Thursday, September 03, 2015

September 3, 2015 - We Didn't Choose It

I ran across a remarkable essay today, called "An open letter to healthy people from a former healthy person." The author is Charis Hill, a young woman of Sacramento, California, who lives with a chronic inflammatory arthritis called Ankylosing Spondylitis (no, I hadn’t heard of it before reading her essay).

Charis writes of how she struggles to define herself to those she meets as someone other than a chronic disease sufferer (who wants to be known as a sufferer, anyway?). From her essay:

"Many of us you see who are broken, you know us only in our current brokenness. But remember, many of us once were full of life, full of vigor and energy. Remember, many of us still recall the days we had full control and freedom with our bodies. We desired everything and still believed nothing could keep us from being professional soccer players, chefs, teachers, doctors, parents, ballerinas. Remember when you see us that we once were like you, healthy and full. Remember that we still remember what we’ve lost. Remember we still have hopes and wishes and dreams, and they are no less important, no less meaningful, and no less worthy than yours.

We love. We dream. We hope. We fight. We need. We survive. We succeed and fail. We live. Love us...."

Chronic illness is a life-transforming experience. After the rock-my-world disruption of diagnosis — and after we’ve got some months of treatment under our belts — we find we are different, as a result of what we’ve gone through and continue to go through.

There are significant losses that are sometimes hard to describe to others:

"We are still alive but we grieve the loss of who we were before this weight of helplessness and disease was inserted into our chest, our brains, our backs, our hearts. We have been blessed with the curse of witnessing and grieving our own symbolic deaths as we learn to be something or someone we never imagined we’d see in the mirror. We learn to see ourselves from the outside looking in (while desperately peeking outward) because we are strangers in these new bodies and we may never know how to inhabit their unpredictability. If the pain doesn’t take your body the side effects of the pain medication will."

Charis wisely resists the tendency some of our neighbors have to clap us on the back and tell us how commendable we are for our "courageous fight." Of all the things people said to me during my months of chemotherapy, it was this sort of comment that rang most hollow. I didn’t want to be commended for being sick. I hadn’t chosen it. If I’d had the choice, I would have run the other way and cheerfully claim the label of coward.

It’s hard to own the adjective "courageous" when we have no choice in the matter.

Charis evidently feels the same way:

"We are not strong, we are not admirable, we are not role models because we woke up and chose to be. We are strong, admirable role models because we have no choice but to fight for sanity and purpose every day of our lives, with every beat of our heart, with every step of our feet or our cane or our walker or our wheels. What we do is not commendable because our career dream as a third grader was to become a chronically ill warrior. What we do is commendable because we do not give up the fight against what we did not choose to become. Because we have two choices: give up or fight."


Monday, August 03, 2015

August 3, 2015 - Thief or Messenger?

Being diagnosed with cancer — especially if it happens earlier than the twilight of a full lifespan — can be a faith-shaking experience. I found it to be so with my diagnosis at age 49. Much of this blog has been a journal of my continuing efforts to understand the spiritual dimensions of this medical reality.

On this past weekend’s episode of PBS’ Religion and Ethics Newsweekly, I heard a fellow cancer survivor address this aspect of the cancer experience.

Father Cassian Folsom is abbot of the Benedictine monastery at Norcia, Italy.  Norcia (sometimes spelled Nursia) is the birthplace of Benedict, the founder of western monasticism in general and the Benedictine order in particular. In 1998, Father Cassian moved from St. Meinrad’s Abbey in Indiana to re-establish the Benedictine monastery at Norcia. That monastic community had been dissolved in 1810 under the rule of Napoleon.

Benedictine monasticism is now thriving again in the birthplace of its founder, but Father Cassian has been faced with a new, very personal challenge. Several years ago, he was diagnosed with multiple myeloma. He is now in his second remission.

You can view the interview here (the segment in which Father Cassian speaks about his medical situation is found at about 5:45):

The interviewer, Judy Valente, was asking Father Cassian whether he, as a monk, felt he somehow deserved a better deal from God than other people, when it came to his cancer diagnosis. Here’s what he said:

“It’s just a part of life, that’s all. I would say this: we can look at death as a thief or a messenger. A thief comes and steals what is most valuable to us, and so we’re afraid. A messenger who comes to tell us that our beloved is at the door, we respond much differently, don’t we?”

