Does the risk of overdiagnosis mean people should stop getting cancer screenings?
Doctors on both sides of the debate increasingly say patients should weigh all the pros and cons—including their health, age, family history and tolerance for uncertainty—and decide for themselves.
That may sound obvious, but the concept of "shared decision-making" is still relatively new in cancer care. Some hospitals have started programs to implement it.
Proponents say shared decision-making requires doctors to be more candid about the upsides, downsides and unknowns of both screening and treating early-stage cancers.
"We in our health-care conversations have not adequately explained both sides," says Otis Brawley, chief medical officer of the American Cancer Society. For example, he says, mammograms do save lives, but not as many as most people think. For women in their 60s, regular screenings reduce the risk of dying of breast cancer by about 30%. "But 70% of women who were going to die of breast cancer will still die of it," Dr. Brawley says.
Patients often overestimate the lifetime risk of dying of cancer, he says. For prostate cancer and for breast cancer, it's about 2.7%. Put another way, for every 10,000 women in their 60s screened annually for 10 years, between five and 49 breast-cancer deaths will be averted; about 90 women will die of breast cancer anyway and 64 to 194 will be treated unnecessarily, according to a recent analysis in JAMA. An additional 940 will have biopsies that find no cancer.
For some patients, lowering even a small risk of dying of cancer is worth undergoing frequent screening and aggressively treating even low-risk cancers. Many cancer survivors say they are glad their cancer was found early, and don't second-guess if it needed to be caught at all. Some say they'd rather know they have even a low-risk cancer than stop looking and be left to wonder.
"Knowledge is empowering—you don't have to act on it, but you should keep an eye on it," says Gary Bloom of Olney, Md., who was treated for an aggressive papillary thyroid cancer 19 years ago.
Official screening guidelines, meanwhile, are moving away from one-size-fits-all recommendations and are telling patients to consult their doctors.
That takes more time, but doctors say it's the best way to manage uncertain risks and myriad human emotions.
Says dermatologist Brett Coldiron : "The era of paternalistic medicine is over."
Research shows that creativity and intelligence are linked with the physical connections in our brains. Here's how to connect the dots.
There’s a key difference between knowledge and experience and it’s best described like this:
The image is from cartoonist Hugh MacLeod, who came up with such a brilliant way to express a concept that’s often not that easy to grasp.
The image makes a clear point—that knowledge alone is not useful unless we can make connections between what we know. Whether you use the terms “knowledge” and “experience” to explain the difference or not, the concept itself is sound.
Lots of great writers, artists and scientists have talked about the importance of collecting ideas and bits of knowledge from the world around us, and making connections between those dots to fuel creative thinking and new ideas.
This is a really fun, inspiring topic to read about, so I collected some quotes and advice from my favorite creative thinkers about the importance of making connections in your brain. I’ve added emphasis to the important parts, but if you have time I’d recommend reading the whole post and even digging into the sources I’ve linked to.
To start with though, I want to look at some research that shows intelligence is closely linked with the physical connections in our brains.
The researchers found that, rather than residing in a single structure, general intelligence is determined by a network of regions across both sides of the brain.
One of the researchers explained that the study showed the brain working as a distributed system:
“Several brain regions, and the connections between them, were what was most important to general intelligence,” explains Gläscher.
The study also supported an existing theory about intelligence that says general intelligence is based on the brain’s ability to pull together and integrate various kinds of processing, such as working memory.
At Washington University, a research study found that connectivity with a particular area of the prefrontal cortex has a correlation with a person’s general intelligence.
This study showed that intelligence relied partly on high functioning brain areas, and partly on their ability to communicate with other areas in the brain.
Aside from physical connectivity in the brain, being able to make connections between ideas and knowledgewe hold in our memories can help us to think more creatively and produce higher quality work.
Steve Jobs is an obvious person to reference whenever you’re talking about creativity or innovation, so I wasn’t surprised to find that he has spoken about making connections before. This great quote is from aWired interview in 1996:
Creativity is just connecting things. When you ask creative people how they did something, they feel a little guilty because they didn’t really do it, they just saw something.
That’s because they were able to connect experiences they’ve had and synthesize new things. And the reason they were able to do that was that they’ve had more experiences or they have thought more about their experiences than other people.
… in order for us to truly create and contribute to the world, we have to be able to connect countless dots, to cross-pollinate ideas from a wealth of disciplines, to combine and recombine these pieces and build new castles.
She’s given a talk on this at a Creative Mornings event before, and made some great points. Being able to read about a wide range of topics is often one of of the most important elements. I really liked how she pointed out the way our egos affect our willingness to build on what others have done before:
… something we all understand on a deep intuitive level, but our creative egos sort of don’t really want to accept: And that is the idea that creativity is combinatorial, that nothing is entirely original, that everything builds on what came before…
My favorite part of this talk is Popova’s Lego analogy, where she likens the dots of knowledge we have to Lego building blocks:
The more of these building blocks we have, and the more diverse their shapes and colors, the more interesting our castles will become.
