OP-ED

The Difficult Science

“The mind leans over backward to transform a mad world into a sensible one, and the process is so natural and easy we hardly notice that it is taking place.” Jeremy Campbell

On the same day in November, headlines from the Wall Street Journal and the New York Times reported on the same story about a federal panel’s recommendations on consumer intake of vitamin D.

“Triple That Vitamin D Intake, Panel Prescribes” read the WSJ story;

“Extra Vitamin D and Calcium Aren’t Necessary, Report Says” stated the New York Times. (http://ow.ly/3tJMe) Since I had recently started taking vitamin D daily, I was interested in what the experts in Washington, DC were recommending.

How should you decide what advice to follow about the relationship between your diet, lifestyle, medications, health, and wellness?

Is this just another example of how the media does a terrible job? Many of us resonate with the view of media watchdog Steven Brill who said, “When it comes to arrogance, power, and lack of accountability, journalists are probably the only people on the planet who make lawyers look good.” (http://ow.ly/3tKdM)

The media does play a role here and needs to improve, but it turns out that it is really complicated to figure out what the “truth” is about diet, exercise, medicines, and your individual well being. Everybody (journalists, government panel members, scientists, patients, physicians, and nurse practitioners) needs to change.

It is really hard to establish with certainty the cause of any disease. Pierre-Daniel Huet ‘s Philosophical Treatise on the Weaknesses of the Human Mind is my favorite skeptical analysis of causality. He writes in 1690 that any event can have an infinite number of possible causes. (http://ow.ly/3tLy2) David Hume, the great Scottish philosopher, makes us realize that until we know the Necessary Connection / cause of things then all human knowledge is uncertain, merely a habit of thinking based upon repeated observation (induction), and which depends upon the future being like the past. (http://ow.ly/3u5Fs) All involved in giving medical advice should read Nassim Nicholas Taleb who studies how empirical decision makers need to concentrate on uncertainty in order to understand how to act under the inevitable conditions of incomplete information. (http://ow.ly/3tLy2)

But don’t scientific studies establish the cause of diseases so that we can either prevent them or treat them with evidence-based methods? The philosopher Karl Raimund Popper’s theory of science emphasized that there are really only two kinds of scientific theories: those that have been proven wrong and those that have yet to be proven wrong. For Popper, and Taleb who greatly admires him, one needs to be skeptical of definitive truths because the world is very unpredictable. (http://ow.ly/3tNOf)

However, many of us would agree with physicist James Cushing’s statement that “scientific theories are to be taken as giving us literally true descriptions of the world.” A straw poll at a university department of physics found ten out of eleven faculty members who believed that what they were describing with their equations was objective reality. (http://ow.ly/3tNIL)

And yet Edmund Gettier showed that one can have a justified, true belief and still not know what he believes. A man believes there is a sheep in a field because he mistakes a dog for a sheep, but hidden behind a rock out of view in the field is a real sheep. “The three criteria for knowledge (belief, justification, and truth) appear to have been met yet we cannot say that this person actually knows there is a sheep in the field, since his ‘knowledge’ is based on having mistaken a dog for a sheep.” (http://ow.ly/3tNIL)

Science does not give us truth or certainty. As Lys Ann Shore says, “The quest for absolute certainty must be recognized as alien to the scientific attitude, since scientific knowledge is fallible, tentative, and open to revision and modification.”
(http://ow.ly/3tNIL)

When I graduated from Case Western Reserve School of Medicine in 1980, the evidence-based causes of peptic ulcer disease included stress, spicy food, chewing gum, and inadequate parenting. In 1982, Perth pathologists Robin Warren and Barry J. Marshall proposed that infection with Helicobacter pylori was the real cause, but physicians did not readily agree. When Marshall developed gastritis 5 days after drinking a Petri dish full of Helicobacter pylori, the scientific community slowly accepted the new theory. Treatment changed from a bland diet and psychotherapy to a combination of two antibiotics and a proton pump inhibitor. In 2005, Warren and Marshall were awarded the Nobel Prize for Physiology or Medicine. Medical knowledge is indeed “fallible, tentative, and open to revision and modifications.”

So how can the average person evaluate the latest scientific breakthrough that is reported in the press? One must become an informed skeptic. Scientific studies come in different types. Observational studies are often untrustworthy. Epidemiological studies are better, but still can lead us astray. Meta-analysis try to aggregate the knowledge discovered by many studies and can be useful. Randomized controlled clinical trials are the trustworthiest and considered the gold standard of evidence. (http://ow.ly/3tKdM)

John Ioannidis, MD, faculty member at Tufts-New England Medical Center and University of Ioannina Medical School, has studied the accuracy of all those medical studies we read in the popular press, and he has discovered that by a two to one margin discoveries in the most prestigious medical journals are either refuted or the results are found to be exaggerated by later papers. (http://ow.ly/3tQbX)

