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- [00:00]
Molly Biscar
Foreign.
- [00:06]
Dr. Erin Nance
It's Dr. Nance. We have a very special guest today. We actually have Molly, who is our producer. She is filling in for Anna and is sitting in with me for today's story.
- [00:19]
Molly Biscar
Hi, I'm back with my avocado hand.
- [00:25]
Dr. Erin Nance
For those of you who did not hear, I think our last episode, Molly had cut her finger with a knife cutting open an avocado. And she called and she goes, I think we need to push the episode. I go, no, we need to cancel the episode because you need to go to the ER girlfriend.
- [00:44]
Molly Biscar
It was a good time to know a hand surgeon. I've never been more happy to know a surgeon. Yes.
- [00:51]
Dr. Erin Nance
But I mean, we almost had our own medical mystery because you were told to not grab great advice from your ER doctor who said that there's nothing could be done. You know, damage was the damage. And I was like, oh, no, no, no, no.
- [01:07]
Molly Biscar
I know. Literally, thank God for Dr. Nance because, yeah, I, I, so I sliced my hand open. I immediately couldn't feel my finger. I go to the er, they stitch me up, and the ER doctor said, oh, that happens. The nerve will regrow, hopefully. So then I text Dr. Nance and I ask what she thinks about that. She immediately said, absolutely not. So, yeah, that led to surgery, and because of Dr. Nance, I now will regain feeling in my finger. So thank God for that.
- [01:39]
Dr. Erin Nance
It's a very important pointer finger for all the clicking and editing and. Absolutely, very, very important. Now I have come to accept up my role in my friends and family as the Chief Reassurance Officer.
- [01:54]
Molly Biscar
Yes.
- [01:55]
Dr. Erin Nance
And that's really, you know, it's. I mean, even in this particular case, I am an expert in what the problem was, but you are in LA and I am in New York City. So I'm just glad that you were able to get timely care, because this is an instance where if you had waited even a couple more weeks, you might not have even been able to get the treatment. So that's why the right information from the right sources is the most important. And sometimes you have to get multiple opinions from doctors, like we always say.
- [02:25]
Molly Biscar
Yeah, yeah. And I think, I mean, I really learned my lesson. We've talked a lot on the show about how ER doctors are there to make sure you do not die and that everything's okay in that moment, and they're not specialists. And to get a second opinion after the er. I mean, that ER doctor did great at stitching me up. He did what he had to do. But I think it's a good lesson in that they, they might not know enough about nerve and tendon damage of your hands or hyper specific things like that.
- [02:54]
Dr. Erin Nance
Absolutely. And one thing I tell people is that also the timelines that the ER hands out, they're like, oh, just see, you know, a doctor in the next two weeks. No, no, you need to see the doctor the next day. Even if, let's say you broke your arm, like, no, we want to see you back in a week after that. That's fine. Let that come from the specialist to tell you how soon you have to be seen. So again, ER doctors and ERPAs are doing incredible, amazing things. They are the number one triage for America. But when it comes to a specific injury, you have to check in with the expert.
- [03:28]
Molly Biscar
Yeah. And I also have learned that avocado hand is one of the most common ER injuries in America.
- [03:36]
Dr. Erin Nance
So avocado hand, bagel hand, these are all. I mean, do not. What were you trying to stab the pit?
- [03:44]
Molly Biscar
I was trying to stab the pit.
- [03:46]
Dr. Erin Nance
I did it. I did a video about this years ago. I was like, do not stab the pit. Okay. Unless you are on like Top Chef and this is, you know, your livelihood. Do not stab the pit.
- [03:58]
Molly Biscar
Don't stab the pit. I've been, I have now been de pitting, depitting my avocados with a spoon now. And I'm encouraging everyone else to do so. I was joking that I need to make an Amazon affiliate link for those avocado deep. I'm about to become an avocado de pitting influencer.
- [04:15]
Dr. Erin Nance
Yes, definitely, definitely. And then I can be the expert witness.
- [04:19]
Molly Biscar
Yes, yes, I love it. Link will be in the episode description if you want to buy an avocado de pitter. So today I actually have something a little different for you, Dr. Nantz. Usually we have guests on to tell their stories, but today I thought we would try something new. And if you guys, the audience like it, let us know and we'll do more of these. But I have a little bit of a story time, a medical story time to actually tell Dr. Nant kind of flip the tables on you a little bit today.
- [04:52]
Dr. Erin Nance
I love it. So I get to be in the listener shoes.
