THE FORCES OF DIGITAL CONFUSION HAVE WON --for now!

I can’t get the blogging robot that governs “Myrl’sBlog” to relent an allow me to publish any more pictures.  Perhaps, at 172 blogs and nearly 10,000 hits it feels that I’ve used up my welcome.  However, the “Fight Back against Ovarian Cancer” blog robot still is willing to cooperate.  So this pathetic entry is to inform you that, for the immediate future at any rate, I will be posting new stuff to the “Fight” address.  For those of you who follow me directly, you can bookmark www.quiltcutie.blogspot.com and go directly to the site.  For those of you who follow me on Facebook, nothing will change.  And for those of you who don’t follow me at all:  shame on you.

Also, I am going to be away for the next ten days or so, so re-read old blogs and give me some feedback.  Thanks.  Myrl

NUTS ASPIRIN COFFEE: All good for us? Why?

  To see the picture you'll have to click on: http://quiltcutie.blogspot.com/2013/11/nuts-aspirin-coffee-all-good-for-us-why.html.  When you get to the bottom you'll know why.

Amazing how quickly some news items get around!  There is a new paper by Dr. Ying Bao  (and six others) in the New England Journal of Medicine.  It is about nuts: they help you stay alive, apparently.   

In the last 24 hours I have heard about this study on TV (once), radio (twice), and read about it in two newspapers.  Contrast this with the cancer-sniffing-dogs story that broke in early September on “Sixty Minutes”, of all places, but has just now made it to the NY Times.  Maybe the Times was saving it for a slow-news day?  Anyway:

The nut result falls out of two massive studies, conducted on medical professionals, which lasted for a long time.  After “controlling” for potential confounding factors, nut-eaters appeared to die less (at any given age, of course; we all die eventually) than do non-nut-eaters.  Die of things like cancer and heart disease, that is – people who only eat nuts while driving rapidly on the freeway probably gain no net benefit.  The question of “why” doesn’t seem to have a definite answer as yet; there was some mention of reducing cholesterol (heart) and inflammation (cancer), but a detailed explanation was lacking.  The result apparently is robust statistically; although maybe we should get Dr. Ioannidis involved.  Moreover, it was logically dose-dependent: the more nuts you ate, the less likely you were to die.  So, pass the nut bowl.

As you can imagine, there are many “confounding factors" to be "controlled" for.  That is, maybe the cause and effect chain only carries nuts along for the ride.  To make up a stupid example:  When I drink beer with my buddies I often eat nuts.  I don’t doubt that there are many more beer-drinkers  like me.  So, maybe it is the beer that reduces mortality.  Or, to make it even more absurd, note that many people who drink beer drink too much, get a headache, then take aspirin.  It has been shown that aspirin is effective against some cancers, and also thins the blood, hence helps with stroke.  So maybe it’s the aspirin that goes along with the beer that accompanies the nuts that deserves the credit.  These are the sort of things that need to be controlled for.  Again, calling Dr. Ioannidis.

One disturbing fact about this study is that it was partially funded by the United Nut Pickers of the World, or some such body.  It is stated that they had no hand in the design of the experiment  nor interpretation of the results.  I’m sure that’s true – isn’t it?

Here are the links:

The popular press version:  http://www.foxnews.com/health/2013/11/21/study-says-nut-eaters-have-lower-cancer-heart-disease-risk/

The paper itself:  http://www.nejm.org/doi/full/10.1056/NEJMoa1307352

My references to Dr. Ioannidis:  http://ljb-quiltcutie.blogspot.com/2013/11/beware-greeks-bearing-manuscripts.html

 Like I've said many times before:  I am from a generation that used dial telephones attached to the wall.  It is a wonder I have learned as much about computers as I have.  But - I have hit an intractable impasse:  I cannot get this damned Blogger program to allow me to post a picture.  As you may know, I have two blogs; the other one is called Let's Fight Back against Ovarian Cancer.  I semi-abandoned it months ago.  The interesting thing to me is that this orphan blog site will allow me to post the picture I wanted to post here - but not "Myrl's Blog".  As I am aware that most of you mainly use my painfully crafted blog essays as background for a picture gallery, I direct you to that other blog site.  I will keep on experimenting.   I will now try abject. groveling  surrender, in the hope that the computer gods will relent. 

The next day:  groveling didn't work. 

 

BEWARE GREEKS BEARING MANUSCRIPTS

Guess where

First Sabbatical, mid-1980s

On 5/22/12 I wrote a blog about Dr. John P. A. Ioannidis, a citizen and predominantly a resident of Greece.  At the time I thought he was primarily a Stanford University professor, but that appears to be only one of his part time jobs; He does most of his damage (I should say “work”) from his home country.  He is a world-renowned biostatistician and, it appears, one of the more influential persons in medical research.  My ignorance led me to give him short shrift:  see ALL IS NOT LOST, 5/22/12.

I returned to Dr. Ioannidis because I ran onto an article by a fellow Greek biostatistician, Dr. Eleftherios Diamandis.  Dr. D. was born on Cyprus, educated in Athens, and currently is a prominent member of the University of Toronto medical establishment.  This makes him a big gun, no question. 

