The right to die... and why cancer is so hard to beat

First, on the right to die:

The Case for Actual Death Panels
By Tina Dupuy | June 7th, 2011 | 19 Comments

Dr. Death is dead.

Murad (Jack) Kevorkian, whose name has been synonymous with doctor-assisted suicide, died last week at 83. He spent eight years in a maximum-security prison for helping the sick end their suffering. But Kevorkian was no angel…of death. He was eccentric, flamboyant and obstinate about his pet cause. He taunted the authorities, doing himself no favors in the process. But he did force us as a country to talk for a minute about the rights of the dying.

David Fitzsimmons / Arizona Daily Star (click for more Kevorkian cartoons)

Kevorkian himself died quietly in a hospital due to a blood clot.

We tend to treat death as something we can beat. You’re supposed to beat cancer, the number two cause of death in this country. We celebrate those who triumph over disease. Survivors become centerpieces of schmaltzy fluff segments on the evening news. We whistle past the fact we are all at some point going to die.

Three states have Death with Dignity Laws: Oregon, Washington and – due to a court decision and the failure by the state legislature this year to outlaw it – Montana....
More:http://blog.cagle.com/2011/06/the-case-for-actual-death-panels/

And about the war on cancer:

As We Boomers Age, the War on Cancer Is a Bigger Business Than Ever on Our Campuses
By Jim Castagnera
Special to the Greentree Gazette (September Issue)
Having turned 60 last October, my mind has been much on cancer. A bump on my head justified a biopsy in December… benign, I’m relieved to report. Two close colleagues came down with breast cancer during the past 12 months or so… survivors, I’m equally relieved to report. And then there was my trip to Tampa over spring break back in March.
Staying with longtime friends, my wife and I visited the H. Lee Moffitt Cancer Center and Research Institute, where the husband works. Following a ten-cent tour of his lab, we headed for lunch. Waiting for the institute’s valet-parking service to bring the car, I observed the steady streams of patients flowing in and out of the center. Some wore surgical masks; their immune systems, my friend explained, were dangerously depleted by chemo and radiation. Others required wheelchairs to transit the short distance between the main entrance and a van or SUV.
A January 2008 press release, announcing a new cancer-research partnership with neighboring Florida Southern University, described the Moffitt as “the only Florida-based cancer center with the NCI designation as a Comprehensive Cancer Center for its excellence in research and contributions to clinical trials, prevention and cancer control. Moffitt currently has 15 affiliates in Florida, one in Georgia and two in Puerto Rico. Additionally, Moffitt is a member of the National Comprehensive Cancer Network, a prestigious alliance of the country’s leading cancer centers, and is listed in U.S. News & World Report as one of ‘America’s Best Hospitals’ for cancer…. Moffitt’s sole mission is to contribute to the prevention and cure of cancer.”
Yet, as large as it is, the Moffitt is only one cylinder in the massive engine of research, prevention and treatment powering the so-called War on Cancer. NCI --- National Cancer Institute (one the federal National Institutes of Health) --- had a budget just below $5 billion during this fiscal year and is predicting a $6 billion budget in fiscal year 2009, which begins October 1st. The agency expects to commit nearly $4 billion of that budget to the funding of existing and new research grants. Of its mission, NCI says, “Every life is touched by cancer. As the leader of U.S. efforts to understand, diagnose, treat, and prevent cancer in all its forms, NCI must play the central role in bringing together basic and clinical researchers, patients, care givers, policy makers, and many others in a common cause.”
More amazing than the amount of money Uncle Sam devotes annually to cancer research is how long the quest for a cancer cure has gone on. According to Dr. Devra Davis, director of Pitt’s Center for Environmental Oncology and author of The Secret History of the War on Cancer (Basic Books, 2007), “When Mary Lasker created the famed Lasker Awards for Cancer Research in 1946 as a birthday present for her husband, Albert, she fully expected a cure for the disease within a decade.”
She adds in her book, which was a Newsweek “must read pick” last October, that the nation harbored the same high expectations when President Nixon signed the National Cancer Act in 1971, officially declaring the War on Cancer. Davis quotes Dr. Philip Randolph Lee, later an assistant secretary of health in the Carter Administration, saying in opposition to the act, “I just didn’t see the logic. I thought we were promising people things we could never deliver.”
NCI indicates why, 62 years after the Lasker Awards were established and 37 years after the War on Cancer was commenced, cancer continues to consume enormous financial and human resources. “The convergence of new biomedical technologies with information technologies has revealed to us just how complex cancer truly is. Indeed, the biology of cancer is intimately intertwined with the unique genetics of each person, making it an ‘individualized’ disease.”
“The ability to deliver individualized interventions,” adds NCI, “requires the integration and collaboration of disciplines not traditionally thought of as part of cancer research. This broader view of the cancer research community extends to mathematicians, physicists, and chemists as well as others in the physical sciences….”
This point is underlined by Dr. Gary Margules, Nova Southeastern University’s vice president of research and technology transfer, who explains that psycho-social oncology is one of a number of emerging disciplines in the broad front of the 21st century phase of the War on Cancer.
“Psycho-social oncology is especially significant,” he explains, “in the area of breast cancer. If patients manage stress and depression after diagnosis, surgery, chemo and radiation, this can make a tremendous difference in the five-year survival rate. We know that stress has a significant impact on the quality of the patient’s immune system.” Since a mastectomy can be a depressing prospect, returning the patient to a positive mental attitude following the procedure can make all the difference.
Margules, who joined NSU in January, performed in a similar role at the University of Miami since 1992. Before that he held senior positions with Senmed Medical Ventures, Pfizer Hospital Products Group, and Cordis Research Corporation. He kindly walked me through the complex layers of what he labeled “translational medicine,” which he defined as “lab bench to bedside” services. To be designated among the nation’s elite Comprehensive Cancer Centers, such as the Moffitt and Sloan Kettering, “you need to qualify both in terms of patient care and home grown technologies.”
