Monday, August 31, 2009

Speaking of New Orleans

There was a story today in the New York Times about how this magnificent city is clawing its way back trying  make itself better than it was before hurricane  Katrina and  with some success.
It reminded me of  a bad decision the leadership of the American Society of Clinical Oncology ( ASCO) made to  drop New Orleans from it's list of meeting sites.
When someone commented that New Orleans would no longer accommodate a meeting the size of ASCO, I checked with a colleague of mine in New Orleans and was assured it wasn't true. The convention center , hotels and New Orleans outstanding  eateries are well able to handle the meeting.

I was told by ASCO's  EVP Alan Lister, that it was primarily a financial decision . ASCO can make more money from the exhibits at the Chicago convention center than at New Orleans because of the way it's configured. But it turns out New Orleans is not suffering from discrimination .  ASCO is gong to be in  Chicago in perpetuity despite  good facilities at other cities as well.

Now don't get me wrong, I like Chicago-just not every year. Not to mention that ASCO could do it's part  by helping the economy of New Orleans.

I told the ASCO leaders that I thought if the ASCO members were polled  they would probably  have voted for  variety over Chicago in perpetuity.

Annoyance was obvious. I was told it was a board decision to make. As a member I disagree.
I was at the founding meeting of ASCO. The society was founded for the benefit of its members, and had as it's primary role  the dissemination of information, not to become a bank.
I don't suppose the annual budget to run  the society of 90 million dollars had anything to do with  this?

The Slippery slope

I read with great interest the story in the 30 August Sunday Magazine section of the New York Times  on the  tragedy at Memorial Hospital in New Orleans in the days following hurricane Katrina.
If the story is accurate , patients who would have been difficult to move or who had signed a " Do not Resuscitate Order" ( DNR) were euthanized by lethal injections on a grand scale.
The doctors involved justified it by saying the police told them if they were not out by 5 PM on that last day they would be left behind . And they wouldn't have survived anyhow.
There were clearly patients who were conscious and not ready to die  and those who had signed DNR orders as a statement, not because they were terminal.
Now the surgeon who administered the lethal doses of drugs is campaigning for laws that would exempt doctors from liability if they did these things under emergency conditions.
And, of course, the doctors were not indicted  even though euthanasia is illegal.  New Orleans politicians, it appears , had decided they had had enough bad  exposure.
I mention  this because it is an example of what can go wrong if you give doctors the right to judge who should live and who should die. I am a cancer doctor and know physicians who believe that patients who have metastatic cancer should be left to die anyhow, with dignity of course, but early. My worst nightmare has always been to wake up from a cancer operation and find one of these guys looking down on me. I would not have wanted to be a cancer patient at that  hospital after Katrina.
Giving doctors that power is a first step down a slippery slope, especially if we end up with a government run health care system and rationing.

Saturday, August 29, 2009

Jim Watson's editorial in the NYTs

I read Jim Watson's editorial in the New York Times   a few weeks ago about the war on cancer , and actually agree with his thoughts about our ability now to design smart drugs.
This vision is better than the one he had  that saw cancer cured by Judah Folkman 's antiangiogenesis factors "in two years," 8 years ago, a prediction he repeated to no avail two years later at a meeting in Aspen. But clinical cancer is not Jim's strong suit.
Everything else was  wrong , as well , especially about how the money allotted to the war on cancer was spent.
He was also wrong about  why he was dropped from the Presidentially appointed National Cancer Advisory Board (NCAB). I was there and watched his interaction with Cancer Panel Chair, Benno Schmidt, who attended every board meeting.
 Jim expressed nothing but contempt for the new war on cancer  and the NCAB and showed it by coming to the board meeting with the New York Times , putting his feet up on the table , reading the paper and ignoring what was going on. When somebody said something about a program he  didn't like he would lower the paper and spit out an expletive. " This is a pile of  s** " was his favorite.
He made the mistake one day of saying that about a program and forgetting he was a major beneficiary .  Benno , in a way only the eloquent Benno Schmidt could do, pointed this out. Since this was a public meeting, it made the news. Jim was quiet for the next few board meetings
The President's Cancer  Panel had oversight function for the NCI and the NCAB, and Schmidt thought his behavior  was rude and non contributory  and was  hurting the program . He  asked for his removal  two years into a six year term and the White House complied.
 In truth , while I suppose I may have missed it somewhere, I never heard Watson  utter a single positive suggestion about  anything  to do with the National Cancer Program.
His constructive criticism of the NCI  that led to his removal , he said in his editorial ,was to put all the money into basic research but "instead" he said, " they went clinical". 
Eighty five percent of the money did go onto basic research. He wasn't paying attention.
The remaining 15 % is responsible for the declining national mortality rates from cancer we have been witnessing since  1990, something else he may have  missed.
My guess is ,the hundreds of thousands of people whose lives were saved would agree that Benno  Schmidt did the right thing.
But hey, 1 out of 3  is considered good in some sports.