Friday, January 30, 2015

OF GOOGLE AND ME

 
Linda and a grand nephew, Heron Island, Maine
 

As you probably know already, I have arranged for Google to alert me whenever an article concerning ovarian cancer appears in the world media.  Well, appears in English, I guess – nothing in Lithuanian so far.  .  Many of the articles they cough up are inconsequential, and a few are downright stupid.  However, some useful references also emerge.  As an example of the former, the Mirror (a U.K. tabloid – possibly the one that prints a full-page nude female on page three of every issue) reports that fizzy drinks cause cancer.  What they mean is that: (1) drinking an improbable amount of fizzy, sugary fluid causes puberty in girls to come a month or two early, and (2) early puberty increases the chances of developing certain kinds of cancer, especially breast and ovarian.  So, I guess our lesson here is to avoid fizzy drinks – mainly because they are disgusting in taste, make you fat, and rot your teeth.  Fear of cancer would appear to be fairly low on the list of reasons.
As an example of a useful article, the American Society of Clinical Oncology refers you to the following report:
This is something like an annual report of what ASCO regards as important advances in cancer research.  I can’t pretend that this is “I just couldn’t put it down” literature, but it has some interesting sections.   As you probably could have guessed, it contains an anguished plea for more Federal funding – the claim is made that the purchasing power of the cancer research community has decreased by 29% in the past decade.  No word about rearranging the way the available funds are distributed, of course – ASCO is cancer establishment, bigtime.  I, too, am unhappy when cancer funding is cut, but I continue to argue that the funds could be put to far more effective use:  see the following fascinating little essay
which you should re-read.  I’m sure my email buddy Clifton Leaf would agree.
In passing: a large percentage of “serious” articles that Google dredges up for me concern research that demonstrates that certain genetic mutations are related to certain kinds of cancer.  I guess such discoveries are cause for jubilation – or at least, a fleeting, grim little smile.  Clearly, simply knowing what aids and abets cancer-acquisition is of little value so long as we don’t know what to do about it.   So, your genomic investigation tells me that my daughter is carrying a mutation that may cause ovarian cancer.  So, what then?  Can we fix the mutation?  Can we reverse its malign effect?  That’s what I really want to know.  What am I paying your salary for, anyway?  Come on guys – get cracking
**I should warn you that opening this site may result in an obnoxious add – on my machine it does about half the time.  However, just close the add and the meat of the article will appears.
 
 

Monday, January 26, 2015

ZACH

Cousins
Linda, Carolyn, Elsie, David
missing: Richard, Karl
 
A quick little post:  I subscribe to something called “Google Alerts”: they “alert” me to items in the media that touch, however lightly, on ovarian cancer.  In following up one such  I  discovered the following:
This video talks a bit about medical application of genomics.  The little boy featured here had some of the experiences of Seamus, my great grandson – but in spades, and with many more complications.  The Cordova contingent will be especially interested.
Please watch this video, and then ask yourself two questions:
How can they do such incredible stuff, and isn’t it wonderful that they can?
How in Heaven’s name can we (as a society) afford it?
 
 
 
 


Sunday, January 25, 2015

A DEFINITE BUMMER

Linda and Ella, not so many years ago.
She was never happier than with a baby.
 
