9 ms·

One of the ironies is that a very common side effect of standard issue chemotherapy is a marked and often permanent weakening of the immune system by altering a

feiss 11y ago
Until then, let the blood run.. :(
wyldfire 11y ago
What if the side effect of the chemotherapy (on appetite, etc) were actually responsible for more of the therapeutic value than the primary effect?
- lr4444lr 11y ago
  Incontrovertible proof that we deserve to be the laughingstock of the universe.
- ch4s3 11y ago
  The pathways involved in chemo destroying fast growing cells (traditional cytotoxic CTX) are pretty well understood. It isn't dissimilar to how T Cells work in your immune system.
  - wyldfire 11y ago
    Well, correct me if I'm wrong: you can understand the mechanism by which the chemotherapy acts in the body, but when trying to understand the effectiveness of the treatment you couldn't really isolate the "side effect" from the primary effect in terms of its therapeutic value. Unless you had chemotherapies which were effective despite a lack of those side effects.
    - ch4s3 11y ago
      You can compare it to more targeted forms of chemo (for a narrow range of cancers) that don't have those side effects, and to surgical procedures. The common thread here being that killing or removing the cells remediates the problem. You can also demonstrate that other things that cause similar side effects don't affect apoptosis (programmed cell death). I mean, it isn't like researchers pull these ideas out of thin air. Some forms of cancer are more thoroughly researched than just about any other topic in medicine.
- Mz 11y ago
  The gut constitutes about 70% of your immune system. I don't have cancer (though, as noted in a different comment of mine here, many of my relatives have had cancer) but I do have a genetic disorder that significantly impacts gut function. I have done a lot of reading and self-experimentation in this area. I also have a relative who was Patient Zero in a cancer study and another relative who was interviewed on tape for two hours by a doctor and whose views and practices changed the way two different cancer clinics dealt with certain issues for their patients. The path forward here is to come to a completely different understanding of the problem space. Allopathic meds have their uses, but it comes at a known high cost. This is why medications routinely have a long fold-out of warnings, provisos and explanations of the side effects. We know that chemo can permanently impair brain function as well. We know that it does all kinds of bad things to the body. We also know that overuse of antibiotics both harms the gut function and promotes antibiotic resistant infections. I think a first step in the right direction would be for conventional medicine to counteract the drug side effects after therapy is done. I have never had a doctor tell me that I should consume yogurt after being on antibiotics, though that is common knowledge in some circles. We just issue drugs and even when the side effects are known and some fairly easy counter to the side effects is also pretty well established, few doctors tell their patients "You need to undo the damage the drugs do to you and here is how." If we at least did that much, we could ameliorate some of this. That approach is totally within reach and essentially ignored.
jkot 11y ago
Blood letting was benefitial, it saved many limbs from amputation. Leech releases enzyme to prevent thrombus formation. That improves blood circulation.
- dsugarman 11y ago
  "Bloodletting (or blood-letting) is the withdrawal of blood from a patient to cure or prevent illness and disease. Bloodletting was based on an ancient system of medicine in which blood and other bodily fluids were regarded as "humors" that had to remain in proper balance to maintain health." - Wikipedia I am pretty sure leeches are still used, they are highly effective for the reasons you describe, but bloodletting is a dangerous practice of trying to get rid of blood from the body to cure someone.
  - rz2k 11y ago
    I'm pretty sure jcot is aware of the problemmatic theoretical foundations for historic bloodletting, and the attending reputation that persists. However the interesting part is that it could have therapeudic uses, but physicians are understandably adverse to performing a procedure considered typical of medieval quackery. Here's an excerpt from the BMJ: >Bloodletting was done by the barbers in England at the request of patients and must, therefore, have had some beneficial effect even if it was just a placebo effect. It is very possible, however, that there were very real benefits in selected patients especially those in left ventricular or congestive cardiac failure. In withdrawing blood the venular outflow pressure from capillaries and cardiac filling pressures would have been immediately reduced. The pressure gradient between capillary and interstitial fluid may have been decreased or even reversed if it was elevated(6,7). A reversal of the pressure gradient in oedematous patients would have promoted the mobilisation of oedema fluid and excretion in urine provided renal function was normal. Bloodletting would also have improved capillary blood flow, which can be severely disturbed in septic patients, by decreasing viscosity and improving the rheological chacteristics. >Repeated epsiodes of bloodletting will cause anaemia which is an independent risk factor for adverse outcome in patients with heart failure (8). As heart failure may cause anaemia by compromising the synthesis in the Krebs cycle of substrate needed for haemoglobin synthesis and blood formation in the bone marrow this risk might be a consequence of the heart failure rather than the cause. In adequately nourished and oxygenated bone marrow haemoglobin pools should be replenished by resynthesis unless the bloodletting was repeated too often. >In the short term bloodletting achieves what the venodilators glyceryl trinitrate and isosorbide mononitrate achieve, a reduction in venular outflow pressure in capillary beds. In patients with heart failure venodilators improve exercise performance and reduce mortality (9). Whilst ACE inhibitors, angiotensin II receptor agonists and beta blockers may also decrease mortality in patients in heart failure, partly or wholly by similar mechanisms, inotropes and beta agonists may increase mortality from heart failure. These