Generally speaking, prostate cancer don’t get no respect. Going into my biopsy, I was reasonably sure I had it because of family history and four elevated PSA scores. I wasn’t much concerned, though, because as everybody knows, prostate cancer is slow growing and rarely fatal unless you catch it very late. I already knew what my treatment option was going to be: watchful waiting, meaning I’d test again in a year and see if it was going anywhere. If not, more watchful waiting.
I was half right. I have prostate cancer. Over the last few months, though, I’ve learned more than I imagined possible about the dizzying array of treatment options. In the end, the patient has to make the tough choice of which one is right for him, and for me, watchful waiting is not an option.
If you’re diagnosed at, say, age seventy, chances are good that your cancer is slow growing and you’ll probably outlive it. Plenty of men choose to treat it aggressively anyway, but an equal number choose to watch and wait. It would be my choice at that age.
At sixty, though, which is my age, your cancer by definition is more aggressive, and now the choice is between surgery, radiation, implanting radioactive seeds, or a host of less common treatments. There’s still time to look at all the options carefully and make a choice that’s best for you, but it’s not something you want to put off for a year and see how it’s going. In a year, it could be too late. My friend John was just diagnosed at age 45, and for him it’s important to begin treatment immediately. His outlook is also favorable but there’s not the luxury of going on vacation for a few months and then getting serious about treatment options when you get back.
This has been a hard decision, but I finally settled on surgery, radical prostatectomy, which is considered the “gold standard” treatment if the cancer is still organ confined. Still, it’s not an easy choice. If they don’t get all the cancer, follow-up treatments include radiation, chemotherapy, and/or hormone therapy, also cheerfully referred to as “chemical castration.” Or then again, there’s actual castration.
Even if you have a good outcome on the surgery, the complications can be life changing: mild or serious incontinence (which I frequently mispronounce as “incompetence”) and mild or serious impotence. Everyone experiences some degree of these conditions, but in most cases men regain at least near-normal function within about a year. Some men never do.
I’m optimistic. I’ve chosen a surgeon in Medford, who has much more experience than our local guy here in Klamath Falls but is still close enough that I can be out of the hospital and back home in a few hours. If there are complications, and there usually are to some degree, I can be back in his office equally quickly.
I’m scheduled for September 10th.
Generally, my emotional state is very good, though I sometimes get either depressed or angry about the whole thing. In the end, though, I expect to have all of this behind me a year or so from now. In the meantime, I’m trying to keep a good attitude and stocking up on good books and films (with an emphasis on comedies).
Again, I urge all my men friends to get regular PSA tests. Since I’ve learned I have prostate cancer, it’s amazing how many men I know who have the same thing, most of them my age or younger.
Monday, July 28, 2008
Once more to Laguna
My plans for getting down to Laguna Seca this year were the same as they have been for the prior three years since MotoGP has returned to US soil. I like to get an early start, like five days early, take my time riding my motorcycle down the coast and the back roads of Northern California, and stay with friends in Santa Cruz the Wednesday before the race. Thursday, I move on to a campground to meet up with my friend Keith, who trailers his CBR 1000 from Eugene in a one-day crunch down I-5.
But as race week approached, my plans were looking increasingly doubtful. Over 2,000 fires were reported burning in NorCal, and the state map posted on the Cal Fires website looked like a minefield. My first stop this year was going to be in Redding to stay with friends I hadn’t seen in a few years, and from the map it looked like Redding itself was in flames. My usual trip down highway 96, the Klamath River Highway was complicated by a major fire near Happy Camp. Going west from Redding looked like the worst option available, with major fires in and around Whiskeytown and Weaverville.
Fortunately, I’d decided not to camp this year at Big Sur for the races because Big Sur was fighting off the biggest fire in the state, and all the campgrounds there, and everything else for that matter, have been evacuated. Checking the weather reports for various towns along the way, I found heavy smoke warnings for every location I looked at. It seemed destined to be an uncomfortable trip at best.
Things looked so bad I actually thought about waiting until Thursday and going the I-5 route. The smoke along the interstate was reported to be as bad as everyplace else, but at least I’d be in it for fewer days. Going the back roads and camping along the way was looking like a ride into Dante’s Inferno.
In the end, though, I decided to stick more or less to the original plan. If things got bad enough, I figured I’d find a motel to hide in and hope conditions would be better the next day. In fact, it turns out I had the best trip down and back of anybody I talked to, purely out of dumb luck and one good choice. Redding, though smoky, wasn’t much worse than a moderate smog alert in LA or San Jose, two cities I grew up in. I was in my twenties before I could personally confirm that the sky was actually blue.
After staying in Redding, I rode the thirty miles down to Red Bluff and cut over for the coast on Highway 36 and was lucky the whole trip. I rode through one extensive burn area, but by the time I got there the fire was out, with only a few spots where I still noticed some smoldering undergrowth. The worst of it was having to ride with special care because of all the fire crews, trucks and equipment on the road.
I had the same good luck in Santa Cruz. My friends there reported that smoke conditions had run from bad to worse for several weeks, but the day I arrived we had a nice breeze off the ocean. As usual, the ride across the Golden Gate Bridge was exhilarating, and the coast highway from San Francisco to Santa Cruz was sunny and brisk.
