Chemotherapy School
INTERESTING STUFF – 2 September 2017

Amazing Medical Advances (?)

A whole bunch of you, TGB readers, sent me a medical story published this week about the development of a deceptively simple test for pancreatic cancer – nothing more than a smartphone app called BiliScreen that uses the whites of a person's eyes to diagnose the disease.

The reason the five-year survival rate for pancreatic cancer is only nine percent is that there are few symptoms and no tests to catch it before it has spread.

”One of the earliest symptoms of pancreatic cancer, as well as other diseases, is jaundice, a yellow discoloration of the skin and eyes caused by a buildup of bilirubin in the blood,” reports Science Daily.

“The ability to detect signs of jaundice when bilirubin levels are minimally elevated - but before they're visible to the naked eye – could enable an entirely new screening program for at-risk individuals...

“In an initial clinical study of 70 people, the BiliScreen app...correctly identified cases of concern 89.7 percent of the time, compared to the [bilirubin] blood test currently used.”


Of course, much more testing is needed but it sounds good, right? Well, pardon my skepticism.

For the 20-odd years I've been studying ageing, I've been subscribing to a variety of reports on health and medical developments and have been disappointed again and again.

They generally sound as amazing as this one and the medical media excitedly report them as breakthroughs that are “closer than you think.” And then they disappear never to be heard of again. And in this case, I wonder what who is "at risk" for pancreatic cancer. Until my diagnosis, no one ever mentioned that it was a potential problem for me.

Nevertheless, how I hope this is not one of the advances that disappears. I was lucky my diagnosis was early enough to treat. I would hope that everyone who is told they have pancreatic cancer could, like me, be eligible for the surgery. Early diagnosis is not a cure, but it does give a patient a better shot at it.

Also announced this month are several reports of the development of blood tests for cancer. In one, from the American Council on Science and Health, a test for a certain type of DNA would allow cancers to be detected at earlier, and therefore more treatable, stages:

”It was tested in people who were in an early stage of four different types of cancer: colorectal, breast, lung and ovarian. Using this approach, they examined 58 cancer-related genes.

“Out of the patients studied that were in the earliest stage of cancer (stage I), the ctDNA was detected in 50% with colorectal, 67% with breast, 45% with lung, and 67% with ovarian cancer.

“An even higher percentage of people were able to be detected from the pool of people with more advanced cancer."

A lot of researchers, including my surgeon, have been working to develop a blood test for cancer for a long time and they are increasingly encouraged. This, of course, would be wonderful for the same reason the Biliscreen app would be: earlier detection.

Here's my question about this one: All the test subjects had already been diagnosed with a certain cancer. If people not known to have cancer are tested, how would doctors know what kind of cancer the patient has?

Yes, I'm a skeptic. I've been disappointed too many times with “breakthrough” announcements and it seems to me that most advances in health care are rarely of the quantum leap variety and more of the small incremental steps variety.

But that doesn't mean I'm not hopeful.


Some of these diagnostic 'tools' spring from the fields of alternative medicine and spiritual healing. However much we may feel skeptical about these practitioners , I think that eons of years of observation of human health (and illness) may have equipped them with some strategies that have met the test of time, and are being adopted by conventional medicine. Observation of the human eye is said to reveal a myriad array of conditions in the rest of the body. There may be some truth to this.

I am skeptical about that app as well. I take a lot of photographs using 2 different Sony point and shoot. I have adjusted peoples pictures from their cell phone. The point I wish to make if cameras 'see' colors differently what assurance is there an app can 'see' actual color?

I was fascinated by a TV news feature a while ago in which trained dogs were used to detect skin cancer! Anyone else see that?

I saw the feature about dogs detecting skin cancer; looks promising.

You have probably all heard about CRISPR, which is the new gene (DNA) editing/engineering procedure to "cure" genetic health issues before they actually occur. I think I also read this can be done on a fetus while still in the womb. At any rate, when I first heard about it, I was really excited -- thought it was fantastic. What you might not have heard later is that any time this gene editing is done, they've discovered hundreds of other genetic mutations/changes occur. And get this, they DO NOT know what those other "changes" might cause to DNA. I remember when I read the article about those "side effects"...I wondered if the researchers would properly inform patients about that? I don't think there's been much done along that line with humans just yet, but it is sure to come in the future.

As for screening for bilirubin, you can buy urine test strips from Amazon that checks for various levels of certain bodily functions. I use those to check my urine since I have to keep it alkaline to prevent acidic kidney stones. Don't know how accurate the bilirubin would be, but mine have always been within normal; and also normal in blood tests at the doctor.

