Young Woman Forced To Undergo Chemotherapy Against Her Will
[guest post by Dana]
Cassandra C, as she is known, is a 17-year old girl with cancer. She was given an 85-90% chance of recovery with chemotherapy treatment for Hodgkins lymphoma, one of the most treatable forms of cancer. However, Cassandra did not want chemotherapy, believing it was “poison.” Her mother, Jackie Fortin said Cassandra believed chemo would not just kill her cancer, but “everything in her body” as well. Fortin stood along side Cassandra in her decision not to undergo chemo treatment:
“[These] are her human constitutional rights to not put poison in her body,” Fortin said. “Her rights have been taken away. She has been forced to put chemo in her body.”
After losing an appeal to the Connecticut Supreme Court, Cassandra is now being compelled by the state to undergo chemotherapy:
The state’s highest court reviewed the case under an emergency appeal filed by attorneys representing Cassandra and her mother, taking up an issue previously decided by several other states – whether some minors are mature enough to make decisions about their own bodies.
On Thursday, the judges decided that Cassandra is not mature and will continue to receive chemotherapy. She turns 18 in September, a year after her cancer diagnosis.
“Connecticut Children’s respects the decision provided by the Supreme Court this afternoon. Now that a ruling has been issued, we will continue to work with the Department of Children and Families in providing care for this child,” said Bob Fraleigh, director of corporate communications at Connecticut Children’s.
In an op-ed written by Cassandra, she describes the whole ordeal as “horrifying”:
Words cannot describe what my life has become over the last few months. “Horrifying” seems like an understatement. What I have been going through is traumatizing. Never did it cross my mind that one day I would be diagnosed with cancer. In September, after a stressful summer of blood work, examinations and biopsies, I was diagnosed with Hodgkin’s lymphoma.
…
My mom and I wanted to make sure my diagnosis was correct, so we agreed to seek a second opinion. We wanted to be 100 percent sure I had cancer. Apparently, going for the second opinion and questioning doctors was considered “wasting time” and “not necessary.” My mom was reported to the Department of Children and Families for medical neglect because we weren’t meeting the doctors’ time standard.
As a result, DCF put Cassandra into foster care. She was permitted to return to her own home after promising authorities that she would begin chemotherapy. She underwent treatment for two days, quit and ran away in order not to be forced to put something into her body that she did not want. Fearing authorities would assume her mother was refusing to disclose her whereabouts (which her mother did not know) and perhaps be jailed, Cassandra returned home. And once again she was picked up by DCF. Her ordeal was not over, far from it:
In December, a decision was made to hospitalize me. I didn’t know what was going to happen, but I did know I wasn’t going down without a fight.
I was admitted to the same room I’m in now, with someone sitting by my door 24/7. I could walk down the hallway as long as security was with me, but otherwise I couldn’t leave my room. I felt trapped.
After a week, they decided to force chemotherapy on me. I should have had the right to say no, but I didn’t. I was strapped to a bed by my wrists and ankles and sedated. I woke up in the recovery room with a port surgically placed in my chest. I was outraged and felt completely violated. My phone was taken away, the hospital phone was removed from my room and even the scissors I used for art were taken.
I have been locked in this hospital for a month, missing time from work, not being able to pay my bills. I couldn’t celebrate Christmas and New Year’s with my friends and family. I miss my cat and I miss fresh air. Having visitors is complicated, seeing my mom is limited, and I’ve not been able to see all of the people I’d like to. My friends are a major support; I need them. Finally, I was given an iPad. I can message my friends on Facebook, but it is nowhere near like calling a friend at night when I can’t sleep or hearing someone’s voice to cheer me up.
This experience has been a continuous nightmare. I want the right to make my medical decisions. It’s disgusting that I’m fighting for a right that I and anyone in my situation should already have. This is my life and my body, not DCF’s and not the state’s. I am a human — I should be able to decide if I do or don’t want chemotherapy. Whether I live 17 years or 100 years should not be anyone’s choice but mine.
How long is a person actually supposed to live, and why? Who determines that? I care about the quality of my life, not just the quantity.
At the heart of the issue is the question of when a minor is mature enough to make medical decisions for themselves. While 17 other states have the “mature minor” doctrine, Connecticut does not. The courts did not believe Cassandra or her mother proved Cassandra capable of making life and death decisions:
The state Supreme Court order argues that Cassandra, along with her mother, had a chance to show that she was a mature minor and did not do so. It also says that even if you presume the mature minor doctrines can be considered in Connecticut, Cassandra and her mother failed to prove she is “capable of acting independently” when it comes to her illness and treatment. (The court cites the fact that Cassandra ran away from home for a time and stopped her treatment as a part of this finding).
And then there is the ambiguity and seeming inconsistency about a set age defining maturity:
The existence of age-related laws and requirements creates a certain gray area. Does a person who is one week shy of turning 21 change dramatically over the ensuing week before being deemed mature enough to drink alcohol? It is tough to argue that a mere matter of days represents enough time for incredible change to occur for each and every person governed by these laws. There are also exceptions to the rules that exist. You typically have to be 25 to rent a car, but in some states younger drivers can rent a car if they are willing to pay an additional fee.
Interestingly, abortion for minors in Connecticut is legal and does not require parental consent or notice. There is, however, a requirement for minors under 16 to receive counseling beforehand, which must include the possibility of informing parents.
–Dana
Hello.
Dana (8e74ce) — 1/24/2015 @ 2:45 pmMore details would be important.
I would hope there had been significant effort to explore the girl’s thinking, which was at least not fact based, if not “irrational” (though it opens the issue of what is “rational” once given certain beliefs).
Hard to let a 17 yo give up an 85% chance of cure.
MD in Philly (f9371b) — 1/24/2015 @ 2:52 pmThis young lady is very unhappy. I question whether her treatment will be effective given her mental state, because mental state is important in cancer treatment. And she obviously doesn’t have confidence in her doctors, so that makes it ever more difficult for everyone. It’s a shame, too, because lymphoma is one of the most treatable cancers and, depending on the type, the initial treatments may not be debilitating. What this case needs is an American Cancer Society mediator.
DRJ (a83b8b) — 1/24/2015 @ 2:55 pmThis kills me.
JD (6dfb13) — 1/24/2015 @ 2:57 pmI would let her die.
We had a somewhat similar case when I was a cardiac surgery resident. A 17 year old came in with Tetralogy of Fallot. This is the most common “blue baby” cardiac anomaly and none of us had ever seen a patient this old. Untreated they died at about age 6 to 12 before the surgery. The twist was that he had become a Jehovah’s Witness 6 months !!! before we saw him. They will not accept blood so open heart surgery is very difficult and often fatal. Denton Cooley made a big name by doing open heart surgery on Witnesses but that was later with more modern heart-lung machines. Denton is a wonderful surgeon and a bit of a character. He was an All American basketball player at U of Texas in 1944. I wanted to train with him but my wife wouldn’t leave Los Angeles.
Anyway, Burt Meyer our chief was not going to do open heart surgery on this kid with no blood. He was so cyanotic he was purple. His hemoglobin was 25. We did an older procedure, the Blalock-Taussig operation on him that was developed before open heart surgery.
If he ever changed his mind he could have a complete repair which would be technically easy. Even the limited surgery was tricky as he l\bled way down to about 7 grams go hemoglobin. Those cyanotic cases don’t clot normally.
I would treat this girl as an adult and let her die.
Mike K (90dfdc) — 1/24/2015 @ 2:57 pmGoddam autocorrect.
“the limited surgery was tricky as he bled way down to about 7 grams of hemoglobin.”
Mike K (90dfdc) — 1/24/2015 @ 2:59 pmMike K,
But you can’t since she’s been adjudicated to be a minor who isn’t eligible to be treated as an adult. Thus, a court has said she’s the one person that doctor can treat as an adult.
DRJ (a83b8b) — 1/24/2015 @ 3:00 pm… the one person doctors can’t treat as an adult. And ditto re: autocorrect.
DRJ (a83b8b) — 1/24/2015 @ 3:01 pmMD,
I read that the court heard two hours of testimony and it took them just a couple of minutes to render their unanimous decision:
The teen’s attorneys argued that in previous hearings they were not able to fully explore and demonstrate her maturity level. They say the hearings were too focused on her prognosis. Her attorneys argued she is nine months from her 18th birthday, and through the Mature Minor Doctrine she’s ready to take on this life decision.
From the Asst. Attorney General:
Dana (8e74ce) — 1/24/2015 @ 3:01 pmEh, should have quotation marks:
Dana (8e74ce) — 1/24/2015 @ 3:06 pmWhen BA was being treated, there was a felon from jail being treated. He was non-compliant, in and out of treatment, refused much treatment, and became cancer-free. He had no desire to get better, yet did.
JD (6dfb13) — 1/24/2015 @ 3:07 pmAlternate: child with curable cancer has life saved by treatment her mother refused to let her have. Father nowhere to be seen.
Robibtn (c260c0) — 1/24/2015 @ 3:10 pmThis is from the Joint Reply of Cassandra and her mother:
Dana (8e74ce) — 1/24/2015 @ 3:15 pmBut you can’t since she’s been adjudicated to be a minor who isn’t eligible to be treated as an adult.
Oh, that’s local law. The kid we had was an emancipated minor.
Connecticut is also the state that is the most hostile to families of psychotics trying to get treatment.
Blue state lunacy.
Mike K (90dfdc) — 1/24/2015 @ 3:23 pmJD,
The American Cancer Society supports what you say and discounts what I said, so I guess a good attitude won’t make medicines work better or worse. But I still think attitude matters. In addition, I’ve seen people with cancer give up and when they give up, so do the providers. Cassandra may feel unlucky but maybe she’s lucky these doctors were willing to take her case to court.
DRJ (a83b8b) — 1/24/2015 @ 3:26 pmDRJ – I didn’t mean you were wrong, I just meant it is unfair for those that wish to die to get better, when there are people that want to live don’t. Sour grapes.
JD (6dfb13) — 1/24/2015 @ 3:30 pmI don’t think someone can get well just by wishing for it or putting on a happy face. My point is it’s easier to deal with cancer if you feel positive about your treatment and the people who are treating you. It’s hard to do that during most cancer treatments, because there are a lot of emotional ups and downs. It’s impossible to do that if you start off believing it’s the wrong thing to do.
DRJ (a83b8b) — 1/24/2015 @ 3:33 pmWhen I was in the same year of residency, we had one of the most courageous kids I’ve ever seen. Not a heart case. She had had rhabdomyosarcoma of the buttock at age 9. This was very early in the history of chemo and when she presented with her tumor there was none (about 1963). An old cancer surgeon I knew named Ian MacDonald did a super radical surgery on her called a hemipelvectomy which removed her leg and hip. She had a prosthesis and was walking with it. Over the years, she had several recurrences but they were resectable and she was 9 years along. She was in the hospital for the latest brain metastasis to be removed and, a couple of days postop, she had her wig and her prosthesis on and was ready to go home.
In the years since her first surgery, both of her parents had died and she was raising her younger siblings with the help of some other relatives. She was a beautiful girl and had a terrific attitude. I’ve never forgotten her and hope she made it long term.
The other kid is a whiny teenager as far as I am concerned. I wouldn’t fight to treat her. The role of emotion and attitude is over rated in cancer but it would be too tough to deal with her. I’ve treated many kids with cancer and it is tough enough.
Mike K (90dfdc) — 1/24/2015 @ 3:33 pmI didn’t take what you said personally but I was wrong, JD, and it’s interesting to learn that it doesn’t matter whether you are a positive person or not. It also fits with new reports that most types of cancers result from genetic reasons or chance, so there isn’t much we can do to avoid most cancers.
It can be unfair, though. In this life, but not in the next.
DRJ (a83b8b) — 1/24/2015 @ 3:36 pmThe American Cancer Society says spirituality and prayer can help your quality of life, and it sounds like a good attitude can help keep your doctors on board. So maybe attitude is important after all.
DRJ (a83b8b) — 1/24/2015 @ 3:44 pmAnyway, I hope Cassandra responds to treatment despite her anger at the cancer and her doctors. Many lymphoma treatments take up to a year or more. I hope she has good results before she turns 18.
DRJ (a83b8b) — 1/24/2015 @ 3:45 pmInterestingly, abortion for minors in Connecticut is legal and does not require parental consent or notice.
But, of course, a berserk-blue state should be ass-backwards about so many things, intrusive when it should back off, and out-to-lunch when closer scrutiny is advisable. This goes hand-in-hand with the recent approval by the berserk-blue city of New Orleans of a super intrusive, super nanny-state law that bans smoking—of tobacco, btw, and not pot.
The quip that liberalism is a form of mental illness really isn’t a quip.
Mark (c160ec) — 1/24/2015 @ 3:54 pmMost kids are good little troopers. The worst to care for are teenagers. Open heart surgery is usually in younger kids and most childhood cancers are in younger ages. One tough problem is renal failure and dialysis. The other is diabetes. Both are fairly common in teen years and treatment is a real burden for the docs. I know it’s the kids who are sick but cooperation makes it easier on everybody.
I was present at Children’s Hospital in LA as a student when the first leukemia cures occurred. It was amazing. The kids were living 5 years for the first time and went on to lead normal lives. I remember when the first girls who had survived childhood leukemia had their first babies. Everybody was afraid the chemotherapy would damage eggs but they did fine. Boys were not so lucky and men now freeze sperm if they need chemo or radiation to the testes.
As a student I saw the first cure of a tumor that had a 100% mortality before chemotherapy. It was Choriocarcinoma a malignancy of the placenta. It went from 100% fatal in months to 95% curable when I was a student. Some of that prompted my interest in history.
Mike K (90dfdc) — 1/24/2015 @ 3:55 pmShe is not behaving like an adult. The court got that right. In many respects she’s not behaving like a thinking being, either.
She doesn’t like the chemo (and having watched my wife go through chemo, I can understand that), but cannot weigh that discomfort against the future discomfort of later cancer stages, by which time treatment will be too late.
Note that he choice is not to die — that would be a valid option from an “understanding the consequences” point of view — she’s just reacting to the pain like a flower reacts to light. Good thing the Gom Jabbar isn’t in use in California.
Part of me says she should be allowed to rule her own, short, life, but I also know that when the pain REALLY starts she’s going to be right back at the same hospital demanding the do something to fix it. And they will, uselessly, at great cost.
I think the court got it right, so far as they can with this child.
Kevin M (25bbee) — 1/24/2015 @ 4:01 pmCassandra may feel unlucky but maybe she’s lucky these doctors were willing to take her case to court.
She and her mother should have been as tricky and disingenuous as our society in general is increasingly becoming (hello IRS, etc!) and — if she really despised the medical treatment recommended for her — and told her doctors, etc, that she and her family were moving to another state, and ta-ta, we’ll get back to ‘ya. In this Age of Insanity, an underhanded ethos is becoming more and more necessary, such as what faces shopkeepers being sued by self-entitled customers who believe their oddball lifestyle must be respected and approved by all.
Mark (c160ec) — 1/24/2015 @ 4:03 pmGiven the ups and downs of teenage years, along with immaturity, I wish someone would tell Cassondra that what she believes and feels about life and treatment now will likely not be how she feels in three months or six months or year. Her entire being is in a state of flux at 17 years old. Life changes and she will change too as is meant to happen. It’s hard when you are young to see the big picture or anything outside of the immediate moment.
Someone needs to hand her hope.
Dana (8e74ce) — 1/24/2015 @ 4:08 pmIn my estimation, her mother is the immature one. A parent makes decisions in their children’s best interest. They are not swayed by the emotional appeal of a teenager. They hope and believe when the kid cannot do so for themselves and they take the arrows gladly because they can see the bigger picture and know that and 85 to 90% recovery rate ensures a very good life for their child.
Dana (8e74ce) — 1/24/2015 @ 4:13 pmAs my wife points out, the level of support she got prior to treatment, and degree of warning about what to expect is important to a cancer patient. What that was is not clear.
Clearly now, the “support” is wanting (or perverse) and her outcome may be effected by that.
Kevin M (25bbee) — 1/24/2015 @ 4:13 pmShe may be afraid of losing her hair or of having her appearance change dramatically. Death is the ultimate consequence of cancer but appearance is the immediate consequence, so it’s something that everyone thinks about. I think a teenager would be bothered by this a lot.