But once I got to the track at Laguna Seca, all thoughts of smoke and fires evaporated in the excitement of the races and the pageantry of thousands of race fans, most of them riding sport bikes ranging from the commonplace to the exotic. Crowds were down a little, which is never a bad thing, and the weather was perfect.
And the racing was some of the best I’ve ever enjoyed. Although all of us were there primarily for the MotoGP, I had a hunch the best races of the weekend might be the Red Bull Rookies cup, two races featuring the most promising young road racers, ages thirteen to sixteen, from North and South America. I wasn’t disappointed. These twenty-four riders, at such tender young ages, all have years of racing experience already behind them.
Riding KTM two-stroke 125s, identical even down to the paint scheme, the races are pure tests of rider skill and maturity, and the best riders quickly move to the front of the pack where they fight it out with perhaps less finesse than older riders but a wild determination that makes the races thrilling. In race one on Saturday, thirteen-year-old Benny Solis of California and sixteen-year-old Argentinean Leandro Mercado traded the lead frequently around the demanding Laguna Seca track and were never more that a bike length or two apart.
On the last lap, Solis dove under Mercado in the last turn and they came out dead even in an elbow-throwing rush to the finish line, with Solis winning by 1.0001 second. That’s one ten-thousandth, if I’m not mistaken. Lots of people, including the track announcer, were saying it was the most exciting race they had ever seen, and I had to agree.
Sunday’s Rookies Cup was almost as good, with the addition of Hayden Gillem in a tight three-way race for the win. In the end, though, it was Solis first across the line again. Watch for this kid to be riding in the big leagues in a few more years. For more on the Rookies Cup, visit the official website at http://us.redbullrookiescup.com/index.php.
After all that excitement, the GP race might have even been an anti-climax, especially with Casey Stoner absolutely dominating practice and qualifying. It looked all but certain that if he got the race lead, he’d ride away from the pack, and the only real interest to the race would be in who else would make the podium. And Stoner did get the jump and lead going over turn one, but by turn two, Valentino Rossi made a bold pass on the brakes and the race was on.
Stoner had the slight advantage in bike speed but Rossi kept the pressure on, with frequent lead changes until Stoner finally made a mistake in turn eleven and went into the sand. Even after dropping his bike, he still got back on the track in second place, but by then Rossi had a commanding lead and the race was virtually over. American Nicky Hayden could only pull out a respectable fifth place, but Rossi, ever popular no matter where he races, got a huge ovation from the crowd. Good racing makes heroes of everyone.
After all the fun at Laguna, I decided to make a quick trip home with a blast up I-5 and made it to the door for dinner Monday afternoon, tired but happy once again.
As long as MotoGP comes to the West Coast every summer, I hope to be able to make it down. For me, Laguna Seca remains the premier motorcycle event of the year in the United States.
But as race week approached, my plans were looking increasingly doubtful. Over 2,000 fires were reported burning in NorCal, and the state map posted on the Cal Fires website looked like a minefield. My first stop this year was going to be in Redding to stay with friends I hadn’t seen in a few years, and from the map it looked like Redding itself was in flames. My usual trip down highway 96, the Klamath River Highway was complicated by a major fire near Happy Camp. Going west from Redding looked like the worst option available, with major fires in and around Whiskeytown and Weaverville.
Fortunately, I’d decided not to camp this year at Big Sur for the races because Big Sur was fighting off the biggest fire in the state, and all the campgrounds there, and everything else for that matter, have been evacuated. Checking the weather reports for various towns along the way, I found heavy smoke warnings for every location I looked at. It seemed destined to be an uncomfortable trip at best.
Things looked so bad I actually thought about waiting until Thursday and going the I-5 route. The smoke along the interstate was reported to be as bad as everyplace else, but at least I’d be in it for fewer days. Going the back roads and camping along the way was looking like a ride into Dante’s Inferno.
In the end, though, I decided to stick more or less to the original plan. If things got bad enough, I figured I’d find a motel to hide in and hope conditions would be better the next day. In fact, it turns out I had the best trip down and back of anybody I talked to, purely out of dumb luck and one good choice. Redding, though smoky, wasn’t much worse than a moderate smog alert in LA or San Jose, two cities I grew up in. I was in my twenties before I could personally confirm that the sky was actually blue.
After staying in Redding, I rode the thirty miles down to Red Bluff and cut over for the coast on Highway 36 and was lucky the whole trip. I rode through one extensive burn area, but by the time I got there the fire was out, with only a few spots where I still noticed some smoldering undergrowth. The worst of it was having to ride with special care because of all the fire crews, trucks and equipment on the road.
I had the same good luck in Santa Cruz. My friends there reported that smoke conditions had run from bad to worse for several weeks, but the day I arrived we had a nice breeze off the ocean. As usual, the ride across the Golden Gate Bridge was exhilarating, and the coast highway from San Francisco to Santa Cruz was sunny and brisk.
But once I got to the track at Laguna Seca, all thoughts of smoke and fires evaporated in the excitement of the races and the pageantry of thousands of race fans, most of them riding sport bikes ranging from the commonplace to the exotic. Crowds were down a little, which is never a bad thing, and the weather was perfect.