- [04:56]
Molly Biscar
What do I. Yes. So let's get into it. So today I'm going to be telling you the story of Dr. Alice M. Stewart. And I am kind of obsessed, honestly, with Dr. Alice Stewart because she's like the original medical detective. She actually called herself a medical sleuth and she really earned that title of medical sleuth because she actually solved one of the biggest medical mysteries in history. In 1953, childhood cancer rates started skyrocketing and nobody knew why. All of a sudden, more and more kids were being born with childhood cancer, which was something that was understood to be very rare. So this was super strange and nobody could really figure out what was going on, what was the connection, what was causing this, until Dr. Alice Marie Stewart. So to get the full picture of this story and who Dr. Stewart was, we got to go back all the way to the beginning to 1906, when Alice Stewart was born in Sheffield, England to two physicians, Lucy Welburn and Albert Nash. So, you know, she was born in 1906 to two physicians, one of them being her mother, which is pretty incredible. Her mom became a doctor in 1902, which was only about 30 years after the first woman ever became a doctor in the uk. So they were total badasses. And they were both pediatricians who dedicated their lives to children's welfare. And actually they set up the first infant welfare clinic in Sheffield. So Alice grew up in a house where the dinner table sounded like a ward round. And Lucy and Albert really wanted to instill curiosity and a thirst for knowledge in Alice and her seven siblings. Seven siblings. I don't know how they were doctors, both doctors, and managed to have eight kids. I have no idea how that happened. But this is where Alice really learned to think about not just how to treat a patient, but why patients get sick in the first place. Which was a question that both of her parents were very fascinated by, and.
- [07:16]
Dr. Erin Nance
One that is still a main question today.
- [07:19]
Molly Biscar
Absolutely, absolutely. So that question and curiosity is what carries Alice through her schooling and to Cambridge, where she follows in her parents footsteps and studies medicine. So she ends up going to Cambridge and there were only four other women in this program. And as you can imagine, she faced a lot of discrimination there. The men in this program didn't want to be studying medicine with women. And she tells one story in an interview about a time where she was walking into a lecture hall right when she was beginning school, and every seat that she tried to take, a man would move into the seat so that she couldn't sit there. And as she was walking down the lecture hall, getting further and further down, they started to pound on the desks. The men in this class started to pound on the desks in beat with her steps as she walked down and down and down until she had to be in the, in the front row. And this was all just to intimidate her, to try to get women like her to not want to be in medical school with these men. But Dr. Stewart did not let it stop her. She was kind of galvanized by this bullying and discrimination, and it only made her work harder, and it really prepared her for what the future would hold. She then does her clinical training at the Royal Free Hospital in London, which is one of the few places that trained women for clinical medicine at all at the time. So she continues on that route. And this is when the war breaks out, World War II, and England needs doctors who can solve problems at scale. And Alice is pulled into Oxford's new world of social medicine. So this is a program at Oxford that did many, many things, but it was set up in 1943 and it was driven by the wartime experience, which highlighted medicine's role as a community problem and established social medicine as a field focused on how social and economic factors affect how health and disease.
- [09:27]
Dr. Erin Nance
And it sounds like the beginning of public health.
- [09:30]
Molly Biscar
Yes, it is the beginning of public health in the uk. So her first case that she takes with them is she sent to the Royal Ordance factories, which was a government factory that made components for Britain's wartime weapons. And all of these factory workers were coming down with this mysterious illness and they were turning yellow and their livers were failing and nobody could figure out why. And so Alice is sent in with a team of other doctors to try and figure out what is happening at this factory so that they can continue to make these, you know, wartime weapons at a very important time for weapons to still be being made. So she sent in and this is where she discovers her love for surveys. She does blood tests, she does surveys, she maps the symptoms and exposures, and she discovers how effective surveys can be in medicine.
- [10:22]
Dr. Erin Nance
And.
- [10:22]
Molly Biscar
And when she discovers this love of surveys, that's really what changes the world, because her surveys are what one day will crack the case of this massive medical mystery. I'm wondering if you have experience in surveying for clinical studies or anything like that.
- [10:41]
Dr. Erin Nance
You know, I have never myself conducted a survey research, but I am a participant in many surveys. I'm part of the American Society for Surgery of the Hand. So we will do a survey, you know, how many hand surgeons are treating dupuytrens with surgery versus how many people are treating it with xiaflex, which is like an enzyme breakdown. So that when we go to treat our patients, we go, well, actually, you know, half the surgeons are using surgery, half the surgeons are using enzymes. And it just gives a bit of a broader picture as opposed to, I may not know how to use the enzyme clagenase. So all I'm offering my patients is so surgery. So I think that there's a lot of value in surveys.
- [11:24]
Molly Biscar
Yes, totally. How many people have you treated with avocado hand this year, for example?
- [11:32]
Dr. Erin Nance
How many people. How many people cut their hand stabbing the pit or here. Here's an interesting correlation. And my husband always thinks about whenever I. This stat always reminds him of me that we did a retrospective study of people who had open elbow fractures, meaning the fracture went through the skin. It was so severe that that's how bad the break was. And it was almost 100% correlation of people who drive with their arm out the window.
- [12:04]
Molly Biscar
Oh, my gosh. Oh, my gosh.
- [12:07]
Dr. Erin Nance
So do not drive with your arm out the window, because when you inevitably, unfortunately get into an accident, it will cause severe, severe elbow trauma.
