I had three clinic visits at my cancer center today. Following a physical exam by my oncologist he said I looked great. I asked about a longer term prognosis. Paraphrasing, he said that I’ve had no evidence of disease for long enough such that he felt the immediate danger was far reduced. He also said I beat some pretty tough odds to be where I am today with no evidence of disease for 19 months. We discussed the rash which I mentioned in my last blog entry. He did not feel it was cancer treatment related. My other concerns about poor blood circulation and foot neuropathy did not deter him from having me continue on with the daily dose of 150 mg Tarceva pill. In about 6 six weeks I’ll go back for a head and neck CT scan.
On the obturator (mouth prosthesis) front, we abandoned trying to get the new one to fit properly. They adjusted my old obturator. With the device in, I’m estimating that my speech is approaching 85% of the quality of my pre-surgical voice. It still takes some effort, but I’m quite pleased with this progress.
I also saw the physicians and clinicians in the Supportive Care unit. They have been a great resource to me over the past year. They helped me address fatigue, nutrition, and depression. Given the positive trend in my health (both physical and mental), we agreed that I’d call them if there is a future need.
That sums it up for the day. Take care and good health to you all.
Wednesday, May 13, 2009
Tuesday, May 12, 2009
Treating Cancer as a Chronic Illness
I had a lively discussion a little over a week ago on the subject of taking chemotherapy drugs (any chemotherapy drug) to keep my cancer (if it exists) at bay. What I tried to explain in this theoretical discussion was the potentially toxic side effects of the chemo drugs (e.g., stroke, death) and as a result why one would want to not take these drugs. I’m not sure the recipient of this discussion understood my perspective.
Today, my brother sent an excerpt he had found on the FDA MedWatch website. The article posted on 5/9/09 (less than one week ago) was about Tarceva. See reference 1 below for the full article. In essence, the pharmaceutical company, Genentech, that manufactures Tarceva added wording to their “WARNINGS AND PRECAUTIONS” section on their prescription instructions. Fatality was one of the new adverse side effects. Per my prescription, I have taken the maximum recommended dose of Tarceva (150 mg) daily for over 17 months. That works out to 517 doses. So, my theoretical discussion of just over a week ago has turned into something a bit closer to home. Although rash was a previously known side effect, the new warning seemed to heighten this side affect as a more severe warning sign. To compound the issue, I have a moderate rash on my side that appeared about a week ago. Even before I became aware of the updated warning today, it was one of my top subjects for tomorrow’s cancer center clinic visit.
Here’s what I currently believe. On the plus side, Tarceva is keeping my cancer at bay. On the negative side, Tarceva is causing a moderate rash, continued neuropathy in my feet, and poor blood circulation. I’m guessing my oncologist will examine me tomorrow and recommend that I begin taking a smaller daily dosage with a warning about staying in close touch with him if the rash gets worse.
The bottom line to all this is that treating cancer as a chronic illness is a step in the right direction, but it is not without its pitfalls. This can certainly be a case of the cure being worse than the disease.
On a separate subject, my original diagnosis was April 29 2005. That’s over 4 years ago. I’m still here, but the journey has left me scarred both physically and mentally for life. Last night I had a dream (actually a nightmare) that my right side neck lymph nodes were swollen. This would mean (at least in my mind) that my cancer had returned. It was so real that I spent time feeling the lymph nodes in my neck when I woke up to see if they were swollen. They weren’t, so it was a dream. It was also a relief. This disease will never leave me completely alone. On that note…
Take care and good health to you all.
=======================
Reference:
http://www.fda.gov/medwAtch/safety/2009/safety09.htm#Tarceva
Today, my brother sent an excerpt he had found on the FDA MedWatch website. The article posted on 5/9/09 (less than one week ago) was about Tarceva. See reference 1 below for the full article. In essence, the pharmaceutical company, Genentech, that manufactures Tarceva added wording to their “WARNINGS AND PRECAUTIONS” section on their prescription instructions. Fatality was one of the new adverse side effects. Per my prescription, I have taken the maximum recommended dose of Tarceva (150 mg) daily for over 17 months. That works out to 517 doses. So, my theoretical discussion of just over a week ago has turned into something a bit closer to home. Although rash was a previously known side effect, the new warning seemed to heighten this side affect as a more severe warning sign. To compound the issue, I have a moderate rash on my side that appeared about a week ago. Even before I became aware of the updated warning today, it was one of my top subjects for tomorrow’s cancer center clinic visit.