Those who are inclined to view cancer as a vehicle for divine justice may be perplexed when a person with a religious vocation is diagnosed. At times, I’ve gotten that reaction from others. Father Cassian gently deflects that line of questioning: “It’s just a part of life, that’s all.”

Cancer — even a cancer that goes into remission or is cured — is an abrupt reminder of the inevitability of death.

What the Abbot says next is, to me, what’s truly memorable. He says we can regard death as either a thief or a messenger. That decision on how to interpret the meaning of our cancer can make all the difference.

If we regard cancer as a thief, the only sensible response is to bolt the door — or, if our uninvited guest has already crossed the threshold — to energetically fight it off.  Fear and anger are the emotions associated with such a response (hence, military metaphors like a patient “battling with” cancer).

Yet, if we entertain the possibility that cancer could be a messenger, that it may have something valuable to teach us, then our response is different. We probably won’t open the door and invite it in for tea, but we’ll at least take some time to discern what message it’s bearing.

I’ve had a strong sense throughout this process — and have written about it upstream in this blog — that an early cancer diagnosis can cause a person to race through the normal stages of adult development and begin confronting issues others don’t begin to address until they’re in the retirement home. I think this may be what Father Cassian is getting at when he speaks of cancer as a messenger.

The spiritual question is: Do we have ears to hear?

Tuesday, July 28, 2015

July 28, 2015 — Your Cheatin’ Cancer

An item in yesterday’s New York Times provides a different perspective on cancer and how it operates within the body.

George Johnson writes about cancer as an evolutionary cheater.

The idea that life began in “primordial soup” with single-celled organisms is well-known. The truly remarkable thing is that those microorganisms learned how to cooperate with one another, developing specialized functions useful to the larger aggregation of cells.

“Each of these collectives,” writes Johnson, “is held together by a delicate web of biological compromises. By surrendering some of its autonomy, each cell prospers with the whole.”

Now, here’s where cancer comes in:

“But inevitably, there are cheaters: A cell breaks loose from the interlocking constraints and begins selfishly multiplying and expanding its territory, reverting to the free-for-all of Darwin’s pond. And so cancer begins.”

It’s possible to trace this cellular cheating phenomenon across the full range of living organisms, from the most primitive to the most advanced.

The cheating becomes truly destructive when, ironically, the cheater cells resist the entirely natural process of dying:

“In a healthy organism, a cell replicates only as frequently as needed to maintain the population and allow for modest growth. Cancer cells begin reproducing wildly, consuming more than their share of resources and spewing poisons that degrade the environment and reshape it to their own advantage.”

The cancer cells cease living for the good of the organism and begin living only for themselves. If that means damaging or destroying some of the cells around them, so be it. Individual survival at any cost is the cheater’s motto. Sounds a little like libertarianism, no?

Many cancer cells develop their own collective within the larger organism — cooperating with other nearby cancer cells, but not so much with the larger body. Some malignant cells develop specialized functions within their sub-collective. The cheaters come together in something resembling gangs.

So, the disease we’re seeking to overcome is a cheating, selfish aggregation of cells.

Makes it a bit easier to go after these cheating cells with all the therapeutic weapons in the oncologists’ arsenal, doesn’t it?

The ultimate irony is that, if the cancer succeeds in bringing about the death of the organism, it dies too. Ultimately, cheaters depend on others they can cheat.

Wednesday, June 03, 2015

June 3, 2015 — Rituximab’s Latest Dance Partner

Some encouraging news from the world of lymphoma research:

“Polatuzumab plus rituximab in relapsed/refractory follicular lymphoma showed high overall response rates at two doses of polatuzumab, with a higher complete response rate at 2.4 mg/kg, data presented at the 2015 American Society of Clinical Oncology (ASCO) annual meeting have shown....

Researchers enrolled 45 patients with relapsed/refractory follicular lymphoma and assigned them to receive polatuzumab at 2.4 mg/kg or 1.8 mg/kg with rituximab 375 mg/m2 every 21 days until disease progression or unacceptable toxicity.

Results showed that overall response rates were 76% (19/25) and 75% (15/20) in the 2.4 mg/kg and 1.8 mg/kg groups, respectively.”

Rituximab — which I received, in conjunction with the CHOP chemotherapy cocktail in 2006 — continues to be the gold standard in treating non-Hodgkin lymphoma. For refractory (recurring) disease, the doctors are continually trying new combinations of rituximab with other drugs. This combination — for indolent disease — is the latest variation.