DRJ (a83b8b) — 1/24/2015 @ 4:14 pmI have a hunch the same people that ruled against Cassandra would have, by contrast, ruled in her favor if she wanted an abortion against the wishes and consent of her mother.
The mindset of the do-gooders in Connecticut in this case have a vaguely similar tone to the officials in PRC China, who after executing a criminal (perhaps for a crime other than murder), then send the bill to the families of the deceased for the cost of the bullets or noose.
Mark (c160ec) — 1/24/2015 @ 4:16 pmshe’s going to be right back at the same hospital demanding the do something to fix it.
A cardiologist friend of mine had a sister who was an odd duck and sort of a hippie back in the late 70s. She had breast cancer and refused conventional treatment. When she had a remission, she was bragging all over southern California how she had proven doctors were crooks only after money.
When she had her fatal recurrence, I had the unpleasant duty of putting IVs into her so she could get her palliative care.
Mike K (90dfdc) — 1/24/2015 @ 4:17 pmThat’s a good point about her being concerned about her hair and her looks being impacted by chemo, however all the more reason for her mom to step up to the plate and parent. I bet her reassurances could go miles given how close they seem. I wonder if mom is instead indulging Cassandra’s fears.
Dana (8e74ce) — 1/24/2015 @ 4:20 pmOne thing from the article popped out at me, when it talked about a second opinion. I asked for the same thing because we’ve seen on TV and heard it from the insurers that second opinions are a good thing — something responsible people ask for. Thus, I don’t blame them for wanting this and for being leery that no one wanted them to get a second opinion.
The same thing happened to me, and I found out later that cancer diagnoses are based primarily (if not exclusively) on pathology reports. If there is any confusion or discrepancy, the pathologists send the studies to other pathologists for second opinions — that happened in my case because I have a rare cancer — so cancer may be one area of medicine where asking for a second opinion on the diagnosis isn’t important. A second opinion on the treatment may be a good idea, but it wasn’t clear to me if that’s what the family wanted. I don’t think it was.
DRJ (a83b8b) — 1/24/2015 @ 4:25 pmIt’s so hard to know whether to trust doctors if you have a sick child and no experience with medical issues. We can’t know what’s happened between them but, in general, I won’t blame the mother for not trusting the doctors. I blame the doctors for not earning her trust.
DRJ (a83b8b) — 1/24/2015 @ 4:26 pmMy family has been treated by many incredibly good doctors, including doctors who saved my kids’ lives when the odds were against them. We’ve also been to doctors who almost cost my kids their lives. They all want you to trust them, and it’s hard to know who to trust when you have a complex medical case that is more art than science. I don’t know what kind of lymphoma Cassandra has. It may be fairly straightforward and the doctors’ opinions of how to treat it may be spot on. Or not. It’s hard to know who is being unreasonable here, or if anyone is.
DRJ (a83b8b) — 1/24/2015 @ 4:31 pmShe had breast cancer and refused conventional treatment.
Which makes her unusual since the average, typical person will become so frightened and panicked after getting a diagnosis of cancer, that he or she will want the medical establishment to move mountains and earth (and all the costs thereof) for his treatment. For Cassandra and her mother to have approached the issue with a bit less panic and instead more skepticism towards conventional wisdom is rather interesting, yet less surprising in the context of the following.
BTW, I understand that fat and not sugar is responsible for America’s big problem of obesity. Yea, uh-huh.
Mark (c160ec) — 1/24/2015 @ 4:32 pmcancer may be one area of medicine where asking for a second opinion on the diagnosis isn’t important
In my wife’s case there was no clear location of the primary tumor — throat cancer is usually found first in a metastasized lymph node, as it was in this case. Then the primary tumor needs to be found for the radiation target. Three doctors, including the chief of radiation oncology, at UCLA and two doctors at her medical oncologist reviewed the PET scans and only two would sign off on the primary’s location. So they did a biopsy to confirm the location (it was where the inconclusive PET scan suggested).
They really treat this as important the first time, and asking for a second opinion suggests that they do not, and delays the treatment which is never a plus.
Kevin M (25bbee) — 1/24/2015 @ 4:36 pmI’ve asked for second opinions on far less than cancer. If one isn’t settled with a diagnosis or still has doubts, why the heck not.
Dana (8e74ce) — 1/24/2015 @ 4:38 pmOr not. It’s hard to know who is being unreasonable here, or if anyone is.
You go by reputation, if you can.
When we found out about my wife’s diagnosis, and her being on Obamacare, we were scared spitless that we’d have to make do with some Urdu-speaking hack. Her ENT who had to give her the bad news, suggested a particular clinic in Santa Monica. Before I could check on that, I talked to someone whose opinion I value and he suggested, out of the blue, the same private cancer clinic. It turned out that they took her insurance. Their guy for this kind of cancer was BFFs with the head of radiation at UCLA and got us an appointment there without the usual wait.
God is indeed there when you need Him, even unasked.
Kevin M (25bbee) — 1/24/2015 @ 4:46 pmIt goes against everything we laymen are taught, Dana, but I think Kevin M’s comment is representative. They don’t diagnose you with cancer unless they have done a lot of testing, with reviews at multiple layers of doctors. If you have insurance, the insurance doctors also look everything over. In essence, I think you effectively get a second opinion already. But pairing a diagnosis with treatment is the art part of cancer, and that’s where a second opinion from a top cancer institute may be valuable.
DRJ (a83b8b) — 1/24/2015 @ 4:48 pmI’ve participated in proceedings, on the side of the State, to get blood transfusions for the children of Jehovah’s Witnesses. Color me unmoved.
nk (dbc370) — 1/24/2015 @ 4:48 pmDana, the point is that cancer diagnoses and treatment plans are reviewed by many doctors, where a diagnosis of bronchitis may not get the same attention. Before the hospital and insurance company spend a quarter million dollars, they also want it to be the right plan.
Kevin M (25bbee) — 1/24/2015 @ 4:49 pmReputation certainly helps, Kevin M. I went to MD Anderson and it’s well-regarded, and it also helps if you have a cancer that has genetic markers that help identify the most effective treatments. Otherwise, it’s my understanding the best treatment may not be identifiable until you do a round (or two) of chemo/radiation and see what happens.
DRJ (a83b8b) — 1/24/2015 @ 4:51 pmI just read the wiki on Hodgkin’s lymphoma, and I don’t feel any more informed than this young lady.
Th symptoms are all sort of vague. Night sweats, itchy, palpable lymph nodes, pain from consuming alchol on rare occasions, back pain, red blotchy sink.
There’s no word about this being a death sentence that will kill you by such and such time. Nothing about what it will do to you as that date approaches.
Do people survive without treatment? Do they walk the Earth with grotesque deformities like the Elephant man?
Could she feel absolutely normal while suffering the cancer?
papertiger (c2d6da) — 1/24/2015 @ 4:52 pmYou are so right, Kevin. God is here for us all.
DRJ (a83b8b) — 1/24/2015 @ 4:53 pmShe could feel normal, papertiger, especially if she is in the early stages. But the blood tests show something is wrong and the pathology reports confirm what it is. As for how long she has, it depends on the type of cancer and the stage (I, II, III, or IV). Some kinds of aggressive and some kinds of indolent (slow). She could anywhere from weeks to decades, and I don’t think we can know based on what’s in the reports.
DRJ (a83b8b) — 1/24/2015 @ 4:55 pmNice, nk. I guess that settles it.
Steve57 (fa06b0) — 1/24/2015 @ 4:56 pmDRJ,
And indeed the exact plan of action (how much chemo, which drugs, and how many weeks of radiation) was the subject of some discussion. The standard-of-care treatment was set up for tobacco-related tumors and the non-tobacco kind she had got a far better response from the drugs. So there were a couple of dose-lessening trials available. We learned an AWFUL lot about the treatment plans, the risks of too much and too little treatment and the track records of each. In the end, we took the most-conservative trial, and so good so far.
Kevin M (25bbee) — 1/24/2015 @ 4:57 pmAt the point at which they denied her the second opinion they lost it. This is a case for rope and gallows, not tar and feathers.
Failing that, each and every person who agreed with this gets her chemotherapy treatment. Needed or not.
htom (4ca1fa) — 1/24/2015 @ 5:29 pmCassandra’s case is set against the backdrop of more and more Americans, and perhaps more people in the medical establishment too, inching towards the idea of assisted suicide, which is already a well-carved phenomenon in Scandinavian countries, where do-gooder liberalism reigns supreme. In turn, that’s set against the backdrop of underaged, dependent girls — here in the US and presumably even more so in Europe — being socially and politically hugged for getting abortions, even without parental consent.
All this on the heels of the ethos that the road to heaven (and not hell) is paved with good intentions. Which makes me wonder how such “compassionate” thinking squares with (or doesn’t) the philosophy of those doctors and members of the judiciary most insistent on Cassandra getting chemotherapy, her preferences and those of her mother be damned.
Mark (c160ec) — 1/24/2015 @ 5:30 pmBTW, does anyone believe that op-ed was written by Cassandra?
Kevin M (25bbee) — 1/24/2015 @ 5:37 pmMark, this isn’t a case of a person refusing medical treatment because they have religious objections, or because they don’t believe in medicine and want to try Wiccan healing. It isn’t a case of someone just wanting to die at home. Cassandra just doesn’t like being told to take her medicine and she is repeatedly acting out. A particularly willful teenager throwing tantrums. She’d rather be hanging with her friends.
Don’t try too hard to find a principle here, there may not be one.
Kevin M (25bbee) — 1/24/2015 @ 5:44 pmKevin M,
You could be right about Cassandra and her mother’s motive. They could also feel overwhelmed or it could be they don’t understand/agree with the treatment plan. We don’t know the details, at least I don’t, and I can think of reasons why they might legitimately resist treatment. What if she has an indolent kind of cancer in an early stage? Some doctors suggest not to treat that kind of cancer. She could also have genetic markers that make her more likely to develop an aggressive cancer, so that could be another reason to delay treatment.
I hope the court has done the right thing and it works for Cassandra. I hope this is Cassandra and the family acting out, because that means the doctors are right and treatment is the way to proceed. Most of all, I hope she has a kind of cancer that can be cured and she is cured.
DRJ (a83b8b) — 1/24/2015 @ 5:57 pmI’m thinking that due to both the confidentiality of juvenile court proceedings and medical confidentiality, only the judges got both sides of the story.
As a legal question, I approve of parens patriae. I also approve of age of consent laws. They are, of necessity, arbitrary. Seventeen may be borderline but I’ll defer to the courts for the reason that 1) they’re are the only ones that know the whole story and 2) they get paid the big bucks to make these decisions.
nk (dbc370) — 1/24/2015 @ 6:10 pm^ I’m skeptical of the details of this case necessarily making the state instead of the girl and her mother look like sages, since Connecticut is notoriously full of liberal people, and the stupidity of modern-day liberalism never ceases to amaze me. BTW, Kevin M, that’s the principle (or observation) I’m applying to this matter, so, of course, YMMV.
Mark (c160ec) — 1/24/2015 @ 6:22 pmThe kid and her Mother don’t want the chemotherapy. So let her die. Seems simple enough. What business is it of the government?
Achilles (ef6bfa) — 1/24/2015 @ 6:45 pmWe need her to make babies for soldiers for our armed forces, and to work and pay taxes for our Social Security.
nk (dbc370) — 1/24/2015 @ 6:54 pmso put on your best boys and i’ll wear my pearls
happyfeet (831175) — 1/24/2015 @ 7:06 pmThe problem with reviews is that they tend to suffer from confirmation bias. I’ve seen it too often in cases of family and friends. It works both ways, “this isn’t cancer, it’s only X” (it was a treatable cancer), and “this is cancer” (and it was X); those are the cases caught by second opinions who didn’t know of the first opinions. The cases uncaught we’ll probably never know; presumably the pathologists know and tell someone.
This troop was locked into their opinion. Why else object to an independent second opinion and go to court, rather than insist the patient get an independent second opinion before going to court?
htom (4ca1fa) — 1/24/2015 @ 7:21 pmOur society lacks consistent, rational rules about when a minor – or even an adult female, in some cases – has the right to exercise informed consent. The situation is particularly inconsistent for women and typically depends on the politics of their intended actions. Can a sick and frightened 17-year-old exercise informed consent? I tend to doubt it.
And, of course, I’m wondering “Where’s her father?” and does his absence color the positions of the girl and her mother. My knee jerk response to this story is that these women are a dysfunctional pair and not sympathetic, at all. Perhaps, that’s just me.
ThOR (a52560) — 1/24/2015 @ 7:21 pmI will amplify what I meant by saying we don’t know enough.
What we do know, from what was posted and my general fund of knowledge,
is that she is said to have Hodgkin’s Lymphoma, which is generally quite treatable and has been for many years,
it is a relatively fast growing cancer, not as emergent to treat as some types of acute leukemia (diagnosed today, getting treatment tonight), but it is definitely NOT “slow-growing”, and as most cancers the stage at beginning treatment is important. A second opinion (both of the pathology and the patient) is reasonable to request if they were willing to do it promptly, and not saying they wanted one just to put things off.
What we don’t know is whether the medical team first tried real hard to communicate with the patient and her mother, have them meet a few people who had been through treatment for it. It is “relatively common” as these things go and it shouldn’t have been hard to find people willing to meet with them.
Whether this was attempted or whether it quickly became a power strugggle of the medical people telling them what to do, I don’t know. Maybe they took time to listen to concerns and answer questions, maybe they didn’t. Maybe the pt and mom were eager to learn, maybe they didn’t want to hear anything and had their minds made up from the get-go. Maybe mom and daughter are immature, maybe they have serious mental illness.
All of those things should have been addressed before it ever became a legal issue. I don’t think everything is solved by going to court, in fact most things are better solved without a court and likely without lawyers. Going to court is a last result after other things have broken down.
But yes, legally there are conflicting principles depending on whether “they” want to make it easy for a minor to act independently with their “reproductive rights” or in getting their ears pierced, let along treatment for some major medical condition.
But 17 yo’s aren’t what they used to be, now some say adolescence lasts into the early to mid 20’s, many people certainly act that way, rather than being ready to bear adult responsibility.
MD in Philly (f9371b) — 1/24/2015 @ 8:30 pmhtom,
The only review I’ve been part of came out with “we don’t know” (5 doctors, 3 results) as to whether a PET scan showed tumor location well enough to bypass a difficult biopsy. So they did the biopsy. No confirmation bias there.
Kevin M (25bbee) — 1/24/2015 @ 8:37 pmI heard something to the effect that:
1) Cassandra was worried about the possibility that she would lose the ability to have children.
2) They were considering “alternative treatment” – probably quackery. But they wouldn’t know enough to tell. (the second opinion was some doctor(s) the doctors she then had considered quacks)
I’m not sure about those two things, but I sort of heard that.
Apparently as soon as that happened, the doctors went to court or rather to child services or whatever, which is easier. They only wanted to look into it – hadn’t committed to it. Nobody tried to reason with them. Once they were dismissed as doctors, they would have no authority. The law would uphold the right to use a properly licensed quack. It was now or never.
The girl ran away, then saw her mother was getting into trouble, decided to try out the chemotherapy, but didn’t like it. Nobody was trying to convince her it was any good – just forcing her. Now that she had been put into foster care, it wasn’t necessary any longer that she or her mother agree. So they didn’t try. She felt violated, as she said. She was treated like a dog.
The whole thing is like forced feeding except that she feels terrible afterwards.
So now a petition was made that she is a mature minor. As far saving her life, she now said she cares also about the quality of life. Nobody said anything to her about pain, so that is not an issue.
Sammy Finkelman (e806a6) — 1/24/2015 @ 9:17 pmDRJ, MD Anderson is a great place to go, and of course it’s terrible to have to go there.
I hope you’re doing well.
Lost a loved one to appendix cancer about a week ago, but I think they caught it too late. Awful business knowing too late and waiting.
Putting this woman into foster care over cancer is horrible to her obviously distraught family, and horrible and dangerous for her. Foster care is dangerous and should be used only in serious situations. It’s so bizarre to me how CPS will be asleep at the wheel over truly serious cases and yet junkyard dogs about minor ones. In my meager life experience that sort of arrangement is born of cowardice.
