2. Was the war on cancer a failure? why or why not?
3. The 1980 Canadian mammography trail was possibly flawed because technicians steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technician's lab coat. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized?
4. Review the case of Nelene Fox. In your view was it appropriate for the HMO to refuse to pay for the expensive bone marrow transplant?
1. One chance discovery was Farber's antifolates. He did not know whether or not it would help but he found that is did prolong his patients life even though it did not cure cancer.
ReplyDelete2. I believe the war on cancer was a failure because the study that was presented in the book by Bailar and Smith showed that cancer related deaths had actually increased. They were putting all their efforts into finding a cure but not into prevention.
3. I would have recruited a friend for the mammogram group had I known they had a history of breast cancer. I know this contributes to a non random trail. If they had wanted to make a randomized trail they should have only taken names and then allocated each person to a group rather than taking their medical history first.
4. From a business stand point is was understandable why the insurance company refused to pay because they dont want to put out all that money to find that their customer died because the experimental procedure did not work. It is sad from the perspective of Nelene because if she hadn't raised the money to pay for the experiment she would never know if it would have worked for her.
1. Another accidental discovery was the identification of mustard gas as hematopoietic suppressing chemical. Mustard gas was developed to be a chemical warfare agent during the war--- it causes blistering of the skin and lungs. It was inadvertently discovered that mustard gas also caused a reduction in white blood cells. This prompted the studies of the effects of mustard gas on conditions like Hodgkin’s lymphoma and leukemia. This became one of the first chemotherapeutic drugs to be developed.
ReplyDelete2. The War on Cancer was not a failure as it is still going. It was very naïve to set a deadline to end cancer by a certain date, especially when cancer was not fully understood. Still, we have made incredible discoveries and progress in the fight to end Cancer—so much that some forms of cancer are largely curable through chemotherapy, radiation, and surgery. As we continue to build on the knowledge that was gained from the initial War on Cancer, it is certain that we will continue to make strides in our ability to identify, manage and even cure more types of Cancer.
3. In such cases of clinical trials there is always the risk of experimenter bias. Even when trying to be completely objective, we are subject to our subconscious judgment of situations and individuals. It is likely that if I were in the situation of the lab technician—I would have acted similarly and done what I thought to be the right thing—especially if my friend’s health was at risk. For this reason, it is important to follow strict guidelines when addressing clinical trials and establishing double-blind experiments that purposefully avoid these sorts of situations. Also, I think it is important to allow access to possible life-saving procedures during the clinical trial period—as long as they are performed outside of the clinical trial boundaries.
4. The issue of insurance company’s refusing to pay for costly and experimental treatments is very common. I am not sure of the standards that insurance companies use to determine what treatments are part of their coverage and which are not—but I think that it is an insurance company’s ethical responsibility to provide their customers with potentially life-saving treatments regardless of cost or other factors. Death due to insurance company’s refusal to comply with medical advice should not be acceptable.
1. So many of the scientific breakthrough that impacted cancer research such as the discovery of X-rays occurred by accident. What other chance discoveries appear in the text.
ReplyDeleteCytotoxic agents were discovered by accident. Farber saw the connection between vitamins, bone marrow, and normal blood led Farber to the accidental discovery of antifolates. Due to his first failed trial, which showed that folic acid accelerated the condition of his leukemia patients, led to the idea of using antifolates to treat leukemia patients.
2. Was the war on cancer a failure? why or why not?
The war on cancer is not a failure because the war isn’t over. There is still a lot of research being done and new treatments have been shown to be effective in treating different types of cancers as well as new cancer therapies. There have been times where battles against cancer have been lost and patients died, however, there are stories of success where patients survive. The war is still a long way from being over and we cannot deem success or failure to something that is still in progress.
3. The 1980 Canadian mammography trail was possibly flawed because technicians steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technician's lab coat. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized?
Whether I would have allocated my friends to the mammogram group depends on whether or not I knew they had a previous case of breast cancer. If they had no previous history, I might be inclined to assign them to the mammogram group because it would make more sense. I think these types of trials are nearly impossible to randomize unless done by an outside source and the terms were non-negotiable, unlike the Canadian case, which showed that women could flip-flop to either group of the trial. This led to a lot of discrepancies within each group.
4. Review the case of Nelene Fox. In your view was it appropriate for the HMO to refuse to pay for the expensive bone marrow transplant?
I do not believe that Health Net’s decision to refuse treatment to Nelene Fox was morally correct. However, I do believe that some kind of protocol was necessary for their company. During this time period there were a lot of drug trials going on and unless a treatment had been heavily reported with positive results, a treatment would not make it onto the HMO standard list of clinically proven protocols. The fact that it was her last option and that she had 3 children, I believe there should have been other protocols in effect instead of leaving her with no other choice but to raise the money herself.
