Observations
I hate writing. I love having written.
Dorothy Parker
As my readers know, I have retired from my medical practice after 50 years, and now consider myself in my second career as a writer. I finally retired my medical license because it was unnecessary and I became tired of paying a lot of money every year for governmental licensure.
I write because I like the creative process. And I am able to do so because my wife, Becky and I always lived frugally, so I don’t need to make a living from writing. Becky teases me when we receive royalty checks for books I’ve published, by inviting me to go to Chick-fil-A for lunch.
There are benefits to being your own boss. My “homemade” essays are my own. I write about what interests me. And I only have to answer to my wife and editress!
Even though I am retired, medicine continues to interest me and I still follow three medical journals. And people still ask my opinion regarding medical issues, even though I’m quick to point out that I’m retired, no longer have a medical license and, consequently, unemployable. I’m no longer in the medical trenches, but the observations of five decades afford some measure of discernment.
My skepticism of media reporting is well known. However, a number of recent medical stories raises issues worthy of comment from the so-called bird’s eye view of an emeritus internist and geriatrician.
Recently, Kate Middleton’s illness and cancer diagnosis captured the world’s attention. I have no inside information on this young lady’s final diagnosis and respect her privacy where so many did not. The media circus and speculation were deplorable. Most people are sincere and concerned when they learn of someone’s cancer diagnosis. But as a cancer survivor, I can say that most patients do not want to be the subject of speculation or discussion. And repeatedly asking a cancer patient how they are doing is problematic.
When I first heard of Kate Middleton’s abdominal surgery, I thought about diverticulitis, which sometimes perforates the colon leading to surgery and a temporary colostomy. I have had many patients with diverticular disease. But I later learned she had a history of Crohn’s Disease which is a chronic inflammatory bowel problem. Not infrequently, Crohn’s Disease can lead to elective or urgent surgery. And inflammatory bowel disease can predispose to colon cancer which might only be discovered during pathologic analysis of surgical specimens. My analysis is obvious conjecture, but perhaps marginally better than untrained journalistic speculation.
Too often we read of tragic illnesses such as cancer in young people. However, having survived cancer, I can state that cancer at any age is terrible. However, a recent report of data from 57,000 patients collected between 2010-2019 suggests that colon, breast and endocrine cancers appear to be occurring more frequently in younger patients, defined as those less than 50 years old. Interestingly, cancer rates are declining in older people as defined as those older than 65. The explanation for increased cancer in younger people is unknown, but causative speculation includes obesity, alcohol, exposure to pollutants and carcinogenic chemicals as well as smoking. I mention the time period because the data is pre-Covid, so delayed cancer screening during the pandemic can’t be indicted.
Every doctor has what medicine describes as an “anecdotal case.” You might say an illness which is unusual. I remember a young woman who was pregnant and complained of a breast mass. Her obstetrician told her it was a swollen milk duct, but when it increased in size, I sent her for a mammogram. I later found out that the radiologist told her she was “too young for breast cancer” and refused to do the mammogram. Months later, breast cancer was finally diagnosed with a tragic outcome. The lesson is: don’t delay screening or medical care, and don’t let “experts” override common sense.
The standard screening test for colon cancer is colonoscopy, although stool testing for occult blood or stool analysis for cancerous DNA is also utilized. A study in the March 14, 2024, New England Journal of Medicine reported a study analyzing blood samples to screen for cancerous colonic DNA. And if you develop colon cancer the DNA of the cancer can be analyzed and a diagnostic test can be developed to screen blood samples for recurrent tumors. And researchers are working to develop a technique to stimulate the immune system to recognize the DNA of colon cancer proteins and fight the cancer. Sounds like Star Trek.
In experienced hands, the colonoscopy procedure is safe and reliable. The big drawback is the prep to clean the colon. But once that’s done, the wonderful “rush” of propofol anesthetic knocks you out and explains why propofol was Michael Jackson’s drug of choice. Unfortunately, it was administered by unskilled people and it cost Jackson his life.
Next, a paper in Nature magazine reports a study where up to 50% of aggressive colon cancers were associated with the bacterium (fusobacterium nucleatum). The explanation is complicated but may be related to what is called the gut microbiome. The lower intestine is full of bacteria that participate in digestion, make vitamin K for coagulation and produce molecules regulating some aspects of the immune system. We live in a symbiotic relationship with the bacteria in our intestinal tract. It is speculated that the fusobacterium somehow “cloaks” cancer cells from chemotherapeutic drugs.
Lastly, a study regarding marijuana caught my eye. The harmful and carcinogenic effects of partially combusted tobacco leaf (smoke) is well known. Years ago, I predicted that the legalization of marijuana and exposing millions to partially combusted marijuana leaves would lead to vascular disease. The study showed that people who smoke marijuana also have increased risks of heart attacks, strokes and vascular disease.
Aldous Huxley borrowed Shakespeare’s term for Huxley’s futuristic, dystopian book, “Brave New World.” I can identify with that term as I read that 10% of doctors are using AI to research medical articles and make diagnoses. A report from the University of Kansas studied the use of AI in clinical practice. Reportedly, there was 92% accuracy and inaccuracies were said to be uncommon. I’m not a technology luddite, but the description of AI “hallucinations” (making up information) in the Kansas paper disturbs me.
Admittedly, I’m old school with books and journals. Research with machine learning should continue, but this seasoned Doc believes AI is not ready for medical prime time.