Here’s what I currently believe. On the plus side, Tarceva is keeping my cancer at bay. On the negative side, Tarceva is causing a moderate rash, continued neuropathy in my feet, and poor blood circulation. I’m guessing my oncologist will examine me tomorrow and recommend that I begin taking a smaller daily dosage with a warning about staying in close touch with him if the rash gets worse.
The bottom line to all this is that treating cancer as a chronic illness is a step in the right direction, but it is not without its pitfalls. This can certainly be a case of the cure being worse than the disease.
On a separate subject, my original diagnosis was April 29 2005. That’s over 4 years ago. I’m still here, but the journey has left me scarred both physically and mentally for life. Last night I had a dream (actually a nightmare) that my right side neck lymph nodes were swollen. This would mean (at least in my mind) that my cancer had returned. It was so real that I spent time feeling the lymph nodes in my neck when I woke up to see if they were swollen. They weren’t, so it was a dream. It was also a relief. This disease will never leave me completely alone. On that note…
Take care and good health to you all.
=======================
Reference:
http://www.fda.gov/medwAtch/safety/2009/safety09.htm#Tarceva
Wednesday, April 15, 2009
Health care IQ – The results…
Thank you for filling out the survey from my April 13th blog entry. My source for this information came from a book titled, “Redefining Health Care” published in 2006 by authors Michael Porter and Elizabeth Teisberg. Michael Porter is a professor at Harvard Business School and Elizabeth Teisberg is a professor at the University of Virginia Business School. They specialize in competition, business strategy, and innovation. Michael has authored about 20 books and published 70 papers since the mid 1970s, many of them focused on health care.
Survey Q&A
Question #1
How many years does it take between the results of a successful clinical trial and that drug / process becoming a standard medical practice?
· 2 years
· 5 years
· 10 years
· 17 years
80% of survey respondents chose 5 and 10 years. 20% of respondents chose 17.
The answer is, 17 years. I don’t know about you, but this really blew me away. I watched the standard of care change for head and neck cancer patients over the past few years. 4 years ago the standard of care was radiation followed by surgery followed by wait and see. The current standard of care is concurrent radiation and chemotherapy followed by wait and see. I don’t often dwell on how my life could be different “if only” this or that happened. But I do focus on this one. What if the standard of care adaptation had been speedier? 17 years is just too long. And, here’s the sad part. My cancer hospital is probably an early adapter to change. There may still be great cancer hospitals out there treating head and neck cancer today with the old standard of care. I feel bad for the impact on the lives of those patients.
Question #2
Motor vehicle accidents cause more deaths per year than in-hospital medical errors (e.g., wrong drugs, preventable infections). True or False?
80% said false, 20% said true.
The answer is false. According to a study published by the Institute of Medicine (IOM) in 1999 (a little dated), there were an estimated 44,000 to 98,000 preventable in-hospital deaths per years. Motor vehicle deaths were about 45,000. My perspective on this is that preventable in hospital deaths have dropped dramatically since the 1999 study was published at the higher quality hospitals due to building quality, accountability, and transparency into the patient care process.
Question #3
There were (fill in the blank) Americans without health care insurance coverage in 2004. Possible answers were:
- 25 Million
- 45 Million
- 65 Million
- 85 Million
Survey participants were split evenly on the first three choices... 25, 45, and 65 million.
The book quotes a figure of 45.8 million Americans without health insurance in 2004. So, everyone was close to the right answer. The World Factbook puts our current population at 307 million. So, that boils down to about 1 out of every 7 people in the US is without health care insurance coverage. 45.8 million is a huge number. One issue with this is that for most of these people, their first line of health care is a trip to the emergency room. There, they are treated and admitted or sent on their way. Unfortunately, emergency room treatment is expensive and puts a drain on everyone else. One could write an entire book on this subject alone. There are no good quick fixes here.
Question #4
There is a high correlation between how much one spends for health care and how satisfied one is with their care. True or False?
Most survey participants chose false. False is the correct answer. I won’t get into the details of the book, but they measured health care costs in all 50 states. For a similar population set and type of services, costs ranged from a low of $3,500 per year in Hawaii to a high of over $8,000 per year in Louisiana. There was virtually no correlation between health care cost and satisfaction.
Question #5
Medical care spending in the US is 14% of our Gross Domestic Product (GDP). Medical spending in Mexico is less than half that of the US. Life expectancy in Mexico is higher than in the US. True or False?
About 40% of survey participants chose false, the rest chose true. The answer is false. Again, the data is a bit dated (from 1996), but the US life expectancy is 79 years and Mexico is a bit over 76 years. The highest life expectancy is in Japan at 83 years. They spend about half as much on health care as those in the US.
