Human Papilloma Virus and Cancers

In recent years, it has become clear that certain types of human cancers have a viral component to their etiology. Cancers due to Human Papilloma Virus (HPV) are most common among these. This has been a study of intense research for number of years. Specific types of HPV genotypes were found to be the causative agents of some common cancers, most notable invasive cervical carcinoma. Apart from this anogenital cancer, HPV’s are also causally associated with other anogenital cancers such as cancers of vulva, vagina, penis and anus. HPV is also responsible for approximately 20-30% of head and neck cancers.

Association OF HPV with Cervical cancer

The link between HPV and cervical cancer is now established beyond doubts. Many epidemiological, and molecular evidences suggest the causal association of HPV’s with cervical cancer. It has been estimated that about 500,000 women acquire cervical cancers every year and 75% of this are from developing countries. In United States about 13000 cervical cancer cases are diagnosed every year and about 7000 deaths annually from prevalent disease.
Evidence suggests that the great majority of all grades of cervical intraepithelial neoplasia can be attributed to cancer-associated types of HPV infections. It has been estimated that only about 10% of the HPV patients would develop cervical dysplasia and of these only few people would develop cervical cancer. Studies conducted on HPV DNA in a variety of genital lesions suggested that HPV types 16 and 18 are most closely associated with risk of genital cancers and some of HPV types are considered to be more prevalent among cervical cancer patients in a specific geographical areas; HPV 45 in Western African.
The development of cervical cancer is associated with factors other than just high risk HPV infection. Factors like impaired cell mediated immunity, long term use of contraceptives and smoking also increase the risk of gaining and the persistence of HPV types which in turn may lead to cervical cancers.

Association of HPV with other anogenital cancers

Strong links between HPV and anogenital cancers such as penile, anal, vulvar cancers have been demonstrated by many studies. These cancers are formed from lesions develop in the vagina, vulva, penis and anus as the result of sexual contact. But the exact role of HPV in the natural history of anal squamous intraepithelial lesions is still unknown.
Studies indicate that about 1% of sexually active adults in the United States show visible genital wart and about 15 % have sub clinical infection. The most commonly detected HPV types were found to be HPV 16 and 18. But, HPV types 56, 59-64 and 71 also have been isolated in vulvar intraepithelial neoplasia.

Association of HPV with head and neck cancer

The term head and neck cancer refer to the cancers in the oral cavity, lip, nose, para nasal sinuses, naso-pharynx, oro-parynx, larynx, oesophagus, salivary glands, soft tissues of the neck and ear. Oral cancer is the sixth most prevalent cancer worldwide and about 620,000 patients are diagnosed with cancer of oral cavity every year. Many studies have found evidence suggestive of a role for human papilloma virus in head and neck cancer. Though the exact mode of transmission of HPV infection in the head and neck region has not been determined, it’s association with sexual behavior and perinatal transmission have been demonstrated.
During the pathogenesis of HPV, it enters to the host through the mucosal epithelial layer surface. Oral mucosa resembles the mucosa of the genital region in their histological structure. As the correlation between HPV and cervical cancer are well established, the resemblance of the mucosal histology led to the suggestion that HPV could play a role in the development of benign and malignant lesions of the oral mucosa.
After the first report of papilloma virus in tongue carcinoma, many studies have shown the presence of HPV DNA in oral cavity and head and neck cancer. The most prevalent HPV types in these were found to be HPV 16 and 18. Further epidemiologic and molecular investigation should be carried out to establish a precise relationship between HPV and head and neck cancer.

HPV INDUCED CANCER DETECTION

Detective measures to date have centered on screening programs for HPV induced cancers. The most common and the traditional way of screening for cervical cancer and cervical dysplasia are to conduct a pap smear test. This has significantly reduced the incidence of cervical cancers in recent years. If the result is turned out to be positive, then the colposcopy would be carried. Since cervical cancer and anal cancer resembles in their biological features, it has been observed that screening for anal high grade squamous intraepithelial lesions with anal pap smear allows detecting individuals at risk of developing anal cancers. To obtain a confirmatory result, an anoscopic examination should be performed.
Detection of earlier stage of head and neck cancers as well as premalignant lesions can be done by regular physical examinations by the doctor. Any abnormalities should be further evaluated. An endoscopy is performed on the samples obtained from throat, larynx, and upper esophagus. Computed tomographic (CT) scans, magnetic resonances imaging (MRI) scans or ultrasounds could be performed to identify the size and extent to which the cancer has spread from its site of origin.
No standard screening tests are followed for vulvar cancers. In vulvar cancer lymph node pathologic status is the most important predictive factor. A study conducted by De Ceccoc et al indicated that Lymphoscintigraphy and sentinel-node biopsy under gamma-detecting probe guidance are easy and reliable methods for the detection of sentinel node in early vulvar cancer. Coloscopy can also be used to detect abnormalities on vulvar epethilia.
The above mentioned tests cannot be used to detect the presence or absence of the virus which would eventually cause a cancer. A test based on the hybrid capture technologies is now available to detect 13 cancer causing kinds of HPV. This technology is based on the principle of signal amplification of a hybrid species produced by RNA probes fixed with HPV DNA. Polymerase chain reaction is one of the most sensitive tests for HPV DNA detection. But Zhao M. et al suggest that there could be limitations in this method when applying to a broad population. Studies indicate that HPV DNA testing is one of the most effective tests which could be used for the prevention of cervical cancer.
In a study conducted by Reid et al, to compare the efficacy of cervical cytology, cervicography and/or DNA hybridization for cervical cancer screening, showed that none of the tests succeeded in identifying all the abnormalities.

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Ovarian Cancer - Don't Ignore the Warning Signs

Around 1.5 percent of women are likely to develop ovarian cancer at some stage of their life. It is less common than breast cancer but is considered as the most serious and fatal of all gynecological cancers.

The reason for this is that the cancer is usually advanced before it is diagnosed, making treatment difficult. The ovaries cannot be easily examined and, because the warning signs are unclear, late diagnosis is common.

Because of the lack of screening tests available, it is imperative to know the early symptoms and the possible risk factors.

Understanding ovarian cancer

The ovaries are two small organs that are a part of the female reproductive system and they are situated each side of the uterus. These ovaries contain germ cells that become eggs which are released when the woman menstruates.

They also produce estrogen and progesterone, the hormones that adjust the menstrual cycle and have an effect on the growth of breasts and body hair as well as affecting the development of the female body shape.

What types of tumors are there?

This normally happens in an organised manner but occasionally they grow abnormally and form a growth that we know as a tumor.

This tumor may be benign or it may be malignant. If it is benign, it is not cancerous and does not spread to other parts of the body. A malignant tumor, on the other hand, is cancerous and will often spread, making mestastases or secondary cancers.

Ovarian cancer is malignant and can occur in either one or both of the ovaries. There are three main groups that are related to the cells where the cancer starts.

Epithelial ovarian cancer, as its name implies, grows in the epithelium which is the surface of the ovary. It is the most common and accounts for around 90 percent of ovarian cancer. It mainly affects post menopausal women.

Another kind of epithelial tumor is a borderline tumor which grows much more slowly than its regular counterpart. These can normally be removed successfully even if diagnosed at an advanced stage.

There is a very rare form of ovarian cancer called germ cell ovarian cancer that starts in the cells that develop into eggs. This only accounts for about 5 percent of ovarian cancers and usually occurs only in women under 30.

The other five percent of ovarian cancers are generally sex-chord stromal cell ovarian cancer that affects the ovary cells responsible for female hormones. It can affect women of all ages.

Who is at risk of getting ovarian cancer?

The cause of ovarian cancer is unknown but there are some risk factors that have been identified through research. Although having these risk factors may increase your chances of developing ovarian cancer, they do not mean that you will necessarily get the disease. However, knowledge of these risk factors can be helpful. If you are concerned by having any of these risk factors, it is important to talk to your healthcare professional.

Factors that may increase your risk of ovarian cancer include:

Age- Around 90 percent of ovarian cancers affect women over 40.

Cultural background - Caucasian women in western society have higher rates of ovarian cancer than African or Asian women.

Number of pregnancies - Women who have never been pregnant appear to have a higher risk of ovarian cancer.

Family history - Between 5 and 10% of ovarian cancers are genetic. Researchers believe that the genes responsible for breast cancer (BRCA1 and BRCA2) are involved in almost all cases of familial ovarian cancer as well as familial breast cancer. It is also thought that these same damaged genes may be responsible for some endometrial and colon cancers. If you are genetically predisposed to any ovarian, breast, endometrial or colon cancers, you may have an increased risk of getting ovarian cancer.

Infertility and taking fertility drugs - Women who have had fertility drugs may be at a higher risk although infertility itself is a risk factor so this cannot be taken as a clear indication.

Hormone Replacement Therapy - The use of estrogen only HRT which is usually when you have had a hysterectomy, has been identified as a possible risk factor for ovarian cancer, particularly if you have been on this therapy for over ten years.

Lifestyle factors - Obesity is a risk factor associated with ovarian cancer as is a diet that is high in fat.

Can I reduce the risk of ovarian cancer?

Currently, there are no known procedures to prevent or detect early ovarian cancer but there are ways to reduce the risks. Some of these are:

Oral contraceptives - Research has found that the use of oral contraceptives can cut the risk of ovarian cancer by up to 60 percent if taken for a period of five years during your life.