Dustin (2a8be7) — 1/24/2015 @ 9:27 pm63. My antecedents keep on changing.
http://connecticut.cbslocal.com/2015/01/05/state-forces-connecticut-teen-with-cancer-to-receive-chemotherapy/
One comment:
In the case of colon cancer, the full colonoscopy probably removes pre-cancers, (it takes out polyps) so it should reduce the death rate, absent doing anything else that increases the risk, and the same thing applies to removing warts from the skin. Now if you called that a cured cancer, you’d indeed be inflating the survival statistics.
And this was not a random screening. But there may be a point. Do Cassandra’s doctors actually know the natural history of the disease, if they always treat it?
Sammy Finkelman (e806a6) — 1/24/2015 @ 9:37 pmCan a sick and frightened 17-year-old exercise informed consent? I tend to doubt it.
Which is why I could detect fairly quickly just how much socio-political nonsense was influencing the opinions of the medical and judicial people in Connecticut wrestling with Cassandra and her mother if the same decisionmakers in another scenario totally trusted the choice made by the same young woman if it were for the procedure of abortion, even more so over the exclusion or, worse of all, opposition of her mother. Of course, this controversy transcends ideological boundaries, but I’m always extra suspicious about the core of any type of judicial activism emanating from liberal nirvanas like Connecticut.
Mark (c160ec) — 1/24/2015 @ 9:55 pmBilly Best ran away from home and now, 20 years later, is alive and healthy in Massachusetts and has a toddler aged son.
Interesting coincidence and irony given that another case not too different from that of Cassandra’s is also based in a blue-berserk Northeastern state, or a place where the official motto should be “the road to hell is paved with good intentions.”
Mark (c160ec) — 1/24/2015 @ 9:59 pmwe all play the game and when we dare we cheat ourselves at solitaire
especially those sleazy patriot losers
happyfeet (831175) — 1/24/2015 @ 10:19 pmShould’ve claimed she was just doing “assisted suicide. Her right to die or some other garbage. Then they would’ve been all for it.
P.S. I know it’s been mentioned, but she has the right to kill her unborn child as a minor, but not get an aspirin at school or decide her own chemo treatment.
NJRob (d36337) — 1/24/2015 @ 10:50 pmWe have crossed the Rubicon. Government FUKTARDS now make decisions for you. Most of these morons are pro-abortion too.
Gus (7cc192) — 1/24/2015 @ 11:05 pmDoesn’t Zeke Mengele want USELESS PEEPS dead??? WTF? We need a real WAR.
Gus (7cc192) — 1/24/2015 @ 11:07 pmLive free or die.
Fred Z (5db617) — 1/25/2015 @ 12:20 amDie free or live?
Dustin (2a8be7) — 1/25/2015 @ 12:32 amnk’s earlier comment about the court (with which I agree) also reminds me that not many litigants go to court frivolously — with the obvious exception of the litigant who targeted our host. Thus, I think we should look closer at legitimate concerns on both sides of this case. The oncologists’ concerns are clear. They want to promptly treat Cassandra’s cancer so she will survive. They might feel especially compelled to do this since there are good, even excellent, survival rates with lymphoma and it’s possible Cassandra has a late-stage or aggressive form of cancer.
Why would Cassandra and her mother oppose this treatment? Maybe they are being rebellious, resentful, or simply foolish but they could also be informed and concerned about the long-term complications of lymphoma and its treatment. Lymphoma is a blood cancer and it is among the most researched cancers. Many lymphoma patients have high survival rates, in part because of the research and because there are several available treatments. These advances in research and treatment also mean there is a “growing population” of lymphoma survivors, and studies on the survivors show there are sobering long-term risks of these treatments.
The long-term risks don’t mean as much to a 50-60 year old person diagnosed with blood cancer as they would to a teenager, who faces the risks in her 40’s (or sooner) instead of at 80-90. We older cancer patients have had our families, lived much of our lives, and have a shorter life expectancy than Cassandra. Maybe her concern is thus about other treatment options that minimize these risks. I sympathize with that concern. I also know living now is a good thing.
I still hope the American Cancer Society or other providers can offer alternatives to resolve this because getting cancer treatments alone and in restraints is hard, especially for someone this young.
DRJ (a83b8b) — 1/25/2015 @ 4:39 amWhat’s up here? The standard treatment for Hodgkins Lymphoma is well within established medical practice with an exemplary success rate. No one in their right mind, especially a young person, would reject a life saving medical treatment and suffer the ravaging horrors of advancing cancer till it chokes the life out of what remains of their rotting body.
This kid’s mother is a whack job – she’s obsessed with the notion that chemotherapy is poison that will kill everything in the girl’s body. That’s pure nonsense, chemo will save the girl’s life. It’s the mother doing the poisoning – of her daughter’s mind. We’re looking at a case of attempted Suicide by Mother.
(Notice there’s no daddy involved and note the mother’s revealing repetition of variations on the refrain: Her human constitutional rights not to put poison in her body; and She has been forced to put chemo in her body. A closer look at Mommy Dearest is in order.)
ropelight (6b42a5) — 1/25/2015 @ 6:04 amThis kid’s mother is a whack job – she’s obsessed with the notion that chemotherapy is poison that will kill everything in the girl’s body.
Oddly enough, there are a lot of similarly “whack job” people in the medical establishment itself.
Mark (c160ec) — 1/25/2015 @ 6:38 amstudies on the survivors show there are sobering long-term risks of these treatments.
The problem of long term risks is solved by dying of the original diagnosis. Simple !
3 of every 4 doctors and scientists would refuse chemotherapy for themselves due to its devastating effects on the entire body and the immune system, and because of its extremely low success rate.
There is no link but I suspect that the “natural news” is an interest group that selects data for an agenda. If I had stage IV cancer, I would refuse chemotherapy in hopes of a few more months of life. I have given that advice to patients and would do the same thing.
Mike K (90dfdc) — 1/25/2015 @ 6:48 amdeaths from stomach cancer are down by a higher percentage than for colon cancer, and nobody gets screened for stomach cancer.
Sammy, have you been reading “natural news” too ?
The Japanese, who have much higher rates for stomach cancer than the US, have a successful screening program that involves gastric washings screened for cancer cells. They also have successful treatment based on early diagnosis.
Try not to spread ignorant information around, please.
Stomach cancer has been dropping in the US for many years, possibly from a reduction in the consumption of smoked food. It is still pretty common in Japan, just as liver cancer is more common in China and southeast Asia. There are multiple environmental reasons including the liver fluke in China and southeast Asia.
Google is your friend, Sammy.
Mike K (90dfdc) — 1/25/2015 @ 6:58 amC’mon Mark, the second sentence of Dana’s post states: She was given an 85-90% chance of recovery with chemotherapy treatment for Hodgkins lymphoma, one of the most treatable forms of cancer.
Maybe some of those 3 out of every 4 doctors and scientists who would refuse chemotherapy were referencing more virulent cancers, you know, the ones with considerably lower than 85-90% chances for recovery. And, maybe they hadn’t been diagnosed with cancer and were just talking through their hats.
ropelight (6b42a5) — 1/25/2015 @ 7:03 amThe lady may be a whack job, but it’s not easy to raise parents. Parents who love their children dearly, with the best intentions in the world, can make mistakes. A big one is forgetting that their children are children. It’s good, especially in circumstances as exigent as this, to have some help from experts.
nk (dbc370) — 1/25/2015 @ 7:07 amHey Mark, I looked up your “source” for the statement about chemotherapy. As I suspected, it is a whack job itself. I suppose you agree with this statement.
Can measles vaccines work to protect against measles? Absolutely they can in some people, but they are not without their own risks as you’ll see below. Despite the way I have been deliberately mis-characterized by others, I am not opposed to the theory of immunization.
Yup, an anti-vaccination junk science center.
Mike K (90dfdc) — 1/25/2015 @ 7:42 amYup, an anti-vaccination junk science center.
Mike K, it goes beyond just one website or source, since for many years I’ve been aware of — and fascinated by — polls that indicate many doctors themselves are quite cynical or skeptical about chemotherapy. Moreover, I remain astounded that the medical establishment has long avoided stressing just how harmful sugar is to human health, with some supposed experts (at least originally) instead claiming that fat in food was the big boogeyman and should be avoided, while saying little to nothing about carbohydrates.
BTW, people who would have cited the following phenomenon some time ago also could have been dismissed as “whack jobs,” and originally I might have fallen for that characterization.
^ I keep such things in mind when, for example, global warming and CO2 are being discussed and another group of supposed experts (ie, know-it-alls in the field of climate) are trying to hog the spotlight.
Mark (c160ec) — 1/25/2015 @ 8:41 amMaybe some of those 3 out of every 4 doctors and scientists who would refuse chemotherapy were referencing more virulent cancers
ropelight, in this Age of Insanity, with feel-good do-gooderism often outflanking reason and objectivity, I merely want people to stand back and always remember the bigger picture. IOW, please don’t give the state of Connecticut more benefit of the doubt than what it deserves, than what is given to Cassandra and her mother.
Plus, I’m really irritated right now because another set of experts (or “experts”) in another blue-berserk state, California, referring to its Supreme Court, has recently ruled that judges cannot be members of non-profit organizations that discriminate (or “discriminate”). The ruling is directed at the Boy Scouts of America, since the “experts” believe that, no, it isn’t good enough that the BSA now allows young troop members who are gay. It has to also allow adults into the organization who are gay. BTW, I don’t think it’s pure sarcasm to say such “experts” must believe that if it’s good enough for the Catholic church, it’s good enough for the BSA.
Mark (c160ec) — 1/25/2015 @ 8:54 amDr M wrote:
Her 18th birthday is eight months away, at which time she’ll have the option of telling the doctors and the state of Connecticut to go to Hell; I guess that we’ll see if she does it.
If she does at that point, we’ll then see if the state, in its infinite wisdom, tries to declare her incompetent, and force the treatments on her anyway.
The Dana who can count (1b79fa) — 1/25/2015 @ 9:09 amHowever, a serious problem has arisen: with the placebo effect getting stronger and stronger, these “wonder drugs” that pharma has been spending millions of dollars “developing” have increasingly been failing clinical trials, because they can’t out-perform placebos.
More junk science. Mark, I will keep your sources in mind when reading your comments. Thanks.
Placebo Effect had nothing to do with pharmaceuticals. It was discovered during the Anzio beachhead battle by a Harvard anesthesiologist, Henry K Beecher, who was observing wounded. He found that soldiers wounded in combat required far less pain medication than equivalent civilian injuries or soldiers injured in non-combat circumstances. The effect, he concluded, was from the removal from a life threatening combat situation where they were facing death. The wound saved their lives, at least in their own opinion. They were euphoric and the term “million dollar wound” became known. That is the origin of placebo effect.
Mike K (90dfdc) — 1/25/2015 @ 9:28 amWow. What a thread. You know, I have learned the hard way that folks sure do like to argue, and not to read, or look at their sources critically. There is something in the American psyche that loves controversy or conspiracies; I think it comes from the fact that most Americans truly do care about the idea of fairness.
I always appreciate Dr. K’s commentary on issues about health care and medicine. I have known him electronically for a lot of years, and he has strong opinions, but has thought carefully and critically about issues.
We live in a weird world. A fifteen year old girl can get abortion assistance without parental notification or approval, but not a tattoo. I cannot see my 14 year old son’s medical records without him signing a release, but he can’t get an aspirin at school without special permission.
My mother died of ovarian cancer. She was diagnosed with Stage IIIC. She lived fourteen years after that, using standard and off-label chemotherapy. My mother got to watch my children grow up a little before she died. She got to watch me earn tenure in the crazy academic world I inhabit. She got to watch my brother’s son create a fine career.
These are things she told me the night before she died.
In fact, I think my mother would still be with us if she had agreed to the original surgical procedure that would have left her with a colostomy. She and I talked it over, since my brother and father were too devastated. Then she and I spoke to her oncological surgeon. I did not push her. I supported her decisions, but I told her to recall the costs on others. That should be part of the decision.
Anyway, the young girl will be 18 soon. If she decided to cease treatment at that time, fine.
I’m a small “l” libertarian. I am supposed to believe that we can make all of our own personal decisions, and I do. But not for subadults. We can discuss when such a person becomes an adult.
I will also observe, as a parent, that the mother sounds quite odd.
Sorry for the speech. And more to the point, best wishes to all the other folks posting here who have dealt or are dealing with cancer—both personally or with a family or friend.
It’s a road we walk by ourselves.
Simon Jester (c8876d) — 1/25/2015 @ 9:54 amI think my mother would still be with us if she had agreed to the original surgical procedure that would have left her with a colostomy.
Maybe not. There are some prices that are just too hard to pay. Hubert Humphrey had bladder cancer, treated initially with chemo. When it recurred, he was told that removal of the bladder, leaving him with an ostomy for urine, would be curative. He still wanted to run for president and declined. He died a few years later from the cancer.
Mike K (90dfdc) — 1/25/2015 @ 10:02 amDr Mike K,
Cassandra could decide to die but I hope she doesn’t because the same medical advances that brought her life-saving treatments may also someday bring solutions for the long-term consequences of those treatments.
I would chose living today, and I have chosen that, but I was trying to understand why Cassandra and her mother might make another choice. I see that as the best way to address this and, maybe, try to solve it.
DRJ (a83b8b) — 1/25/2015 @ 10:03 amChemotherapy damages a lot. Someone who had lung cancer his potassium go down. And he died after the chemotherapy. A bad hospital Beth Israel in Brooklyn, now called Mount Sinai, next to Community hospitals are bad. A nurse told me both need to be closed down.
Sammy Finkelman (e806a6) — 1/25/2015 @ 10:04 amSammy,
A lot of people almost die or do die because of chemo, but a lot of us live because of it. It’s one of the reasons a cancer diagnosis inspires such fear, but medicine is finding new, better treatments every day — biologics like Retuxan, and other effective, targeted therapies with few side effects.
DRJ (a83b8b) — 1/25/2015 @ 10:12 amAll the good teachers are gone from the nursing schools. And foreigners, especially from parts of the old soviet Union, have no knowledge. They are afraid to do anything, because they might lose their licenses. They learned how to pass tests that’s all. When they get out into the field, it’s no good.
The good doctors also retired.
No infection control. They don’t even know what it is.
If there was a way to get this into the newspapers, if someone could write a knowledgeable article about this
A lawyer said the nurse is absolutely right. When he sees a Russian name he is scared. They have D.O. (They know how to Pain medication and injections, that’s all)
Sammy Finkelman (e806a6) — 1/25/2015 @ 10:13 amBless you, Sammy. Find a family member you trust to talk about big decisions like health care.
DRJ (a83b8b) — 1/25/2015 @ 10:18 amDRJ, I don’t know if you remember this story about my mother.
Normally ovarian cancer goes quickly (it did for my sister-in-law). My mother had an unusual case, from all reports.
Her first oncologist used to hug her when he met with her. My mother was very old fashioned, and she would ask why he did that.
“He digs you, Ma,” I would reply. “Don’t let Dad find out.”
The truth was, he didn’t see many patients do as well.
After that oncologist took a job in Philadelphia, the new oncologist wasn’t as interested.
It all depends on the health care provider. They are not saints, nor sinners. They are people.
Simon Jester (c8876d) — 1/25/2015 @ 10:24 amSurely a state that can force a woman to undergo chemothearpy to save her life can prevent a woman from having an abortion to save the life of her baby?
gahrie (12cc0f) — 1/25/2015 @ 10:43 amI remember that but I’m so glad you shared that here. I’m glad she had that doctor and the extra time.
DRJ (a83b8b) — 1/25/2015 @ 10:44 amRight now I have no problems, except what took care of itself, but I would consult every person you can find. Even after you think you have the answer as to where to go, still ask. People will know different things.
Sammy Finkelman (e806a6) — 1/25/2015 @ 10:44 amMore junk science.
How so, Mike K? If there are studies that refute the findings of the placebo effect vis-a-vie pharmaceuticals I’d welcome reading about them.
