Learning

In writing a few of these blog posts now, I’m starting to realize that the purpose of this blog is really to summarize things I have recently learned.  Writing things down helps me solidify my understanding of a topic.  I also write because I want to share my knowledge with others.  I have always loved learning, and sharing that learning.  I guess this is my attempt to accomplish both of those passions.

Book Review - part 2

See previous post below for part 1

The War on Cancer

The Laskerites, named after Mary Lasker, were a group of philanthropists who worked to raise awareness about cancer in the ‘40s, ‘50s, and ‘60s, culminating in the creation of the American Cancer Society.  One of their original battle cries was to “win the war on cancer” as if there were a specific, single cure similar to the polio vaccine.  What they did not realize, however, was the incredible diversity and potency of cancer.  It is an ever-evolving enemy.  The author described cancer as a more perfect form of us.  It finds better, faster ways to reproduce than even the normal human body.  Just when researchers discover a protein that inhibits one cancerous mutation, the cancer develops an alternative, and then another.  I don’t know that medicine will ever fully catch up.  However, in playing the catch-up game, we are succeeding in extending the lives of cancer patients.  Towards the end of the book, Muhkerjee suggests re-defining “winning the war on cancer.”  Oncologist Richard Doll prefers the aphorism: “Death in old age is inevitable, death before old age is not.”

Life Lessons

Do not ignore your body’s warning signals.  If something feels out of the ordinary, do not ignore it.  I’m not saying that your pain is cancer, but it certainly could be.  When you’re at the doctor’s office, challenge him or her with every ailment you can think of.  Next to avoiding known carcinogens (like smoking), being proactive is the best possible thing you can do to avoid cancer. 

Do not wait for a terminal illness to compel you to act on the things you’ve been meaning to do.  Muhkerjee gave a number of examples of young patients with no prior medical issues who came to the hospital with a late-stage cancer.   Many died.  Some were fortunate enough to be treated and survive for several more years.  Many of those individuals resolved to change their lives and do things they should have done years ago.  My hope is that all people live the lives they want to live, without waiting for a deadline to start to act. 

Definitions

Anemia is a low red blood cell count, linked to the blood cancer, leukemia. 

Metastasis is the migration of cells from one site to another.  Some cancers metastasize much faster than others.  Generally, the more metastasized the cancer is, the more difficult to treat.

Leukemia is an explosive form of cancer in which the white blood cells divide uncontrollably.  The word has its etymological origins in the Greek word leukos, which means “white”.  I remembered this from my baseball days, when the guys that would dip tobacco would talk about how it causes leukoplakia, the white spots on the inside of the lip.   

A Rorschach test is the name of the psychology test with the black ink blots where the subject is asked to describe what they see (a butterfly, for example).  I never knew what that was called. 

When AIDS became prevalent in the early 80’s (much later than I thought) it was called GRID (Gay-Related Immune Disease).  You can bet it wouldn’t be given that name today.

Pathology is the study of diseases.

Oncology is the study of cancer.

A prophylactic medicine is prescribed to prevent disease.

A therapeutic medicine is prescribed to cure disease.

Endocrine = hormonal

A pyrrhic victory is one that comes at a great cost to the victor. 

Quotes

“In God We Trust.  All others must have data.”  - A reference to the need to back up all claims with statistical evidence.  Statistics, as it turns out, is a huge part of proving the effectiveness of drugs in clinical trials.

 “Counting is the religion of this generation.  It is its hope and its salvation.”  - Gertrude Stein.  I like this one for obvious reasons.

“Death in old age is inevitable, death before old age is not.” – possible re-definition of the goal of cancer researchers.

Book Review: The Emperor of All Maladies (A Biography of Cancer) - part 1

I first heard about this book from a radio interview of the author, Siddhartha Muhkerjee.  In the 15 minutes that I was listening, Muhkerjee, an oncologist, was able to explain some incredibly complex concepts (genetic mutations, radiology, surgical procedures) in a way that a non-scientific audience could not only understand but appreciate.  The man is brilliant (graduated from Stanford, Oxford, and Harvard, a Rhodes scholar, and now professor and physician at Columbia).  After the interview, I took my phone out and wrote down the name of the book (yes, while driving).  I bought it soon after and really enjoyed reading it.  Here are some of the interesting things I learned from the book. 

