In month of February I met a doctor, a surgeon, who is working for government insurance hospital. As i needed by certificates to be attested, i had approached this hospital and had bumped into him. As he came to know that i am an oncologist he started asking about breast cancer. His questioning made me realize that someone known to him is suffering from breast cancer and has also developed metastases. He mentioned that the lady is post menopausal and has hormone positive breast cancer. I drew the algorithm of breast cancer treatment and recommended him to start letrozole 2.5 mg and a bisphosphanate. I mentioned that letrozole may cause osteoporosis.
The surgeon intermittently kept calling me. Also i had to help him get letrozole as it was not available easily in local pharmacy shops. This non availability was also a result of restriction on its supply because it was being rampantly misused in treatment of infertility. Pharmaceutical companies used to sell letrozole for more than 35 Rs when marketed for infertility but same for breast cancer patients was available for around 2 Rs!!
Yesterday made a house call to the surgeon's home. The patient was none else than his wife. She was using a walker to help her walk and appeared tired. She had pain in thoracic and lumbar spine. It was tender on palpation. From what she mentioned made the clinical judgement that the left ischium, left side of pelvis are also involved. Went through her reports.
She was diagnosed of breast cancer in December 2010. She had undergone surgery in early 2011. Was advised adjuvant chemotherapy and radiation. She had declined to take them both. This fear of chemotherapy and radiotherapy was from what she had read and seen. Her mother had suffered from carcinoma cervix and had some side effects from radiation therapy.
This lady is well read, runs a trust and a school. Takes pride in social activities and is respected and consulted in local area. She surfs the internet for answers.
What she had gathered she has refused to take main stream medicine. She takes HOMEOPATHIC medicines. She is reluctant to stop taking homeopathic medicine.
When i asked the surgeon whether she is taking letrozole for last 3 months, he sheepishly mentioned that he had brought the tablets but she has not taken them because i had mentioned that it may cause osteoporosis. Ah! I regretted!
I gave them assurance, explained about observational bias. Somebody else had recommended MRI but since she is claustrophobic they did not want to get it done.
I strongly recommended that they should get 8 gray single fraction radiation to the painful bone areas. It should hardly take 60-90 minutes inside the hospital-from registration, X-ray to getting radiation done. Start letrozole immediately.
I did feel sorry for the doctor. Being a relative and a doctor is never an easy task. His decision making was hampered because of his emotions.He was concerned and also feeling guilty. But he was not making the right decisions.
I am hurt and angry. This is because there is no need for the lady to suffer in pain. She deserves a good palliative treatment.
What do we learn?
1. The scientific community fails to educate its own members about the risks and benefits of present and emerging evidence based treatment.
2. Fear handicaps and paralyses us. It also makes us take wrong decision.
3. Allowing homeopathic treatment to be available, accepted and taken by patients? Why do we not demand the same scientific rigor from homeopaths? The scientific community by being quite about it, is also equally responsible for nurturing unscientific treatments. I would love to be proved wrong about homeopathic medicine by good scientific research. See the reference section to what i could assess.
4. Anecdotal experience can wrongly influence doctors and patients decisions.
I know it is not easy to take decisions. I do not suggest that you should blindly accept experts. But please make an informed decision. Consult different doctors, take second opinion, speak to survivors.
This is only one of the stories which i have narrated. I have had multiple patients, educated and uneducated who have taken ayurvedic, herbal, homeopathic only to come back for palliative treatment.
References:
1. Bannerji protocol-Homeopathy http://www.homeopathyeurope.org/media/news/beneficial-effect-of-homeopathic-medicines-on-breast-cancer-cells
2.Homeopathy in general: http://rationalwiki.org/wiki/Evidence_for_homeopathy, http://www.guardian.co.uk/notesandqueries/query/0,,-9542,00.html
3. Treatment of metastatic breast cancer: http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page7
4. Treatment algorithm: https://tmc.gov.in/cancerinfo/breast/Popup/clinical%20staging%20algorithms-MBC.pdf
The surgeon intermittently kept calling me. Also i had to help him get letrozole as it was not available easily in local pharmacy shops. This non availability was also a result of restriction on its supply because it was being rampantly misused in treatment of infertility. Pharmaceutical companies used to sell letrozole for more than 35 Rs when marketed for infertility but same for breast cancer patients was available for around 2 Rs!!
Yesterday made a house call to the surgeon's home. The patient was none else than his wife. She was using a walker to help her walk and appeared tired. She had pain in thoracic and lumbar spine. It was tender on palpation. From what she mentioned made the clinical judgement that the left ischium, left side of pelvis are also involved. Went through her reports.
She was diagnosed of breast cancer in December 2010. She had undergone surgery in early 2011. Was advised adjuvant chemotherapy and radiation. She had declined to take them both. This fear of chemotherapy and radiotherapy was from what she had read and seen. Her mother had suffered from carcinoma cervix and had some side effects from radiation therapy.
This lady is well read, runs a trust and a school. Takes pride in social activities and is respected and consulted in local area. She surfs the internet for answers.
What she had gathered she has refused to take main stream medicine. She takes HOMEOPATHIC medicines. She is reluctant to stop taking homeopathic medicine.
When i asked the surgeon whether she is taking letrozole for last 3 months, he sheepishly mentioned that he had brought the tablets but she has not taken them because i had mentioned that it may cause osteoporosis. Ah! I regretted!
I gave them assurance, explained about observational bias. Somebody else had recommended MRI but since she is claustrophobic they did not want to get it done.
I strongly recommended that they should get 8 gray single fraction radiation to the painful bone areas. It should hardly take 60-90 minutes inside the hospital-from registration, X-ray to getting radiation done. Start letrozole immediately.
I did feel sorry for the doctor. Being a relative and a doctor is never an easy task. His decision making was hampered because of his emotions.He was concerned and also feeling guilty. But he was not making the right decisions.
I am hurt and angry. This is because there is no need for the lady to suffer in pain. She deserves a good palliative treatment.
What do we learn?
1. The scientific community fails to educate its own members about the risks and benefits of present and emerging evidence based treatment.
2. Fear handicaps and paralyses us. It also makes us take wrong decision.
3. Allowing homeopathic treatment to be available, accepted and taken by patients? Why do we not demand the same scientific rigor from homeopaths? The scientific community by being quite about it, is also equally responsible for nurturing unscientific treatments. I would love to be proved wrong about homeopathic medicine by good scientific research. See the reference section to what i could assess.
4. Anecdotal experience can wrongly influence doctors and patients decisions.
I know it is not easy to take decisions. I do not suggest that you should blindly accept experts. But please make an informed decision. Consult different doctors, take second opinion, speak to survivors.
This is only one of the stories which i have narrated. I have had multiple patients, educated and uneducated who have taken ayurvedic, herbal, homeopathic only to come back for palliative treatment.
References:
1. Bannerji protocol-Homeopathy http://www.homeopathyeurope.org/media/news/beneficial-effect-of-homeopathic-medicines-on-breast-cancer-cells
2.Homeopathy in general: http://rationalwiki.org/wiki/Evidence_for_homeopathy, http://www.guardian.co.uk/notesandqueries/query/0,,-9542,00.html
3. Treatment of metastatic breast cancer: http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page7
4. Treatment algorithm: https://tmc.gov.in/cancerinfo/breast/Popup/clinical%20staging%20algorithms-MBC.pdf
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