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The Way We Have Always Done It

Posted October 11, 2012

That’s not the way we have always done it. That’s new. We can’t change the way we have always done it. Where are the double-blind, placebo-controlled studies?

Medicine is slow to innovate. While pharmaceutical drug reps may push the latest drug, in general medical doctors are slow to adopt any procedure or any therapy that is new. There are many reasons to explain this including the length of time doctors invest in medical school education, residency, and internship. You actually may hear a doctor say “I didn’t learn in medical school.” That is code for “it is new, unproven, and you won’t catch me using it.” After all, it something new fails to work, that practitioner is faced with explaining to the Board of Medicine that granted his/her license why something new was used in favor of something in current use, their malpractice carrier, and to an opposing attorney who may be seeking mega-damages. While the medical literature doubles every five years, many practitioners are so focused on the practice of medicine they fail to continue to read, learn, innovate with the excuse “I invested 4 years in an undergraduate degree, 4 years in medical school, 1-2 years in internship, and 2-6 years in residency. I am ready to just practice medicine.” In fact, many wags will tell you that medicine changes every 30 years, the length of time for a generation of practitioners to become educated, practice, and then pass away. The rising cost of medical school education and post-school training is a powerful incentive to keep your head down and just practice to make some money.

Just over a year ago my husband faced a diagnosis of Stage III Large B cell lymphoma. After consulting with a local oncologist, Dr. Ralph Moss of Cancer Decisions, Dr. Moshe Frenkel formerly of the Integrative Cancer Center of MD Anderson Hospital, and Dr. Robert Nagourney, director of Rational Therapeutics, Long Beach, CA., he made the decision to send a lymph node sample, specially prepared, to Rational Therapeutics for chemotherapy agent sensitivity testing  (more properly known as chemosensitivity and resistance assay or CSRA) . Because it was his second cancer challenge, he wanted to insure that he chose wisely regarding the agent that would be used to treat his lymphoma.

In his book “Customized Cancer Treatment”, Dr. Ralph Moss details the published studies and mainstream oncologists who embraced the testing and all the reasons why the oncology profession, by and large, now discards it as “that’s not the way we have always done it.”

We were provided a test kit by Rational Therapeutics Lab in which the radiologist would put the lymph node sample for the chemotherapy agent sensitivity testing. The radiologist was more than accommodating to comply with our request. Our own local oncologist, while indicating he was not familiar with this testing, agreed to write the necessary orders. When Rational Therapeutics called the next day to inquire why they had failed to receive the package containing the lymph node for testing, a saga ensued. It was finally determined the pathologist who handled the sample provided to him by radiologist who performed the biopsy under anesthesia using a portion for pathology and sending on the remaining sample to Rational Therapeutics, had decided on his own “That is not the way we have always done it.”  This same pathologist never replied to several letters of correspondence sent overnight mail to him. A second biopsy procedure under anesthesia was actually performed with all its inherent risks to obtain the necessary sample for testing.

When the results arrived, it was clear my husband was resistant to one of the proposed chemotherapy drugs in the five-drug mixture his treating oncologist intended to use. This particular chemotherapy drug was known for the side effects, often permanent, associated with its use. When we attempted to discuss leaving it out of the chemotherapy regime with which my husband would be treated, we were informed “That’s not the way we have always done it.“ Reluctantly, we agree to its use. The treatment was successful however my husband continues to suffer from the side effects associated this particular medication. While we took steps suggested Dr. Moss and Dr. Frenkel to mitigate the side effects of the chemotherapy drugs and were successful to a large extent, his quality of life will be negatively impacted, perhaps permanently, by this medication used that had no therapeutic benefit to him.

According to Dr. Jeffrey Blumberg of Tufts University School of Medicine, the research concerning nutritional medicine doubles every year.  Innovation in patient care is occurring at a rapid rate. Interestingly, recently USA Today recently printed an article entitled “Cancer cures could emerge from patients’ mini-tumors; they’re grown in lab, then tested with drugs”. Click here to read it in further detail.   The article concluded “The new technique may show in advance if a specific drug would help without losing time if it doesn’t work.”

The article detailed the medical nightmare of a 24-year old man who has endured over 350 surgeries since childhood to remove recurring tumors that now threaten his life. The promise of testing his tumor cells in a lab setting was to “test drugs to see which works best.”

I have considered sending a copy of the USA Today article to the pathologist whose decision caused a second surgical procedure and the oncologist whose decision caused the use of a medication to which my husband was resistant but from which he continues to suffer the side effects. What if the way we have always done it is not good enough?