- [12:19]
Molly Biscar
Oh, my gosh. That's so interesting. It really is a part of medicine I have not thought a lot about before doing the research for this story of that. You know, there's the doctors we see in the office, and then there's obviously doctors that are doing research. But this idea that we can just look at patients and talk to them about why this happened, what they were doing, how it happened, and get down to the root of it instead of just treating the illness. That's why I feel like she really is an OG medical detective, because she was like, she's a doctor, but she's in there doing actually more like detective work. So she realized at that point that she really loved was this more like detective work in medicine to try to get to the root cause. And like I said, that really started when she was a kid. Her parents had this question, and now she's done all this schooling and gotten to this place where she can really start to actually answer the question that started her medical career of why people are getting sick instead of just how to treat them. So.
- [13:18]
Dr. Erin Nance
Well, I just want to interject because right now, the term root cause is kind of causing a kerfuffle amongst doctors on social media right now, because a lot of times that term is being used by wellness influencers or people who are saying that the traditional healthcare system only cares about, you know, getting paid by big pharma, and they don't care about the root cause. There's a Great video by Dr. GlockenFlecken, who's this hysterical ophthalmologist on social media, and he's like, is there a rootier cause? Or, you know, and. And what? I want to make sure people Understand is that sometimes on our show I even talk about how sometimes a diagnosis is really more a description and not the quote, quote, unquote, root cause. Why? Right? Are you sick? We can determine you are sick with this illness or disease. But what was it? Was it an environmental exposure? Was it an infection by a virus? And in the end, that is really the root or the origin. We can call it. We can call it the disease origin.
- [14:24]
Molly Biscar
Story, if you want.
- [14:25]
Dr. Erin Nance
Just to give you like a quick example, my grandfather was a plumber. And his union was the New York 509 asbestos unit. His job was to install asbestos into the pipes all around the city. He actually helped build Shea Stadium, which was the Mets first baseball stadium. And he laid down all the asbestos. Okay. Years after they all retired, they all started dying. Every single one of them of the plumbers in his union was dead. And they were all diagnosed with mesothelioma. Okay. If you've ever seen like an injury lawyer television commercial, you've heard like, have you been diagnosed? Okay. All of that research was done on his union. Wow. And so the diagnosis is mesothelioma, but the cause, the root cause was exposure to. To asbestos. Okay, yes. So that's a way that we can think of that sometimes, yes, you have a diagnosis, but there could be a way to intervene if we know what the root cause of that diagnosis is.
- [15:38]
Molly Biscar
Yeah, absolutely. And that, I mean, that really goes back to what Alice is doing at this time. Because in this factory, they know that they have liver failure. That's the diagnosis. But why is it happening? They have no idea. So she goes in, she does these surveys, blood tests, she maps symptoms and exposures, and her and her team eventually discover that the culprit is a chemical called tnt. And this helps these people in this factory. It also goes on to help people for decades and decades to come to know that TNT is, can cause liver failure when exposed in this way. So she cracked the case. She figured out what was going on at this factory. And this really propels her forward into the next part of her career. So before she was a clinician, but after this is when she decides that she's going to fully go into epidemiology. And I'm wondering, Erin, if you can describe for the listeners what epidemiology is.
- [16:42]
Dr. Erin Nance
Epidemiology is the study of disease on a mass scale. So if we said the prevalence of COVID during this time point was, you know, 10 million people or whatnot, those are epidemiologists who are collecting this data from around the country, from around the world, that helps determine whether there are outbreaks that help. You know, like sometimes in the. In the news, you'll hear, like, a Legionnaires outbreak. That was very recently, that the source was a hospital in the Bronx, the air conditioning. So all of a sudden, all of these patients who are at the hospital come down with this serious lung disease. Well, the epidemiologists are the one to trace it back to, oh, it was this exposure through air conditioning units at the hospital. That's why 100 people were, you know, exposed to Legionnaires. So that's the study of epidemiology. Kind of like disease at scale.