Meanwhile, when I see things like the following, I’m reminded of all the Americans out there who happily, nonchalantly eat tons of sugary junk food while dropping by McDonald’s and making sure their cup of Coca-Cola is diet instead of regular. The mindset behind that is to food and health what voting for Obama (etc) is to politics.
Dwight Eisenhower in a famous speech said that we need to be beware of the military-industrial complex. Personally, I’m a bit more worried about the do-gooder-government-IRS-NSA complex, but I’ll add the private sector of Big Pharma to the list.
Mark (c160ec) — 1/25/2015 @ 10:45 amA bad hospital
Strongly suggest otherwise.
One (One!) of the big problems with Obamacare are the narrow networks in some states. In Los Angeles, there are 4 or 5 excellent hospitals (and two that are in the nation’s top 10), but of the various Exchange plans available, only two plans cover any of them, and only one plan covers most of them.
There are 30 or so mediocrities, where they can treat a broken leg just fine, but you really wouldn’t want open-heart surgery at any of them.
Kevin M (25bbee) — 1/25/2015 @ 11:15 amA layman’s understanding of how chemotherapy works, from someone who was forced to pay attention:
1. Cancer cells are damaged cells. They are harmful because they are damaged in pernicious ways. But the key to beating them is that the damage hasn’t been corrected by the normal error-correcting mechanisms in the cell — those too are broken.
2. Since they cannot correct, cancer cells are fragile. Stressing them will kill them. The same stress on healthy cells will damage the healthy cells, but their ECC will almost always allow them to recover.
3. Chemotherapy drugs, chosen correctly and administered in the right doses, provide the right type of stress to kill seen and unseen cancer cells while killing as few healthy cells as possible. If the bulk of the cancer is localized, you attack that directly with radiation in a way you cannot attack loose or fluid cancer cells.
4. There are side-effects, of course, and they vary among individuals. Some are temporary, some less so. So the dosage is important.
Kevin M (25bbee) — 1/25/2015 @ 11:28 amI’m sure the medical people here will correct me if my layman’s understanding is meaningfully wrong.
Kevin M (25bbee) — 1/25/2015 @ 11:29 amsometimes when i find myself forced by a fascist whorestate like connecticut to undergo life-saving medical procedures
i stop and ask myself
is this the hill happy?
c’mon dude answer me is this the hill?
and usually I’m all like no happy this is not the hill
and i go in and get all cured up
you know how it is
a foolish consistency and all that
happyfeet (831175) — 1/25/2015 @ 11:50 amLies, damned lies, statistics, and malevolent omission
no way that a majority of doctors, let alone 75%, would refuse chemo for Hodgkin’s disease, or whatever the quoted figure was
if you want to say that 75% of docs might forgo chemo in certain circumstances, that I could believe, depending on those circumstances.
Attitude is significant, sometimes it is the difference between life and death. I had many patients with HIV that just did not have the perspective and will to put up with inconveniences with their meds and they got sicker and died. Some were doubtful and slow to decide to take medicine, but when push came to shove they did with a desire to live that was bigger than fears and uncertainty about the future and they lived.
Sometimes people may have a lot of will but they just have a bigger adversary, sometimes people may have little will but get some breaks and have some others drag them along.
MD in Philly (f9371b) — 1/25/2015 @ 11:57 amThe will to live is powerful and important and can be the difference, but individual cases are always just that.
Kevin M., I would say your explanation is a pretty good first approximation.
But it is also a first approximation.
The main way that cancer cells are damaged (in a utilitarian kind of sense) is that they multiple out of control, often this means they replicate faster than other cells, they force new blood vessels to grow to feed them nutrients. In fact sometimes the faster growing cancers are easier to treat than slow growing ones, it is easier to find a dose of a medicine that kills the cancer cells with less damage to normal cells.
MD in Philly (f9371b) — 1/25/2015 @ 12:02 pmSo, she can elect to have an abortion, and kill a fetus, but to believe that admitting “chemo” into her own body is to be killing herself and is something that she will not do, is not permitted and she must submit to the will of the State and its minions.
Madness, in The Constitution State!
askeptic (efcf22) — 1/25/2015 @ 12:04 pmBTW, where is the father in all of this?
askeptic (efcf22) — 1/25/2015 @ 12:05 pmI think the quality of medical care has significantly decreased simply because a doc doesn’t have the time to devote to think about a patient and communicate meaningfully to others as they once did. I’ve seen this with my own care and with that of family members. Because things are so hectic 10 minutes of time can’t be given that would have prevented an ER visit or repeat hospitalization that costs thousands of dollars, let alone the unnecessary human suffering.
MD in Philly (f9371b) — 1/25/2015 @ 12:06 pmMore on lies, damned lies, statistics, and malevolent omission
One of my pet peeves is medical economics.
So, the united states spends more money than other countries on health care.
Maybe one needs to look more broadly at what we get for that expenditure. Perhaps we get people who live and work and lead productive lives and raise a family when they would have died elsewhere. Perhaps we get people with a disability that can lead a productive life from a wheelchair, when in other places they would have been a beggar who died an early death. Perhaps a person lives a relatively stable life with bipolar disease or schizophrenia when they would have been homeless or institutionalized in a hell hole, either way resulting in an early death.
The primary work of medicine is to help people be as healthy and functional as possible.
The primary work of a health care system should be to help get medical care to people when and as they need it,
but it has become an industry taking care of human widgets preoccupied with profit margins, etc., and bureaucrats thinking they are important by hovering over those profit margins.
Perhaps the most fundamental error of marxism is to define all of life in materialistic terms, which by necessity has no place for human dignity, which is why the deaths of millions are no obstacle for the better system.
MD in Philly (f9371b) — 1/25/2015 @ 12:18 pmOne of miriad ways people reject God and think they can run the universe better.
One of the big problems with “modern” care is the that the EMR system has been co-opted by the “money’ side and does not serve the medical side. But what do I know?
felipe (56556d) — 1/25/2015 @ 12:20 pmMD in Philly (f9371b) — 1/25/2015 @ 12:18 pm
Amen, doc.
felipe (56556d) — 1/25/2015 @ 12:23 pmMadness, in The Constitution State!
No, politics. And the problem is not that she doesn’t have this choice, but that a child has others. IMHO, in a regime where elective first-trimester abortion is legal, it should still be the parent’s decision — they are the ones who will have to pick up the pieces either way.
Kevin M (25bbee) — 1/25/2015 @ 12:35 pmwhere is the father in all of this?
Yes, well, shut up.
Kevin M (25bbee) — 1/25/2015 @ 12:52 pmThat we spend more per capita than anyone else on healthcare speaks more to the bloat than anything else. Chicago spends more per capita on education than anyone else. Unions.
Gazzer (00500e) — 1/25/2015 @ 12:59 pmCT, acting in parentis loco!
askeptic (efcf22) — 1/25/2015 @ 1:00 pmfrom what i can see, neither the mother nor the daughter are rational.
while i think the court acted properly, perhaps the gene pool would have been better off without her remaining in it…
redc1c4 (2b3c9e) — 1/25/2015 @ 1:20 pmDRJ (a83b8b) — 1/25/2015 @ 10:12 am
This is actually what the doctor who is caught up in the Sheldon Silver scandal is said to have done in today New York Daily News.
http://www.nydailynews.com/news/politics/exclusive-dr-taub-lauded-patients-silver-link-article-1.2090957
He changed the chemotherapy regimen for Mesothelioma (a cancer that is supposedly caused by asbestos exposure) from injecting it by IV into an arm to flooding the abdomen with the drug. all these patients used to die with a year. Now 70% are alive after 10 years. Of course, there is the possibility that maybe many they don’t actually have the disease!)
Anyway this is what the doctor did: He agreed to refer patients to the law firm where New York State Assembly Speaker Sheldon Silver was a member and Sheldon Silver was collecting one third of all the law firm got from the settlements as well as a salary for being associated with this firm.
The prosecutor finds a problem with the fact that Sheldon Silver did no other work for this money besides the referrals.
Sheldon Silver also gave the doctor $250,000 twice from a 9/11 research fund he had virtual control over, and the prosecutor complains he never cared about what research was done in return. It’s not clear what the other $8 million the fund had accomplished. The doctor had originally asked for the law firm to funds his asbestos research, as another firm had done, but Sheldon Silver had a better idea.
When the doctor asked for a third round of funding in 2008, Sheldon Silver said the program was over – actually he had lost control over it – and the doctor subsequently reduced substantially the number of patients he referred, and when Sheldon Silver asked why, the doctor explained because he stopped getting the money and another law firm was funding his research.
Sheldon Silver did direct $25,000 to a nonprofit that the doctor’s wife sat on the board of, and had an official Assembly resolution passed in 2011 honoring the doctor, and in 2012 got his son a job with another non-profit which was a recipient of his patronage {OHEL)
Sheldon Silver also kept all of this hidden except his membership in the law firm.
And today the New York Post reports, asbestos cases from his law firm are fast-tracked in court.
The Manhattan Supreme Court divides cases in Weitz and non-Weitz cases on its web site. They’ve taken over a section of the courthouse. And there is a special section for asbestos cases. More than half the asbestos cases are handled by Silver’s firm. Money is literally pouting into the firm, and asbestos is the biggest piece of its business.
The other day other lawyers had all their cases postponed because the firm was given the entire jury pool.
Judges have allowed the firm to join together cases and a judge reversed a 20-year old decision limiting punitive damages on asbestos cases.
The average award for an asbestos case is two or three times larger than in other courts nationwide according to Bates White Economic Consulting (that might be partly because they are consolidated)
The American Tort Reform association has called NYCAL (New York City Asbestos Litigation) the nation;s top judicial hellhole, saying it plaintiff’s lawyers are brazenly favored by the judges.
Sheldon Silver is notorious for standing in the way of tort reform.
He wasn’t indicted for that. This is more in the nature of a conflict of interest.
L
Sammy Finkelman (e806a6) — 1/25/2015 @ 1:29 pmOne everyone is forgetting is at 17 with parental consent, she could join the military and be walking around with an assault weapon, and die in combat at 17.
Gerald A 11/2006 (2c96c6) — 1/25/2015 @ 1:57 pmAfter that oncologist took a job in Philadelphia, the new oncologist wasn’t as interested.
Oncology is a very tough field. My closest friend from medical school is an oncologist. One time, unthinking, I mentioned that seeing patients who live in my small city and knowing them for years was one of the pleasures of practice in a suburban setting. He said something about getting nice gifts from some patients before they died, and I could have bitten my tongue out. I never mentioned this again.
A sympathetic oncologist is a treasure. I know such a guy in this community although he has probably retired by now. He was swamped with patients. The entire group he was in treasured him because his ability to compartmentalize was so rare. The emotional burden must be like PTSD.
I don’t even understand how someone could do pediatric oncology although the results have gotten terrific the past 50 years I have been in medicine.
Surgery is usually a pleasure and I still miss it. You have to do a good job. I imagine poor surgeons must have serious emotional problems but the feeling of being able to do tough cases and have success is a real high. Almost all patients get well. I followed all my cancer patients forever and never charged for postop visits. I learned this from an old surgeon I started with in practice. He said, “Ask someone who has had surgery, who their surgeon was. They don’t remember. Encourage them to keep coming back after surgery and you find out if you have had bad results and the next time they need surgery, they will remember you,”
Good advice. Harvey Cushing started the first tumor registry by asking all his brain tumor patients to send him a postcard on the anniversary of their surgery. Yale still maintains that registry 70 years after his death.
Trauma is popular because patients come to you hurt and, if they don’t recover, it wasn’t your fault. Unfortunately that also conceals some bad surgeons.
I worry a lot about the effects of Obamacare and some of the other forces on medicine. I still teach medical students and enjoy it but I avoid talking about economics because I feel sorry for them. I encourage them to consider joining the military, which will pay their tuition, but they don’t. I don’t know how they will repay their student loans. The group I have this year are all engineers and will probably go into a bio-engineering field.
Sammy, you need some better information. The old nursing schools were closed at the insistence of the nursing societies that are as bad as ed schools about teachers. There are good nurses but the working conditions have deteriorated and I don’t blame them for joining unions.
Mike K (90dfdc) — 1/25/2015 @ 2:14 pmDear Kevin M: I actually teach about this topic. Students can get sleepy, but they sure wake up when I talk about cancer. Especially the types that have hit my family, and myself. Truly focuses the mind.
Anyway, it’s interesting, and makes me think about Greek myths (be careful what you wish for).
On a basic level, cells have signaling systems that tell them to divide (“Go“) and systems that tell them not to divide (“Stop“). Cancer is due to problems arising in these two processes. But here is the kicker: these processes are necessary for cells to live and reproduce normally.
So it is a trade off!
It also takes several mutations to lead to an end product of cancer.
To be sure, tumors can and do promote vascular tissue to “feed” them with oxygen and nutrients. And in fact, my mother was kept alive by a monoclonal antibody that inhibits that “angiogenesis” process: avastin.
Here is a good place to see some simple background on the cell cycle and cancer, if you are interested:
https://www.youtube.com/watch?v=eoWRZbtqB_s
Best wishes as always.
Simon Jester (c8876d) — 1/25/2015 @ 2:14 pmSpot on as usual, Dr. K.
Simon Jester (c8876d) — 1/25/2015 @ 2:16 pmIf there are studies that refute the findings of the placebo effect vis-a-vie pharmaceuticals I’d welcome reading about them.
No, you wouldn’t. I long ago learned that people who go to quacks cannot be convinced that they are wrong. I used to get referrals from a guy in our community who was into chelation therapy, which is a use of a legitimate treatment of heavy metal poisoning that was adopted by quacks to “treat” atherosclerosis. It has no effect except to transfer money from patient to “doctor.” He would send me his failures and, if possible, I would operate on their arteries and send them back to him. There was no way I could convince them to chafe to conventional (the quacks call it “allopathic”) medicine.
I once operated on a guy, well known and a political candidate in an election, for cancer of the rectum. He had been treating himself with celery juice and was convinced that he hadn’t used enough juice.
Steve Jobs regretted before he died that he had chosen “alternative medicine” to treat his, probably curable, pancreatic cancer. There are a few types that are curable and his long course suggests he had one of them.
I will say that there has been massive over use of anti-depressants but that is another subject. More about culture than medicine.
Mike K (90dfdc) — 1/25/2015 @ 2:24 pmWhether or not the girl, and her mother, are head cases, the fact remains that the state treated this condition different than they would have, from a legal perspective, than they would a pregnancy.
askeptic (efcf22) — 1/25/2015 @ 2:24 pmIt seems to be a pretty simple 14th-A/Equal Protection matter, but then IANAL –
just a guy who is under the delusion that the damn Constitution means what it says it means.
“A sympathetic oncologist is a treasure.”
Mike K – I agree. More than 13 years after my mother’s death from cancer her oncologist came to my father’s wake. It was very much appreciated.
daleyrocks (bf33e9) — 1/25/2015 @ 2:25 pm120- “Don’t Worry, Be Happy!”
askeptic (efcf22) — 1/25/2015 @ 2:26 pmmy mother was kept alive by a monoclonal antibody that inhibits that “angiogenesis” process: avastin.
Simon, do you know the incredible story of avastatin ? Probably you do. The discoverer is one of my heroes in surgery and medicine, Judah Folkman. He was a famous pediatric surgeon who got interested in cancer research. His findings were rejected for years because “everybody knows surgeons are just ignorant plumbers.”
He is now appreciated by everybody but it wasn’t always so.
I apologize if you knew all these things, as you probably do.
Mike K (90dfdc) — 1/25/2015 @ 2:30 pmDaley, I have to agree. My late mother’s “good” oncologist was a fabulous fellow.
I remember seeing him at the back of the building, holding a tissue to his face as he weeped a little. He had seen a young couple just after my mother, and I’m sure the news wasn’t good.
Folks like that need to be supported. I know my mother felt that way.
Simon Jester (c8876d) — 1/25/2015 @ 2:31 pmDRJ, your comment about peritoneal mesothelioma prompted me to look for evidence.
International Journal of Colorectal Diseases. 2015 Jan;30(1):1-10. doi: 10.1007/s00384-014-2029-1. Epub
2014 Oct 21.
Advances in malignant peritoneal mesothelioma.
