Deregulation would probably help modern medicine cure cancer even with fewer side effects, but social capital matter too

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Malcolm Gladwell is perhaps the liberal-progressive correspondent to the “conservative” David Brooks.  Both columnists want to teach us how to “be good”, or perhaps just dutiful.   Gladwell, for example, has discussed the moral problematics of even being a football fan (even of the Fighting Irish) given the concussion problems.

Gladwell has a long column in the New Yorker, “Tough Medicine: a disturbing report from the front lines on the war on cancer”    .  The link was placed on Facebook by a friend who works in national security circles, and I tweeted it to Jack Andraka, the kid who invented the new pancreatic cancer test at a science fair – and also traded tweets on the idea that college students in dorms today should be vaccinated separately on both major forms of bacterial menigitis.

Gladwell summarizes what went on at NCI at NIH in the years shortly after my own “psychiatric” stay in 1962.  I even had an “occupational therapy” job in a lab where I worked with urine sediment specimens from cancer – mostly lymphoma—patients.  Little did I suspect that shortly after I left some of these patients would start excruciating but revolutionary rounds of chemotherapy, and undergo nights of violent vomiting and total hair loss in the process.

In the less regulated world at NCI, doctors found that they could cure  (or at least place in indefinite remission) lymphomas – particularly Hodgkin’s Disease – in patients able to withstand several cycles of this unprecedented suffering and bodily humiliation. Over time, the regimes changed, and become somewhat more tolerable while just as effective.  But once federal regulation of the treatment cycles toughened, Gladwell argues (actually with somewhat a “libertarian” ideology) doctors had a harder time expanding their cures of various cancers, especially lymphomas and leukemias. Rules seemed too concerned with regulating the discomfort and side-effects on the patient. Gladwell is arguing a position you would expect from the Cato Institute (and probably from David Brooks, too).

I think one could argue with Gladwell.  Newer treatments that really work do have fewer side effects.  For HIV, for example, patients can stay in remission for years with decreasing side effects for newer drugs, which can melt away Kaposi’s Sarcoma if it recurs after a period of no use.   New immunotherapries seem to work for melanoma.  And patients like ABC’s Robin Roberts can undergo complete bone marrow transplants to cure pre-leukemia conditions.  And Maryland governor Larry Hogan, who could have been a desirable GOP presidential candidate had he wanted to run, is placed in remission from non-Hodgkin’s lymphoma, and he indicates that the treatment was not as horrible as feared.  Yes, Jack Andraka could be his oncologist a decade from now if Hogan needs one.

Gladwell discusses prostate cancer, which comes in many forms.  My father died (at 82) of an aggressive variation of it, rather suddenly.  He did what he wanted until the last few weeks and never knew disability.  He may have suspected he had it during his last two years or so,  but did not want to put himself and my mother through the idea of what he suspected the treatment could include – castration and treatment with female hormones.  (One can imagine parallel challenges in a marital relationship from breast cancer.) It’s arguable that with prostate cancer, and some other tumors, older patients will live with more quality if you leave them alone as long as possible.  That may be true of some lymphomas and multiple myeloma.  But when my mother was 96, a surgeon still wanted to do a breast dissection for a nodule, which sounded ridiculous under the circumstances.

In fact, Jack Andraka’s test (which has a reasonable chance of approval in some form in a few years, even according to my own physician) is predicated partly on the notion that pancreatic cancer is much more likely to be curable if “caught early”. Right now, it is one of the deadliest when diagnosed, usually in middle age.

Today, medicine can treat diseases that used to be quickly, or at least inevitably, fatal.  But it comes with a new challenge, that people who receive care have the family and social support systems behind them to keep them going.  In an individualistic world of smaller families, this won’t be easy.  When I was growing up, despite the pretense of “family values”, there was little thought given to expending the effort to help the elderly live well and longer, or to making the disabled feel more valued as people.  Today, we can do these things, but “healthy” people, in and outside the affected families, have to become personally supportive.

I tend to remain personally aloof emotionally about these things.  I don’t like to “join in” with naïve calls for cures.  But it is possible that many cancers will one day be curable with similar treatments, because most cancer cells have similar underlying vulnerabilities (cells that don’t die).

One other thing.  For the life of me, I don’t know why it is such a big deal for the government to accept the use of whatever components of marijuana will effectively control the nausea of chemotherapy. Actually, I think this changed this year (link ).  In the 1980s, I had a friend in Dallas who reported surgery and chemo for testicular cancer in his twenties, and who said that street marijuana from a dealer took care of the nausea and vomiting from bleomycin and cis-platinum (and use of a homeopathic salve saved his hair).  Later, in 1978, I would have reason to suspect a friend might have been treated for something like Hogkins, something that led me to an epiphany where I realized there were disturbing signs something was already wrong in the gay community in NYC.

(Published: Tuesday, September 6, 2016 at 11:30 PM EDT)

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