BISCUIT AND GRAVY, BACON, AND THE WALL STREET JOURNAL

Linda clearly wants to play on the grass

Christ Church, Oxford University

 

I cannot eat breakfast without something to read.  Well, or someone to talk to, but that is rare these days.  Usually I read the Economist, but owing to the expanding muddle inhabiting my skull  I forgot to renew my subscription.  That lead me to spend $3.00 on a Wall Street Journal  this morning – God help my finances if my new  Economist subscription takes very long to arrive.  (For you liberals muttering that I should have purchased the New York Times instead; it was $4.50.  Remember when you could get a good newspaper for a quarter?  No, of course you don’t.)  But anyway, I found an interesting article in today’s Journal which I wanted to share with you, but the cheapskates won’t let me access it on line unless I subscribe, which I will not do.  The article is framed as an attack on Hillary, but it has some good stuff on the FDA and generic drugs which I will summarize below.

As all of you know, if a drug company dreams up a new drug it must get permission from the Federal Drug Administration to place the drug on the market.  This costs many millions of dollars and sometimes takes a half-dozen years or so.  However, if the drug is approved the company then has exclusive right to manufacture and market it for a set period of time.  When that time is up the drug becomes “generic”, and its price usually falls dramatically.  I thought that becoming generic was automatic, quick and cheap, but I was wrong.  If your wonder drug for growing hair recently has gone off patent and I want to manufacture an identical generic, I must submit something called an Abbreviated New Drug Application to the FDA.  This can cost me between $1 and $5 million!  There are said to be thousands of such drugs waiting approval; on average, four submissions and resubmission are required.  Also, there has been a recent “crackdown “on generic  drug manufactures, which the author of the piece – a medical doctor but also obviously a conservative – views with some skepticism.  The bulk of the piece nit-picks some of Hillary’s pronouncements on drug pricing, but that part can be ignored with no significant loss of value.  Who cares what Hillary thinks, anyway – Biden/Warren looms.

The moral of this story seems to be:  Some regulation is useful, even necessary, but it is easy to get carried away.



MORE ON ASPIRIN

Sisters, 2008

Back to our old friends, the USPSTF*.  I haven’t always been exactly fair to them, usually treating their suggestions with skepticism or downright annoyance.  However, this time I think they have hit the nail squarely, and countersunk it.  They recommend daily small-dose aspirin for adults over 50.  The article I am quoting appears in The Week, a good magazine.  However, cheap buggers that they are, they won’t let you read the article unless you have a subscription.  Hence:  Here it is:

*United States Preventative Services Task Force

 

An influential task force of medical experts has sparked controversy by recommending that adults over 50 take a daily low-dose aspirin to prevent both heart attacks and colorectal cancer. The U.S. Preventive Services Task Force, appointed by the federal Department of Health and Human Services, said its extensive review of data found that adults who are at increased risk of cardiovascular disease could benefit from daily aspirin use, even if they have not had previous heart problems. One study found a 22 percent reduction in heart attacks. A daily low-dose aspirin taken over 10 years also lowers the risk of colon cancer by up to 40 percent, the panel said. Many doctors, however, oppose daily aspirin for people with no prior history of heart disease, on the grounds that the drug’s anti-clotting effect can cause bleeding in the stomach, intestines, and brain and possibly lead to strokes. But the task force, whose recommendation will have strong influence in the medical community, said the benefits of low-dose aspirin outweigh the risks, especially for people in their 50s with signs of heart disease or a history of heart attacks. Dr. Douglas Owens, a Stanford University professor and task force member, told CBSNews.com that the recommendation does not mean that people should take aspirin without consulting their doctor. “If you’re a person trying to decide whether to take aspirin, you’d want to be aware of all the potential benefits and the potential harms,” Owens said.

The Week

 



TO GET OUT FROM UNDERFOOT OF THE CLEANING LADY

Our peculiar digs, in Evanston, 1984

I spent this morning at my office, mainly to get out from under the feet of the cleaning lady.  There being no really private place to doze off in a WWU faculty office, I tried to do something useful.  I settled on a Google Scholar search.  Typing “ovarian cancer prevention” in the “all of these words” block, and asking for articles published in the past two year – I got 44,500 hits!  To put it otherwise – in less than two years 44,500 scholarly articles have emerged that dealt at least in part with the prevention of ovarian cancer.  I did it again, for the period 2010-2011, and got 48,500 hits!  Why, it seems permissible to ask, does ovarian cancer still exist?  My view is that most of these papers need never have been published, as they added little or nothing to the desired goal.  Let’s face it: given the way research funds are allocated, long publication lists are essential to tenure and promotion.  The current method of funding is whacky, and should be scrapped.  See my tirade on the subject published earlier:

http://ljb-quiltcutie.blogspot.com/2014/06/the-truth-in-small-doses-at-long-last_7.html

