For those who are not following the horrific treatment of our retired and wounded soldiers, here is a quick version:
Bureaucrats that can not process life sustaining treatments to our veterans cheat the system and "officially" report short wait times. In the meantime, they have a secret "off the books" waiting list that they are really using - with wait times much, much longer. They report the shorter times to the higher ups, then to Congress, and everyone is happy.
Unfortunately, the vets are still waiting for treatment, and some have died waiting for those treatments.
Yes - this really pisses me off.
Yes - it is criminal, reporting false data to Congress.
Yes - vets are dying and Eric Holder sees nothing wrong.
In the last 15 years I have been in plenty of hospitals (not all for me) and the VA in Reno is one of the "best". It was scary going in there, and would not pass any inspection I would do there. I don't know if they fall under the Joint Commission's jurisdiction, but it would certainly get a bad review.
The Washington DC butt covering is truly disgusting.
My political opinions (more accurately described as rants), My family, and my multiple myeloma treatments. Hey, might as well put it down while I am on this side of the dirt... jc
Hey - Chemobrain exists! Why am I their poster-boy?
http://journals.lww.com/oncology-times/Fulltext/2014/04250/NCCN_Survivorship_Guidelines_Now_Include.3.aspx
NCCN Survivorship Guidelines Now Include Chemobrain
Susman, Ed
HOLLYWOOD, Fla.—A major hurdle in developing guidelines for the treatment of cancer-associated cognitive dysfunction—now usually called chemobrain—was first getting the medical field to believe that it actually existed. So said Elizabeth Kvale, MD, Director of the Supportive Care and Survivorship Ourpatient Clinic at the University of Alabama at Birmingham Comprehensive Cancer Center, speaking here at the National Comprehensive Cancer Network's Annual Conference, “Advancing the Standard of Cancer Care,” discussing the NCCN's expansion of its Survivorship Guidelines to now include that problem.
Once it was established that the phenomenon was real and had wide impact, the next concern was convincing people who developed cancer-associated cognitive dysfunction that it was not a precursor of dementia. “We can tell our patients that it is likely that the cognitive dysfunction will go away on its own, but even if it doesn't it is not a progressive dementia-type disorder,” she said.
“Reassurance and watchful waiting are not unreasonable strategies for patients exhibiting symptoms of cancer-associated cognitive dysfunction. For most patients these symptoms will resolve on their own over the course of time. Reassuring them that this is not a progressive dementing condition is a perfectly reasonable thing to do.
“When we look at the qualitative experience of cognitive loss in the context of cancer treatment, patients say things like, ‘My mind is just not as sharp as it was’; ‘The total effect of the symptoms is a complete loss of confidence in myself’; and ‘I now work 30 rather than 40 hours a week and I struggle to even do that much,’” Kvale continued.
“For a subset of patients, cancer and cancer treatment disrupt ‘normal’ cognitive functions. We know that this is very clearly the case in people who have primary brain tumors, brain metastases, and those who receive brain-directed treatment such as prophylactic cranial irradiation. In those populations of patients, cognitive effects are anticipated, and generally we do a fairly good job of getting these people to rehabilitation where they address these things.”
HOLLYWOOD, Fla.—A major hurdle in developing guidelines for the treatment of cancer-associated cognitive dysfunction—now usually called chemobrain—was first getting the medical field to believe that it actually existed. So said Elizabeth Kvale, MD, Director of the Supportive Care and Survivorship Ourpatient Clinic at the University of Alabama at Birmingham Comprehensive Cancer Center, speaking here at the National Comprehensive Cancer Network's Annual Conference, “Advancing the Standard of Cancer Care,” discussing the NCCN's expansion of its Survivorship Guidelines to now include that problem.
Once it was established that the phenomenon was real and had wide impact, the next concern was convincing people who developed cancer-associated cognitive dysfunction that it was not a precursor of dementia. “We can tell our patients that it is likely that the cognitive dysfunction will go away on its own, but even if it doesn't it is not a progressive dementia-type disorder,” she said.