1. Another "chance" discovery was made by Joseph Lister. His leap of logic resulted in "antisepsis" practice. Lister thought of Louis Pasteur who had previously shown that meat broth left exposed to the air would soon turn turbid and begin to ferment, while meat broth sealed in a sterilized vacuum jar would remain clear. Based on these observations, Pasteur had made a bold claim: the turbidity was caused by the growth of invisible microorganisms-bacteria.Lister reasoned if post surgical infections were being caused by bacteria, and perhaps an antibacterial process or chemical could curb these infections. Lister had observed sewage disposers cleanse their waste with a cheap carbolic acid. He began to apply carbolic acid paste to wounds after surgery. As he hoped, the patient's skin had completely healed.
ReplyDelete2. I don't believe the 'war' on cancer has failed. Primarily because the war is still marching on! As science, technology, medicine, education continue to advance in cancer research, failure is not up for discussion. For the millions of patients in remission, or who have survived multiple recurrences, I bet you can't convince them that the war is/was a failure. If we surrender to cancer's strong will, then we fail in war.
3. Obviously the negative end result was unknown initially. But, no considering the fact that more women died of breast cancer in the mammography group than in the unscreened group, I would not have allocated my friend to the mammography group. Compassion should always play an important role in cancer treatment but protocol must be strictly adhered to if the trial is to succeed. The 'screened' groups should consist only of individuals that qualify and the same is required of those in the 'controlled' group. Randomization can not tolerate favors from friends, administrators with sloppy record keeping, or patients who have two sets of answers to the questionnaire.
4. I believe it WAS inappropriate for Health Net not to pay for the bone marrow transplant. If for no other reason I agree with her brother when he said to Health Net, "You marketed this coverage to her when she was well, please provide it now that she is ill." Nelene had already exhausted all conventional therapies and the bone marrow transplant was suggested by her physician. The procedure was priced anywhere between $50,000 to $400,000 per patient. The Fox family was eventually awarded $89 million in damages. Even though they settled out of court for a smaller amount, Health Net could have saved more money in the long run and most importantly, probably could have helped to save Nelene's life.
1. So many of the scientific breakthrough that impacted cancer research such as the discovery of X-rays occurred by accident. What other chance discoveries appear in the text.
ReplyDelete• The scientific breakthroughs that were most prominent were that of anesthesia and antisepsis, which is the prevention of bacterial infection. The most important was that of anesthesia. When the doctors met at the theater to perform a surgery where the patient was under anesthesia, they were all amazed when the patient himself woke and said he did not experience any pain during the procedure. Another medical breakthrough was of Blumberg. He, accidently, came across what was a viral infection in the liver that was cause hepatitis. He saved many lives by discovering that the infection can be spread with human contact and through blood tranfusions. Little did he know that the HBV virus was/is a “live carcinogen.” Another chance discovery was that of the src gene it had already been known that it was involved in the carcinogenesis of chickens but they did not know the origin. They found that the src gene was “everywhere” even in humans. The discovery that it was the src gene that was carried by the cell and the discovery that v-src was due to a mutation was major. The src gene was then to be name “proto-oncogene”, by Bishop and Varmus.
2. Was the war on cancer a failure? why or why not?
• I personally, do not believe the war on cancer is a failure. In order for it to be considered a failure, we must have given up or surrendered to cancer. I can ASSURE anyone that this is not the case. There is extensive research being done to try to find cure, treatments, and therapies, for the many different cancers present today. Sure we have invested a lot in this war, but we, researchers, have found a great amount of valuable information. However, I also strongly believe that cancer is something that cannot be prevented, genetically speaking. Anyone who has DNA is susceptible to mutations, and such mutations can cause loss of critical genes that will eventually lead to cancer. Hopefully in the near future, cancer is something that can be obtained, genetically, but can easily be cured with a vaccine, pills, or even syrup. Let’s all hope we will all be around to see that happen.
3. The 1980 Canadian mammography trail was possibly flawed because technicians steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technician's lab coat. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized?
ReplyDelete• I would not hesitate to put a friend, or anyone for that matter, in the group that were going to get mammograms, had I known they would benefit. I think it is because of compassion any “normal” person would do the same. I think allowing a third party to choose the people that will be in the different groups can randomize trials. Ideally it would be more simplistic to choose the groups first before they assign each person the group, yet this also has its set back. There is nothing stopping the lab technicians from switching the woman after they obtain the medical history, which is what likely happened due to the many whiteout marks and erasing that was seen in the notebooks. There is no easy way around having a completely randomized, non-biased, trial.
