A Comedian Tells the Story of His Child’s Cancer

Yesterday a video came my way on Facebook. It’s a stand-up piece by Anthony Griffith, who tells what it was like working as a comedian when his 2-year old daughter had recurrent cancer and died.

This 9 minute clip packs sadness and pain:

The Moth Presents Anthony Griffith

“If you don’t know about cancer, when it comes back it comes back hard.” It’s “meaner and stronger,” he explains. To compensate for its added aggressiveness, doctors raise doses of chemo and radiation. That’s not easy for anyone, a child no less.

He reflects on his daughter’s condition back then: “So she’s bald, which she doesn’t mind because every kid in the ward is bald, and she thinks it’s a part of life…”

He recalls his predicament, as a parent: “You’re not prepared for this. There’s no books, there’s no home-ed class to teach you,” he says.  Therapists were off-limits in his community. “So you try to figure it out.”

“What did I do?” he wondered, trying to make sense of his daughter’s illness. His musings cross all kinds of barriers.

Griffith was thrilled to appear several times on Johnny Carson’s Tonight Show. But NBC is “all about nice and everything is going to be OK.” He felt pressured to keep everything “light” when he wanted to speak honestly.

He recounts how he felt. “And I’m hurting, and I want everyone else to hurt because somebody is to blame for this,” he shouts, two decades later. He suppressed his anger, bucked up, and performed.

Rage persists, understandably, still.

The powerful clip is produced by the Moth, an NPO dedicated to storytelling. H/t to Jen Singer.

Thank you to Mr. Griffith, the comedian and actor, for telling it like it is.


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Don’t Blur the Message on Cancer Screening

This week the USPSTF renewed its position on ovarian cancer screening. The panel reminded the public that there’s no value in doing blood tests, like measuring the CEA, or having sonograms to evaluate healthy-feeling women for the possibility of ovarian cancer. One problem with the CEA measurement is that it goes up in various conditions; it’s not a specific test. Similarly, abdominal ultrasounds tend to pick up all kinds of blobby images that are rarely ovarian tumors. More often than not, ovarian cancer screening tests lead women to undergo more tests, such as CT scans and even surgery, without any benefit. The CEA tests and ultrasounds rarely “catch” ovarian tumors in an early stage.

This information on the lack of effective ovarian cancer screening methods is hardly news. What I hope is that this week’s headlines and editorials don’t add to the blurriness of the public’s perception of cancer screening – that people might think it’s a bad thing all around. The details matter. For some cancers, screening the general population – if it’s done right – can save lives and dollars. That’s because for most tumor types, treating advanced, metastatic disease is costlier than treatment of early-stage, curable tumors.

A few words on other cancers and screening –

Prostate cancer screening by PSA testing has never been shown to save lives. Because prostate cancer is unusual in young men and occurs commonly in elderly men, and in those cases tends to be slow-growing, screening’s potential – even if it were safe and effective – to save men’s life-years is limited. What’s different, also – and I think this is where some journalists get the story wrong by omission – is that early treatment of prostate cancer is rarely beneficial. By contrast, early treatment of breast cancer is often life-saving.

Lung cancer screening may be helpful in people at high risk, such as smoking, but one could argue that the CT scans used in those studies – which involve more radiation exposure than do mammograms, besides that they’re more costly – need a higher threshold of benefit to justify their use.

Colon cancer screening has been shown to save lives. For this tumor type, I think the issue is whether it’s worth doing colonoscopy in everyone over the age of 50, periodically, or better to test everyone for tiny amounts of blood (or, in the future, cancerous DNA markers) in the stool. Checking for occult blood in stood samples is a simple and perfectly safe method of getting a little bit of information about the probability of someone having a polyp or frank malignancy in the gut. If people who want to be screened for colon cancer would reliably take a sampling, it’s possible they might safely skip colonoscopy if there’s no evidence for bleeding or other signs of disease.

As for cervical cancer screening, that has definitely been an advance. Pap smears and other liquid cytology methods, now, perhaps HPV testing, have successfully countered this disease. Years ago, women would present, typically in their 30s, 40s or 50s, with large cancers pushing into the body of the uterus and lower abdomen. These were rarely curable. Rather than a scrape, or slightly bigger procedure in a gynecologist’s office, the women needed hysterectomies and radiation to the pelvis, which caused problems down the road if they were lucky and survived. In communities where young women get gynecological care now, we rarely see advanced cases of cervical cancer. For this disease, the question now is in fine-tuning the frequency of screening and understanding how HPV tests can inform or supplement the Pap smear.

As for mammography in breast cancer screening, please don’t get me wrong. I am not fixed in my position that it’s worthwhile and should be performed every other year in most women over the age of 40 until they reach the age of 70 or so, depending on their wishes and overall health. Rather, I acknowledge it’s far from a perfect screening tool, and I genuinely hope that in the future we’ll prevent breast cancer entirely or at least find a better, safer way to detect it early on. But until that happens, for the time being, mammography is a well-established, routine procedure that is the best we’ve got to prevent tens of thousands of middle-aged women from dying every year in the U.S. from metastatic BC.