Pregnancy and breastfeeding - Breastfeeding delays ovulation after childbirth and therefore decreases your risk of ovarian cancer. However, there is no guarantee that breastfeeding will stop you from developing ovarian cancer.

Enjoy a low fat diet - A high fat diet has been identified as a risk factor in ovarian cancer. Therefore, it makes sense to stick to a low fat diet with lots of fresh fruit and vegetables.

Tubal ligation or hysterectomy - These operations are only performed with a valid medical reason but it is believed that they both reduce the risk of ovarian cancer.

People with a strong family history of ovarian cancer may opt to speak to a genetic counselor that can assess whether you are at risk of developing the disease. If your family history suggests the damaged genes associated with ovarian, breast, endometrial, or colon cancer, it may be wise to have genetic testing. If these tests show the damaged BRCA1 or BRCA2 genes, you may be refe.rred to a gynecological oncologist to consider ways to reduce your risk.

Early symptoms of ovarian cancer

Because there is no screening test available for ovarian cancer, it is recommended that you have a regular pelvic vaginal checkup to see if there are any changes in your ovaries. It is also vital that you consult your healthcare specialist if you notice any possible signs of this illness. Because the symptoms are often common to many other medical conditions, diagnosis of ovarian cancer can be difficult

However, if you have any of the following symptoms that are unusual for you and that persist for more than a week, see your doctor without delay.

Some symptoms of ovarian cancer may include:

Stomach discomfort of pain in the pelvic area

Persistent nausea or wind.

Feeling constantly bloated or ‘full'.

Unexplained weight gain.

Loss of appetite or unexplained weight loss

Bowel changes

Frequency or urgency in urination

Lethargy.

Pain during intercourse.

Unexplained vaginal bleeding.

Sometimes, ovarian cancers are wrongly diagnosed as irritable bowel syndrome or menopause so if you are concerned, ask to be referred to a gynecological oncologist who can order tests to rule out ovarian cancer. It is rare that these symptoms will be ovarian cancer but if it is, early detection gives an excellent chance of survival.

Diagnosing ovarian cancer

If your doctor suspects ovarian cancer, you will be referred to a gynecological oncologist who will organize tests which may include any or all of the following:

An internal pelvic examination.

Blood tests

Chest and stomach x-rays.

A barium enema to rule out bowel problems

Ultrasound scans

If the results show a likelihood of ovarian cancer, you will be recommended to have an operation to confirm the diagnosis (none of the abovementioned tests can be sure). During the operation, if the surgeon finds ovarian cancer, they will normally remove the cancer as well as the ovaries.

It is important to understand before the surgery that this may happen so learn all you can about your illness and the outcomes before the operation.

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Information About Various Types of Cancer

The organs and tissues of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells. Cells in different parts of the body may look and work differently but most reproduce themselves in the same way.

Cells are constantly becoming old and dying, and new cells are produced to replace them. Normally, cells divide in an orderly and controlled manner. If for some reason the process gets out of control, the cells carry on dividing, developing into a lump which is called a tumour.

Cancer is a term for diseases in which abnormal cells divide without control and can invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems.

Brain Cancer

A brain tumor is a group or clump of abnormally growing cells that can be found in or on the brain. They're rare in kids Brain tumors can either start in the brain or spread there from another part of the body - some cancers that start in other parts of the body may have cells that travel to the brain and start growing there.

Lung Cancer

Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the United States. Cigarette smoking causes most lung cancers. The more cigarettes you smoke per day and the earlier you started smoking, the greater your risk of lung cancer. High levels of pollution, radiation and asbestos exposure may also increase risk. Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer.

It usually spreads to different parts of the body more slowly than small cell lung cancer. Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are three types of non-small cell lung cancer. Small cell lung cancer also called oat cell cancer, accounts for about 20% of all lung cancer.

Skin Cancer

Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer, melanoma, is more dangerous but less common. Skin cancers are the fastest growing type of cancer in the United States. Skin cancer represents the most commonly diagnosed malignancy, surpassing lung, breast, colorectal and prostate cancer. Cancer that forms in tissues of the skin. There are several types of skin cancer. Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in basal cells (small, round cells in the base of the outer layer of skin) is called basal cell carcinoma

Ear Cancer

Cancer of the outer ear occurs chiefly in instances where the outer ear has been exposed for many years to direct sunlight. A small and at first painless ulcer, with a dry scab covering it, that slowly enlarges and deepens may be a skin cancer. It is diagnosed by removing a small bit of tissue from the edge and examining it under a microscope.

Head And Neck Cancer

Tobacco is the most preventable cause of these deaths a lump in the neck Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible. Of course, not all lumps are cancer. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voice box (larynx), thyroid gland, or of certain lymphomas or blood cancers. Such lumps are generally painless and continue to enlarge steadily.

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Detect your Cervical Cancer With Pap Test!

Cervical cancer is the cancer of the cervix. It is a disease caused by the abnormal growth and division of cells that forms in the lining of the cervix. It is the second common form of cancer that affects women today. It is very common in middle age women and older.

The statistics of cervical cancer in the United States, according to American Cancer Society (ACS), shows that about 11,150 women are diagnosing with this cancer and approximately 3,670 women die from this cancer every year.

To understand more about cervical cancer, it is important to note what a cervix is first. The cervix is the lower part of the uterus (womb) that connects the uterus to the vagina (birth canal) in a woman's body.

Usually, cervical cancer exhibits no symptoms to detect the presence of cancer in your body. It is known as a slow growing form of cancer. When cancer develops in your body, the healthy cells in the cervix begin to change into abnormal cells, which then turn into pre-cancerous cells. If left untreated, these pre-cancerous cells will turn into cancer.
Risk factors of cervical cancer:
Although the cause of cervical cancer is not known there are certain risk factors that increase the risk of developing this cancer. Risk factors are the things that will affect the chances of developing a disease greater.

Human Papilloma Virus (HPV), a sexual transmitted disease is highly associated with invasive cervical cancer.

Sexual transmitted diseases occur due to sexual contacts with an infected person. Chlamydia, syphilis, gonorrhea, genital herpes, HIV/AIDS are some of he examples of sexual transmitted diseases.

Other risk factors that increase your chances of developing cervical cancer are: a history of sexual transmitted diseases, having sexual intercourse with multiple partners, having sexual activities in very young age (without using contraceptives).

Smoking doubles your risk of having cancer of the cervix. Weakened immune system, regular usage of birth control pills, age, giving birth to many children, and irregular pap tests increases your risk of developing cervical cancer.

As the cause of cervical cancer is unknown, it can be detected with regular Pap tests or pap smears. It is very important for you to have regular Pap tests to identify the condition early to take appropriate treatment and prevent cervical cancer from developing.
Pap test to detect cervical cancer:
With Pap tests, you can detect the cancer in the early stages before it spreads to other parts of the body. Pap smear is a procedure where scraped cells from the cervix are examined under a microscope to check for the changes in the cells of your cervix that leads to cervical cancer.

The rate of cervical cancer in women has greatly decreased in recent years in the United States due to regular pap smears.

As cervical cancer is a malignant tumor, it is very important for you to have Pap tests done annually. Remember, it is not a good idea to wait for signs to consult a doctor as early detection is the key to being treated successfully

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Cancer - One in Two Men and One in Three Women Will Get It. What to Do?

There is nothing that puts more fear in people than a diagnosis of Cancer. Statistically speaking, we now have one in two chances (male) or one in three chances (female) of getting cancer before the end of our life (American Cancer Society statistics for the year 2003). At the beginning of the 20th century, statistics gave us one in 500 chances of getting cancer.

All cancers considered, if you have a primary cancer (in one location only) the most optimistic statistics only give you 28% chances of recovery. If you have metastatic cancer (in more than one location) then your chances of recovery are 0.1% or in other words, one chance in one thousand to recover - (statistics from Dr Philip Binzel book "Alive and Well" published by American Media).

The news is bleak to say the least. However, as we will see later on, this need not be the case.

Ever since I can remember, I have read newspaper articles, heard claims on TV or radio, reporting new "wonder" cures on the war against cancer. Victory against this terrible disease was, according to these reports, just around the corner. Why is it then that so many people are still dying from this disease? Are the 600 UK cancer charities (The largest UK charities being Imperial Cancer Research Fund, Cancer Research Campaign and Institute of Cancer Research) lying to us?

The "American Cancer Society" is the richest charity in the world. All debts paid, it would still have half a billion dollars in the bank!

Linus Pauling, the winner of two Nobel prizes, seemed to think so when he said: "Everyone should know that most cancer research is largely a fraud and that the major cancer research organisations are derelict in their duties to the people who support them."

What is Cancer?

Modern researchers have for many years been exploring the virus connection at a cost of billions of dollars and pounds. The pitiful result is that "no cancer that was incurable 25 years ago is curable today and that, for the most common cancers that kills 90% of patients today chemotherapy is no better than snake oil" (The Cancer Handbook. What Doctors don't tell you publication. By Lynne Taggart).

When you are diagnosed with cancer, what the doctor is really saying is that you have one or several tumours in your body and that at least one of the tumours contains some cancer cells. They see the tumours as the enemy that has to be fought and destroyed and all their efforts are directed against eradicating the tumours.