Summary

The book is a history of cancer and cancer treatments, interwoven with stories about the author’s cancer patients. 

The real history of treatment picks up in the 1800’s, when the only remotely effective method of treating cancer was with the knife.  The surgical removal of malignant tumors and lumps.  This was an awful time for cancer patients.  Not that being a cancer patient is ever easy, but up until the 1950s, surgeons, seeing some limited success from their surgeries, continuously expanded the reach of their knife.  Take, for example, breast cancer patients.  A mastectomy is the removal of the breast in breast cancer patients in an attempt to remove the tumor.  Gradually, surgeons started chasing after metastasized (see definition below) tumors and began cutting more and more of the patient’s insides away.  The radical mastectomy, as it was called, would sometimes reach all the way to the neck and armpit area of patients.  After surgeries, the patients would be permanently disfigured and sometimes lost normal control of their arms.  It wasn’t until controlled studies and major statistical efforts proved that there was no added benefit from such radical surgeries that they began to be phased out.  Regular mastectomies, however, are still common today. 

The next form of treatment discussed was radiation.  Marie Curie discovered the element radium in 1902.  Subsequent discoveries that radium (and X-rays) attacks DNA and consequently kills cells led to the practice of radiation treatment on cancer patients.  The key effect of radium on cells is that it causes them to cease to divide.   And what divides most rapidly?  Cancer cells.  Radiation treatment preferentially kills cancer cells!  It has numerous adverse effects though, including anemia (definition below).   Marie Curie herself died of leukemia due to repeated exposure to radiation.  Radiation treatment is still used to this day. 

A third form of cancer therapy is chemotherapy: the use of toxic chemicals to kill cells (both normal and cancerous).  The effect is most visible when fast-reproducing cells are killed (such as hair).  Some drugs occur naturally, and others are bioengineered.  Scientists today have expansive programs to develop new drugs, but a great many were and still are stumbled upon.  Modern oncologists tend to treat patients with a mix of chemotherapy drugs, as there are inevitably some peripheral cancer cells that escape death from a single drug and continue to divide.  The supplementary drugs can often kill those rogue cells. 

Unfortunately, none of these treatments reach the core of cancer.  For hundreds of years, scientists and doctors were approaching cancer backwards.  They simply tried to figure out how to kill cancer after it had progressed, without a fundamental understanding of the genesis of cancer.  It was a reactive, rather than a proactive, approach.  The latest, and most hopeful, assault on cancer, however, attempts to understand the origins of cancer.  Excluding carcinogens such as smoking, cancer is fundamentally a genetic disease.  Genes, as I was forced to remember from freshman biology, are carried on a cell’s 23 pairs of chromosomes.  The Human Genome Project, completed in 2003, was the first full sequence of the approximately 23,000 genes in a normal cell.  Researchers are now working on the next logical step: sequencing the genomes of common cancer cells.  The leader of the HGP predicts that this could end up being the equivalent of more than 10,000 HGP’s, which itself took 13 years.  This will allow researchers to identify every single mutated gene.  From there, work can begin on determining which mutations occur most frequently in cancer cells, which mutations drive cancerous behavior, and, finally, how to block those mutations.  One early success story is the development of the drug Gleevec, which inactivates the hyperactive kinase in CML (a variant of leukemia) cells.  Long story short, there is hope for alleviating cancer through genetic research. 

Fans

I’m struggling with my identity as a Bengals fan given their consistently poor leadership and on-field performance over the past 20 years.  That got me thinking, why am I a Bengals fan?  Or, more generally, what makes me a fan of any particular team?  Here’s the reasons I came up with:

1.      Affiliation (geographic, university matriculation) - growing up in Cincinnati, I was raised to cheer for the hometown teams: the Reds and Bengals.  In the four years as an undergraduate at Notre Dame, I became a big Notre Dame sports fan.  Affiliation is probably the most commonly listed reason people give for cheering for a particular team.  I’m no different.  In fact, I’m being converted to a Packer fan since my fiancé is from Wisconsin. 

