Cancer is increasingly survivable – but it shouldn’t depend on your ability to ‘wrangle’ the health system
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One in three of us will develop cancer at some point in our lives. But survival rates have improved to the point that two-thirds of those diagnosed live more than five years.
This extraordinary shift over the past few decades introduces new challenges. A large and growing proportion of people diagnosed with cancer are living with it, rather than dying of it.
In our recently published research we examined the cancer experiences of 81 New Zealanders (23 Māori and 58 non-Māori).
We found survivorship not only entailed managing the disease, but also “wrangling” a complex health system.
Surviving disease or surviving the system
Our research focused on those who had lived longer than expected (four to 32 years since first diagnosis) with a life-limiting or terminal diagnosis of cancer.
Common to many survivors’ stories was the effort it took to wrangle the system or find others to advocate on their behalf, even to get a formal diagnosis and treatment.
By wrangling we refer to the practices required to traverse complex and sometimes unwelcoming systems. This is an often unnoticed but very real struggle that comes on top of managing the disease itself.
The common focus of the healthcare system is on symptoms, side effects of treatment and other biological aspects of cancer. But formal and informal care often falls by the wayside, despite being key to people’s everyday experiences.
The inequities of cancer survivorship are well known. Analyses show postcodes and socioeconomic status play a strong role in the prevalence of cancer and survival.
Less well known, but illustrated in our research, is that survival is also linked to people’s capacity to manage the entire healthcare system. That includes accessing a diagnosis or treatment, or identifying and accessing alternative treatments.
Survivorship is strongly related to material resources, social connections, and understandings of how the health system works and what is available. For instance, one participant who was contemplating travelling overseas to get surgery not available in New Zealand said:
We don’t trust the public system. So thankfully we had private health insurance […] But if we went overseas, health insurance only paid out to $30,000 and I think the surgery was going to be a couple of hundred thousand. I remember Dad saying and crying and just being like, I’ll sell my business […] we’ll all put in money. It was really amazing.
Assets of survivorship
In New Zealand, the government agency Pharmac determines which medications are subsidised. Yet many participants were advised by oncologists or others to “find ways” of taking costly, unsubsidised medicines.
This often meant finding tens of thousands of dollars with no guarantees. Some had the means, but for others it meant drawing on family savings, retirement funds or extending mortgages. This disproportionately favours those with access to assets and influences who survives.
But access to economic capital is only one advantage. People also have cultural resources – often described as cultural capital.
In one case, a participant realised a drug company was likely to apply to have a medicine approved. They asked their private oncologist to lobby on their behalf to obtain the drug through a compassionate access scheme, without having to pay for it.
Others gained community support through fundraising from clubs they belonged to. But some worried about where they would find the money, or did not want to burden their community.
I had my doctor friend and some others that wanted to do some public fundraising. But at the time I said, “Look, most of the people that will be contributing are people from my community who are poor already, so I’m not going to do that option”.
Accessing alternative therapies, almost exclusively self-funded, was another layer of inequity. Some felt forced to negotiate the black market to access substances such as marijuana to treat their cancer or alleviate the side effects of orthodox cancer treatment.
Cultural capital is not a replacement for access to assets, however. Māori survivorship was greatly assisted by accessing cultural resources, but often limited by lack of material assets.
Persistence pays
The last thing we need when faced with the possibility of cancer is to have to push for formal diagnosis and care. Yet this was a common experience.
One participant was told nothing could be found to explain their abdominal pain – only to find later they had pancreatic cancer. Another was told their concerns about breathing problems were a result of anxiety related to a prior mental health history, only to learn later their earlier breast cancer had spread to their lungs.
Persistence is another layer of wrangling and it often causes distress.
Once a diagnosis was given, for many people the public health system kicked in and delivered appropriate treatment. However, experiences were patchy and variable across New Zealand.
Issues included proximity to hospitals, varying degrees of specialisation available, and the requirement of extensive periods away from home and whānau. This reflects an ongoing unevenness and lack of fairness in the current system.
