My Paranoia and Cancer Vaccines

The latest best hope in oncology is cancer vaccine. The wave of the future, it has applications for both the treatment of existing disease & in the prevention of cancer in high risk populations.

The US Food & Drug guys have just approved another specific preventive– hurrah! – but, as of June 2006, none of the cancer treatment vaccines have passed muster. Although still strictly experimental for the targeted therapy of existing disease, we do have some insight now. Can vaccines effect a permanent cure? No signs of that yet. Can they make tumors shrink or disappear on imaging tests? You betcha! Will a good response significantly impact on length of survival or consistently upgrade quality of life? Hmm… wait & see. Are they safe? Zhou's 2006 article in BLOOD says there's a possibility that therapeutic vaccines may eventually worsen a patient's immune response to tumor– a not permanently insurmountable problem, just the identification of a new angle to address.

It makes sense to beware for now, don't you think? A stand is especially pertinent these days, when every other PhD & his mother are cooking up a home brew, with even less scrupulous types cashing in on the topselling product called "hope". Well, if we duly inform people about drug limitations & how incomplete our current understanding is, in toto, are oncologists already justified to offer therapeutic vaccines outside of a controlled clinical trial setting? Someone, please clue me in. I confess that in some instances, I'm reminded of psychic surgery's claims which require a similar leap of faith in an unregulated process. Its too much like a cash cow & so little like good science to offer up vaccines at tremendous costs in some parts of the world without even the pretense of a formal study– sans the critical details of procedure or provenance.

Common sense sayeth: in clinical medicine, the devil is in the details.

Thanks again to Mr Buck Cash

Wish on the moon

At home, everyone who's meant to sleep-in for the night has retired by 11p.  By 12a, one may steal mere pecks on cold noses– sadly, for us bear-hug enthusiasts.   Long-suffering help open up in PJ's to let this bedraggled cat in, serve dinner as a cold-core mess, then leave me to wind down with terminally blue journals & saxophones.  So when 930p comes around when there's still no hope of an early escape, I just may dig in for a solo flight, dine out with TIME magazine, then chat with those hospital-bound patients who share a similar insomniac fate. 

Mellow yellow-- no blues in the night.

You can learn a lot from patients, if you give up the time for a close listen.  Its a tough trade for domestic comforts but, given my idiosyncrasies, it sure beats Discovery Channel & my own worn fantasies.  Besides, I always did favor autobiographies, and there's hardly any b.s. between people in a life & death situation.  Nope, no time.  Then there's this inexplicable rapport.  Both hurts & highs flood the breach in my direction– a paradoxical control?   Its as though they mean to stamp out disease by force of personality. Well, my ears are right for this job. I do allow myself some empathy, but never pity.

So I listen and learn what Dizzy Gillespie was like, how a billion dollar enterprise was conceived, a mean politico's hopes for the country in his lean youth, how a farmer sold his own future to send a son through grad school, Japayuki travails, how MacArthur posed Leyte beach shots, the joy of dreams fulfilled, the lingering wonder over a beloved.  Lives well-lived, ends similarly so.  Then there are the stingers, sadder than any disaster dealt by fate: the lives filled with regret.   Unfaithfulness, abandonment, paths not taken, promises broken, what-ifs & should-have beens.  The willful sacrifice and irredeemable loss of that something they never knew.

Man! While we are young & stupid, we roll our eyes & close our minds to such tales.  Lately, this job has me reading regret like the Surgeon General's warning on a pack of smokes.

Blogging this

"We at MP Stat have reported before on tech-savvy physicians operating Web logs, but those physicians either assiduously avoided clinical content and used their blogs as psychological steam vents or presented Internet smorgasbords of personal and medical observations."  So says a 2004 article on the nominations for a clinical blog contest, as quoted in Pinoy MD's website.

This one got me thinking.  Anyone who has worked this job knows that there is a serious information problem among many cancer patients and their kin…and lots of ignorant or unscrupulous types lying in wait.  A lot of us would love to help, but where does one begin?

• Which is the demographic that will benefit the most from oncology treatment information?
• How would they access the information?
• What language do they speak / read?
• How do they finance their medical expenses?

Its not as simple as it had first seemed to me.  Educating the Philippine public about the cancer treatment options will not have the same impact as the drives on its prevention and early diagnosis.  We just don't have the national health benefits that would make it relevant as a large scale priority, translated into X number of dialects, maintained by Y committees– at considerable public expense.  On the macro level, infections are still the biggest of the major killers, not malignancies.  For the small subset that can afford to self-finance optimal antineoplastic therapy, how are their information requirements best served?  Are enough wired & online to make an official authoritative presence worthwhile?  And if government has other health priorities, who will serve these needs?  Who will watch for abuse, self-promotion, and quackery?  This is an interesting area for study– by whom… subspecialty societies?  NGO's?  tertiary hospitals?  All of the above, and more?