VISION, JANUARY 2011
JANUARY 2011
Laughter - it’s fun and it’s free
Johannesburg Support Group’s members enjoyed a morning of fun
in December when laughter coach, Janine Grobler of Laugh SA took
over the meeting.
The session comprised a series of playful and energetic laughter exer-
cises while moving around in a group, making good eye contact while
laughing with each other – never at each other patients, caregivers
and buddies found themselves joining in with genuine laughter.
In fact, laughter seriously benefits our health and thousands of
scientific studies highlight the many benefits of laughter.
Laughter is nature’s stress buster. Considering that more than 80%
of all illness today is stress-related, and that 80% of all prescription
medicines are for stress-related conditions, laughter quickly reduces
our stress levels and keeps them down.
In 20 minutes of laughter we get thousands of Rands of natural and
healing organic pharmaceuticals with no bad side effects. Extended
1
hearty laughter causes our body to release a cocktail of drugs, hor-
mones and neuropeptides into our blood that quickly reduce stress,
make us feel good, boost our immune system and more.
It can help doctors, nurses and caregivers cope with the extreme stress
of dealing with patients, families and the ongoing stress of their occu-
pation. Taking home work stress can negatively impact on family life
and marriage – by reducing stress and providing tools for coping with
ongoing stress, laughter can make a real difference to caregiver’s lives.
Regular laughter sessions also provide caregivers with better tools
for dealing with patients and improve emotional intelligence. Even
caregivers approaching burnout can benefit from a fast energy re-
charge and feel the stress levels drop after even one session.
Laughter quickly reduces the harmful negative emotions including
fear, anger, distrust that lead to anxiety and depression. It increases
positive emotions that make life a wonderful experience for us and
those we come in contact with.

THE VIEW FROM THE OTHER SIDE -
Why David
hates insurance
companies!
I am involved in a case right now that epitomises all that is wrong
with commercial health insurance. All in one case. How convenient.
My patient is a young adult with a sarcoma diagnosed in her liver.
There is one large mass and several smaller ones. The tumour is not
resectable right now, so she will need chemotherapy.
Two issues have arisen this week: one related to diagnostic imaging
(radiology) and the other related to quality of life.With both issues I
have faced significant roadblocks, placed by the patient's insurance
company, that impede my ability to provide the care this young
woman needs.
I'll start with the imaging issue. The patient's sarcoma is not one
that typically arises in the liver. Also, the presence of multiple mass-
es is more consistent with spread TO the liver, rather than the
tumour arising FROM the liver. That means, if we hope to cure this
young woman, we need to find the primary tumour.
A CT scan of her chest, abdomen, and pelvis showed nothing. An
MRI of her pelvis, to better evaluate her uterus, a place that this
tumour could arise, showed nothing. Because a tumour like she has
can come from anywhere in the body, I ordered a PET scan. The
insurance company denied coverage.
Why?
Because, the physician reviewer told me, there is no evidence that a
PET scan is useful in this disease.
Of course, the physician reviewer is not an oncologist, and therefore
not a sarcoma specialist, so I'm sure he does not keep up with the
latest literature about PET scans and sarcomas. But I do. A quick
search of PubMed using the terms "sarcoma" and "PET" revealed
Cancer Coping Kit
The multi-lingual Cancer Coping Kit helps cancer patients cope
with their journey to recovery, thanks to a grant from the
National Lottery Distribution Trust Fund (NLDTF).
The Cancer Coping Kit is available in English, Afrikaans, isiZulu
and seSotho. It provides knowledge and understanding for peo-
ple diagnosed with cancer. The kit also provides family members
and caregivers with information and coping techniques. Patients
or caregivers can obtain the kit from:
Bev du Toit: 073 235 1571
People Living With Cancer: 073 975 1452
The Breast Health Foundation: 076 479 0400
CANSA: 011 648 2340
2
VISION, JANUARY 2011
This survey may change the way
medical aids pay for medicine
- so take a look
Elsabé Klinck Consulting is conducting a survey on behalf of the
Pharmaceutical Industry Association of South Africa (PIASA)! The
survey will allow PIASA to make constructive proposals to med-
ical aids and insurance companies - and your input is needed.
The survey aims to obtain information as to what happens with
medicine reimbursements in terms of motivations, changes in
medication and co-payments.