medications have not been established to improve disability-adjusted or un-adjusted longevity. >Bloodletting might have been much more effective than venodilators and as effective as diuretics for in increasing th tone of the precapillary sphincters and establishing a pressure gradient between interstitium and capillary the excretion of oedema fluid would have been promoted. If in inducing a gastric intramucosal acidosis bloodletting were also to induce preconditioning by, for example, activating anf K(atp) channel, bloodletting might even have had extended benefits not seen with medical therapy. [1] I wouldn't agree that patients' requests meant that it must have been beneficial, since people willingly do all sorts of crazy things to their bodies based on the most tenuous new age theories. It also doesn't make sense that regular bloodletting would be beneficial to an already healthy subject, since we'd presumably have evolved with a mechanism to dispose of excess "bad humors". However, as an alternate mechanism for achieving results that treat a condition like congestive heart failure, it seems a lot like drilling a hole in your head to treat a head injury — ridiculous sounding, but effective in certain cases. [1] http://www.bmj.com/rapid-response/2011/10/29/treating-heart-failure-and-sepsis-bloodletting-and-leeches http://www.bmj.com/rapid-response/2011/10/29/treating-heart-...
catshirt 11y ago
it's fun, to think of what practices today will seem barbaric or primitive in the future. surely all "modern medicine" will fall into that category.
- dvdcxn 11y ago
  This assumes our future doesn't involve a global collapse of society.
  - deleted 11y ago
    [deleted]
- Udik 11y ago
  I strongly hope they will be seen as primitive. As for barbaric, I don't think so - our medical practices are based on (mostly) solid peer-reviewed studies and statistics, so at least we know that they do work, albeit in some cases definitely not enough.
  - Houshalter 11y ago
    To take a devil's advocate to that, there's not a lot of evidence that much of modern medicine is that helpful. I read about a study where people were given health insurance didn't do better than those without it, even though they went to the doctor far more, got better treatments earlier, etc. Another study that most surgeries weren't better than placebo surgeries. And we don't even test surgical placebos yet. And then another study that a significant portion of deaths were due to hospital errors. Of course that's ignoring that there is a lot of medicine that obviously does work and is great. No one is going to dispute that antibiotics are literally the greatest thing ever, or that insulin saves tons of diabetics, or that cancer treatment has saved a lot of lives. On the other hand some things we do are quite horrible, like keeping old people alive long past the point it's worth it. Or not cryogenically preserving everyone because it's "weird".
    - scottlocklin 11y ago
ansible 11y ago
One of the ironies is that a very common side effect of standard issue chemotherapy is a marked and often permanent weakening of the immune system by altering a person's microbiome. Advances in oncology perhaps within our own lifetime will make today's treatments seem as embarrassing as medieval blood-letting. It's embarrassing now, never mind later. We just don't often have better alternatives than to pump already sick people full of poison in the hope that the poison kills the cancer faster than the rest of the person. It is horrible, and has (in my opinion) only improved slightly in the last few decades.
- robbies 11y ago
  > pump already sick people full of poison I don't think it's unreasonable to ask for explanation/references/proof of what you mean when you say 'poison'. I don't know your particular experiences with chemotherapy, but I hear this soundbite parroted too often without any effort to actually research what chemotherapy is actually trying to accomplish. I'm not saying people shouldn't investigate their recommended treatment plans, but this often unwarranted suspicion of modern cancer treatment techniques is mystifying to me.
  - scarmig 11y ago
    It's a sound bite because it's true. That's not a reason to avoid chemotherapy--it's probably the best method we have right now of fighting cancer--but the biggest concern with prescribing chemotherapy is how much and how long can the patient sustain it, and does the benefit outweigh the costs.
  - iskander 11y ago
    Chemotherapy, for most cancers, achieves tumor shrinkage and a temporary extension of life, at the cost of severe life quality degradation. It's a tradeoff that most cancer patients think is worth it. I think that this therapeutic benefit puts us in a grey zone with regard to the definition of poison. The substances would undoubtably be considered poison in other contexts (e.g. mustard gas) but the doses are carefully calibrated to just-barely not kill a patient. Maybe "poison" is a function of usage intent?
Gatsky 11y ago
Disappointing to see a complex field summarised in this fashion. For some reason, ill-informed individuals love to adopt extreme views about cancer therapy and air them in public. This is totally irresponsible, and I hope nobody making decisions about cancer therapy reads this. For example: 1. 'Weakening' of the immune system is the wrong idea. Preclinical and clinical studies have shown that there is synergy between the immune system and chemotherapy, and also between the microbiome and chemotherapy. For some cancers, combining modern immunotherapies with other treatments including chemotherapy is likely to be necessary to achieve the best outcomes. 2. Your analogy to medieval blood letting is totally ridiculous. The chemotherapy used today has been carefully studied in randomised controlled trials with many thousands of patients. These patients have been followed up for many years with meticulous documentation of early and late side effects, disease outcomes and patient reported quality of life measures. This information is invaluable to patients who have to make decisions about the pros and cons of cancer therapy. Is chemotherapy pleasant? Definitely not. Do some people experience terrible side effects that may be permanent and life threatening or even fatal? Yes. But it saves lives, and it comes with a host of supportive therapies designed to make the process as tolerable as it can be.

