THERE ARE TINY BUGS CRAWLING AROUND INSIDE YOU!

Linda and the author, 2010

Fecal transplants.

Now that I have your attention, let me introduce the Fred Hutch Winter Magazine, which largely is devoted to new developments in studies of what the researchers chose to call the human microbiome. You know what that is:  the trillions of tiny creatures that happily live and die inside us, everywhere, inside and out.  These creatures consist of bacteria, fungi, viruses, and other microscopic uglies left unnamed.  It is said that there are two pounds of these little creatures living in our colons alone.  Another estimate holds that on average each of us plays host to 40 trillion of the things – enough to adorn each cigarette smoked in China last year with 16 of them.  Disgusting, right?  Read on.

Recent research indicates that a lot of what you regard as “you” is strongly influenced by your particular mix of microbes.  Not only your digestion, your propensity to gain weight, or your susceptibility to disease – your microbiome even influences your sex life.  Enough people already know this that an entirely new sub-set of quackery has sprung up.  There is even mention of things called “fecal spas”.  Other equally disgusting practices are discussed.  There are definitely some instances in which messing with the microbiome is useful – it sometimes even helps with cancer.  But too little is known for the amateur to dive in head first.  So, the recommendation is caveat emptor, or for those of us born since the 19^th century, let the buyer beware. 

This really is an interesting article.  You would enjoy reading it..

http://getinvolved.fhcrc.org/site/MessageViewer?em_id=35367.0&dlv_id=35462&printer_friendly=1&s_AffiliateSecCatId=1

I wrote about this topic several years ago:

http://ljb-quiltcutie.blogspot.com/2012/11/microbes-maketh-man.html

A lot seems to have happened since.

Let's be Nice to the FDA

Two happy people on the Nile

Maybe Congress reads this blog, because they are attempting to do something about the FDA, my long-time punching bag. 

  As this Washington Post article explains, FDA is being encouraged – nay, required – to speed up its activities.  More money is provided, and restrictions are loosened, IF THIS BUNCH OF LEGISLATION IS ENACTED INTO LAW.  You would think this would be a slam-dunk; both parties are in favor, and President Obama already has his approval pen in hand.  Yet this matter has been held up for months, and may not survive.  Why?  Why, politics, of course.

To put it succinctly, Democrats want more, and Republicans worry about where the money will come from.  Then there special-interest groups, ranging from the AFL-CIO to the Breast Cancer Alliance, that want specific fiddles.  My opinion: The perfect can be the death of the good.  For God’s sake, let’s get something written into law quickly, ‘cause only the Lord can predict after the inauguration – and even He is scratching his head!

I should add that I now partially comprehend  why the FDA grinds so slowly; not only are they entangled in restrictions, but they are also short-handed.  Apparently they are 700-odd technical staff short, partly because they can’t meet the salaries available in the private sector.  This pending legislation will fix that, if and when.

Read this.

https://www.washingtonpost.com/national/health-science/long-stalled-fda-reform-sits-on-senates-lame-duck-calendar/2016/11/22/14268224-b040-11e6-840f-e3ebab6bcdd3_story.html

BURDEN

A Joyce ceremonial caramel cake

Yum!

Did you know that the number of cigarettes consumed in China this year, if laid end-to-end, would extend to the moon and back nearly four times?  Well, neither did I, and in fact I’m actually not absolutely sure of it – I just made a quick  back-of-the envelope calculation using my cell phone.  But whether that’s right or not isn’t important – the average Chinese smoker consumes 22 cigarettes daily, and the total consumed adds up to a yearly total of 2.5 trillion.  Those numbers alone invite further arithmetic:  for instance, 2.5 trillion cigarettes divided by 22 cigs per day times 365 days per year suggests that there are 311 million smokers in China.  India may be nearly as bad.

So, for your homework:  If all the cigarette butts generated in China were dumped in Nebraska, how deep would the pile be?