PIASA and its members do not have any access to the website
and cannot see any individual or collated information. Should
you have any questions, please contact the survey manager at
elsabe@ekconsulting.co.za.
To participate in the survey please go to
htp://www.surveymonkey.com/KD9SLLW
Elsabé gave an exceptionally interesting talk to our Cancer
Support Group this month and the advice she was able to
give about PMBs and how to deal with the medical aids was
invaluable.We look forward to welcoming her back later in
the year.
471 articles. I faxed him 4 four of them yesterday. I hope that is suf-
ficient evidence to allow me to get the test I, the treating physician,
believe my patient needs in order to maximise my chance of curing
her. I'll find out later today or tomorrow.
The other roadblock involves her quality of life. My patient will need
a chemotherapy drug called ifosfamide to treat her tumour. This
drug has a significant risk of infertility associated with it.
After consultation with a reproductive endocrinologist, we decided
that the best was to try to protect her fertility would be to use a
drug called Lupron. Unfortunately, Lupron is expensive, so it requires
prior authorisation from the insurance company. I just received an
email from our clinic coordinator that read, in part, "It won’t be cov-
ered if it’s for fertility reason (per her case manager)."
So... I have some choices to make. Do I lie and say the drug is being
prescribed for another indication? Do I tell the truth and risk the
family having to pay $750 per dose out of their own pockets? Or do
I choose a different drug, one that will not work as well, and know
that I am not providing optimal care for this young woman, and am
increasing her risk of infertility?
All because her health insurance company wants to save a few
bucks. At least they are "not for profit." Imagine the difficulties we
face when the insurance company is trying to provide dividends for
their investors, instead of health care for their customers.
”Dr David Loeb is Assistant Professor of Oncology and Pediatrics, Director,
Musculoskeletal Tumour Programme, and Co-Director, Sarcoma Centre at
Johns Hopkins, Baltimore, USA.You can subscribe to Doctor David’s very
readable blog at
http://doctordavidsblog.blogspot.comReadingRoom/HealthBlogs/Reflecti
ons.htm

San Antonio Breast
Cancer Symposium
At the recent San Antonio Breast Cancer Symposium, researchers
discussed how bone-loss drugs and hormone treatments might
affect breast cancer. They also presented findings showing that
insured women might not receive recommended mammograms.
Bone-loss drugs: The bone-loss drug zoledronic acid does not appear
to decrease recurrence of breast cancer in women in the early
stages of the disease, according to a study discussed at the sympo-
sium last week, the New York Times reports. For the study,
researchers examined 3,360 mainly British patients who had surgery
to remove breast tumours, followed by chemotherapy or other
treatments aimed at preventing recurrence. According to the study,
women who received the bone-loss drug had roughly the same
recurrence rate after five years as those who did not receive the
drug. the results did suggest a benefit for women who were at least
five years past menopause. Researcher Robert Coleman, of the
University of Sheffield in England, said this finding suggests the drug
could help prevent recurrence in women who lack estrogen or other
hormones after menopause. This conclusion could explain results
found in a “widely publicised trial” two years ago that found the
bone drug could help women avoid relapses of the cancer, the Times
reports. In that study, none of the1,800 participants had reached
menopause, but they all had received treatments that shut down
their ovaries and prevented estrogen production (Pollack, New York
Times, 12/9).
Drug Combos: Combining the drugs Herceptin and Tykerb to treat
early-stage breast cancer doubled the number of women whose
cancer disappeared compared with women who took only one of
the drugs, according to a study presented at the symposium, the
AP/MSNBC reports. The study - conducted by Jose Baselga, associ-
ate director of the Massachusetts General Hospital Cancer Center
—involved 455 women who were also treated with the chemother-
apy drug paclitaxel. The women were treated for about four months
before having surgery to remove their tumours, followed by nine
months of treatment. The researchers found that the cancer disap-
peared in just over 50% of the women who received the drug com-
bination, compared with 25% to 30% of women who only received
one of the drugs. Baselga said, “The possibility that we have here is
to enhance the number of patients that are cured” and prevent fur-
ther treatment that could be more costly (Marchione, AP/MSNBC,
12/10).