Ioannidis states, “Amazingly, most medical treatment simply isn’t backed up by good, quantitative evidence.” He also writes that the problem is not confined to medicine, “The facts suggest that for many, if not the majority, of fields, the majority of published studies are likely to be wrong.” (http://ow.ly/3tKdM)

To better understand how this can be so, let’s take a look at hormone replacement therapy for women. In 1966 a best selling book Feminine Forever argued that menopause was a disease that could be treated by taking estrogen, and hormone replacement therapy became a best selling drug in the United States. In 1985 the Harvard Nurses’ Health Study reported that women on estrogen had only a third as many heart attacks as women who did not receive the drug. In 1998 the Heart and Estrogen-progestin Replacement Study (HERS) found that estrogen increased the likelihood that women who already had heart disease would experience a myocardial infarction. In 2002 the Women’s Health Initiative (WHI) concluded that hormone replacement therapy increased the risk of heart disease, stroke, blood clots, and breast cancer.

One journalist estimates that tens of thousands of women suffered harm because they took a prescription drug that was prescribed by their physician to treat menopause and protect them from heart attacks. (http://ow.ly/3tSko) What happened and why?

The Harvard Nurses’ Health Study is a well designed, large (122,000 subjects), and well-run prospective cohort study that examines disease rates and lifestyle factors to generate hypotheses about what caused the diseases. Although such studies can say there is an association between two events (women who took estrogen had fewer heart attacks), they cannot determine causation. (http://ow.ly/3tSko) Huet writing in 1690 was right; there are a lot of possible causes for any one event. Ioannidis estimates that there are as many as three thousand different factors that might cause a condition like obesity, so it is not surprising that many hypotheses turn out to be wrong. (http://ow.ly/3tKdM)

That is why the hypotheses generated by such observational studies need to be tested by the gold standard randomized controlled clinical trials like the HERS and WHI. There are three ways to reconcile the difference between the clinical trial and the Nurses’ Health Study results. (http://ow.ly/3tSko) The association of estrogen with fewer heart attacks could be explained by the healthy user and prescriber effects; the women who took hormone replacement therapy were different from those who did not take it and the physicians prescribing it to women who took it were different from the physicians who treated women without it. Another possible explanation for the discrepancy is that it is hard to accurately find out if the women in the observational study actually took the estrogen before their heart attacks occurred. The third possibility is that both the clinical trials and the observation got the right answer, but to different questions. The Nurses’ study had mostly younger women, and the clinical trials had mostly older women. It is possible that estrogen both protects the hearts of younger women and induces heart attacks in older women, and this is now known as the timing hypothesis. (http://ow.ly/3tSko)
We really don’t know which of these three possible explanations is correct.

What I take away from this is that the skeptical consumer needs to be wary of all the new advice coming from scientific breakthrough studies reported in the lay press. A principal investigator with the Nurses’ study from 1976 to 2001 warns, “Even the Nurses’ Health Study, one of the biggest and best of these studies, cannot be us
ed to reliably test small-to-moderate risks or benefits. None of them can.” (http://ow.ly/3tSko) Skeptical consumers need to understand the inherent limitations of such observational studies.

David H. Freedman in Wrong: Why Experts Keep Failing Us – And How to Know When Not to Trust Them (http://ow.ly/3tKdM) writes about the certainty principle. Drawing upon behavioral economics studies, he shows that humans are biased to advice that is simple, clear-cut, actionable, universal, and palatable. “If an expert can explain how any of us is sure to make things better via a few simple, pleasant steps, then plenty of people are going to listen.” And experts know that people will pay more attention if they make dramatic claims, tell interesting stories, and use a lot of statistics.

Freedman provides some guidance for those of us who want to be informed, skeptical, wise consumers of medical tests, therapies, and expert advice. Under characteristics of less trustworthy expert advice he lists:

• Simplistic, universal, and definitive advice
• Advice supported by a single study, or many small studies, or animal studies
• Groundbreaking advice
• Advice pushed by people or organizations that will benefit from its adoption
• Advice geared toward preventing the future occurrence of a recent crisis or failure.

Characteristics of expert advice we should ignore according to Freedman include:

• It’s mildly resonant
• It’s provocative
• It gets a lot of positive attention
• Other experts embrace it.
• It appears in a prestigious journal
• It’s supported by a big, rigorous study
• The experts backing it boast impressive credentials.

Freedman’s characteristics of more trustworthy advice:

• It does not trip the other alarms
• It’s a negative finding
• It’s heavy on qualifying statements
• It’s candid about refutational evidence
• It provides some context for the research
• It provides perspective
• It includes candid, blunt comments.