And the racing was some of the best I’ve ever enjoyed. Although all of us were there primarily for the MotoGP, I had a hunch the best races of the weekend might be the Red Bull Rookies cup, two races featuring the most promising young road racers, ages thirteen to sixteen, from North and South America. I wasn’t disappointed. These twenty-four riders, at such tender young ages, all have years of racing experience already behind them.
Riding KTM two-stroke 125s, identical even down to the paint scheme, the races are pure tests of rider skill and maturity, and the best riders quickly move to the front of the pack where they fight it out with perhaps less finesse than older riders but a wild determination that makes the races thrilling. In race one on Saturday, thirteen-year-old Benny Solis of California and sixteen-year-old Argentinean Leandro Mercado traded the lead frequently around the demanding Laguna Seca track and were never more that a bike length or two apart.
On the last lap, Solis dove under Mercado in the last turn and they came out dead even in an elbow-throwing rush to the finish line, with Solis winning by 1.0001 second. That’s one ten-thousandth, if I’m not mistaken. Lots of people, including the track announcer, were saying it was the most exciting race they had ever seen, and I had to agree.
Sunday’s Rookies Cup was almost as good, with the addition of Hayden Gillem in a tight three-way race for the win. In the end, though, it was Solis first across the line again. Watch for this kid to be riding in the big leagues in a few more years. For more on the Rookies Cup, visit the official website at http://us.redbullrookiescup.com/index.php.
After all that excitement, the GP race might have even been an anti-climax, especially with Casey Stoner absolutely dominating practice and qualifying. It looked all but certain that if he got the race lead, he’d ride away from the pack, and the only real interest to the race would be in who else would make the podium. And Stoner did get the jump and lead going over turn one, but by turn two, Valentino Rossi made a bold pass on the brakes and the race was on.
Stoner had the slight advantage in bike speed but Rossi kept the pressure on, with frequent lead changes until Stoner finally made a mistake in turn eleven and went into the sand. Even after dropping his bike, he still got back on the track in second place, but by then Rossi had a commanding lead and the race was virtually over. American Nicky Hayden could only pull out a respectable fifth place, but Rossi, ever popular no matter where he races, got a huge ovation from the crowd. Good racing makes heroes of everyone.
After all the fun at Laguna, I decided to make a quick trip home with a blast up I-5 and made it to the door for dinner Monday afternoon, tired but happy once again.
As long as MotoGP comes to the West Coast every summer, I hope to be able to make it down. For me, Laguna Seca remains the premier motorcycle event of the year in the United States.
Wednesday, July 09, 2008
Healing and the mind
Here’s an article that was posted in an online forum on prostate cancer. Following is my reply that I posted online:
The Median Isn't the Message by Stephen Jay Gould
“My life has recently intersected, in a most personal way, two of Mark Twain's famous quips. One I shall defer to the end of this essay. The other (sometimes attributed to Disraeli), identifies three species of mendacity, each worse than the one before - lies, damned lies, and statistics. “Consider the standard example of stretching the truth with numbers - a case quite relevant to my story. Statistics recognizes different measures of an "average," or central tendency. The mean is our usual concept of an overall average - add up the items and divide them by the number of sharers (100 candy bars collected for five kids next Halloween will yield 20 for each in a just world). The median, a different measure of central tendency, is the half-way point. If I line up five kids by height, the median child is shorter than two and taller than the other two (who might have trouble getting their mean share of the candy). A politician in power might say with pride, "The mean income of our citizens is $15,000 per year." The leader of the opposition might retort, "But half our citizens make less than $10,000 per year." Both are right, but neither cites a statistic with impassive objectivity. The first invokes a mean, the second a median. (Means are higher than medians in such cases because one millionaire may outweigh hundreds of poor people in setting a mean; but he can balance only one mendicant in calculating a median). “The larger issue that creates a common distrust or contempt for statistics is more troubling. Many people make an unfortunate and invalid separation between heart and mind, or feeling and intellect. In some contemporary traditions, abetted by attitudes stereotypically centered on Southern California, feelings are exalted as more "real" and the only proper basis for action - if it feels good, do it - while intellect gets short shrift as a hang-up of outmoded elitism. Statistics, in this absurd dichotomy, often become the symbol of the enemy. As Hilaire Belloc wrote, "Statistics are the triumph of the quantitative method, and the quantitative method is the victory of sterility and death." “This is a personal story of statistics, properly interpreted, as profoundly nurturant and life- giving. It declares holy war on the downgrading of intellect by telling a small story about the utility of dry, academic knowledge about science. Heart and head are focal points of one body, one personality. “In July 1982, I learned that I was suffering from abdominal mesothelioma, a rare and serious cancer usually associated with exposure to asbestos. When I revived after surgery, I asked my first question of my doctor and chemotherapist: "What is the best technical literature about mesothelioma?" She replied, with a touch of diplomacy (the only departure she has ever made from direct frankness), that the medical literature contained nothing really worth reading.