Estrogen: Some postmenopausal women who have had hysterec-
tomies and take estrogen might be shielded from breast cancer,
researchers said at the symposium, the New York Times reports
(Parker-Pope, New York Times, 12/9). For the study, University of
British Columbia oncologist Joseph Ragaz re-analysed data from the
Women’s Health Initiative, which found that women taking both
estrogen and progestin had their risk for breast cancer increase
(Roan, Los Angeles Times, 12/9). According to the new study, women
who had had hysterectomies, took only estrogen and did not have a
family history of breast cancer had a statistically significant lower
risk of getting the disease (New York Times, 12/9). Ragaz recom-
mended more research on whether endogenous estrogen produced
by the body —which is believed to incite cancer growth —and out-
side estrogen sources have different effects on women’s risk of get-
ting breast cancer (Los Angeles Times, 12/9).
Mammograms: About half of insured women ages 40 and older do
3
VISION, JANUARY 2011
Want to be a
Laughter Leader?
Janine Grobler of Laughter SA is running a training course for
laughter leaders and on completion of the course delegates are
qualified to conduct laughter workshops, laughter classes, laugh-
ter consultations and talks. The course is also excellent for self
development and growth. The course syllabus includes the dif-
ferent techniques used when laughing with various groups such
as cancer patients, senior citizens, the corporate environment
and so on.
Saturday 29 and Sunday 30th January 2011 (both days from
9H00 - 17H00). The venue will be confirmed but is most likely
in Bryanston. Closing date for registration and payment is Friday,
21 January 2011.
This course is great fun and a positive life-changing experience
for all who attend. It teaches us to put more joy into our lives
and the lives of all the people we come into contact with
through laughter. It takes only 90 seconds of unconditional
laughter to to change our state of mind from negative to posi-
tive, thus increasing memory, communication skills, productivity
and creativity, all of which are seriously compromised by stress.
Contact Janine on 082 516 7047 or email: laugh@laughsa.com
or go to www.laughsa.com to find out more about Laughter SA.
not receive annual mammograms to screen for breast cancer, and
nearly 40% of those ages 50 and older do not receive recommend-
ed biannual mammograms, according to a study conducted for
Medco Health Solutions, Reuters reports (Steenhuysen, Reuters,
12/9). Debate over how many breast cancer screenings women
should get and at what age has become more intense since 2009
recommendations from the US Preventive Services Task Force,
which said women should be screened once every two years start-
ing at age 50, according to the Wall Street Journal‘s “Health Blog”
(Wilde Mathews, “Health Blog,”Wall Street Journal, 12/9). Lead
researcher Milayna Subar said in a statement, “Our study suggests
that even among an insured population, many women do not meet
that target, and a surprising number do not even have one mammo-
gram in four years” (Reuters, 12/9). The researchers studied a data-
base of 12 million health insurance claims from 2006 through 2009.
They found that an average of 47% of women in their forties
received an annual mammogram, as did 54% of women ages 50
through 64. among women 40 and older, 77% had at least one
mammogram in four years, and 60% had at least two in four years
(“Health Blog,”Wall Street Journal, 12/9).
Source:Women’s Health Policy Report, published by the National
Partnership for Women & Families
http://www.nationalpartnership.org/site/News2?news_iv_ctrl=-
1&abbr=daily2_&page=NewsArticle&id=27060
CONTRIBUTIONS FOR PUBLICATION IN
“VISION” NEWSLETTER
Articles and letters submitted for publication
in VISION are welcomed and can be sent to:
cansurvive@icon.co.za
 VISION, JANUARY 2011

News from Dates to remember

around the world 15 January
2 February
R4R Volunteers meeting 10h00
R4R General meeting/Support 13h30
4 February World Cancer Day
5 February Bosom Buddies meeting
Blood test to spot cancer . . . . 12 February Cancer Support Group, Parktown 0900
A blood test that can detect cancer or determine whether a cancer 16 February Cape Town PLWC Gala Dinner at Zip Zap
has begun spreading to other parts of the body has moved a little Circus
closer to your doctor’s office.
26 February Bosom Buddies Valentine’s Bal
Health care giant Johnson & Johnson announced this month that
two of its units will begin working with Boston researchers to bring 28 February Cape Town PLWC Support Group
the test to market. Four major US cancer centres will also start 1-4 March R4R Volunteer Training
studies on the blood test this year.
