Posts Tagged ‘medicine’

The two types of stem cells

June 18, 2011

A couple of years ago, I delved into a personal research project,  in order to write my second novel,  Glass Chimera. From a layman’s perspective, I was learning about  genes, DNA, cloning, and other areas of scientific endeavor that pertain to the science of genetics.  I learned a lot about the human genome, more than I can ever understand or explain.

One particular area of genetics that is often discussed in our era is  the use of stem cells. My limited investigation into the subject has brought me to this observation about stem cells: there are basically two types of them.

Embryonic stem cells are those found in the fertilized egg, or the embryo, of a newly-conceived fetus in a female’s uterus. These are the controversial stem cells, because the harvesting of them for medical use will most likely alter or terminate the embryo’s fetal development.  Embryonic stems cells are pluripotent, insofar as they have potential to differentiate into many types of cells that are necessary for a fully developed body to, after birth, sustain life. These cells can be directed by the DNA genetic code to become, for instance,  blood cells,  skin cells,  muscle,  nerve, or whatever cells. My limited studies have  indicated that the  main value of embryonic stem cells is found in their use for medical research.

In the novel that I wrote while studying this, I include a hypothetical conversation between two graduate students in microbiology. In chapter 24, Erik is explaining  stem cells to his friend Sam:

 “. . .these guys that are doing this type of work, they remove the stem cells from the ICM (inner cell mass) that has congregated inside the 5-or-6-day old blastocyst—“

“So they’re sacrificing the embryo?” Sam wondered.

“I guess you could call it that,”

“What do they do with the outer part?”

“Oh, the trophoblast, God only knows.  I suppose they use it for something or other in the lab, or maybe they culture those cells for some other developmental purpose. I don’t know.  Anyway,  they place the totipotent stem cells into culture and propogate them.”

“That’s what we call a stem cell line,” observed Sam.

“Uhhuh, but it’s tricky.  Those cells have a built-in tendency toward differentiation.  If they’re kept alive unto themselves, without chemical restraints, they’ll start to organize themselves into an embryo again.”

This “differentiation” potential of stem cells is their most useful attribute. At the same time, it is the very thing that makes them somewhat dangerous.

I mentioned above that there is another  type of stem cells: adult stem cell.  Their differentiation potential is quite limited, as compared to the embryonic type, but they are much safer for medical applications, mainly because they are obtained from a patient’s body, and then injected back into that same patient. So there’s no conflict between the genetic info in the medically modified stem cells and the genetic data resident in that patient’s other billions of cells.  This second type of stem cell, the “adult” type, exists in the body of every child and adult. They enable the growth of new bodily tissue, and they exist in every part of the body.

Yesterday, June 17 2011, I was fascinated as I listened to a very informative discussion  on the radio about new medical treatments  utilizing these adult stem cells to repair damaged tissue.

Ira Flatow was again demonstrating his customary excellence in science journalism. The depth and scope of  his NPR reporting  keeps  his show, Science Friday, on the cutting edge of popular science education. I always obtain galactical levels of new information and insight when I can listen to his Friday program, or catch it later online.

The spot I heard yesterday was SciFri 061711 Hour 1: Black Holes, Untested Cell Therapies, Solar Update, which I had clicked on at

http://www.sciencefriday.com/about/listen.

 

Ira was speaking to two medical doctors about Bartolo Colon, the great NY Yankees pitcher whose injured pitching arm required medical treatment. Ira explained that since the pitcher was in the latter years of his baseball career, surgery to correct his elbow problem might be too risky. So Bartolo had elected to have this relatively untested therapy performed on his arm by doctors  in Dominican Republic.  And guess what, it worked! Bartholo has made an impressive comeback in his pitching career, at the age of 37.

Dr. Rick Lehman, an orthopedic surgeon at the US  Center for Sports Medicine (in St. Louis), described how cells taken from Bartolo’s own body had been medically treated and then injected back into his injured shoulder and elbow. The immature stem cells, as the doc explained, act to recruit blood  supply, enhance healing of ligaments, and improve the natural healing mechanics inside the patient’s body.