“Reassurance and watchful waiting are not unreasonable strategies for patients exhibiting symptoms of cancer-associated cognitive dysfunction. For most patients these symptoms will resolve on their own over the course of time. Reassuring them that this is not a progressive dementing condition is a perfectly reasonable thing to do.
“When we look at the qualitative experience of cognitive loss in the context of cancer treatment, patients say things like, ‘My mind is just not as sharp as it was’; ‘The total effect of the symptoms is a complete loss of confidence in myself’; and ‘I now work 30 rather than 40 hours a week and I struggle to even do that much,’” Kvale continued.
“For a subset of patients, cancer and cancer treatment disrupt ‘normal’ cognitive functions. We know that this is very clearly the case in people who have primary brain tumors, brain metastases, and those who receive brain-directed treatment such as prophylactic cranial irradiation. In those populations of patients, cognitive effects are anticipated, and generally we do a fairly good job of getting these people to rehabilitation where they address these things.”
The Focus of the Guidelines
The guidelines focus on patients who do not receive central nervous system-directed treatments but who may be experiencing cognitive change. “These changes have important quality-of-life and functional implications,” Kvale said. “Generally, patients maintain stable global cognitive function, so they are able to get through much of their daily life without struggle, but they will notice difficulty in specific cognitive domains.”
Estimates of how frequently this happens vary from 17 to 61 percent of patients receiving non-CNS-directed cancer treatment. That wide range may relate to various methodologies, she said, explaining that much of the research involves cross-sectional studies that may not take into account patients' pre-cancer cognitive function.
“Longitudinal studies are necessary to evaluate this problem in cancer survivors, because the research can then look at both the cancer survivors' cognitive function prior to exposure to chemotherapy and after exposure to chemotherapy,” she said.
The guidelines focus on patients who do not receive central nervous system-directed treatments but who may be experiencing cognitive change. “These changes have important quality-of-life and functional implications,” Kvale said. “Generally, patients maintain stable global cognitive function, so they are able to get through much of their daily life without struggle, but they will notice difficulty in specific cognitive domains.”
Estimates of how frequently this happens vary from 17 to 61 percent of patients receiving non-CNS-directed cancer treatment. That wide range may relate to various methodologies, she said, explaining that much of the research involves cross-sectional studies that may not take into account patients' pre-cancer cognitive function.
“Longitudinal studies are necessary to evaluate this problem in cancer survivors, because the research can then look at both the cancer survivors' cognitive function prior to exposure to chemotherapy and after exposure to chemotherapy,” she said.
Looking at Patients Longitudionally
In her presentation, she reviewed the neuropsychological testing, neuroimaging, and animal studies that demonstrate the existence and plausibility of the condition. “Most of the time when we look at patients longitudinally we demonstrate that there is an effect of cancer and cancer treatment,” she explained. A recent meta-analysis demonstrated that in general patients exposed to standard chemotherapy regimens performed worse than non-breast cancer chemotherapy patients in spatial ability.
“An interesting finding is that in some patients cognitive impairment precedes cancer treatment. If we compare those patients with a diagnosis of cancer with those who are not diagnosed with cancer—even at baseline—even controlling for things like depression and emotional distraction during that period, the results suggest that there may be different mechanisms involved.”
Neuroimaging can also show differences in the brains of cancer patients and non-cancer patients, she said. For example, in one study of identical twins asked to do cognitive challenges, the twin who had been exposed to chemotherapy activated greater areas of the brain than her twin. “We see this in larger studies as well,” Kvale said.
“Patients exposed to chemotherapy activate more of their brains to accomplish cognitive challenges. It can also be seen as differences in the gray and white matter in the brain as visualized with diffusion tensor imaging.”
In addition, a series of animal studies indicated that even trace amounts of chemotherapy agents are toxic to brain tissue. “While chemotherapy does not cross the blood-brain barrier sufficiently to treat cancer in the brain, enough chemotherapy may get through as the barrier becomes leaky in the context of inflammation, particularly when patients are exposed to serial treatments,” she said.
In her presentation, she reviewed the neuropsychological testing, neuroimaging, and animal studies that demonstrate the existence and plausibility of the condition. “Most of the time when we look at patients longitudinally we demonstrate that there is an effect of cancer and cancer treatment,” she explained. A recent meta-analysis demonstrated that in general patients exposed to standard chemotherapy regimens performed worse than non-breast cancer chemotherapy patients in spatial ability.
