I’m pressed for time but wanted to draw your attention to a very interesting number of the New England Journal of Medicine, the top medical journal in the country. There are three fascinating features.
First, it turns out you can get, I kid you not, anthrax, from using animal-hide drums made in the developing world. Overpowered by funk, indeed. (old spores are liberated by the banging on the drum and then inhaled or swallowed.)
Second, a flawed but intriguing study suggests that Tai Chi may be beneficial when compared to listening to lectures and doing a few minutes of stretching in patients with fibromyalgia. While the study does not answer the question of whether it is the sense of empowerment, belief, and independence that comes from doing Tai Chi (or any similar practice) or something about channeling the qi itself (I rather suspect the former), it does suggest that lecturing to someone about fibromyalgia will not fix them. This also is an important step forward in demedicalizing certain conditions in which medicalization has often led to narcotic dependence and complications from injection therapy (I once met a lady who literally almost died from “trigger-point” injections). I am eager to see further studies that help to define what other disciplines or modes of empowerment will be useful in this disease and frankly will be delighted if enrollments in Tai Chi studios increase.
Third, a provocative study from Massachusetts General Hospital suggests that incorporating “palliative care” early in the course of metastatic lung cancer actually improves survival by 2 months, a result that will get a new chemotherapy approved by the FDA as beneficial. This is stunning, and we should be careful not to make too many conclusions from a single (albeit well-designed) study. Before we assume this is true, we should wait for more studies of larger groups of people. The authors suggest that the survival advantage relates to less depression among patients with cancer and point to well-known but probably misleading association between depression and early death in cancer. The other striking possibility, and one the authors do not address adequately with their data, is that aggressive care at the end of life may actually shorten it (there are other possible explanations as well). Often patients are presented with a dire choice–try more experimental chemotherapy (and the aggressive care that surrounds it), or you will be giving up and you will die. This study may suggest (and we need to remember to be tentative here) that choosing “aggressive” care may actually be shortening lifespan in some circumstances. A sobering thought indeed.
NOTE THAT THIS IS NOT MEDICAL ADVICE. THERE ARE MANY CANCERS THAT CAN BE ENTIRELY CURED BY CHEMOTHERAPY, AND THIS OBSERVATION, IF IT IS CORRECT, PROBABLY ONLY APPLIES TO LATER STAGE, MOSTLY EXPERIMENTAL, CHEMOTHERAPY.