Truth at the End of Life

Elaine Waples

Posted 3/5/13 on TEDMED

Elaine Waples and Her Husband, Brian Klepper

Most of us have spent some time thinking about our own deaths. We do it with a sense of dreadful curiosity, but then we push it aside with “well, we’ve all got to go sometime.”

Unlike most people, I probably know the how, the why, and maybe even the when of that event. It is profound information that turns the world upside down for us, our families, friends and caregivers.

I have cancer that is incurable, aggressive, and has negligible survival odds. My chemotherapy is a long shot. I will leave a spouse, children, siblings and a life that I love and cherish. I cannot imagine existence without them.

Is Sugar Carcinogenic?

Dov Michaeli

Posted 4/30/12 on The Doctor Weighs In

Last Sunday on his show on CNN, Dr. Sanjay Gupta interviewed pediatrician, Dr. Robert Lustig, who made the assertion that sugar is toxic, and probably carcinogenic. This attention-grabbing statement had earned him a wide following on UTube. But is it true? Let’s examine the evidence.

How is sugar used in the cell?

Every cell in our body needs energy in order to survive and perform its functions. Our biochemistry has evolved over billions of years to extract energy from simple sugars, like glucose and fructose. I mentioned the evolutionary ancient-ness (is this a word?) for a reason. In the beginning (relax, I am not getting into the creation debate) the atmosphere was poor in oxygen. Yet cells had to extract energy from their nutrients. The solution? Extract energy from glucose without the participation of oxygen. This process is called anaerobic glycolysis, and even today, there are anaerobic bacteria that survive solely through glycolysis. This process nets a measly 2 ATP molecules (these are the molecules that store the energy necessary to drive chemical reactions in the cell), and two 3-carbon molecules of pyruvic acid.

Continue reading “Is Sugar Carcinogenic?”

Flaws in Cancer Screening

Tom Emerick

Posted 4/24/12 on Cracking Health Costs

Lisa M. Schwartz, MD and Steven Woloshin, MD wrote a good article published in the New York Times called “Endless Screenings Don’t Bring Everlasting Health.” Click here to read the full story.

Many Americans have high expectations for avoiding cancer with the right regimen of tests.  After all isn’t that what our wellness programs teach us? Isn’t that what we hear trumpeted in the popular media? Getting such screenings on a regular basis just makes good sense, no?

Continue reading “Flaws in Cancer Screening”

Is My Cancer in the Wrong Body Part?

Elaine Waples

Recently, our city hosted the fifth annual national marathon to fight breast cancer.  This is not part of the Komen “race for the cure” but rather a grassroots effort that mushroomed from its inception five years ago into the impressive event it is today. Thousands of people participate as runners,  volunteers, and cheerleaders clad in the signature color.  I must admit, seeing some grown men run twenty six miles wearing pink tu-tus is both awe inspiring and a testament to dedication over self-image.

It’s supporters include corporate sponsors, vendors, and exhibitors, and (no surprise) pharmaceutical companies. Its originators are a local TV celebrity breast cancer survivor and a cancer physician at Mayo clinic. It promises to donate 100% of the money to breast cancer research or care. To date, the event has raised millions of dollars and has met its contribution promise. It’s all very worthy, noble and heartwarming.

Continue reading “Is My Cancer in the Wrong Body Part?”

An Appreciation: Monique Doyle Spencer

Paul Levy

Posted 11/27/11 on Not Running a Hospital

Brian’s Note: When I read this poignant piece about one woman’s brave perspective on fighting cancer, I showed it to my wife Elaine, who is dealing with late stage primary peritoneal (ovarian) cancer. She commented, “Ah! Someone else who doesn’t want to be categorized as a ‘victim’ or ‘survivor’!” It clearly struck a chord.

Monique Doyle Spencer (seen here in July 2010) died peacefully and surrounded by her family last night after a long stint with metastatic breast cancer.  By any measure, she was an extraordinary person, full of ideas, strongly held views, and with a marvelous sense of humor.  I was privileged to be her friend.