Cao S(1), Jin S, Cao J, Shen J, Hu J, Che D, Pan B, Zhang J, He X, Ding D, Gu F,
Yu Y.
Author information:
(1)Department of Medical Oncology, Harbin Medical University Cancer Hospital,
No.150 Haping Road, Harbin, 150081, China, cs.bo@163.com.
BACKGROUND: Malignant mesothelioma is a rare, insidious, and aggressive tumor
arising from the mesothelial surface of pleural and peritoneal cavities, the
pericardium, or the tunica vaginalis, with an increasing incidence worldwide,
high misdiagnosis rate, and overall negative prognosis. A total of 20 % of all
cases is peritoneum in origin.
METHODS: The present study is a review of literatures focusing on the advances in
epidemiology, clinical presentations, radiological features, diagnosis,
misdiagnosis, management, and prognostic factors of malignant peritoneal
mesothelioma (MPM) occurred in the past decades.
RESULTS: Asbestos, SV40, and radiation exposures have been demonstrated to be
correlated with the pathogenesis of MPM. The main presentations are abdominal
distension and pain. Computed tomography (CT), magnetic resonance imaging (MRI),
and positron-emission tomography (PET) play an important role in the preoperative
imaging and staging. Definitive diagnosis is made on the basis of
immunohistochemistry. Prognostic factors have been identified and verified.
Negative indicators include advanced age, male gender, poor performance status,
non-epithelial histology, and absence of surgery. The management of MPM has
evolved from single chemotherapy to multimodality treatment of cytoreductive
surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC),
chemotherapy, radiotherapy, and immunotherapy. Promising results have been
achieved after a combined treatment of CRS and HIPEC, with an elevated median
survival time of 29.5-92 months and a 5-year survival rate of 39-63 %.
CONCLUSIONS: CRS and HIPEC represent the standard treatment strategy for selected
patients with MPM, and patients with unresectable tumors can benefit from the
combined treatment of chemotherapy, radiotherapy, and immunotherapy.
New information to me. Note the article is from China, probably one of the last reservoirs of asbestos on earth.
Mike K (90dfdc) — 1/25/2015 @ 2:52 pmDr. Mike and MD in Philly,
I second your comments. Also, I think most doctors are caring but the type or demands of their practices make it hard for them to spend time with patients. There are exceptions where doctors can spend more time with patients (like the doctors at the Mayo Clinic, the NIH, and I’m sure there are others, but these are the ones we’ve seen) but most doctors are too busy and it’s by necessity. If they don’t see the patients, the patients probably won’t be seen.
There are parallels for attorneys. As a profession, attorneys have to limit the amount of time they spend with most clients because of cost and time constraints. I think it’s important to explain what’s going on so the client can give informed consent, but sometimes there isn’t time to explain everything. Furthermore, some attorneys and even some clients prefer to let the attorney make the decisions. When I first started practicing, clients wanted to understand the details but that changed as the issues became more complex. I don’t know if they didn’t want to spend the time to learn or if they felt they couldn’t understand or if they simply wanted the convenience of hiring someone to do it for them, but it was a problem for me because I think people need to understand important life concerns like legal and medical issues.
DRJ (a83b8b) — 1/25/2015 @ 2:58 pmDr. Mike
I wish it had been my comment that piqued your interest but it was Sammy’s. That is an interesting subject.
DRJ (a83b8b) — 1/25/2015 @ 3:00 pmAh, Dr. K…I knew about JF, but he became a hero because of my mother.
I spent a couple of months working at Yale a few years ago, and came across a few packages of avastin in the lab coldroom. They represented a lot of money.
Nothing wrong with reminding people of the man. His work gave my mother a lot of extra years.
Simon Jester (c8876d) — 1/25/2015 @ 3:13 pmThe issue of doctors spending time with patients is an interesting one. The course I teach is a lot about instilling empathy in medical students early, before they become calloused by contact with tired, overworked residents who tend to dismiss many patients, especially those with minor illnesses or who are troublesome, like that girl.
Unfortunately, I feel we are fighting a losing battle. The students we teach to be empathetic will not have time to be so if they practice in one of the Obamacare industrial clinics. I tell students interested in primary care to get MBAs as they will be managing “lesser licensed practitioners,” like nurse practitioners and physician assistants. Several of them have done so and USC has a dual degree program that takes five years instead if four.
The future, I think (and hope) will belong to the cash medical practice, run by physicians who accept no insurance, including Medicare and Medicaid (also know as Obamacare). These practices are popping up everywhere.
A little information about it
Internist Garrison Bliss, MD, a movement pioneer, sits on the board of the Direct Primary Care Coalition and is Founder and Chief Medical Officer of Seattle-based Qliance Medical Management, the nation’s first direct primary care practice. Begun in 1997, it now has 5 locations in Washington State.
This is growing and will provide, I think, the alternative to Obamacare if it is not repealed or collapses. The threat is that government, once this trend becomes obvious, will try to force doctors to take Obamacare to be licensed.
Massachusetts=, as usual, is setting a trend.
[Senate bill 2170 and house bill 4452] would require physicians and all other health care providers to accept 110% of Medicare rates for health insurance for small businesses. For physicians, acceptance of set rates would be as a condition of licensure! Moreover, physicians would have to accept all such patients – and such rates – if they participate in any other plan offered by that insurer.
Canada has seen a huge rise in private clinics since they had a supreme court decision that “a health plan is not health care.”
We’ll see. This will be my last year teaching as the trends, including the abysmal electronic medical record, have worn me out.
Mike K (90dfdc) — 1/25/2015 @ 3:18 pmMikeK, this is a good resource for cash doctors that I came across.
Gazzer (00500e) — 1/25/2015 @ 3:22 pmhttp://theselfpaypatient.com/
Dr. Mike,
That does seem to be the future of medicine, at least I hope it is. They call it concierge medicine in my area. We still have our health insurance but we also pay a physician a set amount per month per patient and have a contract for specified services each month. It’s tailored to meet our needs — including personalized care if we have to go to the ER, same-day appointments, 24/7 calls, and even home visits if we need them — plus our doctor is able to think in depth about our medical needs so the quality of care is greatly enhanced. I think it also works better for the doctor because we get focused care and don’t have to make repeated office visits, and so we’re using less of his time.
DRJ (a83b8b) — 1/25/2015 @ 3:34 pmSimon Jester,
What is the relationship, if any between tumor suppressor/oncogenes and apoptosis?
DRJ (a83b8b) — 1/25/2015 @ 3:41 pmDRJ, TX can be proud of one group of caring physicians: MD Anderson in Houston.
askeptic (efcf22) — 1/25/2015 @ 3:43 pmA close friend has spent way too much time there (but the alternative was not as attractive) for a bout of Hereditary Hemachromatosis (HH) aka Iron Overload disease.
He and his wife have nothing but praise for the care they have received from the doctors, nurses, and staff at MD Anderson. Of course, it doesn’t hurt that he seems to be in remission, and just might beat it.
I’m really glad they helped him. My son and I have both been patients there and the doctors’ knowledge base is superb, but it’s so big and busy. It’s more pleasant for non-cancer care because you don’t get put in the pipeline, but I like the Mayo Clinic better for non-cancer care. It’s regimented, too, but not as much.
DRJ (a83b8b) — 1/25/2015 @ 3:49 pmRegimented Health-Care…..at the VA you get the former, but the latter seems to be lacking for a great many.
askeptic (efcf22) — 1/25/2015 @ 3:52 pmPerhaps MD Anderson can conduct a seminar?
Concierge medicine is growing in my neck of the woods, too. My neighbors just opted for it and pay $2,000 year. A great part of the focus is preventative care, thus down the line less money is spent on controlling preventable diseases as thorough attention has been paid to the individual’s propensity toward particular issues that might arise based on heredity or genetics. Also, with an increasing network of doctors now signing on to this, patients are not limited to just a select few to choose from who could easily become as overtaxed as any other doctor if the client base gets too large.
Dana (8e74ce) — 1/25/2015 @ 3:54 pmHi DRJ:
Apoptosis is more a quality control mechanism, not directly involved with proto-oncogenes or tumor suppressors. But it is clear that the mechanisms communicate.
For example, the “king” of tumor suppressor genes, the famed p53 protein, can itself induce apoptosis—again, as something like quality control.
http://www.jeccr.com/content/30/1/87
https://www.youtube.com/watch?v=PwHmY9Z4XKE
Those are places to start. I’m not an MD (I’m a geneticist), but happy to help however I can.
Simon Jester (c8876d) — 1/25/2015 @ 3:58 pmMike K.,
MD in Philly (f9371b) — 1/25/2015 @ 3:59 pmThis is not aimed at you because I know you and where you are coming from and you are not part of the problem,
but if I was prone to outbursts of anger and cussing, hearing some folks in medicine and med administration talk about how docs need to be empathetic is one thing that would provoke me.
There is some poster about how if you want people to grow up kind, treat them kindly as children, etc.;
the corollary would be if you want physicians to be empathetic treat them with empathy as students and residents,
relatively few were the times I was treated with empathy relative to the contrary, but then those dishing it out had been on the receiving end first, so there were few who I blamed for being worse than they needed to be.
No, you wouldn’t. I long ago learned that people who go to quacks cannot be convinced that they are wrong.
Come on, Mike K. I know you’re fully aware of all the experts who pray at the church of global warming and the way they often respond when dealing with a “just the facts, ma’am” skeptic of conventional wisdom based on what the supposed professionals say in today’s era of insanity.
If studies of the placebo effect and pharmaceutical drugs have all been carried out by quacks, then I’ll understand the point you’re trying to make.
Incidentally, the placebo effect transcends merely the matter of drugs taken orally.
^ Keep such things in mind when discussing who really does or doesn’t deserve the label of “quack.”
Mark (c160ec) — 1/25/2015 @ 4:05 pmAh, it’s always interesting to see folks on the Right side of the aisle forming circular firing squads.
Our good friend Mark is nothing if not reliable.
Simon Jester (c8876d) — 1/25/2015 @ 4:11 pmThere are a lot of SF readers in this comments section, I know.
So Sprague DeCamp’s famous “Lest Darkness Fall” comes to mind.
Especially the part about “elf shot.”
Simon Jester (c8876d) — 1/25/2015 @ 4:12 pmA great part of the focus is preventative care
To figure out just how much closer or further away we as a society are from reaching that point, go to a typical grocery store and observe what the average consumer buys. If you see tons of cruddy, processed food in most people’s shopping carts, many of the items chock full of sugar, including the fake kind, you’ll have an inkling of why the concept of “beware the military-industrial complex” can be extended to far too much of BOTH the private and — most certainly — public sectors.
BTW, due to clumsy approaches and dogma-ridden thinking in general, scolds like Michael Bloomberg or Michelle Obama don’t help matters and reflect even more of the irony in this Age of Insanity.
Mark (c160ec) — 1/25/2015 @ 4:17 pmOur good friend Mark is nothing if not reliable.
How so, Simon?
Mark (c160ec) — 1/25/2015 @ 4:18 pm“They call it concierge medicine in my area.”
I think the term was invented by the New York Times to suggest that only the rich are to served. We had a small primary care clinic in Dana Point run by two entrepreneurial women MDs 30 years ago. They took cash and credit cards and had their own lab and x-ray. Most of their patents were HMO members who did not want to wait forever and they did very well. I don;t know if the clinic survived their retirement. Many Urgent Care clinics do the same thing but I think most take insurance and so, must follow the high prices and heavy paperwork to get paid.
Mark I could tell you about double blind studies but I doubt you would pay attention. You could read read my book if you want to know more about it.
Mike K (90dfdc) — 1/25/2015 @ 4:24 pmDr. K. and MD in Philly: I never really understood all of this until later in life. Many of my friends in college became MDs. I still didn’t get it. I have spent a couple of decades teaching undergraduates on the premed trail. I still didn’t get it.
This is the man who gave my mother the extra years of life, the chance to know her grandchildren a little bit, and who cares so much for his patients and their families.
http://penn-medicine-physician-announcements.blogspot.com/2013/12/Penn-gynecologic-oncology-welcomes-Robert-Burger.html
Simon Jester (c8876d) — 1/25/2015 @ 4:31 pmSimon Jester,
Thank you very much for the apoptosis links. I need some time to study them but I can already tell they are going to help me understand apoptosis, a concept I need to learn more about.
DRJ (a83b8b) — 1/25/2015 @ 4:34 pmIt’s not just about quality control, DRJ. It’s also part of development.
And why we don’t have webbed fingers and toes!
Again, I think so highly of you. Happy to help in any way I can.
Simon Jester (c8876d) — 1/25/2015 @ 4:57 pmI’m sure that physician would appreciate your kind words.
One of my favorite patients was an ovarian cancer patient. She was a wonderful woman and put up with all of us and her tribulations with a great fortitude. She had been heavily radiated and developed radiation strictures of her small bowl. I explored her abdomen expecting to find cancer but found the radiation damage instead. I was by that time pretty aggressive in dealing with these problems and I basically took out all her small intestine except for about one foot (25 feet is normal) and her rectum and lower colon were too scarred to do anything with, so she ended up with one foot of small bowel and about two feet of colon. She had a colostomy and I put her on codeine to slow transit time. She lived with that, working in her garden and enjoying life until, a few years later, the cancer came back in a lymph node and she died about a year later. All in all, she had about ten years of useful life.
I remember that I went to see movie with my son in a theatre down the hip from the hospital and, when I decided I didn’t like the movie, left and went up the hill and sat with her and her husband until my son came up and we went home. I would rather sit and visit with her than watch a bad movie.
A guy I know, an excellent GYN oncologist, just got arrested for having child pornography. I have no other information but it seems a sad end to a fine career. Whether it indicates the pressures of treating nasty diseases, I have no idea.
Mike K (90dfdc) — 1/25/2015 @ 5:08 pm140.
They didn’t have nothing done.
What they had was a form of acupuncture.
It could be that the placebo is itself a good treatment.
Sammy Finkelman (e806a6) — 1/25/2015 @ 6:27 pmWhat they had was a form of acupuncture.
It could be that the placebo is itself a good treatment.
Double blind studies are very hard to do in surgery for obvious reasons. Only very minor procedures are possible for ethical reasons. The arthroscopy study was one and showed that placebo effect was probably the reason why that particular application of arthroscopy was dubious. When I was a medical student there was another example which had to do with an obsolete surgery for coronary heart disease.
Here is a link to one of the studies that was done at the time. This was long before coronary bypass and there are several Italian studies showing “proof” that angina was improved by this procedure which was ligating small arteries behind the sternum. The theory, when nothing else worked, was that this would improve collateral circulation to the coronary arteries.
The only way to assess benefit in those days was angina pain and this, of course, was very subjective. Patients reported less angina. This was not the only surgical approach but it was the least invasive and dangerous. It also lent itself to a sham study, which was done when I was a freshman student.
The incision was NOT “faked” but it was quite small and patients signed a consent to participate in a randomized trial where they did not know if they were getting the whole operation or the sham. After a series of about 50 cases was done, the code was broken and the results published. One of the sham cases actually had his EKG revert to normal. Anyway, this was a very early example of a double blind study in surgery. The arthroscopy study was another.
The story of coronary artery surgery is in my book. It is quite a story as the man who originated it was an Argentine who had been punished by the government for political views and he had to come to America to try his method. It was coronary artery bypass.
Mike K (90dfdc) — 1/25/2015 @ 7:33 pmWow. Fascinating.
DRJ (a83b8b) — 1/25/2015 @ 8:04 pmI never really understood all of this until later in life.
I think there are many, many things in life that we cannot comprehend until we are in them or through them; all that we may have learned before hand is at best helpful in keeping us oriented instead of losing our way. “Oh, so this is what that meant…”
MD in Philly (f9371b) — 1/25/2015 @ 8:12 pmWhat I want to know is, by what legal theory does the State force medical treatment on anybody, minor or not, and why aren’t more people scared silly by this precedent?
C. S. P. Schofield (848299) — 1/25/2015 @ 10:27 pm154- Exactly!
askeptic (efcf22) — 1/25/2015 @ 11:38 pmMy opinion on this case is:
1) The prognosis is “Get better with treatment, die without.”