I generally ascribe to the “less is more” school of medicine. But that doesn’t mean we should ignore early-stage breast tumors, especially when they occur in young-ish women. Rather, it means that we should treat what cancers we do find carefully and conservatively, with the least therapy needed to raise a woman’s chances of leading a normal, healthy and full life.

All for now,


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Notes on the Social History of American Medicine, Self Reliance and Health Care, Today

Over my vacation I read a bit on the history of health care in the United States. The Social Transformation of American Medicine, by Paul Starr, was first published in 1982. The author, a professor of sociology and public affairs at Princeton, gives a fascinating, relevant account in two chunks. In the first section, he details the rise of professional authority among physicians in the U.S. In the second part, he focuses on the relationship of doctors to corporations and government.

I couldn’t put this book down. Seriously, it’s a page-turner, at least in the first half, for anyone who cares about medical education, doctors’ work, and how people find and receive health care. In an early chapter, on medicine in colonial and early 19th Century America, Starr recounts the proliferation of medical schools and doctors, or so-called doctors, in the years after 1812. One problem of that era, besides a general lack of scientific knowledge about disease, was that it didn’t take much to get a medical degree. State licensing laws didn’t exist for the most part, and where they did come in place, such as in New York City, they were later rescinded. Then as now, many practicing folks didn’t want regulations.

Doctors were scarce and not always trustworthy. People, especially in rural areas, chose or had to be self-reliant. Many referred to lay sources for information. Starr writes of the “domestic” tradition of medical care:

…Women were expected to deal with illness in the home and to keep a stock of remedies on hand; in the fall, they put away medicinal herbs as they stored preserves. Care of the sick was part of the domestic economy for which the wife assumed responsibility. She would call on networks of kin and community for advice and illness when illness struck…

As he describes it, one book – William Buchan’s Domestic Medicine, was reprinted at least 30 times. It included a section on causes of disease and preventive measures, and a section on symptoms and treatments. By the mid 19th Century a book by John C. Gunn, also called Domestic Medicine, or Poor Man’s Friend…offered health advice in plain language.

Starr considers these and other references in the context of Protestantism, democracy and early American culture:

…while the domestic medical guides were challenging professional authority and asserting that families could care for themselves, they were also helping to lay the cultural foundations of modern medical practice – a predominantly secular view of sickness…the authority of medicine now reached the far larger number who could consult a physician’s book.

Reading this now, I can’t help but think of the Internet and other popular and accessible resources that challenge or compete with doctors’ authority. Other elements of Starr’s history pertain to current debates on medical education, credentialing and distribution of providers.

Just days ago, for example, the New York Times ran an editorial on a trend of getting Health Care Where You Work. The paper reported on Bellin Health, an allegedly non-profit entity, that designs on-site clinics for medium-sized companies. “It has managed to rein in costs while improving the availability and quality of care — in large part by making it easier for patients to see nurses and primary care doctors,” according to the Times opinion. The clinics are “staffed part-time by nurses, nurse practitioners or physician assistants, who handle minor injuries and illnesses, promote healthy living and conduct preventive screenings.”

The editorial touts Dartmouth Atlas data and other high marks for the care Bellin provides at low costs to possibly happy workers and their satisfied employers. Still, it’s not clear to me that an on-site clinic would be a great or even a good place to seek care if you had a subtle blood disorder or something like the newly-reported Heartland virus.

On reading the editorial on delivering health care to the workplace, I was reminded of Starr’s tale of the development of clinics at railroad and mining companies in the first half of the 20th Century. This happened mainly is rural areas where few doctors lived, at industry sites where injuries were frequent. The workers, by Starr’s account, were generally suspicious of the hired physicians and considered them inferior to private doctors whom they might choose if they became ill. They resented paying mandatory fees to support those on-site doctors’ salaries. Doctors’ groups, like the AMA, generally opposed and even ostracized those “company doctors” for selling out, or themselves, at a lower price.

The second half of the Social Transformation, on failed attempts at reform before 1982, is somewhat but not entirely outdated in light of Obamacare and 40 years intervening. But many of the issues, such as consideration of the “market” for doctors and the number of physicians we need, relate to the papers of this week including an Economix column by another Princeton professor, Uwe Reinhardt, who puts forth a view that, well, I don’t share. As I understand his position, Reinhardt suggests that there may be no real shortage of doctors, because physicians can always scrunch their workloads to fit the time allotted. But that’s a separate matter…

In sum, on the Social Transformation, today: Worthwhile! Curious! Pertinent! Starr’s book is chock full of history “lessons” that might inform medical practice in 2012. And I haven’t even mentioned my favorite segments – on prohibiting doctors’ advertisements (think websites, now), the average workload of physicians before 1900 (think 5 or so patients per day), and the impact of urbanization on medical care and doctors’ lives and specialization.

Lots to think about, and read.

All for now,



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