4. Review the case of Nelene Fox. In your view was it appropriate for the HMO to refuse to pay for the expensive bone marrow transplant?
• I don't believe it was appropriate to deny Nelene Fox’s bone marrow transplant. I think the company purposely did not want to pay for the services and they though they could get away with it. In the end they didn't and had to award the family $89 million dollars, which they latter settled for a smaller amount. If they had approved the transplant, then they wouldn't have had to pay a large sum. Most importantly Nelene would have received her treatment earlier and she may have had recovered before the cancer became malignant and traveled throughout her body, even her brain. I think it is the company’s obligation to provide such services to people like Nelene. If they are not willing to cover certain treatments they should make it known, and it is the responsibility of the patient to refuse or accept such terms.
1. Ever since Wilhelm Rontgen’s finding of the “strange leakage” from his electron tube that had the power of penetrating through his wife’s fingers, Curie and other subsequent scientists discovered that this chance discovery of X-rays also had the ability to “selectively kill rapidly dividing cells” (75). In the subsequent pages, Mukherjee also notes of another accidental discovery of cancer therapeutics—which was actually discovered in 1919 around the time WWI. American pathologist Edward and Helen Krumbhaar, while studying two soldiers who have survived the effects of a toxic cloud of mustard gas, found that these patients had a tremendously low blood count. An analysis of this phenomenon had brought these scientists to a realization that this toxic mustard gas chemical had a characteristic of targeting cells of “specific affinity”—a useful characteristic for the field of cancer research. (88)
ReplyDelete2.Ever since cancer research advocates Sidney Farber and Mary Lasker steered the way for Nixon’s official declare on the “war on cancer” in 1970, the National Cancer Act was signed and up to $1.5 billion dollars in the course of next three years have been provided towards cancer research. Although a big step was taken towards building up ammunition so to say against the battle of cancer, humanity has yet to win this war. One reason for this ‘yet defeat’ is from Mukherjee’s implication of the adverse effects of human social habits, such as tobacco use, that impede the significant decline on cancer. Due to such cancerous persistence, humanity is continuing to battle against this long fought war. Fortunately, Mukherjee also implicates the small victories achieved from this war as many scientists continue to unveil bits and pieces of the molecular mysteries of cancer. Only until we discover the complete nature of what we’re battling against—we continue to battle against cancer.
3. Clearly what the Canadian National Breast Screening Study (CNBSS) mistaked from “randomizing [the patients] after her medical history…examination” consequently leading to clinical trial administrators to easily control who is categorized, tampered with the purpose of proper mammogram randomization for any scientific analysis (298). Which brings up a good point: proper randomization requires the patients to be categorized PRIOR examining the patients’ medical history. Trials can randomized only through this way—for this takes out the factor of potentially tinkering the data.
Had I been in those technicians lab coats, I’d be sure to sure to first abstain from being the trial administrator when my a friend walks in the door—to eliminate conflict of interest from occurring in the workplace. But instead restricting my friend from the benefits of being mammogram-ed, I may have her come by after the clinical trial—if she were placed in the placebo group, to come back to receive a mammogram.
4. Breast cancer patient Nelene Fox was suggested by her doctor for an autologous bone marrow transplant but was denied the procedure by her insurance company/HMO because of the iffy “investigational” nature of this transplant (322). Sadly, the decision made by the HMO—as some say—caused a “delay” of potential treatment which may have attributed to Fox’s death (324). Although I feel it was rather inappropriate for the HMO to deny a patient’s opportunity of immediate potential treatment, I feel it may have been a practical decision to not fund an expensive uncertain procedure, and rather save the fund a clinical case for already tested therapeutic treatments. This implies the necessity of carrying out “investigational” tests, hence reducing the amount of potential treatments of this nature.
1. Another one “chance” discovery was when the author mentions an accidental discovery of cancer therapeutic possibility based on an abnormal observation. It occurred when two American pathologists Edward and Helen Krumbhaar were studying two soldiers that had survived the effects of a toxic cloud of mustard gas. In these patients, it was observed that they carried a tremendously low blood count. After further analysis, the scientists realized that this toxic mustard gas chemical had a unique characteristic for targeting cells of “specific affinity” and therefore was seen as a particularly useful finding in the field of cancer research.
ReplyDelete2. 2. I do not believe the “war” on cancer has failed because the war against cancer still continues. Since it is an ongoing war, humanity has yet to win the actual war and only picks and chooses the battles it thinks it can win. But one thing humanity has to its advantage is constant need to advance in the field of science, technology, and medicine. And although we can only advance as far as our understanding, cancer gives us the motive to do so in the sense that it is ever evolving and continuous. And for those people who are affected by such cancers; for them it is a constant war that is never ending and for that reason majority of scientists and brilliant minds thrive forward in the need to solve or at least balance the equation to win a battle against the war on cancer.