feiss 11y ago

Until then, let the blood run.. :(

wyldfire 11y ago

What if the side effect of the chemotherapy (on appetite, etc) were actually responsible for more of the therapeutic value than the primary effect?

lr4444lr 11y ago
Incontrovertible proof that we deserve to be the laughingstock of the universe.
ch4s3 11y ago
The pathways involved in chemo destroying fast growing cells (traditional cytotoxic CTX) are pretty well understood. It isn't dissimilar to how T Cells work in your immune system.
- wyldfire 11y ago
  Well, correct me if I'm wrong: you can understand the mechanism by which the chemotherapy acts in the body, but when trying to understand the effectiveness of the treatment you couldn't really isolate the "side effect" from the primary effect in terms of its therapeutic value. Unless you had chemotherapies which were effective despite a lack of those side effects.
  - ch4s3 11y ago
    You can compare it to more targeted forms of chemo (for a narrow range of cancers) that don't have those side effects, and to surgical procedures. The common thread here being that killing or removing the cells remediates the problem. You can also demonstrate that other things that cause similar side effects don't affect apoptosis (programmed cell death). I mean, it isn't like researchers pull these ideas out of thin air. Some forms of cancer are more thoroughly researched than just about any other topic in medicine.
Mz 11y ago
The gut constitutes about 70% of your immune system. I don't have cancer (though, as noted in a different comment of mine here, many of my relatives have had cancer) but I do have a genetic disorder that significantly impacts gut function. I have done a lot of reading and self-experimentation in this area. I also have a relative who was Patient Zero in a cancer study and another relative who was interviewed on tape for two hours by a doctor and whose views and practices changed the way two different cancer clinics dealt with certain issues for their patients. The path forward here is to come to a completely different understanding of the problem space. Allopathic meds have their uses, but it comes at a known high cost. This is why medications routinely have a long fold-out of warnings, provisos and explanations of the side effects. We know that chemo can permanently impair brain function as well. We know that it does all kinds of bad things to the body. We also know that overuse of antibiotics both harms the gut function and promotes antibiotic resistant infections. I think a first step in the right direction would be for conventional medicine to counteract the drug side effects after therapy is done. I have never had a doctor tell me that I should consume yogurt after being on antibiotics, though that is common knowledge in some circles. We just issue drugs and even when the side effects are known and some fairly easy counter to the side effects is also pretty well established, few doctors tell their patients "You need to undo the damage the drugs do to you and here is how." If we at least did that much, we could ameliorate some of this. That approach is totally within reach and essentially ignored.

