I should have known it. I should have known that the reaction wouldn’t take very long. I should have known it based on prior history. The news story to which I am referring is, of course, the revelation yesterday in the New York Times editorial page by Angelina Jolie that she had decided to undergo prophylactic bilateral mastectomies (removal of both breasts) because she had learned that she was a BRCA gene mutation carrier, and the particular mutation that she apparently carried portended an 85% lifetime risk of breast cancer. The reaction to which I am referring is, of course, the same sort of despicable reaction that we see all the time from one of the crankiest of quackery-promoting quacks, Mike Adams, publisher of NaturalNews.com.
This is the first in a two parter, not strictly about the medical rationale behind Jolie’s decision (which I’ve had some discussions about), although there is some of that.
It deals with the ‘alternative’ medicine guys who decry the maiming of her body when it could have been saved if she had only listened to them and their snake oil dreams.
Some of the real danger from her public approach is the huge pushback from those selling their own non-reality based treatments. Reading what some of them have written – seeing how they get simple biology wrong – is quite scary.
Having them jump out of the woodwork at this is not surprising at all. They have something to sell.
But the article highlights another problem – that many women are choosing preventative mastectomy even if they do not have a high risk for breast cancer, such as the BRCA1 mutation. From the NYT:
For women’s health advocates, the trend toward double mastectomies in women who do not have mutations is frustrating. Studies in the 1970s and 1980s proved that for many patients, lumpectomy was as safe as mastectomy, and the findings were seen as a victory for women.
Even so, there is increasing demand for mastectomy. Dr. Morrow says that she has often tried to talk patients out of it without success. Some imagine their risk of new or recurring cancer to be far higher than it really is. Others think that their breasts will match up better if both are removed and reconstructed.
Patients demanding surgeries they do not need seems to me to arise from the impreciseness of how we do medicine. Illness rates, drug effectiveness and much of the rates are based on statistics of populations. They say nothing about the real chance of an individual to get the disease or react to the medication.
In many ways health numbers are like the decay of a radioactive material. We know with exact precision what the half life of such an element is. In X amount of time, half the molecules will have decayed. But we have little idea of which specific molecule will. we could look at one and it might decay faster than the half-life or slower.
Our numbers only work for the group not for the individual. I believe as we gain more data, information and knowledge about an individuals personal health – genomic, metabolomic, miRNA, etc. – we may get a clearer picture.
Until then, I expect to see even more confusion with women who really do not need the surgery demanding it from doctors and medical snake oil sellers telling women who might need the surgery that they have a miracle herbal/lifestyle cure.