Keep at it, researchers!

Friday, May 22, 2015

May 22, 2015 — Dying and Unafraid

Anyone who’s read widely about religion in America knows the name of Phyllis Tickle. As the longtime religion editor for Publisher’s Weekly, she’s had a great influence on contemporary religious writing. In recent years, she’s garnered acclaim for several books of her own, most notably The Great Emergence. These have sought to make some sense of the rapidly-changing American religious landscape.

She hasn’t written much about her own faith journey, though — or, at least, nothing I’ve seen in print. She’s been diagnosed, now, with Stage 4 lung cancer and has been told that her condition is not curable.

Maybe that diagnosis has freed her to share more deeply about her inner life. In a Religion News Service interview published today (“Author Phyllis Tickle faces death just as she enjoyed life: ‘The dying is my next career’”), she shares the details of a near-death experience she had as a young woman of 21. She’d been given an experimental drug to prevent a miscarriage, and things went south after that:

In the middle of the night, she stopped breathing; her husband, a medical student at the time, was able to revive her long enough to get her to the hospital.

“Mine was a classic near-death. So, not much to say,” she begins. “I was dead.

“I was like a gargoyle up in the corner of the hospital room,” she continues. “And I remember to this day looking down and watching Sam beat on me again and screaming for the nurses, and the nurses coming with the machines and the whole nine yards. And then the ceiling opened and I just went out the corner and into a tunnel, which was grass all the way around. Ceiling, sides, the whole thing.

“And I went to the end of the tunnel to this incredible — people call it ‘the light.’ I guess that’s as good a name as any. But an incredible peace, a reality, unity, whatever. The voice, which was fortunately speaking in English” — she laughs again — “said, ‘Do you want to come?’ And I heard myself saying, ‘No, I want to go back and have his baby,’ meaning Sam.”

She recalls that she turned around and went back down through the hole in the ceiling and into her body.

Her analysis, all these years later?

“You’re never afraid of death after that,” she told the interviewer. “I’m sorry. You could work at it but you’d just never be afraid of it. … You don’t invite that kind of thing. It’s a gift. It’s not like you can prepare for it or anything. It’s part of the working material you’re given.”

Such experiences are truly a gift — both for those who have them and for those who hear about them.

Tuesday, May 12, 2015

May 12, 2015 — The Mountain Lion in the Fridge

“What’s it like to go through cancer treatment? It’s something like this: one day, you’re minding your own business, you open the fridge to get some breakfast, and OH MY GOD THERE’S A MOUNTAIN LION IN YOUR FRIDGE...”

That’s the beginning of a rather creative blog post by a cancer survivor named Caitlin Feeley. It brought a smile to my face because it’s so accurate.

Not the mountain lion in the fridge part, of course: but the things various people say to you as you’re trying to claw your way up the mountain where the only creature capable of fighting off the mountain lion — a bear — happens to live. Things like, “That’s not really a mountain lion, it’s a puma,” and “I read that mountain lions are allergic to kale, have you tried rubbing kale on it?”

I don’t feel right about cutting and pasting the whole thing here, but here’s a link where you can read the whole piece.

Well done, Caitlin. You captured the experience.

Sunday, April 19, 2015

April 19, 2015 — Blood Test for Cancer?

This is huge.

Today’s New York Times tells of some research now under way that could lead to a simple blood test that could be used to diagnose cancer, particularly blood cancers like lymphoma (Gina Kolata, “Blood Test Shows Promise as Alternative to Cancer Biopsy,” New York Times, April 19, 2015)

From the article:

“The hope is that a simple blood draw — far less onerous for patients than a traditional biopsy or a CT scan — will enable oncologists to quickly figure out whether a treatment is working and, if it is, to continue monitoring the treatment in case the cancer develops resistance....

‘This could change forever the way we follow up not only response to treatments but also the emergence of resistance, and down the line could even be used for really early diagnosis,’ said Dr. José Baselga, physician in chief and chief medical officer at Memorial Sloan Kettering Cancer Center....

A National Cancer Institute study published this month in The Lancet Oncology, involving 126 patients with the most common form of lymphoma, found the test predicted recurrences more than three months before they were noticeable on CT scans.”

