Thank you for this. It highlights above all the pressing need for informed, shared decision making that meets a patient's goals. Too many people are disempowered by healthcare systems.
On cancer screening, there is only one intervention that has moderate evidence of benefit, flexible sigmoidoscopy for colorectal cancer. But there are no RCTs for cervical screening, which may be deemed to be a 'parachute' intervention.
On prostate, the finding that for every 1,000 men aged 50-60 screened with a PSA test, up to two lives would be saved is not what it seems - two men may not die of prostate cancer but they don't live any longer and die from other causes.
What a wonderful loving interview. You are so lucky to have your father. I stumbled across your Substack after searching broadly for essays on negative capability. The thought that it could be applied to one's mortality hadn't occurred to me, but of course it makes sense and bring such poignancy to his story and your framing of it.
I will ask. He’s been moved home and the poking ability of social care system is clearly doing his head in. Really hope this can be normalised or it'll be demoralising in the extreme. Lorra love xxx
Oh my goodness Kate. Your Dad sounds absolutely glorious. Intelligence, integrity, balance & warmth. An absolutely fascinating & important piece. And not that we should need it but a fine example of why we shouldn’t ever take advice from tabloids & celebrities- ONLY from experts. How lucky you are to have him. Thank you sooo much much for this ❤️❤️❤️
Thanks Lorraine. I appreciate this comment very much. I ghosted a piece for The Times given he has the same situation as Biden going on, and it came with the proviso we not criticism media, celebrities etc because of course, Britain’s had enough of experts to quote Govey.
It’s refreshing to hear such a smart and considered reflection on quality of life, death and disease. Last year I was diagnosed with high grade DCIS after a routine mammogram and had a lumpectomy and targeted partial breast radiation. I’m grateful it did not require anything harsher although it may if it does recur. But I also live with and care for my 95 year old mother and through that experience understand something about quality of life. Our obsession with longevity is frightening. People are constantly telling me how wonderful she is. She is now incontinent, has no memory and watches television all day. She finds it difficult to hold a conversation and only yesterday told me she ‘had forgotten to get up to go to the toilet’. I look at the people who say how wonderful she is in disbelief. Why is it considered wonderful to simply be alive at 95? I don’t want to ever be wonderful in that way. I’m grateful for DCIS beginning my own hard journey to clarity about death, decisions and, as importantly, living. It’s inspiring to read this interview - thank you. Holding both of you in the light.
Such vital and verve-infused words Kate. Thanks for documenting this conversation. The urge of the non-medical amongst us to doctor-shop as your darling Dad states here, I think has mushroomed in quite a carcinogenic cloud way itself since it all become so monetised, our health. I'm reading this piece and thinking of the blunt screening and interventions prompted for a person in my life here. A really thought-provoking piece.
They do not and yet the contagion of currency and care is real and of immense concern. I suppose private medicine, in some unofficial capacity at least, has existed for a very long time.
There was largely only private medicine, and witches (see Popgun passim https://rdspicer.substack.com/p/the-open-door) until the creation of the NHS. The acceleration of capitalism since then has been significant, though.
Very honest, explicit and useful. (Not sure correct on net health value of bowel and breast cancer screening though).
But : screening is driven an industry with shareholders driven by surplus-value (profits, careers) which manipulates the human psyche and its drive to use fear to incite demand despite over diagnosis, opportunity costs and the degradation of the NHS (any budget limited state funded healthcare service).
Very clarifying. The voices of real medical professionals are rarely heard in these debates and this will be very helpful to people needing to make their own decisions
Thank you for this. It highlights above all the pressing need for informed, shared decision making that meets a patient's goals. Too many people are disempowered by healthcare systems.
On cancer screening, there is only one intervention that has moderate evidence of benefit, flexible sigmoidoscopy for colorectal cancer. But there are no RCTs for cervical screening, which may be deemed to be a 'parachute' intervention.
On prostate, the finding that for every 1,000 men aged 50-60 screened with a PSA test, up to two lives would be saved is not what it seems - two men may not die of prostate cancer but they don't live any longer and die from other causes.
What a wonderful loving interview. You are so lucky to have your father. I stumbled across your Substack after searching broadly for essays on negative capability. The thought that it could be applied to one's mortality hadn't occurred to me, but of course it makes sense and bring such poignancy to his story and your framing of it.
