Dr. Len's Cancer Blog

Caregivers for cancer patients are very special people.  They frequently are the ones who listen most carefully to what the doctors have to say, and they frequently provide the support that patients need to get through their arduous journey once a cancer is diagnosed.

I don’t need to tell you that some of the most difficult and feared words that a doctor can say to a patient are, “You have cancer.”  We know that once those words are uttered for the first time, a person can go emotionally and even physically numb. 

That’s where the caregivers step in.  But I think it is more than “giving care.”  It is one of the most special partnerships that any of us can imagine.  So I am going to suggest that we consider changing this phrase to one that perhaps more accurately describes this relationship, namely “carepartners.”

Those of you who read this blog regularly know that I frequently make the comment that if New York City can go smoke-free, anyone can.

During yesterday’s meeting celebrating the release of the new guidelines for smoking cessation, I was particularly struck by some information mentioned by one of the speakers outlining the incredible success and impact of New York’s smoking ban that went into effect in 2002.

Now I have the actual data, and I believe it is proof positive that when you have the political and public will to do something, there are real benefits to be gained.  And those benefits are not just economic in terms of dollars, but also include a reduction in illness and the saving of lives.

Bottom line, these numbers make it hard to argue against the fact that effective public policy has a real impact on our health and the quality of our lives.

It is clearly evident in this room today, where the Public Health Service is unveiling its updated guidelines for treating tobacco use and dependence, that Dr. C. Everett Koop is one of the heroes of this moment and this movement.

As he just mentioned during his remarks at this meeting, Dr. Koop is in his tenth decade of life.  He has seen a lot, and done a lot.

Dr. Koop became one of the outstanding Surgeons General of my lifetime.  He attacked AIDS and vigorously fought the tobacco companies.  Whatever his personal beliefs, he became an articulate spokesperson and advocate for what was right in medical science, medical care and the public health.

Today I am in Chicago, attending a meeting where the United States Public Health Service is releasing their updated guidelines titled “Treating Tobacco Use and Dependence: Clinical Practice Guideline 2008 Update.” 

These guidelines are an update of recommendations that were first published in 1996, and revised in 2000.  The current report represents evidence from over 8700 published articles in the medical literature, which have been published beginning in 1975.

What has surprised me is that some of my colleagues believe that there may not be much interest in this guideline, that it may be “more of the same.”  Yes, they say, we have had successes, but given those gains people and health care professionals are no longer focused on the importance of smoking cessation.  Simply put, we have moved on to other “big new ideas.”

I don’t agree.

I am going to let you in on a little secret.

My confessional is prompted by the realization this past weekend, when I was on a call with someone referred by a friend, that I haven’t shared something with you that I rely on regularly when I talk with patients, families or friends who have questions about cancer treatment.

That “secret” is a website which provides what I consider the most up-to-date information used by doctors to guide their treatment of cancer.  That website is hosted by the National Comprehensive Cancer Network, or NCCN.

There is an article on the front page of this morning’s Wall Street Journal describing the experiences of a Texas woman diagnosed with acute leukemia who had to come up with hundreds of thousands of dollars before she could be treated for her life-threatening disease.

The basic premise of the article is that hospitals are no longer going to treat first and bill later.  The rising number of uninsured patients and those who do not pay their bills is reportedly creating an increasingly severe burden on non-profit hospitals, which in the past would have absorbed the costs.

I can’t say that I am surprised that this is going on.  I am surprised that it has taken so long for the issue to get attention.

There is a quiet, early revolution going on in medicine.  We are beginning to redefine how we provide primary care, moving from a traditional “one on one” patient/doctor relationship to a new model which emphasizes a medical team providing patient focused care.

The name of this new model of care is usually referred to as a “patient centered medical home,” or some variation of those words.  The impact of this change—which will take years to better define much less accomplish—has the potential to be enormous and transformational.

If done right, this effort has the potential to vastly improve the care we provide our patients, emphasizing prevention as well as more effective, evidence-based primary care medicine when someone develops an illness or a chronic medical condition such as diabetes or heart disease.

If you want to understand why some of us are concerned about conflicts of interest, you need go no further than an article that appeared in last Friday’s edition of the Cancer Letter.

The Cancer Letter article, written by Paul Goldberg, goes into great detail to explain why a scientific review on vitamin D, sun exposure and tanning booths which appeared in the New England Journal of Medicine last July may have been influenced by tanning industry funding.

The fallout from this conflict, in my opinion, may have substantial negative impact on how we are able to regulate tanning bed use, especially among young women who are putting their health at risk from the adverse effects of articial tanning.

The headline on the CBSNews.com website is loud and clear: “The Kanzius Machine: A Cancer Cure?”

The story goes on to promote an interview which is being broadcast this Sunday night on 60 Minutes.  The interviewer is Lesley Stahl, and the interviewee is John Kanzius.

Mr. Kanzius’ story is an interesting one.  According to various news stories, Mr. Kanzius has terminal leukemia, which has been under treatment for six years.  His experience with his disease and his treatments has focused him on developing a treatment for cancer that will be more effective and less toxic.

Unfortunately, in my opinion, the headline is terribly misleading for patients whose lives may be hanging in the balance.