FINANCIAL TOXICITY, Part 2

Linda and the Hunsinger twins

Kalamazoo

So, there was this old house in the country, somewhat run-down, owned and occupied by a sweet little old lady.  It also was home to a considerable colony of mice but, being intelligent mice, they contrived to coexist with the sweet old lady without incident.  However, realizing that she was lonely, one day the sweet old lady brought home a cat for companionship.  Well, you can imagine the result – death, destruction and terror in the mouse colony.  So the mice formed a committee to suggest a remedy, which quickly came up with the obvious answer – we’ll just hang a big bell around the cat’s neck to warn us if it is close by.  Then arose the obvious question: how in hell are we going to bell this cat?

The first War on Cancer was declared during the administration of Richard Nixon (roughly, the early 1970s).  It was well intentioned, well-funded and, based on the state of cancer science, well designed.  As we all know now, it went next-to-nowhere, owing to the fact that “cancer” was not a single-headed monster but rather a hydra, with many heads, each of which had to be chopped off individually.  Progress against cancer has indeed been made since Nixon’s time but, as we all also know, not nearly enough.

As part of this early War something called the President’s Cancer Panel was created, to keep our chief executive and the public at large appraised of progress being made against our hydra-headed foe.  Presumably there have been annual PCP reports ever since – but this is the first one I have encountered (it appears in the NCI bulletin).  It treats of an important question: how in heck can we “afford” to conquer cancer?  Here it is:

https://www.cancer.gov/news-events/cancer-currents-blog/2018/presidents-cancer-panel-drug-prices?cid=eb_govdel

Imbedded within this link is another link that will give you the complete text – wordy, but non-technical.  Here is the gist:

New cancer drugs cost too damned much; so much, in fact, that many patients must choose between health and bankruptcy.  New cancer drugs may cost billions to bring on line.  Some new cancer drugs are well worth their cost, but many simply provide a few more weeks of life.  Drug pricing in the United States is an inefficient amalgam of feeble market forces and bumbling bureaucracy.  And nobody seems to know what to do about it.

So, it is agreed by everybody that everyone with cancer ought to receive efficacious care – if that exists.  Also agreed upon is the proposition that drug prices ought to reflect efficacy, not cost to develop and distribute.  The problem, of course, is obvious.  How in hell do we bell this particular cat?   How do we keep the drug companies solvent and churning out new products - and at the same time assure that high-priced remedies yield worthwhile results?  In fact, can we as a society actually afford to be healthy?

Damned it I know.  What do you think?

LINDA ON HER WEDDING DAY. Our 36th.

Her new family

This would have been our 36^th wedding anniversary.  I wish she were here to enjoy it with me.

http://engage.fredhutch.org/site/TR?px=1148821&fr_id=1573&pg=personal

FINANCIAL TOXICITY, Part 1

Linda and Sue Broadhurst

at Sue's wedding

Remember my suggestion that a large fraction of Liberal Arts graduates go to work for the federal government – and spend the rest of their lives writing reports?  Well, PhDs and M.Ds write reports, too.  Here is an important one.

https://www.cancer.gov/news-events/cancer-currents-blog/2018/presidents-cancer-panel-drug-prices?cid=eb_govdel

In a nutshell, a learned panel considered the following question – “How can we afford cancer treatment?” – and came up with a lengthy discussion of possibilities.  I was prepared to use some cute adjectives – “turgid”, perhaps, or “bureaucratic”, or even “annoying” – but they don’t fit.  The report is long, but it is well written, well organized, well-illustrated, and even thoughtful.  I intend to study it carefully and give you my take in a few days (too busy right now, what with my mad social life and all.)  You might give it a try.  To whet your appetite:

The average yearly cost of new cancer drugs is $100,000.  Some go as high as $400,000. 

Some of these drugs are truly transformative, but others only provide a few more months of life.

Urgently needed is a way to process drug effectiveness into pricing policy.

I love the term in introduced by the panel – “Financial Toxicity”.

I THROW IN THE TOWEL: and leave the work to you

Linda says "read every word of this blog"

My computer, when it deigns to work, constantly reminds me that I have upwards of 160 notifications of ovarian cancer news – unread.  So what is an FOF to do?  I’ll tell you what: ask you to study THIS

https://www.cancer.gov/news-events/cancer-currents-blog/2018/new-online-march-2018?cid=eb_govdel

Did you ever wonder what those hordes of liberal arts B.A. graduates actually DO when they graduate?  Well, a significant percentage of them must go to Washington, D.C., and spend the rest of their lives writing reports.  Consequently you, the voter and private citizen, have no excuse not to know what your government is up to; all you need do is read reports, maybe 16 hrs/day.  That’s why you need honest bloggers like me to tell you what to think.  Don’t snicker.

Anyway, I can’t keep up, either.  Do your own damned research – starting with the NCI link (above).  Here are a few things I noticed on my first pass through it, in no particular order.

The NCI budget for last year was $5.69 billion.  That’s a bundle in my world, but Elon Musk can waste that much in one rocket blast.  Let’s get our priorities straight, gang.