What
A
Man.
Ask him what he thinks of surgical robots prostate poking efficacy.
Sending love
xx
I will ask. He’s been moved home and the poking ability of social care system is clearly doing his head in. Really hope this can be normalised or it'll be demoralising in the extreme. Lorra love xxx
Oh my goodness Kate. Your Dad sounds absolutely glorious. Intelligence, integrity, balance & warmth. An absolutely fascinating & important piece. And not that we should need it but a fine example of why we shouldn’t ever take advice from tabloids & celebrities- ONLY from experts. How lucky you are to have him. Thank you sooo much much for this ❤️❤️❤️
Thanks Lorraine. I appreciate this comment very much. I ghosted a piece for The Times given he has the same situation as Biden going on, and it came with the proviso we not criticism media, celebrities etc because of course, Britain’s had enough of experts to quote Govey.
I hung on every word. Thank you both for such a well constructed, informed piece. Wish you peace and gentle days Richard.
It’s refreshing to hear such a smart and considered reflection on quality of life, death and disease. Last year I was diagnosed with high grade DCIS after a routine mammogram and had a lumpectomy and targeted partial breast radiation. I’m grateful it did not require anything harsher although it may if it does recur. But I also live with and care for my 95 year old mother and through that experience understand something about quality of life. Our obsession with longevity is frightening. People are constantly telling me how wonderful she is. She is now incontinent, has no memory and watches television all day. She finds it difficult to hold a conversation and only yesterday told me she ‘had forgotten to get up to go to the toilet’. I look at the people who say how wonderful she is in disbelief. Why is it considered wonderful to simply be alive at 95? I don’t want to ever be wonderful in that way. I’m grateful for DCIS beginning my own hard journey to clarity about death, decisions and, as importantly, living. It’s inspiring to read this interview - thank you. Holding both of you in the light.
Thank you for this. We both appreciate it and wish you luck and love, Kate and Richard
What a refreshing dose of humane good sense. Thank you.
Thank you Spicers for educating me today. I will ask my husband to read this too..It really is much appreciated..😌
Thank you for the thank you. Means a lot right now
Such vital and verve-infused words Kate. Thanks for documenting this conversation. The urge of the non-medical amongst us to doctor-shop as your darling Dad states here, I think has mushroomed in quite a carcinogenic cloud way itself since it all become so monetised, our health. I'm reading this piece and thinking of the blunt screening and interventions prompted for a person in my life here. A really thought-provoking piece.
Thank you. Medicine and money do not mix well. Private medicine, not always but sometimes, can have concerning motives.
They do not and yet the contagion of currency and care is real and of immense concern. I suppose private medicine, in some unofficial capacity at least, has existed for a very long time.
There was largely only private medicine, and witches (see Popgun passim https://rdspicer.substack.com/p/the-open-door) until the creation of the NHS. The acceleration of capitalism since then has been significant, though.
Ah yes, I can see this now that you're pointing it out!
Thought provoking and enlightening. We don’t know what we don’t know.
Very honest, explicit and useful. (Not sure correct on net health value of bowel and breast cancer screening though).
But : screening is driven an industry with shareholders driven by surplus-value (profits, careers) which manipulates the human psyche and its drive to use fear to incite demand despite over diagnosis, opportunity costs and the degradation of the NHS (any budget limited state funded healthcare service).
See: on breast cancer screening
https://www.lrb.co.uk/the-paper/v48/n04/paul-taylor/a-way-to-be-a-person
And: my PhD thesis on the psycho politics of screening:
https://research.manchester.ac.uk/en/studentTheses/the-science-praxis-and-perversion-of-evidence-based-healthcare-an
And my book on same:
(Can be found on eBay!)
“Anticipation and Medicine
A Critical Analysis of the Science, Praxis and Perversion of Evidence Based Healthcare
By Owen Dempsey
Copyright 2019”
https://books.google.co.uk/books/about/Anticipation_and_Medicine.html?id=VlEPEAAAQBAJ&source=kp_book_description&redir_esc=y
Very interesting, thanks, and will share with Dad.
Very clarifying. The voices of real medical professionals are rarely heard in these debates and this will be very helpful to people needing to make their own decisions
You are my favourite!