I came to know Monique during one of her stays in our hospital.  She mentioned that she had been writing a book about her experience with cancer, but that no one would publish it because it was funny.  Without a pause, I said that we would publish it as a book from our hospital, and the result was The Courage Muscle, A Chicken’s Guide to Living with Breast Cancer.  Those title words were chosen carefully because her whole being was about living.
Continue reading “An Appreciation: Monique Doyle Spencer”

AIDS Virus in Service To the Fight Against Cancer

Dov Michaeli

First posted 10/02/11 on The Doctor Weighs In

Yes, you read it right: the dreaded AIDS virus provided a breakthrough in the search for cancer treatment.  In a brilliant Jiu Jitsu maneuver University of Pennsylvania scientists (Dr. Carl June and his group) turned the strength of the virus into an advantage to the patient.

Here is the background to their feat.

There are 2 types of lymphocytes (white blood cells): T cells and B cells. T cells are the “generals,” directing the attacks on non-self interlopers, like bacteria, viruses and virus-infected cells, and importantly –cancer cells.

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Less Education, More Cancer

Merrill Goozner

First published 6/24/11 on Gooz News

A new study from the American Cancer Society shows that people with only a high school education are nearly three times more likely to die from cancer than people with college and advanced degrees. From the Associated Press story:

For all types of cancer among men, there were about 56 deaths per 100,000 for those with at least 16 years of education, compared with 148 deaths per 100,000 for those with no more than 12 years of school. For women, the rate was 59 per 100,000 for the most educated and 119 per 100,000 for the least educated. People with a high-school education or less died from lung cancer at a rate four to five times higher than those with at least four years of college education. More than a third of premature cancer deaths could have been avoided if everyone had a college degree, cancer-society officials estimated.

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VoucherCare for Cancer

Merrill Goozner

First published 6/6/11 on Gooz News

The health care cost debate takes place on two stages using two languages, one scientific, the other economic. The net result is a failure to communicate.

The scientific texts emanated over the weekend from the American Society of Clinical Oncology meeting in Chicago. Ongoing clinical trials showed that science has come up with new drugs that can reduce the incidence of breast cancer and prolong life for people with skin cancer. The former is an estrogen inhibitor that would have to be taken by tens of millions of older women to have a major impact on reducing the rate of breast cancer. The latter would only be given to a subset of the 68,000 new cases of melanoma each year, and would extend life from a few months to a few years for some of the 7,700 who die from the disease each year. Again, most of those people are older, although there are a number of younger people, especially young women, who disproportionately get advanced skin cancer.

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Book Review: “Overdiagnosed” and the Paradox of Cancer Survivorship

Kenneth Lin

First published 4/12/11 on Common Sense Family Doctor

OverdiagnosedAccording to the National Cancer Institute and the Centers for Disease Control and Prevention, the number of cancer survivors in the U.S. has increased dramatically in my lifetime, from 3 million in 1971 to 11.7 million in 2007. From 2001 to 2007 alone, the number of persons living with a cancer diagnosis rose by nearly two million. Most people would probably see these statistics as good news: an indication that our cancer treatments are improving and allowing people to live longer, or that earlier diagnoses are giving people a better chance to survive by catching localized cancers before they spread and become impossible to cure.

Continue reading “Book Review: “Overdiagnosed” and the Paradox of Cancer Survivorship”

Book Review – The Emperor of All Maladies: A Biography of Cancer

Brian’s Note: With yesterday’s announcement that Siddhartha Mukherjee’s The Emperor of All Maladies had won the Pulitzer for General Non-Fiction, I thought it might be appropriate to rerun this review from last December 5, 2010.

BRIAN KLEPPER

The opening page of Siddhartha Mukherjee’s The Emperor of All Maladies begins with a quote by Susan Sontag that is so on-point, yet so rare and fresh, that one can’t help being excited by the prospect of what’s to come.

Emperor of All MaladiesIllness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.

Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

You open the book with great expectations. It is weighty, yes – 570 pages, 100 of which are end notes – but beginning, you immediately find its expansive scholarship wrapped in a writing style so fluid and lyrically engaging that it instantly dispels any hesitancy, and you are captured.