With due respect to Freedman who has written an informative book, his advice is confusing and not all that helpful to the layperson trying to decide if he should take extra Vitamin D. Although experts with impressive credentials have given advice that should be ignored, others with similar expertise have also performed rigorous prospective, randomized clinical trials whose findings should be followed. Think not smoking if you want to avoid lung cancer or heart disease. It is also true that the really skeptical epidemiologists accept very few diet and lifestyle factors as true causes of common diseases: smoking is a cause of lung cancer and heart disease; sun exposure does cause skin cancer; sexual activity does spread the papilloma virus that causes cervical cancer. (http://ow.ly/3tSko)

So where does all this reading get me as far as Vitamin D is concerned? Primary care physicians, relying on findings of an association between Vitamin D levels and a higher risk for a variety of diseases including heart disease, cancer, and autoimmune disease, started telling their patients to take supplemental Vitamin D. The sale of Vitamin D rose 82% from 2008 to 2009, reaching $430 million a year in the United States. One expert is quoted in the New York Times saying, “Everyone was hoping Vitamin D would be a kind of panacea.” (http://ow.ly/3u5YJ) As far as I know, none of these claims for Vitamin D preventing disease have been proven by a randomized controlled clinical trial.

And what about the conflicting WSJ and New York Times headlines? In a way, they both were right. The WSJ concentrated on the recommendation that people should get 600 IU of Vitamin D every day which is three times as much as the old standard of 200 IU a day. (http://ow.ly/3u63J) The New York Times concentrated on the finding that most of us get enough Vitamin D from our diet and exposure to sunlight. (http://ow.ly/3u5YJ)

So what did I decide? Following in the footsteps of Huet, Hume, Popper, Taleb, Ioannidis, and Freedman, I decided to stop taking Vitamin D and not to test my blood level. Sometimes you have to act based on incomplete knowledge of an unpredictable world, and I tend to be a skeptic and a minimalist when it comes to doctors and medical advice.

Kent Bottles, MD, is past-Vice President and Chief Medical Officer of Iowa Health System (a $2 billion health care organization with 23 hospitals). He was responsible for the day-to-day operations of a large education and research organization in Michigan prior to his work with in Iowa with IHS. Kent posts frequently at Kent Bottles Private Views.

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21 replies »

  1. Was ist los? Mein Name ist Jason, 29, ich lebe in Schopp, Deutschland vorerst bis ich wieder nach Hause nach Denver, Colorado bewegen im August nächsten year.I ‘m verfolgt derzeit meinen Bachelor of Science in Computer Networking und Sicherheit. Ich bin bei dieser Website um weitere machen es zu einem alltäglichen Bestandteil meines Lebens. Ich möchte lernen und wachsen mit Ihnen allen als zukünftige Vernetzung professioneller.

  2. Ssorry to bother you! Oonly this:
    —–Original Message—–
    From: pascu_gabriel2002@yahoo.com
    Sent: 1/5/2011 02:09:46 AM
    To: undl@emailcenter.cancer.org
    Subject: Fw: Re: Re: Fw: Specific cancer diagnosis or treatment, (THREAD ID:1-2XNDS9E) (ACTIVITY ID:1-2XP45J8)
    Without an official request from the American Cancer Society, for more
    information on “Gravitational Theory of Life”, our dialogue, on purely technical
    issues, ends here.
    But there is another topic on which we can have a dialogue:
    I know that in US is enacted a law that give to a person the opportunity to
    be undergo to unapproved treatments, on their own responsibility. I would be
    interested in some advice on this direction considering that I wish to induce
    cancer in my body, with laboratory methods, and thereafter, following the
    signing of a protocol for a specific experiment with specialists interested, to
    can be treated by applying one of the methods of treatment based on my theory.
    It is possible something like that in the U.S.?
    Regards!

  3. Finally, here is someone (Steve) to notice my messages! Even if it refers only to their length!
    To try a connection with this blog:
    In those messages was described a scientific approach which, in principle (and more) give a solution for cancer treatment. It is only a bit? Maybe yes, maybe not … But the approach is strictly scientific (even if not from the medical field). Furthermore,it is stated, based on reasoned conclusions,which are very important, that the biological systems, from the cell and ending with the complex organisms, does not work like a consequence of a causally interrelated phenomena!
    If it is so, methods of analysis of “scientific ” (which respects the principle of causality) would not fit with “not causally” nature of the phenomenon “life”. I give the example of “variability of antibodies” which medical science could not explain it . Unlike my theory!
    Could this be the motivation of why the principle of “denervation” of the tumor is ignored so elegant by the specialists?
    If users of this blog consider that my posts (excepting this one ) does not belong here, I will personally ask the administrator to delete them! Thanks!

  4. What is the long email post from Gabriel Pascu? I cannot figure out what it is or how it relates to this blog post.

  5. Wow Kent! A very interesting read! I suspect I tend towards the skeptical and minimalist cognitive style. Thanks for all the links, especially ‘Wrong: Why experts keep failing us–and how to know when not to trust them’.