I'm beginning to believe that cancer is a "given" to humans. We have been exposed to carcinogens all our lives and, if we don't die of a stroke or heart disease, it is cancer that finally does us in. I think it's endemic, inborn, and, when it is said that people died "of natural causes," it's cancer that does us in. Certain cancers are insidious, not detectable early enough to be stopped. Then, when detectable, it's too late. Going through chemo and radiation may cause "remission," but it's just a delay in the dying process. We're all going to die sometime, of something. Sometimes earlier, sometimes later. But there is no escape from death. The chemo and radiation just make you think you've done all you can, but there is no escape...

Sounds crackpot, doesn't it? It's probably a fraud perpetrated by the health care community in concert with the government to keep us spending large sums of money toward the end of our lives to avoid leaving large sums of money to our heirs. Remember, it's all about the money. If you have enough money to prolong your life, you can add many years to your life. If you don't have very much money, you die earlier.''

The media read scientific articles or press releases and then have to "translate" them into terms the general public will understand. So the news gets filtered through reporters who may or may not know much medicine and who also want to hype their stories. It's crucial to read medical/scientific news from the original journal/source if you want accuracy without hype.

Cancer is still a crap shoot. There are so many different kinds of cancer. And while there are some risk factors that predispose certain people to certain cancers, much of it is pure, dumb luck. A couple of cells turn rogue for some reason and you're off to the races.

Right now the blood test may become useful for early detection of recurrences, in itself a blessing for those who've already had cancer. Eventually, maybe, it can become a screening test in the general population, indicating both the presence of cancer cells and their type.

I've been the beneficiary of cancer drugs that didn't even exist 10 or 15 years ago. Progress, even in baby steps, is still progress.

That is too skeptical, Theresa. At death's door in January I am alive and reasonably well after finishing six rounds of chemo. These last months have been months I would have been very sorry to miss. Ronni: Don't let the pessimists discourage you. The game is worth the candle.

10/10 what Marianna said.

Your Montreal Fan in Prague.

Betty is a 99 year old senior who lives in the ILR where I volunteer busing tables.

You probably heard me say how much fun it is to overhear conversations in an ILR dining room.

"I'm not siting with Eileen. She hogs all the space."

The greatest benefit of busing is the life lessons from tenants who have almost become an extended family.

Resident Betty had breast cancer over 20 years ago. She will never forget her fantastic doctors and nurses.

She told me this after inviting me into her spotless apartment and showing me a photo album of her former home.

Betty is 99, in case I forgot to mention that.

Ninety nine.

Betty is one cool woman.

Many many moons ago I had my first new furniture; a beige circular couch and chocolate brown side chairs. My aunt made new drapes for me. The material colors were a beige background with a brown figure and touches of orange. I needed a new carpet to pull it all together. The first rayon carpets had just come on the market and there was one with the vibrant colors of a dark brown base with touches of beige and orange. I was thrilled with the appearance and had it installed. The carpet started showing signs of wear all too soon. Within a very short time it was deteriorating (no guarantee either). Within a short period of time there were no more rayon carpets on the market.

What has this to do with the subject of today's post? It was the advice given me by the man who sold us the furniture. "Do like the farmer's s do. Let someone else try out a new item for at least a year before buying it." I have never forgotten that advice and I remain skeptical of first time things whether it is the material used in a couch or a new medical advance or drug.

That saved me from having a thalidomide baby. I had nausea the entire 9 months of my first pregnancy and was offered the new drug to combat it when again I became pregnant with the accompanying nausea. I declined the drug since it was new. I did not want to put any drugs in my body that might affect the fetus. A friend did take the drug and she gave birth to a baby with no arms. The drug, like rayon carpets, was pulled from the market.

You are right to be skeptical at this point. I would keep an eye on the progress, if any, and see if there are follow-up studies.

Y-a-a-y for 99 Y/O Betty. We share that nickname. I don't know how she likes it--me, not so much, but it just kind of stuck.

For me, it comes down to quality of life. Betty recovered (was "cured") and that's wonderful. If I had contracted cancer at 70 and the odds were that I'd have 20 more healthy, good quality years of life, I'd probably have made the same choice she did.

However, at 80 Y/O, I would need to be convinced that there would be a pretty good chance of remission and manageable side effects. Absent that, I don't think I would elect to spend my remaining time battling cancer plus the side effects of chemo. My mother died of breast cancer at 69 after 2 years of chemo and radiation. I do not think I would choose that road, but of course who knows what they would do unless they're in a similar situation?

