A thought-provoking article yesterday from Science Daily. It's called "Are Cancers Newly Evolved Species?" and describes work by a cell biologist who says that we are looking at cancer in the wrong way. Cancer, he says, does not develop from problems with an individual's chromosomal variations, but goes beyond that, so that cancer cells actually evolve into different species. In other words, cancer cells are no longer human cells, but something other than human, because their DNA changes so much. It's a very different take on how scientists view cancer right now.
I have mixed feelings about this proposed theory of cancer.
In some ways, the science seems possible. Cancer cells do mutate and change in ways that are obviously problematic, in terms of figuring out how to deal with them. A new view of how cancer develops could be necessary to determining how to fight it.
On the other hand, I'm not crazy about the "bacteria" metaphor. It seems a step backwards in some ways. We used to view cancer as something outside of ourselves, something to be attacked -- like bacteria. We now view cancer as a "perfect version of ourselves" (as Siddartha Mukherjee puts it in Emperor of All Maladies): our own cells that have figured out a way to keep from dying.
The implications are important. If we view cancer as coming from ourselves, we figure out ways to fight it that are very different than if we think of cancer as an outsider.
So I'm all for a fresh perspective on cancer, but also concerned that the perspective not pull us away from the progress we're making. Certainly this evolutionary theory is a whole lot more complex than older theories about cancer being caused by a virus or something like that. It will be interesting to see how the community reacts to it.
Thursday, July 28, 2011
Monday, July 25, 2011
Science Fair
This is such a cool story.
"First Place Sweep by American Girls at Google's First Science Fair," from the New York Times earlier this week, is pretty much summed up in its title. Google sponsored its first science fair. It was international: 10,000 kids from 90 countries submitted applications online, and finalists were chosen to compete. The three girls who won their age groups were all from the U.S. Very cool that they were all American, and cooler that they're all girls (said the father of a girl).
But the coolest part was the 17-18 year old winner, whose project looked at ways to improve the efficiency of a common cancer drug. She also won best overall, and her prize is a $50,000 scholarship, a trip to the Galapagos Islands, and a trip to the CERN particle physics laboratory in Switzerland.
The 13-14 year old winner also had a cancer-related project: she found that lemon juice and brown sugar marinades decrease the number of cancer-causing compunds in grilled meat, while soy sauce increases them (Which spells doom for my soy-ginger London broil.)
But the coolest part of all is the trophies that the girls got, which look like they were made out of Legos.
As you know fom reading, I'm always looking to the future. And it certainly looks bright.
"First Place Sweep by American Girls at Google's First Science Fair," from the New York Times earlier this week, is pretty much summed up in its title. Google sponsored its first science fair. It was international: 10,000 kids from 90 countries submitted applications online, and finalists were chosen to compete. The three girls who won their age groups were all from the U.S. Very cool that they were all American, and cooler that they're all girls (said the father of a girl).
But the coolest part was the 17-18 year old winner, whose project looked at ways to improve the efficiency of a common cancer drug. She also won best overall, and her prize is a $50,000 scholarship, a trip to the Galapagos Islands, and a trip to the CERN particle physics laboratory in Switzerland.
The 13-14 year old winner also had a cancer-related project: she found that lemon juice and brown sugar marinades decrease the number of cancer-causing compunds in grilled meat, while soy sauce increases them (Which spells doom for my soy-ginger London broil.)
But the coolest part of all is the trophies that the girls got, which look like they were made out of Legos.
As you know fom reading, I'm always looking to the future. And it certainly looks bright.
Friday, July 22, 2011
Hospital Rankings
U.S. News has published its annual hospital rankings, and naturally I'm most interested in their rankings for cancer hospitals.
Yale-New Haven, with its brand new Smilow Cancer Hospital, comes in at #24 -- pretty close to (if not exactly -- I can't remember) where they were last year, which is comforting, since it's about 15 minutes from my house.
Just as comforting is the fact that 8 of the top 25 are located within a 6 hour drive of my house: Sloan-Kettering in NYC (#2); Johns Hopkins in Baltimore (#3); Dana-Farber (#5) and Mass General (#7) in Boston; UPenn in Philadelphia (#15); New York Presbyterian (#19); U Maryland in Baltimore (#22); and Yale. That's pretty cool. I don't expect to need any of the other 7 any time soon, but it's nice to know, ya know?