Conclusion
You all did pretty well with your health care IQ. What we need in this country is a health care system which is transparent, reports results (good and bad), looks at care holistically from the patients perspective (from prevention, to care, to rehabilitation), and allows free market competition among heath care providers. I hope you learned something from participating in the survey or at a minimum it gave you some good food for thought.
Thanks again for participating.
Enjoy, take care, and good health to you all.
Survey Q&A
Question #1
How many years does it take between the results of a successful clinical trial and that drug / process becoming a standard medical practice?
· 2 years
· 5 years
· 10 years
· 17 years
80% of survey respondents chose 5 and 10 years. 20% of respondents chose 17.
The answer is, 17 years. I don’t know about you, but this really blew me away. I watched the standard of care change for head and neck cancer patients over the past few years. 4 years ago the standard of care was radiation followed by surgery followed by wait and see. The current standard of care is concurrent radiation and chemotherapy followed by wait and see. I don’t often dwell on how my life could be different “if only” this or that happened. But I do focus on this one. What if the standard of care adaptation had been speedier? 17 years is just too long. And, here’s the sad part. My cancer hospital is probably an early adapter to change. There may still be great cancer hospitals out there treating head and neck cancer today with the old standard of care. I feel bad for the impact on the lives of those patients.
Question #2
Motor vehicle accidents cause more deaths per year than in-hospital medical errors (e.g., wrong drugs, preventable infections). True or False?
80% said false, 20% said true.
The answer is false. According to a study published by the Institute of Medicine (IOM) in 1999 (a little dated), there were an estimated 44,000 to 98,000 preventable in-hospital deaths per years. Motor vehicle deaths were about 45,000. My perspective on this is that preventable in hospital deaths have dropped dramatically since the 1999 study was published at the higher quality hospitals due to building quality, accountability, and transparency into the patient care process.
Question #3
There were (fill in the blank) Americans without health care insurance coverage in 2004. Possible answers were:
- 25 Million
- 45 Million
- 65 Million
- 85 Million
Survey participants were split evenly on the first three choices... 25, 45, and 65 million.
The book quotes a figure of 45.8 million Americans without health insurance in 2004. So, everyone was close to the right answer. The World Factbook puts our current population at 307 million. So, that boils down to about 1 out of every 7 people in the US is without health care insurance coverage. 45.8 million is a huge number. One issue with this is that for most of these people, their first line of health care is a trip to the emergency room. There, they are treated and admitted or sent on their way. Unfortunately, emergency room treatment is expensive and puts a drain on everyone else. One could write an entire book on this subject alone. There are no good quick fixes here.
Question #4
There is a high correlation between how much one spends for health care and how satisfied one is with their care. True or False?
Most survey participants chose false. False is the correct answer. I won’t get into the details of the book, but they measured health care costs in all 50 states. For a similar population set and type of services, costs ranged from a low of $3,500 per year in Hawaii to a high of over $8,000 per year in Louisiana. There was virtually no correlation between health care cost and satisfaction.
Question #5
Medical care spending in the US is 14% of our Gross Domestic Product (GDP). Medical spending in Mexico is less than half that of the US. Life expectancy in Mexico is higher than in the US. True or False?
About 40% of survey participants chose false, the rest chose true. The answer is false. Again, the data is a bit dated (from 1996), but the US life expectancy is 79 years and Mexico is a bit over 76 years. The highest life expectancy is in Japan at 83 years. They spend about half as much on health care as those in the US.
Conclusion
You all did pretty well with your health care IQ. What we need in this country is a health care system which is transparent, reports results (good and bad), looks at care holistically from the patients perspective (from prevention, to care, to rehabilitation), and allows free market competition among heath care providers. I hope you learned something from participating in the survey or at a minimum it gave you some good food for thought.
Thanks again for participating.
Enjoy, take care, and good health to you all.
Monday, April 13, 2009
Health care IQ
I’m continuing to read about our US heath care system. It’s good bed time material. To make this fun and maybe a bit more interactive, I’ve designed a quick one page 5 question survey to test your heath care IQ. Please click on the link below.
http://www.surveymonkey.com/s.aspx?sm=rHPY9Eo1NK_2fTqplS7RP7tA_3d_3d
It takes less than a minute to complete and doesn’t even have a place to include your name or comments. I’ll publish the answers and the survey results towards the end of this month.