When facing a terminal or life-limiting diagnosis, the capacity to wrangle the system makes a difference. We shouldn’t have to wrangle, but facing this reality is an important first step.
We must ensure it doesn’t become a continuing form of inequity, whereby people with access to material resources and social and cultural connections can survive longer.
Kevin Dew, Professor of Sociology, Te Herenga Waka — Victoria University of Wellington; Alex Broom, Professor of Sociology & Director, Sydney Centre for Healthy Societies, University of Sydney; Chris Cunningham, Professor of Maori & Public Health, Massey University; Elizabeth Dennett, Associate Professor in Surgery, University of Otago; Kerry Chamberlain, Professor of Social and Health Psychology, Massey University, and Richard Egan, Associate Professor in Health Promotion, University of Otago
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Understanding Cellulitis: Skin And Soft Tissue Infections
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What’s the difference between a minor passing skin complaint, and a skin condition that’s indicative of something more serious? Dr. Thomas Watchman explains:
More than skin-deep
Cellulitis sounds benign enough, like having a little cellulite perhaps, but in fact it means an infection of the skin and—critically—the underlying soft tissues.
Normally, the skin acts as a barrier against infections, but this barrier can be breached by physical trauma (i.e. an injury that broke the skin), eczema, fungal nail infections, skin ulcers, and other similar things that disrupt the skin’s ability to protect us.
Things to watch out for: Dr. Watchman advises we keep an eye out for warm, reddened skin, swelling, and blisters. Specifically, a golden-yellow crust to these likely indicates a Staphylococcus aureus infection (hence the name).
There’s a scale of degrees of severity:
- Class 1: No systemic toxicity or comorbidities
- Class 2: Systemic toxicity or comorbidities present
- Class 3: Significant systemic toxicity or comorbidities with risk of significant deterioration
- Class 4: Sepsis or life-threatening infection
…with antibiotics being recommended in the latter two cases there, or in other cases for frail, young, old, or immunocompromised patients. Given the rather “scorched earth” results of antibiotics (they cause a lot of collateral iatrogenic damage), this can be taken as a sign of how seriously such infections should be taken.
For more about all this, including visual guides, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Of Brains & Breakouts: The Brain-Skin Doctor
- Beyond Supplements: The Real Immune-Boosters!
- Antibiotics? You Might Want To Think Thrice
Take care!
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Brazil Nuts vs Hazelnuts – Which is Healthier?
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Our Verdict
When comparing Brazil nuts to hazelnuts, we picked the hazelnuts.
Why?
In terms of macros, Brazil nuts have more fats (including more omega-3, and/but also including more saturated fat) while hazelnuts have more fiber, carbs, and protein. So, which one wins this round is a little subjective; we’d say it’s the fiber for hazelnuts that cinch it, but we could also reasonably declare this round a tie.
In the category of vitamins, Brazil nuts are not higher in any vitamins, while hazelnuts are higher in vitamins A, B1, B2, B3, B5, B6, B7, B9, C, E, K, and choline. And the margins of difference are large in most cases. An easy win for hazelnuts here.
When it comes to minerals, things get interesting: Brazil nuts have more calcium, magnesium, phosphorus, and selenium, while hazelnuts have more iron, manganese, and potassium, but!
Before we crown Brazil nuts with a 4:3 win in this category, though, let’s take a closer look at those selenium levels:
- A cup of hazelnuts contains 13% of the RDA of selenium. Your hair will be luscious and shiny.
- A cup of Brazil nuts contains 10,456% of the RDA of selenium. This is way past the point of selenium toxicity, and your (luscious, shiny) hair will fall out.
For this reason, it’s recommended to eat no more than 3–4 Brazil nuts per day.
We consider that a point against Brazil nuts.
Adding up the sections makes for an overall win for hazelnuts, but by all means enjoy either or both, we just recommend to practise moderation when it comes to the Brazil nuts!
Want to learn more?
You might like:
Why You Should Diversify Your Nuts
Enjoy!