  6. Speaking of “weird comments”. I feel concerned and I apologize. There is an explanation: I could not post my comments and I’ve repeated attempts until I found that all were posted. Even and those which I did not want to.
    In connection with Rich and Co.’s comment: I understand that the conclusion would be that “science” is not great but is only what we have. Somehow or another, the cancer treatment method described by me in a previous comment will be verified in terms attested. Why, because that does not involve anything “non scientific”. And the theory which is at the basis of this method, that uses only purely scientific arguments, explain also “why” and “where” is wrong the “science”.
    I created a theory (“Gravitational theory of life”)
    that tries to link the scientific formalism with the way it is generated: by
    the ” life form” in the first place and by “intelligent life form”, in the
    second row.
    The “Body” is an “order” (non material), in time and space, with a certain support. His material part (which is “seen”) is only that support for this “order”. Evidence in this regard is that the contact between its material base (of the “order”) and the environment (also “material”), a process that obeys the laws of the interaction, of “transformation”, the “order” (“form”) in time and space of bodies ( interrelationship “function-> relative position” of the processes that constitute them) remains unchanged (within certain limits) despite these contacts.
    “Gravitational theory of life” trying to solve the problem of generation in space and time and preservation of the resulting geometrical disposition of the bodies, because:
    1) in animal cell, the flows of high intensity (mass, ionic) occur before the equilibrium areas, which means “structure”. I mean there is a “flow”, which initially did rely on “nothing”, but nevertheless, it is perfectly oriented in space and time. And FURTHER cellular structure is only a consequence of statistical equilibria occurring in the contact zone of the routes of these “flows”. An attempt to solve this problem did Ilya Prigogine, Belgian scholar of Russian origin, the Nobel laureate.
    In Gravitational Theory of Life is a critical analysis of Prigogine’s approaches (as tried and Romanian-born American scientist Adrian Bejan in the 90s in “CONSTRUCTAL” theory ). Constructal Law, issued by Adrian Bejan says:
    “For a finite-size (flow) system to persist in time (to live), its configuration must evolve such that it provides easier access to the imposed currents that flow through it.”
    The meaning of this formulation is that a fluid, in order to (auto)preserving flow (equivalent for Bejan to “life”) should flowing on where is “correct” (in geometrical sense). Why Bejan contradicts Prigogine’s theory ? For ordinate this flow in space and time, Prigogine suggests that necessary actions must comes from outside the system. But in this case Prigogine had to “build” some poly of entropy (differences in temperature, pressure, etc.) between that occurring the “flow”, in the living cell. And this poly does not exist in nature (in most cases the environment around a cell is homogeneous and isotropic). And Bejan, sensing that “forcing” says: “No! The flows must to orient themselves independently, based on this law, which, by his nature, is statistic, “the constructal law”.
    According to the “gravitational theory of life” both are right and, paradoxically, both wrong:
    a) Prigogine is right: imposing entropic polarizations and ordering the flow, in space and time (flow), by actions which comes from the outside. But if exist such imposition, of material nature, that kind of hypothesis contradicts the independent motion (against any entropic polarization) of the living systems. The fact actually “charged” by Bejan.
    b) Now: if the “flow” would meet to the “constructal law”, the stable flow ( means “life”) should be independent but, implicitly, would occur spontaneously: “Life” should have and other sources than “life” itself. What is not found.
    Solution of “Gravitational Theory of Life” is: “a way of imposing flow must coming from outward, and which must have an informational nature, which overlaps the scalar ( fixed) information from in of the DNA. That mean gravitational and inertial actions plus a “text”. In this theory is accepted that the gravitational influences (primarily from the solar system bodies, ordered by relative motion between them, including the Earth) do not have a material nature (until proven otherwise, the experimental discovery of the particle generating the gravitational field, “graviton “and the gravitational wave).
    2) in complex body, the nature of parameters which can ordering in space and time these dynamic processes implies the existence of “vectors” which DNA can not contain. Also resulting in an apparent state of structural equilibrium, also, is circumvented the principle of causality in the processes which take place simultaneously.
    The “order” ( stable interrelationship “function->relative position” of the structural parts) shall be preserved permanently (for a healthy body). It follows that, in a sense, the action of an external stimulus, which automatically tends to “spoil” this order, is destroyed in a timely manner.
    EXAMPLE: variability in time of antibody
    A step in deciphering this phenomenon was a development, in 1965, of a model of recombination of genes, so that multiple genes, and not always the same, give rise to a protein chain according to the principle “more gene – one protein ” by William Dreyer and Claude Bennett. In fact, not one but an infinite number of variations of the same protein.
    This model was verified experimentally ( in laboratory conditions) by Susumu Tonegawa, Nobel laureate in 1987.
    But there are serious reservations regarding its operation under real conditions (in vivo). “Given the slow evolution in time (reflected by latency τ) of these processes, how do you explain that a foreign substance is recognized almost instantaneously, and the body may starts already making the appropriate antibodies ?” – Karen Bulloch – University of San Diego, 1978.
    Any biological causal chain involves a latency τ, as follows:
    A biological system, regardless of its complexity, can be defined by a linear operator (S), which acts on some input quantities ui and generate the outputs yj, according to the expression:
    yj (t + τ) = (S) ui (t)
    where t is time and τ is the latency of biosystem.
    Then, by what mechanism such a processes can give almost instant response? It is known that the complex interrelationship between the structures of “evoluated” bodies (tissue, organ, body) have a structure of “CLOSED CAUSAL CHAIN”: Francois Jacob – Nobel laureate for genetics said:” … each component (of life systems) becomes for the other its own condition of existence, equally cause and effect. ” But a “closed causal chain” of the processes (process “1” generated process “2”, process “2” generated process “3” and so on, and at last process “n” generated the first process “1”), if it’s followed by a state of stability (we found this on organisms), involves the simultaneous development of each of these processes (which it transform in “CLOSED ORDERED CHAIN”). Or, their chemical nature, burdened by a latency ( slow evolution in time), and so, certain cell produces a certain amount of substance in a given period, make that some structures will can not operate simultaneous, for lack of “raw material”. Or, in the body, all structures must function simultaneously, so that the flow of the substance which functional unites them to be continuous and closed. It follows that some cells must begin working before receiving “raw material” from previous functional cells, based on a quantity of substance which is available for processing in his very structure. Handy command for the very moment when this phenomenon must take place must have a “support” more “rapid” than a chemical process (the “latency” high). He must be an electrical signal. Vegetative (autonom) nervous system role is to provide such synchronization signals of chemical processes at the contact of the structures (sensitive and effector) with environment. The result of synchronization is a continuous mass flow between the different structures of the body which provides geometric and functional stability.
    If in a “links” of the “chain” that supports an external stimulus, and that flow tends to be interrupt because of this stimulus ( means “dead” ), but not “mechanically” but “informational” interrupting (repetitions with intervals shorter than “latency” of such chemical processes, which, default, is forced to consume more) then, the following functional structures may remain without “material” (even without the quantity of substance from his own structure which is for maintain simultaneity of processes). Under the electrical impulses pressure that forces them to work on and in this kind of conditions they come to destroy their own internal functional structure (the one that gives them the “function” ) turning them into malignant cells (cancer).
    So the electrical signals that provide simultaneous processes in the body, under certain conditions, forcing some structures to operate in a specific way, initially it is useful for body (to avoid the spontaneous collapsing under the action of certain types of stimulus, informationally organized ).
    So, the tumor is an independent organism ( from his host). He is intelligent, he can take decisions, he can adapt at the specifics external stimulus (treatments or action of immunologic system). This coordinated tip of behavior of malign cells is facilitated by the connection of the tumor with the nerves of autonomic nervous system ( which offer a rich informational support and which exist- the connection- in all situations, known or not by the medicine).
    So, the principle of a method (for cure the cancer) is that: the tumor mast be isolated by the influence of activity of the nerves (cutting the nerve or stop the electrochemical signals circulation influence from synapses to the tumor by activity of a neurotoxin-see American patent: Pub. No. : US 2005/0031648 A1; Pub Date: Feb. 10, 2005). Main and Prehn have performed such experiments in 1957 ( they pull out the tumor and pull in the same tumor to the same animal) with promising results. But they follow a different theoretical idea (the existence of a specific tumor antigens).
    There is a material which shows that the results of Main and Prehn experiences ( the specific immune response of the organism for tumor) have not had, until now, an accepted explanation .
    I can put at disposal for anyone interested a treatment solution that complies with the principles set forth above and which most probably has not been used nowhere in the world.
    Gabriel Pascu; phone; +40733846532, mail: pascu_gabriel2002@yahoo.com