“An interesting finding is that in some patients cognitive impairment precedes cancer treatment. If we compare those patients with a diagnosis of cancer with those who are not diagnosed with cancer—even at baseline—even controlling for things like depression and emotional distraction during that period, the results suggest that there may be different mechanisms involved.”
Neuroimaging can also show differences in the brains of cancer patients and non-cancer patients, she said. For example, in one study of identical twins asked to do cognitive challenges, the twin who had been exposed to chemotherapy activated greater areas of the brain than her twin. “We see this in larger studies as well,” Kvale said.
“Patients exposed to chemotherapy activate more of their brains to accomplish cognitive challenges. It can also be seen as differences in the gray and white matter in the brain as visualized with diffusion tensor imaging.”
In addition, a series of animal studies indicated that even trace amounts of chemotherapy agents are toxic to brain tissue. “While chemotherapy does not cross the blood-brain barrier sufficiently to treat cancer in the brain, enough chemotherapy may get through as the barrier becomes leaky in the context of inflammation, particularly when patients are exposed to serial treatments,” she said.
General Principles
The general principles of the treatment guideline states: “Growing evidence supports the validity of the patient-reported experience of cognitive dysfunction associated with cancer treatment; there is modest correlation between patient reports of cognitive dysfunction and objective deficits with testing.”
In addition, patients with focal neurological defects and those who have been diagnosed and treated for brain metastases of primary brain tumors should be directed to imaging and neuropsychological evaluation. ... Patients benefit from validation of their symptom experience, a thorough evaluation of this concern, and related issues and education.”
However, the guidelines note, there is currently no effective brief screening tool for the problem. Kvale said the Mini Mental State Examination—the ubiquitous test employed to assess mental condition in a variety of scenarios—lacks the sensitivity to find this kind of subtle decline in mental performance.
The guidelines suggest that clinicians treating patients who experience cognitive dysfunction should assess the patients' medications and possible side effects; hormone status; emotional distress such as depression and/or anxiety; symptom burden of pain, fatigue, and sleep disturbance; comorbidities; and use of alcohol or other substances that may affect cognition.
Patients exhibiting cognitive dysfunction should be instructed in enhanced organizational strategies such as the use of memory aids; should avoid multitasking; should limit the use of alcohol; and should exercise regularly.
In addition, second-time therapies could include the use of psychostimulants such as methylphenidate or modafinil.
“What you should take away from this talk is that this problem is a real phenomenon,” Kvale said concluded. “We don't have a great sense of what causes it; we don't have a great sense about what we can do about it, but we do know this is about patient experience and we see those anatomic and physical functional differences in our studies that demonstrate that this is a real thing.”
The general principles of the treatment guideline states: “Growing evidence supports the validity of the patient-reported experience of cognitive dysfunction associated with cancer treatment; there is modest correlation between patient reports of cognitive dysfunction and objective deficits with testing.”
In addition, patients with focal neurological defects and those who have been diagnosed and treated for brain metastases of primary brain tumors should be directed to imaging and neuropsychological evaluation. ... Patients benefit from validation of their symptom experience, a thorough evaluation of this concern, and related issues and education.”
However, the guidelines note, there is currently no effective brief screening tool for the problem. Kvale said the Mini Mental State Examination—the ubiquitous test employed to assess mental condition in a variety of scenarios—lacks the sensitivity to find this kind of subtle decline in mental performance.
The guidelines suggest that clinicians treating patients who experience cognitive dysfunction should assess the patients' medications and possible side effects; hormone status; emotional distress such as depression and/or anxiety; symptom burden of pain, fatigue, and sleep disturbance; comorbidities; and use of alcohol or other substances that may affect cognition.
Patients exhibiting cognitive dysfunction should be instructed in enhanced organizational strategies such as the use of memory aids; should avoid multitasking; should limit the use of alcohol; and should exercise regularly.
In addition, second-time therapies could include the use of psychostimulants such as methylphenidate or modafinil.