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The Mental Health First-Aid That You’ll Hopefully Never Need
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Take Your Mental Health As Seriously As General Health!
Sometimes, health and productivity means excelling—sometimes, it means avoiding illness and unproductivity. Both are essential, and today we’re going to tackle some ground-up stuff. If you don’t need it right now, great; we suggest to read it for when and if you do. But how likely is it that you will?
- One in four of us are affected by serious mental health issues in any given year.
- One in five of us have suicidal thoughts at some point in our lifetime.
- One in six of us are affected to at least some extent by the most commonly-reported mental health issues, anxiety and depression, in any given week.
…and that’s just what’s reported, of course. These stats are from a UK-based source but can be considered indicative generally. Jokes aside, the UK is not a special case and is not measurably worse for people’s mental health than, say, the US or Canada.
While this is not an inherently cheery topic, we think it’s an important one.
Depression, which we’re going to focus on today, is very very much a killer to both health and productivity, after all.
One of the most commonly-used measures of depression is known by the snappy name of “PHQ9”. It stands for “Patient Health Questionnaire Nine”, and you can take it anonymously online for free (without signing up for anything; it’s right there on the page already):
Take The PHQ9 Test Here! (under 2 minutes, immediate results)
There’s a chance you took that test and your score was, well, depressing. There’s also a chance you’re doing just peachy, or maybe somewhere in between. PHQ9 scores can fluctuate over time (because they focus on the past two weeks, and also rely on self-reports in the moment), so you might want to bookmark it to test again periodically. It can be interesting to track over time.
In the event that you’re struggling (or: in case one day you find yourself struggling, or want to be able to support a loved one who is struggling), some top tips that are useful:
Accept that it’s a medical condition like any other
Which means some important things:
- You/they are not lazy or otherwise being a bad person by being depressed
- You/they will probably get better at some point, especially if help is available
- You/they cannot, however, “just snap out of it”; illness doesn’t work that way
- Medication might help (it also might not)
Do what you can, how you can, when you can
Everyone knows the advice to exercise as a remedy for depression, and indeed, exercise helps many. Unfortunately, it’s not always that easy.
Did you ever see the 80s kids’ movie “The Neverending Story”? There’s a scene in which the young hero Atreyu must traverse the “Swamp of Sadness”, and while he has a magical talisman that protects him, his beloved horse Artax is not so lucky; he slows down, and eventually stops still, sinking slowly into the swamp. Atreyu pulls at him and begs him to keep going, but—despite being many times bigger and stronger than Atreyu, the horse just sinks into the swamp, literally drowning in despair.
See the scene: The Neverending Story movie clip – Artax and the Swamp of Sadness (1984)
Wow, they really don’t make kids’ movies like they used to, do they?
But, depression is very much like that, and advice “exercise to feel less depressed!” falls short of actually being helpful, when one is too depressed to do it.
If you’re in the position of supporting someone who’s depressed, the best tool in your toolbox will be not “here’s why you should do this” (they don’t care; not because they’re an uncaring person by nature, but because they are physiologically impeded from caring about themself at this time), but rather:
“please do this with me”
The reason this has a better chance of working is because the depressed person will in all likelihood be unable to care enough to raise and/or maintain an objection, and while they can’t remember why they should care about themself, they’re more likely to remember that they should care about you, and so will go with your want/need more easily than with their own. It’s not a magic bullet, but it’s worth a shot.
What if I’m the depressed person, though?
Honestly, the same, if there’s someone around you that you do care about; do what you can to look after you, for them, if that means you can find some extra motivation.
But I’m all alone… what now?
Firstly, you don’t have to be alone. There are free services that you can access, for example:
- US: https://nami.org/help
- Canada: https://www.wellnesstogether.ca/en-CA
- UK: https://www.samaritans.org/
…which varyingly offer advice, free phone services, webchats, and the like.
But also, there are ways you can look after yourself a little bit; do the things you’d advise someone else to do, even if you’re sure they won’t work:
- Take a little walk around the block
- Put the lights on when you’re not sleeping
- For that matter, get out of bed when you’re not sleeping. Literally lie on the floor if necessary, but change your location.