I remember reading that cancer cells lurk in our body all the time and it is our immune system that fights them off so I do not believe that everyone dies of cancer, any more than of heart disease or strokes, or accidents, pneumonia, etc.

My father was 94 and died of congestive heart failure, ate anitbiotics like candy during his working years; my mother died of a major stroke at the age of 83 and she was always healthy, over eater, overweight, and alcoholic. However, her last 10 years- when she quit drinking -saw a steady decline in functioning, both mental and physical, while my father took care of her.

My point is we all need to be aware of what we eat, keep moving and exercise, keep interested in a hobby, in life, and have a support system. That said, sometimes "bad things happen to good people". I forced myself to go to yoga this morning and it was worth it for the mental and physical refreshment I felt afterward.

Thank you, Ronni, for continuing to tell us the latest, and complain all you want, you deserve to after what's happened to you, and for your readers' comments, I always read them.

Ronnie, here is another quote that I think will interest you. I am hoping that bringing these quotes to you will help you to focus on the positive aspects of your illness- not the negative:

"The more serious the illness, the more important it is for you to fight back, mobilizing all your resources- spiritual, emotional, physical."

I have been fortunate in that I have never had any serious illnesses. However, that does not preclude me from deeply empathizing with you at this time.

Wishing you all the best, Estelle R.

Glad you pointed out issues that swirl around research studies and how we need to regard them without becoming unrealistic in our interpretations and expectations.

I recommend people refer to one of several internet links on how to assess scientific research studies. One is American Assoc. for Cancer Research. There are others written more specifically for the lay person. Also, over time determining science writers who best report summaries of research studies can become more familiar to readers.

I'm always interested in the reliability and validity of studies, including the information about participants such as number, age, gender, and variabilities, etc. I also want to know if the study results have been repeatable with the same results by others reputable in research. Who is paying for this research? Those are just a few matters to consider along with using common sense, logical reasoning when reading research -- especially their summaries. Did they actually test what they said they tested?

The value for me in making note of new research is simply being aware of its existence so I can be alert to what is occurring in a given area. Obviously, if I have a certain disease or ailment I'm going to pursue learning more, certainly in consult with my physicians. What might or might not have application for me would have to be assessed. I certainly would never jump to the conclusion the reporting of a research study, no matter how hyped in the media and even by others, can be assumed to be a wonder solution to any medical problem.

There are no easy answers. We have to do our homework, not be afraid to ask questions -- there are no dumb questions if something is on our mind. Clearly your thorough research methods and skills developed through the years benefit you now. You can exercise meaningful judgement in a rational manner when you are presented with well-intended information from others about your situation.

As always, lots of intelligent and thoughtful comments here today. The topic of research and medical advancements is a very interesting one. I am waiting for the day when the little tuning fork instrument used by Dr. McCoy on Star Trek can be held against our bodies and instantly diagnose and fix whatever's gone wrong. Until then, I remain skeptical about a lot. I have done research and have observed several things that continue to cause me concern when an amazing new study or breakthrough are announced.

There were some good suggestions made here already regarding research and studies, including asking who's funding the research, who will benefit most from it, who reviewed the work and whether it has been replicated, the numbers and diversity of the subjects involved, etc.

The strongest tool at your disposal may well be your attitude. Studies done years ago about the placebo effect began to open the discussion about the power of attitude and belief. While there are strong arguments on both sides, I feel pretty strongly that attitude makes a big difference, but also find that I don't have nearly as much power of controlling mine as I'd like.

Another blog I follow wrote today about the "bumps in the road." The writer is 81, and is pretty active and vibrant, leading a couple of guided tours to his homeland of Scotland each year, and putting out a weekly radio program on Celtic music on WETS-FM each Saturday. In pondering what it is that brings us back up after hitting bumps, which for him recently has included sicknesses, work pressures, unexpected slap-downs and news of the deaths of friends," he shared the observation that, in his experience, what brings us back up "can be quite a sudden feeling but doesn’t actually have to be all that dramatic." He asks, "Is it just chemicals in the brain? Or is it the much wider network of subtle interactions between people who share a set of basic needs and common values? " I suspect it's some of both, but I never underestimate the power of those subtle interactions between people to affect the chemicals in the brain, and vice versa.

Stay strong Ronni, and remember when you hit those bumps in the road, a lot of people are here to help you over them.

"Until my diagnosis, no one ever mentioned that it was a potential problem for me."

