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HEALTH & WELLNESS
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THE WALL STREET JOURNAL.
© 2015 Dow Jones & Company. All Rights Reserved.
Tuesday, August 25, 2015 | D1
Sarcasm: A Dangerous Game
Between people who trust each other, sarcasm can foster intimacy and creativity, but it can misfire
Of course, you
never get lost
You‛re going to
wear that?
DON’T DO IT IN A CAR
DON’T GO TOO FAR
Another dozen
roses.
Are you going
to a wedding?
New Way to
Use Radiation
In Treating
Breast Cancer
BY MELINDA BECK
Breast-cancer specialists are
sharply divided over a new radiation
technique that costs less and is more
convenient than conventional therapy.
The technique, known as intraoperative radiation therapy, or IORT, involves administering a
HEALTH
single dose of radiation
JOURNAL
at the same time a patient is having lumpectomy surgery to remove a tumor. A large, randomized
controlled trial concluded that IORT
has fewer side effects and appears to
prevent the return of cancer nearly
as well as traditional treatment, in
which patients undergo radiation sessions five days a week for up to
seven weeks.
Oncologists with opposing opinions have been debating that conclusion in letters and editorials in major
medical journals, including the Lancet and BMJ. Some critics point out
that the study found women who had
IORT face twice the risk of a cancer
recurrence compared with traditional
radiation (3.3% versus 1.3% over five
years).
Some also criticize the design of
the IORT study and say patients
haven’t been followed long enough to
draw conclusions. “A lot of us are
scratching our heads as to why
[IORT] would be appropriate,” says
David Wazer, chair of radiation oncology at Brown and Tufts medical
schools and a vocal critic.
KYLE T. WEBSTER FOR THE WALL STREET JOURNAL
Many patients opt for the
single-dose treatment
despite a higher risk of
cancer recurrence.
DON’T DO IT IN FRANCE
BY ELIZABETH BERNSTEIN
When Richard Laermer walked into an eyeglass store in Paris, he was surprised to find
fewer than 10 frames for sale, each displayed on
top of its own large pedestal. He looked for another room or some sign of a second floor. But
that was it.
A clerk stopped dusting. “Hmmm?” he asked.
Mr. Laermer says he couldn’t resist his reply:
“Don’t mind me,” he told the clerk. “I’m sure I’ll
find something in the 30 seconds it will take to
look over your inventory.”
Mr. Laermer was shown the door.
Does sarcasm have a place in polite conversation?
Experts say yes, but it depends on who is on
the receiving end. While sarcasm can baffle—or
even offend people—when it is expressed between friends, or people who know each other
well, it can be good for everyone involved.
DON’T MIX IT WITH ROMANCE
Oscar Wilde, the Irish author and playwright,
called sarcasm “the lowest form of wit but the
highest form of intelligence.” It is a form of
irony in which apparent praise conceals another,
derisive meaning. The word comes from the
Greek and Latin for “to tear flesh.”
Mr. Wilde was on to something. Researchers
don’t know if sarcastic people are smarter, but
they do know that sarcasm requires abstract
thinking—discerning meaning beneath the surface—which is known to be a hallmark of intelligence. Both women and men use sarcasm in the
same amounts, experts say, but they believe that
women are judged more harshly for it by society.
Sarcasm has many uses, depending on the degree of sharpness. The most common is to allow
someone to show a negative emotion but soften
the blow with humor. “You can express anger but
do it in a socially acceptable way,” says Roger
Kreuz, a professor of psychology at the University of Memphis.
You can also use sarcasm to increase intimacy, either as a flirtation or by teasing a friend.
“You only say the opposite of what you really
mean if you know the person is going to understand you,” says Dr. Kreuz. By using sarcasm, he
says, “you are saying, ‘I trust you. I am bringing
you into the club.’ ”
A series of studies by researchers at Columbia
Business School, Harvard Business School and
Insead, a European business school, published
online this month in the journal Organizational
Behavior and Human Decision Processes, asserts
that people who are able to understand sarcasm
are more creative and better able to solve problems. But, to avoid conflict, sarcasm is best used
between people who trust each other.
Participants in the studies were randomly assigned to a sarcastic, sincere or neutral condition. In one study, a group was divided into
thirds and each segment was asked to recall a
Please see SARCASM page D2
Yet proponents of IORT say the
risk of recurrence with either radiation treatment over five years is tiny,
and IORT’s advantages could outweigh the higher risk of recurrence
for some patients.
