Why Everyone Seems to Have Cancer

A thoughtful take on comparing heart disease and cancer by George Johnson in The New York Times.

Half a century ago, the story goes, a person was far more likely to die from heart disease. Now cancer is on the verge of overtaking it as the No. 1 cause of death.

Troubling as this sounds, the comparison is unfair. Cancer is, by far, the harder problem — a condition deeply ingrained in the nature of evolution and multicellular life. Given that obstacle, cancer researchers are fighting and even winning smaller battles: reducing the death toll from childhood cancers and preventing — and sometimes curing — cancers that strike people in their prime. But when it comes to diseases of the elderly, there can be no decisive victory. This is, in the end, a zero-sum game.

As people age their cells amass more potentially cancerous mutations. Given a long enough life, cancer will eventually kill you — unless you die first of something else. That would be true even in a world free from carcinogens and equipped with the most powerful medical technology.

The author is keen on pointing out that the future of medicine will be focused on prevention rather than treatment.

The CDC on Antibiotic-Resistant Infections in America

A troubling new report from the CDC estimates that in the United States, more than two million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result . The estimates are based on conservative assumptions and are likely minimum estimates. From the report:

Each year in the United States, at least 2 million people acquire serious infections with
bacteria that are resistant to one or more of the antibiotics designed to treat those
infections. At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. Many more die from other conditions that were complicated by an antibioticresistant infection.

In addition, almost 250,000 people each year require hospital care for Clostridium difficile (C. difficile) infections. In most of these infections, the use of antibiotics was a major contributing factor leading to the illness. At least 14,000 people die each year in the United States from C. difficile infections. Many of these infections could have been prevented .

Antibiotic-resistant infections add considerable and avoidable costs to the already
overburdened U .S . healthcare system . In most cases, antibiotic-resistant infections require prolonged and/or costlier treatments, extend hospital stays, necessitate additional doctor visits and healthcare use, and result in greater disability and death compared with infections that are easily treatable with antibiotics . The total economic cost of antibiotic resistance to the U .S . economy has been difficult to calculate . Estimates vary but have ranged as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) .

Here is one important point: taking antibiotics when it they are not needed can lead to the development of antibiotic resistance. When resistance develops, antibiotics may not be able to stop future infections . Every time someone takes an antibiotic they don’t need, they increase their risk of developing a resistant infection in the future.

The New York Times raises this point:

One point of contention has been the extent to which industrial-scale animal farming contributes to the problem of antibiotic-resistant infections in humans. The government has estimated that more than 70 percent of antibiotics in the United States are given to animals. Companies use them to prevent sickness when animals are packed together in ways that breed infection. They also use them to make animals grow faster, though federal authorities are trying to stop that.

A note on MRSA (page 77 in the report):

Infections from one of the most pervasive types of drug-resistant bacteria tracked in the report, MRSA, have been declining. Invasive MRSA infections in hospitals went down by more than half from 2005 to 2011, according to a paper published Monday in the journal JAMA Internal Medicine. However, the number of invasive MRSA infections picked up outside health care settings has not changed much, and researchers pointed out that the number of those types of infections has for the first time outstripped the number acquired in hospitals.

The Girl Who Turned to Bone

Carl Zimmer, writing for The Atlantic, reports on a very rare disease called fibrodysplasia ossificans progressiva (FOP) and a girl named Jeannie Peeper who’s lived with it and decided to bring people with the disease together:

In 1998, this magazine ran a story recounting the early attempts by scientists to understand fibrodysplasia ossificans progressiva. Since then, their progress has shot forward. The advances have come thanks in part to new ways of studying cells and DNA, and in part to Jeannie Peeper.

Starting in the 1980s, Peeper built a network of people with FOP. She is now connected to more than 500 people with her condition—a sizable fraction of all the people on Earth who suffer from it. Together, members of this community did what the medical establishment could not: they bankrolled a laboratory dedicated solely to FOP and have kept its doors open for more than two decades. They have donated their blood, their DNA, and even their teeth for study.

Four times a year, Peeper sent out a newsletter she called “FOP Connection.” She included questions people sent her—What to do about surgery? How do you eat when your jaw locks?—and printed answers from other readers. But her ambitions were much grander: she wanted to raise money for research that might lead to a cure. With a grand total of 12 founding members, she created the International Fibrodysplasia Ossificans Progressiva Association (IFOPA).

Peeper didn’t realize just how quixotic this goal was. FOP had never been Zasloff’s main area of research. As the director of the Human Genetics branch of the NIH, he had discovered an entirely new class of antibiotics, and in the late 1980s, he left the NIH to develop them at the Children’s Hospital of Philadelphia. His departure meant that no one—not a single scientist on Earth—was looking for the cause of FOP.

As a trivia side note, I had no idea there was a definition for a “rare disease”:

 A rare disease is defined as any condition affecting fewer than 200,000 patients in the United States. More than 7,000 such diseases exist, afflicting a total of 25 million to 30 million Americans.

Read the entire story here.

Angelina Jolie on Her Medical Choice: Preventive Double Mastectomy

An incredibly poignant and brave piece by Angelina Jolie on her choice to have a double mastectomy to minimize her risk of developing breast cancer, which was estimated to be at 87% prior to surgery. A must read:

I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.

It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.

On her choice to go public with this revelation:

I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.

So, so important to get this message out to women out there.

Getting Lost Inside Your Home: Developmental Topographical Disorientation

If you think you have a bad sense of direction, you may be relieved that there are people like Sharon Roseman, who suffers from Developmental Topographical Disorientation (D.T.D.), a rare neurological disorder that renders people unable to orient themselves in any environment.

Click here to watch The New York Times video describing this debilitating condition:

Before she was given the D.T.D. diagnosis, doctors told her she might have epilepsy or a brain tumor. She kept her condition a secret from her husband, worked close to home and was terrified of not being able to take care of her children in the event of an emergency. After the diagnosis, she says she felt validated for the first time in her life: “I can now talk freely about D.T.D. and teach others what it is, so that someday a young child can be diagnosed and not have to grow up being afraid.”

On Hope and Numbers

We try to provide hope, but not false hope.

So we give ranges, starting with the best estimate of survival, because my patients have told me they shut down after they hear the worst estimate. We talk about setting goals, about maximizing quality of life, because we don’t have much leverage with quantity of life. We emphasize spending as much time as possible with family and friends, and as little time as possible with people wearing white coats. We tell them we’re not going to give up if they don’t give up.

But the truth is, we don’t know.

–Dr. Mikkael Sekeres, director of the leukemia program at the Cleveland Clinic, on hope and numbers in this New York Times post. Powerful.

Woody Allen on Hypochondria

Woody Allen pens a great (and hilarious!) piece about hypochondria

But why should I live in such constant terror? I take great care of myself. I have a personal trainer who has me up to 50 push-ups a month, and combined with my knee bends and situps, I can now press the 100-pound barbell over my head with only minimal tearing of my stomach wall. I never smoke and I watch what I eat, carefully avoiding any foods that give pleasure. (Basically, I adhere to the Mediterranean diet of olive oil, nuts, figs and goat cheese, and except for the occasional impulse to become a rug salesman, it works.) In addition to yearly physicals I get all available vaccines and inoculations, making me immune to everything from Whipple’s disease to the Andromeda strain.

Best line in the op-ed:

Even when the results of my yearly checkup show perfect health, how can I relax knowing that the minute I leave the doctor’s office something may start growing in me and, by the time a full year rolls around, my chest X-ray will look like a Jackson Pollock?

I, too, would classify myself as an alarmist. But an occasional one, not a full-time one like Woody Allen.