Arguments with Albert: 86% of Oncologists

Arguments with Albert: 86% of Oncologists
 “86% of oncologists won’t prescribe chemotherapy to themselves or a family member,” says Al. Immediately, my mind starts to calculate the odds and the incongruity of Al’s comment as well as the likelihood I could ever persuade him otherwise. The chance of convincing him the statement is both alarmingly wrong and harmful is about as high as it is that the statement is true.

 “86% is pretty high,” I say. “It’s probably higher”, he replies.

 “So, Al. I have a few follow-up questions, if you’ll permit me.” He neither gives consent nor objects. “To begin with, are you referring to all oncologists in the Milky Way? Earth? Western Hemisphere? Detroit? Responders to someone’s survey? Who exactly are these oncologists?” “It’s been widely reported,” he huffs. “I can find you a dozen references if you want.” “A dozen references to the same misreport”, I think to myself.

"And, Al, are you saying this includes all types of cancers and all types of chemotherapy? “I don’t know, look it up for yourself. Any way you look at it, doctors who treat cancer won’t prescribe this poison to a loved one. Or take it themselves.”

Most surprising in Al’s charge is his unawareness of the implicit condemnation of oncologists as being immoral, greedy and wicked. “If what you say is true, Al. Then 86% of oncologists are inhumane, brutal human beings unfit to practice medicine.”

 “I didn’t say any such thing,” Al protests, ‘I’m just saying they know the damage it does and they would never go against the AMA so they keep prescribing it. But not if it’s a loved one.”

 “Right. These oncologists are perfectly happy to pour poison into their patients – merely for profit, or out of callousness or cruelty. If so, not only are they mean but stupid as well. By admitting they administer chemotherapy to patients, but would refuse to do the same for someone they loved, they are admitting their malevolent involvement in the practice of killing patients, or at best not helping them. If it were true that in general oncologists would not prescribe chemotherapy to family members because they believed the treatment was either ineffective or poisonous, don’t you think they’d keep this to themselves?”

 “I’m sure most of them are good people just doing their jobs, but facts are facts, these things don’t get widely reported if they’re false.” Al weakly proclaims. Al is guilty of contemporary confirmation bias: having an opinion and then Googling until you’ve found confirming evidence of what you already believe to be true. As is usually the case, numerous articles can be found spouting the same information, almost always originating from the same source that affirms the opinion you started with. Any Google hit with a conflicting opinion is ignored.

 In the case of the fabrication of oncologists refusing to prescribe chemotherapy to themselves or family members, the perpetrator of the myth leads back to a 1987 Canadian study. One hundred and eighteen Canadian doctors who treated lung cancer were asked how they would wish to be managed if they had non-small cell lung cancer. (Mackillop, 1987) Four clinical situations were described. Although opinion was divided as to the role of immediate radiotherapy in inoperable cancer, and the role of post-operative radiotherapy following incomplete surgery, there was little controversy as to the role of chemotherapy. Three percent of doctors wanted adjuvant chemotherapy after surgery for early disease, 9% wanted chemotherapy for advanced disease confined to the chest and 15% wanted chemotherapy for symptomatic metastatic disease. This study only addressed non-small cell lung cancer, not any of the other dozens of cancers.

Furthermore, data accumulated from 1985 to 1990 at the Massey Cancer Center, indicated that only a small minority (19% of Virginia non-small-cell lung cancer patients) were actually receiving chemotherapy. (Thomsas J. Smith, 1998). Thus, this selective data describes that while doctors in the 1980’s may well have been reluctant to treat themselves with chemotherapy if they had this particular cancer, they were only using it with less than 1 in 5 patients. In a 1998 follow-up study, Smith found that “In the MacKillop et al study, only 17% of medical oncologists said that they would take chemotherapy for painful bone metastases and another 17% said that they would undergo radiotherapy to the spine, in addition to chemotherapy, for a total of 34%. Our results show that 64.5% would now take chemotherapy indicating nearly a doubling from 34% to 64.5% of those now willing to have chemotherapy plus radiotherapy and a quadrupling from 17% to 64.5% of those who would take chemotherapy alone.” (Thomsas J. Smith, 1998)

 I persisted, “Al, if you look deep enough you find there is a lot more to the story. The actual numbers are that in 1987 a study conducted in Canada (118 doctors) reported that 34% of doctors would take either chemotherapy or radiation and in a follow up study that included 126 doctors, results showed that 64.5% would now take chemotherapy indicating nearly a doubling from 34% to 64.5% of those now willing to have chemotherapy plus radiotherapy and a quadrupling from 17% to 64.5% of those who would take chemotherapy alone.” (Thomsas J. Smith, 1998) Two-thirds of doctors, not 14% as you suggested, and this was nearly 20 years ago. There’s a good chance the results would be even higher in favor of chemotherapy, given that over the years chemotherapy has shown enhanced clinical benefits and medication to lessen the side effects has improved greatly. ((EBCTCG), 2011)

 “Say what you want,” Al cries defensively, “We all have a right to our opinions.” “This is so,” I lament, “But if it’s false that 86% of oncologists would refuse chemotherapy for themselves or loved ones, and you tell someone with cancer that it’s true, and that person chooses not to seek treatment because of it, then you’re partially culpable for the outcome. At a minimum, if you insist on holding this opinion, at least do more than read articles that make vague claims and general references. Find the research and read it.”