What is a tumour though? A tumour is only a symptom; it shows that something has gone wrong in your body and that your immune system is no longer available to fight it. Many researchers claim that we all have tumours in our body and that several times in our life we get cancer. However, we do not all die from cancer. The reason is that our body's defence mechanism spring into action when a tumour is formed and gets rid of it or at least neutralises it. If cancer cells are beginning to form, these are killed off by our immune system and all is back to normal.

However if for some reason our immune system is severely deficient and we are unable to fight off the formation of the cancerous cells, then disease spreads.

What needs to be done to fight the tumour is not so much to remove it (surgery), burn it (radiation) or poison it (chemotherapy) as all these will weaken our immune system (damaging both our liver and kidneys to a point where it is difficult for our body to fight off any health problem). But to find out why the tumour formed in the first place and remove the cause.

Fighting it according to Dr Binzel is no good, our body now has in its memory the recipe to form tumours and uses the negative ingredients we feed it with to form new tumours and it will rarely stop doing so unless we remove the cause. The lack of positive ingredients (Vitamins, minerals and essential enzymes) to fight off the tumour is just as important.

Let me compare this reasoning with the simple example of a tooth infection. There is no point in taking painkillers to fix the tooth. I grant you that they will probably relieve the pain but I profess that they will not cure the tooth. What needs to be done is to get rid of the infection with antibiotics or have the tooth removed.

What do cancer cells feed on?

Several factors such as diet, negative emotions/ stress and environmental toxins are usually responsible for the development of cancer. Dietary speaking, cancer cells need food to survive. Dr Otto Warburg received the Nobel Prize for scientifically proving that cancer feed from the fermentation of sugar:

"in cancer cells [the feeding] is replaced by an energy-yielding reaction of the lowest living forms; namely, a fermentation of glucose" (quoted in prevention - May 1968).

According to Macrobiotic medicine theory, cancer cells also feed on animal protein (all types of meat, especially chicken but also very much on dairy, eggs etc..)

Detecting cancer

Currently, surgeons often perform a biopsy when cancer is suspected. A biopsy is a way of extracting a quantity of matter from a tumour and test it to see if it is cancerous. The problem with this method is that if the tumour is cancerous and the tumour is punctured, there is a definite risk that the cancerous liquid will spread to surrounding cells and spread the cancer around the body (Roger Delin - medical analyst - Philippines.

Breast cancer is often diagnosed using a mammogram. The main manufacturer of mammographic equipment is a company called "Smarlight Mammographics". They state: "We expected error rates to be around 30%, but the wide range of results (10%-90%) was an eye-opener." Amazing admission from the largest manufacturer of what is considered as the ultimate test to detect breast cancer. Unbelievable !

It is interesting to learn that autopsies have shown that many undetected cancers were present in the body of people who died from other causes. This makes a mockery of medical statistics and confirms that in fact a substantial number of cancers are never detected and do not obligatorily cause death.

A Swedish study has revealed that 15% of major cancers were not revealed before death and around half were of a type normally considered fatal (ref: wddty).

Modern approach and progress on cancer

The modern approach to treat cancer is surgery, radiation, chemotherapy, hormones and immunotherapy. The percentage of oncologists (cancer doctors) who would not participate in chemotherapy trials is an alarming 75% (due to its toxicity).
John Robbins

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Breast Cancer - Causes, Symptoms and Treatment

Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Over the course of a lifetime, one in eight women will be diagnosed with breast cancer. Breast cancer is a cancer of the breast tissue, which can occur in both women and men. Breast cancer may be one of the oldest known forms of cancer tumors in humans.Worldwide, breast cancer is the fifth most common cause of cancer death (after lung cancer, stomach cancer, liver cancer, and colon cancer). Breast cancer kills more women in the United States than any cancer except lung cancer. Today, breast cancer, like other forms of cancer, is considered to be a result of damage to DNA. How this mechanism may occur comes from several known or hypothesized factors (such as exposure to ionizing radiation, or viral mutagenesis). Some factors lead to an increased rate of mutation (exposure to estrogens) and decreased repair (the BRCA1, BRCA2 and p53) genes. Alcohol generally appears to increase the risk of breast cancer.

Breast cancer can also occur in men, although it rarely does. Experts predict 178,000 women and 2,000 men will develop breast cancer in the United States. There are several different types of breast cancer. First is Ductal carcinoma begins in the cells lining the ducts that bring milk to the nipple and accounts for more than 75% of breast cancers. Second is Lobular carcinoma begins in the milk-secreting glands of the breast but is otherwise fairly similar in its behavior to ductal carcinoma. Other varieties of breast cancer can arise from the skin, fat, connective tissues, and other cells present in the breast. Some women have what is known as HER2-positive breast cancer. HER2, short for human epidermal growth factor receptor-2, is a gene that helps control cell growth, division, and repair. When cells have too many copies of this gene, cell growth speeds up.

Causes of Breast Cancer

Simply being a woman is the main risk for breast cancer. While men can also get the disease, it is about 100 times more common in women than in men. The chance of getting breast cancer goes up as a woman gets older. Nearly 8 out of 10 breast cancers are found in women age 50 or older. About 5% to 10% of breast cancers are linked to changes (mutations) in certain genes. The most common gene changes are those of the BRCA1 and BRCA2 genes. Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother’s or father’s side of the family. Woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from the first cancer coming back Many experts now believe that the main reason for this is because they have faster growing tumors. Asian, Hispanic, and American Indian women have a lower risk of getting breast cancer. Certain types of abnormal biopsy results can be linked to a slightly higher risk of breast cancer.Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer

Some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of losing the baby. Recent studies have shown that these women (and their daughters who were exposed to DES while in the uterus), have a slightly increased risk of getting breast cancer. Use of alcohol is clearly linked to a slightly increased risk of getting breast cancer. Women who have 1 drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. The American Cancer Society suggests limiting the amount you drink.Being overweight is linked to a higher risk of breast cancer, especially for women after change of life and if the weight gain took place during adulthood. Also, the risk seems to be higher if the extra fat is in the waist area. Breast-feeding and pregnancy: Some studies have shown that breast-feeding slightly lowers breast cancer risk, especially if the breast-feeding lasts 1½ to 2 years. This could be because breast-feeding lowers a woman’s total number of menstrual periods, as does pregnancy. Women who began having periods early (before 12 years of age) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer.

Symptoms of Breast Cancer

1.Lumps.

2.Rash.

3.Breast Pain.

4.Cysts.

5.Nipple Discharge.

6.Inverted Nipple.

Treatment of Breast Cancer

1.Hormonal therapy (with tamoxifen).

2.Chemotherapy.

3.Radiotherapy.

4.Surgery.

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Stomach Cancer – Causes of Stomach Cancer

Stomach cancer is more readily treated when caught early. Unfortunately, by the time stomach cancer causes symptoms, it's often at an advanced stage and may have spread beyond the stomach. Yet there is encouraging news. You can reduce your risk of stomach cancer by making a few changes in your lifestyle. It is hard to diagnose stomach cancer in its early stages. Indigestion and stomach discomfort can be symptoms of early cancer, but other problems can cause the same symptoms. In advanced cases, there may be blood in your stool, vomiting, unexplained weight loss, jaundice or trouble swallowing.
Stomach cancer is more common in developing nations, while becoming less common in Western countries including Australia. At present, stomach cancer is still the fourth most common cause of death from cancer. There appear to be two types of gastric (stomach) cancer. Cancer of the stomach, or gastric cancer, is a disease in which stomach cells become malignant (cancerous) and grow out of control, forming a tumor. Almost all stomach cancers (95%) start in the glandular tissue that lines the stomach. The tumor may spread along the stomach wall or may grow directly through the wall and shed cells into the bloodstream or lymphatic system. Once beyond the stomach, cancer can spread to other organs.
Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original tumor and entering the bloodstream or the lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis. There are about 9,000 new cases of stomach cancer diagnosed every year and it's more common in men, particularly in late middle age. Stomoch cancer is on the decrease and is now about half as common as it was 30 years ago.

Causes of Stomach Cancer

Tobacco and alcohol use. Tobacco use can irritate the stomach lining, which may help explain why smokers have twice the rate of stomach cancer that nonsmokers do. Alcohol has been associated with an increased risk of stomach cancer, but the link between the two isn't clear.

Type A blood: Blood type groups refer to certain substances that are normally present on the surface of red blood cells and some other types of cells. These groups are important in matching blood for transfusions. For unknown reasons, people with type A blood have a higher risk of getting stomach cancer.

Cancer can either be malignant or benign. Benign cancer is curable, meaning that there is some medical way of being able to provide a curing solution to the cancer-hit part of the body. On the other hand, malignant cancer is a lot more serious since this means that cancer has developed into something complicated where medical resources have close to lesser chances of medicinal resolution.

People who have pernicious anaemia (an autoimmune condition where the lining of the stomach becomes thin, less acid is produced and anaemia develops due to lack of vitamin B12), atrophic gastritis, or a hereditary condition of growths in the stomach are at a higher risk of developing this type of cancer.

A diet high in salt and nitrates and low in vitamins A and C increases the risk for stomach cancer. Other dietary risk factors include food preparation (e.g., preserving food by smoking, salt-curing, pickling, or drying) and environment (e.g., lack of refrigeration, poor drinking water). A diet high in raw fruits and vegetables, citrus fruits, and fiber may lower the risk for stomach cancer.

