On Delivering Bad News

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Delivering bad news is part of my job, an important part. It is fashionable nowadays to speak of the doctor-patient relationship as a partnership. In the sense that both doctor and patient have important roles to play for the patient to get good care, that's very true. But even in the best of times, it's a very asymmetric partnership. Even in a run-of-the-mill visit for a sinus infection the patient and the doctor bring very different skills, experiences, and expectations to the encounter. ...
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All Ashkenazi Jewish Women Should be Tested for BRCA

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Mutations in two genes called BRCA1 and BRCA2 greatly increase the risk of breast and ovarian cancer. Last year I wrote about Angelina Jolie’s discovery that she carries a harmful BRCA1 mutation and her decision to have preventive double mastectomy. In the general population mutations in these genes are quite rare, but among Ashkenazi Jews these mutations are much more prevalent. One in 40 Ashkenazi Jews carries a mutat...
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Raining on the Ice Bucket Parade

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Amyotrophic lateral sclerosis (ALS, sometimes called Lou Gehrig’s disease) is a truly horrible illness. It is a progressive fatal neurodegenerative disorder that leads to worsening muscle weakness. Weakness in the limbs initially makes handwriting sloppy and makes it hard to button clothes and eventually causes paralysis. Patients also develop weakness in the muscles that control swallowing and speech, eventually requiring them to use feeding tubes and computer text-to-speech software. Ev...
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The New Uncertainty about Mammograms

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“I’d like to be tested for every kind of cancer.” All primary care doctors have heard this request. Our answer is an explanation that we can’t. Understanding this explanation is important before we get to the most recent study about mammograms. We don’t test for all kinds of cancers for an important reason. The outcome of most cancers don’t depend on when they are diagnosed. This may come as a surprise to many, since we’ve all heard the message of the importance of ear...
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Marie Curie Helps Patients with Metastatic Prostate Cancer

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Anytime you or I feel particularly content with our achievements, we would be well advised to review the biography of Marie Curie. We would then quickly realize that we are unambitious mediocrities who should be much more productive. The magnitude of her accomplishments is dizzying. Virtually everything we know about radioactivity rests on the work of Madame Curie and her husband Pierre. The Curies coined the term radioactivity. She discovered the elements polonium and radium. She r...
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Even More Studies You Should Ignore

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Back when I was a medical student (in the Cretaceous Period) we were taught that someone once did a study comparing folic acid levels in the blood of cancer patients compared to the blood of healthy patients. The cancer patients had, on average, significantly lower folic acid levels. And the ones with the largest, fastest growing tumors tended to have the lowest folic acid levels. “Aha,” they thought. “Something about folic acid deficiency predisposes them to cancer. We should give folic aci...
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The American College of Physicians Releases Prostate Screening Guidelines

My regular readers have been following the controversy about prostate cancer screening for some time. The controversy boils down to the following question. Should healthy men be routinely tested for prostate cancer? The most recent chapter in the controversy was written last year when the US Preventive Services Task Force (USPSTF) recommended against prostate cancer screening for men of any age. If this is news to you, or so...
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Newsflash: Smoking is Very Unhealthy

I have shocking news. Smoking is very very bad for you. In 1964 the US Surgeon General issued a report summarizing the known adverse health effects of smoking. At that time about 40% of American adults smoked. A widespread campaign followed informing Americans about the link between smoking and lung cancer, emphysema, stroke, and heart attacks. Federal law required the placement of health warnings on cigarette packages, and school children all learned about the adverse health effects of smoki...
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Many Women Who Don’t Need Them Are Still Getting Pap Tests

My regular readers know that I frequently bemoan the fact that we have no effective way to test for most cancers, and that in many cancers early diagnosis does not improve survival. Cervical cancer is one of the few exceptions. Since Georgios Papanikolau developed the test named after him, the Pap test has dramatically reduced the incidence and mortality of cervical cancer. More recent advances have shown that cervical cancer is caused by human papilloma virus (HPV), a sexually transmitted in...
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