 (EBCTCG), E. B. (2011, December 6). Chemo after breast cancer surgery cuts deaths by one-third. Cancer Research Center UK News Report.

 Mackillop, W. (1987). Non-small cell lung cancer: how oncologists want to be treated. Int J Oncol Bio Phys. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3034842?dopt=Abstract

Thomsas J. Smith, M. (1998). Would Oncologists Want Chemotherapy If They Had Non-Small-Cell Lung Cancer?

The New Workplace: Employee Advocacy

A business may ask employees to actively promote the organization, often through social media, as an element of their jobs. However, the most compelling employee advocacy consists of freely-offered communications on the part of the workforce. The question of whether or not staff members are likely to freely promote an organization is highly related to the degree of employee engagement in the workplace, and employee engagement is largely a factor of the corporate culture and the employer’s ability to make working for them a positive experience. Forrester research studied the status of employee advocacy through a global survey of over 5,500 information workers. The survey used a 10-point Likert scale to quantify the response to two questions: How likely are you to recommend your company's products or services to a friend or family member? How likely are you to recommend a job at your company to a friend or family member? The results of Forrester’s research indicated that there is a great deal of room for improvement. Overall, the North American score was negative twenty-four percent on the employee advocacy score for recommending their company's products and services. Forty-nine percent of the information workers sampled were detractors, twenty-four percent were neutral and just twenty-seven percent were promoters. For job referrals, the overall score was negative sixteen percent, with forty-three percent detractors, twenty-nine percent neutral and twenty-seven percent promoters.

How do you know you're communicating with God?

How do you know that your connection to God, your personal relationship, isn't just a conversation in your brain? Write your own personal explanation using between 5 - 500 words and the author who's response helps me better understand this phenomenon will receive one ticket to the 2015 Wild Goose Festival. ( I purchaed the ticket hoping to attend but I won't be able to make it, maybe next year). Email me at treybien33@yahoo.com by June 18th, 2015. Background: on the continuum I sway between a reluctant athiest and a skeptical agnostic. I'm pretty far from the "true believer" end of the spectrum. But, I keep an open mind. Personally, I can't sense any reality beyond the natural world. So, I'm interested to understand how/why people of faith know their personal relationship with a supernatural being exists as opposed to it just being a dialogue in their mind/brain.

Didn't know it, but looks like I'm an Epicurean

Epicureanism is a system of philosophy based upon the teachings of the ancient Greek philosopher Epicurus, founded around 307 BCE. Epicurus was an atomic materialist, following in the steps of Democritus. His materialism led him to a general attack on superstition and divine intervention. Following Aristippus—about whom very little is known—Epicurus believed that what he called "pleasure" is the greatest good, but the way to attain such pleasure is to live modestly and to gain knowledge of the workings of the world and the limits of one's desires.

Words I Use Incorrectly

There’s great joy to be gleaned from using and understanding words with precision. For the linguistically inclined, it can be the pleasure of reading and writing. It can also be an obsession. Recently, for example, a man named Bryan Henderson made headlines for editing thousands of Wikipedia pages to eradicate the phrase “comprised of” in favor of “composed of.” Of course, even amongst avid readers, there are a handful of words that often are confused and misused. So we've rounded up some of these tricky word pairs and their definitions, adding sentences to help you remember the distinctions. Join in the fun by commenting with your own mnemonic sentences that include these words. Twins - Female twins posing in hats. Image ID: 1685125 eminent v. imminent eminent: adj. famous and respected within a particular sphere or present to a notable degree imminent: adj. about to happen She was an eminent author, winning prestigious awards and accolades. At the moment, what she was most anticipating was not the National Book Award ceremony, however; it was the imminent arrival of her breakfast burrito. substantive v. substantial substantive: adj. having a firm basis in reality and so important, meaningful, or considerable substantial: adj. of considerable importance, size, or worth My point is substantive, derived from thorough research, and it is this: Your substantial chocolate stash takes up an entire drawer, so you should be willing to share. censure v. censor censure: v. express severe disapproval of (someone or something) censor: v. examine (a book, film, etc.) officially and suppress unacceptable parts of it They wanted to censor the film, removing the sex scenes. So we censured the decision in a scathing op-ed article called, "Give the People What They Want!" indeterminate v. indeterminable indeterminate: adj. not exactly known, established, or defined indeterminable: adj. not able to be definitely ascertained, calculated, or identified The goodie bag's contents were indeterminate until we opened it. There we found a coupon worth "a gajillion hugs," a number of hugs that was indeterminable. denote v. connote denote: v. signify the literal meaning connote: v. (of a word) imply or suggest (an idea or feeling) in addition to the literal or primary meaning According to the dictionary, the word denotes strength. Unfortunately, when he used the word to describe my perfume, it seemed to carry a negative connotation, especially once he began coughing. elude v. allude elude: v. escape from or avoid (a danger, enemy, or pursuer), typically in a skilful or cunning way; fail to be attained by (someone) allude: v. suggest or call attention to indirectly; hint at He eluded the trip to see the horror movie by playing sick, but the following day, when his friends alluded to the scene when the zombie attacks, he actually felt ill. ambiguous v. ambivalent ambiguous: adj. open to more than one interpretation; not having one obvious meaning ambivalent: adj. having mixed feelings or contradictory ideas about something or someone She was ambivalent about the date because he was funny but also hogged the popcorn during the movie, which would give anyone mixed feelings. When he sent her an ambiguous text message that she couldn't decipher, she decided she preferred watching Downton Abbey to dating.