“Of course, trying to keep an intellectual away from literature works about as well as recommending chastity to Homo sapiens, the sexiest primate of all. As soon as I could walk, I made a beeline for Harvard's Countway medical library and punched mesothelioma into the computer's bibliographic search program. An hour later, surrounded by the latest literature on abdominal mesothelioma, I realized with a gulp why my doctor had offered that humane advice. The literature couldn't have been more brutally clear: mesothelioma is incurable, with a median mortality of only eight months after discovery. I sat stunned for about fifteen minutes, then smiled and said to myself: so that's why they didn't give me anything to read. Then my mind started to work again, thank goodness. “If a little learning could ever be a dangerous thing, I had encountered a classic example. Attitude clearly matters in fighting cancer. We don't know why (from my old-style materialistic perspective, I suspect that mental states feed back upon the immune system). But match people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say, tend to live longer. A few months later I asked Sir Peter Medawar, my personal scientific guru and a Nobelist in immunology, what the best prescription for success against cancer might be. "A sanguine personality," he replied. Fortunately (since one can't reconstruct oneself at short notice and for a definite purpose), I am, if anything, even-tempered and confident in just this manner. “Hence the dilemma for humane doctors: since attitude matters so critically, should such a sombre conclusion be advertised, especially since few people have sufficient understanding of statistics to evaluate what the statements really mean? From years of experience with the small-scale evolution of Bahamian land snails treated quantitatively, I have developed this technical knowledge - and I am convinced that it played a major role in saving my life. Knowledge is indeed power, in Bacon's proverb. “The problem may be briefly stated: What does "median mortality of eight months" signify in our vernacular? I suspect that most people, without training in statistics, would read such a statement as "I will probably be dead in eight months" - the very conclusion that must be avoided, since it isn't so, and since attitude matters so much. “I was not, of course, overjoyed, but I didn't read the statement in this vernacular way either. My technical training enjoined a different perspective on "eight months median mortality." The point is a subtle one, but profound - for it embodies the distinctive way of thinking in my own field of evolutionary biology and natural history. “We still carry the historical baggage of a Platonic heritage that seeks sharp essences and definite boundaries. (Thus we hope to find an unambiguous "beginning of life" or "definition of death," although nature often comes to us as irreducible continua.) This Platonic heritage, with its emphasis in clear distinctions and separated immutable entities, leads us to view statistical measures of central tendency wrongly, indeed opposite to the appropriate interpretation in our actual world of variation, shadings, and continua. In short, we view means and medians as the hard "realities," and the variation that permits their calculation as a set of transient and imperfect measurements of this hidden essence. If the median is the reality and variation around the median just a device for its calculation, the "I will probably be dead in eight months" may pass as a reasonable interpretation. “But all evolutionary biologists know that variation itself is nature's only irreducible essence. Variation is the hard reality, not a set of imperfect measures for a central tendency. Means and medians are the abstractions. Therefore, I looked at the mesothelioma statistics quite differently - and not only because I am an optimist who tends to see the doughnut instead of the hole, but primarily because I know that variation itself is the reality. I had to place myself amidst the variation. “When I learned about the eight-month median, my first intellectual reaction was: fine, half the people will live longer; now what are my chances of being in that half. I read for a furious and nervous hour and concluded, with relief: darned good. I possessed every one of the characteristics conferring a probability of longer life: I was young; my disease had been recognized in a relatively early stage; I would receive the nation's best medical treatment; I had the world to live for; I knew how to read the data properly and not despair. “Another technical point then added even more solace. I immediately recognized that the distribution of variation about the eight-month median would almost surely be what statisticians call "right skewed." (In a symmetrical distribution, the profile of variation to the left of the central tendency is a mirror image of variation to the right. In skewed distributions, variation to one side of the central tendency is more stretched out - left skewed if extended to the left, right skewed if stretched out to the right.) The distribution of variation had to be right skewed, I reasoned. After all, the left of the distribution contains an irrevocable lower boundary of zero (since mesothelioma can only be identified at death or before). Thus, there isn't much room for the distribution's lower (or left) half - it must be scrunched up between zero and eight months. But the upper (or right) half can extend out for years and years, even if nobody ultimately survives. The distribution must be right skewed, and I needed to know how long the extended tail ran - for I had already concluded that my favorable profile made me a good candidate for that part of the curve. “The distribution was indeed, strongly right skewed, with a long tail (however small) that extended for several years above the eight month median. I saw no reason why I shouldn't be in that small tail, and I breathed a very long sigh of relief. My technical knowledge had helped. I had read the graph correctly. I had asked the right question and found the answers. I had obtained, in all probability, the most precious of all possible gifts in the circumstances - substantial time. I didn't have to stop and immediately follow Isaiah's injunction to Hezekiah - set thine house in order for thou shalt die, and not live. I would have time to think, to plan, and to fight. “One final point about statistical distributions. They apply only to a prescribed set of circumstances - in this case to survival with mesothelioma under conventional modes of treatment. If circumstances change, the distribution may alter. I was placed on an experimental protocol of treatment and, if fortune holds, will be in the first cohort of a new distribution with high median and a right tail extending to death by natural causes at advanced old age.“It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity. Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die - and when my skein runs out I hope to face the end calmly and in my own way. For most situations, however, I prefer the more martial view that death is the ultimate enemy - and I find nothing reproachable in those who rage mightily against the dying of the light. “The swords of battle are numerous, and none more effective than humor. My death was announced at a meeting of my colleagues in Scotland, and I almost experienced the delicious pleasure of reading my obituary penned by one of my best friends (the so-and-so got suspicious and checked; he too is a statistician, and didn't expect to find me so far out on the right tail). Still, the incident provided my first good laugh after the diagnosis. Just think, I almost got to repeat Mark Twain's most famous line of all: the reports of my death are greatly exaggerated.