  7. Human knowledge is always imperfect and usually wrong, but it gets better very, very slowly. Few items:
    – Per John Ioannidis: “Science is a low yield activity.”
    – Adding to the challenge the is the recent realization from brain science that our perceptions are instant, mainly unconscious and shaped by the perceptual limitations of our organism.
    For example, the world is not naturally logarithmic or numeric but our sense of numbers is because of the visual perspective ability evolved to see objects in dim light in forests — bugs mainly. To eat.
    Our brains are instant-reflex based, they will never be evidence-based. But what is our alternative to science?
    In any case, effectively, no one either believes in or applies science to their lives, e.g., medical care. Magic and supernatural ideologies are, by far, the dominant way to make sense of and manage experience. Likely that will increase.
    Finally, we adhere to Feynman’s pronouncement that “All science is wrong, some is just less so.”
    Heck, identifying the problems and mistakes is half the battle.
    We also like the statement by….hmmm?…have to find that name: (paraphrase) “We work as hard as we can for decades to think and construct a theory. Then we test that theory with all the rigor we can muster. Then we work even harder to disprove out theory.” Now that’s fun.

  8. No one, until now, has not conducted experiments of the “tumor GROWTH, IN VITRO, begining only with the cells and/or healthy tissues”, so they can said ” we know how the mechanism of the phenomenon “cancer” evolves”.