jkot 11y ago

Blood letting was benefitial, it saved many limbs from amputation. Leech releases enzyme to prevent thrombus formation. That improves blood circulation.

dsugarman 11y ago
"Bloodletting (or blood-letting) is the withdrawal of blood from a patient to cure or prevent illness and disease. Bloodletting was based on an ancient system of medicine in which blood and other bodily fluids were regarded as "humors" that had to remain in proper balance to maintain health." - Wikipedia I am pretty sure leeches are still used, they are highly effective for the reasons you describe, but bloodletting is a dangerous practice of trying to get rid of blood from the body to cure someone.
- rz2k 11y ago
  I'm pretty sure jcot is aware of the problemmatic theoretical foundations for historic bloodletting, and the attending reputation that persists. However the interesting part is that it could have therapeudic uses, but physicians are understandably adverse to performing a procedure considered typical of medieval quackery. Here's an excerpt from the BMJ: >Bloodletting was done by the barbers in England at the request of patients and must, therefore, have had some beneficial effect even if it was just a placebo effect. It is very possible, however, that there were very real benefits in selected patients especially those in left ventricular or congestive cardiac failure. In withdrawing blood the venular outflow pressure from capillaries and cardiac filling pressures would have been immediately reduced. The pressure gradient between capillary and interstitial fluid may have been decreased or even reversed if it was elevated(6,7). A reversal of the pressure gradient in oedematous patients would have promoted the mobilisation of oedema fluid and excretion in urine provided renal function was normal. Bloodletting would also have improved capillary blood flow, which can be severely disturbed in septic patients, by decreasing viscosity and improving the rheological chacteristics. >Repeated epsiodes of bloodletting will cause anaemia which is an independent risk factor for adverse outcome in patients with heart failure (8). As heart failure may cause anaemia by compromising the synthesis in the Krebs cycle of substrate needed for haemoglobin synthesis and blood formation in the bone marrow this risk might be a consequence of the heart failure rather than the cause. In adequately nourished and oxygenated bone marrow haemoglobin pools should be replenished by resynthesis unless the bloodletting was repeated too often. >In the short term bloodletting achieves what the venodilators glyceryl trinitrate and isosorbide mononitrate achieve, a reduction in venular outflow pressure in capillary beds. In patients with heart failure venodilators improve exercise performance and reduce mortality (9). Whilst ACE inhibitors, angiotensin II receptor agonists and beta blockers may also decrease mortality in patients in heart failure, partly or wholly by similar mechanisms, inotropes and beta agonists may increase mortality from heart failure. These medications have not been established to improve disability-adjusted or un-adjusted longevity. >Bloodletting might have been much more effective than venodilators and as effective as diuretics for in increasing th tone of the precapillary sphincters and establishing a pressure gradient between interstitium and capillary the excretion of oedema fluid would have been promoted. If in inducing a gastric intramucosal acidosis bloodletting were also to induce preconditioning by, for example, activating anf K(atp) channel, bloodletting might even have had extended benefits not seen with medical therapy. [1] I wouldn't agree that patients' requests meant that it must have been beneficial, since people willingly do all sorts of crazy things to their bodies based on the most tenuous new age theories. It also doesn't make sense that regular bloodletting would be beneficial to an already healthy subject, since we'd presumably have evolved with a mechanism to dispose of excess "bad humors". However, as an alternate mechanism for achieving results that treat a condition like congestive heart failure, it seems a lot like drilling a hole in your head to treat a head injury — ridiculous sounding, but effective in certain cases. [1] http://www.bmj.com/rapid-response/2011/10/29/treating-heart-failure-and-sepsis-bloodletting-and-leeches http://www.bmj.com/rapid-response/2011/10/29/treating-heart-...

