SOME COOL STUFF FROM THE ECONOMIST

Friday Harbor during her second chemo

She didn't let cancer take over her spirit.  Brave beyond my comprehension. 

 

It is snowing in Bellingham.  I have 3 inches of the stuff on my deck, and more is accumulating rapidly.  Sure, for you folks from the great northern steppes this is nothing, but here it is a moderately big deal.  For instance, the 4^th St hill in front of my house is now the haunt of sleds and snowboards.  A few cars came up early on, but for the last few hours the only motorized objects I have seen out there are a pair of emergency vehicles, and a tow truck.  This is a good day to stay inside and pack for Borrego Springs.  I intend to leave in three days’ time, when it is supposed to rain.  I have lived in the Pacific NW for 45 years, so rain is my natural habitat. 

Last week’s Economist was a high-grade ore cart of medical information. I am not in the mood to write summaries, so I invite you to read for yourself.

The first article gives you an insight into the economics of drugs.  It may make you hate Big Pharma a little less.  Here it is:  http://www.economist.com/news/business/21596557-there-are-reasons-hope-latest-biotech-boom-will-not-be-followed-another

This next one is a book review.  The book reviewed describes the birth and growth of a small biotech company, of the sort that have been springing up like spring crocuses for the last decade.  I haven’t read it and probably won’t.  The review is interesting, though.  http://www.economist.com/news/books-and-arts/21596489-how-pharmaceutical-world-evolving-when-times-were-changing

Finally, there is an encouraging article about a novel method to combat metastasis in breast cancer.  The method has obvious ramifications for other kinds of cancer.  Re-read my blog on metastasis of a few days ago.  Here is the new article:  http://www.economist.com/news/science-and-technology/21596501-better-way-understand-metastasis-secondary-goals

There is a teeny problem here, however.  The Economist won’t let you read more than one article (per month?  week?) free.  I get the print edition so I can read all I want.  They (the Economist) ask you to “register”, for up to three freebies.  As soon as I post this I will see what “registering” entails.  I will let you know by means of a Comment.

Now to find a suitable picture.

 

 



HUTCH REPORT ON OVARIAN AND PROSTATE CANCER

Henley on Thames

If she were standing there now she would be knee deep in water

Notice how I always seem to pose her with the sun directly in her eyes. 

 

The monthly Fred Hutch newsletter just popped up on my computer.  I really shouldn’t write another blog today; I have churned out two in the past two days, and I risk boring you to death.  However, it is snowing, I have done my knee exercises, and Olympic coverage won’t start for several hours.  I could take a nap, but I think I’ll risk another blog instead.

You can see the newsletter by clicking on

https://bay172.mail.live.com/default.aspx?id=64855&owa=1&owasuffix=owa%2f#n=1562242092&fid=1&mid=7f000bb3-9b55-11e3-b9fe-00215ad96b8e&fv=1

There are three items that are of particular interest.  One concerns the benefits of coffee for men with prostate cancer.  Another describes a method to predict the course of ovarian cancer, using a new technology developed at the Hutch.  The third, of great interest to me, describes the effects of Vitamin E and selenium on the risk of contracting prostate cancer.

I have written about prostate cancer before (3/27/12, with five Comments, all by me.)  Most of the argument at that time revolved around whether or not to use PSA measurements to predict the presence and virulence of prostate cancer.  I also reported preliminary results concerning whether or not coffee is good for you (5/30/12).  Well, this newsletter describes experimental results that indicate that – yes – coffee helps with prostate cancer.  The experiment followed men who already had prostate cancer.  Those who drank as little as one cup per day had a significantly lowered risk of cancer recurrence or rapid growth.  Men who drank up to four or more cups also benefitted, but not by much more.  They also followed tea drinkers, who experienced no benefit at all.  There is some speculation as to why coffee might help, but I will spare you – it is a bit “biofuzzy”.  My take: I drink coffee all the time and I’m going to keep right on doing it.

Ovarian cancer continues to be a tough nut to crack.  Several Hutch scientists have learned that the quantity of TILs active in an ovarian-type tumor will help predict how long the victim will live.  TIL stands for “tumor-infiltrating lymphocytes”   Lymphocytes are part of the immune-systems arsenal.  The more TILs, the better.  The Hutch scientists have developed a method for measuring TIL concentrations.  I find this report less than exhilarating.  We want to fix it so that women do not DIE of OVCA, not predict how long they will last!  But, I guess every little bit of knowledge helps.  I hope. 