The new test follows a novel approach: searching for tiny snippets of cancer DNA that the body sheds into the bloodstream. The DNA shards are tiny and short-lived (they last for only a few hours), but extremely sophisticated blood tests are evidently now able to pick out this particular needle-in-a-haystack.

Early signs are that the test may be more useful for follow-up with existing patients who are known to have had tumors than for first-time diagnoses. It doesn’t appear to be the sort of test that could successfully be given as a routine screening for healthy patients:

“Another possible application — early diagnosis of cancer — is trickier. If a blood test showed cancer DNA, what would that mean? Where is the tumor, and would it help to find and treat it early? Some cancers stop growing and even go away on their own. With others, the outcome is just as good if the cancer is found later.”

If this blood test is successfully developed for clinical use, it could greatly reduce the need for CT and PET scans in monitoring patients during and after treatment.

As I’ve said, this is huge (although, admittedly, still just a theory at this point). I’ll be watching for further news on this.

Monday, April 13, 2015

April 13, 2015 — Bankruptcy Fears

Here’s a factoid I ran across today, in an article in Cure magazine. Over one-third of cancer patients, in a recent study, identified bankruptcy as one of the worst fears they’re facing as a result of their treatment.

Think about that: one-third! (Actually, it was a little worse than that: 37.1 percent). That’s an awful lot of worried, seriously-ill people, who are obsessing over something not directly connected to their disease.

Now, here’s the real kicker. From the article:

“Most of the [480] patients were covered by an employer-based plan or some form of Medicare; 18 participants had purchased their coverage through a health insurance marketplace; and five patients reported not having insurance of any kind and being unable to afford a plan.”

Most of the people who such worries about going bankrupt have insurance! So much for insurance providing peace of mind. What does that say about the quality of the insurance safety net so many are depending on?

Even worse than worrying about inadequate insurance is the worry about having no insurance at all. A great many survey respondents spoke of certain trade-offs they’ve had to make, to keep their medical funding in place, “such as choosing doctors based on co-pays, cutting back on food, activities — including education — to save money, and becoming isolated from family members. 'Even if I starve to death, I will not let go of my insurance. That is my life,' said one woman.”

It’s a sad commentary when a seriously-ill person is reduced to describing her insurance policy as her life.  For far too many in our country, medical insurance is indeed a life-or-death matter.

Time for national single-payer health insurance — such as nearly every other industrialized nation already has — wouldn’t you say?

Thursday, April 09, 2015

April 9, 2015 — Obscenity and Glory

Easter’s come and gone. The day, anyway. For Christians who follow the liturgical year, the season lives on, in the forty days between Easter Day and Pentecost.

Today I ran across this quotation from a collection of sermons by Frederick Buechner, The Magnificent Defeat (HarperCollins, 1985). Buechner is a preacher’s preacher. Although he doesn’t step into a pulpit that often, his influence as a writer is widespread, and much-appreciated by those who craft sermons week in and week out.

Here’s the excerpt:

“Anxiety and fear are what we know best in this fantastic century of ours. Wars and rumors of wars. From civilization itself to what seemed the most unalterable values of the past, everything is threatened or already in ruins. We have heard so much tragic news that when the news is good we cannot hear it. But the proclamation of Easter Day is that all is well. And as a Christian, I say this not with the easy optimism of one who has never known a time when all was not well but as one who has faced the Cross in all its obscenity as well as in all its glory, who has known one way or another what it is like to live separated from God. In the end, his will, not ours, is done. Love is the victor. Death is not the end. The end is life. His life and our lives through him, in him. Existence has greater depths of beauty, mystery, and benediction than the wildest visionary has ever dared to dream. Christ our Lord has risen.”

What I like about this expression of Easter faith is its realism. There no illusions, here, that life is never hard. There’s no attempt to sell the idea that God offers the baptized a “Get out of suffering free” card. There are plenty of purveyors of spiritual snake oil out there who carry around whole stacks of such cards, and hand them out as a come-on. (It works. They always seem to be surrounded by hopeful hordes waving dollar bills.)

Buechner’s got too much integrity for that. For him, the cross is not an item of sparkly gold jewelry, but an “obscenity” that — paradoxically — leads to glory.

For people with cancer, or anyone else who’s on a hard road, there’s hope in that vision. Hope doesn’t come from finding a way around life’s struggles and heartaches. It comes from resolutely forging on through them — knowing that, on the other side, someone’s waiting for us. Someone who’s been through it, too.