2) The objections sound a lot like religious superstition.
3) The mother did a bad job in raising a daughter so irrational that she is more willing to commit suicide than take medicine.
4) Do we permit a mother to indirectly kill her daughter via poisonous, superstitious beliefs? I lean towards no.
JWB (6cba10) — 1/26/2015 @ 4:30 amWhat I want to know is, by what legal theory does the State force medical treatment on anybody, minor or not, and why aren’t more people scared silly by this precedent?
C. S. P. Schofield (848299) — 1/25/2015 @ 10:27 pm
Let me Google that for you: http://en.wikipedia.org/wiki/Parens_patriae The precedent dates to 1608.
nk (dbc370) — 1/26/2015 @ 4:37 am#154, CSPS, in this specific case, the State’s actions seem appropriate, there is no rush to judgment, even an appeal was upheld by the Connecticut Supreme Court.
The girl has a life threatening condition for which an 85-90% successful chemotherapy treatment is available, yet both mother and daughter reject treatment on the grounds chemo would not just kill her cancer, but “everything in her body” as well.
Such an idiotic statement reveals a thoroughly irrational grasp of the nature and consequence of Hodgkins Lymphoma and ignores the benefits of chemo treatment. Apparently, Mother and daughter have allowed their overwhelming fear of chemo’s side effects to blind them to a rational cost/benefit decision which would almost certainly save the girl’s life.
Rejection of chemo by both Mother and daughter is contrary to self-interest, and the unwillingness or inability to grasp the fundamental elements of so simple a life and death equation demonstrates mental incompetence sufficient for the State to intervene. Obviously, mother and daughter aren’t thinking clearly, and State agencies were right to step in – the courts agree.
Now, CSPS, in response to your question, …by what legal theory does the State force medical treatment on anybody, minor or not, and why aren’t more people scared silly by this precedent? I offer the following.
The mother refuses to act to save the life of her minor child, and in such cases the State has an obligation to petition the courts to remove an incompetent decision-maker and appoint an appropriate guardian. I’m not frightened because the State’s actions are consistent with commonsense and reason.
ropelight (79435c) — 1/26/2015 @ 6:07 amI agree with you ropelight,
MD in Philly (f9371b) — 1/26/2015 @ 6:57 ambut I think the concern is, given the state of our government, that what “they” think is commonsense and reason isn’t necessarily so, like making high school girls on the girls basketball team accept a person who looks like a boy but identifies as a girl on their team and in their locker room and showers.
Of course that is an example that is currently applicable in only 2 1/2 states, but still (Massachusetts by law 1st, then CA, and the “1/2” is CO where there is no state law but their is state court precedent).
See, we do legislate morality, it just depends whose, how, and when.
For any on looking not aware of my previous comments on the subject, context for my last post:
I am all for respecting a person with gender identity issues and not belittling them in any way,
but my version of that does not mean to ignore the obvious.
To try to resolve individual difficult situations with state or federal laws helps only those who have a political/social/moral agenda.
There is the well known story of the “Wisdom of Solomon”, who settled a custody dispute between two women by declaring the child to be cut in half and each woman given one half. When one woman protested and wanted the child spared, Solomon said that woman was the true mother and awarded her the custody of the child.
MD in Philly (f9371b) — 1/26/2015 @ 7:20 amSome would like to make a federal law to guide govt. behavior in such circumstances, but it would not work. In fact, it may not have worked a second time even for Solomon once the story was known.
Solomon picked the woman who valued the baby as more than a possession, not necessarily the biological mother.
nk (dbc370) — 1/26/2015 @ 7:30 amWhich is, for purposes of clarification, the argument between “parents’ rights” and “the best interests of the child”. Children are taken from bad biological parents and placed with good adoptive parents every day.
nk (dbc370) — 1/26/2015 @ 7:35 amMark I could tell you about double blind studies but I doubt you would pay attention.
Mike K, I’m still not sure where you’re coming from in regards to the placebo effect. Are you saying the testing methods indicating what, in effect, is the power of the mind over matter haven’t been reliable because double-blind methods weren’t used?
Mark (c160ec) — 1/26/2015 @ 8:08 amtrue, nk, but I always thought the assumption was that the “real” mother, the woman who birthed the child, would be the one more concerned for the child’s welfare
There is imagery in the prophets to the effect “Can a mother forget her nursing child? How much more will the Lord not forget you!”
The assumption is made that the mother is acting like a mother should.
MD in Philly (f9371b) — 1/26/2015 @ 8:17 amAnd that’s what I learned in catechism too, MD. But you know, a lawyer can cite Scripture for his purpose. 😉
nk (dbc370) — 1/26/2015 @ 8:29 amindeed, nk
MD in Philly (f9371b) — 1/26/2015 @ 8:38 ambut there are warnings about that!!
I likely mentioned this once before,; years ago I attended a church where one person had chronic schizophrenia and though not actively delusional did have trouble with rational thought. He did have a struggle knowing what to think about some church members who belonged to the legal profession, as Jesus said “Woe to you lawyers”.
I bet if the girl committed a murder, the state would have little trouble trying her as an adult.
Watched my dad suffer through chemo, twice. First time, colon cancer, and he got another 15 years of good life. It was quite miserable for him. Second time, at 72, non-Hodkins T-cell lymphoma, less than 5% success rate. Did chemo from June until December. We had Christmas together, and he said, no more. Died 12/31.
I get that chemo sucks. But at 17 with a 80%+ success rate, hell yeah.
Loren (1e34f2) — 1/26/2015 @ 8:53 am151. Mike K (90dfdc) — 1/25/2015 @ 7:33 pm
But coronary artery bypass has since itself been proven to be worthless, except for relieving angina!
The theory was that fatal heart attacks are caused by artery blockages. Actually these seem to originate just as probably in smaller vessels. Or may be some sort of the end result of physiological processes related to electrolytes or nitric acid.
Sammy Finkelman (e806a6) — 1/26/2015 @ 9:54 amIt really doesn’t matter if Cassandra and her mother have good reason or bad reason or no reason to refuse treatment.
It’s purely a question of whether the state should be forcing people into treatment against their will, to the point of seizing a sick minor and putting her in foster care.
This isn’t like the aftermath of a car accident, which has to be decided right now. It isn’t like setting a bone or treating serious burns or any other situation where the outcome is as close to certain as medicine ever gets.
This is the state forcing a young woman, against her will and her mother’s, into months of unwanted pain and expense that is far from guranteed to work.
The point “if Cassondra had wanted an aborion” is well taken. What if Cassandra didn’t want an abortion but the doctors said she’d die if she didn’t get one? How is this different? Except that when doctors say a birth will kill you they are for more certain than when they say chemo will save you.
Gabriel Hanna (64d4e1) — 1/26/2015 @ 9:59 amBut coronary artery bypass has since itself been proven to be worthless, except for relieving angina!
Good grief ! I took you for a serious person. My apologies.
Mike K (90dfdc) — 1/26/2015 @ 12:44 pm“But coronary artery bypass has since itself been proven to be worthless, except for relieving angina!”
Mike K (90dfdc) — 1/26/2015 @ 12:44 pm
You’re just not up to date. I thought that would surprise you.
http://www.uptodate.com/contents/stable-ischemic-heart-disease-indications-for-revascularization
Sammy Finkelman (d22d64) — 1/26/2015 @ 1:31 pmgulp.
elissa (7700c8) — 1/26/2015 @ 1:36 pm170. .http://harvardmagazine.com/2013/03/a-cardiac-conundrum
Sammy Finkelman (d22d64) — 1/26/2015 @ 1:38 pmThis power to take away the right to consent from the patieent or famuily members is very dangerous:
New York Times front page article today: To Collect Debts, Nursing Homes Are Seizing Control Over Patients
Sammy Finkelman (d22d64) — 1/26/2015 @ 1:42 pmThey also get people on to Medicaid.
Sammy Finkelman (d22d64) — 1/26/2015 @ 1:43 pmSammy, please don;t try to make an instant expert of yourself.
The goals of therapy in patients with stable ischemic heart disease, which includes individuals with severe symptoms to those who are asymptomatic, are to alleviate symptoms, delay or prevent the progression of coronary artery disease, and decrease the risk of adverse outcomes such as death, heart failure, or myocardial infarction. To this end, all patients should receive optimal medical therapy. Revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is reserved for:
●Patients with unacceptable angina
●Patients likely to have a survival benefit from revascularization, based upon the location and severity of the lesion, the number of diseased vessels, and the presence of left ventricular dysfunction.
In other words, coronary bypass or stenting is used for those who need it.
Maybe you should go to medical school, Sammy.
Mike K (90dfdc) — 1/26/2015 @ 4:41 pmAnd that can be all the time or almost never.
85% of the time, or 15% of the time.
They don’t say if there is a survival benefit more often, less often, or the same percentage of the time as what they thought before.
176. Mike K (90dfdc) — 1/26/2015 @ 4:41 pm
Almost a tautology.
I noticed that.
Why did I use it? I couldn’t locate a better citation very fast, but I assure you there’s something more specific about a coronary artery bypasses not helping survival.
It’s not a good citation – except for the fact that: (and these two points cannot be disregarded)
1) they used the words reserved for
Which I think is there as an indication that it should be done less often than they used to do it.
That term “reserved for” = less than 50% of the time, and maybe even less than 25% of the time, and could be even less. On any case less often than they used to.
AND
2) angina is separated out as an indication, indicating that a coronary artery bypass is advisable far less than 100% of the time there is a blockage in a cornary artery because if not, why have a separate indication for angina?
It looks like they couldn’t agree, so they adopted vague wording.
In other words, coronary bypass or stenting is used for those who need it.
Maybe you should go to medical school, Sammy.
Sammy Finkelman (e806a6) — 1/26/2015 @ 5:24 pmA study published about 1990 reported that coronary artery bypass surgery did not prevent heart attacks, which was an unexpected result, but it did increase the probability of surviving them.
Sammy Finkelman (e806a6) — 1/26/2015 @ 5:37 pmSammy, I truly believe you don’t mean it to come out that way because you are a decent person. But when you try to argue with an actual MD and a surgeon (Mike K. in this thread) about medical procedures or insinuate that you know more than him because you found and copied an article on the internet, it is insulting to him and his experience and his schooling– and it makes you look very foolish.
elissa (ae9e01) — 1/26/2015 @ 5:44 pmDear elissa: the situation with SF is nothing new. It has happened over and over again.
And—unless I have missed something—he has never admitted that he was wrong, or misinformed when he disagreed in this fashion with someone. But it has certainly been this way for some time.
Some folks belief the gentleman in question is “neurodiverse.” It is certainly true he seems to have little idea how he comes across.
In the final analysis, it’s not my party. It’s Patterico’s.
But I think you advice to SF is spot on. I’m just not sure he will take it. I’m pretty sure he is a nice fellow in person. But you are right, his actions really do take away from the topic, and probably make other people just ignore him. Which is a shame.
Simon Jester (c8876d) — 1/26/2015 @ 6:23 pm179. Is that also true for anyone who found points wrong or omitted in his book?
I’m not foolish. Everybody always knows something that the other person doesn’t.
Here, I am going by published reports that rely on many doctors.
And the point was that coronary artery bypass surgery did not seem to help survival because the big blockages were not related to heart attacks, but they did help angina, because these big blockages were related to the amount or frequency of angina.
It wasn’t non-doctors who were the ultimate source of that. Mike K. just may not be familiar with that.
It wasn’t only one article. I read this before, and I have a kind of feel for when it’s real.
And now I had to find it again.
I found it, because it is a true conclusion of a study.
Maybe not perfect, but I know it’s there.
I was right too about people with type AB blood being practically immune to cholera – at least that Matt Ridley had written that – and his source was indeed a study (in India) Not actually immune to cholera but cholera as we know it.
Besides the uptodate.com link, I also found this link which I posted @173:
http://harvardmagazine.com/2013/03/a-cardiac-conundrum
This is even stronger (still not quite good, and omits the point about angina)
This reviews a 2012 book, “Broken Hearts: The Tangled History of Cardiac Care” (Johns Hopkins), by David S. Jones, who did go to medical school, and which is all about Mike K originally posted about – clinical trial about surgery.
Maybe he should get and review the book. I don’t say and I don’t think that that book is perfect, and it may be even very wrong at times, but it’s probably got footnotes and citations.
It talks about how there’s a problem with trials because you’re always comparing the results of outdated procedures.
Maybe the earlier history agrees with what Mike K said. It would be interesting to see what the book says about that man from Argentina.
Anyway…
Deep in the review it says:
Which is pretty much what I said.
What is not quite in that quote, is that it is worth doing to relieve angina, because coronary artery bypass does indeed relieve angina. Web MD gives some other indications, like if you have to do open heart surgery anyway, or the blockages are extreme.
Here’s an excerpt from that book: (courtesy of Google, which Mike K. said is my friend)
It continues that many heart attacks arose from small plaques that could not even be seen.
He cites a study as far back as 1988 saying coronary bypass surgery or angioplasty would not prevent most heart attacks.
And this was exactly what the randomised trials had shown in the 19780 and 1980s
Exactly what I said. My only mistake, then, was saying this was something new. It may be newly accepted.
Further:
Needless to say, Jones, or the 2006 researchers doesn’t find any of these explanations good. But they made the cardiologists feel better.
Sammy Finkelman (e806a6) — 1/26/2015 @ 6:58 pmThere is also the study, way back around 1990, mentioned here:
http://www.nytimes.com/1991/03/26/science/the-doctor-s-world-heart-bypass-data-yield-surprise.html
It says that while coronary artery bypass surgery did not prevent heart attacks, it did increase the probability of survival.
But obviously it is necessary to dig down deeper into this and find out why. It could be only because they had better doctors or more attentive care or were closer to a major hospital or because the non-bypass group wasn’t getting any form of revascularization.
The heart attack rate also was higher in the group undergoing bypass in the 1970s, but maybe the two groups didn’t start off with equal chances.
Note Alice Park summarizing David S. Jones is saying that the wrong explanation for heart attacks is still predominant. So Mike K should be expected to disagree with that, but he’s not disagreeing just with me then.
Park says that Jones says that the obstructions in the coronary vessels that were the indications for coronary heart bypass surgery were not, as thought, heart attacks-in-waiting.
Jones also says that stent shouldn’t be done so much – that doesn’t help more than drugs. Probably because we’re dealing with numerous small blood vessels, or the lack of sufficient volume of blood carried in the capillaries. Or something. Whatever it is, something that you can’t cure with surgery, unless you had nanobots doing it.
Sammy Finkelman (e806a6) — 1/26/2015 @ 6:59 pmFWIW, I appreciate the vote of confidence on this, Simon. I think that having a broad range of knowledgeable specialists who come here to comment at Patterico’s is important for this blog’s continued success. (Whether the specialty is medicine, genetics, economics, business, engineering, the military, law, etc. etc. ) I worry that if it becomes too much trouble to participate in meaningful discussion we will just lose some of these valuable contributors to frustration, which would be a real shame.
Hopefully, each of us can occasionally bring something focused and relevant and new to the discussion table from our personal life experiences and geography. I do appreciate reading Sammy’s opinions on New York politics and its unique culture, and Jewish topics, for example. They are often enlightening, I think. But for some topics, frankly, we are each simply better off being voyeurs rather than participants. I, for example, don’t opine much on car engines and weaponry because I realize I would look stupid or silly if I did.
elissa (ae9e01) — 1/26/2015 @ 7:06 pmMD in Philly (f9371b) — 1/26/2015 @ 8:17 am
You’re missing a sentence in the middle.
It goes really: “Can a mother forget her nursing child? Yes, they can forget. But the Lord will not forget you.”
Condensed and slightly paraphrased from Isaiah 49:15
Sammy Finkelman (e806a6) — 1/26/2015 @ 7:11 pmCommenters like Sammy make it hard to follow comment threads, don’t add much of interest to me, and thus have caused me to limit my reading and commenting. But it’s a big virtual world and I understand why Patterico wants his blog to be open to all.
DRJ (a83b8b) — 1/26/2015 @ 7:23 pmHopefully Mike K will come back. I’m doubtful.
DRJ (a83b8b) — 1/26/2015 @ 7:29 pmThank you for the clarification/amplification of the verse, Sammy.