Finally, there is a report on the effects of high doses of selenium and vitamin E on the occurrence of prostate cancer.  I find this particularly interesting because, not too many years ago, I was part of a nationwide trial (called SELECT) to see if these two substances helped to ward of prostate cancer.  After a few years the trial was abruptly stopped, and now I know why. Far from preventing prostate cancer, Vitamin E and selenium actually ENCOURAGE it.  Woops!  Back to the drawing board.  But, anyway, I drink lots of coffee and  I’m too old to worry about this kind of stuff.



ASPIRIN REALLY IS THE WONDER DRUG. I guess.

Linda and Carolyn pose in front of Linda's mobile home on Lake Samish

Probably about 1980

 

Way back on April 2^nd, 2012 I wrote about aspirin as a potential weapon against cancer.  At the time the evidence was ambiguous.  Now, however – thanks to my good friend Kathy O’Briant of Fred Hutch – I can tell you of more definitive results from a “meta study” involving an artfully statistical blending of the findings from 12 separate investigations conducted all over the place.  The research was authored by about four dozen people from at least three dozen distinct institutions, making it, no doubt, absolute gospel.  At least current absolute gosple; these things have a way of evolving or becoming “inoperative”.  (Some recent politician was ridiculed for saying his previous statements were “inoperative”.  Who was that?  Can't remember/).  So this may not be the last time I write about aspirin – but I hope it is.

Anyway, this study was specific to ovarian cancer.  In addition  to aspirin, the effects of taking non- aspirin, non-steroidal anti-inflammatory drugs (NSAID) (would that be ibuprofen?) and acetaminophen (Tylenol?) were investigated.  The results were as follows:

Regular use of small-dose (<100 mg) aspirin significantly reduced the risk of contracting epithelial ovarian cancer, the most common kind, and the most deadly.

Large (>400 mg) daily doses of aspirin also helped, but not as much.

Large doses of non-aspirin NSAIDs also gave some benefit.

Acetaminophen didn’t help at all.

Small doses of aspirin also are known to reduce the risk of heart disease, and now seem to be effective against ovarian cancer as well.  So, one might ask: WHY IN HELL DON’T ALL WOMEN TAKE A BABY ASPIRIN EVERY DAY?  Sadly, there are reasons.  Side effects of aspirin include peptic ulcers, upper gastrointestinal bleeding, and even hemorrhagic stroke.  It seems that the best course of action is for women in high-risk categories to take low-dose aspirin but for the general population to hold off, awaiting the results of new and even bigger “meta studies” that surely will be performed, NIH and the Federal budget willing.

 



CIRCULATING TUMOR CELLS: Another of nature's bad ideas.

In an English garden, somewhere along the Thames

 

As a member of the American Geophysical Union I have received a copy of a journal of the American Institute of Physics, free, for many years.  My free journal is called Physics Today, and is aimed at – I think – people with a science background and an interest in physics, but who are not specialists in the same.  At one time I wanted to be a physicist, but freshman physics at Caltech quickly cured me.  I scarcely ever even skim Physics Today, before tossing it on the “Absolutely Free” table outside the geology department office.  (They disappear: some closet physicist must roam our halls.)  But I did check the latest issue closely enough to find an interesting article on cancer, which I will tell you about.

Largely, cancers develop in some isolated spot, grow, and then spread their malign presence throughout the body.  The spreading is called metastasis, as I’m sure you know.  If a cancer can be pounced on and killed or excised before it starts metastasis, cure is not only possible, but probable.  After metastasis occurs the prognosis is much worse; most people who die of cancers such as ovarian die from the damage done by metastases and not from the original tumor.  So, what goes on in metastasis?

Well, what goes on is that nasty little things called “circulating tumor cells” (CTC) get into the bloodstream and get pumped all around the body.  They are bigger than normal blood cells, and more fragile, so many of them get stuck or broken up – but, unfortunately, rarely all of them croak.  Eventually some of these little missiles of doom find a safe harbor, anchor, and start multiplying.  Then the future is far less bright.

The existence of these CTCs has been known for some time, and potential uses of this knowledge have been proposed.  For instance: the initial appearance of CTCs in the blood might be a life-saving clue that a cancer has begun to grow.  Thus, CTCs conceivably could be the long-sought early warning signal for ovarian cancer, for instance.  The trouble is: it is damned hard to isolate CTCs, count them, and study them.  Physics Today being a physics journal, most of the article is given over to explaining clever processes for isolating and quantifying CTCs.  You should be thankful that I didn’t really understand these processes – or I would try to explain them to you.  But I didn’t, so you luck out.

Anyway, CTC-study might be a novel approach to dealing with some types of cancer.  Apparently my Hutch group considered pursuing this angle some time ago but gave up the idea, mainly (I gather) because of all the technical difficulties.  Maybe a new look would be worthwhile.