Dr. Scott Rodeo, orthopedic surgeon at the Hospital for Special Surgery (in New York City) contributed to their fleshing out of the subject with specific comments about Bartolo Colon’s surgery, but also with some interesting facts about the different kinds of stem cells.  For instance, risk of cancer is far lower with the use of these adult stem cells than the risk from using  more primitive stem cells, such as those pluripotent ones found in embryos.

As a writer whose research had skirted these areas pioneering medicine, I was fortunate to have heard their productive talk on NPR about the  minimally surgical restoration of a great pitcher’s arm.

And congratulations to Bartolo Colon, whose baseball career has been renewed.

Glass Chimera

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Robby’s dream

November 28, 2010

From chapter 25 of Glass Chimera:

Robby had a dream.

It was the hammer and sickle thing.  Freedom verses Slavery:     Embryos crying out for personhood, but being herded instead into  chimeric concentration  camps under glass,  their chromatic hammers swinging with molecular  blacksmithery,  forging the  plasmidic implements of a bogus new world.

Eggs of Women crying out for fertility and progeny, but instead being scythed into  Auschwitzian  abyss.

And he heard their singing:

Hmphh .. . Ah .. .Hmphh .. . Ah .. .

That’s the sound of the men working on the chain

gang.

That’s the sound of the men working on the chain

gang.

And he knew the grunts of thousands of men a-groanin’;  he heard the songs of millions of  women a-moanin’,  giving birth. He heard the cries of their wounds,  the pangs of their wombs. Slaves, they were.  He heard them singing.  Don’t ya hear Jerusalem moan?  Don’t ya hear Jerusalem moan? No, it weren’t all voluntary.  No, Virginia, it weren’t all voluntary.  Hmphh .. . Ah .. . Hmphh .. . Ah .. . Pull that barge.  Tote that bale. He saw the burlap cotton sacks dragged upon the ground. Hmphh .. . Ah .. . Hmphh .. . Ah .. . He heard Moses demanding of the pharaoh, Let my people go. He heard Moses demanding of the pharaoh, Let my people go. He heard America singing,  follow the drinking gourd, follow the drinking gourd.

He saw the strong brown arm of Washington Jones pull his great grandfather from the  flood that swirled about a faltering riverboat. He felt the loss of  footing as the boat careened upon raging waters, felt the lurch as the boat hit the mama oak and came to a sloshing, creaking crashing halt.

He saw, beyond the torrential horizon,  the sod ripped from prairies by oxen teams, and he heard their bellowing, the cracking of the whips as Herculean animals strained and primordial prairie grasses became torn, the black earth turning up its wormy, smarmy loam to be kissed by the sun and drenched by the spring rains, the winter snows, the corn’s roots, the wheat’s shoots.  He heard America singing,  strains of music born of the resolve of freedmen, homesteaders, pioneers, farmers, Scandinavians, Scotch, Irish, African, indentured to the soil, and to their hopes for promised land.

Oklahoma! He heard Oklahoma, thousands of homesteaders spread in expectation across the dawning prairie horizon, buckboard wagons, horses, mules in anticipation of that great sounding signal from Uncle Sam, brought forth beneath the billowing skirts of fertile farming women, freckle-faced children in the shaded wagons, oxen in the sun, horses on the run.

Freedom? Yes, some were free, but ‘t’weren’t all that sweat dripping into from free brows, Virginia. Much of it had come slitherin’  in wet slavery drops of toil and blood and tears.

He heard low, slow, insidious  munching of the dreaded boll weevil, chomping into oblivion acres upon millions of acres of lily-white wads of forced servitude.

He heard, like God, innocent blood crying out from the ground.

He heard the clanking of chains, the clashing of  cultures and civilizations.  Can you hear the Cherokee moan?  Can you hear the Chickasaw moan?. He felt the tearing of their platted cords, the stomping of their ancestral hordes. It was a mournful cry heard round the world.

He heard the  low, slow  voice of Willie’s embryonic call, Freedom!

He heard the  high, spry  response of Bo’s ironic refrain,  Freedom! blasting forth in totipotent nuclear song.  The strains were there, ringing  in his dream, clear as a splitting bell, bringing forth the clarion knell.  He knew he heard the song; then it was gone.

