Respectful Insolence

Basic concepts

On our backchannel discussion forum, we ScienceBloggers have been discussing a rather interesting idea that we could use to provide extra value to our readers. The idea is to do short articles about basic concepts in science. It’s an intriguing idea, and, while I could try my hand at posts about a number of basic concepts in science, I think that, given my background, my strongest contribution would be basic concepts in my areas of expertise. These could include questions such as:

What is cancer?

What is a randomized clinical trial?

How does chemotherapy work? (Certainly The Cheerful Oncologist could also answer this one and do it perhaps better than I.)

How does radiation therapy work?

Both Chad and Jake are asking their readers for suggestions, and Mark has already started by posting an explanation of means, medians, and modes, as well as normal distributions; so I thought I’d ask you: What sorts of basic concepts about science or medicine would you like me to try to explain in a brief, hopefully pithy post. At this point I’m just looking for ideas. I’m not sure how well I could do this, given the my tendency towards long-windedness, and I tend to like to pontificate about things more than explain basic concepts, but I’m game to give it a try and see how it goes.

All I need are examples of basic concepts that our readers are interested in having explained.

Comments

  1. #1 Pseudonym
    January 17, 2007

    How about: How does anaesthetic work? And why is there no such thing as a “knock-out gas” like we see in the movies?

  2. #2 Ahistoricality
    January 17, 2007

    How about an introduction to simple surgery? I don’t understand how doctors can do so much cutting when a simple cut seems to cause so much damage and bleeding when done accidentally….

  3. #3 bones
    January 17, 2007

    For some articles such as “Why am I still breathing?” and “The craniorectal basis of my thoughts” would be enlightening.

  4. #4 Shinga
    January 17, 2007

    Judging by the recent and current discussions over at Dr. Flea, it would be very helpful to have an introduction to what vaccines are, how vaccines work and the concept of herd immunity.

    Regards – Shinga

  5. #5 Tanta
    January 17, 2007

    Orac, first of all, bless your heart. I carry you in mine.

    I am a stage IIIC ovarian cancer patient who has no CT/manual exam evidence of solid tumor or metastasis, but a still-elevated CA 125 (230, last count) at the end of “first-line” taxane/platinum therapy, to which I managed to develop a hypersensitivity response at cycle 8 and to which my CA 125 stopped dropping in response(it had been halving at each cycle). My doctor is recommending that I switch to liposomal doxorubicin. I could be a candidate for second-look surgery, but because I started chemo so quickly (one week) after my original surgery–given my severe ascites and my presurgery CA 125 level of 28,000 (“normal” being less than 35), that level of aggressiveness seemed warranted–I never fully healed from the surgery and have been dealing for months with an infected dehisced midline. I do not want to undergo additional surgery unless we think I’m done with chemo, at least in the near term, so that I can expect some reasonable chemo-free interval after surgery to heal. I know I have to have the second surgery eventually, assuming I have a reasonable enough prognosis to care, to permanently correct the complications of the first surgery and finish it (I was under too long; the surgeons “triaged” and I still have a uterus and cervix, as well as a colostomy, all of which I need to get rid of.) As that surgery will be relatively “dirty,” whatever we do to prepare for it (“enterocutaneous fistula” resulting from unhealed bowel resection, still mildly purulent in spite of all the IV and oral antibiotics we’ve tried), I’m out of the “normal” risk for infection and into one of those risk categories we all need help understanding. In any case, I dutifully did my “informed patient” research on doxorubicin, wherein I discovered that I must first decide whether I am “stable disease,” “platinum-sensitive,” “platnium-refractory,” “progressive,” “salvage,” “palliative,” or what. I am not suffering enough from effects of the cancer itself–I have no solid tumor anyone can see on CT or feel on manual, no bowel obstruction, etc.–to want “palliative” chemo at this point: I am only interested in continuing chemo right now if there is still some reasonable chance that it will put me into “remission,” if that’s a term that still means anything. But I’m having a very difficult time figuring that out, because of course the literature isn’t written with a lay reader in mind, my doctor is a well-meaning person but doesn’t have the time or, well, the communication skills to work these things out with me, and I end up sort of bouncing from just taking it all on trust (but I’m supposed to be an educated partner in my own health care) and cudgeling my tired brain against a subject I have not been prepared by education and training to grasp at a particularly sophisticated level (but I’m supposed to trust my doctor). The problem, you see, isn’t just understanding what “median survival time” means, although help with understanding the statistics would be appreciated. It’s also that one has to put oneself in a category (stage vs. diagnosis, occurrence vs. recurrence, stable disease vs. progression vs. metastasis, cure vs. salvage vs. palliation, sensitive vs. responsive vs. refractory, etc.) in order to find the right statistic to usefully interpret, and that’s probably harder than a lot of doctors think because you’re used to those terms and we aren’t, and your attempts to be kind to us (don’t overload on the jargon, use gentler terms like “stable disease” insead of “you are no longer getting better”) are appreciated when we are in our simple human emotion mode, but sometimes self-defeating when we are able to achieve enough distance to think rather than feel. I’m aware that means, more or less, that you’re damned if you do and damned if you don’t. I admire oncologists in no small measure because you are willing to enter this rigged contest with us patients, when you don’t have to. I’m trying to face certain facts, not to complain.