“What you should take away from this talk is that this problem is a real phenomenon,” Kvale said concluded. “We don't have a great sense of what causes it; we don't have a great sense about what we can do about it, but we do know this is about patient experience and we see those anatomic and physical functional differences in our studies that demonstrate that this is a real thing.”
Want to piss me off? Follow through with this!
http://www.breitbart.com/big-government/2014/04/02/exclusive-house-republicans-secret-immigration-ploy
The above article is proof that the GOP is the party of stupid.
jc
The above article is proof that the GOP is the party of stupid.
jc
EXCLUSIVE: HOUSE REPUBLICANS' SECRET IMMIGRATION PLOY

House Republicans are quietly working to insert immigration legislation into the text of the Department of Defense authorization bill that would allow so-called DREAMers to obtain permanent legal residency by joining the military, Breitbart News has learned.
The language, which if successful would mark the first effort by House Republicans to provide any form of amnesty since the GOP took control of the House in 2010, has set off a panic among top immigration hawks that the effort could open an immigration Pandora’s box, paving the way for broader legislation.
Sophomore Republican Rep. Jeff Denham of California, a close ally of GOP Whip Kevin McCarthy, is leading the push to add the text of his “ENLIST Act” into the National Defense Authorization Act, which could come to the House floor as early as next month.
The effort, which has not previously been reported, is fairly advanced, and House Judiciary Committee Chairman Bob Goodlatte – who killed the proposal as an amendment to last year's NDAA in a dramatic floor struggle – is weighing whether to approve the maneuver, which would circumvent his committee on one of its key matters of jurisdiction.
“We're working on it,” Goodlatte said.
Meanwhile, top immigration hawks ripped the proposal as ill-conceived and a clear effort to build momentum for a comprehensive immigration bill.
“If we're going to put out the bait, which is: come into the U.S., break in, so to speak, smuggle yourself into the military, put on the uniform of the United States, take an oath to uphold our Constitution, which may or may not mean anything to them, and now we're going to reward you with citizenship -- I think it's just a bizarre thing to do, to reward people for breaking our laws. That's what amnesty is,” said Iowa Republican Rep. Steve King.
“As soon as they raise their hand and say 'I'm unlawfully present in the United States,' we're not going take your oath into the military, but we're going to take your deposition and we have a bus for you to Tijuana. That's the law. Are they going to then suspend the law that requires ICE to place people into removal proceedings that are unlawfully present?” he added.
Key proponents of a comprehensive immigration bill said they support Denham's effort but that it's not part of a broader push for amnesty.
“Remember, to get the big things done, we still have to deal with the 800 lb gorilla, which is border security, and the folks that are here. That fact remains. I think that part that he's dealing with is a very important part but it's relatively noncontroversial,” Rep. Mario Diaz-Balart told Breitbart News.
At the same time, though, GOP proponents of Gang of Eight-style legislation have recently begun to worry that the window for enacting immigration bills is rapidly closing, causing them to ramp up their behind-the-scenes efforts.
The reason: a growing certainty that President Obama is planning to enact amnesty by executive fiat, blowing up the chances of legislation for the rest of his presidency.
“It's going to happen. He's getting a lot of pressure, and he's already told some people he's going to. He's told a bunch of people. I think he will. I think he has to,” said one senior member of Congress who asked that his name not be used.
“I'm hearing that he will do it by August. When that happens, it's poof! The right will go off the rails, just because it's unconstitutional -- and they'll be right about that stuff. They'll fly off the rails, which will then get the Democrats [to close ranks]. And then it's a presidential election. That's coming, and as soon as that happens, it's over,” the lawmaker said.
Denham, who was the first Republican to co-sponsor a Democratic immigration bill modeled after the Senate Gang-of-Eight legislation that passed last year, is pushing to add the language to the “base” NDAA bill – meaning it would not get its own vote.
A House Armed Services Committee aide said Chairman Buck McKeon hadn't committed to including the language in the bill, which runs through his committee. McKeon, on his way to the House floor to vote, declined to comment.
But Denham has acquired significant support, including from a number of top conservatives that could help insulate him from the inevitable blow-up when the effort becomes public.
