sweasel.com

Note: please pretend this item was topped by a photograph of a squirrel skeleton; a priceless and unique work of the photographer’s art.

Not sure what, not sure where. Best guess: squirrel, walls. Never mind. Nothing says “buy this house!” like the pervasive stench of death.

Changing the subject, I had a doctor’s appointment yesterday (fine, thanks. Blood pressure check) and I read a really interesting article in Discover magazine about spontaneous remission of advanced cancers. Bad news: it’s extremely rare and they still can’t figure out why it happens. They think it’s an immune system thing.

In fact, they theorize that many of us host small cancers throughout our lives that we successfully put down. Only when a cancer reaches a certain potency are our immune systems overwhelmed. They liken it to a fire in the wastebasket: reasonably easy to put out unless the drapes catch.

They make the case that extremely early detection of cancers is, therefore, not such a boon after all. Especially for people at both ends of life. Relatively mild and slow-growing specimens of breast, prostate or skin cancer might smolder for many years with little impact; if you’re old, the cancer may be less life-threatening than the treatment.

When science developed a urine test for the common childhood cancer neuroblastoma, Japan began a routine screening program for infants. Ninety percent were screened, and those with the cancer were treated with the usual combination of surgery, radiation and/or chemo. Not only did survival rates for neuroblastoma not improve, but a percentage of infants died of the treatment. So some percentage of neuroblastomas clearly are either not life-threatening or spontaneously remit. The program was halted.

(I dug around to try and find how many cases turned up before and after they instituted the screen. Interestingly, many hits were to old articles praising the policy and claiming an overall reduction of mortality. Later reports, not so much. Sadly, it takes time for data to catch up with practice. Number of cases caught by screening in one prefecture were ten times the prior number).

This reminds me of something Theodore Dalrymple wrote (in An Intelligent Person’s Guide to Medicine, I think): there is no hard evidence that preventive medicine is a good idea. The whole Health Maintenance Organization structure is built on the proposition that catching disease before people feel sick saves money and lives in the long run. Sure, it makes sense. But lots of things that make sense simply aren’t true. Medication problems, mis-diagnosis and aggressive and dangerous treatments make over-doctoring a risky proposition.

Modern Western medicine is a great achievement. The moment I feel sick, you can be sure I’ll run to the man in the white coat and commence throwing Franklins at him.

But there’s a lot to be said for waiting until you feel sick.