The Four Seasons

October 10, 2010
How different life is now in these ole Appalachians mountains than it was many a year ago. In days gone by, a spring trickling water from the earth itself would have provided the most basic life support for the family.  Apples on the gnarly old tree would have been tumbling down from their rotchety branches.  The surreal orange maples, first firebrands of fall,  well…words cannot capture…
We don’t struggle against the elements on this mountain slope these days; it ain’t like the old days when the settlers forged out their homesteads from hostile nature with samwill lumber right off the land where they was a-livin’. No, we’re locked into the system now, not like them Scots-Irish forebears who came through here just a few years after Dan’l Boone, building barns and fences and cabins that now are old shacks that we pass by in our cars and sometimes take pictures of.
‘Specially this time of year.  There’s somethin’ special about them ole barns this time of year. A hundred and fifty year ago or more, the hard-scrabble struggle would have required a family to be domiciled down on the bottom, by a creek where we’d have a perpetual run of fresh water and a flat, fertile  land with dark loam to grow the crops on, or maybe if it weren’t a bottom it was a homestead by a spring  up on the slope a ways, where clear water is trickling out of God’s green earth, making a cool springhouse and  human household possible. Nowadays we’re up high-tech on the mountain, near the ridge. There ain’t no spring on this 1.5 acres, but there shure ’nuff is an unseen well-shaft ‘xtendin’ six hundred feet underground and a pump runnin’ on 220 that drives our water up here to where we are in the sunlight, and makes our domicile possible..
And by a miracle, on this golden, October Saturday evening,  of electrons racing through copper and silicon and God knows what other elements, I listen to Vivaldi’s Four Seasons, a recording I brought from worlds away, purchased when we were in Venice a few years back.
There’s a whole ‘nother world out there, with thousands of years of European pain and toil and tears and musical dynamicism vibrating through those trained violin, viola, violinocello strings and hands–a world of Venetian musicians, thrubbing now through a cd and a speaker and my mind as I sit here on the back porch in the 21st century beneath the poplars and the blue late-afternoon sky, three hundred and sum’n years after Antonio made the music happen. Hi-tech, y’know. What an amazing world we have wrought upon the raw materials of God. And I just finished setting flat stone in mortar and grout,  a setting-place for a propane fireplace stove that we bought.  It’s not like the old days any more,when the home folks would just keep the wood stove stokin’ through the winter.
We can do that wood-burnin’ thing if we have to, but it’s a lot of trouble for an old guy like me who’s still managing to  hold down a 40-hour. Thank God.
No, that pressurized, bottle-up hydrocarbon  gas will be trucked in from some distant place, maybe some rig out in the Gulf that BP’s a-runnin’, God forgive ’em. Maybe even from the Persian Gulf, I don’t know.
And God forgive me, too, but we gotta be warm in January. Makes me wonder how long this  highly leveraged, technified, transportified thing can go on…At some point that four-season cycle  ended for Vivaldi, and at some point in time it will end for me, but I’m loving the October late afternoon…
Thank God for another day on this golden earth.

Growing old could be hazardous to your health

June 6, 2010

The world  these days is frighteningly different from the one my 80-year-old father-in-law grew up in.
Laid up yesterday in medical suspension, his crankiest complaining-point centered on the attendant whose faulty assistance could not prevent the fall that now confines him to a hospital bed.
“No speaka de English,” railed the old white guy about the “foreigner” minimum-wage health-care provider.
Yeah, it was all her fault, dad, that you fell.
They’re not like your Irish-immigrant ancestors
who were speaking the Queen’s English (ha!) in New Jersey neighborhoods back in the day.  And I guess you forgot about the Italians who had lived around the corner, or maybe you blocked them out of your memory, although I know for a fact that you later gained an intense appreciation of their restaurants and their wine.

Anyway,
This slow drift toward chronic fault-finding with the presently-devolving world is something I’ve noticed lately. I’ve encountered it in my own late-50s bad self. My father-in-law, however, seems to have a full-blown case of the grumpies.

