TheMaster17

Sadly ironic yet appropriate comment

I noticed your comment here Wikipedia:Reference desk/Archives/Science/2009 June 23#Venus Flytrap care And I'm really astounded for what reason anyone should insert such a factual error in a copy of Darwin's text. --TheMaster17. If you're not aware, it was later determined to be the person who claimed to have this copy with the error himself who inserted the factual error apparently not wanting to admit they had been wrong. There's some brief discussion and links here Wikipedia talk:Reference desk#Well done APL, Steve Baker, Kurt Shaped Box and non RD regulars if you're interested to know more.

Just thought you might like to know given your comment, cheers Nil Einne (talk) 16:15, 27 August 2009 (UTC)

Cancer cause discussion

Hi Master17,

I will check your talk page for a few days in case you want to continue the cancer discussion started on Science RefDesk.

I was going to post a scan of a few typical recent pathology reports showing multiple tumour types in each patient (with the patient's identity blacked out of course), however I was unable to figger out how to do it. Do you know how? One case was interesting, as a tumour of one type, presumed to be a secondary of a primary arising several years before, surrounded and infiltrated a primary of a quite different type. It shows quite clearly in the slices.

My main motivation in posting to refe desk was to correct misconceptions and improve the understanding of the topic by the OP and other readers. So if you aren't particularly interested in a private discusion here, then it doesn't matter. But if you are interested, then fine.

My post on Ref Desk about Root Cause analysis coming from Engineering means just what it says. It's something that Engineers have used for decades, because it is usefull to them. It hasn't until now been used much by the medical fraternity, because until recently, it didn't fill a need. That doesn't make it invalid. Lots of times some field has advanced by borrowing a concept from another field. I once asked a chemo oncologist friend what she liked about her job, and what she didn't like. Her answer was interesting: She said the 1 in 10 death rate in her patinets didn't bother her, as that was outside what anyone could do. What made her sad was mainly patients who refused treatment because they knew someone who had cancer who refused treatment and did not die. As tumour detection improves it is becoming clear that the body does know how to deal with it - sometimes. But she also got sad about people who continue to smoke, and young people who take up smoking, because they know folk who smoked all their lives without getting cancer. And people who smoke and say "well, my mother smoked and didn't get cancer", or, worse actually, people who smoke, and say "well my Dad got cancer but he didn't smoke, so it's not the smoking".

Public health authorities need to improve their education strategies - maybe the problem is they give a really too simplified view - "smoked and you may get lung cancer". You can't expect the public to have the understanding of a medical or research professor. Maybe a root cause and trigger model, which is simplified compared to reality, but more sophisticated than the "smoking is a health hazard" message can get a better impact.

Wickwack 60.230.234.252 (talk) 16:26, 24 October 2012 (UTC)

Hi Wickwack,

I'm glad we can continue our discussion here. I always assumed that your goal was to improve the understanding of the OP, I was just critizising your arguments and the unreferenced nature of your comments. In a discussion forum, you can give your opinion about the use of "root causes" and "triggers" in medicine. But on the Refdesk, it is assumed you only post referencable material (which yours clearly isn't).

Getting back to the "multiple tumors in one patient"-thing: I'm aware that there are case-reports about such things, we ourselves get several such tumors each year in our lab. But they are in no way "common", they are very, very rare. There are thousands of tumor patients passing through big clinics each year, and you normally only get one or two patients with multiple tumors at once. And even there, our analysis often shows that they are not that disconnected, for example they could all derive from one hematopoetic stem cell in the bone marrow of the patient because they share several tumor-initiating mutations. In such a case, I wouldn't really speak of "unrelated" tumors. To really find, say, a lung cancer and a completely unrelated brain cancer in the same patient has probably odds in excess of one in several million (as you would expect from the occurence rates of the single tumors themselves).

I also agree that health authorities sometimes make a poor job in communication. But I don't believe that simply "dumbing it down" would help, as that process itself would introduce logical problems into the explanations. It's simply not possible to reduce complex problems to simple ones without losing a lot in the "translation". That's the same for einsteins theory of general relativity (which you can't really grasp without mathematics, in my opinion) or evolution or, in this case, the development of cancer.