And here’s my reply:
Thanks so much, Dutchy, for posting this piece by one of my favorite writers. Here's a summary of his article that might be easier to understand:
"In July of 1982, Gould was diagnosed with peritoneal mesothelioma, a highly deadly form of cancer affecting the abdominal lining and frequently found in people who have been exposed to asbestos. After a difficult two-year recovery, Gould published a column for Discover magazine, titled "The Median Isn't the Message," which discusses his reaction to discovering that mesothelioma patients had a median lifespan of only eight months after diagnosis.[6] He then describes the true significance behind this number, and his relief upon realizing that statistical averages are just useful abstractions, and do not encompass the full range of variation. The median is the halfway point, which means that 50% of patients will die before 8 months, but the other half will live longer, potentially much longer. He then needed to find out where his personal characteristics placed him within this range. Considering the cancer was caught early, the fact he was young, optimistic, and had the best treatments available, Gould figured that he should be in the favorable half of the upper statistical range. After an experimental treatment of radiation, chemotherapy, and surgery, Gould made a full recovery, and his column became a source of comfort for many cancer patients."
Gould in fact lived twenty years, not eight months, before his cancer took him. He became something of a mix between a rock star and a guru at Harvard because of his status as one of the great scientists of our time and his exuberance for life. He believed it was his positive attitude that kept him alive so long, and also allowed him to die with acceptance and a love of life right up to the last minute.
Three books have become very helpful to me as I face my own much more encouraging diagnosis: Surviving Prostate Cancer is already well-known here for its easy to understand explanations of this complicated disease. At the heart of Dr. Walsh's message is one of great optimism.
Bill Moyer's Healing and the Mind documents the great successes many physicians are finding in treating a variety of illnesses with a combination of traditional medicine with nontradional methods such as diet, exercise, and meditation (although "non-traditional might not be the best term since these practices have been with us for thousands of years!). And Jon Kabat-Zinn's Full Catastrope Living is a handbook for "using the wisdom of your body and mind to face stress, pain, and illness." Kabat-Zinn is a doctor at the Harvard Medical School and for many years has run classes that help patients live longer and live better, even in the face of the worst possible medical conditions.
Over the last few years, I've been moving steadily to turn around some of the bad habits that were destroying my health and quality of life. I've quit drinking and smoking, to name the two most important ones. Now that I'm facing cancer, I'm using these three books not just to help me get better physically but to grow emotionally and spiritually as well.
A fuller biography of Gould can be found at http://en.wikipedia.org/wiki/Stephen_Jay_Gould
The Median Isn't the Message by Stephen Jay Gould
“My life has recently intersected, in a most personal way, two of Mark Twain's famous quips. One I shall defer to the end of this essay. The other (sometimes attributed to Disraeli), identifies three species of mendacity, each worse than the one before - lies, damned lies, and statistics. “Consider the standard example of stretching the truth with numbers - a case quite relevant to my story. Statistics recognizes different measures of an "average," or central tendency. The mean is our usual concept of an overall average - add up the items and divide them by the number of sharers (100 candy bars collected for five kids next Halloween will yield 20 for each in a just world). The median, a different measure of central tendency, is the half-way point. If I line up five kids by height, the median child is shorter than two and taller than the other two (who might have trouble getting their mean share of the candy). A politician in power might say with pride, "The mean income of our citizens is $15,000 per year." The leader of the opposition might retort, "But half our citizens make less than $10,000 per year." Both are right, but neither cites a statistic with impassive objectivity. The first invokes a mean, the second a median. (Means are higher than medians in such cases because one millionaire may outweigh hundreds of poor people in setting a mean; but he can balance only one mendicant in calculating a median). “The larger issue that creates a common distrust or contempt for statistics is more troubling. Many people make an unfortunate and invalid separation between heart and mind, or feeling and intellect. In some contemporary traditions, abetted by attitudes stereotypically centered on Southern California, feelings are exalted as more "real" and the only proper basis for action - if it feels good, do it - while intellect gets short shrift as a hang-up of outmoded elitism. Statistics, in this absurd dichotomy, often become the symbol of the enemy. As Hilaire Belloc wrote, "Statistics are the triumph of the quantitative method, and the quantitative method is the victory of sterility and death." “This is a personal story of statistics, properly interpreted, as profoundly nurturant and life- giving. It declares holy war on the downgrading of intellect by telling a small story about the utility of dry, academic knowledge about science. Heart and head are focal points of one body, one personality. “In July 1982, I learned that I was suffering from abdominal mesothelioma, a rare and serious cancer usually associated with exposure to asbestos. When I revived after surgery, I asked my first question of my doctor and chemotherapist: "What is the best technical literature about mesothelioma?" She replied, with a touch of diplomacy (the only departure she has ever made from direct frankness), that the medical literature contained nothing really worth reading.