He always was a perfectionist, though. That’s how it starts, you know, as if Aristotelian attempts to impose logical order on the chaotic–or some would say “dumb”– world, might actually have a constructive impact. He’s an engineer, able to make sense–and productive systems or machines–out of numbers and physical forces. Unfortunately, human beings–and anything that they initiate or maintain–do not conform to those logical paradigms.

A little bit later, though, as our attention to his present circumstance mellowed his attitude somewhat, I became amazed at the old guy’s mental sharpness. Here’s the grumpy fella imprisoned in a hospital bed, but he’s been watching numerous reports about the infamous oil spill in the Gulf. While analyzing this world-threatening problem, his engineer’s mind had recovered every millimeter of acuity. With a precise understanding of what BP guys were attempting to do to stop the gushing oil, he spoke lucidly about their mud-pumping strategies. His practical brain was striving to ascertain where such a massive amount of mud would be readily obtained and stored, and calculating pressure differentials between inside the pipe and outside it, in the mile-deep water…62 and a half pounds per cubic foot of water times x number of feet in height…

What a miserable cataclysm was being presented, by hospital-room tv on the wall, to his octogenerian eyes. What’s happening to the world? Is it going down the tubes?  Where are ya when we need ya, Shirley Temple?

What a debilitating, toxifying effluent cast upon the fertile fish-yielding, mouth-of-Mississippi waters in which his sons had fished only six weeks ago!
What a screwed-up world has unwound during his eighty years…although it is maybe not so alarming compared to what Hitler was doing to Europe when the the Jersey kid was only pubescent.

What a messed up world!  Has it always been this way? Has it always been getting worse, with more pollution spewing, more politicians cheating, more lobbyists bribing, more people speaking alien languages at you, more rogue-states killing, more priests molesting,  more unruly kids fucking, more of the world sucking…has it always been this way?
Or is that paranoia just hyper-critical cantankerism of the washed-up geezers (could that soon be me ?) in a world that has always been so?
Well, I think not.
In times past, we could discern the possibility that man might someday destroy himself. But nowadays,  I fear we might actually have the technological capability to do it.
That’s not a comforting thought for a middle-aged guy like me watching his father-in-law with all those tubes and wires stuck in him, knowing it might be me in the not-too-distant future.
Assuming we have a future.
Oh, shut yo mouth, fool!

Oil-bustin’ mycoplasm laboratorium, someday?

May 24, 2010

The nano-revolution is presently poised to catapult genetics biology into an exponential expansion.
Thanks to Professors Craig Venter, Hamilton Smith, and their colleagues, we now know we can “boot up” software in a living cell.
According to this week’s Economist article about their gene-bustin’ research, we’ve now crossed “a milestone on the road from the craft of biotechnology, which manipulates genes one at a time, to the industry of synthetic biology, which aims to make wholesale changes to living things.”
Pretty big progress, coming from a little mycoplasma.
These persistent researchers have now demonstrated that synthetic chromosomes can be gathered and harnessed, like oxen or a mules bred for specific purposes, to perform genetic tasks in the laboratory.
The scientists started with a computer program, and four chemicals–adenine, guanine, cytosine, and thymine. They whipped up a laboratory concoction, inserted it into a host organism, and came up with a designer life-form.

Intelligent design, don’t you know.
Surely this is a Nobel Prize breakthrough. These guys put together a self-replicating cell whose parent is a computer.

Perhaps one day, they, or those researchers who come after them, will engineer, let’s say, a new algae organism that can produce biofuels on a commercially viable scale.  The naturally-occurring algae are, you see, not inclined to do such a thing. But with a little nudging from us human taskmasters, they could be persuaded to maybe plow up our hydrocarbonal fallow ground for us.
These constructed genes can, as David Baltimore said on the Diane Rehm Show, “drive a cell.”
I think we’ll be, in days to come, like the pioneers of old, who would drive a mule to get the back forty plowed, except that our new customized chromosomal critters will be breaking new ground for medical and environmental progress. Agricultural too, no doubt.

Steve Roberts, sitting in for Diane Rehm this (Monday) morning, facilitated an incredibly instructive discussion about this most recent accomplishment. David Rejeski referred to the breakthrough as “gaining control of matter at a nano level.” Steve Roberts mentioned that we are moving forward toward “controlling the building blocks” of the next industrial revolution.