The other thing that struck me about the list this year is how widespread, geographically, these hospitals are. You could probably find one that's about a day's drive for almost anyone in the country. I know this from the support group; nearly everyone there has an option for a second opinion at a great hospital. So in terms of the bigger picture, it's nice that we're doing such a great job as a country in providing access to quality care for so many people.
If we could just work on that "cure" thing now, that would great....
Yale-New Haven, with its brand new Smilow Cancer Hospital, comes in at #24 -- pretty close to (if not exactly -- I can't remember) where they were last year, which is comforting, since it's about 15 minutes from my house.
Just as comforting is the fact that 8 of the top 25 are located within a 6 hour drive of my house: Sloan-Kettering in NYC (#2); Johns Hopkins in Baltimore (#3); Dana-Farber (#5) and Mass General (#7) in Boston; UPenn in Philadelphia (#15); New York Presbyterian (#19); U Maryland in Baltimore (#22); and Yale. That's pretty cool. I don't expect to need any of the other 7 any time soon, but it's nice to know, ya know?
The other thing that struck me about the list this year is how widespread, geographically, these hospitals are. You could probably find one that's about a day's drive for almost anyone in the country. I know this from the support group; nearly everyone there has an option for a second opinion at a great hospital. So in terms of the bigger picture, it's nice that we're doing such a great job as a country in providing access to quality care for so many people.
If we could just work on that "cure" thing now, that would great....
Tuesday, July 19, 2011
Betty Ford
I've read a few obituaries for Betty Ford over the last couple of weeks. I have to say, I didn't know much about her other than that she founded the famous rehab center. I was a little too young when she was First Lady to remember much about her.
But what's really stood out for me in the reading was how outspoken she was. Disagreements with her husband and his party; honesty about her children; openness about social issues of the day. It's pretty refeshing to hear someone in politics (even if she wasn't an elected politician) speak honestly -- and it certainly sounds like she spoke her mind. (And people appreciated it; apparently she herself had a 75% approval rating when her husband lost to Carter in 1976.)
But what really stuck out for me was her influence on the conversation about cancer. I know that Nixon declared a "War on Cancer" a few years before Ford took over, when he signed the National Cancer Act of 1971, and there was lots of public talk about how important it was to wipe it out in five years, etc. etc. But there still wasn't a lot of talk about people with cancer. Cancer was still something to hide, a word that only got whispered.
And Betty Ford played a part -- a pretty big part -- in changing that attitude. Less than two months after she became First Lady, Ford was diagnosed with breast cancer and had a mastectomy. And, true to form, she was open about it -- after Watergate, she didn't want there to be any secrets at all in the White House. The appreciation in Time Magazine after her death quoted her a few years later as saying "When other women have this same operation, it doesn't make any headlines. But the fact that I was the wife of the President put it in headlines and brought before the public this particular experience I was going through. It made a lot of women realize that it could happen to them. I'm sure I've saved at least one person — maybe more." More women began doing self-examinations after she made her open announcement, which led to an increase in reported cases of breast cancer. The rise in the statistic is now called "The Betty Ford blip."
Certainly, not everything changed overnight, in terms of people's openness about cancer (especially breast cancer). It took a long time for people to speak more openly about cancer, and there are plenty of people who still cover their ears at the word. But this was obviously a big step, way back when.
And I still say that when people hide, cancer wins. It's too isolating a disease to make yourself more isolated, unnecessarily. When people know, people can help.
So thank you, Betty Ford, for your part in chnaging things.
But what's really stood out for me in the reading was how outspoken she was. Disagreements with her husband and his party; honesty about her children; openness about social issues of the day. It's pretty refeshing to hear someone in politics (even if she wasn't an elected politician) speak honestly -- and it certainly sounds like she spoke her mind. (And people appreciated it; apparently she herself had a 75% approval rating when her husband lost to Carter in 1976.)