--TheMaster17 (talk) 08:35, 25 October 2012 (UTC)

Hi Master17,

1. Ref Desk and referencing

I think you share some misconceptions about Ref Desk that a few others have. In Wikipedia articles, the policy is that 1) all information is referenced, that is, references are listed that support ALL the points made, and 2) no original (meaning new & novel)research is presented - the only views presented should be views that are accepted by workers in the appropriate field. This is a very good policy, entirely appropriate to an encyclopedia - "a work embracing the circle of human knowledge" as my Chambers disctionary puts it. Ref Desk is different. The purpose of ref desk is to improve the understanding by folk who post questions. It is NOT an encyclopedia. Responses supported by references are highly desirable, but are not essential. What is very desirable is that the responses improve the OP's understanding, which can be achived if presented in sound logical fashion. Original research is ok too, so long as it makes sense as presented. When I post a response, I give references if I am aware of references that are appropriate. Often I try to present a clear logical reasoning. I usually include and highlight the correct technical terms used in the subject, so that the OP and others have something to search on. Many questions on Ref Desk look like they are homework (not necessarily school homework). It serves the OP better if he is induced to find his/her own references - he'll learn more and retain it better. For the Cancer question, I elected to not use/highlight the technical terms of the subject, and it is most unlikley to be homework. This is because if the OP was smart enough to use medical terminology, he would not have asked that particular question. That decision may have been a mistake on my part.

2. Multiple tumours (in same patient) related

It looks like you and I actually agree - we just talk about it in different ways so it looks like we disagree. I used in Ref Desk the terminology "tumours of different type" rather than "unrelated". It will, of course, be the case that the occurence rate of tunours or diffenent type will be a positive function of their relatedness. And, as I point out on Ref Desk, tumours of very different type are often clearly related on a root cause basis. For example, the same BRCA-2 gentic fault is important in breast cancer, protate cancer, pancreatic cancer and bowel cancer. So all these cancers can be (they aren't always) considered related.

3. Dumbing down the message.

Here again you and I actually agree I think. If you read more carefully, you'll see that I was not advocating further dumbing down the message. I reckon they've dumbed it down too much. I said it would be better if they "smartened it up" - ie presented a model of cancer (genetic causes and environmental triggers) that is ver simplified compared to the truth, but is a close fit to the truth than "smoking is a health hazard."

Wickwack 121.221.86.108 (talk) 08:15, 26 October 2012 (UTC)

Hi Wickwack,

1) I really don't believe I have misconceptions about the reference desk. The guidelines clearly state "We expect responses that not only answer the question, but are also factually correct, and to refrain from responding with answers that are based on guesswork. Ideally, answers should refer (link) to relevant Wikipedia articles, or otherwise cite reliable sources.". In my opinion, your answers were neither factually correct (mentioning design, genetic defects, conflating genes with "faults" etc.; things that don't exist in biology), nor based on the literature. It's true that it's not mandatory to include references, but your answer should in principle be referencable, if someone asks for it. You never supplied any references when I asked for them, because I simply didn't believe your statements were correct.

Your sentence "Responses supported by references are highly desirable, but are not essential." is also clearly wrong. All respondends on the refDesk should strive to give correct answers, and only responses supported by references (even if they are not explicitly given) could be considered correct, couldn't they? Responses not supported by references are guesswork or opinions, and that is exactly the kind of answers that is unwanted on the refdesk.

If you really want to lead the OP to find his own references, why don't you give the correct terms for him to look for? "Dumbing things down" is not a good idea if you wan't someone to be able to make his own literature/google screen. As a side note: It's often also bad to assume someome is "not smart" because he just doesn't know medical/scientific terminology.

2) I think you are still not getting my point. I think we agree in principle about the technicalities of tumors and their relatedness. What I don't agree to is your statement that multiple tumors of "different types" in the same patient are somehow "common". They aren't.

3) I don't mind in principle leaving out details to bring the main points across (everybody has to do that if he wants to be understood, every day). What you did is introduce a method from engineering that is not applicable to cancer (and never was applied, as far is I know), so you offered your opinion instead of correct explanations. In addition, you used incorrect analogies (the defect car for example), that further complicated that already complicated topic, instead of giving straight answers. The OP asked a question about cancer development. You brought in a bunch of other topics and concepts, that in my opinion had nothing to do with cancer or biology. That is not helpful for anyone who wants a deeper understanding of the topic (which the OP obviously wants, if he asks on the science reference desk).

