstairs”.

Except for Dr. Watson.

The latest incarnation of  Watson, IBM’s supercomputer, takes in the Internet as well as other sources of up-to-date medical information, sorts out all the useful stuff, and  shares this with busy medical professionals as it is needed. Easy access to everything. And an algorithm to help.

Maybe you remember Watson. From Jeopardy. Watson was a contestant on the show and trounced  all the other (human) players.

They never had a chance.

IBM now wants to get Watson in the medical game, offering direct help as well as second opinions to physicians. Maybe, eventually, aiding and abetting the delivery of primary health care. (This, by the way, is from Brandon Kleim, Wired Magazine).

Would it work? Is this a good idea? Well… doctors do make mistakes.

No. I’m serious. It can happen.

Like.. all the time.

Thousands of errors every year. People who should get better, don’t. People who should go home, die. Not knocking the docs. They are amazing. But nobody’s perfect, right?

“I am. I am.” (Shut UP Watson!)

Okay. That’s the idea, anyway – that a machine, indefatigable, without human biases, with always up-to-date information – can offer useful assistance to healthcare providers.

So.

Nobody’s threatened by THAT idea, right?

One of the doctors quoted in the article above reminds us that doctors have enough knowledge. No need to waste electricity. We’re fine here.

Mister ScienceAintSoBad will stand aside while the geniuses from medical school figure this out. Some would say that most medical errors can’t be prevented this way. Well, guess what? This one’s inevitable. Watson, Shmatson. Eventually? The strong right arm of every physician will be his Doctor In A Box.

I’m right on this.

Trust me.

Love,

MISTER ScienceAintSoBad.

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Credits for the animation: to Heather’s Animations. Please note that donations are gratefully accepted in return for which (or even without a contribution) you can utilize the work you find there in your emails, articles, and what not.

Penn and Teller are “illusionists with a psychotic twist” (in other words, funny guys). In this bit, they take a look at medical hucksterism. They aren’t big fans of alternative medicine. Their language is a little earthy but their science ain’t bad.

Let's have a look at that pancreas

FINDING PANCREATIC CANCER EARLY

Five percent.

That’s the survival rate. By the time pancreatic cancer is found it’s been there for years. 11.7 years on average. You’re not gonna have much luck with a cancer that’s had 11.7 years to  spread.

11.7 years? You thought this was an aggressive cancer, right? Boom! And you’re a goner?

Nay, nay!  Pancreatic cancer is slow it seems. But it grows in a dark and dingy place. There’s plenty of time after the train leaves the station. But it’ll circle the world a million times before you notice something’s wrong. (Enough with the railroad metaphors?)

So.

Here’s the good news. Dr. Mike Wallace,  a “gut guy” at the Mayo Clinic, discovered a way to use an endoscope (camera on a stalk)  to look at cells in the small intestine. These cells change their appearance if there’s cancer down in the pancreas. I know this sounds cheesy. Why would you look in the intestine? It surprised the Docs too. But it certainly seems to work (though they’re trying to reduce the number of “false positives”.)  The Mayo clinic is in charge of a great big trial to see if his Polarization Gating Spectroscopy technique won’t save lives. Perhaps a lot of them.

And that’s not all.

There’s a new drug, rigosertib, that is now in phase II/III clinical trials (published in Clinical Cancer Research)  and sounds very promising. It interferes with the peculiar timing of cancer cells so that they “get stuck” before completing their reproduction cycle and die out.

Pancreatic cancer’s one of the bad ones. Maybe, with some luck, that will change.

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Image credits: Thank you me.

TRYING TO GET THE PROSTATE TEST RIGHT

A USELESS TEST?

If you’ve been reading the newspaper lately, you probably know to skip the PSA test. Pretty much a scam, right? You risk impotence and incontinence. And for what? You die when you die and your tombstone won’t say “Saved by PSA”.

As usual. There are two (or more) sides to the story.

Dr. Edward Messing (University Of Rochester Medical Center) took a look at the country’s largest cancer registry and he compared data for the period before PSA testing was introduced and after it was introduced. The work was published in Cell.  What did he find out? Surprise! He found that the amount of “advanced” cases  - metastatic cancers that were going to spread –  would have tripled had it not been for PSA testing.

So getting your PSA tested is a good thing, right?

Maybe. But this isn’t a very accurate test. What if it leads you to get an unecessary needle biopsy and the biopsy, itself, makes you sick? What if you wind up with urinary incontinence or impotence from the biopsy? Or what if the biopsy is positive and you get surgery and you swoon in the operating amphitheater years before the cancer would have nipped you?

Well, well, well. This is so complicated you probably wonder what MISTER Scienceaintsobad thinks. I ain’t givin’ no medical advice, but I will tell you what I would do if my own PSA score were to jump.

I would be very calm.

Why? Because, as I say, the tests are usually wrong. And, also, as I said, this cancer is a tortoise. At least, it usually is. So I would probably figure on being around to blog another day.

Your blog’s so b-o-r-i-n-g, most of us readers’ll go out and celebrate when you bloody slip the mortal coil, MISTER ScienceIsSoPredictable! – ReaderOfYourBlog993. 

Hey WATCH it, ReaderOfYourBlog993!

Well what to do with the knowledge from the test? If you’re just going to ignore it, why waste time and money? Why do the test in the first place?

Precisely the argument of the US Preventative Services Task Force.

Here’s the thing. (Gotta stop saying that.) Why not act intelligently on this information? Instead of calling  up the biopsy guy, why not look at  other noninvasive tests that could be used to narrow down the possibilites? Here’s one worth considering. Here’s another.   And, yes, this test not only gives accurate information about the presence of prostate cancer, it also gives an indication of how advanced it is which, after all, is the key. With that information, you know when to act and when to roll the dice on outliving the cancer.

Just one thing. None of these tests is available. They are still “raw science”. They might not make it to the clinic. Ever.

Am just playing with you? Would MISTER ScienceAintSoBad do that? Course not. I do have something with a bit more immediacy here. This study, using currently available drugs,  takes the sloppy PSA test and sharpens it up. It’s the brainchild of  Dr. Steven A. Kaplan and his colleagues at  the NewYork-Presbyterian Hospital/Weill Cornell Medical Center  (published in the Journal of Urology) . They looked at men who keep getting abnormal PSA tests followed by normal biopsies. For these patients, this would happen over and over. Frustrating!

Since the standard PSA test has trouble telling the difference between an inflamed prostate (which is benign if you don’t mind peeing constantly) and cancer,  they tried using certain drugs – drugs that are currently available –  to  shrink the prostate. THEN they did the PSA test.

Good idea.

After shrinking the prostate, the tests were , in fact,  more accurate. Fewer patients had to undergo a needle biopsy with its risks and more advanced cancers were identified. No. This “drug plus PSA test” approach isn’t standard follow-up to a positive PSA test. Not yet.  More thought has to go into how it might be applied to the general population. And, of course, cost/benefit considerations are important when you make a simple test more complex. But all these tests show that we don’t have to be trapped by our current thinking on the PSA test.

The Task Force raised good questions but the panel members need to get out more. Science can offer a broader range of options than just the plain vanilla PSA test.

Science. It ain’t so bad. Right?

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Image credits: That’s actually Margaret Field in The Man From Planet X which you may have caught back in 1951. He isn’t really checking for a prostate, even though it sure looks that way. The alien is trying to kidnap her and take her back to X where they have a huge shortage of librarians.  
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