Author Austin Kleon is someone who immediately comes to mind whenever the topic of connections and remixing art comes up. Kleon is the author of Steal Like An Artist, a book about using the work of others to inspire and inform your own.
It starts off like this:
Every artist gets asked the question, “Where do you get your ideas?”
The honest artist answers, “I steal them.”
Kleon is inspiring because he’s so upfront about how the work of other people has become part of his own work. He’s also keen on the phrase I quoted from Maria Popova above, that “nothing is original”:
Every new idea is just a mashup or a remix of one or more previous ideas.
If you’re looking for advice on creating more connections between the knowledge you have (and collecting even more knowledge), Kleon’s book is a great place to start. He offers suggests like:
When it comes to the field of science, making connections between those dots of knowledge seems to be just as important. In The Art of Scientific Investigation, Cambridge University professor W. I. B. Beveridge wrote that successful scientists “have often been people with wide interests,” which led to their originality:
Originality often consists in linking up ideas whose connection was not previously suspected.
He also suggested that scientists should expand their reading outside of their own field, in order to add to their knowledge (so they would have more dots when it came time to connect them, later):
Most scientists consider that it is a more serious handicap to investigate a problem in ignorance of what is already known about it.
Nature no more obeys the territorial divisions of scientific academic disciplines than do continents appear from space to be colored to reflect the national divisions of their human inhabitants. For me, the great scientific satoris, epiphanies, eurekas, and aha! moments are characterized by their ability to connect.
After all, the more knowledge you have, the more connections you can make. Start by reading more, reading more widely, and exploring new opportunities for gathering knowledge (for instance, try some new experiences—travel, go to meetups or take up a new hobby).
As researcher Dr.Duezel explained when it comes to experiencing new things:
“Only completely new things cause strong activity in the midbrain area.”
So trying something new and forcing a gentle brain overload can make a dramatic improvement for your brain activity.
As Austin Kleon suggests, take a notebook (or your phone) with you everywhere and take notes. Don’t expect your brain to remember everything--give it a hand by noting down important concepts or ideas you come across. As you do this, you may remember previous notes that relate (hey, you’re making connections already!)--make a note of those as well.
You can do this even when you’re in the shower with something like Acqua Notes. The shower is especially a place that has proven to make us more creative.
Going over your notes often can help you to more easily recall them when you need to. Read through what you’ve made notes of before, and you might find that in the time that’s passed, you’ve added more knowledge to your repertoire that you can now connect to your old notes!
Cincinnati-based Bacterial Robotics is engineering a legion of so-called "bactobots" to do our bidding – in the fields of health care, industrial waste management and a litany of others.
It just received National Science Foundation funding to further develop its bacteria that can be used as a surgical tool. It is developing an organism that recognizes a certain type of skull-based tumor called a cholesteatoma that often leads to meningitis, brain abscess and death.
"Our goal is to inject the bactobot into the tumor, and have it recognize the tumor as a feedstock – and then destroy the tumor," CEO Jason Barkeloo said.
Code-named the Auribot, the engineered bacterium is being developed to augment current skull-based surgical practices, he said. It gives surgeons a consumable product that uses lysis to destroy residual cholesteatoma cells after the primary skull-based surgery is complete, he said.
The synthetic biology company is focused on taking natural genes – the genes that allow organisms to complete any given task in a natural setting – and move them into an "industrially robust bacteria," Barkeloo said.
"These little bacterial robots can do anything – produce biofuels, work as surgical devices, clean water – anything you can imagine a bacterium to do," Barkeloo said. "We’re working on one that strips paint off a wall."
The small company sold its first subsidiary, Pilus Energy, last year to San Diego-based Tauriga Sciences for $2.5 million. The bactobot it delivered cleans industrial customer waste.
The company’s business model involves developing these bactobots but then handing over further research and commercialization efforts to market experts.
"We’re able to launch a lot more bactobots then," Barkeloo said. "We’re not a cradle-to-grave company – maybe more of a cradle-to-diapers one."
Top 10 Israeli medical advances to watch in 2014 | ISRAEL21c
ISRAEL21c compiles a list of the 10 most extraordinary medical devices and pharmaceuticals that promise to revolutionize global healthcare.
Prof. Hossam Haick with the Na-Nose prototype.
We promised a top 10 list of the most exciting Israeli medical-device and pharmaceutical developments just around the corner. This list was very difficult to narrow down, because Israeli breakthroughs in this field are a near-daily occurrence. Our top 10 is just the tip of the iceberg....