So, as the cleaning lady probably was still at it, I decided to actually read one of these 44,000 + articles.  I selected the one that had been cited most often, which happened to be a list of recommendations concocted by our old friends the USPSTF: the United States Preventative Services Task Force.  You have met them before: for instance, they are the group that raised the ire of urologists everywhere by recommending that the PSA test be abandoned for prostate cancer detection under most circumstances.  USPTF is a Federal-level, all volunteer group consisting of highly respected scientists and medical practitioners.  You have to take them seriously, but you needn't kowtow, if you know what I mean.

These guys report on their assessment of tests to use for detecting ovarian cancer early.  Specifically, they looked at the usefulness of BRCA testing for breast and ovarian cancer.  Their report ran to many, many pages, most of them of vanishingly small value and some completely redundant.  Frankly, I couldn’t keep awake long enough to swallow the whole thing at one gulp.  Here is what I think they recommend:

If you are worried, go to a genetics counselor and/or a primary care physician well trained in genetics, and have them analyze your family history.  If it appears on the basis of such analysis that your family DNA tree may contain a germline mutation in one of the BRCA genes, get tested (have a part of your genome sequenced.)  If the mutations are there, consider surgery.

If the analysis implies that no such mutations exist, stop worrying and get on with your life.

Yes, sure, there is more to it than that.  Here is the article.  I’ll bet you can’t read it all the way through without a nap.

http://annals.org/article.aspx?articleID=1791499&csrt=10772375032857733912



A (non-cancerous) BOOK REVIEW

This is not HMS Victory

In fact, it is an Icelandic art form.

No comment

For the good of my soul I continue to labor away at the science of cancer.  I hope my soul appreciates it.  Some of the stuff I attempt to comprehend is, to put it bluntly, pretty dull.  For instance, at the moment I am plodding through a book entitled Life’s Greatest Secret, by Matthew Cobb.  It is a retelling of the science leading to – and following – the discovery of the structure and significance of DNA.  An older book I have reviewed, The Eighth Day of Creation, covers the same territory – and much more readably - but only through about 1980.  I am about half way through Cobb’s book, so I will defer judgment until  later.  In the meantime, I am wrestling with prose structures such as (p. 112) “There is no indication that either Watson or Crick had read Shannon or Wiener, or that they were using the term in explicit reference to their mathematical ideas.  As with the word “code”, “information” seems to have been used as an intensely powerful metaphor rather than a precise theoretical construct.”

Poor me.

So, as you have certainly guessed, I need something fun to read for relief now and then, and that is the point of this little essay. 

I highly recommend the 20 volume Aubrey/Maturin series of naval adventures set during the Napoleonic Wars, written by Patrick O’Brian.  A movie was made recently based on two of the books: Master and Commander.  The Far Side of the Earth, starring Russell Crow.  I thought it was great – I’ve seen it at least three times*.  However, the books are better.  They contain great characters, pulse-pounding naval combat, adventures and misadventures in politics, religion, family life and romance, not to mention a good portrayal of life in the Royal Navy around the year 1800.  Now and then some valuable geography and/or history slips in, but painlessly – you don’t realize you’re learning something until it’s already learned.  O’Brian’s books are sometimes lazily compared with the Horatio Hornblower series of naval adventures but – I’ve read them, too – in the words of Jack Aubrey, “Hornblower ain’t in it.”  Some (wildly prejudiced? ) critics have judged O’Brian’s combined works as the greatest historical novel ever written.  I tend to agree.

But I should warn you- you may have trouble “getting into” the story; several of my  friends have given up in frustration.  Once you get inside the main characters you will be okay.  Just don’t go out and buy the whole shooting match; use the library.  The first book is called Master and Commander.  It pays to read the 20 volumes in sequence.

You’re welcome.

*I watched it again last night.  I loved it.