- [17:41]
Molly Biscar
Right. So it makes sense, based on Alice's past work and what she just went through at this factory, that that's what she would decide she's going to go into now. Now, she didn't have any formal training in epidemiology. There was none at the time. But she was running, at that point, a small department at Oxford as part of the social medicine program. And in running this department, she needed funding to try to do some epidemiology studies. And this was a big deal for a woman to be running a department at Oxford. She was finally kind of feeling like she was being respected in her field. And so she needed this funding. She needed the funding to prove to Oxford, to the world, that women can do this job. And that is where these rising rates of childhood cancer came in. They realized that nobody had studied this childhood cancer issue before. Even though it was on the rise, childhood cancer was still rare. And so nobody had studied it. And she says later in interviews that it sounds rather crude that she chose this cause because she needed funding for her department. But that was just the truth. That's what she needed. She needed funding to make the department work. And this was a cause she thought could get funding. Ironically enough, it did not get funding. So she goes to a grant committee to pitch them this study, and they all say no. And like I mentioned at the time, everyone was wondering what was happening with this childhood cancer thing. So the fact that she didn't get the money, I don't know what the men in that room are thinking, but it feels like sexism to me. Everyone is running around England trying to figure out why all these kids are getting cancer. Finally, this is the woman from the job. She's here. She's going to do the damn thing. And no, we're not going to give her the money. I don't know, it's. It's smelling a little fishy to me. But as she's leaving this committee meeting, one of the members of the committee comes up to her and says, I have a thousand pounds from a different fund and it's not going anywhere. If we don't use it, we're going to lose it. So we could give you this £thousand pounds. And £1,000 was not enough to do what she needed to do, but she took it and she decided she was going to make it work. So her and her department got to work on the study and they picked 300 children who had died of childhood cancer and then 300 children who had died of other causes as a control group and surveyed all 600 of those mothers. Now, because £1,000 was not enough to fund her traveling to do all these interviews and finding all these mothers and talking to them, she actually partnered with the NHS, the UK's public health system, which was just, just recently founded, and worked with them to do these interviews through the doctors of the NHS system. Since they had the records and they knew who the mother's doctors were, this really cut down the costs of these surveys. And people questioned her at the time that interviewing mothers was not the right way to go, that the moms would not know enough to give adequate information. But Dr. Stewart pushed back against that. She knew that mothers would have the information they needed for these surveys, and she pushed forward. So the surveys start to come back, and it is a surprise to everyone that is involved in this study how quickly a glaringly obvious answer comes back to what is causing this childhood cancer. And you might think, that's great, that's fantastic. They figured it out. But as soon as the surveys came in, Dr. Stewart knew there was going to be pushback, that this was not going to go over well. And she knew that because the thing that was causing childhood cancer was all the rage at the time. It was being used in medical settings everywhere, but it also was being used outside of medical settings. It was being used in shoe stores to fit people with the right shoes. It was being used as a hair removal technique. It was being used for anti aging, it was even being used at amusement parks as like a novelty. So this thing is everywhere. And now Dr. Stewart knows that she's going to have to be the one to blow the whistle and let the world know that this fun new toy we thought was safe and helpful is actually causing cancer. And that thing was the X ray. And what Dr. Stewart found in this survey was that the mothers of the children who died with cancer were X rayed twice as much as the control group mothers. And at the time, more and more women were getting X rays while pregnant because doctors were using these X rays to look at the mother's pelvis and make sure that they didn't have any issues that could cause fatality in labor. So it was all for really good reason. But what we didn't understand at the time was the effect of radiation, even really, really small amounts of radiation. At the time, it was widely recognized that X ray machines were 100% safe. And even though they were giving off radiation, it was such a small amount, it didn't really matter. And so in 1956, she published her findings in the Lancet, which is a scientific journal. And one thing to note is that in 1956, the Lancet had different rules for publishing than they have now. Now, to publish in the Lancet, everything has to be very peer reviewed. It takes a long time. But in 1956, you could publish more quickly based on just the editor's judgment of the findings. So she published her findings in the Lancet, and she also went and presented her findings to a panel. Have you ever presented a case like this to a panel before?
- [23:31]
Dr. Erin Nance
Yeah, I presented on hip arthroscopy, I presented on cerebral palsy techniques in children, and I've done podium presentations. So usually when you present at these academy meetings, the large body, you are presenting your evidence, and then sometimes not all the times, you defend the evidence to a panel.
- [23:57]
Molly Biscar
So with that knowledge, she comes in, she presents this evidence. How do you think that this panel responds to her?
- [24:05]
Dr. Erin Nance
Well, I'm gonna say that for, well, two things. One, again, at the time, there is no mri, there is no ultrasound. So this is really a lifeline for the doctors to be able to get a better look at the inner lookings of a woman to keep her safe, have a safe childbirth. Because don't forget, death by childbirth was probably the number one cause of women's mortality back in the day. Whatever they could do to maximize the safety of childbirth was probably the utmost concern. So I would not be surprised if there was a lot of pushback because, number one, this is something that in their minds is helping keep childbirth safe.