Just to say it clearly: I never thought (for long) you wouldn't act in good faith. I just ask you to better think about the context you are answering in. The reference desk is no forum, and the science desk expects in general scientific, specific answers to the questions given, that are based on reliable sources. I really regret that I have started a discussion with you on the desk itself (that didn't help anyone), but at first I didn't really know how to contact you.

If you have something to say, I'm glad to read your reply here, and if the thing is settled now, I'm sure we will read each other on the refdesk.

--TheMaster17 (talk) 09:12, 26 October 2012 (UTC)

Hi Master17,

Well, it isn't settled, but there seems no point in continuing this discussion here, because you are still not reading what I say. I wasn't the poster that introduced the term "design", that was poster Wnt, as I pointed out to you before. Go use a text search and see where the word occurs first.

You seem to have a problem with the use of analogy. Analogy is frequently used to explain concepts in all manner of human endeavour. You've said twice that my analogy is wrong, but made no comment whatsover why its wrong. That's not a usefull or intelligent approach. If I thought the analogy example was wrong, I would have used something else. So, what's wrong with it? If you can't explain it, perhaps it is ok after all.

You keep blathering on about dumbing things down to much. I would have thought it blindlingly obvious by now that I was trying to work in the opposite direction, "smartening up" by using, although a still very much simplified version of cancer reality, a model not as dumbed down as the standard approach.

You are still going on about me not quoting references. But you have not provided any references either. You complained that I have not provided a reference when you asked. But, as I pointed out to you before, You asked for a reference to support a statement I made, but you did not identify which of my several statements you had in mind. I invited you to identify which statement you wanted supported - you did not respond on that.

You said on Ref Desk that, and I've copy-pasted this (your spelling corrected): "Seeing a patient with two different cancer types at once is very, very, very rare...", and you have continued with that theme. Well, you have confused simultaniety in time with multiple in place (ie patient). But, in any case, what rot - especially for multiple in place/patient. My wife must be a very very very rare case then, she has had two different types of breast cancer, bowel cancer, and skin cancer. Funny though, neither her general practitioner, her skin specialist, three oncologists, and two surgeons thought so when she raised it with them. She was concerned that it might be secondaries, but pathology etc clearly established they are all distinctly different type primaries. They all said this is something that does happen from time to time. And no, they are NOT secondaries. One surgeon told her he sees cases with 2 different types all the time. My cousin's better, she's only very rare - she has leukemia and breast cancer. Her husband has had prostate and lung cancer (he's about 90 and smoked heavily for about 70 years or so until one lung was removed.) Not so many years ago, things like lung and breast cancer were most times a death sentence, especially lung. But these days the medical art is such that >90% of such patients continue with a normal life span, and have time to grow something different. And of course, treatment options are much wider & specific now, supported by diagnostic tests with a much greater degree of diferentiation.

Wickwack 120.145.205.244 (talk) 10:31, 26 October 2012 (UTC)

Hi Wickwack,

Now I'm really starting to think you are trying to provoke me.

1) It's true that Wnt has introduced the word "design", but you clearly introduced and heavily used the concept ("defect", "wrong" only make sense in a design context). Wnt just used a "sloppy" word, but it is clear from his answer that he didn't want to imply this as a technical word.

2) For my stand on analogy, just read my point 3 above. I stated clearly what I think was wrong with your analogy on a functional level. It didn't clear things up, it introduced totally unrelated concepts and complicated things more. A human is neither fabricated, nor has a manufacturer. The origin of cancer is therefore not understandable in the context of the analogy of a car. Dividing causes in different categories might be useful for an engineer (and even there, the opinions are divided, I've read), but it doesn't seem to be so in biology or medicine, looking at the output of those fields. You can disagree with that, but that's not suitable for the refdesk, as I showed you in the guidelines.

3) I can believe that it was your goal to enlighten the discussion, but I'm trying to tell you you didn't. How can the usage of incorrect analogies and terminologies brighten up a discussion?