Stomach polyps may become cancerous (malignant) and are thus removed. Adenocarcinoma of the stomach is particularly likely to develop if the polyps consist of glandular cells, if the polyps are larger than ¾ inch (2 centimeters), or if several polyps exist.
Exposure to certain dusts, molds, fumes, and other environmental agents at home or in the workplace has been linked to a higher than average risk of stomach cancer.Some experts believe that smoking might increase stomach cancer risk.

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Information on Breast Cancer

The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.

Breast cancer incidence is much higher in industrialised Western countries, whether in Europe or North America, than in developing countries. North American women have the highest incidence of breast cancer in the world. Among women in the U.S., breast cancer is the most common cancer and the second-most common cause of cancer death (after lung cancer). Women in the U.S. have a 1 in 8 (12.5%) lifetime chance of developing invasive breast cancer and a 1 in 35 (3%) chance of breast cancer causing their death. In 2007, breast cancer was expected to cause 40,910 deaths in the U.S. (7% of cancer deaths; almost 2% of all deaths)

Breast cancer is the most common cause of cancer in women and the second most common cause of cancer death in women in the U.S. While the majority of new breast cancers are diagnosed as a result of an abnormality seen on a mammogram, a lump or change in consistency of the breast tissue can also be a warning sign of the disease. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages and a resultant improvement in survival rates.

Breast cancer is the number one disease that women in the United States fear the most, and for compelling reasons. It is the leading cause of death among women between 40 and 55 years of age and is the second overall cause of death among women (exceeded only by lung cancer). Unfortunately, it is also on the rise worldwide. According to the American Cancer Society, this year about 175,000 new cases of invasive breast cancer and about 43,300 deaths from breast cancer will occur among women in the USA.

Breast cancer is the most common malignancy affecting women in North America and Europe. Close to 200,000 cases of breast cancer were diagnosed in the United States in 2001. Breast cancer is the second leading cause of cancer death in American women behind lung cancer. The lifetime risk of any particular woman getting breast cancer is about 1 in 8 although the lifetime risk of dying from breast cancer is much lower at 1 in 28. Men are also at risk for development of breast cancer, although this risk is much lower than it is for women.

Breast cancer is more easily treated and often curable if it is found early. Monthly breast self-examinations should begin at age 20. Recommended screening methods include breast self-examination and mammography.

The most serious cancers are metastatic cancers. Metastasis means that the cancer has spread from the place where it started into other tissues distant from the original tumor site. The most common place for breast cancer to metastasize is into the lymph nodes under the arm or above the collarbone on the same side as the cancer. Other common sites of breast cancer metastasis are the brain, the bones, and the liver.

Death rates from breast cancer have been gradually declining and continue to decline. These decreases are likely due both to increased awareness and screening and improved treatment methods.

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Cancer Bands

In 2004, the Lance Armstrong Foundation created the Livestrong cancer band. This was when these bracelets really became popular. The bracelets are used and worn to raise support and money for cancer research.

The Lance Armstrong Foundation was established in 1997 back when cyclist Lance Armstrong was able to overcome cancer. The foundations mission is to inspire as well as empower people affected with cancer together with their families and friends.

Today, these cancer bands are created for almost every type of cancer. These cancer bands are definitely a great way to support the research for cancer in hopes to find a cure.

Cancer Bands was created in order to inform people of these cancer bands as well as inform them about the many types of cancer. It is said that cancer is the second cause of death in the US - trailing behind heart disease.

Each year, more than a million Americans get some sort of treatment for cancer. Unfortunately, 330000 of them usually die. Cancer attacks people of all ages - from newborns to the elderly. Cancer Research was created to inform, help, and provide ways for people to learn about cancer and donate to cancer research. Cancer Research hopes that spreading the news and awareness of cancer through their website and through cancer bands will help safe lives.

The website provides information about all different types of cancer such as:

• breast cancer,
• prostate cancer,
• lung cancer,
• pancreatic cancer,
• colon cancer,
• skin cancer,
• ovarian cancer,
• cervical cancer,
• testicular cancer,
• liver cancer,
• bone cancer,
• thyroid cancer,
• stomach cancer,
• bladder cancer,
• brain cancer,
• throat cancer,
• kidney cancer,
• uterine cancer,
• and mouth cancer.

With every category of cancer listed on the website, users are able to read information about each type. The website provides information such as incidence of each type of cancer, signs and symptoms, who is at the most risk, prevention, and treatment.

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Cancer Awareness Ribbon Pins

Most people are familiar with the pink cancer awareness ribbons that symbolize breast cancer, it seems that these pink beauties are everywhere. But, did you know that there are many other kinds them out there that represent different kinds of cancer that affect women all around the world? You might have seen one or two different colored pins and not even known what they meant. Here are some of the other colors of cancer awareness ribbons so you will know what they mean the next time that you see them:

Teal This color of cancer awareness ribbons are for ovarian cancer. While this cancer isn't as prevalent as breast cancer, its numbers are, unfortunately, on the rise. So, when you see a teal cancer awareness ribbon or pin, you will know what they stand for.

Peach This color of cancer awareness ribbons are for uterine cancer. This type of cancer is also not one that is mentioned much, but is a killer if not detected early enough and fought correctly.

Lavender This color of are for gynecological cancer. This encompasses several different kinds of cancers, from ovarian to cervical, basically anything that has to do with the female reproductive organs falls under this category.

Teal and White This color are for cervical cancer. This cancer is hard to detect as well, unless it is screened for, but, when caught early, can be removed and treated.

All of these cancer awareness ribbons and pins are different colors to distinguish between the different types of cancer. It helps for survivors and loved ones to spread their message of hope and survival to those who may not have heard of this particular type of cancer and make sure that other women have their screenings to ensure that they catch these potentially fatal diseases early enough for treatments to be effective. So, the next time that you see different colored cancer awareness ribbon pins, be sure to ask the wearer about it and share their story with you. It might just be the motivation that you need to see your doctor and get screened or to push a friend or family member to get their screening. After all, women are more likely to push their friends and family to get in to see their doctors sooner than later. And, like the breast cancer pins and other types of cancer awareness merchandise, most of the proceeds go toward research and the search for a cure.

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Early Detection Of Any Disease Is The Key So What Are The First Symptoms Of Lung Cancer?

Much research work has been dedicated to find out the first symptoms of lung cancer. Cancer is that painful disease that needs no introduction and cancer of the lung is one of its most common forms. It is said that early detection of cancer is the key to its prevention.

Extensive research works conducted at Mesothelioma research clinics have uncovered some symptoms of lung cancer closely linked with the disease.

Lung Cancer Symptoms

People addicted to tobacco and those who are constantly exposed to the ill effects of asbestos are more susceptible to lung cancer. Ignorance about the symptoms of lung cancer may lead to a full-fledged blown up case.

Be on alert if you are having cough most of the time. This is one of the first symptoms. A related symptom may be a change in the nature of coughing. Other symptoms may be- being short of breath and coughing up bloodstained sputum. Mesothelioma research has established that aches while breathing, loss of appetite, fatigue and loss of weight can also be the first symptoms of the cancer of the lung.

These are considered to be the primary symptoms of lung cancer. There are secondary symptoms too.

Sudden development of a hoarse voice is one of the secondary lung cancer symptoms. Difficulty in swallowing is considered as another symptom of cancer of the lung.

Swelling of the face due to blockage of main blood vessel and swelling of neck due to enlarged lymph nodes may be other symptoms as well.

Treat pain in the right rib region and shortness of breath due to accumulation of fluid as warning signals of cancer of the lung. When you notice any of them, visit your physician for a thorough check-up.

Let's combat the deadly lung cancer together.


Source
About the Author
Jon Butt publishes www.the-mesothelioma-guide.com With the web being packed with mis-information www.the-mesothelioma-guide.com is a leading free resource of Mesothelioma support, advice and legal help along with alternative remedies, natural supplements and more. Helping both you and your loved ones

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Four Tips for Organizing Your Breast Cancer Journey

The breast cancer journey is filled with decisions, doctor visits, tests, treatments, medications, side effects, and stress. Below are some tips to help a woman newly diagnosed with breast cancer take control of this overwhelming experience.

Four Tips for Organizing Your Journey

1. Request copies of all your cancer treatment records and set up a personal medical file. Your file may include lab tests, pathology reports, x-ray results, prescription regimen, and follow-up care instructions. Over time, it’s easy to forget when you were treated, who treated you, and what kind of drugs you were given.

2. Buy a journal to organize your thoughts, take notes, and document your experience. Some days you may feel like writing in your journal and other days you won’t. Don’t worry about the entries being sparse; even a few notes can help you remember important emotions or milestones. Keeping a journal can be a great defense against feeling overwhelmed or afraid.

3. Use a directory to maintain personal and medical team information so it will be handy when needed. A directory is a good place to organize information such as physician names, office addresses, phone numbers, and email addresses for people you need to call in an emergency. You can also use the directory to record insurance policy information, contact names, and numbers.

4. Keep track of all of your doctor’s appointments, treatment dates, medicine doses, work schedule, and social activities in one calendar. In addition to recording your upcoming appointments, you may want to describe how you feel from one day to the next. This information will help you and your doctor find ways to make you more comfortable.

Staying organized during your cancer experience will help you stay calm and in control and will give you the order needed to focus your energy on becoming well.