3.Considering the fact that more women died of breast cancer in the mammography group than in the unscreened group, I would not have allocate my friend to the mammography group based on personal history known and therefore would rather she not be a part of the trial because of potential manipulation based on known speculation. Instead of leaving her without a proper screening for a mammography another occasion after the trails would be more appropriate. Compassion should be part of cancer treatment but protocol based on getting the best results for future and further research must be adhered if the trial is to continue forward and succeed. Proper categorization prior to examination of patients’ records should be done beforehand. Those that are considered the “screened” groups should consist only of individuals that qualify and the ditto for those who are in the 'controlled' group. Randomization should not allow manipulation of the data based on friend relationship or personal appeal for the best results ahead of the actual experimental trial.
4. I thought it was inappropriate for Health Net to deny the opportunity of a bone marrow transplant on the assumption of “investigative” nature of the transplant being an autologous and therefore not an emergency or not considered to have guarantee of success. Based on Nelene’s history of treatments, she had already tried all conventional therapies and the bone marrow transplant was suggested by her physician as an alternative method in hopes of regaining time to her disease. In a sense the HMO did not want to pay for a treatment they viewed was not certain to be a success and therefore condemned Nelene to death without the satisfaction of trying every treatment available to her at the time. In my opinion Nelene would have been the exception because she already tried other options with no results and if a doctor recommended the treatment as a form of potential cure it should be weighed in favor of the HMO giving the amount needed for this to occur.
1. So many of the scientific breakthrough that impacted cancer research such as the discovery of X-rays occurred by accident. What other chance discoveries appear in the text.
ReplyDeleteSiddhartha mentions many chance discoveries throughout the book but the one chance discovery I think had the greatest impact was the discovery Farber’s antifolates, the use of chemicals as cancer therapeutic agents. As I read the book I found a quote that I really liked that pertains to this matter, “Every drug is a poison in disguise… and every poison might be a drug in disguise.” Other discoveries I thought were significant enough to note was the discovery of mustard gas. Originally the mustard gas was created to use as a chemical warfare agent and eventually was used in the treatment of leukemia. The mustard gas lowers the white blood cell count in those who are affected by the gas. This poison, the mustard gas, was a drug in disguise.
2. Was the war on cancer a failure? why or why not?
I don’t think the war cancer was a failure. I also think the war on cancer is not over. It is hard to determine whether something was a failure or not when that something has not ended. Although many died during this war on cancer I don’t think the war on cancer was a failure because there are just as much people that have survived this war. I also think that this war is not a failure because I think that even the smallest advancement is a great victory against cancer.
3. The 1980 Canadian mammography trail was possibly flawed because technicians steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technician's lab coat. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized?
Putting myself in a technician’s lab coat I would definitely allocate a friend to the mammogram group, not only a friend but I would also allocate some of the women in my family even if breast cancer was not prevalent in the family, I would do this just to be safe but by me choosing them over other this makes the trail a non-random trail. To make the trail more randomized I think picking names out of a hat would be more randomized instead of looking at medical history first and then making a decision. Although this makes the trail randomized it does not make it logic to do so, I personally think the 1980 Canadian mammography trail made a wise choice, even though the results were skewed in one direction.
4. Review the case of Nelene Fox. In your view was it appropriate for the HMO to refuse to pay for the expensive bone marrow transplant?
I do not think that it was appropriate for the HMO to refuse to pay for the expensive bone marrow transplant that Nelene needed. Even though the bone marrow transplant was an experimental procedure I do think that it was a medical procedure and an HMO should cover medical procedures in general. I think that the insurance company decision was purely based on money; they did not want to pay the money. Thankfully she was able to raise the money she needed to get the procedure done and gave her more time to live. Unfortunately a year later the cancer relapsed and came back more powerful than the first time. The cancer eventually spread to her brain and she died. Her brother, a very good lawyer, sued the HMO company and won and the insurance company was forced to award the family. I think that it is never appropriate for an insurance company to refuse to pay for any kind of medical procedure.
1. As mentioned in a previous response, the discovery of the effect of folates by Farber was not intentional. This discovery provided the framework which several chemotherapeutic therapies are based on. The discovery of antifolates was a hallmark in the development of cancer therapies. I found the section on the discovery of the effects of mustard gas on blood cancers very interesting. We all know mustard gas in the context of being a agent in chemical warfare. I was not aware of its therapeutic uses.