Since his arrival at NSU, Margules says, “I talk a lot to the dean of our business school. He looks at the situation from a mega-business perspective. He speculates about whether, instead of having these Comprehensive Cancer Centers, all spending enormous amounts of money but still scattered across the country, it would be better to have two or three gigantic centers.” Margules suggests that he could agree that “critical mass might make a difference, especially with solid tumors.”
He explains, “Headway in the solid-tumor war has been very slow, due to the complexity of the invasion. Whatever triggers the cells to transform to a tumor, once that happens, they produce factors that encourage themselves. Multiple treatment approaches are the current trend.” While surgery, chemotherapy and radiation are major weapons in the arsenal, starving the tumor of its blood supply is the newest mode of attack. A Margules colleague, Dr. Appu Rathinavelu, has patents pending for fabricated molecules that may do the job, while being cheaper and easier to store than the current crop of mega-molecules in use.
In the realm of early detection, adds Margules, “The Holy Grail would be a blood test that tells you that you have cancer somewhere in your body. Being able to look for clues in bodily fluids is a major research push. Super-early detection is its goal.” The good news is, “Almost all cancers can be treated if detected early enough.” Tumor vaccines and other immunity techniques are also among the R&D priorities.
Environmental oncology is yet another relatively new front in the war. Devra Davis’s book reproduces a 1977 Herblock cartoon. A research scientist sits over his microscope in the foreground. Lined up behind him are five fat cats in suits, identified as the asbestos, chemical, pesticide and tobacco industries. Bending over, a government official is saying to the scientist, “Could you hurry and find a cure for cancer? That would be so much easier than prevention.”
Thirty years later, Davis directs a facility, which bills itself as “the world’s first Center for Environmental Oncology.” However, the University of Pittsburgh is far from alone in the quest for a safer environment. To the contrary, the belated recognition that a comprehensive successful assault on cancer must include prevention goes hand in hand with the Green Campus movement.
For example, as early as 2001, the University of Colorado at Boulder’s “Blueprint for a Green Campus” included frank recognition that “Chemicals and pesticides pose risk to the health and safety of humans and the environment. Pesticides can cause adverse health effects in humans, such as cancer, neurological disruption, birth defects, genetic alteration, reproductive harm, immune system dysfunction, endocrine disruption, and acute poisoning.”
Five years later, citing to the ’01 “Blueprint,” UC-Boulder’s custodial team issued its own report, which commented, “Currently, the Department of Housing, and Facilities Management, and the University of Colorado Student Union cost centers (Wardenburg Health Center, the Recreation Center, and the University Memorial Center) are using a majority of chemicals for cleaning that are harmful to the workers as well as the environment. The goal of the project, therefore, is to reduce potential health risks and environmental impacts associated with the chemical cleaners used on campus. This set of green cleaners should appropriately support cleaning specifications for all units on campus.” This continuity of commitment reflects the sorts of sustained efforts being undertaken, now that the Herblock-era fantasy of a quick fix is fully discredited.
Last, but not least, on the list of cutting-edge strategies in the War on Cancer are dietary directives from the major academic command centers. The MD Anderson Cancer Center at the University of Texas, like Sloan and Moffitt a comprehensive mega-power in the struggle, advises, “Although factors other than diet can play a role in the development of cancer, health experts know that paying attention to diet and related factors (including body weight and exercise) is one of the more effective ways to reduce cancer risk.”
Putting this proposition into practice, Anderson’s Clinical Nutrition Department provides “nutrition assessment and counseling to our patients and their guests. We work with M. D. Anderson’s medical team to pinpoint opportunities for nutritional intervention or support.” Under research, Anderson boasts “Sponsored long-term data collection on lifestyle and health from a large cohort of Mexican-American families to identify predictors of cancer risk and explain why patterns of cancer and response to treatment are different from those in other populations.”
Given the breadth and depth of this continuous campaign, it’s almost impossible to accurately estimate how many dollars cancer contributes all together to the “gross domestic product” of our entire higher education industry. NSU’s Margules notes, “The combined magnitude is staggering.” No surprise here, he adds, since “two-thirds of Americans die of either cancer or heart disease.”
One way to gain an appreciation of the extent of the war’s ongoing impact on higher education is to leave the world of the giant Comprehensive Cancer Centers and descend to the level of our industry’s tinier institutions. For simplicity’s sake, I selected my own undergraduate alma mater, Franklin and Marshall College in Lancaster, Pennsylvania. Here’s what I learned from a quick search of my college’s site.
“Recent research by Franklin & Marshall's Ryan Mehl, assistant professor of chemistry, and two of his former students, Jenny Jackson '05 and Sean Duffy '06, is receiving national attention. The research, which involves improving a protein used in cancer therapy with unnatural amino acids, has been published in a recent issue of The Journal of the American Chemical Society, as well as highlighted in the journal Nature and Breastcancer.net news.” Working at a school with only 2000 students, none of them MA or doctoral candidates, Mehl used the two undergraduate science majors, who have gone on to study biochemistry and medicine at Texas A&M and Temple, respectively.
Gary Margules modestly called his school a “relatively small research university.” With 27,000 students, NSU is a giant compared to F&M. Where the War on Cancer is concerned, both may be mere platoons alongside the Moffitts and Andersons of the America’s army of cancer combatants. All the same, each in its way --- and thousands more colleges and universities across the country --- play their (presumably profitable) parts in the mighty confrontation whose causus belli is that little bump on my old head.

(By the way, I got that bump surgically removed on May 26th.)