Putting things in perspective

It's Wednesday. Much work to do before the weekend, if I can make it there. Time to step back and look at the bigger picture.

Following up on my last post, back in May, my wife's friend has had additional spots showing up on x-rays. She is doing another course of chemo. She will also be going to have appointments for additional evaluation at two of the best cancer centers in the world -- Sloan Kettering in New York and MD Anderson in Texas. She is doing everything she can. I tell my wife honestly that there is reason for hope, but I also have gently warned her to realize the severity of metastases.

At the same time, my wife's friend just published her first paper in a peer-reviewed journal (Nucleic Acids), covering work she did on formation of G4 DNA, as part of her overall work in cancer and her work toward receiving a PhD from University of Washington.

I think I should be able to make it to the weekend.

Breast cancer

One of my wife's oldest friends, JE, who she's known since high school, has been dealing with metastatic breast cancer. She has it in her bones and, probably, elsewhere. I've been playing this voice of reality for my wife, cluing her in to the fact that the outlook is not good. JE is savvy about the science/medicine and has already been through the wringer having survived the first five years of this (I think she's about 7 or 8 years since her original dx). She's been outwardly projecting a calm, but mildly optimistic view of her prognosis, but ultimately I can't know how she really feels. This is all a little uncomfortable for me to have to sit through, having watched my mother die of breast cancer, but in the middle of it, I feel I can at least offer JE, as well as my wife, some advise on how to look at this with an eye toward, at least, not slipping into depression over it and, at best, maximizing the chances (whatever they may be) of surviving it.

I am admittedly, to everyone who happens to discuss medicine with me, cynical about how most (not all) doctors approach medicine, which demonstrates more often than not that (1) they tend to play the percentage game, ignoring any symptom suggesting a particular patient is not in the "typical" 95% of the population, (2) they are invariably more concerned about ego than the patient's best interest, (3) like it or not, they are driven by money, unless they are working for Medecins Sans Frontieres, and I don't know any that are, and (4) medicine, despite all the evidence to the contrary, still has an enormous amount of "art" involved, and the field is populated much more by barely competent technicians than it is by artists.

And yet, despite all this, I try to be optmistic about medicine to those around me. I just remind them to be realistic.

The take home message on this is do what you can, when you can and don't forget to realize that life is so painfully short that you absolutely cannot take it for granted. Do, say and be what you need to now.

Notes on a Thursday

The nature of business just continues to change. Terms like "sales and marketing" mean very different things now than what they did ten years ago, but what strikes me is that they mean something different now than they did even two years ago. Mine is an information business, of course, which makes it susceptible to the steady stream of new technologies -- paradigms (JMJ I hate that word) -- that are overhauling the information society. Electronic professional networking, RSS/blog marketing, search engine optimization, yada, yada, yada. I can't complain (too much). I like learning this stuff, but I wish I could make the whole process more active than it is now. It's all a matter of producing the right exposure in the right way so you are found, all very passive. I want to go out and GET the business.

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Molly's Type 1 is very well under control as a result of aggressive management by us (I do not tolerate bad blood glucose numbers) and a very rigorous soccer schedule including two practices per week, a weekly "speed training" session and two scrimmages (season hasn't started yet). Her last HbA1c was about 7.5, and I am intent on getting it lower and staying there. When she was first diagnosed almost four years ago, I had to adamantly assure Colleen that managing Molly's diabetes would become a matter of routine and that it would not ultimately limit Molly's activity, goals or anything else in any way and, in fact, she might end up being a stronger, healthier kid than other kids as a result of the increased attention on good diet, exercise. Four years later, she is at the top of her class, she's about the strongest kid in her class, she won the school jump rope contest (100+ jumps in 30 seconds!), and she's one of the most talented soccer players on her team. Yeah, yeah, I'm her dad, so I'm supposed to say this stuff. Well, I long ago stopped trying to impress people, since the only ones I really need to impress is my family, and they know the truth. Molly is a fantastic kid. Diabetes has been nothing more than an annoyance.

Ian is my fantastic son. Someone once referred to me as "spooky smart", but I think the phrase better applies to Ian. Long ago, I said that Ian must have been reincarnated, because he seemed to innately understand the world better than he should for someone of his young age, as if he's been here before. He's witty and ultimately a very, very decent kid. In two weeks, he will be testing for his yellow belt in karate. You could give him two weeks and he'd be ready to test for orange.

Burst of medical technology startups

I have witnessed a marked increase in the number of newly formed medical technology companies over the past eight months. It's hard to be convinced that this reflects some newfound optimism by entrepreneurs or an increase in the number of new device ideas. All I know is that, in my routine search for new companies to report on in MedMarkets, my medtech publication, I have found it suddenly easier to find relevant companies with new corporate filings in the past eight months. They span the gamut of technologies and clinical applications. See my press release.

J&J is now having second thoughts about the Guidant acquisition.

Medical errors

As I have said to people I know, my "5% Rule" says that, if 95% of the time a given set of symptoms can be attributed to a specific diagnosis, then woe to the poor patient in the 5%, since few physicians or health systems have the financial wherewithal, diligence or other incentive to determine the accurate diagnosis.

And, as has also been published before... more people die as a result of medical errors than other common causes of death.

Is there any better reason than the above to argue that healthcare consumers have a paramount obligation to ask questions, challenge assumptions and demand satisfaction in healthcare?

Great set of rules to live and work by

Came across this great set of rules today. Some of these rules are already part of what I do. Most of the others I already know, but I'm not quite using yet.

Rhetoric and the Turn of the Tide?

It really did seem like a pivotal point in the Senate, when obstinacy finally turned to pragmatism. Neither side wanted to see an already contentious atmosphere get worse by an order of magnitude. Then why, some ask, would Frist consider doing just that? It speaks of the arrogance, and the lack of vision, that he would see this as the course to take. 51% does not make a mandate. The "Fuck You" approach to government just doesn't work.

So, all the rhetoric was preempted by the few reasonable senators who recognized that we have more to gain by working together than against each other. Oh, how I would like to see that this is the turn of the tide, that the principles that have made "e pluribus unum" true for 200 years were restored, or at least remembered. But I have become quite cynical. The acrimony is too thick. The arrogance is too deep. The ignorance is too rampant.

(Separately, I have to say, faith is scary. When people believe their eternal salvation is at stake, a whole lot of actions that are unreasonable by any other standard suddenly become reasonable to them. How much of the acrimony is driven by a conservative view that Judeo-Christian mores need to be integrated into the U.S. government? And anyone who argues against this is accused of being against "people of faith." I tell you, this is scary.)

I have neighbors whose political views are starkly different than mine. In fact, I am clearly in the minority in this neighborhood. But I really like my neighbors. We have so much in common, wanting to raise our kids safely and with their best interests at heart. If we can focus on that common ground and not the issues that set us apart, we can all succeed. It sometimes seems that it is the most remotely relevant issues to our daily lives are the ones that are the most divisive in their impact.

I'm rambling, trying to see the light at the end of the tunnel, but fearing that the darkness will overtake all of us, leaving our children in a dark, foreboding future.