About the Author: Kim Regenhard is a breast cancer survivor. In spring of 1998, Kim Regenhard discovered a lump in her breast. When tests confirmed the lump was cancerous, Kim felt her world had been turned upside down. Although shocked and scared, Kim quickly decided her best strategy would be to remain positive, active and to educate herself about the disease.

Now cancer free, Kim has used her skills and experience to develop a tool that will help others navigate the physical and emotional course of cancer. With the help of other breast cancer survivors, Kim has created A Survivor’s Guide for the Breast Cancer Journey, a gift from those who have walked and survived the breast cancer journey to those who find themselves taking the first steps.

To learn more about Kim Regenhard, RiverStone Journals, and Kim’s first book, A Survivor’s Guide for the Breast Cancer Journey,

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Breast Cancer Signs And Steps To Take

Breast cancer can strike at any age. Therefore, knowing the breast cancer signs and symptoms is very important, in addition to the actions you should take to catch cancer early in its course. Only your doctor can determine for certain whether any signs or symptoms you are experiencing are being caused by cancer. It is imperative to contact your physician immediately in the event you discover any of these signs. A lump, one which does not feel like the surrounding tissue, is often the first of several breast cancer signs. This is why it's important to do a regular self exam, because early detection is important. If you pay attention to breast cancer signs, you can have any symptoms investigated early on, and the sooner you are diagnosed, the more likely you are to triumph over this awful disease. There are several other breast cancer signs to be aware of, other than a lump. If your breast changes size or shape this is something to take note of and inform your doctor of right away. You might also have some dimpling of the skin on your breast. If your nipples become inverted or you have discharge from a single nipple, these are other things you should keep your doctor informed of. Women are increasingly aware of any changes in their breasts as potential signs of breast cancer. One collection of symptoms they need to pay especial attention to are those surrounding Paget's disease, since it can be an indication of cancer. It's effects can include itchiness, discomfort, flaky or irritation on the nipples, or heightened sensitivity. Only your primary physician will be able to make a final determination, so as with any unusual symptoms, make sure to see them if you notice any of these changes. Sometimes there are other symptoms that can tell you about cancer. a very rapid weight loss for which there is no reason, is sometimes a sign of breast cancer. Fever and chills without any apparent cause are also its symptoms. Bone or pain in the joints, jaundice and different neurological symptoms are also sometimes signs of breast cancer.So you have to keep a watch at these factors. One thing to keep in mind is that most symptoms of breast cancer don't end up being breast cancer. This does not mean that you shouldn't take any symptoms seriously. It simply means that until your doctor can take a look at you and let you know what is going on, there is no reason to be alarmed. Simply make an appointment and get yourself checked out.

About the Author: Breast cancer can strike at any age. Therefore, knowing the breast cancer signs and symptoms is very important, in addition to the actions you should take to catch cancer early in its course. One of the best factors in beating breast cancer is early detection. One of the best methods of detection is the monthly self exam. A lump in the breast is one of the signs of breast cancer. Only your doctor can determine for certain whether any signs or symptoms you are experiencing are being caused by cancer. It is imperative to contact your physician immediately in the event you discover any of these signs.

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What to do before You Have Breast Cancer Symptoms

Breast cancer is a major health concern and you need to know if you have breast cancer symptoms or signs. Women including men have breast cancer as I wrote in my last newsletter. According to the recent survey worldwide, breast cancer is the second most common type of cancer after lung cancer and the fifth most common cause of cancer death in the world.
Breast cancer is by far the most common cancer among women. The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly blamed on the way that we eat and the pollution that exists in the water, air, and food.

The other big factor in cancer is the thoughts that we have. Toxins and chemical pollution cause acid and free radicals in our body and so do negative thoughts. It is these acids and free radicals that change your body’s pH and that depletes the oxygen in your cells allowing cancer to form freely and to multiple.

To protect yourself against cancer, you need to know the signs of breast cancer so you can take action against it right away and to learn good nutritional habits.
Due to the high incidence of breast cancer among older women, screening is now recommended in many countries. Recommended screening methods include breast self-examination and mammogram. This test has been estimated to reduce breast cancer-related mortality by 20-30%. Routine and annual mammography of women older than age 40 or 50 is recommended.
Mammograms do not detect all possible cancer tissue. They can detect micro calcification of calcium, which might indicate the presents of cancer. Calcium can deposit in tissue and this is caused by an acid body. To stay in solution, calcium must have enough sodium in the surrounding liquid. In an alkaline body, there is plenty of sodium to keep calcium in solution, but in an acid body, calcium will precipate out and form crystals.

Early signs and symptoms of breast cancer are usually not painful. This may be the reason why most women don’t know they have breast cancer until after several breast cancer signs and symptoms start to appear. You should see your health care provider, if you notice the following:

· Lump in the armpit or above the collarbone that does not go away in two weeks or so. Although most breast lumps are not cancerous, it always best to check them out

· Breast discharge is a common problem and is rarely a symptom of cancer, but if it is from only one breast or if it is bloody, then check with your doctor

· Nipple inversion is a common in normal nipples, but nipple inversion that has developed recently can be of concern

· Changes in the breast skin including redness, changes in texture, and puckering. These changes are usually caused by skin diseases but occasionally can be associated with breast cancer.

Breast cancer is a condition where you lack oxygen in your cells and when you have an acid body. To prevent cancer from forming, you need to learn how to make your body more alkaline. In my new nutrition course, I concentrate on how you can make your body more alkaline. An alkaline body not only stops cancer but also stops and prevents most diseases from forming in your body.
Don’t wait until you have symptoms of breast cancer or any other disease before you start improving your health habits. Start now learning what good nutrition is and how you can be free from illness.

About the Author: Rudy Silva is a natural nutritionist that has a nutrition course that will help you prevent, stop, or eliminate illness. To find out more about how you can do this, go to: Using Nutrition to Stop Illness

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Hearing Voices

Perhaps, one form of illness where telling a story of the body is most evident is in respect to mental health.
Yesterday’s ruling by the High Court’s Court of Protection, that a 69 year old lady with severe schizophrenia must receive the medical treatment for a prolapsed womb, which she has been strongly refusing and protesting against, reveals the battle that one person’s voice can hold.
Is it pathology to not fight the presence of pathology in the body?

The High Court overruled this lady’s wishes because their position viewed the lady as being overruled by something other than herself. In this respect, is our modern take on mental health, or pathology for that matter, any different from perceptions that our scientific traditions have long abandoned?
Aside from the ethical debate, which has been prompted throughout this case, there is also the issue of what shall we hear?
What words were this lady’s story? And, what words are part of the construct of her illness?
The legal ruling clearly shows that the languages of health and the languages of illness are two distinct regions for the gathering of thought.
The underlying assumption is that this lady’s mental state affected her cognitive ability to be rational, which in turn was affecting her physical condition.
Currently spending time in South East Asia, in a research environment analyzing medical ethical issues, the underlying principles of belief appears to play a significant role in constructing both the experience of a sufferer from mental illness and their relationship with modern medicine. This is an aspect that is negated by workings of a scientific model of the body, which seeks to translate abnormal physiology to the norm. How accurate is such a divide between belief and non belief in traditional and modern medicine, respectively?
The late anthropologist and GP, Cecil Helman, in his book “Tales of a Suburban Shaman”, compared some of his experiences of illness interpretations in his native South Africa with those from his medical practice in London. One passage is particularly enlightening, whereby he describes a Zulu perception of bacteria and viruses. It is not so different, Helman argues, to conceive of as a virus in terms of possession and invasion of the body by an evil spirit.
For a Western scientific model of medicine, the image of a battle within the body is a metaphor.
In traditional medicine, this metaphor is part of the fabric of a story that is told about the body.
The allocation of cause in mental illness, as it is traced through Chinese and Malay traditions, takes it back to powerful forces that have affected a person. For example, mental sickness is the result of the work of kewis (devils). It is through worshipping shen (Gods) that mental sickness can be prevented and which possess healers through trance. During a trance, diagnosis and treatment is revealed.
Across time, therefore, through orthodox to modern medicine, there is a teleology that is threaded through the story of the body.
The differences in language hide a pattern of familiarity. There is a divide between good and evil, healthy and ill, and those who are suffering from those who are cured.
In South East Asia, the meaning of mental sickness is the isolation of the presence of evil spirits, and most sufferers opt to only consult traditional healers, of whom are considered equipped to fight such a battle.
In Western countries, the meaning of mental sickness is also of causality but of organic origins, as is most forms of treatment, and not as a reflection of a person’s spiritual misgivings.
Ultimately, the body is the host. And, the person is the sole provider for their experiential narrative of perception, of introspection towards their existence, including their formation of knowledge about their various states; mental, physical, existential conditions for example.
How the person is listened to is perhaps the most telling account of medicine’s relationship with the person, prior to the evaluation of the person’s relationship to their illness, whether it be physical or mental or both. And, in light of cultural interpretations for a human response of what may be the workings of physical processes or supernatural forces, the instinct is for human protection.
How the story of a person, like this lady’s’, can be both listened to, heard and preserved in its most natural form in accordance to the nurturing of a human, and of humanity, is an endearing and forever challenging task.
[ A link to the case discussed is : http://www.dailymail.co.uk/news/article-1316418/Mentally-ill-woman-faces-life-saving-surgery-will.html ]

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Hippocrates Prize for Poetry and Medicine: Call For Applications

