Friday, April 20, 2018

DYING


Guess Where

Here is a thoughtful, and thought-provoking, piece about miracle cures, palliative care, and the physician’s dilemma.  Read it.



My impressions:  It used to be a simple, if painful, matter for a doctor tending a dying cancer patient to tell the truth – we have exhausted all therapies, you are going to die, so consider palliative care.  Now, however, with immunotherapy and personalized medicine available (albeit at tremendous cost), the matter is far less clear-cut.  Such is our ferocious desire to live that even people in their 80s will choose to fight on, even though (says the article), only about 15% of patients will respond – and we don’t know who they are.  And, of course, side-effects may be horrendous.

I will be 85 in a few weeks.  If I contract cancer, for God’s sake don’t let me try anything heroic.  I want to exit life with a smile on my face and a vodka in my hand!

Monday, April 16, 2018

PROFILES IN RESEARCH EXCELLENCE: Dr. Pamela Kreeger


The Kreeger Lab
Well, not the lab, actually.  Just the people who work in it.

Insofar as it is possible, let me introduce Pamela K. Kreeger, Ph.D.  Dr. Kreeger graduated from Valparaiso University in 2000 (making her ~ 40 years old).  She received her Ph.D. from Northwestern University, post doc’d at M.I.T, and now is an Associate Professor at U. Wisconsin, Madison.  And that’s all I know about her personally, after 30 minutes prying using the internet.  I could email her for more, but I won’t – I want her hard at work, not answering stupid questions from people like me.

Dr. Kreeger is affiliated with the Department of Bioengineering.  The lab has a newsletter:


which tells us that it (Pamela and co-authors) have published 27 studies in the last decade.  From the photo (above) she has nearly a dozen budding young scientists to supervise.  (In my prime I had as many as three, and expended much energy and wasted much time keeping them from killing each other.  I admire you, Pam).

Anyway, MRC has awarded Dr. Kreeger $60,000 to investigate the feasibility of using a drug already approved by the FDA (for other purposes) to inhibit metastasis in ovarian cancer.  It seems that this drug discourages cancer seeds carried in the blood stream from adhering to other parts of the abdomen.   Many mice will die to test whether this is true.  Let’s hope it is.  Thank you. Dr. Kreeger.

Sunday, April 15, 2018

MRC


Scouting for Geronimo
Linda in Chiricahua National Monument

As many of you know, until a few years ago I volunteered with the Marsha Rivkin Center for Ovarian Cancer Research (hereafter MRC).  Gradually, however, my enthusiasm for MRC waned, and finally essentially disappeared.  This was owing to the fate of stuff I wrote for the MRC web site – it all vanished without a trace.  Now I find that I don’t know a single MRC staff member, except Saul  Rivkin himself – who has stopped phoning me, as he once did at least weekly.  Oh, well – Saul is getting old.  He’s almost as old as I am, in fact.  Practically antediluvian. 

But MRC still does good work.  It raises money and doles it out to young scientists who they think may be poised on the brink of an important discovery.  They have just announced their grantees for 2018; you can read about it here:


To demonstrate just how petty I can be, I would like to point out that even this press release contains an error.  Over 22 thousand American women contract OVCA yearly, not die from it.  The latter figure is more than 14 thousand – still an obscenely high number.

Anyway, MRC gives out four types of grant:

Pilot Studies:  These support investigations that are non-mainstream – innovative for sure, and perhaps a bit speculative.  In my not-particularly humble opinion, this is where the bulk of MRC money should go.  This year they awarded eleven Pilot Study grants, of $75 K each.

Scientific Scholar awards:  These also appear to be innovative.  Three were awarded this year, at $60 K per.  These seem to be aimed at extremely early-career investigators because grant applicants are required to designate a “mentor”.

Bridging Funding Awards:  Sad but true:  Not all worthy research ideas get funded by NIH or other governmental funding agencies.  Bridging Gtants - $30,000 for up to six months – give the proposer sustenance and encouragement to try again.  Two were awarded this year.