I thought you said your father died of pancreatic cancer. Perhaps I misunderstood. Or, maybe the medics don't believe that pancreatic cancer has a genetic factor, but the doctors I've been to are always adamant that I get a mammogram annually since my mother had breast cancer, although cancer wasn't the cause of her death.

Perhaps family history might be a good place for them to start.

Until my husband was diagnosed I never really thought about cancer. Members of his family were exposed to many carcinogens -- as were we all. Asbestos, coal dust, cigarettes, talcum powder, seemingly innocuous substances that turn out to "cause" cancer. And we think, "Duh, I should have known that it was bad for me." But corporate interests pooh-poohed our fears and made profits from our exposure, whether from pesticides, lead, herbicides, radium, whatever. Unless we were unbelievably wealthy, we were all exposed to chemicals in varying amounts in the interest of sky-rocketing profits.

Unless you have been diagnosed, you have no idea how many people are going through radiation and chemo -- thousands of people, even in small towns. The schedulers are the miracle workers. They can make or break your life just by scooting your schedule so that you can cope with your disease treatment. Each doctor will give you your fifteen-minute appointment every so often and you will be so grateful that they pay attention to you during that fifteen minutes, never mind that you're paying through the nose for that time. You are grateful that someone actually talks to you about your condition and prescribes every-increasing substances to treat your side-effects from the poisons they're bombarding your body with in an effort to make you a little more comfortable while they're doing it.

You've never had so much attention from medical professionals and you feel special for that fifteen minutes -- until you see how much you're paying for that treatment. Then you are appalled, but it's water under the bridge. You tell yourself that it's normal to have these reactions to the chemicals and radiation and you're still grateful that someone seems to care. It does seem strange that most of the doctors are foreigners from India or Pakistan, but you are so grateful that SOMEONE cares that you overlook their accents. Thank heaven SOMEONE does! The nurses and technicians are usually American and are the upbeat and optimistic sort who make you feel special and not just one of a crowd. And they seem suited especially for this kind of work -- it would be crass to complain about anything even if you're in terrible pain and throwing up everything you eat. After all, they're doing it all for your own good. Easy for me to say; they haven't discovered MY cancer yet.

And, yes, I am cynical. I've worked in the healthcare field for many years and I know about the bottom line. I've worked in labs and hospital rooms, radiation and manufacturing of medical devices. I know the strategies and the sales and the pharmacology. I am skeptical and pessimistic. I want the patients to get well and I want them to be kept comfortable as possible. But I am not fooled by healthcare professionals. We're all just numbers to them, but the skilled people are able to hide that from us.

The U.S.A. is the only major country without universal healthcare. Medicare cannot dicker with the pharmaceutical companies on prescription drugs. We pay the most money in the world for our healthcare. As we age, the number of drugs we take are the most expensive in the world. Our doctors get paid the most in the world. And yet, our life-spans are not the longest in the world. Whether it is our diet choices or the lack of physical exercise, we do not live the longest. We equivocate that we make some poor choices, it's our own fault. However, we didn't choose to have lead pipes or asbestos insulation, we didn't choose to use lead paint or to live next to a pesticide factory. And #45 is turning back environmental regulations even as we speak so as to increase corporate profits. Because profits are more important than quality of life.

This public statement is brought to you by the health insurance company of your choice.

No matter how much money Google and some other tech companies say they are going to spend, humans cannot escape death. Nor should we. If there were no (natural) death, there would be no new people and no new ideas. The earth would stagnate leaving whatever humans were left to suffer miserably.
The only solace we have is that, by passing on, we have contributed to the greater order of things.

Cathy, you're right, the placebo effect does exist and shouldn't be dismissed. When you're a patient, why not get it working on your behalf, right? It's not going to be a magic cure-all, but anything that tips the odds a bit more in your favor is worth paying attention to.

It is hard. The way I look at it, managing my attitude is to some extent a learnable skill like any other. The metaphor I like to use is riding a unicycle! I'm trying to keep my balance in an inherently unstable environment. There are going to be lots of tumbles and skinned knees, especially at the beginning, but it's doable. If I fall off, well, that's only to be expected. As soon as I notice, I can choose to get right back on. The more I practice, the better I can get at keeping my balance.

I've found this is a much better way to think about it. Instead of focusing on the difficulties, which only magnifies them, I acknowledge they're there but treat them as bumps in the road. I can be pleased with myself for learning something hard. When I slip, I tell myself, "Okay, that happened. Ouch. Now... get back on the unicycle! I can do this!"

Don't know if this will work for anyone else, but I figured I'd share. Because the image of me riding a unicycle is so comical, it really makes me laugh! And that's cheering, all by itself.

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