- [24:55]
Molly Biscar
Right. So you're exactly right. She is almost entirely dismissed because they did not want to give up obstetric X rays of mother's pelvises. It just seemed like that would cause more harm than the tiny bit of radiation that's going to the infant that they just thought must be insignificant. So after she publishes this paper and does this talk, she immediately is Getting a ton of backlash. And suddenly it feels like it is her up against the entire medical community of the United Kingdom. So a ton of people are pushing back against Stewart in this paper, but her biggest haters was another epidemiologist from England whose name was Sir Richard Dahl. Now, Sir Richard Dahl actually discovered the connection between smoking and cancer. And Dahl and Stewart were contemporaries. They were working in the same field, they were doing the same things. But this moment really separated their careers, because when this happened and Stuart stood up against the system, Doll immediately went the other way. He was writing papers discrediting her, saying she's an alarmist, saying that her research was bad, even though it was perfect. Now that we look back at it, we can see that her evidence was all there. But instead of backing Stuart, who had the research and the evidence to back what she was saying, the medical system backed Dahlia, and he kind of became the epidemiologist of the system, whereas Stewart from this point forward, becomes the epidemiologist of the people. And Dahl actually later went on to testify for a company called British Nuclear Fuels in a case concerning leukemia cluster near a nuclear plant. And he testified for the company, saying there could not be any connection. When there was later found to be a connection. He also testified on behalf of a company called Monsanto to downplay the link between Agent Orange and cancer. And he also testified for a vinyl chloride company saying the same things. So he really became the golden child of epidemiology in the UK from this point forward. And he was touted as being the best epidemiologist in England. And Stuart was made out to be a fraud and a liar. She was up against an entire system. And at this point, it wasn't just that she was a woman, although I think that was a big part of it. It was that she was a woman and she was not afraid to stand up to these corporations. Now, after Dahl's death, it came out that he was taking money from these companies to write these scientific papers, that back then, it was never public health. That was his concern. And though he made this incredible discovery of the connection of smoking and cancer, he went on to help companies give people cancer. So we know that now, but nobody knew that at the time. And Stuart became a pariah in the medical community. She starts getting called controversial a lot. This word gets thrown around a lot, that she's an alarmist, and she's told to be quiet and consider her reputational damage. If she doesn't drop this, her career is essentially threatened. And I think a Lot of people in this situation would back down at this point. I think that there's an argument to back down, that you don't want to lose your career, that you can do more good if you can continue getting grants and doing these studies. But that's not who Dr. Stewart was. She, at this point was very invested in, in protecting these children. And if you remember her childhood, her parents opened one of the first child welfare clinics in the UK and they really instilled in her this sense of medicine and also social impact. And so because of that, she just couldn't let this go. And so I think about this all.
- [29:14]
Dr. Erin Nance
The time, that life is not easy for the whistleblowers. And in this case, this is, in essence, what she's doing. She's only using scientific evidence to be the whistleblower. It's not enough just for her to say, X rays cause childhood cancer. She is coming with the receipts. And the thing is that they don't want to hear it. That's the simple truth. Because not only do they not want to give up their latest fancy tool, but in the end it makes them complicit in the harm done to these children. Right, so now you're dealing with, oh, crap, I'm the one who caused this problem. I am part of, of the problem. And I talk a lot about how a lot of times doctors are ostriches with their head in the sand and they don't want to admit that something, a complication has happened or a side effect has happened because it implicates them. It doesn't mean that they intended for this to happen. I don't think any of these doctors ever had any right. But at this point now, if you knowingly put someone at risk without at least explaining to them, well, there are these potential risks if we do this X ray or this procedure, or at least look for ways to mitigate the risk. Right. Have you ever heard of a lead shield? I don't know when lead shields were invented, but yes, I think that's part of why they don't want to hear it, is because it also implicates them.
- [30:59]
Molly Biscar
Yeah, and we see this a lot on the show. I mean, a lot of people we've talked to have gone back to the doctors that harmed them and told them, thinking that they're going to be met with, I'm so sorry, I'm going to now use this to not make this mistake in the future. And they're frequently instead met with, well, it's really rare, so we're not really Going to. And I think that that same energy is what caused this delay in the 50s in the UK.
- [31:30]
Dr. Erin Nance
Yes. And we have to be able to know when we're wrong or when we don't know everything. And that is really the mark of a trustworthy person.
- [31:42]
Molly Biscar
Yeah, yeah, absolutely. But I think you're right. At this point she's met with so much disdain from the medical community. It's not just that they're saying, we looked at your findings and we think you're wrong and you should move on. They're publishing articles saying that she is controversial, that her study was done wrong, that she's an alarmist, they're trying to take her down essentially. And they say to her, if you do not stop this, you might not have a career anymore.
- [32:18]
Dr. Erin Nance
So.