Monday, March 23, 2015

March 23, 2015 — God is Bigger

J. Todd Billings is a Reformed Church in America minister who’s on the faculty of Western Theological Seminary in Holland, Michigan. Like me, he’s dealing with an “incurable but treatable” blood cancer diagnosis: in his case, multiple myeloma. He’s written about his cancer experience in a new book, Rejoicing in Lament: Wrestling with Incurable Cancer and Life in Christ (Baker,  2015).

I intend to get the book and read it, but in the few teaser excerpts provided by the publisher, I’ve heard echoes of my own experiences of years past.

I was particularly impressed by an anecdote he tells in the opening pages, of receiving a card from a 15-year-old girl from his congregation with Down Syndrome. By way of encouragement, she wrote: “Get well soon! Jesus loves you! God is bigger than cancer!”

Billings identifies some pretty good theology in the girl’s words:

“While I had received many cards in the previous days, this one was different. ‘God is bigger than cancer!’ Yes. She did not say, ‘God will cure you of this cancer,’ or ‘God will suffer with you.’ God is bigger than cancer. The fog is thick, but God is bigger. My cancer story was already developing its own sense of drama. The sky was closing in, enveloping my whole world so that nothing else could creep in. But God’s story, the drama of God’s action in the world, was bigger. The girl in my church wasn’t denying the fog or the loss but testifying to a God who was greater, the God made known in Jesus Christ, who shows us that “the light shines in the darkness, and the darkness did not overcome it (John 1:5)….”

Billings also finds comfort in the famous first Question and Answer of the Heidelberg Catechism:

“‘What is your only comfort in life and in death? That I am not my own, but that I belong — in body and soul, in life and in death — to my faithful Savior Jesus Christ.’ Like the note from the fifteen-year-old girl in my church, it breaks through the fog of ‘terminal’ and ‘incurable’ and ‘cancer’ by pointing us to the bedrock of what matters: that I belong, in life and in death, to Jesus Christ. My life is not my own….”

I like this concept of the bigness of God, when it comes to living with cancer. The first tendency of many of us, as we learn of a cancer diagnosis, is to allow the cancer to grow in our minds until it crowds out everything else, even our faith. This amounts to making the cancer into an idol, an object of false worship. The god to whom that idol bears witness is a malevolent deity, indeed. But that doesn’t stop us — in horrified fascination — from ascribing to the cancer god all sorts of power over us.

A healthy understanding of the bigness of the one, true God is the way to overcome that false worship. As the teenager with the mighty heart bears witness, cancer’s big, but God is bigger.

Billings goes on to say:

“This place of not knowing is one that sometimes feels like a thick fog for me right now. I could have five years, ten years, or decades. Who knows? Not me. We belong to God — the Alpha and the Omega, who holds time In his hands — but we are not God. We are mortal, and we don’t know when we will die. There is a fog for all of us, whether we realize it or not, that as creatures we do not live in the world as individuals who own it but as temporary stewards of God’s good gifts.”

How easy it is to reduce God to the sum-total of our needs and desires! “Where are you, O God?” is so often our demand, when we learn that our expectations of a long and healthy life are threatened by a cancer diagnosis.

Yet, if God is indeed bigger than our dreams and desires — bigger, even, than our very lives — then isn’t it just a trifle audacious for us to shake our fists at the heavens, demanding an answer to that question?

It’s only human to voice such angry laments, from time to time. I don’t think God is particularly offended by that sort of thing. Because God is bigger. Yes, indeed.

(Quotations from J. Todd Billings,  Rejoicing in Lament: Wrestling with Incurable Cancer and Life in Christ [Baker, 2015], selections from pp. 1-7.)

Saturday, February 28, 2015

February 28, 2015 — Dear Cancer, I Hate You

“Dear cancer, I hate you.” Those words that begin the personal essay are jarring. They’re written by a young woman named Jenna Rose Lowthert, in an essay published in our local newspaper, in memory of her mother, Gina.

Gina died of cancer.

Yes, cancer is something we come to hate. But — as in the odd occurrence of the word “dear” in this letter’s opening — there’s also a macabre intimacy to it.

We live with cancer — both those of us who are actively being treated, and those of us in remission. We hate it, yes. But it’s also become part of our lives.

