HP 330: Oct 4 Notes - Part 2 Review
HP 330: Oct 4 Notes - Part 2 Review HP 330
Popular in Cancer: Perspectives and Controversies
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This 3 page Class Notes was uploaded by Sydney Brummett on Thursday September 29, 2016. The Class Notes belongs to HP 330 at Wichita State University taught by Dr. Paul Danner in Fall 2016. Since its upload, it has received 25 views. For similar materials see Cancer: Perspectives and Controversies in Health Professions at Wichita State University.
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Date Created: 09/29/16
Part Two Review ** All of these notes are quoted from Professor Danner • Mary Woodward Lasker • “If toothpaste deserved advertising at a rate of two or three times $4 million a year then research against disease maiming and crippling people in the United States and in the rest of the world deserved hundreds of millions of dollars,” Mary Lasker o People could make a profit off of the toothpaste, but not the cancer research • In 5 years, Mary Lasker had raised the Cancer society from the dead • The idea of chemotherapy – a chemical that could cure cancer outright – “the penicillin for cancer,” as the oncologist Dust Rhodes at Memorial Hospital descried it – fascinated Lasker • Lasker eventually turned from seeking strategy to publicize the crusade against cancer; she sought a strategy to run the crusade • In 1954, after a furious bout of political lobbying, the senate authorized the NCI to build a program to find chemotherapeutic drugs in a more directed, targeted manner o By 1955, this effort, called the Cancer chemotherapy national Service Center was in full swing • A consortium of researchers was created to share patients, trials, date and knowledge o The proposal changed the field o For the first time an academic oncologist felt as if he had a community o The cancer doctor was not the outcast anymore, not the man who prescribed poisons from some underground chamber in the hospital. • The researchers agreed to proceed with a series of common trials, called protocols, as soon as possible. • In the process, a deep and fundamental principle of oncology was developed: o “Cancer needed to by systemically treated long after every visible sign of it had vanished” • Clinical research became a matter of urgency. • Howard Skipper found two pivotal discoveries: o Chemotherapy typically killed a fixed percentage of cells at any given instance no matter what the total number of cancer cells was o By adding drugs in combination, he could often get synergistic effects on killing • Since different drugs solicited different resistance mechanisms, and produce different toxicities in cancer cells, using drugs in concert dramatically lowered the chance of resistance and increased cell killing • Since most of the early anticancer drugs were cytotoxic the threshold between a therapeutic “cancer-killing” dose and a toxic dose was extremely narrow • William Maloney wrote, “if we didn’t kill the tumor, we killed the patient.” • Thrown into the uncertain frontlines of cancer medicine, juggling the most toxic in futuristic combinations of drugs, the doctors fell back to their oldest principles: o They provided comfort • It was discovered that leukemia cells were growing explosively in the spinal fluid by the millions, colonizing in the brain o The brain and spinal cord are insulated by the tight cellular seal called the blood-brain barrier that prevents foreign chemicals from easily getting into the brain. • The story of leukemia – indeed, the story of cancer – isn’t the story of doctors who struggle ad survive, moving form one institution to another o It is the story of patients who struggle and survive, moving from one embankment of illness to another. • Resilience, inventiveness and survivorship – qualities often ascribed to great physicians – are reflected qualities, emanating first form those who struggle with illness and only then mirrored by those who treat them. • If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the most substantive heroism of their patients. • Instead of trying to tailor the disease to fit his medicine, Kaplan learned to tailor his medicine to fit the right disease • Cancers possessed temperaments, personalities – behaviors o So the same treatment cannot indiscriminately be applied to all o To design an ideal anticancer drug, one would need to identify a specific molecular target in a cancer cell and created a chemical to attack that target. § The fundamental biology of cancer was so poorly understood that defining such molecular targets was virtually inconceivable in the 1960s • Pinkel reasoned that while combinations of drugs were necessary to induce remissions, combinations were insufficient in themselves. o Perhaps one needed combinations of combinations – 6, 7, or even 8 different chemical poisons mixed and matched together for maximum effect • Pinkel realized since the nervous system relapses had likely occurred because even those highly potent chemicals could not breach the blood brain barrier, perhaps one still needed to instill chemotherapy directly into the nervous system by injecting it into the fluid that bathes the spinal cord. • Pinkel said that perhaps even that installation was not enough. Since x-rays can penetrate the brain regardless of the blood brain barrier, perhaps one need to add high-dose radiation to the skull to kill residual cells in the brain • Pinkel realized perhaps one needed to continue chemotherapy not just for weeks and months, but for month after month, stretching into two or even three years o Called it “total therapy” o Also called, “total hell” by the physicians • It was now believed that high-dose combination chemo could cure call cancer – once the right combinations had been found • The prospect of a systemic solution to a cure intoxicated the oncologists • December 9, 1969 a full-page advertisement appeared in the Washington Post that asked for funding for cancer research • The cure for cancer became incorporated into the very fabric of the American Dream • On December 23, 1971 Nixon signed the National Cancer Act at as all ceremony in the White House o Act was an anomaly, designed explicitly to please all of its clients, but unable to satisfy any of them • Its most ominous assessment came from the editorial pages of the Chicago Tribune: o “ a crash program can produce only one results: a crash” • On march 30, 1973 Farber was found with his face resting on his desk o Died of cardiac arrest
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