1. Na-Nose http://israel21c.org/health/the-nose-that-can-smell-cancer-goes-commercialcan detect lung cancer from exhaled breath and will be commercialized in a joint venture with Boston-based Alpha Szenszor – after a few more years of development and testing by the US Food and Drug Administration (FDA). Invented by Technion Prof. Hossam Haick, Na-Nose (the “na” is for “nanotechnology”) has been proven in numerous international clinical trials to differentiate between different types and classifications of cancer with up to 95 percent accuracy.
2. Hervana http://israel21c.org/health/israeli-birth-control-product-wins-gates-grant/non-hormonal, long-acting contraceptive suppository won a $1 million development grant last year from the Bill & Melinda Gates Foundation. The Gates Foundation is banking on the product’s potential to provide a more accessible, cheaper and socially acceptable family planning option in developing countries, though it would be marketed in the United States and Europe .
3. Vecoy Nanomedicines http://israel21c.org/health/new-israeli-tactic-makes-deadly-viruses-commit-suicide nano-scale virus-traps (“vecoys”) capture and destroy viruses before they can infect cells, offering a huge advance over antiviral medications and even vaccines. Through the MassChallenge startup accelerator program last November, Vecoy’s platform was chosen to be tested in zero-gravity conditions on an upcoming NASA space mission.
4. CartiHeal http://israel21c.org/health/good-news-for-kneesAgili-C cartilage regeneration solution for knees can regenerate true hyaline cartilage (the most abundant type of cartilage in the human body) after six months, according to clinical results so far. Based on research at Ben-Gurion University of the Negev, the implant has earned the European Union’s CE Mark of approval. Further clinical studies could lead to FDA approval in the coming years.
5. Oramed Pharmaceuticalshttp://israel21c.org/headlines/groundbreaking-insulin-pill-nearing-marketseeks to change Type 2 diabetes treatment from a daily injection to a daily pill. Its oral insulin capsule recently received patent approval in the EU, and is in Phase 2 clinical trials under an Investigational New Drug application with the FDA. Jerusalem-based Oramed is also moving forward with clinical trials of a capsule to treat Type
6. Premia Spine http://israel21c.org/health/new-implant-is-alternative-to-spinal-fusiondeveloped the TOPS (Total Posterior Solution) System, aiming to revolutionize the spinal implant market with an artificial joint in the same way that total hip and total knee replacement systems made hip and knee fusions a thing of the past. TOPS is available already in Austria, Germany, the UK, Turkey and Israel. An FDA study is now in the follow-up
7. Mapi Pharma http://israel21c.org/headlines/mapi-pharma-patents-new-ms-pain-relief-drugsrecently won US patents for two promising slow-release platforms for drugs to treat multiple sclerosis symptoms and pain. “We believe in two to three years they could be in the final stage of development, and about three years to market,” says Mapi Pharma president and CEO Ehud Marom. Another slow-release platform for a schizophrenia drug is next in the pipeline.
8. Discover Medical introduced the SomnuSeal mask http://israel21c.org/health/new-device-for-sleep-apnea-is-easier-on-the-heart/for CPAP machines – used widely by sufferers of Sleep-Apnea – in Europe. If sales are successful, the US market will be next. Because SomnuSeal is more comfortable than the current masks used with the machine, compliance could be much greater. Plus, the device does not put strain on the heart as the current mask does.
9. Real Imaging is in the midst of European clinical trials of RUTHhttp://israel21c.org/health/a-game-changer-in-breast-cancer-detection, its radiation-free, contact-free, inexpensive and advanced imaging system for early detection of breast cancer.The system, which has won patent approvals in several countries, analyzes 3D and infra-red signals emitted from cancerous and benign tissue, generating an objective report that needs no interpretation. Founder and CTO Boaz Arnon presented RUTH at the most recent conference of the Radiological Society of North America. Initial release of the product will likely be in Europe sometime in 2015. RUTH, a hands-off breast cancer detection alternative.
10. NeuroQuest http://israel21c.org/health/blood-test-for-alzheimers has started clinical testing in the United States, under the auspices of Harvard Clinical Research Institute, for its ground-breaking blood test to detect early-stage Alzheimer’s disease. Initial trials in Israel showed NeuroQuest’s test – based on research by Prof. Michal Schwartz of the Weizmann Institute of Science – to be 87 % accurate with an 85% specificity rate in detecting Alzheimer’s and ALS, two common neurodegenerative diseases.
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About Abigail Klein Leichman Abigail Klein Leichman is a writer and associate editor at ISRAEL21c. Prior to moving to Israel in 2007, she was a specialty writer and copy editor at a daily newspaper in New Jersey and has free-lanced for a variety of newspapers and periodicals
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