It’s part of us. A symptom of our fallen condition on this earth, perhaps. A dark mystery. The intimate companion we never invited into our lives.

Here’s some of what Jenna wrote (click on the link above to read the whole article):

Dear cancer,

I hate you.

You’re terrible.

You are the true definition of a heart breaker.

You single-handedly ruined my entire life in the matter of 10 short months.

You took away my best friend, the only person in this world who will ever love me unconditionally.

You took away my mother — and you took her in the most horrible way possible. You stopped her heart from beating at the young age of 48....

Yet, as Jenna has evidently discovered, cancer is also a teacher, although a harsh one:

The same thing that drives me to live after this loss is the same reason I hate you.

But cancer, you did not win the day my mother gained her angel wings.

You did not beat her. She beat you, as she left this world with her love, her hope, her strength, her bravery and her dignity, surrounded by the people who she loved the most.

You may have destroyed a lot, but you have, in turn, taught me lessons I never thought I would learn by age 25. You showed me just how short and precious life truly is. You showed me that every day is a gift and that I should never take anything or anybody for granted. You have forced me to recognize a strength within myself that I never knew existed.

Cancer, although I hate you with all of my heart, you have brought out the woman in me that my mother always hoped I would be....

And that is why you did not win.

Cancer is our teacher, but it is also our adversary. In contending with this challenge, we grow stronger. And better.

Who’s to say if this is the best way for us to grow? Who’s to say if God could have accomplished the same purpose in some way that’s easier, less painful?

From our limited vantage-point, we can never say for sure. But we can strive to live with cancer. We can strive to do it with courage, as Jenna and her mother have.

Thursday, January 08, 2015

January 8, 2015 - What You Can't See in the Tide Pool

A poignant personal reflection on life and death, today, from Anne Lamott's book, Traveling Mercies:

We were, in fact, going to learn later that afternoon that my father had a brain tumor on the word section of his brain, a metastasized melanoma, something no one had ever survived at that time. In just a week or so, doctors were going to take out as much of the tumor as they could, but they weren't going to be able to get it all; its tentacles reached deep inside his brain. He was going to come home from the hospital to his girlfriend's house looking like Dr. Frankenstein had had a go at him. He was going to have the most aggressive forms of radiation and chemotherapy available, be part of a clinical trial that wouldn't work for him; he was going to have one good year in between these treatments where he would be able to work off and on, and walk with us every day; he was going to live to see John graduate from Berkeley; he was going to live to see my younger brother graduate from high school; he was going to live to see me sell a novel about our family to a fancy New York publisher; he was going to live to read a draft of it while his brain was still functioning.

But then the cancer was going to start to eat away at his mind, and he was slowly going to end up like a huge friendly toddler. He was going to have to bear knowing for a while that his mind was going; he was going to have to bear letting his kids and girlfriend dress him, clean him, feed him; he was going to end up living at the one-room cabin with me and Steve, his girlfriend and oldest friends around, playing Pete Seeger on the stereo, and Billie Holliday, Joan Baez, and Mozart, the Modern Jazz Quartet. He was going to end up in a coma a month before he died, the cabin turned into a hospice room and us the stricken nurses. My father's handsome fair face was going to have tumors on it— tumors on the skin that today was flushed with health. The cancer was going to spread like a chain of stores, and he was going to need morphine and catheters and lemon swabs and fleecy bedding. Maybe he would hear the music we played on the stereo in the cabin, maybe he would be aware of us watching him through the night, but what we did not know that day on the lava rock was that he was going to die two years from this August morning—this morning when the three of us were walking about peering into tide pools, with our dog Muldoon bumping into our legs, the late-summer diffusion of light making everything in the pools seem larger: the sea anemones, the bloom of algae, the tiny crabs.

Saturday, December 27, 2014

December 27, 2014 — It’s Always Something

I ran across an older article today that I had somehow missed when it came out (oh, I know why I missed it — I had just gotten out of the hospital at the time, recovering from my pulmonary embolisms and complications thereof). On January 4, 2014, George Johnson writes, in a New York Times article called “Why Everyone Seems to Have Cancer”:

“The rhetoric about the war on cancer implies that with enough money and determination, science might reduce cancer mortality as dramatically as it has with other leading killers — one more notch in medicine’s belt. But what, then, would we die from? Heart disease and cancer are primarily diseases of aging. Fewer people succumbing to one means more people living long enough to die from the other.”