  9. To Graham Chiu,
    “You think …”? It’s a bit less, given that you don’t know how the phenomenon occurs … so you can determine if “thinking” of yours is correctly or not …
    And I do not want to offend anyone: and doctors must take into account the fact that many of their shortcomings in their work are related to this major lack: a model correctly and completely of the “REASON”!

  10. As we know (and someone correct me if I’m wrong)no one, until now, has not conducted experiments of the “tumor GROWTH, IN VITRO, begining only with the cells and/or healthy tissues”, so they can said ” we know how the mechanism of the phenomenon “cancer” evolves”.

  11. To Graham Chiu,
    “You think …”? It’s a bit less, given that you don’t know how the phenomenon occurs … so you can determine if “thinking” of yours is correctly or not …

  12. I believe you are right. I learned this in my epidemiology class from a professor that from the Harvard School of Public Health. Prevention is more important than cure, which is why I write my blog on how to stay healthy through nutrition ect. I’m a pre-med student at the Harvard University Extension School

  13. In the presence of conflicting expert opinion, the logical choice is the preferred one. I think you made the wrong choice based on evolutionary medicine.

  14. —– Forwarded Message —-
    From: pascu gabriel
    To: feedback@nytimes.co
    Sent: Thu, December 23, 2010 10:49:38 AM
    Subject: Fw: Re: Fw: Specific cancer diagnosis or treatment, (THREAD ID:1-2XNDS9E) (ACTIVITY ID:1-2XP45J8)
    —– Forwarded Message —-
    From: pascu gabriel
    To: undl@emailcenter.cancer.org
    Sent: Thu, December 23, 2010 10:47:19 AM
    Subject: Re: Re: Fw: Specific cancer diagnosis or treatment, (THREAD ID:1-2XNDS9E) (ACTIVITY ID:1-2XP45J8)
    I have claimed a formal request from American Cancer Society for an additional information and you send this… In attach you have a response of the Ministry of Health of Romania, which is similar to yours, and whose confirmation I wait for a long year .
    I know that from the “cancer” they win a lot of money, and many institutions do not behave correctly towards this problem. I hope that is not the American Cancer Society case. However, this correspondence will be disclosed to the American press!
    From: American Cancer Society – Undl
    To: pascu_gabriel2002@yahoo.com
    Sent: Wed, December 22, 2010 9:01:50 PM
    Subject: RE: Re: Fw: Specific cancer diagnosis or treatment, (THREAD ID:1-2XNDS9E) (ACTIVITY ID:1-2XP45J8)
    If you reply to this message, please retain your serial number in the subject line. This reference, (THREAD ID:1-2XNDS9E) (ACTIVITY ID:1-2XZ6AZA) will assist us in locating your questions and answers. To help us evaluate the quality of this email response, please consider participating in a survey that can be accessed through this link:
    http://acs.emailsurvey.sgizmo.com/?aid=1-2XZ6AZA
    Dear Gabriel,
    Thank you for your reply. We have forwarded your message to the appropriate staff member for further research and will contact you if we have additional information to share.
    Thank you for contacting your American Cancer Society.
    Ryan
    Online Cancer Information Specialist
    If you have any questions, please contact us via http://www.cancer.org or call 1-800-ACS-2345. Information Specialists are available 24 hours a day, 7 days a week.
    This e-mail message is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The American Cancer Society makes no warranties of any kind regarding this e-mail message, including but not limited to any warranty of accuracy, completeness, currency, reliability, merchantability or fitness for a particular purpose and such warranties are expressly disclaimed.
    Copyright (c) 2007 The American Cancer Society, Inc.
    —–Original Message—–
    From: pascu_gabriel2002@yahoo.com
    Sent: 12/18/2010 03:11:55 AM
    To: undl@emailcenter.cancer.org
    Subject: Re: Fw: Specific cancer diagnosis or treatment, (THREAD ID:1-2XNDS9E) (ACTIVITY ID:1-2XP45J8)
    Yes! You understand correctly my request.
    Also I announce you that I began preparing the material that will be sent
    to you .
    And I wish you happy holidays!
    ________________________________
    From: American Cancer Society – Undl
    To: pascu_gabriel2002@yahoo.com
    Sent: Fri, December 17, 2010 11:44:39 PM
    Subject: RE: Fw: Specific cancer diagnosis or treatment, (THREAD ID:1-2XNDS9E)
    (ACTIVITY ID:1-2XP45J8)
    If you reply to this message, please retain your serial number in the subject
    line. This reference, (THREAD ID:1-2XNDS9E) (ACTIVITY ID:1-2XRUFX4) will assist
    us in locating your questions and answers. To help us evaluate the quality of
    this email response, please consider participating in a survey that can be
    accessed through this link:
    http://acs.emailsurvey.sgizmo.com/?aid=1-2XRUFX4
    Dear Gabriel,
    Thank you for your reply. Based on your message it seems you are requesting a
    formal documentation from the American Cancer Society expressing our interest in
    reviewing your theory before you submit the entire theory to our Research
    Department. Please reply confirming this information is correct so we may
    forward your request to the appropriate person.
    If this is not the correct understanding of your message, please reply with
    additional details clarifying your request. We apologize for the inconvenience.
    Thank you for contacting your American Cancer Society.
    Ryan
    Online Cancer Information Specialist
    If you have any questions, please contact us via http://www.cancer.org or call
    1-800-ACS-2345. Information Specialists are available 24 hours a day, 7 days a
    week.
    This e-mail message is not intended as medical advice, and should not be relied
    upon as a substitute for consultations with qualified health professionals who
    are familiar with your individual medical needs. The American Cancer Society
    makes no warranties of any kind regarding this e-mail message, including but not
    limited to any warranty of accuracy, completeness, currency, reliability,
    merchantability or fitness for a particular purpose and such warranties are
    expressly disclaimed.
    Copyright (c) 2007 The American Cancer Society, Inc.
    —–Original Message—–
    From: pascu_gabriel2002@yahoo.com
    Sent: 12/16/2010 01:40:39 AM
    To: undl@emailcenter.cancer.org
    Subject: Fw: Specific cancer diagnosis or treatment, (THREAD ID:1-2XNDS9E)
    (ACTIVITY ID:1-2XP45J8)
    I understand that complete reaction to my message involve and structures
    with you have a certain kind of relationship, but you don’t administratively
    controll over them. I would be interested, in the first place, to warned me
    relative to the persons or institutions that have formally expressed their
    interest towards my theory. And this can not be made if the information
    provided by me is available to them freely. In my opinion, it must be done a
    protocol to indicate that this exchange took place.
    On the other hand , the effective response, theoretical and, possibly,
    experimental can be sent for my in to a range that can be left on latitude to
    those persons or institutions.
    Sincerely,
    Gabriel Pascu
    ———————————————————————————————————————————–
    —– Forwarded Message —-
    From: American Cancer Society – Contact Us
    To: pascu_gabriel2002@yahoo.com
    Sent: Wed, December 15, 2010 5:16:08 PM
    Subject: RE: Specific cancer diagnosis or treatment
