During this century there have been striking trends in the incidence of certain important cancers, while others have remained fairly steady. Lung cancer mortality has risen dramatically in the last fifty to sixty years. Colorectal cancer (cancer of the large intestine and rectum) increased in most of the Western world in the 1930s and 1940s but has been steady for the last thirty years. There seems to have been an increase in cancer of the prostate gland in men between 1930 and 1950 but this may reflect improved diagnosis. Melanoma incidence has risen rapidly in the last twenty years and continues to rise, reflecting changes in exposure to sunlight. There has been some good
news. Stomach cancer has been falling steadily for sixty years and continues to do so, and some kinds of gynaecological cancer affecting the uterus in women are now less frequent than they were in the 1940s and 1950s.
The extent to which we can predict future trends by looking at cancer incidence in young people. These trends provide important clues about the cause of cancer, the most obvious one being the parallel between lung cancer and smoking.
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After the physical examination, the physician will develop a differential diagnosis. This consists of a list of possible causes of your specific symptoms. The physician will order specific laboratory tests to rule out certain of the diagnoses and other tests to confirm the proper diagnosis (these tests are described in detail below).
Blood tests and x-rays are seldom helpful in diagnosing R A in the very earliest stage. For this reason, your tests may not uncover any specific abnormalities. On the one hand, you’ll probably be happy that the test results are normal; on the other hand, there’s the frustration of knowing that something is wrong and not having a test result to prove it. Your physician may temporarily have to make an experienced best guess of the diagnosis in this case. Effective treatment can be initiated before test results are diagnostically significant, however.
What Makes RA So Difficult to Diagnose?
RA is the most common of the inflammatory forms of arthritis, and yet it is often difficult to make an accurate diagnosis of it. For this reason, your physician may have initially diagnosed your RA as another type of inflammatory arthritis, such as ankylosing spondylitis, Reiter’s disease, arthritis associated with psoriasis or colitis, gout, pseudo-gout, or systemic lupus erythematosus (SLE). The symptoms of these forms of arthritis are similar to the symptoms of RA, and many excellent doctors initially misdiagnose RA as being another form of inflammatory arthritis (and vice versa). As mentioned above, RA also is often diagnosed incorrectly as the most common form of arthritis, osteoarthritis.
A good clinical history, a thorough physical examination, some laboratory tests, and a good measure of time and patience are required to diagnose RA. A physician who is well acquainted with the pattern of joint involvement in RA is likely to have an easier time making an accurate diagnosis. Board-certified rheumatologists are specifically trained and experienced in making these difficult early diagnoses.
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So genius and wisdom, and by extension talent and competence, do not always travel together, and in fact they often don’t. Most people seem to recognize the difference between these highly desirable traits. Sternberg has studied how people from various walks of life perceive the relationship between creativity and wisdom. It turns out that most of his subjects viewed these traits as being positively but very weakly linked, and in some instances even as being negatively, inversely linked. Interestingly, the same study shows that both “wisdom” and “creativity” were viewed by the subjects as being better correlated with “intelligence” than with each other. This suggests to me that the very construct of “intelligence” is, in the minds of most people, an attempt to capture a sum total of many aspects of the mind, rather than a particular, distinctive aspect of the mind.
The belief that novelty-seeking is the attribute of youth and that wisdom is the attribute of old age seems to be shared by a lot of people. Psychologists J. Heckhausen, R. Dixon, and P. Baltes conducted a fascinating experiment in which they asked their subjects which human attributes appear at what age. Most subjects believed that curiosity and the ability to think clearly become dominant attributes for people in their twenties and that wisdom becomes a dominant attribute for people in their fifties. When asked to rank various attributes in terms of their desirability, wisdom was ranked among the most desirable traits. In a similar study, Marion Perlmutter and her colleagues found that most people associate wisdom with advanced age more than with anything else. This amounts to an interesting syllogism: If people believe that wisdom is the privilege of old age arid also regard wisdom as one of the most desirable traits, then they also must believe that aging has its benefits, its positive side, and its unique and valuable assets.
In the minds of most people competence, like wisdom, is also the fruit of maturity. Understanding wisdom as an extreme degree of competence is consonant with the approach taken by psychologists Paul Baltes and Jacqui Smith, who define wisdom as “expert knowledge,” a highly developed ability to deal with the “fundamental pragmatics of life” involving “important but uncertain matters of life.” They place “rich factual knowledge” and “rich procedural knowledge” among the important prerequisites of wisdom and point out that the accumulation of such knowledge by definition requires a long life.
Following Sternberg’s prudent (and wise!) admonition, I will refrain from discussing the concept of wisdom in all its richness. I will forgo the existential, self-actualizing, and moral aspects of wisdom, so cogently considered by Erikson, Jung, Kohut, and others. I will limit the scope of this book to one aspect of wisdom: the enhanced capacity for problem-solving. This admittedly narrow, morally agnostic approach allows a few villains into the book, along with many heroes. While realizing the limitations of this approach, I feel that it is a big enough slice of an infinitely rich concept to tackle in one book. Problem-solving is the one aspect of wisdom that we are most prepared to explore through neuroscience.
If wisdom and competence (or expertise) increase with age in all their aspects, then how does one reconcile this with the common assumption that one’s mental powers decline with age? Or, to turn it around, if our memory and mental focus decline with age, then how is it possible that our wisdom and competence grow? What sets wisdom and competence apart from other manifestations of the mind and allows them to survive the ravages of aging?
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