“Of course, trying to keep an intellectual away from literature works about as well as recommending chastity to Homo sapiens, the sexiest primate of all. As soon as I could walk, I made a beeline for Harvard's Countway medical library and punched mesothelioma into the computer's bibliographic search program. An hour later, surrounded by the latest literature on abdominal mesothelioma, I realized with a gulp why my doctor had offered that humane advice. The literature couldn't have been more brutally clear: mesothelioma is incurable, with a median mortality of only eight months after discovery. I sat stunned for about fifteen minutes, then smiled and said to myself: so that's why they didn't give me anything to read. Then my mind started to work again, thank goodness. “If a little learning could ever be a dangerous thing, I had encountered a classic example. Attitude clearly matters in fighting cancer. We don't know why (from my old-style materialistic perspective, I suspect that mental states feed back upon the immune system). But match people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say, tend to live longer. A few months later I asked Sir Peter Medawar, my personal scientific guru and a Nobelist in immunology, what the best prescription for success against cancer might be. "A sanguine personality," he replied. Fortunately (since one can't reconstruct oneself at short notice and for a definite purpose), I am, if anything, even-tempered and confident in just this manner. “Hence the dilemma for humane doctors: since attitude matters so critically, should such a sombre conclusion be advertised, especially since few people have sufficient understanding of statistics to evaluate what the statements really mean? From years of experience with the small-scale evolution of Bahamian land snails treated quantitatively, I have developed this technical knowledge - and I am convinced that it played a major role in saving my life. Knowledge is indeed power, in Bacon's proverb. “The problem may be briefly stated: What does "median mortality of eight months" signify in our vernacular? I suspect that most people, without training in statistics, would read such a statement as "I will probably be dead in eight months" - the very conclusion that must be avoided, since it isn't so, and since attitude matters so much. “I was not, of course, overjoyed, but I didn't read the statement in this vernacular way either. My technical training enjoined a different perspective on "eight months median mortality." The point is a subtle one, but profound - for it embodies the distinctive way of thinking in my own field of evolutionary biology and natural history. “We still carry the historical baggage of a Platonic heritage that seeks sharp essences and definite boundaries. (Thus we hope to find an unambiguous "beginning of life" or "definition of death," although nature often comes to us as irreducible continua.) This Platonic heritage, with its emphasis in clear distinctions and separated immutable entities, leads us to view statistical measures of central tendency wrongly, indeed opposite to the appropriate interpretation in our actual world of variation, shadings, and continua. In short, we view means and medians as the hard "realities," and the variation that permits their calculation as a set of transient and imperfect measurements of this hidden essence. If the median is the reality and variation around the median just a device for its calculation, the "I will probably be dead in eight months" may pass as a reasonable interpretation. “But all evolutionary biologists know that variation itself is nature's only irreducible essence. Variation is the hard reality, not a set of imperfect measures for a central tendency. Means and medians are the abstractions. Therefore, I looked at the mesothelioma statistics quite differently - and not only because I am an optimist who tends to see the doughnut instead of the hole, but primarily because I know that variation itself is the reality. I had to place myself amidst the variation. “When I learned about the eight-month median, my first intellectual reaction was: fine, half the people will live longer; now what are my chances of being in that half. I read for a furious and nervous hour and concluded, with relief: darned good. I possessed every one of the characteristics conferring a probability of longer life: I was young; my disease had been recognized in a relatively early stage; I would receive the nation's best medical treatment; I had the world to live for; I knew how to read the data properly and not despair. “Another technical point then added even more solace. I immediately recognized that the distribution of variation about the eight-month median would almost surely be what statisticians call "right skewed." (In a symmetrical distribution, the profile of variation to the left of the central tendency is a mirror image of variation to the right. In skewed distributions, variation to one side of the central tendency is more stretched out - left skewed if extended to the left, right skewed if stretched out to the right.) The distribution of variation had to be right skewed, I reasoned. After all, the left of the distribution contains an irrevocable lower boundary of zero (since mesothelioma can only be identified at death or before). Thus, there isn't much room for the distribution's lower (or left) half - it must be scrunched up between zero and eight months. But the upper (or right) half can extend out for years and years, even if nobody ultimately survives. The distribution must be right skewed, and I needed to know how long the extended tail ran - for I had already concluded that my favorable profile made me a good candidate for that part of the curve. “The distribution was indeed, strongly right skewed, with a long tail (however small) that extended for several years above the eight month median. I saw no reason why I shouldn't be in that small tail, and I breathed a very long sigh of relief. My technical knowledge had helped. I had read the graph correctly. I had asked the right question and found the answers. I had obtained, in all probability, the most precious of all possible gifts in the circumstances - substantial time. I didn't have to stop and immediately follow Isaiah's injunction to Hezekiah - set thine house in order for thou shalt die, and not live. I would have time to think, to plan, and to fight. “One final point about statistical distributions. They apply only to a prescribed set of circumstances - in this case to survival with mesothelioma under conventional modes of treatment. If circumstances change, the distribution may alter. I was placed on an experimental protocol of treatment and, if fortune holds, will be in the first cohort of a new distribution with high median and a right tail extending to death by natural causes at advanced old age.“It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity. Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die - and when my skein runs out I hope to face the end calmly and in my own way. For most situations, however, I prefer the more martial view that death is the ultimate enemy - and I find nothing reproachable in those who rage mightily against the dying of the light. “The swords of battle are numerous, and none more effective than humor. My death was announced at a meeting of my colleagues in Scotland, and I almost experienced the delicious pleasure of reading my obituary penned by one of my best friends (the so-and-so got suspicious and checked; he too is a statistician, and didn't expect to find me so far out on the right tail). Still, the incident provided my first good laugh after the diagnosis. Just think, I almost got to repeat Mark Twain's most famous line of all: the reports of my death are greatly exaggerated.