MD in Philly (f9371b) — 1/26/2015 @ 7:41 pmIn my mother’s defense, she did have Lewy Body Disease.
nk (dbc370) — 1/26/2015 @ 7:48 pmDRJ, I’m sure Dr. K will continue to post. The Wall O’ Texts and frankly ignorance and bad manners of SF is no big deal to a surgeon with Dr. K’s erudition and experience. Until the bizarre posts are just too much to wade through, anyway. This wasn’t one of SF’s shining moments.
Dr. K’s book about the history of medicine is quite wonderful. He does bring value to this comments section, yes.
Simon Jester (0ed4f6) — 1/26/2015 @ 8:27 pmWhat – am I coming on too strong?
Sammy Finkelman (e806a6) — 1/26/2015 @ 8:30 pmYou were coming on arrogant and ignorant, Sammy. And I’m telling you this with all the goodwill in the world. When you can get DRJ, Dr. Mike, and MD in Philly, who are saints for patience, mad at you all at the same time, you are screwing up pretty royally.
nk (dbc370) — 1/26/2015 @ 8:35 pmAre you ok where you are, BTW? It looks like you’ll have nonstop snow until early morning Wednesday.
nk (dbc370) — 1/26/2015 @ 8:38 pmThey keep on predicting 2 to 4 inches of snow an hour for at least several hours. Nothing has happened yet. (except for the snow that fell Friday night to Saturday and this morning. Not too much.)
That was supposed to start at around 11 pm maybe. They shut down the subways, they ordered all traffic off the roads – if anyone is in a car, they are technically comitting a misdemeanor and can get a $300 fine. Exceptions are government vehicles…and the press. No taxis, or car service either. Some places closed a bit early. There was traffic in late afternoon, but it was really gone, according to the press reports by 8 pm or so. They actually were arranging things so that some people might not have away to go home.
Gov Cuomo was asked about whether this ever hapepned before. It didn’t because of snowstorm. He reflected on Bffalo where theer was 7 feet of snow not long ago – and apparently no government orderd shutdown and talked then about how snowplws weer sent from dfowndstate and nowthey were be sent downstate. Cuomo thinks we are having more extreme weather events. Actually they are just reacting differently.
The subways had a soft shutdown (some trains on express tracks) at 10 and ahard shitfown at 11.
Sammy Finkelman (e806a6) — 1/26/2015 @ 9:42 pmTheer were long lines in some places in Manhattan where some people were trying to use some types of mass transit early that hadn’t been added to. PATH I think. One person went to Hoboken and had no lines. New Jersey Transit wass first going to be shut down at 10 and then at 8. Connecticut had all roads closed at 9 pm.
\
I think something is alittle wrong wth the weather forecast. somebody somewhere in Washington is makinbg this out to be bigger tahn it will be. I heard on TV that with sandy the european forecasts were best. To make it 33 inches youd have to have the snow band stuck over the city. why it should just happen that way? But anyway they say theer will be at least a foot to afoot and a half of snow.
The theoretical reason for shutting down the subways is to protect the subway cars and get full service restored more easily. I say serve as many people as posisble for as long as possible and pick up the pieces later. That’s what we used to do.
There is apparenly some feeling in some people to plan – they must plan – even though, all told, they are really making things worse.
The reaosn fro banning traffic is to make snow removal easier. But it also loses the effect of cars crushing the snow. That happens, of course, only when traffic is possible to move.
Sammy Finkelman (e806a6) — 1/26/2015 @ 9:49 pmWhat is your plan if you lose power, Sammy?
DRJ (a83b8b) — 1/26/2015 @ 9:52 pmA blizzard is also supposed to have wind. If you don;t have 35 mph wind, it’s not a nlizzard. You also need ery low visibility. Neither hass happened here yet. Maybe some snow has fallen, not too much too fast, and while there may be abit of wind, a lot for a place so still, not too much.
The storm was supposed to be over Queens awhle ago, and later reach the rest of the city. Isn’t that in reverse? Possibly it is circular.
Sammy Finkelman (e806a6) — 1/26/2015 @ 9:54 pm195. DRJ (a83b8b) — 1/26/2015 @ 9:52 pm
This is not an issue here. It is only people with overhead wires that lose power. This is a problem for Long Island, not in the city, or in Maine and Vermont. Gov Cuomo said there was no way they could make electricity secure in Long Island. Trees will fall.
Lower Manhattan lost power during Hurricane Sandy, but that was because a Con Ed sub-station flooded. Every place else that lost power then was because the wires were above ground. (they are taking longer and longer by the wasy to restore power in case of blackouts. It was faster several decades ago.)
All power lines are underground. There’s no issue of flooding here. The connection between storms and losing power is because power lines are over ground, as they are not in New York City.
They really haven’t been since the blizzard of 1888.
http://www.virtualny.cuny.edu/blizzard/building/building_fr_set.html
After that they put the power lines underground.
http://www.virtualny.cuny.edu/blizzard/building/building_fr_set.html
Sammy Finkelman (e806a6) — 1/26/2015 @ 10:05 pmRe blackouts
There was an almost nationwide blackout in Pakistan because of the Taliban, and there are some otehr ways besides attack to get blackouts, but they are not related to storms. We had 3 blackouts, in November 1965, July 1977 and August 2003. You just wait until the powerr comes back, and maybe use candles for light or flashlights if it at night.
A lot of people now don’t have landlines or the landline is FIOS. Landlines were never affected by blackouts.
Sammy Finkelman (e806a6) — 1/26/2015 @ 10:07 pm“This is not an issue here. It is only people with overhead wires that lose power.”
Strange, if power is disrupted at the source it doesn’t matter if the lines are above or below ground. We get that with Com Ed out here. My neighborhood loses power after some storms but lines are buried. Usually from flooding or overhead lines getting knocked down further away.
daleyrocks (bf33e9) — 1/26/2015 @ 10:24 pmnk @191 nk (dbc370) — 1/26/2015 @ 8:35 pm
Mad is the wrong word. People just started describing how wrong I was and how maybe they didn’t read a block of text and that discussing how I wouldn’t admit I was wrong and so on.
Dr. Mike is a bit arrogant, but not too much, and if he researches this he’ll see that I am right. It will take him some time.
I have to check though what the Argentinian proved. That seems to be only in his book. His link @151 is to a simpler surgery than the bypass one, which I think he says was later on shown by the Argentinian to be no different than doing sham surgery. I said that bypass surgery was also shown to be useless except for getting rid of angina. I knew it would surprise him but it should also be a non-controversial statement.
Sammy Finkelman (e806a6) — 1/26/2015 @ 10:44 pmCon Ed agrees with Sammy that there won’t be many outages, primarily because Con Ed doesn’t think this is a big storm:
Here is the Con Ed outage map.
DRJ (a83b8b) — 1/26/2015 @ 10:46 pmdaleyrocks – if some lines nearby are knocked out, a whole little area could lose power. Power if cut ff to protect the system.
But for miles around theer are only underground wires.
All of New York City lost power 3 times in the last 50 years because of something that happened somewhere else. Some neighborhoods sometimes have lost power. I don’t think it is related to storms but sometimes it can be related to high demand because of heat.
Sammy Finkelman (e806a6) — 1/26/2015 @ 10:49 pmWay to double down, Sammy. Are you trying to make this an all-Sammy, all-the-time blog?
DRJ (a83b8b) — 1/26/2015 @ 10:49 pmI maybe wasn’t right about the stomach cancer maybe @65 but that wasn’t me. I was just quoting someone and saw no reason to doubt the facts on that were wrong. The issue wasn’t whether the rates went down or not, but whether they went down because of screening. Dr. Mike K said @78 that in the United States they didn’t go down because of screening, which agrees with the quote! Because surely the person I quoted there was thinking about the United States. I think he was writing too fast.
I disputed what the quote said about colon cancer, because the colonoscopies could have an effect.
Dr Mike said there was a successful screening program in Japan. His link doesn’t say anything about how successful it was in reducing deaths. In fact it is not about that program, but just alludes to the practice of screening for gastric cancer, and says it is not successful unless it is detected early. I don’t blame him for the tangential link – it is sometimes hard to find a link to something you know.
I brought in the whole quote (which included the vase of the man who ran away in Massachusetts, because of the argument that doctors inflate the survival statistics by overdiagnosing lots of people with cancer who don’t actually have it.
There’s nothing in that link that says that that’s not exactly what was happening with gastric cancer in Japan. I don’t know if his claim that there was a successful treatment in program in Japan is right or wrong, but the link says nothing about whether or not they are diagnosing many irregularities in cells that won’t become deadly cancers. Nothing about that question. That’s the key question here.
They just used to assume that because cancer, let us say, was preceded by certain things, that when you saw that thing preceded, a person was likely to get, or already had, cancer. But it is not taht way.
Sammy Finkelman (e806a6) — 1/26/2015 @ 10:49 pmWhy don’t you just let it go, Sammy. There’s no real reason to pursue the heart surgery thing to the ends of the earth when this thread is about cancer and chemo and the prospect of government forcing treatment against a young patient’s will.
elissa (ae9e01) — 1/26/2015 @ 10:50 pmNow with this girl, we have no idea what he real probability of this developing into a killing cancer was, or into a cancer that couldn’t be stopped if you adopted a policy of watchful waiting.
What we do know if that chemothepy is not a harmless intervention, nor is it even a certain cure.
The court just assumed the doctors were right.
They didn’t even appoint someone totally not connected with them and who might be somewhat satisfactory the girl and the girl’s mother, and who would also talk to anyone they might recommend to review the whole situation.
Sammy Finkelman (e806a6) — 1/26/2015 @ 10:52 pm205. elissa (ae9e01) — 1/26/2015 @ 10:50 pm blockquote> There’s no real reason to pursue the heart surgery thing to the ends of the earth when this thread is about cancer and chemo and the prospect of government forcing treatment against a young patient’s will. There is none, except that everybody seems to be so certain I am so wrong.
Sammy Finkelman (e806a6) — 1/26/2015 @ 10:56 pmSammy:
Cassandra’s mother hired an attorney to represent the family and the court also appointed an attorney to represent Cassandra’s interests alone:
You look foolish when you say things that are totally and provably untrue, just because they fit the narrative you want to believe. We all fall victim to this sometimes, but you do it far more than anyone I’ve ever seen.
DRJ (a83b8b) — 1/26/2015 @ 10:57 pmWhat they did with the girl is not so different than what’s going on with patients in nursing homes in New York: (I linked to this before, but it seems to have been passed over)
http://www.nytimes.com/2015/01/26/nyregion/to-collect-debts-nursing-home-seizing-control-over-patients.html.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:00 pmElissa:
== Cassandra’s mother hired an attorney to represent the family and the court also appointed an attorney to represent Cassandra’s interests alone: ==
That was nothing. The court just disregarded what the lawyers said and the lawyers didn’t pretend to be dealing with the substance of the matter, nor did they pretend to be objective.
I mean they didn’t appoint a guardian who didn’t have a position on whether the doctors were right or wrong.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:03 pmThey never got to the substance, but they really decided it on the basis of the substance.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:03 pmThat the doctors being such highly rated doctors, had to be right that it was absolutely necessary to do what they recommended and they couldn’t wait.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:05 pmAnd yet papertiger (c2d6da) — 1/24/2015 @ 4:52 pm @44 writes:
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:08 pmSammy:
That was my comment, not elissa’s, and you’re speculating. The court appointed a public defender who has no agenda other than to represent Cassandra. His job is to provide legal information and advice to advance and protect his client’s interests. It’s the judge’s job to be objective, and you can’t assume the judge was biased simply because he ultimately decided for one side or the other. And since I haven’t seen any transcript of the proceeding published, I submit you have no idea what was said in that proceeding — other than the minimal reporting linked here.
DRJ (a83b8b) — 1/26/2015 @ 11:10 pm“daleyrocks – if some lines nearby are knocked out, a whole little area could lose power”
Sammy – Exactly, not just people with overhead lines.
daleyrocks (bf33e9) — 1/26/2015 @ 11:10 pmBut what are the chances of recovery without chemotherapy, without anything – especially what are the chances of recovery if she waited till if or when it produced other sysmptoms.
The problems with early detection of cancer, is that what you’re detecting is something that may or may not cause a problem, and may not be a problem right now.
That very high success rate points to a possibility that a lot of the “cancers” they treat weren’t going to cause a probem anyway.
Taht could be something those doctors didn’t want looked into.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:12 pm“Why don’t you just let it go, Sammy.”
elissa – My favorite Dr. Finkelman M.D. comment was this past summer when he said the Texas ebola patient was getting better after it was publicly announced he had already croaked.
daleyrocks (bf33e9) — 1/26/2015 @ 11:13 pm“daleyrocks – if some lines nearby are knocked out, a whole little area could lose power”
daleyrocks (bf33e9) — 1/26/2015 @ 11:10 pm
But in New York City, there’s nobody at all with overhead electricity lines.
There is in Long island, but that will only knock out power in a limited area.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:14 pmdaleyrocks–it’s been a very long night here at casa Patterico.
elissa (ae9e01) — 1/26/2015 @ 11:16 pmHow do you know Cassandra has an early stage of NHL?
DRJ (a83b8b) — 1/26/2015 @ 11:18 pm217. daleyrocks (bf33e9) — 1/26/2015 @ 11:13 pm
That was what the doctor’s had told members of his family, and I had read it in the New York Times.
How was I supposed to suspect – well maybe I was supposed to expect – that the doctors were misleading * some family members, who then spoke to the a member of the press?
* or couldn’t or did not want to admit what the situation was
And he may have had a sign that sometimes means he is getting better, and sometimes odoesn;t mean that at all. Like a fever dropping.
It was only that morning’s paper.
How was I supposed to expect that not only was that wrong, it was really, really, really wrong, and that he would die withi hours after somebody was told he was getting better. I mean that should mean he has at least a few more days even if he gets worse again.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:22 pmYou’re supposed to know the difference between facts and opinions, Sammy. It is an opinion that someone is getting better or worse, unless you have direct medical information about the case. Reading a report in the New York Times is not direct medical information.
DRJ (a83b8b) — 1/26/2015 @ 11:27 pmSammy, I sympathize with your point of view because Cassandra is almost 18. She’s effectively an adult for many purposes and I’m not willing to assume she’s acting unreasonably just because she doesn’t want this chemotherapy. I also hate the way it’s been done, with restraints and in isolation from her family. But you state conclusions as facts, and that’s not helpful.
DRJ (a83b8b) — 1/26/2015 @ 11:33 pmThe governors and mayors seem to be reacting in a very heavy-handed manner because of this storm. Is it justified or is it an overreaction because of what happened with Hurricane Sandy?
DRJ (a83b8b) — 1/26/2015 @ 11:38 pm@220. DRJ (a83b8b) — 1/26/2015 @ 11:18 pm
Well, tiis is what they were saying:
http://www.bostonglobe.com/metro/2015/01/07/connecticut-court-hear-case-teen-refusing-chemotherapy/8cAZ7OtWAnXRwYLpHM39JJ/story.html
It’s not NHL it is Hodgkin lymphoma, which what papertiger was talking about.
Why they say a near certainty of death within two years, I have no idea. Of course the doctors presumably have never let a case go untreated, so they don’t know what happens when someone has a similar profile. They can say what happens when it is treated their way, but how can they say what happens when it isn’t treated??
The only basis would be symptoms years ago before there was treatment. Or some case that didn’t get treated for some reason. Another way might be to look at an old blood test and see how far back you could find something.
They can also watch the progression. But did they? They don’t wanna wait. So how would they know the natural history? Wheer would they get it from? It happens to be well known that many things that look like cancer never go any further, or take along time to go further, presumabkly after another mutation.
In the meantime, they probably gave her and her mother a list bad things that could happen and asked them to give informed consent, but they don’t want anyone to look at that parade of horribles and reconsider giving consent.Informed consent then becomes just a legal formality, but one that they use to try to immunize themselves from malpractice lawsuits.
If is absolutely necessary to do something, then informed consent is irrelevant! Informed consent implies the possibility of refusing to consent.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:43 pm222. DRJ (a83b8b) — 1/26/2015 @ 11:27 pm
It was a secondhand report of what some doctors had said.