But what really stuck out for me was her influence on the conversation about cancer. I know that Nixon declared a "War on Cancer" a few years before Ford took over, when he signed the National Cancer Act of 1971, and there was lots of public talk about how important it was to wipe it out in five years, etc. etc. But there still wasn't a lot of talk about people with cancer. Cancer was still something to hide, a word that only got whispered.
And Betty Ford played a part -- a pretty big part -- in changing that attitude. Less than two months after she became First Lady, Ford was diagnosed with breast cancer and had a mastectomy. And, true to form, she was open about it -- after Watergate, she didn't want there to be any secrets at all in the White House. The appreciation in Time Magazine after her death quoted her a few years later as saying "When other women have this same operation, it doesn't make any headlines. But the fact that I was the wife of the President put it in headlines and brought before the public this particular experience I was going through. It made a lot of women realize that it could happen to them. I'm sure I've saved at least one person — maybe more." More women began doing self-examinations after she made her open announcement, which led to an increase in reported cases of breast cancer. The rise in the statistic is now called "The Betty Ford blip."
Certainly, not everything changed overnight, in terms of people's openness about cancer (especially breast cancer). It took a long time for people to speak more openly about cancer, and there are plenty of people who still cover their ears at the word. But this was obviously a big step, way back when.
And I still say that when people hide, cancer wins. It's too isolating a disease to make yourself more isolated, unnecessarily. When people know, people can help.
So thank you, Betty Ford, for your part in chnaging things.
Sunday, July 17, 2011
Nanotech
I've written several times about nanotechnology and its use in cancer research, and I found another interesting piece about it just this past week. It appeared in the most recent issue of Bostonia, the Boston University alumni magazine, and it's about a BU prof who is doing work in nanotechnology.
Nanotechnology involves using the tiniest of particles to either deliver a treatment, or to serve as the treatment itself. (I wrote once, for example, about doctors using gold nanoparticles that could be heated up to kill cancer cells.) The tiny particles can go places where some molecules can't, delivering their payload directly to the place they need to be.
This particular article is called "Small Wonders," and features the research of Dr. Tyrone Porter, a professor of mechanical engineering (which I think is really cool -- someone other than a Medical Doctor, bringing a different perspective to the cancer puzzle). Dr. Porter is developing nanoparticles that deliver chemo drugs directly to the tumor, by taking advantage of the tumor's structure. As it grows, the tumor's blood vessels grow as well -- so quickly that they develop small openings in them. The nanoparticles are designed to slip into these tiny openings , allowing them to get right to the tumor. The nanoparticles are then manipulated by changing their temperature just slightly, or by changing their pH level, which will be signals to release the chemo. Very cool stuff.
The article also includes a video of Dr. Porter explaining all of this, though the written article also does a nice job of explaining it all.
The issue also has a story on BU alum Garrett Oliver, brewmaster for the Brooklyn Brewery, which makes some really, really great beer, if you're interested in that.
Exciting stuff. (Both the beer and the nanotechnology.)
Nanotechnology involves using the tiniest of particles to either deliver a treatment, or to serve as the treatment itself. (I wrote once, for example, about doctors using gold nanoparticles that could be heated up to kill cancer cells.) The tiny particles can go places where some molecules can't, delivering their payload directly to the place they need to be.
This particular article is called "Small Wonders," and features the research of Dr. Tyrone Porter, a professor of mechanical engineering (which I think is really cool -- someone other than a Medical Doctor, bringing a different perspective to the cancer puzzle). Dr. Porter is developing nanoparticles that deliver chemo drugs directly to the tumor, by taking advantage of the tumor's structure. As it grows, the tumor's blood vessels grow as well -- so quickly that they develop small openings in them. The nanoparticles are designed to slip into these tiny openings , allowing them to get right to the tumor. The nanoparticles are then manipulated by changing their temperature just slightly, or by changing their pH level, which will be signals to release the chemo. Very cool stuff.
The article also includes a video of Dr. Porter explaining all of this, though the written article also does a nice job of explaining it all.
The issue also has a story on BU alum Garrett Oliver, brewmaster for the Brooklyn Brewery, which makes some really, really great beer, if you're interested in that.