David Baltimore recounted that we have been on a path of microbiological progress that turned a big corner in 1953. That’s when Watson and Crick described the molecular structure of DNA.  Since that time we’ve learned to read that genetic code, and to even recreate it. Now, according to Baltimore, we can “see the trajectory of it (our accumulating knowledge.)”

Scientists work collaboratively toward synthesizing more and more genes. It will be a lot of work, for a long time. In the human genome–the main one we’re trying to sustain and protect– are contained 3 billion base-pairs of nucleotides.

This blob-buster microcoding has been a long time in the making–three and a half billion years, accoding to Craig Ventor, the originator of the mycoplasma laboratoriam project.

What an amazing age we live in.

However, not to oil on our parade or anything, but meanwhile down in the gulf…
Other, less controlled human experiments spew hydrocarbon muck irretrievably  into the murky waters just south of Louisiana.
Maybe one day we’ll concoct a nano chromosome to corral a brand-new organism into eating up oil spills.
It will be a petri-dish organism, a Glass Chimera.

How appropriate

March 23, 2010

How utterly appropriate that moment was. In the final hours of  birthing health care reform, our laborious legislative transition pushed us into ensuring the most important coverage of all–protection of each child’s inalienable birth.
Although this is an Inconvenient truth, every kid’s entitled to it.

In your heart, you know he’s right.

March 21, 2010

Now that President Obama has spoken frankly to the US House of Representatives about today’s legislation, which  is “built on the private insurance system that we have now, and runs straight down the center of American political thought…”
Now that he has asked them to pass the bill and  “do it for people who are really scared right now through no fault of their own, who’ve played by the rules, who’ve done all the right things, and have suddenly found out that because of an accident, because of an ailment, they’re about to lose their house…”
Now that our President has publicly admitted to legislators and to the American people that the measures taken are not perfect…
but it is designed in these times of high unemployment to improve an “employer-based system (that is) fray(ing) along the edges…”
Now that he has spoken persuasively to our lawmakers about “all those people who you looked in the eye and you said, ‘you know what, you’re right, the system is not working for you and I’m (you’re) going to make it a little bit better…'”
Now that this “middle of the road” bill is passing…
We offer sympathy to those progressives who complain that the law does not go far enough. We also offer advice: Get busy making this country a better place to grow old and healthy.
We offer sympathy to those conservatives who complain that the law goes too far. We also offer advice: Get busy and make this country prosperous again, so we can all afford reasonable health care.
To the doctors of the USA, we offer appreciation for your excellence and care. And we have counsel for you as well: Strive to do what is best for your patients, without unnecessary procedures and tests. Work to achieve a level of professional excellence without resorting to cover your ass medicine. Protect life.
To the lawyers of the USA, we enter this plea: Lighten up, will ya? Let the docs make the medical decisions.
To the nurses (like my wife, Pat) of the USA, we offer appreciation for all your tender care and professional excellence.
To all health care workers, we request: Do good work, and keep in touch. Be content with your pay; you’re fortunate to even have a job in these hard times.
To the medical administrators of America, I offer these suggestions, as we move toward further improvement of our health care system:
~Set up a clinic next door to your hospital where  folks can get treatment without incurring the expenses.  of emergency medicine. Establish a facility where th ER personnel can say: “You with the bloody nose, go next door (where you can walk out after treatmnt without carrying a bill for a thousand dollars,” or “You with the sprained ankle, we’ll take you next door…
~Find ways to recommend appropriate palliative care for granny and granpa instead of requiring their life’s net worth just to gain another six weeks or six months of being tube-tied. Replace cover your ass medicine with compassionate care wherever possible.

To the drug addicts and alcoholics of America, I highly recommend: Get help and get clean. Turn to Jesus. Cease and desist from your expensive, system-draining, drug-seeking hospital stays. We, the medically-insured people are tired of bailing you out when there are so many people who need real medical attention, and we can’t afford to string you along any more.

