Fingerprint science should be like medical science

This article in Nature looks at the science behind identification by fingerprints. As you read it, you will note how the technical side of identification meshes with practical and empirical reality, and how biases can and will be introduced. A good place for “kappa” studies, and examining a complex human system rationally.

Cancer biology. We know a lot, we don’t know quite a bit …

As we look at natural history in 513, it’s a good idea to remember that being a physician scientist involves having an open mind. We all have in our memories the standard picture of the rise and progression of cancer. One bad cells leads to two, then four etc. In pictures, a little ball of cells becomes a bigger and bigger ball. The message is that bigness is badness, and getting rid of the bigness is in some sense actually attacking the roots of cancer.

Pictures are not reality. This picture might reflect the underlying biological reality. But it might not. The facts we know are reality, and more than one picture might be compatible with the underlying facts. Take a look at this article in Science, which talks about circulating tumor cells and what they might mean. This ties in with an idea in cancer science that the important cells in cancer might actually be a small (actually tiny) subset of the tumor which are cancer stem cells.

The most important disease(s) is(are)?

Judging by television news, you might think that breast cancer is the only disease that exists. If we wanted to spend money on the disease or group of diseases that results (by a considerable margin) in the greatest lost of quality of life years the world over, denying young (and older) people of their lives and quality of life, we would spend our money on mood disorders, schizophrenia, and bipolar illness.

Psychiatry is often knocked by the rest of medicine as being relatively unscientific (ie its all about talking). But the psychiatric community has probably gone farther than most in putting (with some success) their discipline on a scientific basis. One of the remarkable things about psychiatry is the presence of a codified scientifically based diagnostic process. This is diagnosis at the RDC or gold standard. How this is done is quite a remarkable story in itself. Science has an ongoing series of article about the latest revision of the DSM. The articles so far are 1) Proposed Revisions to Psychiatry’s Canon Unveiled, 2) DSM-V at a Glance, 3) Behavioral Addictions Debut in Proposed DSM-V, and 4) Experts Map the Terrain of Mood Disorders.

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Replacing an immune system … it’s hard to do a study

Science (2010-Feb-12) has an article about ablating and replacing the immune system in various autoimmune conditions. It appears that some people have ongoing remission from their conditions (MS, scleroderma, lupus etc). The problem is that some people die from the intervention. The intervention is now being down only at very late stages of the illness because doctors can’t risk death at earlier stages. But it seems reasonable that the intervention would be more efficacious earlier. Would you sign up for a trial? What kinds of studies are sufficient to implement this therapy?

Brawling over mammography

A wonderful look at the recent controversy over mammography for women in the 40-50 age range is in the Feb 19 issue of Science (remember myVPN connection to UBC network). A great discussion of the intersection of evidence with the wonderful spectrum of humanity.

The most beautiful place on earth … will have the least chronic disease on earth … if only …

As outlined in the Vancouver Sun, Health Minister Kevin Falcon came across a striking finding reading a British newspaper last summer. He read that “people who take regular exercise, stay slim, eat a healthy diet and never smoke reduce their chances of developing chronic disease by almost 80 percent.” Thinking about this, he realized that “this issue of health promotion has to go far beyond just printing brochures and telling people they ought to live a healthier life.” Going on, he says “I think we have to figure out how we can be much more aggressive in pushing that kind of a health promotion onto British Columbians.”

Canadians tend to smile at American exceptionalism. These are difficult questions that no society, seemingly, has figured out up to now. Thankfully our Ministry of Health is onto this, and our province will lead the world to a solution, albeit aggressively. Hopefully this won’t involve Tasering people who actively resist the aggression that’s for their own good.

“It’s devastating … no going back to normal.”

Friday’s Globe and Mail had an article about women with breast cancer. These women were/are given a choice of four cycles of Taxotere, or twelve cycles of Taxol for their cancer. The efficacy of these two alternatives is about the same (apparently).

Taxol, the cheaper generic, has “a very tiny risk of permanent hair loss.” Taxotere has a 3 in 100 chance of permanent hair loss (alopecia universalis). This means permanent loss of all body hair (eyebrows, everything). Another study puts this likelihood as high as 6 in 100.

Most women, when given a choice, choose Taxol.

The company’s (Sanofi) response to this is: “We fully understand that persistent alopecia may be a burden for patients, but still we consider it’s certainly something which is not life-threatening or is not something which impairs the likelihood of survival.” In other words, “we saved your life, so there.”

Sounds  like a case of POEM, and a situation where values enter the equation. CDA anyone?

Blood-pressure cuff can curb damage of heart attack

Having an open mind is part of being a scientist. The Globe and Mail has an article about a clinical trial resulting from an idea of Dr. Andrew Redington (Hospital for Sick Children, Toronto). During the ambulance ride to hospital, people with suspected MI were randomized to having a blood pressure cuff inflated and deflated for alternating five minute periods (repeated four times). Once at the hospital they received usual care. You can see the whole writeup at TheLancet.com (type Redington into the search field to find the article).