Oliver Sacks, 1933-2015

He went gentle into that good night
In old age he did not burn and rave at close of day
He did not rage against the dying of the light
He went gentle into that good night

So long, Dr. Sacks

From his article in the New York Times earlier this year:

I have been increasingly conscious, for the last 10 years or so, of deaths among my contemporaries. My generation is on the way out, and each death I have felt as an abruption, a tearing away of part of myself. There will be no one like us when we are gone, but then there is no one like anyone else, ever. When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate — the genetic and neural fate — of every human being to be a unique individual, to find his own path, to live his own life, to die his own death. 

I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers. 

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.

Keeping blood pressure among the elderly at a high enough level

Alan Cassels talks about the dangers of keeping blood pressure low among the elderly.

People who talk about prescribing in the elderly call it an 'evidence-free zone.' ... [B]lood pressure makes a very poignant example of the kind of care the elderly can often be subject to.... The problem is that trying to get blood pressure that low for someone who is 80 is almost totally irrational. Why? Because the physiology of old people is different and most blood pressure studies have specifically excluded people aged 80 and over. Those few studies that have focused on the elderly find something terribly surprising: the patients in the trials who had lower blood pressure had a higher risk of death.

This gets my goat. Because some doctors treat the elderly like they're middle aged and drown them in antihypertensives to keep their bp within the range appropriate for half century old individuals. Hence adverse effects can kick in. As in dizziness and light headedness in my mom's case. Seemingly unable to think out of the box, these doctors (hopefully in the minority) treat their now septua- and octogenarian patients as if they were still in their 50s. And worse, patients have been indoctrinated into believing there is an unquestionable Goldilocks zone for bp which is true for everyone and for all ages. And so they happily go along with their physicians' recommendations.

False positives, incidentalomas, overdiagnosis

"More testing leads to more false positives and incidental findings (abnormalities that don't pose a risk to your actual health). That leads to a higher probability of treatment. And treatment carries side effects." --Charles Ornstein

And from Dr. Gilbert Welch:

The more tests you do, and this is only the statistical process, the more likely one of them will be falsely abnormal. And the more times you do it, the more chance that something will be falsely abnormal.

The problem is you'll always be catching things out of what we would say is normal. This is anticipatory medicine at its worst, where you're really focused on what could be going wrong in the future and you're trying to pick up [a] signal.

The problem is there's so much noise — because the human body is a living organism. Variation is the very essence of life. People will start reacting to this data. I also think it's really important to label it what it is: data. To me it only becomes information to the extent that it accurately predicts something will happen in the future, and it only becomes useful knowledge — a higher level piece of information — if we can do something about it.

[http://www.npr.org/blogs/health/2015/04/06/397848621/tracking-your-own-health-data-too-closely-can-make-you-sick]

Breast cancer overdiagnosis due to screening mammography

Daniel Kopans says, "Overdiagnosis is a myth that has been created by a handful of individuals who provide no care for women with breast cancer."

And yet according to one of the latest studies the cost of overdiagnosis from screening mammography in the United States alone is $1.2 billion annually.

Really difficult to put much stock in what someone with vested interest in mammography says, specially when there are others (without conflicts of interest) producing evidence to the contrary.

[http://www.startribune.com/lifestyle/health/298805201.html]
[http://content.healthaffairs.org/content/34/4/576.abstract]

Web of corruption in clinical trials

Peter Wilmhurst shares his experience of the web of corruption involving industry, doctors, researchers/trialists in the following Evidence Live 2014 talk. Treatment efficacy and patient welfare were the least of their concerns.

Cholesterol Drug War

Watch the 2013 Australian Broadcasting Corp. documentary on statins.

The lone doctor interviewed in favor of statins almost sounds like a pharma shill. Makes one wonder whether he has conflicts of interest to declare.

Epidemic of diagnosis of thyroid cancer

Incidence of thyroid cancer has been going up. Steeply. But the mortality rate has been as flat as the Bonneville Salt Flats. Ergo, either we have an excellent treatment regimen for thyroid cancer or we have an epidemic of thyroid cancer diagnosis. It's the latter.

Currently, there is no way to confidently predict which incidentally detected thyroid nodule may be the precursor to a more aggressive process. Predictions such as these would require more accurate characterization of the biology of individual thyroid cancers than is currently possible. With time, we might prove our ability to confidently differentiate low-risk from high-risk thyroid cancers, but until that happens, routine screening for thyroid cancer by imaging billed as a “health checkup” should not be performed

[http://archotol.jamanetwork.com/article.aspx?articleID=2276788]

Dr. Gilbert Welch explains this lucidly in his cancer screening video (@11 min.)