And here’s my reply:
Thanks so much, Dutchy, for posting this piece by one of my favorite writers. Here's a summary of his article that might be easier to understand:
"In July of 1982, Gould was diagnosed with peritoneal mesothelioma, a highly deadly form of cancer affecting the abdominal lining and frequently found in people who have been exposed to asbestos. After a difficult two-year recovery, Gould published a column for Discover magazine, titled "The Median Isn't the Message," which discusses his reaction to discovering that mesothelioma patients had a median lifespan of only eight months after diagnosis.[6] He then describes the true significance behind this number, and his relief upon realizing that statistical averages are just useful abstractions, and do not encompass the full range of variation. The median is the halfway point, which means that 50% of patients will die before 8 months, but the other half will live longer, potentially much longer. He then needed to find out where his personal characteristics placed him within this range. Considering the cancer was caught early, the fact he was young, optimistic, and had the best treatments available, Gould figured that he should be in the favorable half of the upper statistical range. After an experimental treatment of radiation, chemotherapy, and surgery, Gould made a full recovery, and his column became a source of comfort for many cancer patients."
Gould in fact lived twenty years, not eight months, before his cancer took him. He became something of a mix between a rock star and a guru at Harvard because of his status as one of the great scientists of our time and his exuberance for life. He believed it was his positive attitude that kept him alive so long, and also allowed him to die with acceptance and a love of life right up to the last minute.
Three books have become very helpful to me as I face my own much more encouraging diagnosis: Surviving Prostate Cancer is already well-known here for its easy to understand explanations of this complicated disease. At the heart of Dr. Walsh's message is one of great optimism.
Bill Moyer's Healing and the Mind documents the great successes many physicians are finding in treating a variety of illnesses with a combination of traditional medicine with nontradional methods such as diet, exercise, and meditation (although "non-traditional might not be the best term since these practices have been with us for thousands of years!). And Jon Kabat-Zinn's Full Catastrope Living is a handbook for "using the wisdom of your body and mind to face stress, pain, and illness." Kabat-Zinn is a doctor at the Harvard Medical School and for many years has run classes that help patients live longer and live better, even in the face of the worst possible medical conditions.
Over the last few years, I've been moving steadily to turn around some of the bad habits that were destroying my health and quality of life. I've quit drinking and smoking, to name the two most important ones. Now that I'm facing cancer, I'm using these three books not just to help me get better physically but to grow emotionally and spiritually as well.
A fuller biography of Gould can be found at http://en.wikipedia.org/wiki/Stephen_Jay_Gould
Sunday, July 06, 2008
Trial by fire
Every year in July, I ride my motorcycle down to Monterey for the MotoGP races at Laguna Seca. These are the best riders on the fastest bikes in the world. The races themselves are deliriously exciting, and it’s a huge festival atmosphere.
I take a week or so to get down, riding some of the back roads from I-5 to the coast, then down the coast to San Francisco and on to Santa Cruz, where I stay with friends. I camp along the way and take my time getting back home as well.
This year, the whole route is threatened by the over-1000 fires burning in Northern California. The fire map of the state looks like a minefield. So far no road closures, but I don’t know how bad the smoke might be. The Biscuit Fire in Southwest Oregon in 2002 burned half a million acres (!), and the smoke here in Klamath Falls kept us indoors for the better part of three months. That fire was a hundred miles away, but wind conditions are everything.
One of the big fires is in Big Sur, which isn’t that far from the races. I camped there last year, but this year I’m staying at Mt. Madonna county park, which is near Watsonville. No fires there, as far as I can tell.
I hope none of this spoils my trip. Life is so unfair.
I take a week or so to get down, riding some of the back roads from I-5 to the coast, then down the coast to San Francisco and on to Santa Cruz, where I stay with friends. I camp along the way and take my time getting back home as well.
This year, the whole route is threatened by the over-1000 fires burning in Northern California. The fire map of the state looks like a minefield. So far no road closures, but I don’t know how bad the smoke might be. The Biscuit Fire in Southwest Oregon in 2002 burned half a million acres (!), and the smoke here in Klamath Falls kept us indoors for the better part of three months. That fire was a hundred miles away, but wind conditions are everything.
One of the big fires is in Big Sur, which isn’t that far from the races. I camped there last year, but this year I’m staying at Mt. Madonna county park, which is near Watsonville. No fires there, as far as I can tell.