12 March Cancer Support Group, Parktown 0900
The experimental test looks for cancer cells that have detached
12 March R4R General meeting/Support 10h00
from a tumour and mean that a cancer has either spread, or is likely
to. If left unchecked, these circulating cancer cells can grow into 26 March Bosom Buddies meeting
new tumours. 28 March Cape Town PLWC Support Group
Circulating tumour cells are found at very low levels in the blood- 9 April Cancer Support Group, Parktown 0900
stream and are hard to detect.While there is one test on the market
that can spot cancer cells in the blood - a test called CellSearch, also 13 April R4R General meeting/Support 13h30
made by a J&J unit - it doesn’t capture whole cells that doctors can 18 April Cape Town PLWC Support Group
then analyse to monitor disease progression.
7 May Bosom Buddies meeting
This newest test requires just a couple of teaspoons of blood, mean- 14 May Cancer Support Group, Parktown 0900
ing patients might even be able to skip painful biopsies of cancer
tumours and the can be used to monitor treatment in already diag- 21 May R4R General meeting/Support 10h00
nosed patients. 28 May Bosom Buddies Pink Pyjama Party
The test is so sensitive that doctors can administer a cancer therapy 30 May Cape Town PLWC Support Group
one day and sample the patient’s blood the next day to see if the
circulating tumour cells are gone. 11 June Cancer Support Group, Parktown 0900
11 June Bosom Buddies 6th birthday bash
. . . . but is it such a good idea? 27 June Cape Town PLWC Support Group
Dr. Gil Welch, a professor of medicine at the Dartmouth Institute of 29 June R4R General meeting/Support 14h00
Health Policy & Clinical Practice, reflects on the news about this
test in development in his CNN blog: 9 July Cancer Support Group, Parktown 0900

He writes:"The test could just as easily start a cancer epidemic. 25 July Cape Town PLWC Support Group
Most assume there are no downsides to looking for things to be 30 July Bosom Buddies meeting
wrong. But the truth is that early diagnosis is a double-edged sword.
While it has the potential to help some, it always has a hidden side-
CONTACT DETAILS :
effect: overdiagnosis, the detection of abnormalities that are not
destined to ever bother people in their lifetime. People Living With Cancer, Johannesburg: 073 975 1452,
plwc@icon.co.za
“Becoming a patient unnecessarily has real human costs. There's the
People Living With Cancer,Cape Town: 076 775 6099,
anxiety of being told you are somehow not healthy. There's the
info@plwc.org.za, www.plwc.org.za
problem that getting a diagnosis may affect your ability to get
health insurance. There are the headaches of renewing prescriptions, Bosom Buddies: 0860 283 343, www.bosombuddies.org.za
scheduling appointments and keeping them. Finally, there are the Campaign for Cancer: www.campaign4cancer.co.za
physical harms of treatments that cannot help (because there is CANSA Johannesburg Central: 011 648 2340, 19 St John Road,
nothing to fix): drug side-effects, surgical complications and even Houghton, www.cansa.org.za
death. Not to mention it can bankrupt you.
Reach for Recovery (R4R) : Johannesburg, Antoinette Reis,
“I don't know whether this test will help some patients. It might, but 011 648 0990 or 072 849 2901
it will take years to figure that out. But I do know that the test will Reach for Recovery: Harare, Zimbabwe contact 707659.
lead more people to be told they have cancer (or that their cancer
Cancer Centre - Harare: 60 Livingstone Avenue, Harare
has returned). That will lead more people to receive cancer treat-
Tel: 707673 / 705522 / 707444 Fax: 732676 E-mail:
ment. Because these new patients are bound to be less severely ill
cancer@mweb.co.zw www.cancerhre.co.zw
(if they are ill at all), they will appear to do better. Many will assume
4
 VISION, JANUARY 2011

PLWC Cape Town

that their doing better is because of the new test and early treat-
ment. So the test will be performed more often. And a lot of money
will be made along the way.”
http://www.cnn.com/2011/OPINION/01/11/welch.overdiag-
nosed.cancer/index.html?npt=NP1 Have you, a friend or a family member been diagnosed
with cancer? Do you have any questions or concerns?
An aspirin a day can reduce cancer Do you feel the need to talk to others who have been in
death risk by 21% the same position?