Challenge Grants:  This is a rather funky idea: propose a “grand scientific question to the scientific community”, then award $150,000 to the most promising proposal.  I don’t know what the “grand question” was this year, but – whatever it was – nobody got funded.

MRC, as frustrating as it is, serves one truly vital purpose:  it spurs innovation.  Breakthroughs rarely originate out of old, established research projects – and these, by the way, suck almost all of the oxygen out of available, mainstream, funding sources.  MRC and like organizations enable new ideas to be hatched and incubated.  If the new idea proves to be viable, the likes of Jeff Bezos or Mark Zuckerberg – or even NIH - can step in and do the heavy fiscal lifting.  But first the idea must exist.
  
So, go get ‘em, MRC.  My next blog will be another in my series “Profiles in Research Excellence”, chosen from your 2018 awardees.  Her name is Pamela.  


Sunday, April 8, 2018

AN ANTI-CANCER VACCINE? Nope, not yet


         X-Country skiing, in Canada

According to Google this is the 574th blog entry I have inflicted on you since March of 2012.  In other words, I have been writing these things for over six years, at a rate of about 95 per year.  I hope they have done some good.  Lately, however, I have begun to realize that I am growing non-selective, and repetitious.  For instance, I have written about immunotherapy 38 times, over a span of nearly six years.  What happens is that my sources often make the new process or discovery they are discussing sound like sliced bread, Teflon, or the internet – real society-shaking breakthroughs.  But in general they aren’t.  My tendency is to get all excited, and blog away.  No more, by golly!  From now on I intend to write only about  such things as strike me as certainly significant, useful compilations of information – or just plain interesting.

Partly I am doing this because I can’t keep up with my daily deluge of emailed information.  For instance, somewhere in the last few days I skimmed an interesting blurb about the new FDA director, who is endeavoring to speed up the drug-approval process.  A worthy ambition, certainly – but I have totally lost the article.  Anyway, it appears that we don’t have to hate the Feds quite so much now, at least for the time being.

For something useful to end this blog:  An outfit called Taplmmune, based in Jacksonville, predicts that by 2022 they will have perfected a “vaccine” against OVCA.  This on the basis of a Phase I trial involving ten women with ovarian cancer!  To me, a vaccine is something you somehow ingest in order to avoid getting a disease.  This stuff, with luck, may give a woman six extra months of remission.  I don’t deny the value of another half-year of healthy life; I would have given anything to have had Linda alive and happy an extra  six months.  So Taplmmune’s new concoction may be useful  - but a vaccine it ain’t.




Friday, April 6, 2018

SYNERGY


Linda and Mitzi take a nap

I like to think that I have a pretty good vocabulary.  When I was a kid my parents subscribed to Reader’s Digest, which often featured a section called “It Pays to Increase your Word Power”.  This consisted of 20 unusual words, each with multiple possible meanings – you were supposed to pick the right ones.  I used to compete at that with my dad; he usually won, but I hung close.

So, even today, I wince whenever I run on a word usage that is unfamiliar.  I ran on two such just now.  The first is “synergy”.  I know what it means – roughly, two or more things working together that produce a result greater than the sum of the individual contributions – but I have to stop and think about it.  The other is “inform”.  To me, to “inform” is to squeal on your class mate who has been firing spit-balls at the back of the teacher’s neck.  However, it also can refer to facts bolstering a proposition, as “the laws of physics inform the proposition that, if I turn suddenly and bump this coffee cup with my elbow it will spill all over the floor.”