ReplyDelete2. I wholeheartedly believe the war on cancer in not a failure. Countless front-line soldiers have lost their lives during the war. Doctors and researchers have proven to be relentless in their efforts to develop new treatments. Through research and diligence there will be a day when the Emperor falls.
3. I'll be bluntly honest. I would have allocated my friend to the mammograms group. I could not stand idly by over a situation where I had a a slight influence on. I am aware that in the context of science these actions would be seen as unethical but there are times where compassion supersedes scientific protocol. To ensure that future trials are randomized there should be lottery system where no one can influence the sample groups. Which is obviously easier to do in theory.
4. I found the response of the HMO disgusting. I understand that the treatment was experimental at the time but the Doctors had reason to consider as a potential candidate for the procedure. This is another case of an HMO looking to turn a profit instead of actually trying to treat patients. This profit bases business model should not be applied to health care. Money should be a secondary factor when considering if a HMO or insurance agent will pay for a procedure. This notion is unrealistic and cases like Mrs. Fox are bound to come up again.
1. Other important accidental discovery that I can think of is the therapeutic importance of is mustard gas. It was first developed during World War II, causing serious damage to lungs and eventually leading to death. Accidental discovery in this case was that it also suppresses the growth of white blood cells, which opened gates to new therapeutic studies for diseases like Leukemia. That discovery lead to other therapeutic agents, and was considered a breakthrough in cancer world.
ReplyDelete2. War on cancer was absolutely not a failure, the reason being that it opened up new gates, new techniques, and therapies, to manage cancerous conditions. Consider this, cancer management during the 50s and comparing it to present world, significant improvements have been made, new type of surgeries, minimal damage with chemotherapy, even tailored drugs, that can be specific to certain type of cancer. I do believe that it’s an ongoing war, but as our understanding and knowledge of cancer increases, we can manage it with clarity and perhaps even cure it.
3. When performing such kind of trials, human emotions could play a substantial role, I believe that protocol should be followed. But if I was at the technician, I would have done the same thing; the bias factor comes in place, considering the health of someone close to you. To randomize the trial double blind study protocols should be placed in order, and strictly followed and supervised, so the study can follow as planned.
4. That problem is still present, but not that prevalent, the point of Health insurance is to provide coverage for health issues, but HMO refuses to do so, because it is an expensive procedure, to me it’s more of political espionage, because it seems unethical not to provide coverage for procedure that can be life changing for the patient. But again I am not very familiar with code of ethics for insurance companies, assuming it exists.
1. So many of the scientific breakthrough that impacted cancer research such as the discovery of X-rays occurred by accident. What other chance discoveries appear in the text.
ReplyDeleteThe mustard gas was an accidental breakthrough. The gas was used in the wars which caused many soldiers be affected by the lungs and have blisters on their skin. Also it damaged DNA by killing all the dividing cells including cancer cells. They found out that by using this gas it can kill cancer cells but needed to find a way for it to only target cancer cells and not normal cells. This poison was used for treatment of cancer later in the years after being made for the war.
2. Was the war on cancer a failure? why or why not?
The war on cancer is not a failure because it is still going on now. The reason is because more information has been found about cancer and finding ways to prevent and find a cure. Over the years many patients have died but yet many have been cured to show that the war is not over. Even though it seems cancer is winning because there are so many different types that we still don’t much information, we will still keep finding new techniques and treatments of finding a cure.
3. The 1980 Canadian mammography trail was possibly flawed because technicians steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technician's lab coat. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized?
If I had friends that have a background of breast cancer or have it I would allocate them for the mammogram. Being in the technician in the clinical studies I would have done the same thing. The only thing is to change the way it was done. One way is a lottery system which will pick randomly but from outside source to make sure that the guidelines are followed properly.
4. Review the case of Nelene Fox. In your view was it appropriate for the HMO to refuse to pay for the expensive bone marrow transplant?
I believe it is not right to refuse to pay for the procedure. I understand that at that time there were not many trials performed and have good results enough to be in the list for HMO to approve to pay for the procedure. They could have found a way to help some way by paying partial
1.Another chance discovery that occurred in the text is how Min Chiu Li discovered that you need to administer the chemotherapy drugs until there is no longer a sign of the cancer present in the patient. If Li woulnt have done this process, it might have taken a longer time to discover how a chemotherapy drug might work to cure a patient’s cancer.
ReplyDelete2.The war on cancer is not a failure. This is because with the increased cancer advocacy and public outreach people are more open to talk about cancer, and are more aware about it. People can now learn how to look for signs themselves and what is needed in order to prevent cancers from occurring. Also the increased research in cancer is also providing us with ton of new information every day to help treat patients.
