REPORT FROM THE CHEMO WARS: HOPE PLACED IN NEW GROUP OF CHEMICALS

Imagine if someone came to you and said, “You think you are healthy. You think you are feeling just fine, but I know from tests that I have had conducted on you that you are really carrying around a disease inside you that eventually will shut down some of your major organs while causing major discomfort and considerable pain and then will kill you.

“Now in order to save you what I want to do is make you very sick and even threaten your life. You can count on it making you feel nauseous and stupid and very tired at times, and you’ll lose your hair. And, by the way, you need to know that I make no guarantees that what I am about to do will in fact save you. It might fail, and you’ll die anyway.”

“Forget it!”

Would you consent to going through the extreme, life-threatening procedure? Or would you say, “Forget it. I’ll take my chances by doing nothing. And I’ll save myself a lot of discomfort and pain in the process.” That is until the ultimate discomfort and pain, of course.

This is the kind of choice that a number of cancer experts presented me with back in 2001-2002, an option that I chose, and this is the proposition that has once again been put to me in 2007-2008 by another group of experts. That is the kind of proposition that our health care system with its advanced diagnostic procedures is now routinely able to present to us, the kind of decision that was never possible before in human history.

Complicated for the Mind

In being able to formulate decisions of this type, our medical science has fundamentally changed the very nature of the way we live our lives. Momentous decisions are now put in the hands of our health care providers and in our own hands as patients. All of which helps to provide one of a slew of reasons why life in the 21st Century becomes ever more demanding and complicated for the mind.

Okay, so that’s where I am in my latest round of medical treatments for my fatal disease. I have chosen to go down a similar road that I went down in 2002. That road brought me to Johns Hopkins University Hospital in Baltimore, Maryland, and to an autologous bone marrow transplant. That road brought me five years of remission from my MCL or Mantle Cell Lymphoma.

Wake Forest University

Now I have relapsed, and I have chosen to go down a similar but not an identical road. For one thing, I am going down this road with Wake Forest University Baptist Hospital in Winston-Salem, North Carolina. For another, my oncologist is now a bright young doctor named Denise Levitan. Then too I am being treated with a whole new group of chemicals, at least for this initial phase of my treatment. I am being treated with a suite of chemicals known by the acronym of “Cold Ice.”

What happened to Velcade? A few postings ago, I was filled with not a little optimism about a product known by the generic name of Bortezomib, trade name of Velcade, a proteasome inhibitor. As I explained back then, a proteasome inhibitor has the job of keeping biological mistakes from living, which is what those of us trying to survive cancer want to happen. We want the body’s cancer mistakes to die.

Yes, I went through eight treatments with Velcade as part of a two-drug cocktail. Specifically I received eight Velcade treatments and two Rituxan treatments over a period of six weeks. What do I have to show for it? Nothing, I’m afraid. When I had a CAT scan at the end of my treatment it showed that the lymph node in the mesentery region of my abdominal cavity that we are using as the barometer of my disease had not shrunk at all. In fact, it had grown slightly. Bad news.

Four-Drug Cocktail

And that brings me to Cold Ice. Cold Ice is a four-drug cocktail that happens to include Rituxan. “Why do you want to continue to use Rituxan even though it did not do a thing for me when used with Velcade?” I asked my oncologist. “For its complementary effects,” she responded. “We still like the way it interacts with other drugs.” Also as previously explained in this forum, Rituxan, generic name Rituximab, is a monoclonal antibody that is supposed to do its thing by targeting for destruction a specific antibody in a lymphoma mass. As we now know, it doesn’t always do what we want it to do, but I do hope it works this time. My tolerance for failures is limited.

What is Rituxan supposed to work with this time? These three: Ifosfamide, Carboplatin, and Etoposide, also known as VP-16. The three compose the ICE in the acronym while presumably the “Cold” portion is the Rituxan. All three chemicals are DNA “messer-uppers,”—if I may be forgiven a very unscientific term--either because they force the body to produce easily killed lymphoma cells with corrupt DNA or they interfere with the efforts of the cancer cells to repair damaged DNA and thus save themselves. Remember once again that the objective in our cancer wars is for cancer cells to die.

Only If Remission

Once the Cold Ice puts me into remission –and only when it puts me into remission—can I then proceed to finish the process. That process is finished this time around with an autologous bone marrow transplant. The latest studies for autologous bone marrow transplants for relapsed victims of MCL, which I am, remain somewhat encouraging. In an upcoming Mind Check, I’ll have more to say about autologous bone marrow transplants as well as their counterpart allegenic BMT.

Once again, however, we are not talking about a cure, but a prolonging of life.

To see a sampling of the other writing of Stephen Alan Saft, also known as S.A. Saft, see the website http://www.sasaftwrites.com.

Copyright © 2008 by Stephen Alan Saft

A MODEST PROPOSAL FOR THE PERFORMANCE ENHANCING STEROID CRISIS

Whenever the subject of performance enhancing steroids and athletics takes center stage in our frenetic world of public media, it is almost always accompanied by examples of destroyed reputations and painful humiliations among our athletes and the profound sense of disappointment on the part of everyone who cares about sports and our sports heroes.