Yet another report on the benefits of daily aspirin claims that it Or are you a survivor and would just like to meet and
reduces the risk of dying of cancer by 21% after five years, and the interact with other survivors?
benefits appear to increase with time, persisting for twenty years in
You are invited to join us at our Cancer Support Group
many cases. British researchers revealed this in an article published
in The Lancet, after gathering data from eight clinical studies - a
held at Vincent Pallotti Hospital in the GVI Oncology unit
meta-analysis - involving 25,570 participants who had been on Time: 18h00 – 19h30
aspirin therapy for at least four years. In all cases the trials com-
pared aspirin to a placebo. See the calendar on page 4 for dates
They also found that dying from any cause (not just cancer) was or contact the PLWC helpline on 076 775 6099
10% lower for those on 75mg of aspirin per day. We look forward to meeting you
The doses of aspirin in the eight trials ranged from 75mg to 500mg
per day. The trials studied were carried out originally for the preven-
when the risk of most cancers starts to rise significantly; during a
tion of vascular events. Investigators explained that their findings
person’s mid-40s.
led them to believe that the benefits of daily aspirin for those aged
45 years or more far outweigh any side-effect risks. Long-term
aspirin’s link to stomach and intestinal bleeding risk has historically
Compassion fatigue - spare a thought for
put many doctors off prescribing it. the nurses
Long term daily aspirin was found to: In an article entitled “Compassion Fatigue in Nurses” published on
Medscape, Marilyn W. Edmunds, PhD, CRNP gives an understanding
Reduce 20-year prostate cancer risk by 10%
of the emotional strain on oncology nursing staff.
Reduce lung cancer risk by 30%
Reduce bowel cancer risk by 40% Traumatic events leave indelible marks on those who are touched
by them. Those who care for or help individuals who are working
Reduce esophageal/throat cancer risk by 60%
through a traumatic event can also experience stress. Compassion
Researchers think that the best time to start daily aspirin would be fatigue is the term used to describe the emotional effect of being
indirectly traumatised by
helping someone who has
experienced primary trau-
matic stress. To date, compas-
sion fatigue has been studied
primarily in non nursing
groups.
When watching a patient go
through a devastating illness
or trauma, the nurse may
react by turning off his or her
own feelings, or by experienc-
ing helplessness and anger.
Many nurses find themselves
repeatedly on the margin of a
traumatic event in the course
of patient care.
Compassion fatigue may
occur in situations when an
individual cannot be rescued
or saved from harm, and may
result in the nurse feeling
guilt or distress. Hospice
nurses; nurses caring for chil-
dren with chronic illnesses;
and personal triggers, such as
over-involvement, unrealistic
5

self-expectations, personal commitments, and personal crises, are
linked to compassion fatigue.
Although it is easy to say that nurses should be given the opportu-
nity to recognise and talk about the stress that they experience, and
to make plans for coping, these are challenging tasks. Trauma
research indicates that people involved in traumatic events need to
be able to "tell their story" eight or nine times to defuse the physio-
logic and psychological impact of what they have been through.
Compassion fatigue is often linked to burnout, a related but differ-
ent concept in which the nurse experiences slowly developing frus-
tration, a loss of control, and generally low morale.
Viewpoint
Caring is one of the foundational tenets of nursing.When nurses
cannot care for patients at the therapeutic level, they will be inef-
fective. However, caring too much is a major risk for nurses.
Compassionate nurses are an essential and dwindling resource in
today's healthcare system. The growing nursing shortage mandates
that the nurses who remain must also be supported and cared for.
Nurses don't have a monopoly on compassion fatigue. Other studies
have demonstrated that psychiatrists, in particular, have high rates of
suicide, severe depression, and general compassion fatigue. All health-
care providers need to find methods of mutual support for the anger,
frustration, and helplessness that they experience at work.
http://www.medscape.com/medline/abstract/21035028
A good reason for optimism
According to a Reuter report, optimists live longer, healthier lives
than pessimists. Researchers at University of Pittsburgh say that
their study may give pessimists another reason to grumble.