CBC radio broadcasts something called “White Coats, Black Arts”, which I’ve never heard.  Apparently this program dissects various aspects of medical science, successes and failures, leaving  warts and wrinkles in full view.  To me, this approach sounds like a welcome change  from the way it often is done on U.S. television – you know, Dr. Nancy Snyderman perched across the table from Brian, solemnly telling us something we already knew, or strongly suspected.  This strikes me as definitely better.  Yes, CBC is Canadian.  Face it, the Canucks are ahead of us, again.
The star of the show seems to be a Dr. Brian Goldman.  Dr. Goldman trained as an ER doc, has written a book on that subject, and apparently is a popular fixture on Canadian media.  In this article he takes on the efficacy of cancer screening.  He lobs us an 80 lb. medicine ball – a real downer.  Here it is:
In this article he reports on a new study published in the International Journal of Epidemiology and authored by some people at Stanford - which concludes that, in general, currently available cancer screening methods simply  don’t work.   (It should come as little surprise that one of the authors is our old friend John Ioannidis  – see, for instance:  http://ljb-quiltcutie.blogspot.com/2014/04/metrics-scourge-of-sloppy-science.html, and several other articles mentioned therein.)
To write the blunt truth, after my experience of the last few years I don’t find this surprising. 
Ioannidis and his crew define “work” as improving the chances of not dying.  Some tests do help, but most don’t.  Here is a paragraph that summarizes the problem:
There are several possible reasons why these screening tests have performed so poorly..  The screening test may not detect the cancer early enough to save a life.  It may be that no matter how early the cancer is detected, there is no good early treatment that cures the cancer.  In some cases, there is a treatment but the risks of the treatment are so great that they cancel out the benefits of early cancer detection.  Or, early detection leads to treatment that cures the cancer but the patient is more likely to die of other causes not related to the cancer.”  Tell me this isn’t a bummer!
However, Dr. Goldman’s piece does include some silver lining for this particular dark cloud.  Several new prognostic processes are mentioned, including one currently being tested on ovarian cancer that involves looking for the presence of a certain abnormal protein in the blood.  It also might be useful for other cancers, including breast cancer.  Let us hope! 
There’s more good stuff in this short article; I recommend that you all read it.  And, when I get back to Bellingham, near the Canadian border, I’m going to see if I can tune in on White Coats, Black Arts.  Not much hope, here in Borrego Springs.
 
 
B


Tuesday, January 20, 2015

KEN BURNS AND CANCER

An early quilt
Definitely a toddler quilt
Wonder who has it now.
On October 10th of last year I wrote a blindingly insightful analysis of current “popular” literature about cancer.  I looked at a dozen or more books and “graded” them, as you might expect an old fogy academic to do.  Only three were rated as “must reads”.  The most ponderous and menacing of the three was The Emperor of All Maladies: A biography of cancer, written (in his spare time?) by a young cancer researcher, Siddhartha Mukherjee.  I didn’t really expect you to consume this work – unless you are as driven as I seem to be.  Well, be golly, you are in luck.  Ken Burns is making a documentary out of Mukherjee’s book!  It is set for release next spring.  When I find out precisely when I promise to let you know.  There are few things in this world that I anticipate more.  (Remember: I’m 81, and I’m realistic.)
Read about it yourself: http://www.cancertodaymag.org/Winter2014/Pages/Emperor-of-All-Maladies-Biography-of-Cancer-Documentary-PBS-Ken-Burns-Siddhartha-Mukherjee.aspx 

Oh, I should have told you about my adventures today.  I went with some birders to the southern end of the Salton Sea.  I saw about 1000 snow geese (at times flying in circles overhead - raining their little treasures upon us), and perhaps land-based 500 sand hill cranes.  It was wonderfully impressive and I enjoyed it - but by next year I won't be able to tell one of these birds from the other!  No hope for me, Brad.
 
 


Monday, January 19, 2015

ORPHAN DRUGS


The Agora in Athens, 1983
 
I will start this blog with a scolding.  My last blog was designed to induce you to read a Wall Street Journal Op Ed by an M.D. in Bozeman, Montana who – if not our answer to Mother Teresa – is a close second.  But, it turns out, the WSJ (profit-grubbing capitalist swine that they are) will not let you read their articles on line unless you are a subscriber.  I have concocted a way around this impasse and have asked those of you who want to read about Dr. Bob to let me know by email.  Google tells me that over 20 of you already have looked at that particular blog.  However, only two of you have asked for the article!  More proof that most of you simple look at the picture of Linda and then flip down to the next cute baby or scenery picture.  Fie!  My email is myrlbeck@msn.com.  I expect some action.
The topic of this blog is “orphan drugs”: what they are and how they are created.  We have talked about medical economics at excessive length many times before.  Swell, here’s more.  An orphan drug is a drug designed to treat a very rare disease.  If it is truly rare, there is no way that Big Pharma or anyone else can develop and market a drug specific to that disease, and turn a profit.   It may surprise you to learn that Bog Pharma has no soul, and so is extremely unlikely to deliberately lose money just for the sake of the humanitarian buzz it may provide  Thus, to generate orphan drugs, the public must intervene.  Short of setting up a government owned and operated “Crown Corporation” to do the work, inducements needs must be applied to get Big Pharma rumbling.   These include tax breaks, extended patent limits, simplified approval procedures, and probably lots of other little tricks.  Anyway, these “tricks” seem to be successful, because there are some orphan drugs already on the market, and more in the pipeline.     One of these is “enadenotucriev”. This unspellable and unpronounceable drug (soon to be renamed something short and catchy, you can bet) is being developed by a smallish company in Oxford, England.  It is a treatment for epithelial ovarian cancer.  May it work wonders!



