As earlier noted, the health care crisis is a complex, troubling riddle, but a solution is at hand. It is this: Follow the science for solutions, wherever that leads. This sounds simple and many would indicate that it is not. The interface between science and politics alone brings grounds for confusion and negotiation. There are those that would indicate that to commit resources and efforts to viable solutions, we must adapt to complexities and preferences at every turn.
The problem is, nature is not sitting around the negotiation table. What passes for compromise and negotiation often ends up in wholesale slaughter of the underlying science. Let me use a recent example, that of the use of the Prostate-Specific Antigen, the longstanding test for prostate cancer. This test is commonly referred to as the PSA test. Otis Brawley in his 2011 book, "How We Do Harm", outlines parameters of the issue from a politically-powerful position, that of the medical community, including many venerable institutions and much of government itself. Issues with regard to PSA and prostate cancer policy are as found in the Brawley book unless indicated otherwise.
I will use this situation as an example of what happens when we do not follow the science in question, with notes as to how I believe the issue of pancreatic cancer might otherwise be handled.
PSA has been used for decade as the gold standard for identifying whether a man has prostate cancer. Much work has been done in this period to learn of the effectiveness of the test. Last Fall, the official recommendation to use the test in the United States for prostate cancer screening was rescinded. The test, it was declared, has the potential to be dangerous. The initial reaction of one health professional, when he heard of the announcement was, "how can a blood test be dangerous?" Herein is the story.
The problem is that the PSA test has been found to be imperfect in that it can be used to identify a prostate cancer, but it is a poor measure of whether the person has the kind of prostate cancer that will kill. Technically, PSA will point to a "malignancy", but it will not provide information on whether the cancer is "indolent" or not. Indolent prostate cancer, as it is explained, will not kill a person. It will not spread to other organs in the body.
The question of danger is raised in an unexpected way. With information provided by the PSA test alone, doctors would be inclined to carry out cancer therapy. They would not know simply from the PSA score if the pancreas in question had an indolent tumor or not. Based on the PSA information, hey would go ahead with cancer therapies, which of themselves are highly damaging to the body if not dangerous in their own right. Related actions would involve surgical procedures, chemotherapy, radiation, administration of other cancer drugs, etc. Since such procedures may make the cancer worse and may bring other unintended consequences, and since the sue of such would have been triggered by the test, the test itself is now labeled as being dangerous. After extensive review of the issue at this level, the official suggestion was recently made to not use the test. It does not seem to have been disallowed.
A cursory review of research articles on PubMed, the comprehensive government-sponsored biological and medical research database, shows over 2,800 publications under "pancreatic cancer tests". Not mentioned in the Brawley book, these articles make reference to many such tests. Perhaps, the PSA's use could be supplemented by them. By the same token, they could conceivably be used to replace that test, given its documented incompleteness.
The point here is clear, though not outlined in Brawley. Chronic diseases do not appear out of nowhere. They may surprise individuals and clinicians when they present themselves -- this is often the case. There is little effort to catch chronic diseases in their early stages. Brawley, for example, mentions that prostate cancer is particularly problematic because the prostate gland is located in the center of the body and is difficult to see. This is central to the point; diagnosis is still carried out at a very visual, tactile level. It would be tempting to compare such diagnosis to auto mechanics if it weren't for the fact that that field converted to digital, data-driven evaluation decades ago. What is needed in this and other cases is data, data, and more data, along with the best available interpretive support, ideally from the people most knowledgeable about the subjects at hand.
Cancers and other chronic diseases do not surprise the body. In every case, the body will have created such disorders. Stimulated by natural processes gone awry, life-giving processes express themselves slightly akimbo, perhaps resulting in genetic abnormalities, maybe resulting in incomplete or unresponsive proteins within the system. Understanding functions of inflammatory and immune systems point to underlying conditions that foment chronic disorders. Cancer is the result of runaway cell growth and associated malfunctions with regard to cellular respiration, the means by which the body generates energy and controls growth at the most basis levels. Contrary to popular belief, chronic diseases, including cancers, are based in lifestyle and environmental malfunctions. Toxins are a big factor here.