The “Hippocrates Prize for Poetry and Medicine”, is now accepting applications for the 2011 entry and invites both national and international submissions.
Established in 2009, the competition represents the growing body of poetry that is being included in a variety of prestigious medical journals. An article published in the Lancet this year discusses the relevance of poetry for the physician and as a medium for recording our reflections on Medicine.
The role of medicine through societies and histories has always been integral to respective meanings of life and human experience. Contemporary medicine, however, is of an unprecedented nature. Technological advancements coupled with the development of different languages about the human body, such as molecular biology or neuroscience, have embraced the metaphysical aspects of the beginning and ending of our individual human existences more closely than ever before. The boundaries and definitions of the beginning and ending of life are fluctuating alongside our insights about the nature of the human body.
Thus, a poetic soundboard for such philosophising of medicine is very relevant and as many of us would argue, necessary, for the growth of a sophisticated medical practice.
The link for the poetry competition is :
http://www.hippocrates-poetry.org/
The article, “Poetry, Medicine, and the Hippocrates Prize” by Donald RJ Singer and Michael Hulse” :
The Lancet, Volume 375, Issue 9719, Pages 976 – 977, 20 March 2010; can be found at :
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60427-8/fulltext

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‘The Other Side of the Fence’ by Michael Corbo

Medical student Michael Corbo reflects on what he’s learnt from being a patient.
I am sitting on a green chair in the waiting room. I have been sitting here for hours, but it feels like it has been days. I keep looking at the clock on the wall beside me. The room is filled with people, but all I can hear is the resounding ‘tick tock’ coming from my right side. A thousand beads of sweat start to develop on my forehead, one for every thought racing through my mind.
“Michael Corbo!” My heart stops. “The doctor is ready for you now.”
I follow the nurse’s lead to the end of the hall where we stop at Operating Room (OR) #7.
The air in the OR is cold and crisp. I get on the table and lie down with my face towards the ceiling. Cold sweat begins to drip down my forehead. It is clear that I am apprehensive and yet, none of the healthcare providers have addressed how I am feeling. My hand nervously shakes as a line is inserted into one of my veins. I take one more gasp of air before my eyes gently close and will not open again for at least thirty minutes.
This is an experience that I have been through many times. However, it is the first time that I am the patient. After such an event, it has become clear to me that no matter how minor the procedure, the thought of surgical intervention and going under general anaesthesia is enough to generate a great deal of worry.
As a patient who was evidently nervous going into surgery, the question “why didn’t any of the healthcare providers address my feelings?” was still on my mind hours after the operation. I kept trying to tell myself that this question was irrelevant since the surgery was a success. However, as time passed and perspective was gained, I realized that my concern was a legitimate one. In a profession where another human being completely places their trust in you, how can the physician provide the best care without truly understanding what the patient is experiencing?
Understandably, the thought of entering into an emotional relationship with patients can be a scary notion. However, all medical specialties should have a keen focus on developing these skills and recognizing the most appropriate time to utilize them. To only treat a patient’s physical needs is inadequate; a Holistic approach in which emotional, mental, and physical aspects are all addressed would lead to increased patient satisfaction and care. This is not a skill that comes naturally, but must be practiced and perfected.
As a future physician, I sincerely hope that more resources can be invested into teaching medical students and residents how to treat the patient like a person, instead of just an interesting case. At the end of the day, the majority of people will not remember how well you performed at your job, but rather the level of communication and hospitality that they received while they were under your care.
michael.corbo@medportal.ca

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In Sickness and In Health : The Sharing of Pain in Namibia

Between a doctor and a patient, there is a very special and unique relationship contained in an exclusive realm. The connection is formed from the presenting of an illness and the sick are drawn to the healing. The healer in turn aspires to release the sick from their symptoms and pain. Our wonder of medicine sometimes overlooks the elements that symbolize the very nature of our human condition of this shared relationship – recognition, empathy, compassion of the Other. One example of the act of healing from Namibia however reveals the true essence of the human to human connection and the role of medicine in how we experience our world.
In the desert, distances away from the familiarities of the West, two women sit opposite each other on the bare earth. One of the women, an elder, is experiencing acute pain. She can locate the pain to her heart but the pain is all encompassing. It conducts through the whole of her body and smashes through one cell to another, carrying destruction to reach all of her being. The energy from the pain, its heat and the awareness of the body’s aliveness, transpires into a particular state. In this state, the woman focuses on expelling the pain that she believes is a curse.
The pain’s momentum is experienced as the speed of a spirit that has possessed her body. The body and the spirit are two separate entities that on this occasion have become entangled in her life force. The woman is not powerful enough to kill the curse. She can only direct it towards the woman, a healer, sitting opposite her.
The pain, or curse, is propelled from the body and it is invited to be absorbed into the body of the healer. The healer becomes possessed by the curse, and the elder woman is born back into life. The healer labors through the curse. The curse has entered her body but her powers of healing prevent it from identifying with her physicality. In a heightened trance the curse is combated. Slowly the healer begins to relax and the curse is dissipated.
As the cultural relativists would describe, a culture is a natural entity of which individuals are part of. The medicinal world that the woman elder and the healer belong to are as real and ingrained in experience as our hospital setting is in our experience. Yet, the narratives of each show a common illumination of our human discrepancy. Through embarking in a relationship of kindness – perhaps adopting the words of Hippocrates of “doing no harm” – medicine is the ultimate tenderness of care other than when a mother gives life to her child.
Whilst we in the West prescribe a third party into our medical relationships, namely that of chemical (pills)  or physicist (radiotherapy/ imaging) or biological (transplants) to embody the pain that illness curses, we still embark on a journey to remain with life.
The presence of pain, ironically, enables one to develop the skills to reach and help another person.
And , pain can strike in the deserts, on islands in the wide oceans, within the majesty of mountains or in the hospitals that are sterile and armed with technological apparatus to battle any invasion of suffering.
So, I believe that the lesson to carry in our minds, and let fly in our perspective is that of remembering that no matter how deep our knowledge may travel in the researcher’s laboratory, or the doctor’s clinical room, the essence of medicine is in the joining of one person’s experience to another.
How that experience is conveyed – whether through ritual or narrative or diagnostic charting – is only ever a symptom of what belies the curse of illness – namely, the gift of the relationship between the sick and the healing.

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’21st Century Medicine, Aristotle And The Church’ by Dr. Andrew R. J. Tillyard

I recently attended the funeral of the local parish priest and this led me to consider many of the similarities between what I do in medicine and the role of the ‘Parish Priest’ as well as the ‘misrepresentation’ of 21^st medicine. I work in intensive care, a setting of immense emotional stress for patients and relatives, and not infrequently for staff as well. Intensive care can appear more like the cockpit of an aeroplane – full of machines that bleep and flash as they keep patients alive. This, however, can belie the true meaning of what we do. There is an evolving mis-interpretation of what medicine is: that good medicine in the 21^st century is skill based technical wizardry, where ‘good’ doctors are people, who can diagnose, treat and cure using magnetic resonance imaging (MRI’s), gene therapy, or laser guided scalpels and the like.
I believe that what a patient wants first and foremost is a physician who is compassionate, honest and committed to their cause. Without these under-pinning attributes, their drive to find the best treatment for each of their patients will be diminished. William Osler said in 1907 that “You (physicians) are in this profession as a calling, not as a business, as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow-men. Once you get down to a purely business level, your influence is gone”.[1] And for ‘business level’ one could insert ‘disease or diagnosis’. The patient is just one part of the whole person just as the successful treatment is just one part of an illness journey (al-be-it a vital part). Knowing the physician is compassionate, committed and honest forms the foundation upon which the scientific wizardry starts to work. It also has a very real beneficial treatment effect (placebo). And this is where Aristotle returns to the fray of modern medicine.
Aristotle’s  Nichomachean  Ethics sets out the three stages of virtue ethics: arête (knowledge), phronesis (practical wisdom) and eudaimonia (flourishing – performing as an expert).[2] Part of knowledge is an understanding of what personal attributes (dispositions such-as compassion, humility, justice and courage which Aristotle called ‘virtues’) are required to ‘flourish’. As doctors (and I assume clergy) become more knowledgeable and experienced, the good virtues (dispositions) that make them strive to do the best for patients becomes in-grained in how one performs as a physician. Put generally, we professionals, sailors, gardeners, mothers, etc have a duty to do what we do with good intentions. And the more we do this, the better our abilities will be. Comte-Sponville has said that to flourish is an individual’s accountable task; virtue and especially that of compassion are pre-requisites and to be without them is to be ‘inhumane.’ [3] Virtue is ‘a force that has or can have an effect’: it gives the person their distinctive excellence. It is this acting well that makes a person ‘more humane’.  In Immanuel Kant’s terms, it is one of the individuals duty’s to others. [4]
An Aristotilean ‘good doctor’ or ‘good priest’ will not always make a good decision. Indeed, there is a circular argument here: it could be considered morally presumptuous to assume a consultant physician is a virtuous, or good doctor just on the basis of training or level of seniority, and therefore will always make good decisions. But, this in-part misses the point. It is the underlying virtues of a doctor that will make them reflect and study, coupled with experience and a desire to determine what is in the patients best interests, that will lead to good decisions. Put more simply, it is the underlying virtue to help that is necessary to start being of help.
As our lives become ever more technological (internet, texting and tweeting), there is a risk to three necessary elements of living well: communication, listening and understanding. There is a cliché – time heals all wounds, but I would argue based on my experience with patients and their loved ones that, providing them with understanding and a chance to voice their views, will heal those wounds more quickly. Thankfully, as technological advances allow us to preserve the heart beat of patients ever longer, the Department of Health is also starting to recognise the importance of understanding the person as a whole, as evidenced by the drive to allow patients to say what they would ideally like or not like when they come to the end of their lives (the “Preferred Priorities of Care” and “Advance Decisions” (living wills) documents that people can complete). This is first and foremost though, a role of family, friends and professionals.
References
1: Osler W. The reserves of life. St Marys Hospital Gazette. 1907; 13:95-8
2: The ethics of Aristotle: the Nichomachean ethics. (translated JAK Thompson, revised Hugh Tredennick). London, Penguin Books, 1976
3: Compte-Sponville A. A short treatise on the great virtues. London: Vintage, 2003
4: Ameriks K. ‘Immanuel Kant’ in The Cambridge Dictionary of Philosophy. Ed. R. Audi. Cambridge: Cambridge University Press 1999
Dr. Andrew R. J. Tillyard
Clinical Academic Lead for Medical Ethics and Law, Peninsula Medical School
Consultant in Intensive Care Medicine, Derriford Hospital
andrew.tillyard@pms.ac.uk

