Obama vows in State of Union address that effort will be made to cure cancer once and for all

It's all good, 81GyGuy, unless someone gets goofy and makes it bad...

http://www.cnn.com/videos/health/2016/01/15/cancer-cure-treatment-soon-shiong-intv-wbt.cnn


A very good quote from this interesting, short news video about cancer moonshot which puts the notion of a "cure" into a clearer short-term context. Think if the goal being:

The ability to put the patient into remission with a high quality of life, and then to treat it as a chronic disease.

You mean someone actually watched Obama talk...

www.cnn.com/2016/01/13/health/american-cure-for-cancer-obama-state-of-the-union/

So far we have a perfect record.

Perhaps a best way to begin curing cancer is to stop cutting funding to the NCI to get the job done (last year we cut NCI research funding by 25%)

(This is intended to be at all Presidents that made the same statement regardless of political affiliation as shown in the video. Not a political comment at all)

Good point, fairwind. A couple of years ago I remember reading an article in New Yorker along this general subject, and it asked the fair question: at what point do we acknowledge that a person is starting the cascade and TELL them that further treatment is pointless?

I guess where I land on this is that if the real idea is to turn cancer treatment into treating it as a chronic condition....and I think that's a manageable and achievable goal...then there still will come a point where decisions will need to be made, and our cultural denial of death will need to be dealt with. At what point does treatment increase suffering without hope for cure?

I think of a family I know well,who had a grandmother in her 90's. First, she was found with stage 4 colon cancer, and they made the decision to treat with surgery and chemo. Then, during the chemo she fell and broke a hip, and they went for surgery to install a prosthesis. She lived (maybe) 6 months after the hip surgery and developed pneumonia and died. Did all those interventions prolong her life? Or did they just prolong her suffering?

I know this is a move somewhat OT, but it's the true medical/ethical dilemma of our day. At what cost do we prolong life beyond hope?

Oh, as far as the topic goes, I always recall something I heard back in my school days: The President proposes, and Congress disposes. We have a significant block of people in this country who neither know much about, nor do they want to accept the findings of, science. Research will always get the funding cut because a certain group want science...particularly science that shows that the world is more than 6000 years old and that Darwin was mostly right...to just go away.

And that, while it skates close, I don't believe is either a religious or political statement.

compiler said...

My concern: will my doctor follow such Directives.

Doctors are very hesitant to just LET GO.

Mel

Mel, I had to go through this with both my parents. But I am starting to see a change in the medical community that is starting to accept the fact that some times it's best to let go.

In my mother's case, the doctors quickly agreed that it was over and put her on hospice. However, some nurses resisted and I had occasional conflict with a few enforcing my Mother's wishes and the doctor's orders.

My fear is not having a strong family advocate at my side when the time comes to say, enough.

Andrew

My brother had an Advanced Health Care Directive that stated he wanted no heroic measures, but as he fought MDS last year there were significant differences between what his wife (and I) thought were exceptional measures versus what his doctor said. When it got to the point where he needed forced feeding and his wife said that was too much, it caused a tremendous uproar with his medical team. I thought his Directive was pretty specific, but it's clear that it wasn't specific enough.

halbert said...
Is it considered a good idea to put specific 'not that's' into advanced directives?

That's why you need to set up an advanced directive using a good lawyer. Mine had a questionnaire that listed methods like, "feeding tube," "ventilator," and so on. Not foolproof, but better.

Andrew

FWIW, my will contains a "Living Will Declaration" as a subdocument, and it covers the situations we are talking about, whether "heroic measures" will or will not be applied in probable end-of-life scenarios.

I offer this document from my own will as an example of how these things are worded. I assume they are more or less the same from state to state (or country to country).

It's a bit lengthy because of the legalese, so I have reduced it to the relevant quotes:

"If there is no reasonable medical expectation of my recovery from a physical or mental disability, I do not wish to be kept alive by artificial means or heroic measures."