- [32:18]
Molly Biscar
So meeting her with that energy feels like it's coming from a place of not just we don't think this is true, but I think you're right that, oh no, maybe we are complicit in all of these children getting childhood cancer and we don't want to face that. So instead we will just push out this whistleblower. And so she lost all of her funding. She self funded her research from this point forward because nobody would give her grants. But she knew she just could not let this go. And she began doing her research on her own, refusing to give up until she could get people to stop using these X rays. So she continues to do these studies and her and a statistician named George Neal go back to the data and they run more surveys. They run surveys in different countries, they really tighten up their methods, they test every rival explanation. She knows at this point that if she's gonna go back to them, there cannot be a single flaw in her work. She knows that the X rays are causing childhood cancer. She needs to convince the rest of the UK medical community and she knows that to do that she has to be perfect. So that's what she does. She goes back to the drawing board with the statistician named George Neal and they do bigger surveys, they look at data from other countries, they make their data absolutely perfect and they find the same thing with this larger study, that there is a link between X rays of pregnant women and childhood cancer. So she's thinking, at this point, my studies are perfect. We've worked so hard on this. I know that this is true now. And looking at this, I know that when I present it, they will also think it's true because my work is perfect. So she goes back, she presents again and they do the same thing. They don't want to believe her. So at this point, Dr. Stewart decides that she's going to go past the gatekeepers and start talking directly to clinicians, to midwives and to the public. She starts spreading this message directly to them, to only X ray when it's absolutely necessary. She explains her findings and just decides, if they're not going to publish me, if this isn't going to become the status quo in England, I'm going to try to do as much harm reduction as possible, go straight to the public and to the clinicians that can help this and explain what I found, and hopefully they will listen. So what she's really trying to spread to these people is that there is no safe dose of radiation for a fetus. And she learns quickly that this speaking out comes at a price because she's already been hit with this from the medical community. But once she starts going above their head, that is when things really start to get bad for her and her career. She is kept out of everything. Her invitation's thin. They want to silence her, so they just keep icing her out more and more and more and putting out more articles that are calling her horrible things in the hopes that they can slander her enough to shut her up.
- [35:48]
Dr. Erin Nance
And.
- [35:50]
Molly Biscar
She continues to do what she's been doing. I think a lot of people at this point would give up, but she just refused. And so she just continues to fight and fight and fight and try to get the word out.
- [36:03]
Dr. Erin Nance
And she really wants to go on TikTok.
- [36:06]
Molly Biscar
I know, I know.
- [36:08]
Dr. Erin Nance
If only.
- [36:09]
Molly Biscar
If only there was TikTok, this never would have happened. Well, while she's continuing to do this work, word about what she's been doing is obviously getting to other doctors, it's getting to other countries. And in 1962, there is the first major independent confirmation of this study, which was in America by Dr. Brian Mahone. And he published a large US study in the Journal of National Cancer Institute that found the same risk that Dr. Stewart found. He used hospital records rather than maternal recall, which was the major complaint that people had about Dr. Stewart's findings was that she was surveying parents. Which goes back to our whole premise of this show that patients know these cases and their lived experience should be heard. And that is what she was doing with these surveys. And that is what doctors said. Oh, they don't know what they're talking about. So this doctor used hospital records instead. So Dr. Brian Mahone runs a study, and of course he's a man, so everyone believes him and finally, the risks of X rays are taken seriously. This paper is what brought in the new rules around X ray saying that there should be no routine fetal X rays. And that became true in the US and the UK and then on a wider scale because of that study. But that study only happened because of Dr. Stewart. And now decades later, Dr. Stewart is recognized for discovering this connection and saving countless number of children from childhood cancer. But that is only now in hindsight that we are able to recognize her for that. At the time, she was told to shut up and pushed to the outskirts of the medical community just for a man to come in, do the same kind of study and get the recognition for this discovery. Dr. Stewart went on to do a lot more work with the harm of nuclear. She discovered a connection between men working at nuclear plants and their children later having cancer. She is the reason why we understand the harm of radiation today. And her whole career she continued to fight against corporations and the establishment, not protecting consumers and everyday people. And that is the story of Dr. Ella Stewart, a woman who against all odds changed the world. She hit so many walls along the way, they would bully her out of class. Then she finally graduates and they won't give her funding. Then she solves this massive medical mystery and nobody will listen to her. And despite all of this, she just kept going. And that is really the reason I wanted to tell the story today. Because Dr. Alice Stewart was a medical detective. Absolutely. But she also was a woman who wouldn't give up, which I think is every woman that we've talked to on this show. And it is because of women like Dr. Alice Stewart who that we today get to make a show like this. And platform women who wouldn't give up, who continued to fight to get their diagnosis. And I think that a little bit of Dr. Alice Stewart is in all of us at the Medical Detectives. So I hope you enjoyed her story.
- [39:41]
Dr. Erin Nance
Oh, that's amazing. And I'm very close to my heart because I may have the numbers slightly off. Female orthopedic surgeons have a four times higher risk of breast cancer cancer than the general female population. And that is directly linked to the amount of X ray that we are doing as part of our job. And most of the times if we are given like a, it's called a lead shield, which is like an apron. Right. They're not made for us, they're made for men who are six inches taller than us. And so the armholes hang lower and so there's this huge gap where are the side of our breasts and the location where we most commonly have it is the outer, upper, outer quadrant, which is the part that's most exposed. Dr. Betsy Grunch, she's a neurosurgeon, spine surgeon, has been working with a company that is trying to get better fitting lead. And we were told distinctly, remember many lectures as a junior resident, that if you use what's called a mini C arm, which is like, if you've ever broken a bone, they're going to bring this little kind of portable X ray in and do it. Especially when we reduce people who have broken wrists, we reduce their arm, we use the mini C. Because I can. I can move it with my knee and hold the wrist at the same time. We were always told, oh, that only has the amount of scatter of a basketball. Well, that's just not true. And the numbers of women orthopedic surgeons getting cancer, that proves that it is not true. We also have, I believe it's three times the rate of infertility as the general population. So we as a community are physically sacrificing our body, our future chances at having healthy families. And we have done our own studies again and again. Again, there's a society called the Ruth Jackson Society. They're made up of female orthopedic surgeons. They do a ton of surveys and research to show these issues. But it's still not as if the day I show up my internship year, I'm fitted with my own lead to protect myself.