Personal note:  I am leaving Bellingham next Wednesday and will be at Carolyn’s place in Eureka by Thursday evening.  Then, unless she kicks me out sooner, I will leave the following Tuesday and be in Borrego Springs the next day.  ETA: 1730 hrs 3/5/14.  I will stay there until it gets too hot.

 

 

 

 

 



TO SQUEEZE OR NOT TO SQUEEZE

Linda and Carolyn

What can I say?  Beautiful.

 

If you watch NBC news you will be familiar with Dr. Nancy Snyderman.  Dr. Snyderman is Brian Williams’ go-to expert on medical news.  Last night Dr. Snyderman reported on a newly-released study performed in Toronto that purports to show that mammography does women little if any good, and in fact may be harmful on balance.  A large cohort (90,000 women) were followed for up to 25 years.  There were two comparison groups: women who had a breast examination from a nurse, accompanied by mammography, and women who had the examination alone.  The mortality rates between the two groups were indistinguishable.  The mammography + examination group did report more cancers, but – as mortality was the same – it was possible to conclude that these extra cancers were non-lethal and best ignored.  And, of course, dealing with those “benign” tumors was costly in terms of expense and anxiety.  So, I guess we scuttle the mammogram?  Not so fast.

Note that this is big news, as testified to by the fact that it appeared next day in the pages of The Bellingham Herald, no less.  I imagine it will have come to a newspaper near you; this is big medical stuff, that’s for sure.

The counter-attack, as you might have predicated, was swift.  For instance, a Harvard medical expert testifies that, when he was asked to comment on the Canadian research, he had noted that the equipment used was old, second-hand and inadequate.  Naturally, the Toronto doctors in charge of the work replied, with palpably hurt feelings, that the Harvard expert is full of crap.  And so it goes, and will go – for a long time.  I predict we will have a feminine version of the Prostate Cancer Wars, about which I have written many times.  (See blog for 3/27/12). 

It is important to add that this dispute is between having a breast exam + mammogram, or the exam alone.  It is not suggested that women skip the exams altogether. 

So, what to think?  It probably depends on your point of view.  If your main concern is to reduce the overall burden of medical expenses on the economy, then it may follow that mammography should be discontinued.  However, from the point of view of the individual woman, until it is shown without question that mammography does not contribute to survival, surely the prudent thing to do is to continue it.  The American Cancer Society recommends mammograms every two years for women over 50.  If I were a woman with a familial history of breast (or ovarian) cancer, I would start earlier.

Finally, withhold judgment; there will be lots more studies and statistics brought to bear on this problem.  As I have said several times above, this is a big deal.



WHY AM I DISCOURAGED? Glad you asked.

Linda and Amenhotep III

This is one of the famous "Colossi of Memnon"  There are two.

One used to sing, but now it doesn't.

I have just been taken to task by an old classmate for publically admitting to being “BORED AND DISCOURAGED”  (Blog for 2/4/14).  Unless I am mistaken, this person (she will be called ‘Margery”) and I went through grades K -  12 together, in tiny classes consisting of people who knew nearly everything about each other.  When I grew out of the age cohort that regarded girls as merely soft tattle-tales that couldn’t play football (for me, probably about age 12), Margery became an object of extreme interest.  From then on, until I left home for college, I wanted to have Margery as my girlfriend.  (Of course, there were another three or four girls who also fell into that category.)  However I was a nerd, and she was a princess.  It never occurred to me to ask her out; I knew what the answer would be.  I stuck with younger girls; they thought I was cool because I needed to shave.       

Anyway, Margery now lives in South Florida and seems to have an idyllic life, despite the fact that she must be daily tormented by heat and high humidity, poisonous snakes, and alligators.  Also, Florida is flat; nearly the worst thing you can say about any state.  But anyway, she asks why I am discouraged.  So, I will attempt to explain. The short answer is: I care a lot about cancer research, and sometimes I despair of its ultimate utility.

For instance, there is an article in today’s NY Times* about The Cancer Genome Atlas (TCGA).  This is an effort, funded by NIH, to investigate which genes are mutated in various kinds of common cancers.  The project was initiated in 2005 and has just reached what appears to be a finish, or at least a convenient spot to stop and take stock.  If my algebra is correct, they seem to have identified about 135 suspicious genes.  The cost to date is $365 million.  The director of TCGA wants to expand their efforts to encompass 50 cancer types.  If I understand the article, this would entail sequencing about 100,000 samples.  So, let’s say completing the Atlas is feasible.  The question then forces itself upon us: SO WHAT?  Cancer is very heterogeneous; what is referred to as ovarian cancer may actually represent the work of many combinations of genes gone wrong.  Some types of ovarian cancer have molecular affinities to breast cancer, while others may more closely resemble the causative factors in – say – colorectal cancer.  Also, few cancers are caused by a single mutation; often two or more are needed.  So, even if we know which genes tend to be screwy in which kinds of cancer, how in heaven’s name do we devise antidotes?  A successful targeted therapy is mentioned in the NY Times article, Tarceva by name, which is effective against non-small-cell lung cancer.  Unfortunately, the gene Tarceva “fixes” is only present in 10% of this particular cancer type, which is but one of several varieties of lung cancer.  How much would it cost to devise a Tarceva-like solution to the hundreds (hell, maybe thousands) of distinct genetic problems that result in what we call cancer?  Can we afford it?  Sure we can, but will we?

