WARTS AND ALL

Studying the geology of Split Mountain

Wow!  Have I ever got a book tip for you!  It is important, it is timely, it is readable, and it grabs you and won’t let you go.  But I must issue a warning:  If it is important to your sense of security and general satisfaction in life to believe that the medical profession is composed dominantly of rational, scientific-minded, altruistic, consistently high-minded people, give this a pass.  This book tells it like it is, warts and all.

The book is The Death of Cancer, by Vincent T. DeVita, MD, and co-authored by Dr. DeVita’s daughter Elizabeth, who is a professional science writer.   You can buy it hardcopy from Amazon for $17.50, or for your Kindle for $15.99.  Moreover, if you wait a few months you ought to be able to pick up a like-new copy from Abebooks for $3.57, with free shipping.  However, as we all cherish small, independent local business, go buy it from your local bookstore – but only after you read my review.

DeVita is an 80-year-old oncologist who has spent 50 years in the front lines of the War on Cancer.  He has extensive clinical experience, but seems, as an administrator, to have expended most of his time and energy slogging through a sticky and malodorous, quintessentially Federal bog, inhabited by the people who control the money-tap upon which cancer research depends.  Although he once was director of NCI, he doesn’t like it much.  Likewise, he is critical – very critical – of NIH, but he saves his most explicit scorn for the FDA.  Much of the fun in this book arises from the way he illustrates problems by reference to the unforgivable and inexplicable errors of real people (although, as if alarmed that he has gone too far, he often says – in a footnote – that Dr. So and So went on to have a valuable and productive career.  You can hear his daughter saying, “Now, Dad…..).

So, anyway, I am so excited about the book that I just decided to read it again, before trying to summarize it in any detail.  However, so you won't feel cheated, here are several things to ponder.

DeVita thinks we are winning the War on Cancer, almost despite ourselves.  He is excited by progress in targeted therapy, and he is upbeat about converting deadly cancers into chronic diseases by means of chemo cocktails composed of multiple drugs.  Many of these drugs are new, and often are the results of our growing understanding of cancer-causing mutations and the biochemical pathways they use to do their dirty work.  On the negative side, he ignores cost completely.

There seems to be a distressing amount of ass-covering, turf defending, character assassination and the like going on in medicine.  I always wanted to believe that medical people were above all that.  Maybe not.

DeVita propounds one rule of behavior that should be obvious to us all, but hadn't occurred to me.  Never give up on a patient.  At the rate new drugs are being developed, if you can keep a patient alive for a few more months a cure may come along.

And finally, Dr. DeVita agrees with me that we need a Cancer Czar to allocate funding to the most productive programs.  He doesn’t think that simply drowning NCI in money, while letting it carry on as usual, will work.  Now, where have you heard that before? 

More, later.

THE MOONSPLUTTER

Never happier

Well, an early splutter of the Moonshot has materialized, and as I had feared it involves a committee.  A group of established experts on ovarian cancer has assembled, deliberated, strained – and brought forth a mouse.  Pomposity is evident: the group calls itself The Committee on the State of Science on Ovarian Cancer Research.  It answers to the Institute of Medicine, and is supported by the Center for Disease Control and Prevention.  A spokesman for the group is identified as Dr. Adekunle Odunsi, MD, PhD, FRCOG, FECOG.  If I understand the various articles describing this non-event (and there are at least a half-dozen), the whole shooting match is under the aegis of the National Academy of Science, Medicine and Technology.

Get my point?

I don’t begrudge a bunch of ovarian cancer experts getting together to talk shop – no matter how high the per diem.  Something useful might result, regardless of the choice of gin for their martinis.  But the report of this committee is as close to totally useless as one can be and avoid prosecution for fraud.  It starts with a short description of the dilemma of OVCA: how deadly, how complicated, how difficult to detect – there is nothing here that even a casual reader of this blog would not know already.  Then, the bulk of the report concerns recommendations for further work on the part of researchers, clinicians, administrators, etc.  These could be summarized, it seems to me, as “You know what to do, so for God’s sake do it”.  Except that more words are involved.

I was in a negative mood when I took up this report, but I really exploded when their “Overarching concepts” section was rolled out.  These are:

                High grade serous carcinoma is the most lethal form of OVCA, so concentrate on that.

                Cancer centers should cooperate, not compete.  They should share information and resources.

                Tell clinicians about any useful advances and assist them in putting these advances to work curing patients.

Isn’t all that fairly obvious?

So, I don’t think this report is very useful, and it diverted some high-powered scientists from their labs.  However, it did keep a considerable number of governmental administrative staff in beans, and it assured the general public that the Moonshooters are on the ball.  In my view it is a net loss to humanity.  It did, however, also have the effect of stressing that March is Ovarian Cancer Awareness Month.  Wear your teal ribbon.  If you don’t have one, let me know and I will send you one while they last.  This offer is invalid in Russia and the Ukraine.

You want to read the report?  Start here.

http://www.medscape.com/viewarticle/859777

   

MORE ON MICE

Linda getting her exercise, Rams Hill, 2009

Mice are very cute.  Currently I have several running around in the guest quarters of my Borrego place.  They ignore my traps, baited with cheese and peanut butter, and instead invade my stash of chocolate-covered nuts and any scraps of food left on the table.  I hate to expel or kill them, but I am afraid no one will visit me if they are required to sleep with rodents.

So, mice are the dominate theme in a new cancer study described in The Economist.  Here it is:

http://www.economist.com/news/science-and-technology/21693419-active-life-protects-against-cancer-researchers-now-understand-why-run-day

The question here is why does exercise protect against cancer?  Apparently the fact that it does is old news, although it was new news to me.  To find out, a hard-hearted scientist from Denver performed a series of fiendish experiments on our tiny furry friends.  It transpires that exercise stimulates the production of both epinephrine (adrenalin) and something called interleukin-6 (a small signaling protein).  Both are active in the immune system.  Mice that were allowed to exercise had high levels of these things, and better luck with cancer – 74% better than their fat, indolent cousins.  So, problem solved: exercise enhances the supply of things that, in turn, activate the weapons of the immune system: cytotoxic T-cells were mentioned.  So, great – get out there and sweat!

But how about me?

Well, I used to average about 20 miles of jogging per week, and later on I went hiking every chance I could - and I didn’t get cancer!  Now, however, I am lucky to walk 2 miles a week, and that very slowly.  Could they, I wonder, produce a soft drink heavy to epinephrine and interleukin-6 for us old farts?  Maybe put it in a snazzy bottle and give it a cute name.  How about Eau de Youth?