- Change your bedding, or at least your clothes
- If changing the bedding is too much, change just the pillowcase
- If changing your clothes is too much, change just one item of clothing
- Drink some water; it won’t magically cure you, but you’ll be in slightly better order
- On the topic of water, splash some on your face, if showering/bathing is too much right now
- Do something creative (that’s not self-harm). You may scoff at the notion of “art therapy” helping, but this is a way to get at least some of the lights on in areas of your brain that are a little dark right now. Worst case scenario is it’ll be a distraction from your problems, so give it a try.
- Find a connection to community—whatever that means to you—even if you don’t feel you can join it right now. Discover that there are people out there who would welcome you if you were able to go join them. Maybe one day you will!
- Hiding from the world? That’s probably not healthy, but while you’re hiding, take the time to read those books (write those books, if you’re so inclined), learn that new language, take up chess, take up baking, whatever. If you can find something that means anything to you, go with that for now, ride that wave. Motivation’s hard to come by during depression and you might let many things slide; you might as well get something out of this period if you can.
If you’re not depressed right now but you know you’re predisposed to such / can slip that way?
Write yourself instructions now. Copy the above list if you like.
Most of all: have a “things to do when I don’t feel like doing anything” list.
If you only take one piece of advice from today’s newsletter, let that one be it!
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You, Happier – by Dr. Daniel Amen
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The implicit question “what’s your brain type?” makes this book sound a little like a horoscope for science-enjoyers, but really, the “brain type” in question is simply a way of expressing which neurochemicals one’s brain makes most and/or least easily.
That’s something that a) really does differ from one person to another b) isn’t necessarily fixed forever, but will tend to remain mostly the same most of the time for most people.
And yes, the book does cover figuring out which neurotransmitter(s) it might be for you. On a secondary level, it also talks about more/less active parts of the brain for each of us, but the primary focus is on neurotransmitters.
It’s easy to assume “everyone wants more [your favorite neurotransmitter here]” but in fact, most people most of the time have most of what they need.
For those of us who don’t, those of us who perhaps have to work more to keep our level(s) of one or more neurotransmitters where they should be, this book is a great guide to optimizing aspects of our diet and lifestyle to compensate for what our brains might lack—potentially reducing the need to go for pharmaceutical approaches.
The style of the book is very much pop-science, but it is all well-informed and well-referenced.
Bottom line: if you sometimes (or often!) think “if only my brain would just make/acknowledge more [neurotransmitter], this book is for you.
Click here to check out You, Happier, and discover a happier you!
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Berberine For Metabolic Health
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Is Berberine Nature’s Ozempic/Wegovy?
Berberine is a compound found in many plants. Of which, some of them are variations of the barberry, hence the name.
It’s been popular this past couple of years, mostly for weight loss. In and of itself, something being good for weight loss doesn’t mean it’s good for the health (just ask diarrhoea, or cancer).
Happily, berberine’s mechanisms of action appear to be good for metabolic health, including:
- Reduced fasting blood sugar levels
- Improved insulin sensitivity
- Reduced LDL and triglycerides
- Increased HDL levels
So, what does the science say?
It’s (mostly!) not nature’s Wegovy/Ozempic
It’s had that title in a number of sensationalist headlines (and a current TikTok trend, apparently), but while both berberine and the popular weight-loss drugs Wegovy/Ozempic act in part on insulin metabolism, they mostly do so by completely different mechanisms.
Wegovy and Ozempic are GLP-1 agonists, which mean they augment the action of glucagon-like-peptide 1, which increases insulin release, decreases glucagon release, and promotes a more lasting feeling of fullness.
Berberine works mostly by other means, not all of which are understood. But, we know that it activates AMP-activated protein kinase, and on the flipside, inhibits proprotein convertase subtilisin/kexin type 9.
In less arcane words: it boosts some enzymes and inhibits others.
Each of these boosts/inhibitions has a positive effect on metabolic health.
