Wednesday, January 7, 2015

Does Do No Harm do harm? Food for thought.

Happy New year.  I recently joined an interesting call hosted by the MMRF for a few interested parties, where Dr. Lonial from Emory along with Dr. Daniel Auclairre of the MMRF spoke about the highlights from the ASH conference and took a few questions (some of which were from me).

One thing that struck me in hearing all these trials -- and in the philosophy of Dr. Lonial, who is quite an excellent doctor -- is that our entire medical system remains rooted in the concept of "First do no harm."  Incidentally, I was going to make a wisecrack about Hippocrates but it turns out this phrase originated not with the Hippocratic oath but with 19th century surgeon Thomas Inman.  Thank you, Wikipedia!

Anyhow, back to Myeloma.

A significant result of the "first do no harm" approach is that if you know treatment X is going to have more side effects than treatment Y, and you don't yet know if treatment X is going to be better than treatment Y, one is disinclined to pursue treatment X.  If you consider that the life-expectancy of a newly diagnosed patient is now 5+ years, that means that if we started today with a test of a lower side-effect therapy versus a higher side-effect therapy (Total Therapy qualifies, certainly) it would take much longer than 5 years before we knew enough to decide between the two types of treatments.  Conservatism will err on the the side of the treatment with fewer side effects.

This explains a lot, including the approach that Mayo and other conservative centers take with respect to treating the disease.

Interesting, at UAMS, this is turned somewhat on its head.  BB and Dr. GT, formerly at UAMS and then Huntsman and now in Iowa, have both told me on separate occasions that because they fervently believe that they approach cures a meaningful portion of patients while less aggressive approaches (to "standard risk" newly diagnosed disease) to not, that it would be a violation of medical ethics to put people into a trial that didn't offer then the same chance at a cure.  That "doing no harm" (in terms of not introducing side effects or any treatment related mortality whatsoever) in fact *does* do harm in the long run.

When you combine these two issues -- conservative centers that don't want to risk greater side effects with aggressive centers that believe it would be unethical to randomize into less effective trials -- it points out how challenging it will be to ever get a head-to-head trial to compare Total Therapy with something less aggressive.  And even if such a trial could be put together, it would take many years before results were known.

In other words: there will probably be a clear and definitive cure before there is a clear and definitive universal point of view on Total Therapy.   And until that time, patients will be required to do their own research, form their own opinion, and select a doctor whose philosophy and approach is compatible with their own belief set, comfort level, risk/reward preferences and other decision-making factors.

Some food for thought.


  1. Nice blog, thank you for sharing, I hope you can share more stuff!
    fifa 15 coins / WOW Gold /

  2. Thank you for your miracle Doctor Osemu Okpamen

    This article is dedicated to the Doctor Osemu Okpamen. I have been married with my wife for 5 years and recently she broke up with me and it hurt me deeply when she told me to leave her alone and that she does not love me anymore when i was always faithful and honest to her. I tried all the ways to get her back buying her what she wants like i always did and she still left me heart broken and she even has a new boyfriend which destroyed me even more until a friend of mine from high school directed me to this genuine spell Doctor called Osemu Okpamen. This man changed my life completely. I followed everything he told me to do and my wife came back begging for me back. I was stunned everything happened exactly like he told me. I had faith in everything he told me and everything was true. Also he was there every moment until i got my happiness back and he also provides spells that cures impotence, bareness, diseases such as HIV/AID E.T.C You can contact him via email at { } or visit his website He will help you in anything you need and quick to answer once you contact him.

    You can also call me for more info +1 (914)-517-3229.

    Is my pleasure to comment on this site and i thank the admin of this site for his/her great work so of the happiest moment in my life was when the doctor confirm that my wife is been free from this illness. this awesome moments makes me the happiest man on earth, I really don't know how to thank DR WILLIAMS for helping my wife get cured for over how many year of suffering from myeloma. i came across DR Williams contact through a headline news on internet about how DR Williams help a woman to get cured of her myeloma and so many other with similar body problem ,i contacted him and he told me how to get his herb,few day later he sent me the herbal portion which my wife take every morning for 28 days, and his medicine was able to cure her completely from myeloma. and now she very mush okay without any side effects whatsoever, If you have myeloma , you can contact him on his email address for advice and for his product.

    I was diagnosed of myeloma in 2011, I have tried all possible means to get cure but all my effort proved abortive, until a friend of mine introduced me to a herbal doctor , who prepare herbal medicine to cure different kind of diseases including myeloma , when i contacted this herbal doctor via his email, he sent me the myeloma herbal medicine via courier service, when i received the herbal medicine he gave me step by step instructions on how to apply it, when i applied it as instructed by Dr Williams i was totally cured from this disease within 1 months of usage. any body with similar problem can Contact this great herbal doctor via his email for advice and for his product,and thanks to you admin for such an informative blog.