USEFUL SCIENCE, FROM STANFORD

Beautiful, in 2010

 

A few months ago Newsweek tricked me into paying for an on-line subscription, so from time to time I check to see if any useful anti-cancer articles have been published.  Usually, no – but this is one:

http://www.newsweek.com/scientists-move-cancer-drug-endangered-himalayan-mayapple-common-lab-plant-371180

It seems that there is a rare, endangered, and hard-to-come-by plant scratching for existence in the high Himalaya (the Himalayan mayapple, Sinopodophyllum hexandrum) from which a very important drug is made.  This plant produces a toxin when its leaves are wounded, from which a substance called podophyllotoxin results.  Podophyllotoxin, in turn, is necessary for manufacture of  the anti-cancer drug etoposide.  Etoposide is classified as an essential medicine by the World Health Organization.  Well, some very clever people at Stanford have figured out just what proteins make up podophyllotoxin, which enzymes are responsible for producing them and, presumably, which genes produce those enzymes.  These, then, they have transplanted into a close relative of the tobacco plant and – voila! – Cheap podophyllotoxin (and fewer dead climbers harvesting mayapple.)  The hope is that it will be possible eventually to produce the stuff using common yeast.  Thus, science in service to humanity.  It undoubtedly cost a bundle to do this research, but the eventual savings will be enormous.

Further reading in Newsweek has convinced me that the silly season in science is truly upon us.  I will publish some examples in Facebook.



BUTTERFLIES, OVARIAN CANCER and the REAL WORLD

Guess Where

 

September is Ovarian Cancer Awareness month.  I’m sure you are aware of ovarian cancer.  The real question: what have you done about it?

Well, in South Carolina they are releasing butterflies.  A Native American belief is that, if you have a wish, you must whisper it to a butterfly, then let it go.  Butterflies can’t talk, so they can relay your wish only to the Great Spirit.  It is a beautiful bit of symbolism, and possibly just as effective as some of the science I read about, too much of which seems to involve spinning wheels, exhaust smoke, and minimal progress.  That’s why I fervently lobby for a change in the way research funds are allocated; see my blog on the book The Truth in Small Doses*.  Here is the article:

http://coladaily.com/2015/09/18/photo-gallery-butterflies-take-flight-raise-awareness-ovarian-cancer/

As for the real world, here is a NYTimes article by a cancer survivor who also is a well-known academic.  She is writing a journal relating her struggles, which have gone on for a few years now.  Read this only if you feel the need to get inside the skin of a cancer victim.  It will not cheer you up.

http://well.blogs.nytimes.com/2015/09/17/living-with-cancer-teal-ribbons/?ref=health&_r=0

http://ljb-quiltcutie.blogspot.com/2014/06/the-truth-in-small-doses-at-long-last_7.html

 

 



IMPORTANT COMMENTS

Would you believe:  These two little kids are mothers now.

As many of you know, I get many leads that result in blogs from Google Alerts.  I get one every day, day in day out, no matter where I am or what I am trying to do.  (For instance, helping Paul Kelly track down and harvest his big moose recently cost me seven Alerts).  When I get too far behind I panic and begin skimming, looking for news I should not ignore.  In the process, though, I often find articles that deserve to be shared, but probably don’t merit a blog of their own.  Lately I have resorted to attaching these news-fragments to previous blogs, by way of the Comment process.  Unfortunately, most of you don’t get informed of new Comments – Blogger only gives me a choice of ten emails to be alerted.  (Unless, of course, you are a “Follower”.  Followership is a mystery to me, and apparently to most others, too, because there seem to be only three Followers of this blog.  If you know how to get Followership status, please let me know – and I will publicize it.)  However, in the meantime, here is a list of Comments that have important content, all from the last few weeks.

How to get your chemo

http://ljb-quiltcutie.blogspot.com/2015/08/intraperitoneal-chemotherapy.html?showComment=1442004381731#c35502648862357424

More on hereditary BRCA and OVCA

http://www.clinicaladvisor.com/web-exclusives/multigene-tests-can-change-hereditary-breast-ovarian-cancer-management/article/432712/

CRISPR

http://www.economist.com/news/briefing/21661799-it-now-easy-edit-genomes-plants-animals-and-humans-age-red-pen

On the meaning of dancer statistics

http://ljb-quiltcutie.blogspot.com/2015/05/survival-vs-cure.html?showComment=1438971633051#c6181785561899624464

A clever new therapy (possibly) in the works
http://www.oncologynurseadvisor.com/web-exclusives/advance-in-photodynamic-therapy-offers-new-approach-to-ovarian-cancer/article/438197/

Reading some of these may be a suitable mental antacid to follow tonight's “Debate”.