4) Come on. I didn't answer to your question about the reference? I now stated several times that I want references for the "multiple tumors in a single patients are common"-claim. And how can you dare to say you don't know what topic I want references for, when your next section clearly grasps what I was asking for? (see my point 5) And I supplied a reference, I linked to the article cancer, pointing out the nice section about causes and the statistics of causes. Most of my other replies were not answering the OP, but were disagreeing with you and trying to point out the errors you made.

5) Your last paragraph above isn't really telling anything. I'm really sorry, on a personal level, for the people you know that suffered. But examples can never show the frequency of an event. There are people that win the lottery, but that doesn't make it "common to win the lottery". Of course, there are people that get multiple, unrelated tumors of different types, even at the same time. But that doesn't make it a common thing, instead I can tell you from the scientific literature that this is really rare. And it has to be rare, just out of simple mathematical reasoning, if the tumors are really unrelated (meaning, in mathematics, that they are unrelated observations). Just looking at the cases above, without giving any advice to you, tells me that there must be a common cause (gene variant? environmental effect? how did they check that they really are no secondaries?) for such a clustering of cancers. The background cancer rates make it very improbable to see such a clustering of cases around you, that all have multiple unrelated tumors. Even the doctor seems to have told you (or your relatives) that "it happens from time to time", meaning it is not frequent or common.

6) I don't want to nitpick, but you are again introducing numbers from thin air. It would really be nice if more than 90% of all tumor patients had a normal life span after therapy, but that is wishful thinking. Have a look in the literature, and you will see this is not the case. It is true that some cancers are basically curable nowadays, but the wide majority kills you rather quickly, therapy or not. Therapy might prolong your life, sure, that's the reason why it is given (2 additional months for someone who would only live 6 months without is a lot). But the cancers that are curable without side effects are a small minority. Why are you doing this? Inventing numbers and using imprecise(wrong?) sentences does not help, neither in a discussion nor in an explanation. And it is making it harder and harder for me to think you are really interested in a factual discussion (which needs facts, not conjecture, from both sides).

--TheMaster17 (talk) 16:02, 26 October 2012 (UTC)

Master17,

You do a lot that you accuse me of. I wasn't trying to provoke you so much as trying to get you to think, and get you to abandon some obsolete ideas you have. You have added much incorrect assertions without reference support - I could use up a lot of time if I was to systematically go thru all your claims and dig out references, as digging out references can take considerable time. I don't have time just to counter ever increasing wild claims. However, as it happens, my wife is a member of the Australian & New Zealand Breast Cancer Trials Group. This is a semi-profesional not-for-profit association whose members are cancer medical professionals and patients who can contribute to conferences and can contribute journal articles. On Friday we received the latest ANZBCG journal, which contains updated statistics.

Unless you (a) live in Australia or New Zealand and (b) you are either a breast cancer survivor or a medical professional working in the breast cancer field, you won't have access to this journal, but the data is taken largely from a report Cancer survival and pevalence in Australia: period estimates from 1982 to 2010, published this year by the Australian Government and available at wwww.aihw.gov.au.

SURVIVAL RATES

Where I state a fact below, number shown in the form [CSV-6) means the fact is on page 6 of the above govt report, [BCT-7] means page 7 of the ANZBCG Journal for October 2012.

Cancer survival rates have over the decades been changing considerably. One needs to take this into account when reading periodic statistical reports such CSV in three main ways: Firstly, lets say the the 10-year survival fraction for cancer type X is 50% for patients diagnosed in 1982 to 80% in 2010. That could be a steady increase of about 1% per year. Extrapolating, it should be 82% in 2012. Secondly, it ignores that breaksthoughs in treatment occur from time to time - this could mean that linear extrapolation is not valid (if a breakthru occured during the study period) or it could mean that the survival rate is now very much better than 82% now (if the treatment breakthru occured in the last 2 years. Thirdly, if a male is diagnosed with cancer at say age 79, the survival statistic is essentially meaningless - he would have died of "old age" (pnuemonia, cardiac arrest, stroke, etc) anyway.

