Paradigm Shift

I’ve heard that phrase too many times. Everything, from getting your razor in the mail to immune stimulation in cancer treatment has been hailed as a ‘paradigm shift.’

I happen to get my razor in the mail and am grateful for the service.

Stimulating the immune system to improve a patient’s response to disease including cancer was contemplated by nonother than Hippocrates himself (circa 5th century B.C.).

With this caution in mind I will try to avoid the term paradigm shift, but I want to talk about what has been claimed, for over a hundred years, to be the future of medicine – preventive health.

Well, whatever that is – I will discuss this shortly – it still isn’t here. In fact in terms of the distance between what is possible, and what is actually done we are farther from the worthy goal of preventive health than when the topic was first broached many years ago.

Let me illustrate. King James the First, in a 1604 A.D. treatise against the dangers of smoking urged everyone to stop; he was adamant to the point of declaiming against ‘passive smoking.’ And we think we are moderns. Well his advice was certainly a blow for preventive health. His advice and what was understood to be good for one’s health, limited by “science,” was remarkably prescient. Theory and practice were almost the same. Preventive health advice circa 1600: don’t smoke and get enough to eat. Check.

Well now we can detect the ill effects of improper diet, poor or inadequate exercise, the ill effects of no spiritual discipline. We can detect cancer months to years before it becomes a serious illness, we can find vascular disease decades before heart attacks and strokes do their dastardly damage. With this information in hand we can alter behavior, institute early treatment, and generally avoid – prevent – health problems.

As a practical fact, little of this – that which is possible – is done. For many decades we have been warned of the risks of false positive and false negative tests, the cost vs. benefits of detailed screening.

Just “don’t smoke, eat right, exercise and…don’t bother me” is the sum of preventive health practice as it now stands. That and take a handful of supplements, the list of which changes month-to-month. There are exceptions, but they are rare, often ridiculed, and struggle against the inertia of a mammoth, no a behemoth, no a gargantuan menace: The Modern Industrial/Medical/Insurance Conspiracy (MIMIC).

In tear-filled detail I can unpack this phrase. It is no calumny. It is a fair description. Two illustrations.

The National Lung Screening Trial dates from the first of this century. UCSF – local guys – were one of the principal research facilities for this trial. They found – watch this phrase – that ‘at risk’ populations could reduce the chance of dying of lung cancer by 20% through CT screening. One in 5 deaths from the most common cause of cancer death could be prevented with rational CT screening. We knew that 20 years ago. Well MIMIC went to work and talked about the risk of “false positives, false negatives, radiation risks” and on and on and still no national, rational screening process is in place; now, almost 20 years later.

“At risk” is MIMIC talk for “don’t smoke and don’t bother me.” Fun fact: one of my patients who had her lung cancer removed after my screening protocols detected very early stage lung cancer was asked, “Why was he even screening you since you don’t smoke?” Well she wasn’t sure about that, but she is very sure it saved her life. They were too.

One more example of MIMIC, by omission, killing people. In the United States pancreatic cancer is rapidly becoming the second most common fatal cancer. It is never – so rarely is it screened for, no judge, capable of statistical analysis, would find me guilty of deception to use the phrase – it is never screened for. One attempt to find out if screening would be of benefit found that such screening would save some lives but would entail too many ‘false positive’ surgeries and cost so much it was not practical. Advice from the researchers: don’t bother looking. “Don’t smoke, don’t bother me.”

The study was inadequate to the problem. Pancreatic cancer comes in many forms including genetic variants, thus a variety, a matrix of screening tools from imaging to simple tumor markers to complex tumor detritus markers themselves need to be employed. You can detect it early; my poor efforts have done so. It is doable. Doable if the will and the funds are there.

Within my fairly small, yet unusual, clinic I have found advanced coronary artery disease in young women with excellent lipid markers, healthy young men with serious osteoporosis, thyroid cancer without family histories of cancer. Such early findings have saved and improved lives.

Look, like it or not, life and death is a numbers game: some die early, some die late, we all die. Still, when your number, or your son’s or daughter’s or wife’s or husband’s number turns up, when it is their turn to die young of lung cancer or ovarian cancer or pancreatic cancer or stroke or heart disease, how much would it have been worth for that not to happen? How different would your life and theirs be now and in the future if that early death had been prevented?

One line of argument against the widespread implementation of the kind of early screening and ongoing prevention that I advocate is cost. MIMIC’s argument is it costs too much, so it limits access to such diagnostic approaches. Well, you know this in your bones if you will only think: if you limit access to anything it becomes expensive; no, more expensive. Limit access to low radiation CT’s and there will be very few as “they are too expensive.” Well, yes, if you limit them they will be. What would happen if there were many?

All of the problems of “false positives” and “false negatives” and “too much radiation” are really just screens for not wanting to do the work, the mind work, of finding another paradigm than MIMIC. Too many jobs, too many turf wars, too many bloated academic institutions weigh against just thinking clearly: “I don’t want my son to needlessly die!” Or my mother or wife, or daughter. Or myself for that matter.

The precision implementation of proper diet, effective exercise, and a consistent spiritual discipline will prevent most things and those who say “but no one will do these things” are right only because nihilism is an easy, even contagious, thing to spread. If we as a civilization will to be healthy, to be diagnosed early and instructed in dynamic, effective preventive practices, we can find killer diseases early and prevent the wasted years and unnecessary suffering that is their true cost.

Give me a team. Let’s go.

Smile, Have Fun, God Speed,

Dr. Mike and Phil

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