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[links] Link salad mulls the weekend - Lakeshore — LiveJournal
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Jay Lake
Date: 2011-10-07 05:33
Subject: [links] Link salad mulls the weekend
Security: Public
Tags:cancer, cool, iraq, occupy wall street, personal, photos, portland, process, science, sex, tech, writing

Getting to the Story’s Core[info]jimvanpelt on the process of teasing out a story.

[conspire] OT: On cultivation of survival traits — The mistake that killed Steve Jobs. Evidence-based medicine, people. Evidence-based medicine. (From [info]rinolj.)

[info]danjite with a contrarian view on Steve Jobs — I take his point, but I think he’s deliberately underestimating the role of organizational leadership in a corporate context.

Meteor Shower This Weekend: Space Station at Risk?

12 gorgeous views of Earth from the International Space Station

“Sex At Dawn” — A Portland talk by the author of Sex at Dawn. Definitely go check it out if you’re in or around the Rose City on November 2nd.

Wall Street Journal: neutrinos show climate change isn’t real — The Bad Astronomer on the latest anti-science idiocy from the American Right. Who needs facts, or logic, when you have the Wall Street Journal op-ed page?

Historians say today’s rebukes of presidents have grown more extremeH.W. Brands, professor of history at the University of Texas-Austin and the author of books on several presidents, said he is not aware of “mockery of the president by elected officials” at the frequency that Obama has been getting it. Given that the default Republican position is that Obama was never legitimately elected, this is hardly surprising.

The Weapons That Were Not There — Ah, the Iraq War. Bush’s gift that just keep on giving, and never had a damned thing to do with 9/11 no matter how hard they gamed the intelligence.

How We Got Into The Primary Calendar Mess — And Why We Can’t Get Out

Sarah Palin’s Die Hard Supporters ‘Stunned,’ ‘Disappointed’ — Only because you were never paying attention to the long con job, people. Ta-Nehisi Coates with more on this.

Best of the Web on Widening Wall Street Protests — I missed yesterday’s Occupy Portland, as going out on damp afternoons doesn’t mix well with chemo fatigue.

The origins of Occupy Wall Street explained — Salon talks to the editor of Adbusters</em> about the practical and philosophical roots of the movement</em>.

?otD: What’s frying today?


10/7/2011
Writing time yesterday: 1.0 hours (2,000 words to finish this short story)
Body movement: 30 minute stationary bike ride
Hours slept: 7.25 hours (interrupted)
Weight: 218.2
Currently reading: The Stone Canal by Ken MacLeod

Originally published at jlake.com. You can comment here or there.

Post A Comment | 11 Comments | | Link






Random
User: halloranelder
Date: 2011-10-07 12:37 (UTC)
Subject: (no subject)
?otD: What’s frying today?

My brain. Writing is hard work, but I guess you knew that. :)
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cathshaffer
User: cathshaffer
Date: 2011-10-07 13:03 (UTC)
Subject: (no subject)
Wow, that story about Steve Jobs is disturbing. And yet without a verified and fact-checked version, it's hard to know what to think. It is not always true that swift surgery/intervention changes outcomes in cancer. It may be that he tried the nine month vegetarian diet with his doctor's blessing. If it is true that Jobs ruined his chances of survival by trying alternative medicine before mainstream medicine, I hope his family will release all of the details and allow the mainstream media to report more fully on it.
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Rick Moen
User: rinolj
Date: 2011-10-07 19:46 (UTC)
Subject: (no subject)
Catherine --

Speaking as someone with a keenly motivated layman's knowledge of the medical standard of care for cancer, and the track record for various alternative therapies, I can really confidently guess any competent doctor's reaction to the idea of eschewing surgery for early stage, highly treatable pancreatic cancer and going on a special diet, instead: something with the words 'insane', 'suicide', and 'good luck; you'll need it.'

Sure, the surgery can kill you outright, or impair you badly. That aside, one of the core truths about cancer treatment is: The fewer cancer cells in your body, the better your prospects. Early attempts at removal reduce the cancer load, possibly even to zero, and your best shot at zero or very low is at an occasion called As Soon As Possible.

My nominee for the patron saint of cancer treatment is Damon Runyon, a born probability theorist if I ever saw one. He wrote (riffing off Ecclesiastes 9:11): 'The race is not to the swift, nor the battle to the strong..., but that's the way to bet.'

