Dr. Joseph Sirven: It's All About Luck

Published: Tuesday, March 10, 2015 - 2:29pm
Updated: Wednesday, March 11, 2015 - 10:13am
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Dr. Joseph Sirven
Dr. Joseph Sirven

Sometimes it’s just dumb luck that plays a role in your health.

The other day, I spent two hours with a patient with a newly diagnosed brain tumor. I explained how tumors start, the prognosis, treatments and side effects. But she kept asking me one question, “Why?”

“I never know why," I said. "Perhaps fate, God or sometimes just bad luck.”

She looked at me and said “that’s unacceptable,” and walked out.  

A recent study in the journal Science seems to support this notion of bad luck causing disease. Researchers discovered that some tissues are overtaken by cancer more readily than others and the main reason for this variation is explained by chance stem cell mutations.

Researchers from Johns Hopkins examined the lifetime risk of developing 31 types of cancer and correlated it with causes of stem-cell division because organs with high stem-cell divisions have more frequent cancers. They found that random mutations accounted for a majority of the studied cancers.

This study polarized both patient groups and doctors. On one side, the concept of bad luck causing a large number of cancer cases is incredibly unsettling and seems to undermine the concept of disease prevention. For others, the idea that an arbitrary force outside our control may cause disease alleviates the guilt and accountability of pursuing poor health habits. But the bottom line is — whether we like it or not — luck is a major player in health.

Often there’s good luck in medicine. The right part of the body is affected, the bullet just missed the spine or a medication approved for another disease is found to be useful for conditions no one would have considered.

And sometimes there’s bad luck. Over my many years as a practicing doctor, you learn that the most disquieting of inquiries for both patient and doctor is “Why me?” This eternal human query is mundane yet profound and, frustratingly, the answer is elusive.

The luckiest draw is finding someone who knows how to break the news that, ultimately, we don’t have all the answers.

Dr. Sirven is the chairman of neurology at the Mayo Clinic.

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