Exciting stuff. (Both the beer and the nanotechnology.)
Friday, July 15, 2011
18 Months
Today is my 18 month treatment-aversary. It was 18 months ago today that I received my first Rituxan treatment.
I think this is worth celebrating. When I went in for the Rituxan, I did a rough estimate of how people in the support group had reacted to the treatment. Some got no response from it at all. Others went a good long while on it. I figured that if Rituxan bought me a year, I would call it a success -- a year seemed to be about the average that people in the support group reported. I learned later on that the median duration of response is 10-12 months, so my guess was pretty good.
Now that I'm at 18 months? That's pretty gosh darn good, I'd say.
Of course, I haven't looked into it deeply enough to know if the median duration of response means 12 months until the lymphoma shows up again, or 12 months until treatment is needed again; I'm assuming the latter. The lymphoma may very well have shown up again by now, and it just isn't affecting me yet. I won't know that for sure until I get my next scan sometime next month. But all indications so far are that I'm still rolling along pretty well.
I tried to write a love poem to Rituxan, to show my appreciation, but I only finished two verses, and then I couldn't rhyme anything with "Antibody-dependent Cell-mediated Cytotoxicity," and then the verses about side effects were just weird, so I stopped. But I'm sure what I did write gives you a pretty good sense of my feelings for Rituxan.
Ode to Rituxan
You might be called, generically,
that sweet rituximab.
If that's the case,
I say to your face,
I still think that you're fab.
You might be called, internationally,
The so lovely MabThera.
Well, what the hell,
As long as to B cells
You remain a terror.
It matters not what I call you
As long as you do your work,
By apoptosis, [And then I had to stop here]
Anyway, learn more abouit Rituxan at the Patients Against Lymphoma web site (http://www.lymphomation.org/rituxan.htm). Really, anything you'd want to know about this amazing treatment.
I think this is worth celebrating. When I went in for the Rituxan, I did a rough estimate of how people in the support group had reacted to the treatment. Some got no response from it at all. Others went a good long while on it. I figured that if Rituxan bought me a year, I would call it a success -- a year seemed to be about the average that people in the support group reported. I learned later on that the median duration of response is 10-12 months, so my guess was pretty good.
Now that I'm at 18 months? That's pretty gosh darn good, I'd say.
Of course, I haven't looked into it deeply enough to know if the median duration of response means 12 months until the lymphoma shows up again, or 12 months until treatment is needed again; I'm assuming the latter. The lymphoma may very well have shown up again by now, and it just isn't affecting me yet. I won't know that for sure until I get my next scan sometime next month. But all indications so far are that I'm still rolling along pretty well.
I tried to write a love poem to Rituxan, to show my appreciation, but I only finished two verses, and then I couldn't rhyme anything with "Antibody-dependent Cell-mediated Cytotoxicity," and then the verses about side effects were just weird, so I stopped. But I'm sure what I did write gives you a pretty good sense of my feelings for Rituxan.
Ode to Rituxan
You might be called, generically,
that sweet rituximab.
If that's the case,
I say to your face,
I still think that you're fab.
You might be called, internationally,
The so lovely MabThera.
Well, what the hell,
As long as to B cells
You remain a terror.
It matters not what I call you
As long as you do your work,
By apoptosis, [And then I had to stop here]
Anyway, learn more abouit Rituxan at the Patients Against Lymphoma web site (http://www.lymphomation.org/rituxan.htm). Really, anything you'd want to know about this amazing treatment.
Tuesday, July 12, 2011
Be Nice to Doctors?
Last week, the Wall Street Journal's Health blog puboished a brief piece called "Do Nice Patients Finish First?", discussing a commentary from a medical journal that looked at whether or not "nice" patients get better care from their doctors.
A fascinating topic, one that brought up some discussion in the support group. Some people talked about going out of their way to be nice to everyone -- receptionists, nurses, doctors -- everyone that they encountered in the office. Someone else pointed out being "nice" should never get in the way of getting the treatment you need, or getting your questions answered. Someone else brought up that she brought treats for the office staff every now and then (something I confess that I did when I went in for a Rituxan treatment).