To the newly unemployed, we offer hope: Although your Cobra coverage may be running out, the people of the United States of America are standing beneath you with a safety net. God bless em’ with all their capitalist and socialist foibles. Now go out and get busy! Find something productive to do, even if you don”t have a the job of your choosing.
To those previously uninsured who will now obtain coverage as a result of the new health care bill: Act responsibly and be thankful.
To those whose previously-existing medical conditions precluded your obtaining insurance: I hope this new law works better for you.
To those whose insurance coverage has ever been canceled due to serious illness or lifetime limits: Hold on. We hope to get som help for you soon.
To everybody else in America:  Quit smoking cigarettes and watching so much tv.
To the world, we say: Thank God for the United States of America.

So make a deal! Trade abortion funding for a new health care system.

March 10, 2010

So Democrats, make a deal: trade abortion funding for a new health care system.
It’s a win/win situation for most citizens of the USA, including:
~uninsured Americans who will obtain coverage;
~insured Americans who will no longer have to accept their coverage being dropped when they get sick and “need it most.”
~Americans with pre-existing medical conditions who will be able to obtain insurance coverage when they “need it most.”
~American children yet unborn with pre-existing conditions that would preclude their entrance into life. They “need it most.”

My friend Frank’s quest for Medicare

February 13, 2010

I was sitting on Frank’s couch while he shuffled around his apartment looking for his Medicare card.  Why was he looking for it?  I’ll get to that.
In the midst of a very busy day and several  inches of new snow atop a foot or so of old snow, I locked myself out of my maintenance office in a moment of confusion at the apartment complex where I try to keep everybody’s stuff from breaking down and their feet from slipping on frozen white stuff, and so there I was suddenly unable to do much of anything productive, tools locked inside the shop with the keys, among other complications.  So I decided to visit my friend Frank, the 94-year-old engineer, while I waited for my manager’s return.
You’ve never met anyone like Frank, and I hadn’t either until a few months ago. His long life has been filled with a multitude of experiences and accomplishments, such as sailing a yacht around the Bahamas for twenty years or so, singing with a quartet in New York City back before the Great War, working as an electrical engineer for a long time with a manufacturing company or two in New Jersey, having a couple kids along the way with a wife whom I don’t know much about except I know their union didn’t work out so well.
Being an engineer, Frank is a veritable fountain of knowledge and common sense for a fledgling maintenance man like myself. During this particular week (that just ended,) he had been consulting with me about the mechanics of salt-spreading, because I had been struggling to distribute various snow-melt substances on the sidewalks that adjoin the 94 apartments that I maintain. The cheapo plastic spreader that I had been using wasn’t working out so well because the salt grains get stuck in the little door inside the machine that’s designed (poorly designed) to let them tumble out so they can melt on the ground where they’re supposed to prevent Frank and me and anybody else from slipping on the snow and ice. We had been having an ongoing discussion for several days about the mechanics of this task. Yesterday the dam thing had finally ceased working altogether when a plastic shaft broke in the middle. I had explained to Frank earlier that I had chosen the plastic salt-spreader thinking that it would not corrode and break down like the cheap metal one that I had used before purchasing the plastic one a few months ago.
So there I was locked out in the middle of the day in a moment of exhaustion and exasperation and therefore decided to visit Frank; his place is next door to the office/shop. I walked in; he was cooking onions to go with something in his lunch and boy did it smell good, although I wasn’t hungry because I had just grabbed a hamburger on the fly some thirty minutes before.
I sat on the couch and had a few chocolates that he keeps in a jar on the end table. Old folks like to keep little sweet treats like that around, you know.
He was looking for his Medicare card and I asked why.  He explained to me, after inserting his hearing aid (which he had earlier removed because it doesn’t work well for phone conversations such as the one he had had just a few minutes before,) that a woman at a medical office had requested, during that phone conversation, some bit of information that would be printed on his Medicare card.
“It’s not in here,” said Frank, in his stunted 94-year-old voice, while flipping through the cards and plastics in his wallet. “I think I know where it is.” He slowly righted himself from the easy chair with a maneuver that took some ten or fifteen seconds, then grabbed his cane. “…best thing an old guy like can do–use a cane. Dexter across the way won’t use one, but it makes more sense to have three legs than two, I’ve found.”
“What information from the card are they requesting?” I asked.
“The name of my doctor,” said he.
“Well, you can tell them that, can’t you?”
“Yeah, but she wants to verify that Dr. Birney’s name is printed on my card. He’s my primary care doctor, but I’m switching to another one, and we need to get all the paperwork straightened out.”  It took a long time, from my 58-year-old perspective, for Frank to vocalize all this. Meanwhile, at the nearby closet door, he’s opening it and pulling documents from a stationery box with one hand while leaning on his cane with the other. “Dr. Birney’s phasing out all his Medicare patients, or that’s my understanding of it.”
“Really, and why is he doing that?”
“I don’t know.” Frank turned his head slowly and peered at me through the bifocals with a goofy smile. “I guess he’s had it with puttin’ up with old guys like me.”
Frank is lol, and I was amused as well, at his cheerfulness in the middle of a locked-out, snowed-in day.
94 years and still laughing; it doesn’t get much better than that.