I hope none of this spoils my trip. Life is so unfair.
Two recent concerts
Last week, Wynton Marsallis and the Jazz at Lincoln Center Orchestra played a concert in Portland, and the review in the Oregonian was glowing. The band, it said, played jazz from all the eras of its long history, but the arrangements were modern and challenging and the soloists were brilliant.
Mary and I saw them a few nights later at the Britt Festival in Jacksonville, and though it was an enjoyable night out, I left feeling dissatisfied. How can this be with fifteen of the best jazz musicians in the country on the stage at the same time? Blame Wynton.
It’s true that some of the arrangements were modern versions of old classics. The band played a particularly appealing arrangement by Ted Nash of Down by the Riverside, rhythmically complex while only faintly alluding to the original melody. Nash also composed the most interesting piece of the evening, a musical reflection on painter Jackson Pollock, and Nash himself was a brilliant soloist. And there were other spectacular solos. Trumpet player Ryan Kisor was brilliant and evocative with a plunger mute.
In fact, everybody who took a solo was sufficiently brilliant, but often the performance seemed just lacking enough in energy to feel like something essential was missing. Wynton sat back in the trumpet section and never stood, whether announcing a song or taking a solo. After a song, he would acknowledge some of the soloists but not all, including the Kisor solo, which to me was the highpoint of the concert.
Marsallis has won just about every award possible in music, including a Pulitzer Prize. He’s the only musician ever to win Grammys for best jazz and best classical album in the same year. But he’s long been unpopular and even reviled among long-time jazz listeners for what is seen as his reactionary attitude towards jazz. It’s not just how he plays, which can sometimes be modern enough, but what he says. Under Marsallis, jazz stays put more than it moves forward, and he seems better overall in marketing himself than advancing as a musician. I’ve liked him best as a sideman with other musicians, but I’ve never thought he was among the best trumpet players in jazz or a particularly interesting composer.
In contrast, I saw Return to Forever a month earlier at the Britt, and although fusion has never particularly appealed to me, the reunion-tour concert by Chick Corea, Al Di Miola, Stanley Clark and Lennie White was one of the most exciting jazz nights I’ve ever enjoyed. Their on-stage energy was enormous, and though they first played these songs together some thirty-five years ago, their solos and unison passages were as fresh as they were explosive. They were clearly having fun, and I can't say I saw much fun in the JLCO.
Even at its most introspective, jazz is about energy, or so it seems to me. If I’m not bopping in my seat, something is missing, and I did little or no seat bopping with the Jazz at Lincoln Center Orchestra. With Return to Forever, I risked rupturing a disc.
Call it my seat-of-the-pants critical theory, or as Ellington put it, It Don’t Mean a Thing If It Ain’t Got That Swing. Sad to say, the JLCO don’t swing.
Mary and I saw them a few nights later at the Britt Festival in Jacksonville, and though it was an enjoyable night out, I left feeling dissatisfied. How can this be with fifteen of the best jazz musicians in the country on the stage at the same time? Blame Wynton.
It’s true that some of the arrangements were modern versions of old classics. The band played a particularly appealing arrangement by Ted Nash of Down by the Riverside, rhythmically complex while only faintly alluding to the original melody. Nash also composed the most interesting piece of the evening, a musical reflection on painter Jackson Pollock, and Nash himself was a brilliant soloist. And there were other spectacular solos. Trumpet player Ryan Kisor was brilliant and evocative with a plunger mute.
In fact, everybody who took a solo was sufficiently brilliant, but often the performance seemed just lacking enough in energy to feel like something essential was missing. Wynton sat back in the trumpet section and never stood, whether announcing a song or taking a solo. After a song, he would acknowledge some of the soloists but not all, including the Kisor solo, which to me was the highpoint of the concert.
Marsallis has won just about every award possible in music, including a Pulitzer Prize. He’s the only musician ever to win Grammys for best jazz and best classical album in the same year. But he’s long been unpopular and even reviled among long-time jazz listeners for what is seen as his reactionary attitude towards jazz. It’s not just how he plays, which can sometimes be modern enough, but what he says. Under Marsallis, jazz stays put more than it moves forward, and he seems better overall in marketing himself than advancing as a musician. I’ve liked him best as a sideman with other musicians, but I’ve never thought he was among the best trumpet players in jazz or a particularly interesting composer.
In contrast, I saw Return to Forever a month earlier at the Britt, and although fusion has never particularly appealed to me, the reunion-tour concert by Chick Corea, Al Di Miola, Stanley Clark and Lennie White was one of the most exciting jazz nights I’ve ever enjoyed. Their on-stage energy was enormous, and though they first played these songs together some thirty-five years ago, their solos and unison passages were as fresh as they were explosive. They were clearly having fun, and I can't say I saw much fun in the JLCO.
Even at its most introspective, jazz is about energy, or so it seems to me. If I’m not bopping in my seat, something is missing, and I did little or no seat bopping with the Jazz at Lincoln Center Orchestra. With Return to Forever, I risked rupturing a disc.
Call it my seat-of-the-pants critical theory, or as Ellington put it, It Don’t Mean a Thing If It Ain’t Got That Swing. Sad to say, the JLCO don’t swing.
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