February 2011

Jive Talking

By Michael J. Katin, MD

January was a huge news month, capped off on the 31st by a decision by District Court Judge Roger Vinson that the increasingly-ironically-named Patient Protection and Affordable Care Act of 2010 is unconstitutional. This not only set off rioting in Egypt, it caused disruption of any ability to plan for the future administration of health services in the United States. There continues to be a huge debate as to whether implementing the act will save money and enhance care or will it cost a fortune and destroy our current system. Representative Paul Ryan has said he will "eat his tie" if the deficit is decreased by this legislation. . However, thanks to recent efforts by Michelle Obama. and the Departments of Agriculture and Health and Human Services , it may be necessary for his tie to be assayed for sodium content before that will be permitted.

Earlier in the month, however, the lead article in Annals of Internal Medicine provided a clue as to how the health of the public can still be preserved even if not as many zillions of dollars are going to be spent orchestrating it. The 14 authors reported the results of the Culturally Sensitive Intervention: Birmingham trial in which 299 patients with hypertension were presented with three DVDs, one every three months. The "intervention" group received DVDs containing patient stories about their dealing with hypertension. The "control" group received DVDs with other topics, presumably much more interesting. After six months, the patients in the intervention group had reduced systolic and diastolic values.

Perhaps this is not so surprising, since many of us have had decreased blood pressures by falling asleep during certain DVDs but if this is now to become a therapeutic option, the next target may be oncologic diseases. Nothing would better help relieve the upcoming boom in health care expenses than to have a treatment option to substitute for the use of expensive chemotherapy and molecular targeted therapy and for complicated modern radiation therapy equipment Could that alternative be storytelling?

If this is possible, then a study could be done on the incidence of cancer in regular viewers of Countdown with Keith Olbermann Every Friday, Mr.Olbermann would conclude his broadcast with a story by James Thurber. Mr. Olbermann announced on January 21 that it was his final broadcast. Unfortunately, even if an effect were to be measured, establishing statistical significance might be impossible since he had only 14 viewers by that point.

It may be necessary for prospective randomized trials to be set up to determine whether storytelling can truly be effective as cancer treatment compared to standard therapies. Funding for this could be obtained from the Stimulus program , since it could provide employment for thousands of out-of-work liberal arts majors and would definitely be considered a shovel-ready project , considering the number of shovels that would be required to get through all the BS generated. There are multiple possibilities for protocols, involving single-agent and combination storytherapy (different sequencing of yarns , parables , tales , sagas, allegories , fables , etc). Treatment of early-stage diseases could be done with gentle but inspiring stories, such as Jack and the B-Cell, The Little Angiogenesis Inhibitor That Could, Snow White Cell and the Seven Antibodies , etc. For treatment of T1 and T2a prostate cancer, Grimm's Fairy Tales could be presented (read by Peter Grimm ).

For cases that are more serious, it may be necessary to modify certain radiation oncology techniques with stories to created Tellmetherapy. This could include Intensity-Modulated Tellmetherapy, in which increasing drama content can be adjusted depending on the level of acuteness, or Imagery-Guided Tellmetherapy, in which cancer cells can be visualized being vanquished by the body .

But when all else fails, it may be necessary to call upon the talents of the greatest storyteller of all time (no, it's not Clinton, Reagan, or Obama).