In the study of more than 100,000 women ages 50 and over they found
that women who were optimistic and expected good rather than bad
things to happen - were 14 percent less likely to die from any cause
than pessimists and 30 percent less likely to die from heart disease after
eight years of follow up in the study. The optimists were also less likely
to have high blood pressure, diabetes or smoke cigarettes.
http://www.edmontonjournal.com/news/partner/shell/Setting+inju
ry+target+zero/3092493/Optimists+live+longer+healthier+lives+S
tudy/1360893/story.html#ixzz1ASq6ScUL
Cancer campaigner gets MBE
A well known British cancer campaigner was one of the deserving
recipients on the Queen’s New Year Honours List for his services to
health.
Medi-Clinic supports PLWC
People Living With Cancer and the Cansurvive Cancer
Support Group Committee wish to thank Medi-Clinic for
their ongoing support, they have allowed us to use their
facilities and provided refreshments for the Group for
the past year and this is much appreciated.
We value the support and generosity of MediClinic and
their commitment to improving services rendered to
cancer patients and their families.
6
VISION, JANUARY 2011
C a n S u r v i v e
CANCER SUPPORT GROUP
The Group is run by members of the
Johannesburg Branch of People Living With
Cancer in association with the Wits Donald
Gordon Medical Centre and is open to any patient
or caregiver.
Meetings are held on the second
Saturday of each month at 9h00 at
18 Eton Road, Parktown
(opposite Wits Donald Gordon
Medical Centre main entrance)
All patients and caregivers are welcome
No charge is made
Enquiries:
073 975 1452
email: jhb@plwc.org.za
website: www.plwc.org.za
Clive Stone said the award has made him more determined than
ever. The 63-year-old, who was diagnosed with kidney cancer in
2007, was put forward for the honour by Prime Minister David
Cameron. Since developing the disease, Mr Stone has since fought
successfully to make the kidney cancer drug Sunitinib available on
the NHS and in July persuaded the Government to allocate £200m
to an emergency drug fund for cancer patients.
Mr Stone is a member of the Kidney Cancer Support Network,
KCSN, and three years ago he launched campaign group Justice for
Kidney Cancer patients.
This has made me more determined to keep fighting than ever. I
look forward to the time when our five-year cancer survival rates
become the best in Europe, and very ill patients do not have to
spend their last days in fighting faceless NHS administrators for
access to effective drugs which are freely available in other counties.
Greater happiness and elevated mood
It appears to be a myth that giving up smoking most likely makes
you miserable. Brown University researchers found that those who
were in the process of quitting smoking were never happier. Their
study appears in an article in the journal Nicotine & Tobacco
Research.
Corresponding author, Christopher Kahler says smokers thinking of
quitting should be encouraged by the double benefit - both physical
and mental. Giving up is far from being a psychological nightmare
done just for the sake of living a longer life, he added.
Kahler and team examined data on 236 male and female smokers
who wanted to give up. They were also heavy social drinkers. They
were all provided with smoking cessation counseling and nicotine
patches and then set a date to give up smoking. A number of the

participants were also given counseling on ways to cut down on
their alcohol consumption.
They all underwent a standardised test for symptoms of depression
seven days before they stopped smoking. Further psychological
evaluations for depression took place 2, 8, 16 and 28 weeks after
their quit date.
Of the 236 candidates:
99 failed straight away (never abstained)
44 were only found to be smoking free during their first evalua-
tion after the quit date
33 abstained successfully right up to their 8-week check-up
33 abstained throughout the whole period of the study
29 exhibited none of the above-mentioned quitting behaviours
Among those who managed to quit for a while, the researchers
found that they were in very high spirits (happy) during the check-
ups when their smoking cessation was being successfully carried
out. However, after failing their moods darkened significantly, and in
many cases to lower depths than before the whole study began.
Kahler said that enhanced mood and periods of abstinence went
hand-in-hand -the correlation was clear. The participants who failed
straight away were still followed up throughout the study and were
found to be the unhappiest of all the groups. The ones who man-
aged to abstain throughout the study period had the highest levels
of happiness, the authors wrote.
The authors added that the link between happiness and smoking
cessation was strong, regardless of whether the participant was
drinking less or the same -the constant was successful smoking ces-
sation.
The researchers believe that giving up smoking relieves symptoms
of depression and that it is a myth to believe smoking eases anxiety.
Kahler said: "If they quit smoking their depressive symptoms go
down and if they relapse, their mood goes back to where they were.
An effective antidepressant should look like that."