3.In order to actually see if a trial therapy or new technology works on a patient it is very important to have randomized the studies. I believe that I of course I would feel compassion for my friends, but I would not steer them the mammography group. This is because there is need of hard evidence in order to make sure the treatment works and if everyone changed how the trial works it might hinder the therapy from reaching the public and saving millions of lives. In order to keep them random, you would need to do some of these studies blind so that there is no bias over certain people.
4.I don’t believe that Health net should have refused to pay for the transplant for Nelene Fox. She had previously had undergone high-dose chemotherapy which didn’t work, and the next step in trying to cure her was transplant. Even though the insurance company believed that this procedure was “experimental” they should strongly take doctors and other patients testimonies for the therapy. At the time Fox underwent this ordeal (1992), there would have been thousands cases where transplantation would have worked, and it was routinely done to other patients.
1. So many of the scientific breakthrough that impacted cancer research such as the discovery of X-rays occurred by accident. What other chance discoveries appear in the text.
ReplyDeleteAside from the anti-folates, another accidental significant scientific breakthrough was the discovery of mustard gas. Mustard gas, a chemical warfare agent, reduces white blood cells.
2. Was the war on cancer a failure? why or why not?
Cancer is a class of disease, just like many other diseases out there. The main difference is that cancer has been harder to manage, treat, and cure than other diseases out there. The challenge to find the cure for cancer continues and so the war on cancer is not a failure. Cancer research and treatments continue to advance slowly but surely with the dedicated and motivated researchers out there. As long as we do not renounce, it will not be a failure.
3. The 1980 Canadian mammography trail was possibly flawed because technicians steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technician's lab coat. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized?
As a compassionate human being, I definitely would allocate my friend to the mammogram group. This would result in a flawed mammography trial as in the 1980 Canadian mammography trial, but doing what is right and in the best interest of friends, family, and patients is important and morally ethical. Trials can be randomized by randomly selecting women for the mammogram group. Possibly having an outside source manage who is eligible or not for the group may also keep these trials random.
4. Review the case of Nelene Fox. In your view was it appropriate for the HMO to refuse to pay for the expensive bone marrow transplant?
I do not think it was appropriate for Nelene Fox’s insurance HMO to refuse to pay for her bone marrow transplant. I think it was an unethical decision that she was left to raise the money herself to get the bone marrow transplant. I am glad that action was taken against the insurance company and that it resulted in Nelene Fox’s favor because it is a step to fight against insurance companies’ egotistical decisions. What happened to Nelene with her HMO refusing to pay for treatment unfortunately is quite common and I think it is horrible for all the victims of neglect by insurance companies.
1. So many of the scientific breakthrough that impacted cancer research such as the discovery of X-rays occurred by accident. What other chance discoveries appear in the text.
ReplyDeleteA major accidental breakthrough mentioned in the book was Farber's antifolates. He had discovered that using folates on lukemia actually accelerated tumor growth, so he decided to search for antifolates to regress the growth of cancer. Another breakthrough is the discover of mustard gas reduces white blood cells, a very important discovery.
2. Was the war on cancer a failure? why or why not?
I believe the war on cancer is not a failure. Only because the battle is ongoing, much like the battle of Flu before penicillin was discovered from a mold. We as scientists have yet to find a defintiive cure. Nonetheless, as long as it is detected early, chances of survival are greatly increased, suggesting we are winning the battle against cancer.
3. The 1980 Canadian mammography trail was possibly flawed because technicians steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technician's lab coat. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized?
Even though the studies were flawed, if I had found someone who was a friend, a loved one, or even someone I suspected had breast cancer, I would most definitely have allocated them to the mammogram group. Even though the technician did wrong for the study, they were morally acting correct. A way to avoid this is by having the patients and the adminstrators, or technicians, not know which group is which, therefore the testing would not be biased.
4. Review the case of Nelene Fox. In your view was it appropriate for the HMO to refuse to pay for the expensive bone marrow transplant?
I believe it was unethical for the HMO insurance not to pay for Nelene Fox's bone marrow transplant. That is what insurance is for, to pay for expensive opperations/treatments that we would not be able to afford by ourselves. Even though there were a lot of drug trials, and unless a treatment had been heavily reported with positive results, a treatment would not make it onto the HMO standard; they should have taken into consideration her personal life as well.
1. The Krumbhaars paper they published back in 1919 was on the Mustard gasses ability to target the bone marrow and wipe out only certain populations of cells was a remote finding. All chemotherapies are poisonous in some manner and dosage; however, this particular chemical agent had a specific affinity for bone marrow cells that I believe might have been a great way to target leukemia cells. It’s interesting to see what the events of the time can do to the discoveries that may have been; unfortunately the Krumbhaars work was “quickly forgotten in the amnesia of war.”