    If you reply to this message, please retain your serial number in the subject
    line. This reference, (THREAD ID:1-2XNDS9E) (ACTIVITY ID:1-2XP45J8) will assist
    us in locating your questions and answers. To help us evaluate the quality of
    this email response, please consider participating in a survey that can be
    accessed through this link:
    http://acs.emailsurvey.sgizmo.com/?aid=1-2XP45J8
    Dear Gabriel,
    Thank you for your interest in sharing your theory about the genesis of cancer
    and its cure with the American Cancer Society. In order for your theory to be
    reviewed by the American Cancer Society, please submit your cure proposal to the
    following address:
    American Cancer Society
    Attention: Research Department
    250 Williams St NW
    Atlanta, GA 30303-1002
    Once received, your proposal will be forwarded to the appropriate American
    Cancer Society advisory group for consideration as part of their overall role in
    determining American Cancer Society positions and actions on a given topic. The
    American Cancer Society carefully monitors the scientific literature on a
    regular basis and, as with any reputable scientific organization, develops or
    amends its positions based on the breadth of this literature and not on the
    results of any single study. Please note that the Society does not perform
    research but provides grants to qualified researchers who choose their own
    subject to study. Furthermore, due to our large volume of mail, you might not
    receive acknowledgment that your cancer cure was received.
    Thank you for contacting your American Cancer Society.
    Nydia
    Online Cancer Information Specialist
    If you have any questions, please contact us via http://www.cancer.org or call
    1-800-ACS-2345. Information Specialists are available 24 hours a day, 7 days a
    week.
    This e-mail message is not intended as medical advice, and should not be relied
    upon as a substitute for consultations with qualified health professionals who
    are familiar with your individual medical needs. The American Cancer Society
    makes no warranties of any kind regarding this e-mail message, including but not
    limited to any warranty of accuracy, completeness, currency, reliability,
    merchantability or fitness for a particular purpose and such warranties are
    expressly disclaimed.
    Copyright (c) 2007 The American Cancer Society, Inc.
    —–Original Message—–
    From: pascu_gabriel2002@yahoo.com
    Sent: 12/14/2010 12:58:51 AM
    To: contactus@emailcenter.cancer.org
    Subject: Specific cancer diagnosis or treatment
    The subject of this letter is CANCER! I am an diplomat engineer in physics at
    the University of Bucharest. The concern for this disease is because I worked at
    the Cernavoda nuclear power plant.
    I think my contacts with medical domain are very consistent. Furthermore,
    coming from outside, my opinions are more likely to be correct!
    So:
    My name is Gabriel Pascu.
    I’m from Romania and i have a well grounding in physics. I created a theory
    that tries to link the scientific formalism with the way it is generated: by
    the ” life form” in the first place and by “intelligent life form”, in the
    second row. The main issue of this theory is about a real and formally accepted
    pattern for living systems. So, the problem that I try to clear up is the fact
    that we can’t create living forms (from amorf forms) in conditions in which all
    the phenomenons (dynamic, chemical and physical) on living forms can be
    individually reproducible by experiments or we could find them in nature. We
    knows that theirs individually developing (out of organisms) are ruled by
    spacial and temporal statistics laws. Or IN the organisms such phenomenons are
    coordinated and the statistics laws are not functioning (the result of this
    coordination is precisely geometrical determined in space-the stable form of the
    result of a holding of dynamic phenomenons-the organism). And this precise
    determination is not a result of a material (physical, chemical) actions (which
    are governed by statistic laws). So, what is the cause of this determination?
    That’s the question? And the answer isn’t “DNA” which is a scalar information
    (not geometrical oriented, which means “vector”). So he can’t generate a very
    precise 3D geometrical distribution of the result of a dynamic process.
    In the same time the answer is not an religious one! It’s a strictly
    scientific answer! I have this answer!
    But we talk here about physics, statistics, theory of information etc.
    The method I found for healing the cancer is based on this answer and is good
    (is verified illegally on peoples in Romania for many years)!
    I have published in my country a few materials about this new theory which
    offer an explanation for genesis of cancer. The main idea of these explanation
    is that:
    The tumor is an independent organism ( from his host). He is intelligent, he
    can take decisions, he can adapting at specifics external stimulus (treatments
    or action of immunologic system). This coordinated tip of behavior of malign
    cells is facilitated by the connection of the tumor with the nerves of
    autonomic nervous system ( which offer a rich informational support and which
    exist- the connection- in all situations, known or not by the medicine).
    So, the principle of a method (for cureing the cancer) is that: the tumor mast
    be isolated by the influence of activity of the nerves (cutting the nerve or
    stoping the electrochemical signals circulation influence from synapses to the
    tumor by activity of a neurotoxin-see american patent: Pub. No. : US
    2005/0031648 A1; Pub Date: Feb. 10, 2005). Main and Prehn have performed such
    experiments in 1957 ( they pull out the tumor and pull in the same tumor to the
    same animal) with promising results. But they follow a different theoretical
    idea (the existence of a specific tumor antigens).
    There is (google) a material which shows that the results of Main and Prehn
    experiences ( the specific immune response of the organism for tumour) have
    not had, until now, an explanation accepted.
    The tumor it must stay there, after her totaly removal, by reintroducing
    her in the same site, immediately, now without any kind of connections with
    the nerves.
    But the nerves mostly fallow the sanguine vessels. That explain the success of
    Avastin (Folkman): no vessels, no nerves ! But this results could be improved:
    the tumor has no food but she mast haven’t no coordination. Because the
    cancer is an “soft”, an program for a coordinated activity of malign cells.
    That’s why the individual sarcoma cell are identified and destroyed by the
    immunological system.
    After 2003 Cubans (escozul-neurotoxin) have their best information on cancer
    from me ( by the Cuban embassy in Bucharest).
    This is the area that I deal with over 15 years. Results exist! In Romania and
    worldwide. But they can not be made public in their real form, because it must
    be recognize my priority of the idea that the genesis of “cancer” phenomenon
    is related to autonomic nervous system activity.
    Because and in this area seem to be much to do, legally speaking, I’d like to
    get some HELP FROM YOU! regarding this issue.
    Gabriel Pascu, +40733846532; mail: pascu_gabriel2002@yahoo.com