Well, the article recommended (below) use both of those words, plus a few medical terms that might be unfamiliar.  It concerns a bright young man who has just received a handsome grant from the National Institutes of Health (NIH) to continue his study of the synergistic effect of employing low-intensity radiation together with an immunotherapy drug to combat cancer.  How it works is a bit of a mystery to your old blogmeister, but it may go something like this.  Irradiate a tumor with X-rays and you will kill a lot of its cells by disrupting their DNA.  Some will survive, however, but may react as if they have been invaded by a DNA virus, causing them to display on their surfaces a type of protein that hollers out “come and kill me” to the immune system – which responds appropriately.  There also is some synergistic effect involving things called Tregs, which I don’t understand.

All this is informed by previous research performed by this bright young man – his name is Zachary Morris, and he now is on the faculty of the University of Wisconsin. 

By the way:  I strongly recommend the NIH  Director’s Blog (which Google), from which this stuff was taken.  You can sign up for automatic delivery to your email account.   It only shows up once/week or so, so it won’t clutter your inbox.


Sunday, April 1, 2018

A HANDY SUMMARY FOR YOU HOT DOGS


Too much sun in our eyes
but a good shot, nonetheless


NCI has published an “infographic” that can serve as a Cliff Note for all you avid students of cancer and genetics.  Here it is:


I am sure that this will be useful, but I can’t claim that I recommend it after careful personal examination.  The text is fine, certainly – but the fancy diagram evades the acuity of my ancient eyes.  I tried to make a paper copy, but rather than respond properly my printer spit out an endless stream of nonsense about a Viking trip – which I couldn’t terminate – and finally stuffed a paper in crosswise, screamed, and shut off.  I can’t get it to try again.

We can build quantum computers and driver-less cars.  Why can’t we build printers that old farts like me can operate?



Saturday, March 31, 2018

FINANCIAL TOXICITY, Part 2


Linda and the Hunsinger twins
Kalamazoo
So, there was this old house in the country, somewhat run-down, owned and occupied by a sweet little old lady.  It also was home to a considerable colony of mice but, being intelligent mice, they contrived to coexist with the sweet old lady without incident.  However, realizing that she was lonely, one day the sweet old lady brought home a cat for companionship.  Well, you can imagine the result – death, destruction and terror in the mouse colony.  So the mice formed a committee to suggest a remedy, which quickly came up with the obvious answer – we’ll just hang a big bell around the cat’s neck to warn us if it is close by.  Then arose the obvious question: how in hell are we going to bell this cat?

The first War on Cancer was declared during the administration of Richard Nixon (roughly, the early 1970s).  It was well intentioned, well-funded and, based on the state of cancer science, well designed.  As we all know now, it went next-to-nowhere, owing to the fact that “cancer” was not a single-headed monster but rather a hydra, with many heads, each of which had to be chopped off individually.  Progress against cancer has indeed been made since Nixon’s time but, as we all also know, not nearly enough.

As part of this early War something called the President’s Cancer Panel was created, to keep our chief executive and the public at large appraised of progress being made against our hydra-headed foe.  Presumably there have been annual PCP reports ever since – but this is the first one I have encountered (it appears in the NCI bulletin).  It treats of an important question: how in heck can we “afford” to conquer cancer?  Here it is:


Imbedded within this link is another link that will give you the complete text – wordy, but non-technical.  Here is the gist:

New cancer drugs cost too damned much; so much, in fact, that many patients must choose between health and bankruptcy.  New cancer drugs may cost billions to bring on line.  Some new cancer drugs are well worth their cost, but many simply provide a few more weeks of life.  Drug pricing in the United States is an inefficient amalgam of feeble market forces and bumbling bureaucracy.  And nobody seems to know what to do about it.

So, it is agreed by everybody that everyone with cancer ought to receive efficacious care – if that exists.  Also agreed upon is the proposition that drug prices ought to reflect efficacy, not cost to develop and distribute.  The problem, of course, is obvious.  How in hell do we bell this particular cat?   How do we keep the drug companies solvent and churning out new products - and at the same time assure that high-priced remedies yield worthwhile results?  In fact, can we as a society actually afford to be healthy?

Damned it I know.  What do you think?