For example, a trio of South Carolina lawmakers, Reps. Jeff Duncan, Mick Mulvaney, and Trey Gowdy – the latter of whom is the chairman of the immigration subcommittee in Goodlatte's Judiciary panel – have cosponsored the bill, as has McKeon.
Overall, the stand-alone bill has 42 cosponsors, including 24 Republicans. Also on the list: key chairman like Rep. Jeff Miller, chairman of House Veterans Affairs Committee and Darrell Issa, chairman of the oversight panel. Two close allies of Speaker John Boehner, Reps. Devin Nunes (R-CA) and Steve Stivers (R-OH) are cosponsors, as is McCarthy.
The bill says illegal immigrants who have been in the U.S. since 2011 and came to the U.S. before they were 15 years old could enlist in the military, upon which he would receive permanent legal status.
The alien's status would be revoked if he was discharged from the military on anything but “honerable” terms.
Legal permanent residents can apply for citizenship after residing in the U.S. for five years, or three if they are married to a U.S. Citizen.
“I support allowing children who were brought to this country through no fault of their own to put their lives on the line to serve our nation,” Denham said in an emailed statement to Breitbart News. “As a veteran, I served with immigrants and there is no better way to show your dedication to the United States and earn legal status than through the ultimate act of patriotism and commitment to our great country.”
During the 2013 House floor battle of the NDAA, Denham, with the backing of Majority Leader Eric Cantor, nearly succeeded in bringing the proposal to a vote as an amendment, which had cleared the House Rules Committee.
But at the last minute on the House floor, Goodlatte asserted his jurisdictional prerogative, killing the amendment.
Denham has worked to garner Goodlatte's support this time around, but whether the Virginia Republican backs his play or not, it is likely to run into a buzzsaw of opposition from amnesty hawks on the lookout for anything that could resurrect a comprehensive bill.
“Amnesty for those illegally here should not be tucked away and hidden within the National Defense Authorization Act (NDAA),” Rep. Louie Gohmert (R-TX) said in an emailed statement. “When someone goes into the military they take an oath to protect and defend the United States of America. How can you raise your right hand and promise to defend the U.S. Constitution, while you are breaking the very laws you are sworn to defend?”
Alabama Republican Rep. Mo Brooks, a member of the Armed Services Committee, said the provision would jeopardize his support of the overall bill, which is one of the last “consensus” bills that typically garners a large bipartisan majority of support every year.
“How do you ensure that illegal aliens are loyal to America and not another country? Is it wise to entrust illegal aliens with questionable loyalties with America’s military secrets and weapons, including weapons of mass destruction? Is it enough that illegal aliens join America’s military, or should they be required to be honorably discharged or serve in combat before receiving amnesty for past illegal conduct? If I don’t have satisfactory answers to these and other questions, I will not support the National Defense Authorization Act that provides amnesty for illegal aliens,” Brooks said in a phone interview.
Brooks added that this could be a part of a bigger play by the amnesty activist community to either revive the Senate-passed “Gang of Eight” immigration bill, the similar “principles” from Speaker John Boehner, or something else like either of those.
“Everything by the illegal alien allies is part of a bigger play,” Brooks said, adding “There is always the risk that those in Washington that wish to betray the American people on behalf of illegal aliens will slip some language into some place that opens the floodgates to the detriment of American workers.”
Mark Krikorian, the executive director of the Center for Immigration Studies, added in an email to Breitbart News that this could be a “Trojan Horse” for a larger amnesty.
“Harry Reid hasn’t even sent the Gang of Eight bill to the House, because he knows it would be struck down on procedural grounds alone – it raises revenue and only bills that start in the House can do that,” Krikorian said in an email. “By including an amnesty provision – however small – in the defense bill, the House leadership would create the opportunity for Reid to insert the Senate bill and send it to the House. It would become a Trojan Horse for amnesty.”
King, who came to learn of the secretive effort in an interview, said he will offer an amendment to the NDAA bill to strip it of the immigration provisions and work diligently to kill the proposal.
“I can't let something like this happen. I can't let it happen,” King said.
having fun today...
I am "Trolling" my Facebook friends with this:
Since there isn't such a thing, they are confused...