Article URL:
http://www.medicalnewstoday.com/articles/210375.php
Tobacco smoke causes immediate damage
According to a report released recently by US Surgeon General
Regina M. Benjamin, exposure to tobacco smoke - even occasional
smoking or secondhand smoke - causes immediate damage to your
body that can lead to serious illness or death.
The report, How Tobacco Smoke Causes Disease: The Biology and
Behavioural Basis for Smoking-Attributable Disease, points out that
cellular damage and tissue inflammation from tobacco smoke are
immediate, and that repeated exposure weakens the body's ability
to heal the damage.
"The chemicals in tobacco smoke reach your lungs quickly every
time you inhale causing damage immediately," Benjamin said in
DISCLAIMER: This newsletter is for information purposes only and
is not intended to replace the advice of a medical professional.
Please consult your doctor for personal medical advice before
taking any action that may impact on your health.
The views expressed are not necessarily those of People Living With
Cancer or those of the Editor.
7
VISION, JANUARY 2011
No compassion, no water!
Research by the NHS Confederation in the UK says things that
matter to those in hospital – such as pain control, privacy, keep-
ing the noise down, and simply talking to them and being cheer-
ful and upbeat – are often ignored by staff. It appears that they
have just discovered that a good bedside manner really does help
patients recover faster and feel happier!
Compassion for the sick is sometimes forgotten in the drive for
savings and efficiencies, they warn.
However, ensuring patients have a good experience can not only
improve the quality of care and success rates but also reduce
costs, says their report.
The UK came bottom of the 2010 Commonwealth Fund apprais-
al of healthcare services in seven countries for patient-centred
care while NHS surveys show 200,000 patients a year have a
‘negative’ experience of hospital care
The report partly blames care scandals at NHS Trusts such as
happened in Maidstone and Tunbridge Wells and Mid
Staffordshire – where patients were so thirsty they had to drink
the water out of flower vases – on inattentive staff!
‘Most NHS staff agree that patient experience could be
improved and that, on occasion, the NHS has badly let down
patients’, says the report, and it adds that ‘a big cultural shift at
many hospitals is needed’.
releasing the report. "Inhaling even the smallest amount of tobacco
smoke can also damage your DNA, which can lead to cancer."
Fortunately, there are now more effective ways to help people quit
smoking than ever before. Nicotine replacement is available over
the counter and doctors can prescribe medications that improve the
chances of successful quit attempts.
An easy-to-read guide, “A Report of the Surgeon General: How
Tobacco Smoke Causes Disease: What it Means to You” is available
on-line from:
www.surgeongeneral.gov/library/tobaccosmoke/index.html
The value of survivors
Joining a new trend in the US, the very popular Health News Review
blog recently made this announcement:
“We are pleased to welcome two breast cancer survivors as news
story reviewers for HealthNewsReview.org.
“This is the beginning of a new attempt to get more voices involved
in the review of stories on HealthNewsReview.org. In 2011 we will
explore ways to involve more "wisdom of the crowds" in our daily
reviews, so that we can better assess what people want and need
from health care news stories - and better judge whether they're
getting what they want and need.”
Hurray! Good to see that someone appreciates the input that can-
cer survivors can add. Some of those medical conferences in South
Africa could do with a good dose of patient wisdom and reality.
He who studies medicine without books sails an uncharted
sea, but he who studies medicine without patients does
not go to sea at all. - Sir William Osler

The term “patient” may describe me
… but it does not define me
In response to an article in the Journal of Participatory Medicine, a
comment posted by E. Michael D. Scott had this to say:
Some people believe we need to replace the term “patient”– the
term we use to describe a person seeking or needing the services of
a health care professional. Such people argue that, “The word
patient has negative connotations.” They believe, with some justifi-
cation, that the term “patient” carries implications of passivity. They
think (or hope) that changing the term will change the way
“patients” are treated. They make note of its historic and etymologi-
cal associations with the concepts of patience and suffering.
I have argued for years – quietly, and usually politely – that replac-
ing the word “patient” with another term will do little or nothing to
change the relationships between health care professionals and
those who seek or need their services.
For interesting historical reasons, in the UK, surgeons are called
“Mister” (or “Ms.”), not “Doctor.” It doesn’t matter. Everyone under-
stands they are still doctors. Calling surgeons “Mister” is just a term
of art that is peculiar to the British medical system.