All this is meant to introduce today’s topic: why is the worldwide burden of cancer increasing so rapidly?  Apparently it is, you know, as the following link describes:

https://www.cancer.gov/news-events/cancer-currents-blog/2016/global-cancer-symposium?cid=eb_govdel

I am aware that most of you won’t read this link, so I will give you the short answer.  There is higher cancer “burden” (expense, suffering, death) throughout the world because poor countries are getting richer.  Being richer, they can afford better health care.  Better health care means that fewer of their people die of malaria, HIV, syphilis, cholera – etc.  This allows them to live long enough to die of cancer, and it gives them pocket money to buy certain agents of doom, such as cigarettes. 

Hell!  There was more to this blog – as there is more to this article – but my computer just ate it all, every word.  And it is time to watch the Seahawks.

CUBA?

Carolyn, Linda with cousin Elsie

Heron Island, Maine

From my scouting team of J & R Ingwall comes this interesting NYTimes article.

http://www.nytimes.com/2016/11/15/health/cancer-vaccine-cuba-medical-tourism.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0

 I have never had any desire to visit Cuba.  I visualize it as something like Puerto Rico, but with older cars.  I spent five days in Puerto Rico once, and came back with foot fungus and a queasy belly.  My rule of thumb is, never visit a place with broad-leaf plants and high humidity.  Iceland, yes.  Indonesia, no.

However, it appears that good can emanate from such a sticky paradise as Cuba must be.   Apparently Cuba has a healthy biotech industry.  They have developed and currently market a vaccine called Cimavax which arrests the progress of one kind of lung cancer.  Many Americans currently journey to Havana to get treatment, and to stock up on the stuff to smuggle home.  In the meantime our FDA is effectively sitting on its hands; it will authorize testing sometime soon.  As you know, I don’t like the FDA very much.

Cuba is an anomaly, at least to me.  In most respects it is very poor – but it has an excellent medical system.  Apparently medical doctors there are everywhere, on every street corner, a dime a dozen.  There are so many of them that they are exported to Venezuela, in exchange for oil.  I wish a few thousand of them would come here.  That way maybe I wouldn’t  have to wait a week to see my primary care physician.

OF MICE AND MEDICINE

Normally I introduce a blog entry with a picture of Linda but, in view of our recent election, I will use this shot to illustrate that there places on earth where no one gives a fig about

 Donald Trump

Medieval armies relied on the horse.  During the Napoleonic Wars, navies relied on oak trees.  Today in the war against cancer the one indispensable creature is, of course, the mouse.  I have mentioned mice 27 times in the course of this blog.  For instance, early on I introduced you to the  “transgenic glowing reporter mouse”, and later to the “sublethally irradiated nonobese diabetic severe combined immunodeficient mouse” (poor little devil!).  I also have heard of “nude mice”, although what they are good for is a mystery to me.  There must exist huge mouse farms, devoted to breeding and genetically screwing up these miserable rodents.  I would guess that the proprietors of these diabolic (but essential) establishments have dreams wherein, having died, they report to the Pearly Gates, only to discover that St. Peter is a huge white rat with angry pink eyes and a swishing tail.

Well, in Holland right now they are killing vast quantities of “immune-deficient mice”, for the good of humanity.  Dutch investigators have determined that existing ovarian cancer (OVCA) cell lines do not do an adequate job of mimicking the effect of their drug of the moment, on high grade serous ovarian cancer (HGSOC).  Thus, they have taken to transferring OVCA cells to their mice from actual OVCA patients.  Results from this seemingly cruel but necessary operation they term “Patient-derived tumor xenografts” (PDXs; these guys seem uncommonly fond of acronyms).  Results so far are encouraging, both for OVCA therapy and for prediction.

This article (which is tough going) is of particular interest to me because it deals with epigenetics (which I have written about even more than about mice.)  One form of epigenetic control is to paste a methyl group (CH₃) on a segment of DNA, thereby somehow preventing the expression of a gene.  It appears that HGSOC is accompanied by a distinctive pattern of methylation, and thus can be used as a predictor.  It seems to me that this knowledge also could be used to derive a drug to reverse the effects of methylation – to scrub the DNA double helix free of the little methyl devils, so to speak.

So let’s hope that global warming and sea-level rise don’t first scrub the earth clean of these valuable Dutch labs!

 http://www.science20.com/tushar_tomar/epigenetic_predictors_of_ovarian_cancer-180648

CANCER CAREGIVING: Not much fun.