Saturday, January 17, 2015

GOOD PEOPLE DO EXIST. We need more.

Carolyn and Linda
When?  Where?
 
This little entry has nothing to do with ovarian cancer, but it has a lot to say about how we should lead our lives.  What I am bringing to you is an Op Ed from today’s Wall Street Journal.  The author is an M.D. practicing general medicine in Bozeman, Montana, a high and desolate mountain village chiefly famous for the fact that my youngest granddaughter is a college student there.  I urge you to read it and then think for a few minutes.  I did just that, and came away taxing myself for not being a better person.  To signal a change in my character I hereby vow not to gloat if the Seattle Seahawks cream Green Bay tomorrow.  And maybe I’ll work on a few other things, too.
I don’t know why this little piece affected me so much.  Maybe it is because my desk is surrounded by pictures of Linda.  This is the way she lived.
 
 

 


Thursday, January 15, 2015

WHY DRUGS COST SO MUCH

Richard, Linda and Carolyn, Kalamazoo, 1952
Throwback Thursday
 
From the Ingwalls comes this NY Times Op Ed, which is guaranteed to make your blood boil.
It concerns a topic we have batted around many times before: How have we arrived at a situation wherein a drug – a pill, say – that some people need to survive costs $2.29 to manufacture, but is sold for $2,290?  (I made those numbers up, but they are not improbably extreme.)  In no particular order, here are some of the answers: 
It costs billions to develop a new, effective drug, and Big Pharma must recoup those billions, plus a decent profit, to placate its stockholders.
The Feds gum up the works with preposterous rules and regulations, presented as means to protect us from the next Thalidomide but really represent a product of the normal evolution of a bureaucracy.
Capitalism encourages the proliferation of a class of blood-sucking leeches who prey on the innocent.
Foreign countries let us (the U.S.) spend cubic kilometers of large-denomination bills to develop healthcare procedures, then duplicate what we do for peanuts.
No medical practitioner dares NOT use a new drug for fear that he/she will get sued.
And so forth.  Some of these are fairly stupid, some are partially true, but even collectively they are not the entire answer.  According to the author of this piece (a prominent M.D.  employed by Memorial Sloan Kettering, itself a true major-league outfit), the problem breaks down something like this:  Drugs obtain approval from the FDA that (a) cost a lot, and (b) aren’t much more effective than existing treatments.  Nevertheless, insurance companies are REQUIRED to offer these drugs, and some physicians prescribe them, either out of primordial CYA instincts, or out of ignorance.  The suggestion here is to, in effect, let competition do its job.  In Europe, it is said, insurance agencies can say “no” to new drugs, and so – if a new drug is developed – it must be priced so as to make it attractive.  Let’s say I am CEO of NastyPharma and I have a new cancer drug in my bag.  Call my drug N, and let’s also  say there is a competing drug already known to work, called C.  I would like to price N at $10,000/month, but C sells for about half that.  The FDA has ruled that N is a little better than C, but not much.  In the U.S., insurance policies must offer both N and C, and for reasons afore said some physicians will prescribe it, or at least not argue too hard if the patient requests it.  However, in Europe the outfits that control such things can say “no” to N, at that price.  Hence, I must price it much lower.  If it must be priced so low that I can legitimately despair of ever recovering development costs, well : Tough stuff.  I should have figured that out early-on and worked on something else.  Benign Capitalism in action, more or less. 
There is more to this article than I have summarized here, but I am beginning to think destructive thoughts about this computer again, as it swallows entire paragraphs and pastes them elsewhere – mainly in cyberspace.  So I will give you the link, below, which you should read.  In my view this is not close to the entire answer to our drug-price problem, although it is a good start.  It may reduce the cost of a drug from $10K/month to $5K, but who can afford even that?  We absolutely must somehow learn to allocate our research dollars in such a way that not many people ever NEED either N or C.  Maximize prevention and early detection so we don’t need to worry so much about cure.