More Comments (added later):

About hereditary breast and ovarian cancer
http://www.medicalnewstoday.com/articles/299413.php

About testing for ovarian cancer
http://ljb-quiltcutie.blogspot.com/2015/09/to-avoid-cleaning-lady.html?showComment=1443460556696#c1461427845118415457

Genetic counseling, 
http://ljb-quiltcutie.blogspot.com/2015/09/to-avoid-cleaning-lady.html?showComment=1445036066384#c6318035315186688946

Big Pharma gets into the testing game

http://www.investorideas.com/news/2015/biotech/10151.asp

If you have cancer, antioxidants may not be good for you.
http://www.newsweek.com/antioxidants-may-lead-cancer-spread-study-says-384528

OVCA, BRCA, familial proclivities, and other stuff
http://www.dentistryiq.com/articles/2015/11/familial-cancer-risk-assessment-breast-and-ovarian-cancer.html 

New article on immunotherapy.  Informative, easy to read, but a bit discouraging:

http://www.scientificamerican.com/article/cancer-immunotherapy-the-cutting-edge-gets-sharper/

Report on a (very insubstantial) study of the effect of diet on ovarian cancer.  Applies most directly to African-American women, but should (if true) apply to other races as well:

http://www.eurekalert.org/pub_releases/2015-11/aafc-hdm111115.php

I am still trying to really understand CRISPR/Cas9 gene editing, because I am certain this technology will pay huge health dividends down the road.  This morning, rather than scrape ancient bacon grease off the grill, I sat down to waste time at my computer – and I discovered this article:

http://gizmodo.com/everything-you-need-to-know-about-crispr-the-new-tool-1702114381

Finally, it seems, somebody has written about CRISPR in a manner suited to all of us without Ph.D. degrees in molecular genetics.  Give it a read.

 

The Ovarian Cancer Research Fund is supporting an OVCA “Dream Team”.  Elizabeth Swisher, M.D., of UW. (and, to some extent, Fred Hutch) is one of two co-leaders.  Their work involves epigenetic markers.  I will attempt to follow up.

http://www.ocrf.org/ovarian-cancer-research/dreamteam

 

Here is a NYTimes article that helps  account for differences in drug pricing.  Why, for example, can you go on an aspirin regimen for $10/year but need to fork over $100,000/year for many new anti-cancer drugs.  Bottom line:  it’s not entirely greed.

http://www.nytimes.com/2015/11/17/upshot/how-to-decrease-prices-for-an-expensive-class-of-drugs.html?ref=health&_r=0 

 



BETA BLOCKERS

Linda enjoying yet again another tyke, 2010

For the past month or so my usual essentially torpid lifestyle has been reduced further, to a state of almost complete physical inactivity - owing to arthritis in more joints that I would care to list.  Monday I will see a specialist in arthritic diseases, so rescue may be at hand.  In the meantime I spend my days reading and pecking away at this keyboard, instead of tromping around outside where (for a few more days) the weather will continue to be warm and beautiful.  In trying to catch up with the backlog from my Alaska hiatus, this morning I ran on this article.  It is moderately tough sledding, so I will summarize what little I got out of it, below.

http://www.medpagetoday.com/HematologyOncology/OvarianCancer/53298

There is a type of blood-pressure medication called a beta blocker.  Mainly, it slows heartbeat- frequency and helps cope with arrhythmia.  It also, in some, makes a person feel like he or she is going about their daily activities in a universe consisting entirely of thin, lukewarm gruel.  I was on a beta-blocker once and felt no effect; probably my normal state is to operate in warm Cream of Wheat. 

It turns out that if you have ovarian cancer and have been taking a certain non-specific type of beta blocker, your chance of a much-extended remission is improved.  However, the drug must be “non-specific”; a common example is propranolol.  What seems to happen is this:  The hormone epinephrine (and its chemically close relatives) have the effect of favoring angiogenesis in tumor masses.  “Angiogenesis”, as you probably know, means building blood vessels.  We have discussed this before: one avenue of research in cancer therapy involves drugs that inhibit angiogenesis.  Non-specific beta blockers inhibit the formation (or activity?) of epinephrine.  Voila!  A side-effect of cardiac protection keeps cancer at bay!  But only at bay; non-specific beta blockers do not reduce mortality.

I need to go outside, if only to sit on my deck and watch my cucumbers grow.  By writing this “explanation” I have relieved you of the need to grapple with such things as pro-angiogenic vascular endothelial growth factors, as well as statistical concepts like HR (hazard ratio).  I go the extra yard for all you guys.  I hope you appreciate it.