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‘Comics & Medicine: The Sequential Art of Illness’: Conference, Chicago, 9-11 June 2011

This second international interdisciplinary conference* aims explore the past, present, and possible future of comics in the context of the healthcare experience.  Programs in medical humanities have long touted the benefits of reading literature and studying visual art in the medical setting, but the use of comics in healthcare practice and education is relatively new.  The melding of text and image has much to offer all members of the healthcare team, including patients and families.  As such, a subgenre of graphic narrative known as graphic medicine is emerging as a field of interest to both scholars and creators of comics.
We are pleased to confirm two important keynote speakers: David Small, author of ‘Stitches’ and Phoebe Gloeckner, author of ‘A Child’s Life’
We invite proposals for scholarly papers (15 minutes), poster presentations, and panel discussions (60 minutes), focused on medicine and comics in any form (e.g., graphic novels, comic strips, graphic pathographies, manga, and/or web comics) on the following—and related—topics:

• graphic pathographies of illness and disability
• the use of comics in medical education
• the use of comics in patient care
• the interface of graphic medicine and other visual arts in popular
• culture
• ethical implications for using comics to educate the public
• ethical implications of patient representation in comics by
• healthcare providers
• trends in international use of comics in healthcare settings
• the role of comics in provider/patient communication
• comics as a virtual support group for patients and caregivers
• the use of comics in bioethics discussions and education

We also welcome workshops (120 minutes) by creators of comics on the process, rationale, methods, and general theories behind the use of comics to explore medical themes. These are intended to be “hands-on” interactive workshops for participants who wish to obtain particular skills with regard to the creation or teaching about comics in the medical context.
We envision this gathering as a collaboration among humanities scholars, comics scholars, comics creators, healthcare professionals, and comics enthusiasts.
300 word proposals should be submitted by Friday, 28 February 2011 to submissions@graphicmedicine.org. Proposals may be in Word, WordPerfect, or RTF formats with the following information and in this order: author(s), affiliation, email address, title of abstract, body of abstract.  Please identify your presentation preference: 1) oral presentation; 2) poster presentation; 3) panel discussion; or 4) workshop. While we cannot guarantee that presenters will receive their first choice, we will attempt to honor people’s preferences, and will acknowledge the receipt of all proposals submitted. Abstracts will be peer-reviewed by an interdisciplinary selection committee. Notification of acceptance or rejection will be completed by 14 March 2011.
This event is co-sponsored by the Medical Humanities and Bioethics Program at Northwestern University Feinberg School of Medicine, the Department of Humanities at Penn State College of Medicine, and the Science, Technology and Society Program of Penn State University, and is supported by a grant from the Charles Schulz Foundation.
*Information about the 2010 conference, “Comics and Medicine: Medical
Narrative in Graphic Novels,” in London, England can be found at
www.graphicmedicine.org.
Dr Ian Williams

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The Genie in the Syringe

Throughout the Christmas season, pantomime performances are one of the UK’s most favoured traditions. The pantomime has a long history with a genesis in Ancient Greek times. In our modern era, pantomimes are often adapted to feature contemporary twists and understandings about the unique and special meanings which have structured certain folk tales with a strength to survive the centuries.
In parallel, modern medicine has its roots in Ancient Greece and has seen many transitions and contemporary adaptations in the knowledge we possess about the human body.
Separated by worlds of fantasy and of reality, I have been struck by how the fables of pantomimes and the facts of medicine collide much closely than one would initially imagine.
“Aladdin” and “Ali Baba and the Forty Thieves” are some of the most famous tales taken from the “Book of One Thousand and One Arabian Nights”. Both of these are underpinned by the magic of transformation. The human body is suddenly enabled to perform the impossible and change the fate of our earthly physical determinants. Magic is also used in reverse to cast illnesses.
In Arabic folklore, the powers of changing fate and the body are called “djinn”, or the infamous “genie” in “Aladdin”. These are narratives reflecting some of the basic teachings in Islamic philosophy about our human condition. Djinns or genies, humans and angels are the three sentient creations of Allah. Like humans, djinns can be good or evil. In medicine, health is good and disease is the invasion of evil djinns.
The divide between creation and destruction, fate and transformation and good and evil is a common theme structuring the opposing worlds of fantasy and reality, pantomime and medicine. Modern medicine, however, does make me wonder. If medicine was not real, what would it be?
Another famous pantomime story is “Sleeping Beauty”, originating from the 16^th century. During this story, a princess is felled to sleep for hundreds of years and then awakened with the touch of another human being. Is this so different to modern medical metaphors? It is a practice in intensive care units to induce a coma and then to return consciousness to a patient.
Medicine is writing its own pantomime with fantasy of restoring life to a person through transforming the sick to the healthy.
There are many interventions akin to Aladdin’s lamp, hence the title of this blog “The Genie in the Syringe”. We insert substances, produce images from radio and sonar waves, manipulate the causal relationship between molecular processes to produce a transformation and create our own audiences in the operating theatre to the inner secrets of the body’s anatomy.
Medicine is a central character in our personal narration, sometimes featuring as a tragedy and at other times, as a miracle. As the meanings of folktales have changed over the centuries and changed from representing an integral part of life to forming entertainment, I wonder how the meaning of medicine will be perceived in future years. Medicine is already showing us performances between the doctor and patient that would have been beyond the imagination of the writers of “Aladdin” or “Sleeping Beauty” in the same way as their relevance exists in a different domain to the place from where it was written.
Thus, as the fantasy and reality of medicine grows in an evermore interweaved nature, it will be increasingly important to ground the roots of medicine’s own narrative in the stories that have stemmed from our curiosity and wonder about our own existence; how much we can change and how much is subject to an inevitable fate is the rule guiding the possible versus the impossible in medicine’s fight between good and evil, health and disease.

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Stories of the Land

Having recently visited some of the most modern hospitals in the world, I have been struck by the style of their architecture. There seems to be a changing face of medicine, whereby the expressions of the building housing the body of medicine mirror certain conceptualizations of the human body. I began to wonder how does this affect our experience of ourselves in both health and illness. From the compartmentalized, sterile structures of cosmopolitan cities to the shacks of mountainside shamans, what are the similiarities and differences to be found?

I have visited hospitals all over the world. I have seen the breeze block clinics hidden in the folds of the mountains of Lesotho, where the Basotho people shield Nature’s elements with huge blankets, cast around themselves like huge wings, too burdened with life to be able to fly.
I stood in the shadows of Pristina’s hospital, of a saddening grey exteriority, central to the country of Kosovo, from where its windows bore witness to the visitor of war haunting its walls, and burrowing into the ground holding its foundational pledge to heal and not to harm.
Then, I move to the neat boundaries of the United States of America and the towering glass buildings, ever so fragile yet not too afraid to expose and make transparent the anti-synthesis of health in this shining landmark. Inside the body remains within the same boundaries that map the grids of the city streets except it is not the way home that we are directed to but the different specializations evolved from years of intensive studying of the human body, that somehow finds the heart of Another in every room.
Following the sun set, I move to the South African plains, where fires and folk tales used to form the horizon swallowed up by an exodus to the cities, moving and forgetting the footprints of the Ancestors. In the air where communication would rise to those beyond a human freedom, the vast is open but empty. Its mind has wandered to a different pasture, into a nature we have created for a new way of being.
A transcending of physicality not quite sure where to go.
And I wonder for the movement of illnesses’ home in all of the travelling lands.
Where does the body of our Being become to belong to?
Hospitals are places where many people dread to enter, and contain the most important facets of our human condition; life, death, dying, and birth. It is therefore entirely understandable that the body, the identification of the person before us, and their experiences and memories are all represented within the structure of a hospital.
Our mind is the architect of illnesses design and hand in hand with Medicine itself, the corridors we walk through are ones constructed of hope, and perhaps, faith, and all lead to the envisioning of a cure, regardless of the material that the hospital is composed from.