“A lot of women who hear about
this option make an informed decision to use it,” says Stephen Grobmyer, director of the breast center at
the Cleveland Clinic, which is collecting data on nearly 1,000 patients who
have had the treatment at 10 U.S.
centers.
At many radiation centers, a big
portion of revenue comes from delivering lengthy courses of treatment to
breast-cancer patients. “Depending
on your perspective, [moving to a
single treatment during surgery] is
either a significant threat or a quantum leap forward,” Anthony Zietman,
editor in chief of the International
Journal of Radiation Oncology, wrote
in an editorial this month.
Radiation has revolutionized
breast-cancer treatment since the
1980s, allowing older women with
small, early-stage tumors to opt for
lumpectomies rather than mastectomies. Survival rates are similar, because radiation helps destroy any
stray cancer cells left behind. About
60% of the more than 200,000
women in the U.S. diagnosed annually with early-stage breast cancer
undergo lumpectomy with radiation.
Radiation’s side effects include fatigue, skin redness and blistering. In
Please see RADIATION page D4
Medical Service That’s Expanding Online: Second Opinions
KERRY CORCORAN
For many patients, it has become
a routine part of the medical process:
Get a diagnosis or treatment plan
and then seek a second opinion.
A growing number of online services are offering second opinions and
some are seeing increasing patient
demand for a second set of eyes.
Some of the services are sponsored by established medical centers,
including MassachuYOUR
setts General Hospital
HEALTH
and Cleveland Clinic.
Others are independent
businesses that work
with specialists on a consulting basis.
Employers increasingly are contracting with such services, and insurance
companies at times require patients
to get a second opinion, such as for
surgery.
Studies show as much as 20% of
patients seek second medical opinions; in specialties such as oncology,
the rate is more than 50%. And recent research has found that second
Dr. Mark Urman of Best Doctors Inc.,
which offers online second opinions.
opinions often result in different diagnoses or treatments.
Second-opinion services are “one
of those areas that is growing fairly
quickly,” said Gregory Pauly, chief operating officer of the Massachusetts
General Physician Organization at
Massachusetts General Hospital. The
hospital’s online second-opinion service, which started about eight years
ago, handled about 10,000 cases last
year compared with fewer than 1,000
five years ago, he estimated. The
growing demand for second opinions,
which cost between $500 and $5,000
depending on the case, has come
from patients, including people from
overseas, and companies that are including the service as part of employee benefits, he said.
Dr. Pauly said opinions are most
often requested in areas such as cancer, neurosurgery, cardiology and orthopedics.
Patients can request their medical
records be sent to an online secondopinion service, which might order
additional tests if needed. The services are especially helpful for people
who live far from major academic
centers that cover a range of physician specialties. Many insurance policies cover in-person second opinions
but don’t pay for online services un-
less they are offered as part of an
employee’s health plan.
Some experts say patients should
seek a second opinion outside of
their normal institution or healthcare network. “There are sometimes
internal cultural approaches to treatment and it’s probably necessary for
patients to go outside to get a new
approach,” said F. Marc Stewart,
president of the Patient Advocate
Foundation, a nonprofit that helps
patients access medical care. However, transferring care to another
doctor can be challenging if the doctor is out of a patient’s insurance
network, said Dr. Stewart, an oncologist and medical director of the Seattle Cancer Care Alliance.
For patients faced with a serious
or life-threatening illness, second
opinions might steer them to different treatment opportunities that are
less invasive, have fewer side effects
or are more targeted to their particular circumstance, said Beth Moore,
executive vice president of program
strategy for the Patient Advocate
P2JW237000-0-D00100-1--------XA
BY SUMATHI REDDY
Foundation, “You don’t always know
what’s available unless you seek a
second opinion,” she said.
Ms. Moore said in-person second
opinions are better in cases that may
require sophisticated tests, such as
with rare diseases. When two doctors
have divergent recommendations, she
recommends getting a third or even
fourth opinion.
“Patients are often fearful that
their physician will be offended”
when seeking a second opinion, said
Ms. Moore. “We’ve found that not to
be the case. You’re going to want the
experts to discuss your case in an
open way once the second opinion
has been issued.”
Easily diagnosed conditions, such
as sinusitis or shingles, don’t call for
a second opinion. But second opinions can be important when symptoms don’t go away despite treatment; when diagnosis is unclear or
appears to involve a serious or rare
condition; or when treatment options
are risky or harmful, said Hardeep
Please see OPINIONS page D4
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