Equally, “patient” is a term of art. The term itself is not inherently
important. What are important are the implications of the term to
the nature of the relationships between each individual patient and
the health care professional whose services are being sought out or
required.
I am a patient, a patient advocate, a patient educator, and a profes-
sional health care communications specialist. There are days when I
am all of these things at different times during a single 24-hour
period. There is no one term that encompasses all these different
functions. They are distinct. They may be interrelated, but they are
not the same thing at all.
The thing that they have in common, when seen from my point of
view, is a perspective: every patient is an individual who is entitled
to the respect and full attention of health care professionals.
Whether the patient is active or passive, the health care profession-
al should act – first and foremost – in the best interests of that
patient. Sometimes that can be ethically, morally, and even person-
Zimbabwe News
A newsletter received from the Cancer Association of Zimbabwe
shows that the Harare Cancer Centre was very active during 2010.
A number of fundraising events were held as well as cancer
awareness talks by Shinga Dakwa. Also a live TV presentation on
breast cancer by Shinga and a Think Pink Dinner Dance.
Weekly events for patients included Meditation and Relaxation
classes together with Aromatherapy, Reflexology, Reiki and Indian
Head Massage.
They express their appreciation of the support received from
sponsors and volunteers and look forward to a full programme in
2011.
Anyone wishing to support the Association with donations or
gifts can contact the Cancer Centre at:
P O Box 3358, Harare or Tel: 707673 / 705522/707444 and on
email: cancer@mweb.co.zw
8
VISION, JANUARY 2011
ally challenging, but the obligation on the health care professional
remains the same. From that point of view, the term “patient” is
actually helpful. It assists the health care professional to remember
that obligation – under all circumstances.
Derived from Latin and Old French, the English noun “patient,”
when used in its medical sense, is at least 628 years old, having
been used by Chaucer in 1382. If some individuals want to redefine
themselves as “e-patients,” “em-patients,” or “clients,” rather than
“patients,” that’s fine. However, the likelihood of successfully forcing
such a wholesale change on even the 300-year-young US health
care system is miniscule. What is necessary is a (gradual) shift in
mindsets, not a sudden change in terminology. Here is a brief list of
mindsets commonly observed in health care settings that probably
drive most readers of this journal to distraction:
The physician’s office receptionist who behaves as though his or
her primary goal is to protect Doctor (yes, with a capital D)
from actually having to see or talk to patients – at almost all
costs.
The patient in the emergency department who believes that
everyone needs to drop everything else because he or she needs
attention now – for his hang-nail, while there is a child with a
severe gunshot wound in the next exam room.
The autocratic nurse who walks you into an exam room, never
attempts to use your name, and simply says, “Take off your
clothes and put this on. Doctor will see you soon,” while tossing
you one of those socially demeaning examination gowns.
The mindsets are the problem, not the terms “patient,” “doctor,” and
“nurse.” The self-empowered patient has learned ways to deal with
the types of mindset exemplified above. The passive patient who
needs help to become empowered will gain the first steps along
that path when he or she is treated with respect and tact. The wise
healthcare professional has learned ways to deal with the patient
who thinks of no one but him or her self.
CHANGE MINDSETS, NOT TERMINOLOGY
Effective participatory medicine requires mutual respect and
acknowledgment of the rights of the various participants. It is not
about how smart or dumb the “patient” is. It’s not about whether
the doctor has a PhD as well as an MD after his name. It’s not even
about whether one is a wise user of Internet-based services. It’s all
about how people interact with each other. If the doctor isn’t listen-
ing to me describe my symptoms, I will know. If I am not listening
to the doctor when he or she is telling me I need stop smoking, he
or she will know. But if I am listening to the doctor as he or she tells
me I need to stop smoking, and I then say, “I hear you, but I don’t
know if I can manage to do that,” then we have the beginnings of
an understanding.
Participatory medicine is going to require a societal shift in how we
interact with each other if we are to achieve definable goals. To
achieve that shift, we shall need some other societal shifts too. It’s
going to be a slow process. Medicine does not encourage sudden
change – and for good reasons. This process may take 100 years to
reach fruition.
To read the article and responses, go to:
http://www.jopm.org/opinion/commentary/2010/12/29/the-term-
patient-may-describe-me-%E2%80%A6-but-it-does-not-define-
me/print/