Continue reading “Book Review – The Emperor of All Maladies: A Biography of Cancer”

Siddhartha Mukherjee – The Cancer Puzzle

Yesterday I had a conversation with a physician colleague who is reading Dr. Mukherjee’s spectacular “biography” of cancer, The Emperor of All Maladies,” reviewed here about a month ago. He commented that the book was so broad and deep in its ambition as to be almost incomprehensible, especially from an author still so young and while conducting all the duties associated with being a newly minted doctor.Then I ran across this 20 minute presentation by Dr. Mukherjee. It’s a worthwhile glimpse into the mind of this very impressive author, as well as an interesting update on the status of cancer knowledge.

Book Review: “Overdiagnosed” and the Paradox of Cancer Survivorship

Kenneth Lin

First published 4/12/11 on Common Sense Family Doctor

According to the National Cancer Institute and the Centers for Disease Control and Prevention, the number of cancer survivors in the U.S. has increased dramatically in my lifetime, from 3 million in 1971 to 11.7 million in 2007. From 2001 to 2007 alone, the number of persons living with a cancer diagnosis rose by nearly two million. Most people would probably see these statistics as good news: an indication that our cancer treatments are improving and allowing people to live longer, or that earlier diagnoses are giving people a better chance to survive by catching localized cancers before they spread and become impossible to cure.  Continue reading “Book Review: “Overdiagnosed” and the Paradox of Cancer Survivorship”

The Long Term Effects of Radiation Exposure

Merrill Goozner

First published 3/15/11 on Gooz News

Reporters and the public are scrambling to understand the health effects of the low-level radiation being absorbed by Japanese civilians and rescue workers from the crippled reactors in Fukushima province. The sad fact is that Japan already is the world’s first and longest running natural history experiment in such exposures. The populations that survived the Hiroshima and Nagasaki bomb blasts have been studied for nearly 65 years. As survivors pass away, their initial exposures and their causes of death are duly noted. That database has provided researchers with a wealth of information for documenting the long-term effects of radiation exposure.

Continue reading “The Long Term Effects of Radiation Exposure”

Using An App to Confront Your Metastatic Melanoma

GEORGE D. LUNDBERG

If you or anyone else you know has had a malignant melanoma, you and that other person, and your respective physicians, should click here to access the Targeted Therapy Finder–Melanoma (ttf-melanoma). It is free and does not require registration.

Collabrx of Palo Alto has developed this first of its kind application (app) under the leadership of noted internet entrepreneur and melanoma survivor Marty Tenenbaum.

Continue reading “Using An App to Confront Your Metastatic Melanoma”

An Introduction to Metformin and Cancer

WILLIAM H. BESTERMANN

The current scientific paradigms that shape our view of chronic conditions are simply inadequate. Clinical medical scientists might think much more seriously about questions like these: Why is it that metformin reduces the risk of heart attack, stroke, and cancer while other drugs lower the glucose and do not protect from these conditions? Why is it that studies of patients treated with insulin suggest an increase in cancer? Why is it that a single dose of metformin or a statin-type drug reduces heart attack size by half in experimental animals?  Why are patients who take certain medications for high blood pressure more likely to develop diabetes.

Today, basic scientists have laid the foundations to begin to answer these questions and the answers are important as we work to improve the quality of care. In practical terms, our scientific literature places little value on work that translates new science into practice. That is part of the reason that there is a large gap between what is known and what we do.  This is the first of a series of articles that we hope will serve to help in closing that gap.  The link between cancer and other chronic conditions is important.  If we can reduce the risk of cancer even slightly by refining the way we manage other chronic diseases, then that is important work.

Another reason for this article and Urgent Science is a very personal one.  Brian Klepper, the founder of CareandCost, has recorded the struggle that his brave wife Elaine endures with ovarian cancer now. I myself have been cured of a very aggressive type of lymphoma.  How many of our friends and family have been struck down by these ailments.  We need to improve our rate of translation.  We invite you to read this first piece carefully and if you have refinements or additions that will help the broader medical community understand these problems better, we invite you to send us your constructive comments. We promise to take them seriously and use them to improve what we all know about the newest science and how it might be used to help our patients.

Bill Bestermann is a vascular physician at the Holston Medical Group in Kingsport, TN.