The comments attached to the article (see the tab at the top) were equally interesting: One says that being too nice sometimes means being ignored, because energy gets put into those other squeeky wheels. Another says a health environment is a jungle, and you have to be aggressive if you want proper care. Still another reminds readers that doctors are human beings with the same emotions as patients, and need a little understanding.
It's all very interesting, and I think the key to it all is to keep in mind what the authors of the original medical journal piece have to say about what it menas to be "nice":
It all depends on how you define “nice” and “better,” one of the authors, Allan Detsky, a professor in the departments of medicine and of health policy, management and evaluation at the University of Toronto. Generally patients who “communicate well, understand their problems, are able to make decisions, adhere to diagnostic and treatment plans, are pleasant and express gratitude for the services they receive” are more pleasant to treat than those who don’t, the commentary says, but the definition of niceness is still pretty subjective.
That seems like a fairly easy definition of "nice" to have to live up to. Communicate well by asking questions and listening to the answers. Understand your problems and explain them fully. Agree to a plan with the doctor, and then stick to the plan. The being pleasant part can be a little tricky -- we all have our bad days, and we express those bad days in different ways. Bt the gratitude part should be easy -- say thank you to the people who help you, even if they're just doing their jobs. In my experience, inside and outside of doctors' offices, people don't get thanked enough, and if you do slip in a sincere thank you, it will pay off later. (Maya Angelou says that people don't remember what you said or did; they remember how you made them feel. And when they see you again, those good feelings are going to come back to them.)
But the really important thing is, don't confuse "nice" with "passive." Asking questions when you don't understand, expressing your fears, asking for opinions, and even (nicely) demanding explanations is all part of your duty as a patient.You can do all that without being obnoxious. And in return, you can say thanks, express appreciation for the doctor taking extra time to talk to you, and let the doctor know when his explanations have been clear and helpful.
And, maybe, bring in some cookies for the staff break room....
A fascinating topic, one that brought up some discussion in the support group. Some people talked about going out of their way to be nice to everyone -- receptionists, nurses, doctors -- everyone that they encountered in the office. Someone else pointed out being "nice" should never get in the way of getting the treatment you need, or getting your questions answered. Someone else brought up that she brought treats for the office staff every now and then (something I confess that I did when I went in for a Rituxan treatment).
The comments attached to the article (see the tab at the top) were equally interesting: One says that being too nice sometimes means being ignored, because energy gets put into those other squeeky wheels. Another says a health environment is a jungle, and you have to be aggressive if you want proper care. Still another reminds readers that doctors are human beings with the same emotions as patients, and need a little understanding.
It's all very interesting, and I think the key to it all is to keep in mind what the authors of the original medical journal piece have to say about what it menas to be "nice":
It all depends on how you define “nice” and “better,” one of the authors, Allan Detsky, a professor in the departments of medicine and of health policy, management and evaluation at the University of Toronto. Generally patients who “communicate well, understand their problems, are able to make decisions, adhere to diagnostic and treatment plans, are pleasant and express gratitude for the services they receive” are more pleasant to treat than those who don’t, the commentary says, but the definition of niceness is still pretty subjective.
That seems like a fairly easy definition of "nice" to have to live up to. Communicate well by asking questions and listening to the answers. Understand your problems and explain them fully. Agree to a plan with the doctor, and then stick to the plan. The being pleasant part can be a little tricky -- we all have our bad days, and we express those bad days in different ways. Bt the gratitude part should be easy -- say thank you to the people who help you, even if they're just doing their jobs. In my experience, inside and outside of doctors' offices, people don't get thanked enough, and if you do slip in a sincere thank you, it will pay off later. (Maya Angelou says that people don't remember what you said or did; they remember how you made them feel. And when they see you again, those good feelings are going to come back to them.)
But the really important thing is, don't confuse "nice" with "passive." Asking questions when you don't understand, expressing your fears, asking for opinions, and even (nicely) demanding explanations is all part of your duty as a patient.You can do all that without being obnoxious. And in return, you can say thanks, express appreciation for the doctor taking extra time to talk to you, and let the doctor know when his explanations have been clear and helpful.
And, maybe, bring in some cookies for the staff break room....
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