Brawley mentions one more factor that calls attention to a wide gap between our treatment of pancreatic cancer challenges and their resolution. He mentions in one section of the book that prevailing definitions of prostate cancer date to the work of pathologists in Germany in the 1840s. He mentions this as a "problem", and adds his opinion that "we need a 2012 genetic definition of prostate cancer" (237-238). Well, yes, and we need to give updated tests a chance. There is obviously a "kink in the hose" with regard to knowledge of the pancreas and related disorders. This is the problem we call attention to. When knowledge is available, it should be evaluated by qualified, committed parties, and it should be used.
This is where the reference to Blacksmith Fork River comes in. As we are broadcasting this message from Northern Utah, in the American West, we look to our own heritage. I have called attention to the work and life of Marriner Eccles in particular. Once he picked up where his father had left off with his untimely death about a century ago, Marriner organized a series of successes there were momentous and unexpected. Yesterday, I created a YouTube presentation of just under an hour where I describe Marriner's career and some of his gifts to us, his beneficiaries. You may want to review that when you have the time.
The point I wish to make now relates to two events in Marriner Eccles' life that demonstrate his dedication to solutions where distractions may otherwise exist. As he began his career, recently having returned from a foreign religious mission, he was working on a family-related business, a hydroelectric project on the Blacksmith Fork River. This is what most would declare is a large stream in an equally small canyon in Northern Utah, near a community named Hyrum. While there at work, he got word of his father's unexpected and untimely death. This sets a serious of events into motion that were both challenging and emotionally taxing. The net result was that Marriner was able to apply his talents and efforts toward the continuation of the family enterprises as outlined to some degree in the video presentation.
About twenty years later, Marriner got another call. This time, he was asked by the Roosevelt Administration to forgo his business interests for the time being to go to Washington, DC, to help the American government to deal with the ravages of the Great Depression. He had offered up suggestions as to how the economy might be put on track -- resulting in about two decades of public service in which he oversaw works projects funding and related administration. Basically, he was a principal in establishing Keynesian economics before Keynes publish his version of the idea. Also, he was a very powerful and influential Chairman of the Federal Reserve System.
The point here, however, relates to what Marriner was doing when he got the call to go to Washington. As it turns out, he was managing the epic project to build the Hoover Dam in Black Canyon on the Nevada-Arizona border. His position was as Chairman of the Six Companies that was building the dam, which ultimately was constructed with two years to spare on the contract.
How did Marriner go from little Blacksmith Fork Canyon to Hoover Dam? Without reciting the detailed history, we can see that the path was a straightforward one. As water runs downstream, Marriner's knowledge of such matters grew over time to a mastery of impressive aspects of hydrology, engineering, construction, finance, and administration. Locals may note that the Blacksmith Fork feeds the Bear River, then the Great Salt Lake, not the Colorado, which winds to the Pacific Ocean. Apart from this technicality, we can see an abiding commitment to the realities of nature that led downstream from one canyon to the other.
This is how nature works. It works in streams, in tree-like patterns. Although there is an element of randomness in individual cases, nature follows patterns generally. It is in the understanding of these patterns, how they relate to one another, what causes elements to follow one path if not another, that we can learn to work with nature. The point of science and related policy is that we need to adapt to it fundamentally, not the other way around. As mentioned earlier, nature does not present itself to the negotiation table.
In our modern world, we spend blissful evenings watching our favorite television shows in high definition while listening to endless recitations of side effects from various pharmaceutical preparations. Interestingly, such lists often begin with terms like "death" and "strokes" and "seizures", recited with blazing speed. Is this the future that was intended for our day? Is this a future that is necessary at all? We cannot chop, slice, and dice away at nature without unintended consequences.
Side effects of pharmaceutical products reflect one aspect of the problem. We have a disjointed approach to the science of health. Dealing with incomplete understanding of or respect for natural flows within the body and in our environment, we end up with shortsighted, stilted results. Although nature itself does not, cannot sit around the negotiation table, it must be the elephant in the room. We need to use methods and tools that call attention to important natural connections. We need to commit to chains of thought that reflect scientific realities and commit to follow them wherever they lead. When we try to turn nature on its head, to impose our will, or simply decide to forget, natural phenomena are still there, ready to "whack us on the head".
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