ReplyDelete2. Can an on going war be called a failure? Should we even be looking at the battle against cancer as one in which one side is winning or not? If so then, then I’d say we are on better standings to combat this disease then we ever were 100 years ago. With the advancement of technology and research today, we find that patients are living longer after diagnosis, and they are more aware of the ways in which to prevent or detect cancers early on. This I would say is at least on the way to gaining some leverage in the war.
3. It’s hard to say if I would have allocated my friends to the mammography group. Clinical trial are always looking at some new radical method of treatment that may have benefit to the diseased, yet how do we know if it even works or if it is actually due to some other cause. Randomization of the patients and also randomization of the treatments can give you a double blind clinical trial. Yet, when does it go against ethical moral fiber to give someone hope of a treatment when you know they are getting nothing at all. Don’t doctors have the responsibility to do whats best for their patients? It’s hard to say what I would do because often times it’s easy to say you wouldn’t alter a trial by allowing a friend at high risk to get a treatment that may help them if it goes against the randomization of the trial unless you were the one actually making the decisions. It will be interesting to see what types of internal struggles I will have to battle through when I get to that point in my career.
4. It’s hard to believe that the HMO’s had any business calling the high dose chemotherapeutic treatment “investigational” when clinics around the country were utilizing it and thousands of papers have been published on the treatment. This is a situation where we see the individual suffer due to the fact that the money involved in the treatment played a larger role than the life that was involved. She should have been given the treatment in the first place and clinics had not business charging what they did, because those clinicians where just as at fault by hiking the prices of care knowing that people would come and pay.
1. So many of the scientific breakthrough that impacted cancer research such as the discovery of X-rays occurred by accident. What other chance discoveries appear in the text.
ReplyDeleteThere are many scientific breakthroughs that have occurred by chance that appear in the text; one of them being the discovery of the anti-folates. He used folates thinking that it might help the patients but it only sped up the process so he realized that an anti-folate would affect the process in an opposite way and therefore he tried it and that’s how its discovery came about. Another breakthrough was the mustard gas which serves as a hematopoetic suppressing chemical. It went from being a chemical used in warfare which killed many soldiers to chemotherapeutic drug.
2. Was the war on cancer a failure? why or why not?
I feel that war on cancer is not a failure, I do think that the chance of getting cancer has increased due to man-made processes but I feel that we can’t just get rid of all those things that cause cancer because some things have become integrated into our system. We aren’t focusing on prevention which I hink we should try to focus as well as a cure for the cancer. Our main focus now is a cure for the different types of cancers. I feel that the war on cancer is not a failure in terms of curing because we can now diagnose cancers using so many different types of diagnostics but if we look at the war in terms of preventing cancer, I feel like it is a failure because we do not try our best to prevent cancer. The war on cancer will still keep going though
3. The 1980 Canadian mammography trail was possibly flawed because technicians steered women with suspected breast cancer to get mammograms, likely out of compassion. Put yourself in the technician's lab coat. Would you have allocated your friend to the mammogram group? If so, how can trials ever be randomized?
Any trial or experiment done has somewhat of a bias involved in it and I feel putting a friend into the mammography trial would be biased if I knew her background history of having breast cancer. I feel that if a study needs to be randomized, the bias can be ignored by not knowing the patient’s history or background for having breast cancer but I feel that trial that was performed was more geared towards getting the women to get a mammogram so that they know whether or not they have breast cancer.
4. Review the case of Nelene Fox. In your view was it appropriate for the HMO to refuse to pay for the expensive bone marrow transplant?
The HMO didn’t want to provide the money to pay for that transplant because if the patient dies, and the procedure doesn’t work then the money would be lost. I feel that from a business perspective it was a realistic thing they did by not paying for it, however I feel that it was inhumane to refuse to pay for that because if Nelene was unable to raise that money, she would have never known if the transplant would have been a success. It was risk she had to take or else she would have died anyways. She was able to get the money and take the risk.
1. A discovery that I found particularly interesting was when they discovered what mustard gas does to the body. Of course it would have dire, serious consequences considering what is was used for, but that makes it that much better. Because of the effects it had in the soldiers exposed to it in the war, they were able to turn that around and use it for fighting leukemia and may have laid the foundation for chemotherapy.
ReplyDelete2. The war on cancer was not, and will not be a failure. A war can only end, once one party becomes victorious (for any reason), and it does not appear that that will happen in this case. Cancer will always be there, if we find cures for some cancers, there will be others to take their places. As long as we continue to fight it and look for cures and treatments, the war will never be lost.