  15. I think a robot or avatar or video game could be an effective shared decision making tool in summarizing the available evidence in a way that a patient like me could evaluate the trade-offs involved in deciding whether to have a PSA test, or take Vitamin D, or undergo back surgery. For whatever reason, most patients seeing most doctors are not getting the necessary information in a way most patients can understand to make decisions that are consistent with what they really want. I think shared decision-making aids and tools will be key if we are ever to get our per-capita costs down and quality up. I am encouraged that a recent Cochrane Collaboration study of randomized clinical trials comparing shared decision making supported by decision aids to obtaining informed consent in the usual way showed an average 24% decline in demand for a wide range of elective surgeries and tests. I think robots, avatars, and video games will be an effective share decision making aid. I guess you and I will just have to disagree about the usefulness of this new technology. Time will tell who is right and who is wrong.

  16. Kent,
    Get a robot, avatar, or CPOE CDS to decide whether you should take Vitamin D. I am glad to see you have retained your cognitive skills.

  17. Wonderfully insightful
    The same insight is applicable to HIT, EHR, CPOE, CDS, and CER. There is little to no evidence that has not been sponsored by the HIT industry, ie EHRVA, HIMSS, C$HIT, CHIMES, and others, that show any benefit for HIT systems, except for the coffers of the vendors and those they pay to shill their wares.

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