catshirt 11y ago

it's fun, to think of what practices today will seem barbaric or primitive in the future. surely all "modern medicine" will fall into that category.

dvdcxn 11y ago
This assumes our future doesn't involve a global collapse of society.
- deleted 11y ago
  [deleted]
Udik 11y ago
I strongly hope they will be seen as primitive. As for barbaric, I don't think so - our medical practices are based on (mostly) solid peer-reviewed studies and statistics, so at least we know that they do work, albeit in some cases definitely not enough.
- Houshalter 11y ago
  To take a devil's advocate to that, there's not a lot of evidence that much of modern medicine is that helpful. I read about a study where people were given health insurance didn't do better than those without it, even though they went to the doctor far more, got better treatments earlier, etc. Another study that most surgeries weren't better than placebo surgeries. And we don't even test surgical placebos yet. And then another study that a significant portion of deaths were due to hospital errors. Of course that's ignoring that there is a lot of medicine that obviously does work and is great. No one is going to dispute that antibiotics are literally the greatest thing ever, or that insulin saves tons of diabetics, or that cancer treatment has saved a lot of lives. On the other hand some things we do are quite horrible, like keeping old people alive long past the point it's worth it. Or not cryogenically preserving everyone because it's "weird".
  - scottlocklin 11y ago

ansible 11y ago

One of the ironies is that a very common side effect of standard issue chemotherapy is a marked and often permanent weakening of the immune system by altering a person's microbiome. Advances in oncology perhaps within our own lifetime will make today's treatments seem as embarrassing as medieval blood-letting. It's embarrassing now, never mind later. We just don't often have better alternatives than to pump already sick people full of poison in the hope that the poison kills the cancer faster than the rest of the person. It is horrible, and has (in my opinion) only improved slightly in the last few decades.

robbies 11y ago
> pump already sick people full of poison I don't think it's unreasonable to ask for explanation/references/proof of what you mean when you say 'poison'. I don't know your particular experiences with chemotherapy, but I hear this soundbite parroted too often without any effort to actually research what chemotherapy is actually trying to accomplish. I'm not saying people shouldn't investigate their recommended treatment plans, but this often unwarranted suspicion of modern cancer treatment techniques is mystifying to me.
- scarmig 11y ago
  It's a sound bite because it's true. That's not a reason to avoid chemotherapy--it's probably the best method we have right now of fighting cancer--but the biggest concern with prescribing chemotherapy is how much and how long can the patient sustain it, and does the benefit outweigh the costs.
- iskander 11y ago
  Chemotherapy, for most cancers, achieves tumor shrinkage and a temporary extension of life, at the cost of severe life quality degradation. It's a tradeoff that most cancer patients think is worth it. I think that this therapeutic benefit puts us in a grey zone with regard to the definition of poison. The substances would undoubtably be considered poison in other contexts (e.g. mustard gas) but the doses are carefully calibrated to just-barely not kill a patient. Maybe "poison" is a function of usage intent?

Gatsky 11y ago

Disappointing to see a complex field summarised in this fashion. For some reason, ill-informed individuals love to adopt extreme views about cancer therapy and air them in public. This is totally irresponsible, and I hope nobody making decisions about cancer therapy reads this. For example: 1. 'Weakening' of the immune system is the wrong idea. Preclinical and clinical studies have shown that there is synergy between the immune system and chemotherapy, and also between the microbiome and chemotherapy. For some cancers, combining modern immunotherapies with other treatments including chemotherapy is likely to be necessary to achieve the best outcomes. 2. Your analogy to medieval blood letting is totally ridiculous. The chemotherapy used today has been carefully studied in randomised controlled trials with many thousands of patients. These patients have been followed up for many years with meticulous documentation of early and late side effects, disease outcomes and patient reported quality of life measures. This information is invaluable to patients who have to make decisions about the pros and cons of cancer therapy. Is chemotherapy pleasant? Definitely not. Do some people experience terrible side effects that may be permanent and life threatening or even fatal? Yes. But it saves lives, and it comes with a host of supportive therapies designed to make the process as tolerable as it can be.