- [41:45]
Molly Biscar
Yeah. Yeah. That is. I'm, like, so angry right now because, I mean, just talking about this story and how much work Dr. Stewart had to do to fight for this little change, just to learn that decades and decades later, women doctors are still having to fight to be protected. And the idea that it's all because we can't fit a lead vest to a woman. And how hard do we have to fight to just get a vest to fit us? It's just. How absurd is that? It's like, I'm very angry right now.
- [42:20]
Dr. Erin Nance
I mean, when I was pregnant with my daughter in fellowship, I always remember that I was outed because. So I was intentionally trying to get pregnant so that I would have my baby the day after I graduated fellowship. Insane. Like, it absolutely. Like, so that I wouldn't inconvenience anyone else.
- [42:44]
Molly Biscar
Right, right.
- [42:45]
Dr. Erin Nance
So, like, to the day. So I knew to the day when I was pregnant. So I tell the chairman and I say, Dr. A, I'm. I'm pregnant. He's like, oh, congratulations. So how far along are you? And I Was like two weeks. Which is like a ridiculous thing to tell your boss when you're. But I was doing cases that involved something called MMA cement. We were, I was on the oncology rotation and we know that exposure is toxic to the fetus. So I, I had had to let him know because if I was in any cement cases, I was going excuse myself. So he goes, you know, he's like, oh, congratulations. Whatever I can do to help you. He was really so wonderful about it. But the first thing that I had to do was report to radiology because they have every doctor who does procedures where there's radiation you, where you wear your lead and you have to have this little badge. And that badge is supposed to be a marker of how much radiation you're exposed to. And there's only a certain amount of exposure you're supposed to be exposed to, you know, every month. And they're supposed to be checking the dosage. So when you're pregnant you get another little badge that's separate, that measures radiation exposure to the fetus. So when I was scrubbing into cases and putting my lead on, I had like my badge that said Erin Nance. But then, and I just wasn't paying attention, there was a big old sticker with a fetus on it.
- [44:16]
Molly Biscar
Oh my God, my name.
- [44:18]
Dr. Erin Nance
So everyone was like, oh, Dr. Nance, congratulations, you're pregnant. And I was like, how did, how does everyone know? Because I'm walking around the big baby.
- [44:27]
Molly Biscar
Sticker because a man invented that. Because 100aman invented that. There's no way a woman invented that.
- [44:34]
Dr. Erin Nance
Like, oh, like a floating fetus with like the umbilical cord attached to it.
- [44:40]
Molly Biscar
We could make it a heart. We could make it just say her specialty. No, it's going to be a fetish fetus.
- [44:49]
Dr. Erin Nance
But so we know that about this risk to fetuses and that's what. And so. Oh. The point of me telling the story was when I would wear the lead, not only would I wear a front lead and then I would wear the two piece lead because that was more protective. So a skirt and a vest as opposed to just an apron. I would double lead and I would put a skirt invest over the back of and around me. So I was eight months pregnant. Plus carrying each lead is probably 20 pounds.
- [45:22]
Molly Biscar
So I was double.
- [45:23]
Dr. Erin Nance
So that's 40 pounds of lead a day.
- [45:28]
Molly Biscar
And there has to be a better way. I mean, why can't we. I mean you'll probably know the answer to this, but why can't we do it outside the Room, like, why can't it be the patient goes in and we can tell them how to get into the right position from outside of the room and just limit the doctor's radiation exposure.
- [45:49]
Dr. Erin Nance
There's, I mean, a lot of reasons and accommodations and things like that. But for example, every time you open the door to leave the room, that exposes more, you know, the outside into the sterile field. Right. Every time I leave the room, maybe that I would have to open un glove and un gown, come back in regal and glove. That's not necessarily all the time. Sometimes we stand is like a little, almost like waiting room on the side of the or. But it adds time to the case. And you only have so much time under a tourniquet. Right. Where you can do the surgery. So it's not just as simple as, like, oh, well, just don't be in that surgery, or, oh, just stand off to the side.
- [46:31]
Molly Biscar
Yeah.
- [46:32]
Dr. Erin Nance
There's a lot of factors, so we try and mitigate the risks as best as we can. And then there are some situations where I was just like, I am not going to scrub in any cement cases. Right. Like, that was my. That's my stand. I'm not. I'm not going in the room. I had attendings who were very common. They're like, of course, like, I'll get another fellow. Like, just, you know, don't even. Don't even.