Amazing medicinal contractions

February 2, 2010

Here are some poetic words that were set down a few millenia ago by a Hebrew sage:

“There are three things that are too
amazing for me,
four that I do not understand:
the way of an eagle in the sky,
the way of a snake on a rock,
the way of a ship on the high seas,
and the way of a man with a maiden.”

The proverb threaded its way into my mind this morning as I read an article about, and I’m not kidding,  possible FDA approval of a new cancer treatment. It’s funny how the mind skips around in its associations, retrieving from some cerebral neuron or other this snatch of a phrase or that fragment of a visual memory. And sometimes I cannot even decide if the memory is based on an actual experience, or something I imagined, or some stupid movie or tv show.
Or, at least that’s the way this poet’s mind works. The inner workings of a truly analytical mind, such as that of my son, or my wife when she’s caring for a patient, are surely quite different from mine. It’s a good thing I have them around to look out for me as my neurons start to misfire a few signals, or perhaps become a little too rigid in their connective malleability.
It was the snake image in the biblical verse above that wrapped itself around my brain as I read, and tried to understand, Michael Shulman’s posting on Seeking Alpha about evaluating Dendreon stock. The pharmaceutical company is working toward FDA approval of their new treatment for prostate cancer, which they have named “Provenge.”
As I read Mr. Shulman’s analysis of the events surrounding FDA approval for Dendron’s proposed new treatment, I was amazed at the complexity of it all. If we consider the many years of research and development required for a new medical treatment, and then the possibllility of FDA rejection after so much capital investment, and then market projections of the treatment’s value when and if it ever hits the market, and then the treatment’s hoped for efficacy…it’s amazing.
It’s like a snake upon a rock. How in the hell does that creature ever get from place to another? My mind strives to comprehend the alternating muscular contractions that propel a legless body along a flat surface.
Then one filed-away mental picture leads to another, and I’m remembering the archaic symbol for medical treatment–a snake spiraled around a rod.
The practice of medicine in our  biologically complex world is truly an amazing phenomenon.
From this layman’s perspective, even a diagnosis must be a crapshoot, not to mention the prognosis and indicated treatments. From an internal medicine physician’s perspective, though, it’s a highly educated guess; one in which the “educated” component costs him/her twenty years of rigorous training and how many hundreds of thousands of dollars?
And then he/she has to figure out, along with the other myriad medical decisions, how to evaluate new drugs coming onto the market for patients to use?
And the pharmaceutical company had to raise enough capital to take a millions-dollar chance on the new treatment?
And the stockholders had to evaluate whether the years-long R&D is worth their risk?
And the FDA has a public responsibility to determine if the treatment is effective without being destructive?
And the hospital accounting department has to send a bill to the patients to whom treatments were prescribed?
And the insurance company has to decide if all this decision-making that preceded their viewing of the expense is medically effective/efficient?
And Medicare/Medicaid, etc has to pass payment judgements on every patient’s case?
And Congress can piece together a reform for this  whole system?
And juries can decide if malpractice has occurred?
Mr. Shulman’s speculation on Dendreon stock, and the ensuing discussion, will open your eyes to a few of the complications that confound medical progress in our diseased world.
It’s like a snake upon a rock I tell ya…amazing.  It’s a wonder we ever get any new medicines, or medical treatments, at all.