I start out with something like this:
https://www.facebook.com/photo.php?fbid=10152351147480960&set=a.95094595959.104791.507060959&type=1&theater
I only put two words then...(more)
Almost done with the troll - and if they read those two words, they will figure it out... eventually.
HA!
jc
Since there isn't such a thing, they are confused...
I start out with something like this:
https://www.facebook.com/photo.php?fbid=10152351147480960&set=a.95094595959.104791.507060959&type=1&theater
I only put two words then...(more)
Almost done with the troll - and if they read those two words, they will figure it out... eventually.
HA!
jc
Quakes, quakes, quakes
Getting tired of this...
The problem is that they are RIGHT UNDER ME. Small quakes RIGHT UNDER ME pop the house and scare the shit out of the dogs... And daughter #2.
I live near the cursor in the above picture... it is only going to get worse.
What a pisser of a birthday...
jc
The problem is that they are RIGHT UNDER ME. Small quakes RIGHT UNDER ME pop the house and scare the shit out of the dogs... And daughter #2.
I live near the cursor in the above picture... it is only going to get worse.
What a pisser of a birthday...
jc
Don't care how they do it, just kill it!
http://mag.newsweek.com/2014/03/28/war-against-cancer-alternative-cancer-treatments.html
From his fourth-floor window at Tampa's Moffitt Cancer Center, Robert A. Gatenby can look down to where patients stand waiting for valets to retrieve their cars. They have gone through chemotherapy, biopsies, radiation. They are pale, anxious, resolute. Some will live and some will die: a young woman with short hair, clutching her partner's hand; an older man, alone. Students from the nearby University of South Florida pop out of patients' cars. Peppy and dressed in blue vests, these cheerful valets look as if they could be working at a luxury hotel in the tropics. But nobody here is on vacation.
Gatenby says he sometimes sees patients retching after chemotherapy, which reminds the 62-year-old radiologist that his Integrated Mathematical Oncology Department—the only full-scale outfit of its kind in the nation—does not have the luxury of time. Mathematics is not generally known for urgency. Few lives hinge on proof of the twin prime conjecture, but the mathematicians and oncologists Gatenby has assembled in Tampa are trying to tame the chaos of cancer in part through the same differential equations that have tortured so many generations of calculus students. By mathematically modeling cancer, they hope to solve it, to make its movements as predictable as those of a hurricane. The patients down there, fresh from treatment, need shelter from the storm.
Gatenby's small corner of Moffitt bears little resemblance to a medical center: There are no white-coated doctors frantically rushing to save patients or synthesizing miracle cures deep into the night. You might think you've found yourself in a sleepy academic department where abstract ideas are kicked around like a soccer ball on the college green. Which, come to think of it, is actually a pretty accurate description of what goes on in Gatenby's lab, though not at all a pejorative one. The mathematicians in his employ are convinced that we do not really understand cancer and that, until we do, our finest efforts will be tantamount to swinging swords in utter darkness. As far as these Tampa iconoclasts are concerned, your average cancer doctor is trying to build a jetliner without having grasped aerodynamics: Say, how many wings should we slap on this thing?
A Malicious Green Cloud
We have been fighting the War on Cancer since 1971, when President Richard M. Nixon declared that the "time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease." Four decades later, 1,665,540 Americans per year hear the dreaded diagnosis, and about 585,720 die annually from some variety of the disease, according to the American Cancer Society. Smallpox and polio have been cured or largely eradicated, but cancer remains the same scourge it was 4,500 years ago, when the Egyptian doctor Imhotep mused, in what may have been civilization's first stab at oncology, about how to treat "bulging masses on [the] breast." Modern oncology makes incremental advances, with a melanoma drug that extends survival by three months passing for a major breakthrough. This is nobody's fault, but everybody's problem.
Gatenby is tired of a fight we keep losing. After 30 years, he has come to the uneasy conclusion that cancer is smarter than we are, and will find ways to evade our finest medical weaponry. The weary warrior wants to make peace with cancer's insurgent cells—though on his own terms, terms that would spare the lives of many more patients. To some within the medical establishment, this might seem preposterous, but Gatenby relishes the role of the outsider.