Long term survival rates for some of the more unusual cancers are quite low. For example, pancreatic cancer has a 10-year survival rate of only approx 4% [CSV-6]; Mesothelioma 3% [CSV-91] (probably because the medical profession has little experience with it). However, the fraction of the population that gets these sorts of cancer is very low, less than 0.6% [CSV-28]

In order of importance, cancer types are: Breast (females), Skin (melanoma), prostate, bowel,and so on, the above 4 types accounting for approx 85% of all cases [CSV-28]. So, for this discusion refuting your claim about survival it is reasonable for me to just cover the top 4.

Your claim that (I quote you) that the wide majority (of cancers) kills you rather quickly, therapy or not, is ridiculous. The 10 year survival for breast cancer (females) has over the study period increased from <64% to 83% [CSV-47]. The current estimate is 89% [BCT-6]. For skin cancer the figures are 85% (1985) to 90% (2005) [CSV-87], 2012 estimate 90%. For prostate, the figures are <45% to 84%. However, during the study period there has been a breakthru in early detection, and it is now realised that probably 50% of prostate cancers never get past Stage 1 naturally (which means half of diagnosed prostate cancers will never kill even if not treated at all). For bowel cancer, the figures are <48% (1985) to 60% (2007). However, as is well known, there was a treatment breakthrough about 10 years ago with the TME-J operating technique perfected by Prof Bill Heald and others in the UK. In Australia, not all abdominal surgeons are trained and acredited to perform TME-J operations yet - it takes time for a new technique to be rolled out. There has been refinement of chemo administration as well, and a lot of radio therapy machines have been replaced in the last few years with new better models. Treatment planning for radio therapay is very complex, requiring the emplyment of specialist physicists. Improvements in the computer software used in planning has has significant improvements in recent years, resulting in better targeting and less human error. There is quite a bit of data to suggest that the new TME-J technique by itself has dramatically cut the chances of secondary tumours, and the estimated 10-year survival is now >90%.

I hope that you accept now that my earlier statement that these days the medical art is such that >90% of such patients continue with a normal life span, and have time to grow something different, is quite valid.

Even if you don't accept that the extrapolations and assumptions about the impact of advances are valid (and that in itself would be silly), your statement the wide majority (of cancers) kills you rather quickly, therapy or not, really is ridiculous.

I've quoted data for Australia. The survival rates in other Western and advanced Asian countries won't be much different - I can assure you there's nothing special about Australian doctors and hospitals. I don't know what country you are in. Statistically, as a wikipedian you are likey to be American. Data for USA may be dragged a little worse because USA has a larger and more diverse fraction of minorities in the population. It seems to be a fact of life that minorities the World over take less care of their health, and don't get as good medical care as the main population. On the other hand USA has some superb hospitals and specialist doctors of a higher calibre than we have in Australia. — Preceding unsigned comment added by 120.145.184.249 (talk) 09:00, 29 October 2012 (UTC)

SIDE EFFECTS

You continue to misread or misinterpret what I say. I never said anything about side effects. The main side effects of chemo can certainly be significant, as can radiotherapy to the abdominal area. However these effects are very much short term. Once your treatment has finished, within a few weeks you are fine. When lymph nodes are taken from armpits or groin areas, physio is critical to retain full range of movement, but it will eliminate long term effects on limbs. The significance of side effects is quite dependent on the patient's attitude. Some people becaome hypocondriacs and never entirely get over it. But most handle it well, and there's no impact on lifestyle.

I may add more later - I have to go out on an errand. I may get time later to show why your para 5 is complete nonsense.

Wickwack 120.145.184.249 (talk) 08:48, 29 October 2012 (UTC)

Hi Wickwack,

1) Blame shifting is no discussion.

2) My claim "the majority of cancers kills you rather quickly" stands. You did not refute it, more to the contrary. The majority of cancers is not the majority of cancer cases, as you seem to assume.