2.      Management/Ownership – most owners and managers/coaches are very serious about putting together and sustaining winning programs.  It is these programs that I respect, even if they lack the other 3 characteristics on this list.  Prime examples are the Steelers , Patriots, and Yankees.  Many people, including me, love to hate these teams because they have won more championships than any other team in their respective leagues.  They are the ‘goliaths’ that no one likes to root for.  But for this very reason, I respect the fact that they are able to win more consistently than any other organizations.  Some might attribute their success to deep pockets, but in the NFL, where parity is the name of the game, it’s hard to ignore the Steeler and Patriot (and Bengal, on the opposite end of the spectrum) outliers. 

3.      Player character – It’s hard to root for quarterbacks who allegedly rape women, players and coaches who are arrested multiple (1 would also be unacceptable) times for drunk driving, and college coaches who recruit student-athletes who, for whatever reason, graduate at rates of less than 50%.  In fact, this makes it much easier to root against those teams.  On the flip side, it’s very easy to root for guys who give back to the community, stay out of trouble, and are known to be team players. 

4.      Fan character – The example that prompted me to write this: I just overheard a Green Bay Packer fan walking through the Atlanta airport, on the eve of Super Bowl XLV (Packers v. Steelers).  Two weeks ago, Green Bay defeated Atlanta in the NFC Championship, shouting “Thank you!...fine people of Atlanta, and the Falcons, for getting whooped, and sending the Packers to the Super Bowl.”  Clearly he had a few on his arriving flight.  Now, up to this point, I would say I’m progressing into more and more of a Packer fan.  But this guy just caused a temporary relapse.  If the Packers do lose this Super Bowl, I wish I could be there to hear that inevitably drunk and annoying Steeler fan berate him a little. 

My message to him and all fans is that you can still enjoy your team’s success without being an a-hole.  Unfortunately, there are annoying and uncouth fans of every team.  There just seem to be a lot more Ohio State Buckeye fans! 

In short, I think Notre Dame and the Reds do well at #1-#3 and, for the most part, 4.  They are my favorite teams.  The Bengals’ overwhelming deficiencies in departments 2 and 3 have led me to officially (if you call this blog official) renounce my status as a Bengal fan. 

Kasich and Railroads

Ohio's new Republican governor, John Kasich.  Don't know much about him, but what I've heard so far, I like.  He sent back federal stimulus money earmarked for a 3C rail connecting Cincinnati, Columbus, Cleveland.  The one that NOBODY would ever ride.  Think about it, it's at most a 2-hour drive between each of these cities.  Let's say it's $15 for a 1-way Cincy to Columbus.  Then, tack on the added cost of getting to the Cincy station by cab, and then another cab from the Columbus station to your final destination.  It doesn't make economic sense for individuals to ride it.  Granted, some people don't have cars.  Well, there's the Megabus and other bus companies, for a lot cheaper.  Until fuel costs, population density, and traffic, make something like this make economic sense for individuals, I'll always be opposed to it.  And I like trains too. 

Now, this guy thinks Kasich's move was stupid becausejobs were lost in Ohio.  Personally, I don't care.  Look at the big picture.  I know the governor represents his state, but he also represents common sense and his country.  I'd rather see jobs created in another state if their project will actually be useful.  Or, better yet, have that money sent back to Washington and used to the reduce federal deficit.  Look at the big picture. 

A long time ago, in the early 1900's, Cincinnati spent a great deal of money to build a subway system.  The Wikipedia article calls it "one of the city's biggest embarrassments."  Let's learn from that mistake.  A thorough estimate of cost and projected payback period for should be completed for any large-scale government and private project.  Voters should not be allowed to vote on the issue until they've reviewed the projections and can take an educated position.