Archive for November, 2019


Nov 18 2019

My Birds are Cooked Before Thanksgiving!

by at 7:04 am

Greetings on a chilly Sunday evening. The football fortunes of both Washington and Philadelphia have been (in the case of DC) and now are, for the Eagles, basically toast. Pitchers and catchers report in about three months, though!

Please remember to attend Monday’s GUMC Convocation to celebrate the accomplishments of two special Lombardi members, the GUMC Lifetime Contribution will be presented to Dick Schlegel and the GUMC Outstanding Service Award to Carolyn Hurley, among other highlights! I will have to skip the reception that follows to host our Internal Advisory Committee meeting, which is chaired by Sandy Swain.

I returned to DC late Friday after a productive fundraising trip in San Francisco. I then received our preliminary letter from our EAC, which made many useful suggestions regarding our recruitment plans and program structure. I will be discussing these at our next Faculty Sector meeting and hope all faculty will attend.

I am looking forward to a week without travel, and hope you have a good week as we head into the homestretch before Thanksgiving.


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Nov 10 2019

Has the War on Cancer Gone Too Far?

by at 1:22 pm

Sunday’s New York Times Book Review section contains a review by Henry Marsh entitled, “Has the War on Cancer Gone Too Far?” Dr. Marsh, a neurosurgeon, reviews a book by a Columbia oncologist, Dr. Azra Raza, recounting the tragic death of her husband to cancer, who suffered greatly during the course of his illness and therapy. I have not yet read this book but look forward to doing so. But something about this review touched a nerve and demanded my response.

Dr. Marsh recycles a reliable old chestnut, “Why should you never give an oncologist a screwdriver? The Answer: Because they will open the coffin and carry on treating the patient.” It is not the oncology I practice and it is not the oncologic practice I have seen evolve over the past 35 years. How might Dr. Marsh feel if I gently reminded him that neurosurgery for gliobastoma multiforme, a deadly brain cancer, is almost never curative yet is routinely performed?

Dr. Raza, whose personal ordeal demands our empathy and respect, is described as stating that most chemotherapy does not work for patients with metastatic disease, and researchers attempting to solve this dreaded Emperor of All Maladies are guilty of hubris. Try telling that to the millions of Americans whose cancers have been cured since the signing of the National Cancer Act; since 1971 cancer cure rates have jumped from about 50% to about 70%. That’s a lot of lives saved, purely driven by advances in cancer research. These apparently smug researchers have not only increased cure rates but have cured increasing numbers of metastatic cancers and are converting others into chronic, albeit eventual deadly illnesses that permit patients to live meaningful lives. These people receive the gift of life that permits them to meet sweet life objectives such as the marriage of a loved one or the ineffable joy of meeting a first grandchild. Who are we to minimize the impact of these advances? There is no reason to believe that this path of progress will fade, as bumpy as it may be.

Certainly some oncologists get swept away by their determination to “do everything” but most are all too aware of their limitations and the importance of letting go at the right point. However, that right point is not always so evident, and this is not the fault of greedy oncologists, evil big pharma or an American obsession with eternal life. Sometimes people just want to live, even when confronted with awful, scary facts. They don’t work for us, we work for them, and the work is not easy.

Several years ago I wrote about one of my favorite patients, a nonagenarian from Germany who had survived the Auschwitz death camp along with his wife of more than 70 years. I had been treating him for several years, always mindful of his age, but he was quite sturdy and wanted me to try anything reasonable. Finally, I had run out of treatment options, and for the first time he was starting to really feel the impact of his cancer. I spent an hour with my patient and his wife, explaining why I believed it was important to consider hospice, reminding them of the profound privilege I had felt to be his doctor.

He chose hospice, and I made a call to his wife shortly after he died. She was curiously cool with me, but I discounted her behavior as a reaction to her grief. Then I got a note from his son, blistering me for “abandoning” his parents, stating that his grieving mother felt betrayed. I was shocked and deeply saddened, and spoke with him too. To this day I don’t know what more I could have done. I suspect that my patient and his wife felt that they could beat anything, having survived Auschwitz, and saw in me, the son of a Holocaust survivor, their perfect partner. In retrospect they would have preferred he die with chemotherapy drugs coursing through his veins, even though it would have been the wrong thing to do. He wanted to die fighting.

In no way do I advocate that every patient refuse to let go, with the assistance of their oncologists. Rather, I want to point out that this is complex stuff. Nobody should be treated with toxic agents when those agents have no chance to be helpful. However, our patients’ voices need to be heard, and they need to hear from us when palliative measures such as hospice represent the best course of action.

I must admit that I do bristle at the notion that cancer research, in all its complexity represents hubris and wastes resources and hope. Research cures cancer, and every life saved keeps one more sacred flame lit. Those flames light our path toward a time when the Emperor has been reduced to a ragged pauper.

Have a good week.


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