"Therefore, if my attending or treating physician and another consulting physician determine that there is no reasonable medical probability of my recovery from any of the following conditions, I direct that life-prolonging procedures be withheld or withdrawn when the application of those procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain, even if that hastens my death."

(The "conditions" referenced above):

"I have a terminal condition caused by injury, disease or illness from which there is no reasonable medical probability of recovery and which can be expected to cause my death if not treated."

"I am in an irreversible end-stage condition that is caused by disease or illness that has resulted in severe and permanent deterioration, indicated by my incapacity and complete physical dependency, for which treatment would be medically ineffective to a reasonable degree of medical certainty."

"I am in a persistent vegetative state characterized by permanent and irreversible unconsciousness in which there is an absence of voluntary action or cognitive behavior of any kind by me, with an inability to communicate or interact purposefully with others in the environment around me."

(if any of the above apply, then I REJECT):

"Placement or continuance on a ventilator or other mechanical device, including internally implanted devices, or dialysis treatment."

"Surgical procedures and blood transfusions, except as needed to prevent or alleviate suffering."

"Placement in an ICU except as an absolute necessity to relieve suffering."

"Chemotherapy or radiation therapy, unless there is a substantial medical probability that my condition will materially improve."

"Resuscitation efforts in the event of arrest of my heart or breathing."

"Active treatment of a new reversible condition such as newly discovered cancer, heart attack, or pneumonia."

"Artificial nutrition and hydration, providing food and water through tubes."

The rest of the document deals with duties of medical power of attorney (my older son in my case) and declaration that I am making this document with sound mind, etc.

So that's an example of what one of these things actually says, and more or less what we would expect it to say, I guess.

The statements seem legally explicit. But whether the doctor is going to follow such a directive in actual practice is, as noted in posts above, uncertain.

To simplify, it appears that there are two drivers for problems with advanced directives from the physician's perspective: One is that they are human beings also. They have been taught that death is a failure. If a patient dies on their watch, they failed. This is deeply ingrained in them. Who wants to fail? The second is that there are just enough people out there who will take a doctor to court for 'not doing enough', and enough judges and juries who will agree, that doctors are really, really afraid to stop treatment.

I suppose I look at it like this: is continuing treatment beyond all hope a form of disrespect of the person being treated? It's partly about what would they want, to be sure. But it's also about us. Our unwillingness to let go, to admit that the story is over.

I was watching television a few minutes ago and came across Biden talking to the docs at Penn. Very interesting dialogue, although I didn't get to watch all of it. It seemed to me that the docs were more excited about the possible prevention of cancer vs. treating cancer.

Combine that with Biden leading a Task Force for the moonshot and I have to take a step back. Can we at least fix the Task Force we have in place currently....at least with respect with prostate cancer? Their recommendation for PC for the past few years has resulted in most people thinking that screening for PC should not take place at any age. So, let's clear that up first before we create any additional government Task Force.

I like Biden's passion however. And hope he can lead an effort to streamline trials, increase funding, and move in a positive direction.

The book, "The Emporer of All Maladies" is a good read for anyone that wants to see where we have been and where we are going with cancer. We have done a lot of great things...but still so far to go with the various types of cancers...

Reltnie said...
If we are really serious about eliminating cancer then I would think a good place to start would be eliminating all the chemicals and preservatives and GMO's in our food. Consuming "Round Up Ready" anything can't be good. At the very least label the stuff so I have a choice.

I wholeheartedly agree.

But as far as what Obama said, if I recall correctly, Richard Nixon said the same thing, and here we are 45+ yrs later, still no cure.

But don't get me wrong, I am not a pessimist. Science has advanced in many ways since then, and maybe our day will come soon with a cure, hopefully, while I am still on this planet. lol

Until that day, people should wake up, and act to spare the coming generations of our sons and daughter and their sons and daughters from the scourge of the Western world, which is cancer.

Post Edited (Jaybee_007) : 1/19/2016 2:23:06 AM (GMT-7)

We're an older and wiser community these days.