So, that is the kind of brooding that renders me “discouraged” My knee is coming along nicely, however, and shortly I will be in Borrego Springs with my friends in the Paleo Society.  We have fun digging up long-dead mammals – as well as throwing pot lucks and giving dinner parties.  I soon will be my old cheerful self again.

*http://www.nytimes.com/2014/02/07/science/a-catalog-of-cancer-genes-thats-done-or-just-a-start.html?ref=research&_r=0

 

 

ANOTHER CHANCE TO HELP!

Linda and grizzled copper miner

Somewhere in Arizona

Sometime in the 1980s

 

One more attempt to separate you from your money.

 

Okay, gang; here is a chance to really make a difference.  The Marsha Rivkin center has established a fund to honor  Dr. Rivkin, on the occasion of his retirement after 47 years as an active oncologist.  The money will be used to fund innovative research into the causes and cures of ovarian cancer.  Any contribution over $1500 will be recognized by a plaque on an honors wall in the Rivkin Center office complex.  I propose to start a sub-fund honoring Linda with a contribution large enough to get us on the board.  I urge all of you to make a contribution – it doesn’t matter how much or how little.  Send checks to Gaynor Hill and make them payable to the Rivkin Center Innovation Fund.  Down in the lower left corner write "In honor of Linda Joyce Beck".  The address is Marsha Rivkin Center, 801 Broadway #701, Seattle WA  98122.

To learn more about the Fund go to the Rivkin Center web site:  www.marsharivkin.org. 



YOU THINK MAYBE IT'S BETTER IN CHINA?

Linda and some VERY big cactus

Phoenix botanical garden, I think

 

Boy, if you think America’s medical system is screwed up, read  about what goes on in China.

http://www.economist.com/news/china/21595431-medicines-are-over-prescribed-and-overpriced-physician-heal-thyself

It’s from The Economist. 

In brief, it seems that because Chinese doctors are paid peanuts, they “supplement” their incomes by accepting bribes from drug companies to prescribe more (and more expensive) drugs than are necessary, and (through the hospitals they work for), selling them at an inflated profit.  As a result, Chinese patients pay up to ten times as much for their medicine as we do.  If you think Obamacare is screwed up (and it is), read this.

 



BORED AND DISCOURAGED

Linda's mom Marion, Linda, Linda's sister Carolyn

What are they looking at?  It must have been fascinating.

Where?  Carolyn's housel  When?  Beats me.

 

This is getting discouraging.  I am hanging around the house, “rehabbing” my left knee, and bored to tears.  I don’t like anything on daytime TV, my serious reading puts me to sleep, and my conscience won’t let me just relax and enjoy something entertaining.  I should be writing more anti-cancer blogs, but my chief sources of ideas all have dried up.  Dick Ingwall is busy running the Anza-Borrego Desert State Park Paleontology website, Parkfriend evidentially doesn’t read the Toronto newspapers any more, and Carolyn is working now and has little time for TIME or Yahoo.  This leaves me to do my own research, and I haven’t been making much progress.  If I were still going regularly to Seattle I would have more to write about – but I’m not.  So, nuts.  The good news is that I find I can work the clutch peddle in my jeep so, in a few scant weeks, I will be on my way to Borrego Springs.  Then, I fear, my blogs will really dry up.  Oh, well.

I did do some personal research using Google Scholar and found myself reading a very depressing article.  Its title is “Current Approaches and Challenges in Managing and Monitoring Treatment Response in Ovarian Cancer”, published in Journal of Cancer just a few days ago.  The gist of the article is that there are multiple treatment regimens and protocols for applying them, all under intense scrutiny – BUT, nothing so far impacts mortality.  The ten-year survival rate for ovarian cancer remains at about 10%.  Much of the article is given over to discussions of cost (tremendous) and quality-of-life issues (important).  The fact, and it is unassailable, is that with regard to ovarian cancer we are doing a rotten job.  We need a dramatic breakthrough, a paradigm shift, or a heck of a lot of dumb luck.  As I said above, I am discouraged – but I am not giving up.  Someday this damned disease will be curable, and if I can help find the cure in any way at all I will be satisfied with a life well spent.

Here.  Read it yourself: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881218/