However, it does also have a slight GLP-1 agonist effect too! Bacteria in the gut can decompose and metabolize berberine into dihydroberberine, thus preventing the absorption of disaccharides in the intestinal tract, and increasing GLP-1 levels.
See: Effects of Berberine on the Gastrointestinal Microbiota
Does it work for weight loss?
Yes, simply put. And if we’re going to put it head-to-head with Wegovy/Ozempic, it works about half as well. Which sounds like a criticism, but for a substance that’s a lot safer (and cheaper, and easier—if we like capsules over injections) and has fewer side effects.
- Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity ← Wegovy and Ozempic are both brand names of semaglutide
- The effect of berberine supplementation on obesity parameters: A systematic review and meta-analysis of randomized controlled trials ← a good recent research review giving clear data on many factors
- Lipid-lowering effect of berberine in human subjects and rats ← this is an older study, 2012, but it gives 3-month weight loss percentages rather than discrete values in the abstract, so it’s easier to compare to the semaglutide study without grabbing a calculator
❝But more interestingly, the treatment significantly reduced blood lipid levels (23% decrease of triglyceride and 12.2% decrease of cholesterol levels) in human subjects.
However, there was interestingly, an increase in calcitriol levels seen in all human subjects following berberine treatment (mean 59.5% increase)
Collectively, this study demonstrates that berberine is a potent lipid-lowering compound with a moderate weight loss effect, and may have a possible potential role in osteoporosis treatment/prevention.❞
(click through to read in full)
Is it safe?
It appears to be, with one special caveat: remember that paper about the effects of berberine on the gastrointestinal microbiota? It also has some antimicrobial effects, so you could do harm there if not careful. It’s recommended to give it a break every couple of months, to be sure of allowing your gut microbiota to not get too depleted.
Also, as with anything you might take that’s new, always consult your doctor/pharmacist in case of contraindications based on medications you are taking.
Where can I get it?
As ever, we don’t sell it, but here’s an example product on Amazon, for your convenience.
Enjoy!
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Is ADHD Being Over-Diagnosed For Cash?
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Is ADHD Being Systematically Overdiagnosed?
The BBC’s investigative “Panorama” program all so recently did a documentary in which one of their journalists—who does not have ADHD—went to three private clinics and got an ADHD diagnosis from each of them:
- The BBC documentary: Private ADHD Clinics Exposed (28 mins)
- Their “5 Minutes” version: ADHD Undercover: How I Was Misdiagnosed (6 mins)
So… Is it really a case of show up, pay up, and get a shiny new diagnosis?
The BBC Panorama producers cherry-picked 3 private providers, and during those clinical assessments, their journalist provided answers that would certainly lead to a diagnosis.
This was contrasted against a three-hour assessment with an NHS psychiatrist—something that rarely happens in the NHS. Which prompts the question…
How did he walk into a 3-hour psychiatrist assessment, when most people have to wait in long waiting lists for a much more cursory appointment first with assorted gatekeepers, before going on another long waiting list, for an also-much-shorter appointment with a psychiatrist?
That would be because the NHS psychiatrist was given advance notification that this was part of an investigation and would be filmed (the private clinics were not gifted the same transparency)
So, maybe just a tad unequal treatment!
In case you’re wondering, here’s what that very NHS psychiatrist had to say on the topic:
Is it really too easy to be diagnosed with ADHD?
(we’ll give you a hint—remember Betteridge’s Law!)
❝Since the documentary aired, I have heard from people concerned that GPs could now be more likely to question legitimate diagnoses.
But as an NHS psychiatrist it is clear to me that the root of this issue is not overdiagnosis.
Instead, we are facing the combined challenges of remedying decades of underdiagnosis and NHS services that were set up when there was little awareness of ADHD.❞
~ Dr. Mike Smith, Psychiatrist
The ADHD foundation, meanwhile, has issued its own response, saying:
❝We are disappointed that BBC Panorama has opted to broadcast a poorly researched, sensationalist piece of television journalism.❞
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