    Besides my own obvious self-interest in this, I cannot but think that the Cherrixes of this world and those who take an opinion on their choices might also benefit from a basic education in what these terms mean offered by a scientist and doctor who understands the high science (I almost cried when I got to the part about why my doxorubicin would be liposomal, just because thirty years ago, the last time I took a final exam in chemistry, I also almost cried, and it doesn’t really have anything to do with having cancer) but who is willing and so able–you’re a fine writer, Orac–to explain it to the rest of us.

    Thank you, very very much, in advance, for whatever you find the time and energy to do with this. If you need to know that you are making a real difference in the life of a lurker with cancer, know it now.

  6. #6 Noodle
    January 17, 2007

    I’ll second Shinga’s comment. A basic intro to vaccines would be good. An intro to cancer followed by something on chemo and radio therapy might be useful as well.

  7. #7 Runolfrl
    January 17, 2007

    How simple and basic could you be in a discussion of the steps physicians go through to diagnose a patient’s condition from symptoms and then decide upon a course of treatment. This could include how to make decisions about what tests are worth performing before prescribing medication or opting for surgery. Seems like this would be a good opportunity to explain the difference between what legitimate medical professionals do and what alternative practitioners do.

  8. #8 Dianne
    January 17, 2007

    How do T-lymphocytes change from being activated to memory cells? Why does immune memory sometimes fade? How do Tregs allow cancer cells to evade immune detection? Well, these are basic questions…you didn’t say basic questions with known answers.

  9. #9 qetzal
    January 17, 2007

    On a different tack, I’d enjoy a brief post explaining all the steps one goes through to become a practicing doctor, and what all those categories that we hear on ER & Gray’s Anatomy mean – intern, resident, chief resident, attending, etc.

    I’m sure I could look them all up if I was sufficiently motivated, but that applies to most of the other suggestions as well. Blog readers – we’re a lazy bunch!

  10. #10 Celine
    January 17, 2007

    It is said more and more that cancer is not A disease, but has many “sub species”. Could you give us an idea of what those subdivisions are?

    Thanks for your wonderfully witty blog ;-)

  11. #11 doctorgoo
    January 17, 2007

    This suggestion is meant to be tongue-in-cheek, but how about a post that explains the basics of woo, and the faulty thinking that unifies all the various types that we love each Friday?

    Not only would it be informative, but I’m sure you Insolence would make it very entertaining.

  12. #12 Baxter
    January 17, 2007

    Confusion between correlation and causality/ w references to epidemiological studies and cancer. The problems w drawing conclusions re how to treat an existing cancer based on what an epidemiological studies suggest is possibly good for prevention.

    Basics of how woosters peddle, w/links to past posts on testimonials etc… Include problem of drawing conclusions from in vivo and/or in vitro data (perhaps a whole separate post)

    Low dose naltrexone is being pushed to cancer patients– perhaps a post on this, altho probably doesnt fall into the basics category….

  13. #13 Renee
    January 17, 2007

    I second Runolfi above; I’d like to see something on the decision-making process that goes into making an accurate diagnosis, and what can happen if a doctor hits a dead-end, diagnosis-wide.

    Also, a brief primer on the basics of cancer surgery would be appreciated.

  14. #14 MattXIV
    January 18, 2007

    I second Ahistoricality’s request for an intro to surgical techniques. It’s not something that comes up very often in writing on medicine for a popular audience.

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