Enjoy, take care, and good health to you all.
http://www.surveymonkey.com/s.aspx?sm=rHPY9Eo1NK_2fTqplS7RP7tA_3d_3d
It takes less than a minute to complete and doesn’t even have a place to include your name or comments. I’ll publish the answers and the survey results towards the end of this month.
Enjoy, take care, and good health to you all.
Wednesday, April 8, 2009
Cost of Bringing New Drugs to Market
Most of us have seen an email making the Internet rounds on the cost of manufacturing a drug (e.g., Advil), the retail price, and the huge markup… 100s or 1,000s of percent. What’s not factored in is the cost of actually bringing a drug to market.
According to a report by the Tufts Center for the Study of Drug Development, the average total research and development cost for new drugs in the late 1990s was $897 million. THAT’S ALMOST ONE BILLION DOLLARS. THAT’S THE AVERAGE. That total was more than double the average total cost of bringing a new drug to market in the 1980s, and more than five times the cost in the 1970s.
Another recent study estimated that only 21.5% of drugs that began Phase I trials ever get to market. This boils down to just over one-fifth of the drugs that looked promising enough in animal trials to warrant human trials proved to provide an advantage over drugs currently on the market.
So, the next time you pop an Advil, Aleve, or Aspirin and think about how much money the drug companies are making, maybe you will factor in their R&D costs and the lives that were saved, prolonged, or improved along the way.
Enjoy, take care, and good health to you all.
According to a report by the Tufts Center for the Study of Drug Development, the average total research and development cost for new drugs in the late 1990s was $897 million. THAT’S ALMOST ONE BILLION DOLLARS. THAT’S THE AVERAGE. That total was more than double the average total cost of bringing a new drug to market in the 1980s, and more than five times the cost in the 1970s.
Another recent study estimated that only 21.5% of drugs that began Phase I trials ever get to market. This boils down to just over one-fifth of the drugs that looked promising enough in animal trials to warrant human trials proved to provide an advantage over drugs currently on the market.
So, the next time you pop an Advil, Aleve, or Aspirin and think about how much money the drug companies are making, maybe you will factor in their R&D costs and the lives that were saved, prolonged, or improved along the way.
Enjoy, take care, and good health to you all.
Tuesday, April 7, 2009
Dust in the Wind
Hi. Sorry, but I wasn’t able to keep to my blog schedule. No excuses. My future plan is to publish when I have something to share.
One of the things that helps get me through tough times is listening to music. For those that know me, you know I’m completely tone deaf. That’s doesn’t seem to take away from music’s meditative effect. Some people like classical music. I’m not one of them, but I’m beginning to understand the appeal. I’m a child of the 60s and 70s and still love good ole rock and roll… as long as it’s not too loud. I listen with my eye’s shut. I also like lite country music, songs from Bonnie Raitt or the Dixie Chicks. My current favorite song is Dust in the Wind by Kansas. Here’s the song and lyrics on YouTube...
http://www.youtube.com/watch?v=p9vWvqUebfc
Give it a try. Sit back, shut your eyes, and go with the music.
Enjoy, take care, don’t take yourself too seriously, and good health to you all.
One of the things that helps get me through tough times is listening to music. For those that know me, you know I’m completely tone deaf. That’s doesn’t seem to take away from music’s meditative effect. Some people like classical music. I’m not one of them, but I’m beginning to understand the appeal. I’m a child of the 60s and 70s and still love good ole rock and roll… as long as it’s not too loud. I listen with my eye’s shut. I also like lite country music, songs from Bonnie Raitt or the Dixie Chicks. My current favorite song is Dust in the Wind by Kansas. Here’s the song and lyrics on YouTube...
http://www.youtube.com/watch?v=p9vWvqUebfc
Give it a try. Sit back, shut your eyes, and go with the music.
Enjoy, take care, don’t take yourself too seriously, and good health to you all.
Wednesday, April 1, 2009
U.S. Financial Markets - The Stimulus Package
Although you didn't come here to read about the economy, since I’m not writing about cancer for now, I thought I’d chime in on a subject that has impacted many people… the state of the U.S. financial markets. Here’s my take. The stimulus package's goals were to 1) prevent the collapse of our financial system, 2) open up the credit markets (e.g., allow prudent borrowing), and 3) allow the free market (i.e., capitalism) to prevail without the ongoing need for government aid.