Rick Moen
rick@linuxmafia.com
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cathshaffer
User: cathshaffer
Date: 2011-10-07 20:02 (UTC)
Subject: (no subject)
Hi Rick. Believe me I also have a keenly motivated layman's knowledge of cancer. In fact, I'm a biotech journalist (trained as a molecular biologist) and I report on experimental cancer therapies several times a week. While it's generally true that earlier intervention is better, it's not always the case for every individual. We just don't know what was said between Jobs and his physician, what treatments he had, and I'm not willing to judge him on the sayso of his coworkers who were never in the exam room with him.
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Rick Moen
User: rinolj
Date: 2011-10-07 20:47 (UTC)
Subject: (no subject)
Fairly put, at least in places. Some quibbles and comments:

It's not necessary to pronounce what is true of 'every individual' in order to say something about the circumstances of Steve Jobs in Oct. 2003: It was an early-stage neuroendocrine tumour in the insulin-producing islet cells, found during routine medical imaging. We do not know, nor may we ever know, how large and isolated/located the tumour was when first found, nor whether there were already metastases. Because of the method by which the tumour was found, I'd guess it somewhat likely this was the asymptomatic subvariety, which tend to be large when identified but also by the same token easily found.

If the tumour was then only near the tail of his pancreas, he could have gotten away with a distal pancreatectomy, removing only half of the organ. It's possible, if you pick your medical centre carefully, to have them avoid the need to preserve your spleen, and to have the surgery done laparosocopically rather than through open surgery. With worse luck, the surgery might have already been into the other half of his pancreas, making the Whipple operation already necessary.

While it's true that we cannot know, and will probably never know, many of the salient facts of Jobs's case, let alone what he and his doctor discussed, I cannot see how any rational case can be made for doubting that earlier intervention in his case would have given him better prospects, and all of your talking around that question made no case for such doubt. The general point still applies: Less malignant tissue, sooner, gives you better odds.

And it's extremely clear that doing nothing, in a case of early-stage islet cell neuroendocrine tumour, except going on a special diet because it was recommended by your naturopath, is a rather poor kind of survival strategy.

Rick Moen
rick@linuxmafia.com
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(no subject) - (Anonymous)
Jay Lake: cancer_tumor
User: jaylake
Date: 2011-10-07 21:15 (UTC)
Subject: (no subject)
Keyword:cancer_tumor
"watchful waiting."

Been there, done that, got the metastasis.
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Rick Moen
User: rinolj
Date: 2011-10-07 22:22 (UTC)
Subject: (no subject)
That's really reaching: I'm trying to imagine any justification for recommending watchful waiting in a case of an early-stage islet-cell neuroendocrine tumour in a 56-year-old man with no other health problems. It's only going to get worse, and the patient's just not likely to live a quality life and die of something else before becoming deathly ill from the cancer.

Doctors recommend 'watchful waiting' if 1. the diagnosis and prospects are still uncertain (non-specific abdominal pain), 2. likelihood of self-resolution is high (ear infection), 3. risks of treatment outweigh the probable benefits (many brain problems), or 4. patient's more likely to lead a full life and die of something else without treatment (old man with Gleason 5 prostate cancer plus diabetes plus a heart murmur).
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cathshaffer
User: cathshaffer
Date: 2011-10-08 01:03 (UTC)
Subject: (no subject)
Also if it's already metastasized and surgery doesn't improve your odds very much. Honestly, there are just a lot of assumptions one has to make in order to make a judgment on this story. As I said, it's certainly very disturbing, and if true I think a great deal of good could be done by bringing it all to light including verified medical facts. As it is now, it's just a rumor, and could very well be a misunderstanding by people who were not direct parties to the decisions.
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Rick Moen
User: rinolj
Date: 2011-10-08 02:06 (UTC)
Subject: (no subject)
That 'also' scenario (which we might call reason #5 why doctors might recommend watchful waiting) is certainly a valid possibility in general terms, but seems incompatible with the specific fact of Jobs deciding to have the Whipple operation in July 2004. If metastasis had already made surgery no longer a reasonable option in October 2003, how would it then suddenly become reasonable again after nine months' delay and cancer growth?
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Rick Moen
User: rinolj
Date: 2011-10-07 22:56 (UTC)
Subject: (no subject)
I forgot to mention: I actually had read with great interest, and profound respect, your observations about 'cancer discrimination in the hospital' and the need to keep going to bat for your mother, over and over again with new teams of mulish doctors. Hang in there, and please accept my kudos and admiration.

(I'm not familiar with your work otherwise, but will try to make a point of following it.)

Rick Moen
rick@linuxmafia.com
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cathshaffer
User: cathshaffer
Date: 2011-10-08 01:04 (UTC)
Subject: (no subject)
Thanks! I appreciate the support. The doctors continue to be mulish, but things seem to be generally getting better.
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