At that rate, Jeff Bezos could fund the NCI for 15 years out of his own pocket, and still have plenty to leave to his kids.

NCI put $300 million into the Moonshot.  The moon is still there, and so is OVCA.

Fred Hutchinson Cancer Research center received about $96 million in funding, and U.W. got another $26 million.  That makes Seattle’s cancer research efforts third most supported; only Sloan Kettering (N.Y.) and MD Anderson (Texas) get more.  

Improvement is noted in OVCA.  Diagnosis and treatment both are said to be progressively more effective.  Well, maybe….. 

If you REALLY want to get buried in this stuff, Google SEER (Surveillance, Epidemiology and End Results program, also NCI) and do your own statistics.  As a parting shot: I used SEER to determine that – corrected for age – the rate of acquisition of OVCA decreased 30% between 1975 and 2014.  The number of deaths from the same disease fell 28.6% over the same period.  Progress, sure.  Good enough? – of course not.

WHY WE NEED MORE GPs

Winter in Chicago

From the U.K., ovarian cancer from the perspective of an overworked general practitioner.  We need more first line docs, better educated first line docs - more and better testing - and of course continued personal awareness and vigilance.  

https://www.hippocraticpost.com/cancer/ovarian-cancer-gps-perspective/

  

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DATA MINING

Early camping trip

I have had a lot of fun as a geologist.  I was paid, mind you, to visit all sorts of interesting and beautiful places all over this half of the world.  I worked in the Caribbean (hot, muggy, boring), the Aegean (well worth a visit, especially off the beaten track), Southwestern South America (wonderful), Italy (good food), and half a dozen places in the United States (a mixed bag.)  I even got paid to go to Antarctica, a trip I never could have afforded otherwise.  And all the while I made interesting friends, who enrich my life even now.

But if I had it to do over again, I would study computer applications, with a double major of molecular genetics.  I would become a data miner.

Here is a story about a data miner at UCLA, doing important work, highly regarded research.

https://directorsblog.nih.gov/2018/03/01/creative-minds-looking-for-common-threads-in-rare-diseases/

This young woman – and she looks oh so young – is using computer techniques to comb through existing data bases of DNA information and related data to find “common threads” amongst various rare, “Mendalian” diseases.  She does it in a manner that I don’t fully comprehend, in an effort to accomplish some things I don’t fully understand, either.  Whatever:  NIH is excited enough to fund her handsomely.  (I got this information from the blog of the Director of NIH:  see http://ljb-quiltcutie.blogspot.com/2017/12/frankenstuff.html)

Well, if you do happen to read the rare diseases article you will run on the following useful little ditty:

https://www.genome.gov/20019523/genomewide-association-studies-fact-sheet/

This explains data mining.  I am going to study it, after my morning nap.

THE MURINE CHRONICLES

Linda pretending to be snookered on our Norwegian cruise, 2004

Sometimes I think that the name for this blog ought to be “The Murine Chronicles”, not “Myrl’sBlog”.  Sure, it is written by Myrl, but much of the time it’s about things we humans do to mice and rats.  This posting is strong to rats.

There is a gene known as RAS which is complicit in many kinds of cancer.  When not mutated it produces a protein (RAS), which serves as a signal within cells, telling them when not to divide.  If mutated, RAS can’t do its job and the cell multiplies like sin to produce, in some cases, cancer.  RAS, therefore, is a “proto-onco gene”, one of the worst.  Clearly, if we could develop a drug to prevent screwed-up RAS proteins from doing damage, we’d be way ahead. 

Oh, maybe here is where I should tell you where the name RAS comes from.  Rat sarcoma.  RAS was discovered by abusing our friend, the brown rat.

Well, all this has been common knowledge for more than a decade, and majestic piles of money, effort – and rats – have been expended on developing a drug to counter the malign effect of mutated RAS, to little effect.  Odd though it seems, drugs like this work by “binding” to the subject bad-acting molecule.  Binding requires a precise shape; your missile of death has to fit precisely into some irregularity on the surface of its target.  And not just any old irregularity; as I understand it, it should be the misshapen hole that is causing the trouble!

Hell, I am in way over my head.  Read this link; it is short, relatively easy to understand, and informative. 

https://directorsblog.nih.gov/2018/02/13/kras-targeted-cancer-strategy-shows-early-promise/

And thank God for your little murine friends.

TROUBLE NORTH OF THE BORDER

Linda and Viv Hailwood

On a hike in Yorkshire Dales National Park

Well, here’s one you (probably) can’t blame on Donald Trump:  even the Canadian government is short-changing ovarian cancer research.

https://globenewswire.com/news-release/2018/02/28/1401168/0/en/Budget-2018-Ovarian-cancer-research-funding-still-a-concern-for-women.html

Ovaries and prostates develop from the same swatch of fetal tissue (I seem to have read somewhere), and both are subject to deadly cancers – yet our Northern Neighbors allocate over twice as much money to prostrate problems as to OVCA.  Not good.

Some Canadian women have organized to do something about this.  They want more support for OVCA research (not less for PRCA, for Heaven’s sake!).  Bless their efforts.  What say, Parkfriend?