When Linda's hair fell out during chemo she briefly considered wigs.  She didn't like them, so went to scarves.  I rather like this wig picture, though

I am going to pass along some information that I hope to hell you never need: how to be an effective cancer caregiver.  This information originates with the NCI, not me, so you can rely on its veracity (and, perhaps, curse its bureaucratic construction.)  Here it is:

https://www.cancer.gov/about-cancer/coping/family-friends/family-caregivers-pdq

God knows that being a cancer caregiver is tough.  Carolyn (Linda’s sister) and I shared the work and the misery during Linda’s last few weeks.  Others helped; Bunny Schneider, Linda’s cousin, Florence DiJulio, her best friend, my kids – and lots of others.  Without all of you people, but especially without Carolyn, I would  not have survived.

So glance through the NCI document, then stash it away.  Chances are you will never need it.  With any luck…..

And if you want to help erase this fucking disease from the face of the earth, grab yourself a charity deduction by sending a check to the Fred Hutchinson Cancer Research Institute, in honor of Linda Joyce Beck.

THE WORST JOB IN THE WORLD

Linda and Ella share the bald look

Let’s say you are a bright, hard-working high school senior with very good grades, cogitating on your future.  Being a normal human being you will be looking for a profession that pays well and stands high in societal respect.  Being a naive  kid you aren’t the least bit worried about how long your training will take - and being from a prosperous family – how much it will cost.  Unless you are 6’ 8” or weigh 280 lbs., professional sports aren’t for you.  What to do?  May I make a suggestion?  Go to a good college, major in pre-med, then go to medical school and become a gynecological oncologist.

You won’t have much trouble getting a job, that’s for sure.  The NYTimes presents an article about how scarce gynecological oncologists are at present – and how much more scarce they will be very soon.  Here is the article; it’s well worth reading:

http://www.nytimes.com/2016/11/03/well/live/a-shortage-of-oncologists.html?_r=0

I have no figures about how well GOs are remunerated, but I’ll bet that in monetary terms it’s tons.  As to societal respect, well –Mother Teresa ranks higher, but not by all that much.  However, there are drawbacks.  To become a GO you are required to study and apprentice for what must seem like half your life.  (That eager 18 year old can count on earning her living by age, say, 32 – if all goes well.)  You must deal each day with people who are indisputably very sick.  Some of those people will be terrified, and will lean on you for hope.  And, of course, no matter how good you are, many of your patients will die.

I remember once telling a GO that he had the worst job in the world.  I was distraught, of course – you can guess the circumstances.  I wish I hadn’t said that.  Even more, I wish I had added my profound thanks for taking on such a difficult but essential profession.

Being an oncologist requires a level of courage and dedication that I am sure I never had.

GLOOM

No baby?  No problem

Linda and unknown puppy.  1978

I am escaping the cleaning lady, hiding in my office, reading the Bellingham Herald, and feeling depressed.  Normally I finish the Herald in about three minutes, but this morning it featured an article on AFM, enteroviruses, and the FDA that nailed my attention.  Here it is:

   http://www.bellinghamherald.com/news/local/article112430207.html

(One should note that it originated in the Washington Post.)

First, some vocabulary:

AFM: Acute Flaccid Myelitus.  This is a nasty disease that seems to have flared up recently.  It affects children; 89 so far in the U.S.  It leaves one or more limbs paralyzed, and has other effects.  A little Bellingham boy recently died from it.

Enterovirus.  An RNA virus that usually hangs out in the gut.  One kind of enterovirus causes polio.

RNA.  Aw, you know what that is.

Compassionate-use exception.  Say you are dying, and out there in the Pharma universe there exists a drug that night help.  The problem, however, is that it is not yet approved for your particular condition by the FDA.  You can ask for it, anyway: after all, you are DYING, for Christ’s sake!  Usually the FDA will say “yes” – but not always, as this article makes clear. 

So read the article and see if, like me, it makes you a little bit angry and more than a little bit depressed.