As a bit of background, I have worked in Washington. First as a summer intern for the Federal Energy Administration (now DOE) between my first and second year at graduate school where I earned a Masters degree in Public Administration from the Heinz School at Carnegie Mellon University and later as a consultant working at the Pentagon for the Strategic Defense Initiative Organization (SDIO - the Star Wars program). What I learned during my years in Washington is that it is very hard to get anything accomplished. The politics, the turf battles, the bidding process, congress, employee morale, you name it… It’s just not that easy.
Now, let’s turn our attention back to the stimulus package. I feel they have succeeded in goal number 1. The stimulus package averted the complete melt down and destruction of our financial system. This was to the initial credit of President Bush who recognized in time the true crisis nature of the situation followed by focused aggressive action on the part of President Obama. I’ve never seen Washington work so hard and so fast in all my years on earth. On goal number 2, the restoration of our financial markets, there is light at the end of this tunnel. And no, it’s not an oncoming train. I know people who are taking advantage of the first time home buyer credit of $8,000 to buy their first home, I know people who are refinancing their mortgages and in doing so are putting significant money into their pockets monthly. This restoration will not happen overnight, but there are positive signs that they are beginning to work. It took us years to get into this mess and it could take years to get us out. On goal number 3, allowing the free markets to prevail, this is the most controversial right now. There are many who would argue that the U.S. went too far in the “forced” resignation of Rick Wagoner (CEO of GM) this week. These are drastic times and drastic measures are needed. Mr. Wagoner seemed like a good guy, he seemed to be trying, but in the end, our government (which is us) decided he wasn’t being successful enough. They didn’t actually force him to resign. They said they would not lend his company any more money if he stayed in place. I don’t want the U.S. car companies to go out of business. I think our government is looking out for our interests. The answer to whether or not we will achieve goal number 3 will not been known for a year or two. I encourage people to have at least a modicum of patience in this area.
Let’s turn to the subject of our deficit. It’s terrible, the worst in history, our kids will surely suffer, and rampant inflation is a given. I’ve heard all of these remarks. They are all possible, but I am willing to support the current deficit when the alternative was a complete collapse of our financial system (see goal 1 above). A collapse of our financial system would have led us into a depression. We have some hard times ahead, future plans about our own personal spending, retirement, and even a child’s education may be altered. But, I say, at least for now, we live to fight another day.
Take care, be patient, and good health to you all.
As a bit of background, I have worked in Washington. First as a summer intern for the Federal Energy Administration (now DOE) between my first and second year at graduate school where I earned a Masters degree in Public Administration from the Heinz School at Carnegie Mellon University and later as a consultant working at the Pentagon for the Strategic Defense Initiative Organization (SDIO - the Star Wars program). What I learned during my years in Washington is that it is very hard to get anything accomplished. The politics, the turf battles, the bidding process, congress, employee morale, you name it… It’s just not that easy.
Now, let’s turn our attention back to the stimulus package. I feel they have succeeded in goal number 1. The stimulus package averted the complete melt down and destruction of our financial system. This was to the initial credit of President Bush who recognized in time the true crisis nature of the situation followed by focused aggressive action on the part of President Obama. I’ve never seen Washington work so hard and so fast in all my years on earth. On goal number 2, the restoration of our financial markets, there is light at the end of this tunnel. And no, it’s not an oncoming train. I know people who are taking advantage of the first time home buyer credit of $8,000 to buy their first home, I know people who are refinancing their mortgages and in doing so are putting significant money into their pockets monthly. This restoration will not happen overnight, but there are positive signs that they are beginning to work. It took us years to get into this mess and it could take years to get us out. On goal number 3, allowing the free markets to prevail, this is the most controversial right now. There are many who would argue that the U.S. went too far in the “forced” resignation of Rick Wagoner (CEO of GM) this week. These are drastic times and drastic measures are needed. Mr. Wagoner seemed like a good guy, he seemed to be trying, but in the end, our government (which is us) decided he wasn’t being successful enough. They didn’t actually force him to resign. They said they would not lend his company any more money if he stayed in place. I don’t want the U.S. car companies to go out of business. I think our government is looking out for our interests. The answer to whether or not we will achieve goal number 3 will not been known for a year or two. I encourage people to have at least a modicum of patience in this area.
Let’s turn to the subject of our deficit. It’s terrible, the worst in history, our kids will surely suffer, and rampant inflation is a given. I’ve heard all of these remarks. They are all possible, but I am willing to support the current deficit when the alternative was a complete collapse of our financial system (see goal 1 above). A collapse of our financial system would have led us into a depression. We have some hard times ahead, future plans about our own personal spending, retirement, and even a child’s education may be altered. But, I say, at least for now, we live to fight another day.
Take care, be patient, and good health to you all.
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