I’ve written about this phenomenon on other occasions. In most cases, tt’s not that cancer is increasing, due to pathogens in the environment or from whatever other cause you may care to name: we’re just living longer because other threats to human survival have been minimized. And the older we get, the more our cells become subject to mutations that can result in cancer.

Something similar is happening with Alzheimer’s Disease, that’s likewise on the rise. It’s a disease of the aged, so if you increase the number of the aged, you’re going to see more disease.

Johnson continues:

“[Cancer] is not so much a disease as a phenomenon, the result of a basic evolutionary compromise. As a body lives and grows, its cells are constantly dividing, copying their DNA — this vast genetic library — and bequeathing it to the daughter cells. They in turn pass it to their own progeny: copies of copies of copies. Along the way, errors inevitably occur. Some are caused by carcinogens but most are random misprints.”

Remarkable progress has been made, Johnson points out, in reducing or curing childhood cancers — mortality from childhood cancers has fallen by more than 50% since 1975. When specific cancers are caused by carcinogens — such as tobacco smoke in the case of lung cancer, or poor public sanitation in the case of some stomach cancers — gains have been made on those fronts, as well. But still, an increasingly aged population means increases in cancers as well.

I’ve occasionally heard some people say, tongue-in-cheek, after the latest news report that some food or chemical causes cancer: “Life causes cancer.” There’s actually some truth to that.

Monday, November 17, 2014

November 17, 2014 — Bye, Bye Bexxar

There are many ways our market-driven healthcare-funding system in the United States is just plain crazy, but one of the most damaging is the way it tends to suppress certain vital and effective medications. This has evidently just happened to Bexxar, which is no longer available. Along with its competitor Zevalin, Bexxar is a radioimmunotherapy agent.

Radioimmunotherapy is an ingenious bonding of a monoclonal antibody drug — Rituxan (rituximab) — with tiny radioactive particles. It delivers a one-two punch: the Rituxan chemically seeks out the cancer cells and the radioactive particle destroys them.

Radioimmunotherapy has proven to be very effective, and has the added advantage of doing its job in just one dose, with minimal side effects.

What’s not to like?

The people who really don’t like it are oncologists. And why? Because not many of them have the proper qualifications to administer it. As a hybrid of nuclear medicine and oncology, radioimmunotherapy requires doctors either to be dual-certified in both disciplines or to be part of a large clinic or group where both specialties are represented (a rare thing, in this case).

Many oncologists profit on two levels: both their professional fees and the fees they charge for running a chemotherapy suite. If their chemo suite doesn’t offer nuclear medicine as well, they lose a big chunk of change by referring a patient out.

An oncologist who refers a patient for radioimmunotherapy loses tens of thousands of dollars in billable fees. That’s a powerful financial incentive to stick with traditional chemo — even though that treatment takes longer (many months of infusions as compared to a single injection) and often has arduous side-effects.

This is not a problem for a large, multi-specialty clinic, but the typical oncology practice — which includes a group of oncologists only — can’t handle it. As Dr. Bruce Cheson of Georgetown University puts it, “patients had to be referred from one doctor to somebody somewhere else, which meant not only losing control of the patient, but also losing income from the patient.”

In many cases, radioimmunotherapy agents cost less — not as a single dose, but when averaged out over the total time required for treatment.

“There is actually no other drug out there with a track record like this,” writes Dr. Mark Kaminski of the University of Michigan, who helped devlop Bexxar. “Approximately 30% of patients can achieve long-term remission with Bexxar lasting over a decade. That's the biggest disappointment with this drug, now that it's gone, for patients with this disease — it was an easy treatment, it took only one week to finish, and if there were any side effects, they were all reversible. I've been giving Zevalin lately because I don't have Bexxar to work with, but I don't have as much confidence that it will be a solution for patients as much as Bexxar would have been.”

If we had a single-payer healthcare system (like Medicare), and if doctors practiced in multi-specialty clinics like the Mayo Clinic or the Cleveland Clinic — where they receive a salary rather than billing patients by the hour — then doctors wouldn’t stand to lose by recommending radioimmunotherapy. More patients would benefit.

Why do we expect physicians to be both medical practitioners and entrepreneurs? Sometimes those two functions are in conflict with one another, and this is a prime example.

Too often in our healthcare system, profits come first and patients second.