The saddest example of what I’m talking about is the story of Marion Jones, a star of track and field, who had to give back five Olympic medals earned at the 2000 Olympic Games when she admitted to having taken performance enhancing steroids. Once celebrated as the world’s most gifted female athlete, Jones also had to endure a six month prison sentence for lying to a Grand Jury.

Who’s Telling The Truth?

In the battle of ace pitcher Roger Clemens and his one-time friend and trainer Brian McNamee before the U.S. House Committee on Oversight and Government Reform, we are subjected to yet another ugly installment of the performance enhancing steroid saga. Who is telling the truth about performance enhancing drug use, pitcher Roger Clemens, definitely one of the heroes of the game, or trainer Brian McNamee? And who will be subjected to a prison term for lying to a committee of the U.S. Congress? Stay tuned to find out.

Will the unholy alliance of performance enhancing steroids and athletics never go away? Maybe not. That’s because every party to the issue including the public has different ideas about the rightness and wrongness of the issue, and too many would prefer not to think about it at all. They just want it to go away. Their anger, if they’re feeling it at all, has mostly to do with being forced to think about it because a segment of the evening news has pushed it under their noses.

Let’s Not Be Naive

And let’s not be naive. There are powerful reasons for athletes to think they need to take performance enhancing steroids and human growth hormone, not least of which is the fear that everyone else in their sport is doing it, and they’re afraid of not remaining competitive. The economic motivations are just some of the reasons. Athletes do care about breaking records in their respective sports, and they do care about longevity in their chosen sport. They love the way winning makes them feel about themselves and the accompanying adulation.

On the other hand, we can’t let our athletes take performance enhancing drugs, can we? How “real” is the game we’re watching as sports fans if we do that? How “honest” is it? Doesn’t the game simply become a case of who has the best pharmacy and the best personal pharmacologist? Is that what we want for our professional teams? Is that what we want as a role model for our young people?

The Libertarian Solution

Or do we really care? Do we really care that although a slew of laws and regulations are already on the books that they are regularly being ignored or violated? Okay here’s my proposal. We decide not to ban steroids at all. We stop all drug testing. Not just in the United States but world-wide. We say that anything goes. Let the athletes be free to take whatever they want, in whatever quantity they want, and as often as they like. Let the athletes decide whether they are willing to chance the health risks. That’s not the public’s concern. In other words we adopt the libertarian solution.

On the other hand, to ensure that public morality prevails and to help ensure public confidence in our professional sports, we will insist on this: All athletes taking performance enhancing substances or who owe their participation in their sport to having used the human growth hormone in the past must wear a prominent sign, both front and back, whenever they are performing their sport that says the following: “Steroid User.” Furthermore in the telecasts of all sporting events, a graphic must appear on screen containing the same information anytime the image of an athlete appears who is a previous or current user. “Steroid User” will flash across the screen.

Steroid User Sign

My proposal also provides a solution for the Barry Bonds and Mark McGwire dilemma. How do we handle the achievements of these baseball players in the record books? We use the asterisk approach in print media, as has been already suggested a number of times and which, as far as a I know, is already being done in some cases, but we also use the graphic approach any time their images appear, whether in print or in video. On audio, whether radio or a recording, an announcer would have the job of giving voice to some version of the “performance enhancing drugs” statement. At the same the official game program for each game would also have to include indicators as to who the steroid drug users are.

Drug Pavilion at Cooperstown

As for future record books, they should probably be published with “drugs” and “drug free” sections. The Hall of Fame in Cooperstown, New York, would include a special “performance enhancing drugs” pavilion. Barry Bonds and Mark McGwire would appear in that wing, not in the same room with Hank Aaron, Babe Ruth and Roger Maris. Pitchers would be handled in a similar manner. Depending how the current Clements McNamee hassle plays out, Roger Clements, that is, his picture and statue, could end up in the special “drugs user” pavilion at Cooperstown.

What do you think of my proposal? Let me know, and anyone interested in sending in a donation for the new “Drugs Pavilion” at Cooperstown why send it right in. Remember to mark your check for the Performance Enhancing Steroid Drug User Pavilion at the Baseball Hall of Fame. Okay, I admit that this is not a pretty proposal. It’s borne out of frustration, a lot of it.

Mandatory Drug Testing

If you don’t like that idea how about that we fully enforce the laws that are already on the books including random, mandatory steroid drug testing? And, yes, cheaters, that is, people who manufacture, sell, inject, and use substances that happen for the moment not to be detectable through current testing technology are guaranteed substantial jail terms, probably even more severe terms than others.

Not pretty at all, right? but the alternate is even less pretty, and that is, to have more and more Marion Jones’s having to give back medals and having to spend time in prison. Nothing pretty about that.

To see a sampling of the other writing of Stephen Alan Saft, also known as S.A. Saft, see the website http://www.sasaftwrites.com.

Copyright © 2008 by Stephen Alan Saft