Gatenby grew up in the Rust Belt town of Erie, Pa., where 12 years of Catholic school instilled in him "an incredible hatred of dogma." At Princeton University, he studied physics with some of the greatest scientific minds of the 20th century. Figuring he wasn't fated to join the physics pantheon, Gatenby turned to medicine. But medical school at the University of Pennsylvania was dismayingly similar "to the rote learning of catechism" he remembered from Saint Luke School. It felt like he was "going backwards."
Whether in the lab, the classroom or the clinic, Western medicine relies on cautious experimentation, its zeal for breakthroughs tempered by the Hippocratic injunction to do no harm. But that can foster a frustrating incrementalism that is itself injurious. David B. Agus, one of the nation's most prominent oncologists and a professor at the University of Southern California, explains that "you are not rewarded, in general, for taking risk. It's very scary to do something radically new."
Gatenby specialized in radiology and, after receiving his medical degree in 1977 and completing a residency, went to work in 1981 for the Fox Chase Cancer Center in Philadelphia. Fox Chase is to cancer research what the Boston Garden was to professional basketball. It was home to David A. Hungerford, one of two researchers responsible for discovering the Philadelphia Chromosome, a major clue to cancer's birth within the human genome. Among its current éminences grises is Alfred G. Knudson Jr., whose "two-hit" hypothesis holds that cancer is triggered by an unfortunate accumulation of errant genes, harmful outside events (too much sun, too much red meat) or a combination of the two.
The study of genes did not interest Gatenby back then, nor does it interest him now, even though much of medicine is now in the thrall of genomics. Gatenby wanted to discover cancer's "first principles," the basic ideas behind the seemingly sudden explosion of cells that want to kill the very body that nourishes them. Sure, you could know the BRCA1 gene better than you know your own mother, but unless you had some insight into why it caused a furiously impervious breast cancer, you were trying to find your way out of a forest by studying the bark of a single tree. Gatenby sought to understand cancer with the same totality that Newton had understood gravity.
As with Newton's famous laws of motion, mathematics seemed to hold the key. Math had been used to model the weather and financial markets, which like the human body are fickle and incredibly sensitive to outside forces (a run on Greek banks; a low-pressure system moving down from Canada). Gatenby saw no reason the same could not hold true for cancer. He spent a year reading math, which puzzled his colleagues. Then, while visiting the Cloisters museum in upper Manhattan with his family, he took a sheet of stationery and started scratching down equations he thought could get him closer to cancer's fundamental truths.
"To say they hated it would not do justice," Gatenby says of the response of his Fox Chase colleagues. Other oncologists told him that "math modeling is for people too lazy to do the experiment" and that "cancer is too complicated to model." The latter is a refrain that, 30 years later, still dogs Gatenby and his staff at the Integrated Mathematical Oncology Department, which includes five mathematicians with no formal experience in medicine.
Among those five is Sandy Anderson, a young Scotsman who dresses as if he were on the way to a Beck concert. There is a bottle of single malt on his desk. "Of course cancer is complex," Anderson tells me, brogue rising. "But how can you say it's too complex? That complexity should be viewed as a challenge that we have to try and tackle. And just because there's complexity doesn't mean there aren't simple rules underlying it.
"What we'd love to do is have everybody's own little hurricane model for their cancer," he explains. This is less a metaphor than you may imagine. Anderson shows me computer models of a breast cancer's growth, the cells spreading like a malicious green cloud across the screen. Different versions of the model show what happens when different treatments are applied: Sometimes the cancer slows, but sometimes it explodes. This seems like an intuitively rational approach to the disease, predicting how it responds to a variety of treatments. But it isn't common. There are about a dozen drugs for breast cancer approved by the Food and Drug Administration. Depending on which form of the disease is diagnosed and at what stage it's discovered, there's a maddening number of viable drug combinations. Best practices exist, but these can be anecdotal, doctors simply doing what they think works. The War on Cancer is fought by competing bands with their own weapons, cancer's chaos exacerbated by our own dismaying disorder. Anderson would like to provide the onco-soldiers with battlefield maps.
Subscribe to:
Posts (Atom)