3) Your numbers are strongly biased (only australia). I can assure you, most of the world (even most of the western world) doesn't come close to those numbers. Even if I take your values, I don't see where your >90% come from (Btw, extrapolating 10-year survival rates seems very optimistic to me. They are not linear over the years, as you seem to understand). If I just take the numbers of this single report (breast 89%, skin 90%, prostate 84%, bowel 60%), I come nowhere near 90%. And as your claim was about 90% of the tumor patients, you have to account for the fact that those four numbers only account for roughly 80% of all cancers (85% in the report), and rare cancers are mostly hard to treat. So your claim about the 90% is not even near the truth. And remember, this is the 10 year survival. Some of the people passing the 10 year mark don't live a very pleasant life, because of therapy side effects (surgical or chemo or radiation). And this tells you nothing about their live expectations, which are for sure reduced after most forms of therapy (see below).

4) You talked about survival rates and life expectancy of cancer patients. This heavily hangs on the side effects of therapy. Some people will die because of therapy, some people will be damaged by therapy (liver, kidneys, lung... I'm sure you know that chemo is not nice to the body). All this lowers statistical life expectancy. By how much depends on a multitude of factors (cancer type, age of occurence, therapy...) , but every statistic I have read clearly showed this effect. Claiming something different seems to be rather absurd to me, as chemotherapy applies highly toxic substances. That chemo and radiation only have short-term effects might be true for some therapies and patients, but for example people losing their fertility would disagree with you (a widespread concern with chemo and some forms of radiation treatment in young adults and children).

If you'd agree, I'd like to stop here. As you never answer my points but instead open new fields of discussion, I have the feeling that neither you nor me will learn anything from this discussion.

--TheMaster17 (talk) 13:13, 29 October 2012 (UTC)

Master17,

Re your points as numbered:-

1) Blame shifting is not an argument, but it appears you still can't provide references to support your now ludicrous claims.

2) You gotta be joking. I have shown that the top 4 cancers account for the majority of cases. Cases are what are counted in the data. It matters not a whit if a certain cancer type (eg pancreas) has a 96 % chance of killing you, if such cancers account for only 0.4% of cases - that's too small a count to change the stats meaningfully counted over all cases. Everybody knows multiple people personally that have been diagnosed with one or more of the top 4. You only get to read about the bottom 4 by reading in the media.

3) Australia is a good representative sample. It is a G20 country (ie statistically significant sample of the world population) whose standard of medical care is not especially good, nor especially bad. We have a major shortage of appropriately trained doctors, and radiotherapy machines, which casues undesirable treatment delays for those with only the standard govt medical insurance. Major Asian countries are about the same, though Japan has much better stats and India much worse, as is well known. Check stats for USA or whatever, it won't be significantly different. 10 year survival rates are a good measure, as it is well known that if you get another 10 years after diagnosis, you're as good as dammit in the clear. This is very well known. Yearly checkups are standard for 5 years after diagnosis (except for skin cancer - yearly checkups usually not required). Mostly, after 5 years doctors loose interest in you. I explained the basis of extrapolating, but you can disregard it if you wish. The stats quoted regardless of extrapolation still show that cancer is not a death sentence for almost all cases.

4) Significant side effects are almost entirely short term for the bulk of cancer cases. Of course if you have a brain tumour, you are going to loose some function permanently. But this sort of tumour is quite rare. Chemo is not that bad for the common cancer types, except for bowel cancer. Most women treated for breast cancer continue working full time throughout chemo and radio therapy, as did my wife, who has a key role in a small business. Except for the temporary loss of hair, and a week off for the lumpectomy and recovery, none of her work colleagues would have known anything was wrong. Almost all skin cancers, accounting for 20% of all cancer cases, are treated with surgery only - zero chemo, zero radiotherapy. However, it matters not what the side effects are or are not. The stats are simple - they count how many patients are still alive 10 years after diagnosis. So the impact of side effects on living or dying before 10 years after have already been taken into acount in the stats. Cancer in children and young people often tragic, but, statistically, these cases are just not significant to the big picture. Cancer is almost entirely a disease of the mature and aged.

Ok, I'm happy to stop here. You asked for a reference and you got it. I can't help it if you choose to not undertand or acknowlege it. You are the one who invited the discussion. I won't come to your party if you don't invite me.

Wickwack 120.145.177.211 (talk) 15:19, 29 October 2012 (UTC)

Martian spherules - sourcing

I've replied to an old post of yours at Talk:Martian spherules#Dates without year make no sense. Hairy Dude (talk) 01:37, 5 July 2015 (UTC)