3. Although it may be wrong, of course I would want to steer people, especially those close to me, to the screening group because I would want to make sure that they had every opportunity to get an early diagnosis, which is what the mammogram is supposed to do. The trials must be randomized in a different way. Women should have been allocated to specific groups before ANY background information was known about them. It’s very hard for people to remain unbiased when emotions get involved. What kind of person would not want to steer a women with a predisposition or history of breast cancer to the study group if she had a family or children? Of course they would want to steer her that way in. That’s why it is important for people to be assigned to test groups prior to medical evaluation.
4. I understand why insurance companies don’t want to pay money for treatments for people who have little chance of survival, but that does not make it right for them to get to decide who has a chance to live or die. A close friend of mine was diagnosed with breast cancer when she was younger and given a 5% chance of survival, yet here she is 20 years later still alive and healthy. My uncle was diagnosed with cancer at 24 and basically told that he was going to die, to get his affairs in order. What do these cases have in common? They both were expected to die, but they were not denied treatment, and they are both healthy and cancer free today. A friend of mine, not too long ago, found a lump on her breast, but had to wait for insurance approval for almost two months before she could even get it looked at. It is so wrong. Two months may not be a long time, but it could mean the difference between life and death for someone. If they could have given Fox the treatment immediately, would she have survived? We will never know.
1. A couple of other accidental discoveries mentioned in the book were Faber’s antifolates and the mustard gas of WWI. Faber discovered these antifolates by first administering Folic acid to patients with leukimia hoping to “restore normalacy to their blood” what he found was just the opposite; folic acid sped up the disease. This was a bog step for cancer because Faber discovered that perhaps by killing the cells instead of saving them we could help save patients from cancer. Mustard gas was a very interesting accidental find as well because they found that mustard gas would kill and dry up white blood cells. This weapon of war may be able to save lives by killing the cells of leukemia victims.
ReplyDelete2. I do not believe the war on cancer was a failure. Everything must begin somewhere and at the time there was no real awareness of cancer and doctors had seemed to have given up. There were no funds and no real national support. Now there are billions of dollars being used on cancer research around the world and possibly even “cures” at the very least many cancer victims can find long term relapse. We have finally begun to understand cancer better on a molecular scale and therefore have better ideas of where to go next with treatment and research.
3. I would definitely want my friend to enter the screening group if she had a history that may give her a predisposition for breast cancer. A good way to keep the trials randomized is to allocate the women to the different groups before knowing any background information about them. Also they could use a double blind procedure and not know which group A or B would be the control group.
4. I do not think it is right for the HMO not to cover Fox’s transplant. Fox had already exasperated all her other options with chemotherapy and radiations; none of these other “non-experimental” procedures were working. so I think the insurance company should pay for a doctor recommended procedure that is still experimental. The patient has paid and trusted her insurance company for years and now that she is sick they are obligated to help her get better by financially backing her treatments.
1. The first example that comes to mind about accidental discoveries would be the effects from using mustard gas in WWII. Obviously, mustard gas was a chemical to use as a weapon but they noticed that that same chemical had therapeutic effects on patients with leukemia. Farber used his antifolates on cancer patients not really knowing what the outcome would be. The fact that some of these did temporary remission and even cured some cancers was by accident. Those types of discoveries are the basis for cancer treatment used today.
ReplyDelete2. No, the war on cancer was certainly not a failure. Due to the difficulty of cancer as a disease, the fact that we have and are learning more about the disease and treating it has been the ultimate weapon against the war on cancer. There are already plenty of methods, drugs, and therapies that cures many cancers today. It was possible because of people like Farber, who took chances and kept trying to find ways to treat the disease. With that will to keep fighting the war, we can only make progress, and hopefully beat cancer.
3. I believe that it was not necessarily a bad thing to steer womwn with suspected breast cancer to get the mammograms, especially out of compassion. If I knew I could get away with getting a friend into the group, then i would. I do not see that someone should be felt like they did something wrong for doing things out of compassion. However, I do understand that in situations like this one, the women were supposed to be chosen randomly. One way to randomize such trials would be to pick the women based patient nickmanes only, like Patient A, Patient B, etc. That way, the women would be chosen based on as little information as possible instead of being chosen based on their medical history. Any other bit of information, like name, age, ethnicity, or medical history, would cause the technicians to also choose certain women. To know the least amount of informaiton about the participants would be the best way picking women at random.
4. I do not believe that it was acceptable for the HMO to not pay for her expensive bone marrow transplant. It's an issue with the insurance companies which I'm sure it is the case today. Unfortunately, the companies are looking out for their own best interest and taking a risk on an expensive procedure that was not guaranteed is not a good investment. This same idea is applied to other types of insurance companies where risky drivers are not approved by some companies for example. But in these cases, it seems more inhumane to refuse to give money to someone who can possibly die because it deals with an individuals life.