Maybe it’s the gloomy weather outside, and maybe it’s the fact that my hip is hurting – but one passage here almost brought me to tears.   It concerns a clinical trial of the drug preconaril, which was tested as a remedy for sepsis caused by enterovirus – in babies.  It is stated that it cut the risk of death to 23%, compared to 43% in a placebo-controlled comparison group.  I couldn’t help but imagine how I would have felt if my new great grandson Finnegan had been chosen for the control group.  These decisions - placebo or the real stuff - often are made by a computer and may be "double blind", meaning that the person administering the treatment doesn't know what the patient is getting.  I surmise that this is vital to medical sanity: imagine having to give a baby a sugar pill and instead of something that might save its life.  God help us if computers ever develop a conscience.

I will scare up a cheery picture to banish all this gloom.

THANK YOU Mr. Bezos

Linda in Nova Scotia

The rocks behind her should be in Norway

Or maybe Auld Scotland

Here is another reason to patronize Amazon.com.  Jeff Bezos has made an unimaginable amount of money selling first books – then nearly everything, on line.  Unlike some of his fellow billionaires, Jeff has not used his wealth to develop space travel, buy professional sports teams, or even run for president.  Instead, like Bill Gates and Warren Buffet he has chosen to use his wealth to benefit the rest of us.  Fred Hutch has just announced the emergence of a clinic devoted to T-cell therapy, named after and paid for by the Bezos family.  Here is the Hutch news release:

https://outlook.live.com/owa/?path=/mail/inbox/rp

I have written about immunotherapy before (24 times to be exact), and T-cells also should be an old friend (94 times!).  Briefly, T-cell immunotherapy as usually practiced today consists of extracting white blood cells from the patient, isolating those T-cells most inimical to the particular cancer cells in question, modifying these T-cells so as to encourage them to bind with receptors on the cancer cells’ exterior wall, growing billions of them – and injecting them back into the patient.  Simple, huh?  Often this works; sometimes, so far, it doesn’t. 

This is an ultra-hot topic in cancer therapy.  Even the Moonshooters agree.  More on T-cell immunotherapy:

https://www.cancer.gov/about-cancer/treatment/research/car-t-cells

T-cell immunology has been used for melanova for some time.

https://www.seattlecca.org/diseases/melanoma/treatment-options/immunotherapy-melanoma

ONIONS are a girl's best friend

Linda and nephew Cash

2010

Onions are my favorite fruit.  I chop them up and use them with everything – hamburger, soup, chili, scrambled eggs, breakfast cereal.  I have often said that a household without onions is a house without sustenance.  Only bacon, eggs and Reyka vodka rival onions in importance.

Obviously I can’t credit onions for the fact that I have avoided ovarian cancer.  However, some Japanese scientists have shown that onions contain a substance – they call it onionin A (ONA) – that inhibits the growth of OVCA cells in mice.  Apparently ONA does a number on “myeloid-derived suppressor cells”, which, in a manner unexplained, act to favor the growth of tumor cells.  How it works and where we go from here is left unaddressed, but it (this research) seems promising so I thought I’d clue you in.

Oh, by the way – “myeloid” refers to having been derived from bone marrow.  Like blood.

http://www.figo.org/news/compound-onions-could-protect-against-ovarian-cancer-0015395

KNOW YOUR ENEMY; Don't get breast cancer

Linda on the beach

2007

Prepare for a blizzard of blogs.  My Alaskan sub-tribe was here for a few days, featuring Finnegan (as cute and quiet a baby as I can recall), and Seamus (everything a three year old should be, and a lot more) – and, oh yes, their mother Amanda (my oldest grandchild) and James (her husband and my personal jeep mechanic.)  Apparently Seamus is doing fine, thank goodness.  Anyway, after a month of company (both here and in Asheville) my calendar is empty and I am several dozen Google Alerts and NCI Bulletins behind.  I think I will migrate south in mid-December, and in the meantime I have nothing much to do but peck away at this keyboard.

Here is a bit of clear and important advice for women with a family history of breast or ovarian cancer.  Summarizing it for you makes no sense.  Just read the thing, for gosh sake!

http://www.seattletimes.com/life/wellness/when-it-comes-to-breast-cancer-know-your-risks/