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“Newspeak (PART TWO): British Art Now is doubleplusgood!” by Dr Jane R Moore

A few weeks ago I visited the new exhibition at the Saatchi Gallery with my group of 4^th year King’s College Medical Students. Visits to galleries, museums and art installations are an integral part of the ‘The Good Doctor’ Special Study Module but I hadn’t included the Saatchi Gallery before.  Modern conceptual art is challenging and I was uncertain how this visit would help in our exploration of medical matters. I need not have worried; our visit was enjoyable, reassuringly accessible and it was easy to make links to the theme of goodness in contemporary medical practice.
Newspeak Two on display in the large bright rooms at the Saatchi Gallery, King’s Road, London continues the showcase of contemporary British Art started in June 2010 with Newspeak One.  All the original exhibits, including the widely advertised Pink Cher by Scott King, have been replaced and the new collection opened at the end of October.  Charles Saatchi’s Sensation! exhibition (Royal Academy 1997) had – sensationally -  brought late 20th century British Art to public notice. This was the outing of Damian Hirst’s shark, Tracey Emin’s unmade bed, Mark Quinn’s blood sculptures, Chris Ofili’s ingenious uses of elephant dung and the Chapman Brothers doing what they do best – shocking us into a reaction.  So what would we make of Newspeak?
George Orwell coined the term newspeak in his dystopian classic Nineteen Eighty-Four[i].  This was the deliberately duplicitous politicians’  language which removed all shades of meaning from words.  For example, “think” used as both noun and verb makes the word thought superfluous so it can be abolished;  if pleasure / pain becomes  ”goodthink” any negative connotations can be dismissed.  In this way the total dominance of the State was reinforced leaving the population passive and malleable.  By calling this collection Newspeak is Saatchi mocking contemporary art?  Or is he referring to present-day “artspeak”, an artificial, pretentious, hollow and at times unintelligible discourse?  For our group this was our first link to contemporary medicine as we considered the role of  “medicspeak”.
Our guide, a postgrad art student, showed us some of her favourite pieces and gave brief descriptions.    We appreciated this guidance which allowed us to move on to our own interpretations and make links to contemporary medicine and society. On our own I think we would have been at a bit of a loss. Though a description of all we saw would not be practical here are some highlights.
Gallery 3 contained three massive, detailed and beautifully painted canvasses of men and machines by Jonathan Wateridge.  We liked Space Program 2008, a group of men posed in front of a spaceship under construction.  However on close scrutiny you could see the spaceship was a milk bottle, the launch control panel a mobile phone key pad, and the astronauts ‘spacesuits’ ordinary workmen’s overalls decorated with bits of household tat. Yet the men, in reality the artist’s friends, give the appearance of authority and confidence. We were reminded of Luke Fildes’ iconic picture The Doctor (1887).  This picture, painted at a time of increasing mistrust in the science of medicine, managed to suggest that medicine and the establishment as a whole, had the power to confront the difficulties encountered by society[ii].  In the same way we are lead to think that Wateridge’s unlikely astronauts’ competence and skill will surely lead to a successful expedition to further man’s mastery of outer space and so all is well with the modern world.
http://www.saatchi-gallery.co.uk/artists/artpages/jonathan_wateridge_space_group.htm
Anne Hardy (Gallery 5) has a series of four photomontages of ‘depopulated rooms that suggest surreal fictions’ according to the exhibition catalogue[iii]. What we saw were detailed photographs of the same space, some frames showing a clutter of carefully arranged seemingly miscellaneous objects:
http://www.saatchi-gallery.co.uk/artists/artpages/anne_hardy_cell.htm
Other frames showed an empty space with the outside crowding in;
http://www.saatchi-gallery.co.uk/artists/artpages/anne_hardy_drift.htm
We found these images claustrophobic but compelling; reminding us of both the workings of the human body with tortuous nerves and blood vessels, and of the machinery of modern medicine which cuts us off from normal communication with our patients.
In Gallery 10 The Followers, Ximena Garrido-Lecca has produced a huge reproduction of a Peruvian burial wall. Each niche containing photos, mementoes, plates of food or a bottle of beer by which the deceased were remembered by their grieving ‘followers’.  This is a beautiful exhibit, but after a short time as observers we became uncomfortable; we felt that we were intruding or showing a prurient misplaced interest in intimate details of people who had had no choice in the display and what it revealed. It was easy to make parallels to the role of the medical practitioner and our patients’ narratives.
http://www.saatchi-gallery.co.uk/artists/artpages/ximena_garrido_followers5.htm
So how do I justify this visit to the Saatchi Gallery to look at contemporary British art?  How can such activity be a valid and relevant and relevant contribution to undergraduate medical education?
Artists observe, capture and record visual images; when patients describe events, feeling, concerns, they set scenes using their own imagery; in turn, doctors listening to patients’ stories and descriptions form pictures in their own minds.  Looking at paintings and any art installations increases our observational skills and allows us an opportunity to practice the interpretation of visual images.  By engaging with the story behind the picture we try to discover our own reactions and in group discussion we have the opportunity to explore these feelings further.
Our visit to the Newspeak exhibition stimulated important discussion about important aspects of contemporary medicine which may not be encountered elsewhere in the medical curriculum. We may not have been able to understand it all the exhibits but certainly some of the pieces we looked at in the Newspeak exhibition were wonderful. We came away feeling we had risen to the challenge that modern art had presented and as a result expanded our horizons.

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Oncologist Sam Guglani wonders what medical care really means

Care infuses medicine. Well, the word ‘care’ infuses the language of medicine – Healthcare, Intensive Care, Palliative Care, Standard care, Standard of care, Best supportive care, Care Quality Commission. But what actually is medical care?Good medical care perhaps primarily describes the quality delivery of evidence-based therapeutic interventions, for example drugs, operations, scans, anaesthetics, and the organisation of services to permit these. It must also necessarily refer to the judgments around such interventions, that is to say the ethical consideration towards appropriate medicine. A skilfully performed pneumonectomy may not reflect good medical care in a patient dying from advanced lung cancer, for example. It seems reasonable then, to suggest that good medical care demands quality clinical medicine and ethical judgment. That the former requires rational thought may not come as a surprise, but the latter? In fact, contemporary ethics and moral philosophy place reason and rational thought at the core of what it is to make moral judgments and act ethically.
However, schools of ethical thought don’t always agree on what it is that constitutes the basis for moral action in medicine. For example, lying to patients may be considered to be bad because lying is bad in principle, or good if the lying perpetuates good outcomes such as hope, or bad again if the consequences, despite the good outcome of hope, generalise towards the negative, such as an erosion of trust.  Further to disagreeing on the basis for moral arbitration, the centrality of ‘reason’ may be questioned. ‘Care ethics’ gives weight, beyond rational thought, to the place of sympathy, emotional understanding and relationships in informing ethical judgments (Beauchamp and Childress 2001, p. 369)
Jonah Lehrer, in his book ‘The Decisive Moment’, describes the place of emotional understanding in morality:  ‘At its core, moral decision-making is about sympathy. We abhor violence because we know violence hurts. We treat others fairly because we know what it feels like to be treated unfairly. We reject suffering because we can imagine what it’s like to suffer.’ (Lehrer 2009, p 174) He goes on to elaborate on the evidence for emotion having a central role in ethical judgment and paints a very interesting picture in aligning often very rational thinking with clear acts of immorality. Even so, what about this, the idea of sympathetic and compassionate care in medicine?
Well, firstly, it seems as though, unlike the parameters of clinical/ technical care in medicine, compassionate care is harder to measure. Technical care is relatively easily measured and to a certain extent such data form the basis of the new outcomes framework for the NHS.  Healthcare staff in general and doctors in particular recognise this and to a certain extent aspire towards it. For patients and relatives, these data may be more opaque, unless significantly removed from the mean. As such, responsibility for judging, monitoring and delivering technically good care may be readily handed over to the profession.
Compassionate and empathetic care is harder to measure and in many respects therefore it just isn’t. Where currently is the section in our appraisal folders entitled compassion?  Doctors seem to value it much less and indeed we almost feel uncomfortable when discussing it.  Patients and families though, recognise this much more readily and indeed are generally very sensitive barometers of it.  Their assessment is probably more reliable, consistent and reproducible than any parametric measure we might use.  We all know (and can recognise ourselves when we become patients) the health worker who cares.
Such care can be a simple and empirical prompt towards good medicine, through sympathetic imagination: how would we want our family or indeed ourselves to be managed in such a situation? Of course this isn’t enough and is potentially open to abuse. But so is a version of medicine informed simply by good technical skills or good ethical judgment.
Compassionate and sympathetic care is arguably a primary prompt and governing steer for the entirety of good medical care. And it is the platform for engaging patients at times of often profound vulnerability. It might motivate finding the bed, asserting the need, chasing the results, over-booking the clinic, calling the family, developing the service, asking for opinions, clarifying all the evidence, seeking consensus, admitting the uncertainty and withdrawing the treatment. It is antithetical to hubris and necessarily connected to a proper medical professionalism, one founded upon a duty to patients rather than the rights of a privileged set.
How do we teach and foster this care? By recognising its importance – now more than ever in a resource -constrained, exponentially more technical NHS with increasing demand and possibility. By selecting students, training doctors and consultant appointments with this in mind. And, perhaps most challenging, but also most pressing, by decanting it through professional example.

References
Beauchamp, T. and Childress, J. (2001) Principles of Biomedical Ethics, Oxford, Oxford University Press
Lehrer, J. (2009) The Decisive Moment, Edinburgh, Canongate

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