Dr. Diamandis published a paper in 2010 which reminded me of Dr. Ioannidis’ ideas.  The title of the paper is “Cancer Biomarkers.  Can we turn recent failures into success?” *  It was published by the National Cancer Institute, which is no fly-by-night outfit, as you no doubt realize.  The paper is mildly discouraging.  In it Dr. D. summarizes work de-bunking several recent studies that, when published, seemed to promise rapid advancement in the war on cancer, but which later were shown to be either inconclusive or downright fallacious.   Painfully, some of them almost smacked of deliberate fraud!    

This is a serious avenue of thought I have stumbled upon, and I want to muddle it about in my head before I go any further.  Maybe after my first gin and tonic this evening it will all become clear.  In the meantime, one thing is obvious.  We need incentives to verify published research findings.  Even big, expensive clinical trials should be tested.  Repeated, even, by disinterested investigators.  As I wrote earlier, as things stand now there may be ample reason to verify work already published, but there is little incentive.  Journals don’t want to publish stuff like that, unless of course it leads to a juicy scandal.  Granting agencies and drug companies don’t want to fund “verification” proposals and – maybe the most powerful disincentive of all – you don’t get promoted by publishing negative results.  And, of course, if you do that sort of work nobody will want to eat lunch with you at the AMA convention.

Anyway, stay tuned for a Comment.  In the meantime, here is an article from The Atlantic that you might find rewarding.  As usual with that rag, it takes 10⁴ words to describe what the NYTimes and The Economist could do in 10^3, and The Week could do fairly well with a couple hundred.  But give it a try, anyway.

http://www.theatlantic.com/magazine/print/2010/11/lies-damned-lies-and-medical-science/308269/

By the way, my second great grandbaby is now at home in Cordova (I think)., joining what my daughter Kristen refers to as Her Royal Cuteness.  Should be quite a sight. 

*http://jnci.oxfordjournals.org/content/102/19/1462.full  

 

THE WAR ON CANCER

Looks like a birthday party

Probably mid 80s.

That piano is back home now, and I am trying to re-learn to play it.

It is over 100 years old.  Even older than me.

 

My thanks to Dick Ingwall for easing me through a dark and dreary Saturday painlessly, and even a little bit profitably.  Dick turned me on to an occasional series in the NYTimes called “RetroReport”, which consists of follow-up accounts of interesting news stories from the fairly recent past.   I spent several happy hours reading them.  However, Dick wanted me to see a Retro on the “War on Cancer”, which I did.  That’s what I’m going to write about.  Here is the link.  It has a video attached which is well worth enduring the inevitable initial ad to play itself out.  Hey, they’ve got to make money some way!

http://www.nytimes.com/2013/11/04/booming/hopeful-glimmers-in-long-war-on-cancer.html?_r=0

The War on Cancer (about which I have written before) began during the Nixon administration – and is still going on.  The idea, which sounded reasonable at the time, was that we could treat the eradication of cancer in the same (successful) way we had treated the Manhattan project (developing the atom bomb before Hitler beat us to it), or perhaps the race to the moon.  It was felt that if the vast resources of America – brains, equipment, money – could be efficiently focused on the task of curing cancer once and for all, success would be inevitable, and  moreover not long delayed.  The most important force behind the War was a New York heiress and socialite, Mary Lasker.  All good causes in this world should have their Mary Laskers.  Unfortunately, few do.

Anyway, we all know how the War is playing itself out.  Cancer turned out to be much more complicated than was conceived in the 1970s.  The “task” of defeating cancer evolved into a multitude of separate tasks, one for each kind of cancer.  “Cancer”, it was realized, was not one disease but a whole bunch of separate diseases.  We made progress good against some of these diseases (cervical, colorectal, lung, for instance) but have made distressingly little headway against others (pancreatic and ovarian are examples.)  Our War has begun to resemble WW I; we are bogged down in the trenches.  Our side is slightly ahead, but there is a long way to go before “Cancer” sues for peace.  This NYTimes article mentions several possible ways to break the stalemate, most of which I have written about before.  Finely targeted therapies based on genetics and molecular biology are the new weapons of choice.  In some fields prevention is prospering.  Early detection is stumbling forward a little.  But - no silver bullet yet.

Oh, by the way.  We have spent about $100 billion in the Cancer War so far.  This may sound like a lot but it is trivial: by one estimate, about 1.5% of the cost of the war in Iraq.. 

I am going to make a reading recommendation, but it is accompanied by a warning:  This book may be hazardous to your mental health.  The book is The Emperor of all Maladies: A biography of cancer*.  The author is Dr. Siddhartha Mukherjee, an oncologist.  Some of the scenes in the book are so horrifying that they pop into my mind when I’m trying to sleep – and make me cringe.  And I read the book at least three years ago.  Dr.Mukherjee got the Pulitzer Prize for this book.  If there is a prize for making peoples’ skin crawl, he should win that one, too.  If you are really interested in cancer I encourage you to read this book.  But not for pleasure.