- [46:55]
Molly Biscar
Yeah.
- [46:56]
Dr. Erin Nance
Case. But if you are the only surgeon in town and you're doing a, you know, a distal femur resection that needs cement, what are you going to do?
- [47:06]
Molly Biscar
Right. Right.
- [47:08]
Dr. Erin Nance
So, yeah, these are occupational hazards that we deal with for patients. These are iatrogenic injuries. Right. Harm caused by physicians, not intentionally, but that have consequences injuries. And we don't talk about this enough, but medical errors are the number three leading cause of death in this country. Yeah. And we talk to these patients every day on our. On our podcast. Right. These are patients who have been done harm through either a procedure that went wrong through a misdiagnosis. Right. These are all part of doctors, unfortunately, sometimes causing harm to people.
- [47:54]
Molly Biscar
Yeah, yeah, absolutely. Well, thanks for listening to the story. I hope that the audience liked it. But let us know what you think about this different kind of episode. If you guys like it, then we'll do it every once in a while. Obviously, mostly we'll be keeping with the patient stories, but, you know, if you like these, then we'll continue doing them here and there. And there's so many medical detective stories from history that can be told, so we'd Love to get your, your thoughts on this, on this new kind of format.
- [48:26]
Dr. Erin Nance
Yeah. And you know this, this is not new, right? Brian, Dr. Brian Drucker came on when he said he was studying for his leukemia research. They were like, you're crazy. Right? They, it sounded like he was pushed out of his lab and had to go to a different lab to continue his studies because they didn't think what he was studying was worth it. So this is not uncommon and still happens to this day. It also doesn't surprise me at all that it wasn't until a man replicated the study that there was any credibility behind the study. But also something that's happening is that a lot of patients are taking it upon themselves to organize and do their own research and, and come up with their own conclusions. But it really isn't considered a valid study unless a physician can replicate the study.
- [49:19]
Molly Biscar
Right.
- [49:20]
Dr. Erin Nance
So again, there are layers or degrees of studies and level one is the gold standard, double blind, placebo, randomized trials. Those trials cost tens of millions of dollars to do. And in the case of babies, right. No one's going to do a study where they're like, well maybe we could cause severe possible harm. So will you, we'll put you in the placebo group, right? No. So we can't even perform the type of studies that are considered gold standard on a lot of pregnant women. And that's why we just don't have for medications. For example, a lot of drugs are considered pregnancy level X. And there's one category where we know the drug is bad, right? Like thalidomide has been proven to be bad, Accutane proven to be toxic. But there are an entire other category of drugs where primarily because we haven't been able to study them in pregnant women, we don't know what the outcome is for long term outcome for a fetus. So we're just not able to give a grade for that. And so for that reason a lot of doctors will say, well, I'm not going to prescribe that because we just don't know what the long term effects are. And that's why it's really, it's really difficult to design these studies to include pregnant women. I mean, especially pregnant women.
- [50:50]
Molly Biscar
Yeah.
- [50:52]
Dr. Erin Nance
Wow.
- [50:53]
Molly Biscar
Well, I'm glad we were able to tell Dr. Stewart's story.
- [50:57]
Dr. Erin Nance
And.
- [51:01]
Molly Biscar
If you have a story that you would like to tell on the show, please send us an email. The email is storieshemedicaldetectivespodcast.com and you can also, if you don't have a story. But you love the show. Give us a rating, leave us a comment on Spotify, follow us on our social media. All of that will be linked in the show Notes.
- [51:26]
Dr. Erin Nance
Also, I am a professional TikTok and Instagram stalker of other people's medical stories, so I am always recruiting people for the platform and because some people just aren't into podcasts and they prefer to post on social media. But I think the thousands and thousands of people this is podcast every week, we find so much value in listening to these stories and I think that this podcast format really allows for the whole breadth of the story more than just a small little snippet on social media. And we're able to talk about the nuance of things and not just make like blanket statements. So I can't wait for next week when we're back to our guests and we'll see you next week.
- [52:16]
Molly Biscar
See you next week. Bye.
- [52:41]
Dr. Erin Nance
The Medical Detectives is a soft skills media production produced by Molly Biscar Sound designed by Shane Draus. If you have a medical story you'd like to see featured on the Medical Detectives, please email it to stories themedical.
- [52:54]
Narrator/Announcer
Detectives podcast.com the information provided on the Medical Detectives is for informational and entertainment purposes only and should not be considered medical advice. While we may feature licensed medical professionals, including doctors, we are not your personal doctors and no doctor patient relationship is established by listening to this podcast or interacting with our content. All discussions are general in nature and may not apply to your specific health situation. Always seek the advice of a qualified healthcare professional before making any medical decisions or taking any action based on the content of this podcast. Never disregard professional medical advice or delay seeking treatment because of something you have heard on this show. If you are experiencing a medical emergency, please contact emergency services immediately or consult a qualified healthcare provider.