Doctor(s) -> some family members -< New York Times.
Nobody had that, aside from one member of the family really.
I had to work from waht I knew.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:47 pmYes, you’re right that it’s Hodgkin’s Lymphoma instead of Non-Hodgkin’s Lymphoma. Thank you for that correction. But how do you know she is in the early stages? What are the results of the tests, is the cancer present in some or all lymph nodes, is it present in other organs, etc.? Do you know the answers to any of these questions?
DRJ (a83b8b) — 1/26/2015 @ 11:50 pmNo blizard, not even any snow falling. Just a steady wind when I pen the kitchen window, and not too many miles per hour.
No more accumulation than I think I saw this afternoon.
Sammy Finkelman (e806a6) — 1/26/2015 @ 11:50 pmDo you acknowledge that cancer in a late stage might require faster treatment than cancer in an early stage?
DRJ (a83b8b) — 1/26/2015 @ 11:52 pmI submit that because the report said Cassandra might die in 2 years, you assume she is in an early stage of cancer. I think that could be wrong.
DRJ (a83b8b) — 1/26/2015 @ 11:56 pm227. DRJ (a83b8b) — 1/26/2015 @ 11:50 pm
I’m not sure that information is available. There may be some argument in the coiurt a papers but that’s a little hard to find. I don’t know if in fact, it is a open and shut case to do this and do this now. I just say we can’t assume that it is.
But again, how can the doctors know the prognosis if she disregards their advice, if they never saw their advice disregarded?
There’s not enough information getting into the average article, even when it seems clear more is publicly available.
Sammy Finkelman (e806a6) — 1/27/2015 @ 12:02 amSammy:
Nor can we assume that it isn’t.
DRJ (a83b8b) — 1/27/2015 @ 12:10 amThere seems to be a lot more snow and wind in upper NY, Boston, and further north. Good luck to all.
DRJ (a83b8b) — 1/27/2015 @ 12:12 am“That was what the doctor’s had told members of his family, and I had read it in the New York Times.
How was I supposed to suspect – well maybe I was supposed to expect – that the doctors were misleading * some family members, who then spoke to the a member of the press?”
Sammy – Plus you were out of date and there was other public information indicating he had gotten worse. You gift of universal knowledge failed you.
daleyrocks (bf33e9) — 1/27/2015 @ 12:16 am“How was I supposed to expect that not only was that wrong, it was really, really, really wrong, and that he would die withi hours after somebody was told he was getting better.”
Sammy – Not within hours. Your info was at least 36 hours old.
daleyrocks (bf33e9) — 1/27/2015 @ 12:17 am“There is in Long island, but that will only knock out power in a limited area.”
Sammy – So what, it is not only a problem for people with overhead lines as you stated. And define your limited area.
daleyrocks (bf33e9) — 1/27/2015 @ 12:20 am230. DRJ (a83b8b) — 1/26/2015 @ 11:56 pm
I don’t know if that is early or late, or what treatment they assumed she might get and when, but I think they were trying to argue that the risk of death is high, which means it is really much lower than what they said.
http://en.wikipedia.org/wiki/Hodgkin's_lymphoma
So maybe two years means not early, but late.
http://www.nejm.org/doi/full/10.1056/NEJMra1003733 The discovery of radiotherapy as a treatment technique in the early 20th century led to long-term survival free of recurrent lymphoma in some patients with what we would today call early-stage disease.1-3 And also many agents worked. Which should lead to the idea that maybe nothing at all, or a placebo would work too. I mean how would they know the difference if every case they find is treated?
And there’s this:
Maybe worth doing if the treatment actually reduces the risk of death, but not so much if it doesn’t. There are many ways apparently to rate the prognosis, maybe other symptoms, maybe the spread of the cells. Who knows what, if any, are right?
We see this:
It seems like salvage therapy leads almost to as good results as what is considered the best treatment.
Sammy Finkelman (e806a6) — 1/27/2015 @ 12:25 am236. A limited area is whatever area might be taken offline if a power line was knocked down. Probably usually a substation. I think maybe could be 100,000 people, or 30-40 or so Census tracts.
Theer are no power lines to knock down anywhere in Brooklyn I think.
Sammy Finkelman (e806a6) — 1/27/2015 @ 12:33 am235. My information was not 36 hours old. It was probably less than 18 hours. And the newspaper went to press less than 12 hours before ut was announced he had died.
Sammy Finkelman (e806a6) — 1/27/2015 @ 12:35 amSometime someone writing tells a little bit more, but sitll it is hard to get a handle on why this was diagnosed and at what stage it is.
Here is some of the history. This version, is by someone who had chemotherapy. Although she sees a point is outraged thatanyne should be forced to doso, and thinks the age of decision making should maybe be reduced to 15.
http://www.foxnews.com/health/2015/01/22/on-connecticut-forcing-teen-to-undergo-chemotherapy/
Sammy Finkelman (e806a6) — 1/27/2015 @ 12:52 amIt’s almost 4 am and still no new snow.
Sammy Finkelman (e806a6) — 1/27/2015 @ 12:55 amWCBS 880
“light snow reported in Manhattan”
“people are already beginning to say this is NOT the worst storm” they’ve ever seen.
This is not the first wrong prediction of snow.
Blizzard conditions maybe somewhere.
No lifting of the travel bans yet.
“snow, some heavy.”
4:04 wind out of the north gusting to 20 mph, visbility about half a mile.
Not a blizzard.
Eastern suburbs get more sense. Islip just reported 17 inches of snow.
Sammy Finkelman (e806a6) — 1/27/2015 @ 1:06 am4:07 All Port Authirity bridges and tunnels closed too.
Alternate side of the street suspended at least for today and tomorrow.
Travel ban remaining in effect
WCBS weather forecaster not ready to say his info is all wrong.
Chicago Tribune:
This time they have it right, Truman Defeats Dewey.
I think the weather models aren’t any better than the climate models, but like them, they are still tilted toward disaster.
http://my.chicagotribune.com/#section/544/article/p2p-82631336/
Sammy Finkelman (e806a6) — 1/27/2015 @ 1:15 amNew York city public schools closed for the only the 10th time in 50 years.
WCBS 880 still not changing its forecast.
New York Stock exchange to be open.
There’s maybe a few inches of snow on the windowsills, but I wouldn’t call what’s falling down now even flurries.
We won’t even have ice.
Sammy Finkelman (e806a6) — 1/27/2015 @ 1:22 amWe were s’posed to get buried here, but I employed my standard snow-defense mechanism: I had the snow blower fueled up and ready to go, and the 4 to 8 inches of snow we were forecast to get turned into 1¼ inches. 🙂
I wish that I had a job where I didn’t have to be right more often than the weathermen.
The Dana with the hots for Jen Carfagno (f6a568) — 1/27/2015 @ 4:32 amWe don’t have that much either, to my daughter’s chagrin. Schools closed early and a snow emergency declared as a preemptive strike-
it worked, the storm stayed away.
I don’t blame city officials too much. In many places out east, esp in big cities where they are not too used to snow, 6 inches can cause a lot of disruption. Many, many other places it means a little bit of exercise and a few minutes brushing snow off of the car.
Sammy, the “natural history” or “course” of a disease is known by the collective experience before there was treatment available.
MD in Philly (f9371b) — 1/27/2015 @ 5:50 amWhen I had a patient who was slow to commit to treatment for AIDS or anything else serious with a grave prognosis (untreated), I would use the following illustration:
Say you are driving down a mountainside for the first time, you don’t know the road, and your brakes go out. You know that the reality is your car is going to pick up speed and you may lose control, have an accident, and die. “Not making a decision” is in fact making a decision that is increasing the possibility of your death every second. Now, it is possible that just seconds ahead the road flattens out or even goes uphill a bit to help you slow down; but it is also possible you will come to a sharp curve and have an accident even earlier than you think.
The emphasis is on that one is making a decisions every moment, do I take action now by running the car into the side of the mountain or jumping out before I am any faster, or do I do nothing and hope for the best when I have little reason to believe that the time for action will ever be better than right now. Maybe if you are in rolling farmland in PA you will take your chances, if you are in the Rockies, you need to do something now.
245. Heh, using a two part rhetorical question at the end of a paragraph describing a complicated problem may not have been the best course of action here, MDinPhilly. 🙂
elissa (623f70) — 1/27/2015 @ 6:31 ambrian burke’s kid was killed in a blizzard a few years ago it was very sad
you have to be very careful when the blizzards happen or you too can die
one smart thing you can do is practice using your emergency brake way before you need it, especially if you’re going into the mountains during a blizzard right after you got diagnosed with aids
also it doesn’t hurt to throw a few extra snack cakes and a bottle of water in the car with you before you head out so you don’t have to eat your frostbitten toes while you wait for someone to dig you out
more advice to come as the situation develops
happyfeet (a037ad) — 1/27/2015 @ 6:41 amWell, I think that elissa and DRJ have been pretty nice.
Still, I laughed out loud at the clearly unconscious irony when Teh Sammeh wrote, about Dr. K.:
This is right up there with “I work here is done” as a tagline for bizarre people at Patterico’s place.
Sadly, Sammy has been schooled repeatedly, but a fair number of commenters here. I understand that SF is “neurodiverse,” and I suspect there are medication issues besides.
I share DRJ’s fear that all the blather could put off other people who have better informed, less reflexive, or reasonable opinions.
But here is the thing. Lots of people don’t like me. My guess is that if I posted as often and as, ahem, faux-authoritatively as SF, I would be cyber-slapped silly. I would hate to see that happen to SF.
So I wish Sammy well. But perhaps he should think about something more important than the opinions of other posters.
Dr. K. has saved an awful lot of lives. Personally. Ditto MD in Philly.
I just teach college and dink around in the lab. Who knows what Sammy does.
But Sammy? This message is for you, and I mean it kindly. You and I haven’t saved many lives. Perhaps biting your tongue and showing respect to folks who have devoted their lives over decades to helping others—directly—might not be a bad strategy. You say arrogance is a bad thing. I quite agree.
I realize you won’t listen, but I wanted to put it out there, just in case.
Simon Jester (c8876d) — 1/27/2015 @ 7:06 amSimon, it’s like trying to talk a girl out of getting a boob job – they won’t listen.
ropelight (7b6dba) — 1/27/2015 @ 7:16 amCassandra needs to eat some tasty porridge and avoid men and she’ll be right as rain
nobody around here is connecting the dots
happyfeet (a037ad) — 1/27/2015 @ 7:23 amMr Feet wrote:
It’s wiser to have a warm blanket or three with you so you don’t get frostbitten toes!
The sagely wise Dana (f6a568) — 1/27/2015 @ 7:31 amfeet, see my comment at #75, I pointed out the curious repetition of references to putting things in the girl’s body, called Mommy Dearest a Whack Job and suggested a closer look at her peculiarities. (I’d start with the medicine cabinet, kitchen cupboards, and fridge, with special emphasis on any pyramids and tin foil hats scattered about.)
ropelight (7b6dba) — 1/27/2015 @ 7:36 amok yeah good call
one of my first things i did here was i ordered like $130 bucks worth of fancy carhartt socks from amazon
they’re gonna last forever cause i hardly ever wear them
what a stupid waste of money
happyfeet (a037ad) — 1/27/2015 @ 7:38 amMr. ropelight her mom would make a really groovy. 115% committed scientologist I think
but they’re both ripe for the pluckin’
happyfeet (a037ad) — 1/27/2015 @ 7:40 amoh. that was supposed to be a comma after *groovy*
happyfeet (a037ad) — 1/27/2015 @ 7:40 am“My information was not 36 hours old.”
It doesn’t matter when the newspaper went to press. What matters is when the hospital allegedly passed on the information to the family, unless you believe placing a patient on a ventilator is a sign of improving health.
daleyrocks (bf33e9) — 1/27/2015 @ 8:19 amDaley, it just doesn’t matter with Sammy.
https://www.youtube.com/watch?v=kQFKtI6gn9Y
It’s like he owns no mirrors.
Simon Jester (c8876d) — 1/27/2015 @ 8:23 am“Daley, it just doesn’t matter with Sammy.”
Simon – He’s like Obama, all he knows is what he reads in newspapers, except he doesn’t understand what he reads.
daleyrocks (bf33e9) — 1/27/2015 @ 8:35 amIf Sammy could limit himself to primarily looking up stuff and minimizing the opining on his half-educated conclusions and stick to opining on things he knows,
he (you, Sammy)would be much more appreciated for your contributions.
Of course, I am known to opine on things I am not first hand knowledgeable of myself, but I hope I at least usually do so with deference to those who do know what they’re talking about.
maybe this would be a good time for somebody to remind us of that software one can use to pre-edit a thread, so one doesn’t have to look at posts by specific authors.
And, Simon, we appreciate the thoughts (taking the liberty of assuming what Mike K. would think),
MD in Philly (f9371b) — 1/27/2015 @ 9:00 ambut no one knows what the simple sincere concern of one to another can do, such as a student getting encouragement or helpful instruction from a teacher.
Certainly a whole lot of discouragement and bad advice get passed on by too many. (probably some by myself more frequently than I would like to be aware of).
Candles and something to light them with. Crack a window or two a little bit. Place the candle on the floor. Bring your feet up the seat. Heat rises and will warm you. The CO2 and CO will also rise out of the window. Fresh air will fall in. Tested in Eskimo ice igloos.
nk (dbc370) — 1/27/2015 @ 9:06 amup *to* the seat
nk (dbc370) — 1/27/2015 @ 9:06 amplus if you bring a clothes hanger after you light the candle you can make s’mores
happyfeet (a037ad) — 1/27/2015 @ 9:19 amIf you bring a Black & Decker you can make a vent hole in the roof and two intake holes in the doors at floor level just like the Eskimos’ igloos (or Cheyenne teepees for that matter).
nk (dbc370) — 1/27/2015 @ 9:24 amNew York gets 2 inches of snow, it’s a blizzard. Chicago gets 12 inches of snow, it’s Monday. (Heard on radio.)
nk (dbc370) — 1/27/2015 @ 9:26 amnk, you remind me of stories about ice fishing.
Thanks, MD. But I have former students who are heart surgeons. They make a difference.
Heck, my ailing father is a retired firefighter: he used to run into burning buildings to save peoples’ lives.
I flounce around in class, and shoot pipet tips into biohazard bags. And try to grade exams fairly.
Not quite the same thing!
Simon Jester (c8876d) — 1/27/2015 @ 9:42 am214. DRJ (a83b8b) — 1/26/2015 @ 11:10 pm
None of the reports give any hint that the substance was ever discussed. Neither would an average lawyer be expected to know much. And neither was that a legal issue. Now there is the tradition of s “Brandeis brief” when the lawyer makes an argument on the substance but her lawyers would not have bene good, or even informed at all about this.
The legal issue was maturity, not whether the doctors were right, and whether it was true that the only reasonable course of action was to immediately take their chemotherapy.
We have two legal fictions here here: “informed consent” and “competence”
It 95% certain that the judge really based the decision on the apparent necessity of taking one particular course of action, but legally whether they were right or wrong was not an issue.
Sammy Finkelman (e806a6) — 1/27/2015 @ 1:13 pmnk (dbc370) — 1/27/2015 @ 9:26 am
I am not sure how much snow Manhattan got, I saw some numbers too fast, but here it was maybe 2 or 3 inches. Some cars were driving on the streets at 11 am. (The traffic ban was lifted) There were fewer people on the street for along time, and most of those there were shoveling snow with a hand or a snow golf cart tractor whatever you call it.
The radio and TV stations were mostly trying to talk as if they weren’t wrong. They were trying to find places with a lot of snow, like Baldwin, Long Island and saying things like:
“New York, Philadelphia etc was spared the worst but CBS meteorologist says some place was hit..”
“Most of the metropolitan area dodged the storm”
“It’s still snowing near JFK”
The fact of the matter is there was heavy snow in eastern Long Island (Suffolk County) – 22 inches to 28 inches – and Greenwich Conn. got 6 inches (2 feet had been predicted) Stores there were all closed, of course.
It is not the firsttime somebody listened to the National Weather Service.
Sammy Finkelman (e806a6) — 1/27/2015 @ 1:50 pm