*Available from Abebooks.com for under $10



MY FIRST GREAT GRANDSON

                                                                       Seamus

Meet Seamus Barry Wiese.  Big (nearly ten pounds), tall (nearly two feet), strong and, of course, beautiful.  He will attend Stanford on a football scholarship, stay on for medical school, and eventually – - cure cancer.  And all before he's 40.

NANO BOMBS AND MATRYOSHKA DOLLS

Linda in Bangkok?

She never was east of Egypt

Where is this, anyway?

From time to time I have urged – even (quite rudely, I admit) ordered - you to read certain cancer-related stories in The Economist.  Well, as my primitive computer skills gradually mature I have discovered that I can just give you a link and let you read the thing yourself – if you feel like it.  I read The Economist while eating breakfast, so – as you read the link – you are to imagine it covered with bacon grease and egg yolk.  I used to donate my magazines to the nearest doctor’s office, but increasingly they are so disgusting I just throw them away instead.  Anyway, here is a link to the story I am about to write about:

http://www.economist.com/news/science-and-technology/21588839-three-layered-chemical-bombs-may-destroy-previously-untreatable-cancers-medical

The article talks about triple-negative breast cancer.  Note immediately:  it is misleading.  Most triple negative breast cancers are, contrary to the title of this story, treatable.  Some are aggressive and nasty, but others are as treatable as any other breast cancer.  Promising research is underway to develop new therapies, and here is a convenient link if you want to follow this up:

http://www.breastcancer.org/symptoms/diagnosis/trip_neg/new_research

I am optimistic about several of these approaches, but especially about using PARP inhibitors.  PARP is a molecule that assists in repairing damaged DNA.  Cancers have DNA too, just the wrong kind.  Chemo and radiation therapies may damage the cancer DNA, and “inhibiting” the PARP keeps the damage permanent.  Ergo, the cancer cell croaks.  Good riddance. 

Exploring this web site would be a useful exercise. 

Anyway, “triple negative” means that the cell lacks “receptors” for two kinds of hormones, estrogen and progesterone.  Also absent are receptors for something called HER2.  Lacking these three kinds of receptors, cancer cannot be attacked with hormone therapy.  But, I emphasize, other treatments are possible and often quite effective.   

The Economist article describes the research of a chemical engineer, Dr. Paula Hammond of MIT, aimed at countering the effect of triple-negative-hood.  She has developed a tiny chemical “bomb”, consisting of three layers.  The outer layer is stuff that is attracted to cancer cells.  The second layer is composed of things called siRNA.   A siRNA is a short double-strand of RNA whose purpose in life is to interfere with the process of making some sorts of protein.  Naturally, the particular siRNA that Dr. Hammond uses is targeted: it prevents birth of a protein necessary to expel chemo drugs from the cell.  Then, not surprisingly, the core of this tiny “bomb” is a chemo drug!  Oh, by the way, Dr. Hammond’s missile is only a few millionth of a millimeter in diameter.  That's what Nano means.

So, anyway, her tiny bombs seem to work on mice.  Maybe someday they will work on humans.

Terms that may cause you to scratch your head as you read this article:

siRNA stands for small interfering ribonucleic acid.  They help regulate gene expression.

Matryoshka doll.  Most of us think of these things as Babyoshka dolls; Russian dolls that have smaller dolls inside them, and so forth.

As I write this I am still waiting to meet my first great grandson, Seamus.  He is taking his own sweet time putting in an appearance, the lazy little bugger! 

 



WHILE I WAIT FOR SEAMUS

At Mata Ortiz, northern Mexico

Where all the expensive pottery comes from

 

Ah, November in Bellingham!  It is dark.  The clouds are scudding rapidly toward Canada.  The wind blows in formidable gusts, also toward Canada (natch).  Earlier it was raining so hard that there were waves of water running down the hill in front of my house (literally).  The cats are virtual zombies.  My monkey puzzle tree courageously fights back against the wind, but I fear for its life.

AND HERE I WAIT, FOR THE BIRTH OF MY FIRST GREAT GRANDSON!

To pass the time I have been trying for hours to figure out how to post something I just wrote, about medical statistics.  Yes, I really did intend to inflict it on you:  it is important, and I am in a bad mood.  But I can’t.  I had to hand draw some illustrations.  I can copy them to the text.  BUT WHEN I POST THE WHOLE THING TO BLOGGER, THEY DISAPPEAR!  I am going to Carolyn’s house for Thanksgiving.  No doubt she knows some sophisticated trick to solve my problem.  You’ll have to wait. 

But not to waste a blog, I have found a reasonably non-technical article on prevention of ovarian cancer.  It was written by Dr Magnus Westgren, of the prestigious Karolinska Institute of Stockholm.  I will give you the link at the end of this blog, if I remember.

In a nutshell, Dr. Westgren divides OVCA into two types.  Type I is relatively harmless and, unfortunately, relatively rare.  Type II OVCA is lethal – and, most often, originates in the fallopian tubes.  Dr. W recommends they be removed, especially in women with the BRCA 1 mutation.  He explains why he thinks as he does, but I didn’t understand everything he writes.  Maybe you will.

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0412.2012.01484.x/full