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Cancer Blog

Sunday, August 31, 2003


6 days in

Well, it's the afternoon of the 6th day of my first course of treatment in this clinical trial and I must say I do feel better than I did a week ago. Hopefully, things will continue to get better.

We met with the doctor Tuesday morning and I received the chemotherapy that afternoon. It took about 5 hours: 1 hour for the premeds, 3 hours for the Taxol, one of the chemotherapy drugs, and 1/2 an hour for the Carboplatin, the other. The worst thing about the whole ordeal was probably the daytime network TV which was 'conscientiously' piped into the infusion space for all the helpless cancer patients to imbibe, whether they wanted to, or not. I'm pretty sure I don't fall into the demographic that is most likely to enjoy 'All My Children'. Next time, I will bring earplugs.

After getting the chemo, we flew back to Nashville. The side effects from the chemo are relatively mild and have a lag effect. I think I'm passed the fatigue; the worst of that was on Thursday and Friday. I still have some numbness and pain in my feet which is also one of the predicted side effects, but hopefully that will soon pass. I'm supposed to be losing all of my hair in a couple of weeks. This, again, is no great tragedy for either the universe, or humanity as a whole. In fact, it may be an improvement.

Now my only tasks are to take the Bayer pill twice daily and go in to Vanderbilt Hospital to get blood drawn twice a week. The chemo hits your blood counts pretty hard, so they have to regularly monitor them to make sure everything's okay. If everything remains 'ok' then I will return to Philly on September 16 to start the second round of treatment and receive the second dose of chemo. We will basically repeat this three week regimen until the cancer is gone, or it's clear that the treatment isn't working.

So far, so good though. If I can get to the point where I'm not experiencing symptoms directly from the cancer, then I'll be in good shape.


Monday, August 25, 2003


here we go

Finally, tomorrow is the day. Today, we leave for Philadelphia and tomorrow I see the doctor and get the chemo. Not a moment too soon. I've been feeling really rough for the last week or so; not much sleep, eating is difficult, back pain. Ideally we would have started this thing three weeks ago, but it wasn't possible. A new problem this morning: I got sick after a yogurt and an orange juice for breakfast. I hope this doesn't mean I won't be able to keep food down. Hopefully it was just the orange juice. The tumor in my stomach/bowel is causing the most problems; eating is a chore. I'm about 10 pounds off my normal weight.

The dose of chemo should put a stop to the tumor growth, but it could be a while before it starts to shrink them, so it could be a while before I start to feel better; but it would still be fantastic if at least things stopped getting worse. I'm in pretty bad shape. I hope it's not so bad that it complicates the treatment. Anyway, off to Philly in a few hours.


Wednesday, August 20, 2003


globalizing pains II

Last month I posted and commented on a NY Times article discussing a somewhat new phenomenon: high-end tech jobs leaving the U.S. for India and China. As an economist, I roundly denounced taking measures to prevent this natural evolution of the economy. Brad Delong has a less vituperative analysis of similar phenomena. I'm happy to report that our conclusions more or less coincide, as well they should, since it is just basic economics.
... When foreign countries acquire the capability to make stuff, there are two impacts on the American economy. First, we can no longer sell the stuff we make abroad for such high prices as we did before: our exporters face more competition as they try to sell abroad. Second, our consumers and domestic businesses can buy things made abroad more cheaply: producers of import-competing goods and services find that they face more competition and must lower their prices, but other businesses find that their costs fall, and households find that their incomes buy more good stuff.

Which effect dominates? Theoretically, either one can. The opening of the Suez Canal and the coming of large-scale cotton production to India and Egypt after the U.S. Civil War was surely not good for the gross economic product of America's cotton south, and contributed (along with the boll weevil, the neglect of education and other public services, and the corruption of the herrenvolk democracy that set up Jim Crow) to the south's economic retardation toward the end of the nineteenth century (how big a role Egyptian and Indian competition played in this is not something I am confident that I can judge). But in the post-World War II world, it seems clear that the U.S. has gained much more than it has lost from the economic development of its trading partners. The U.S. as a whole benefits enormously from the fact that Japan is a rich industrial economy rather than something like Indonesia. The producer and consumer surplus the U.S. gains from trade with rich western Europe far exceeds what it gains from trade with poor eastern Europe. The way to bet seems to be that examples like the growth of other producers to compete with the cotton south are the exception, and win-win benefits are the rule.

If this is not to be the case in the future, there needs to be an argument made as to why the normal post-World War II pattern will be broken. And I haven't heard anybody make such an argument yet...
Read the whole thing. It's very good.


Thursday, August 14, 2003


Babylonian marriage auctions

I'm reading Herodotus' Histories. In the first book, Herodotus relates a very interesting marriage institution in 6th century B.C. Babylon, which, by his time (5th century B.C.), had fallen out of practice (book one, chapter 196):
In every village once a year all the girls of marriageable age used to be collected together in one place, while the men stood round them in a circle; an auctioneer then called each one in turn to stand up and offered her for sale, beginning with the best-looking and going on to the second best as soon as the first had been sold for a good price. Marriage was the object of the transaction. The rich men who wanted wives bid against each other for the prettiest girls, while the humbler folk, who had no use for good looks in a wife, were actually paid to take the ugly ones, for when the auctioneer had got through all the pretty girls he would call upon the plainest, or even perhaps a crippled one, to stand up, and then ask who was willing to take the least money to marry her -- and she was offered to whoever accepted the smallest sum. The money came from the sale of the beauties, who in this way provided dowries for their ugly or misshapen sisters. It was illegal for a man to marry his daughter to anyone he happened to fancy, and no one could take home a girl he had bought without first finding a backer to guarantee his intention of marrying her. In cases of disagreement between husband and wife the law allowed the return of the purchase money. Anyone who wished could come even from a different village to buy a wife.
This strikes me as an elegant, no-nonsense, matching scheme. And compared to what was going on elsewhere in the ancient world, women got a pretty fair deal: they could reject whatever husband purchased them, or was paid to 'purchase' them, ("In cases of disagreement...") and presumably give the auction another go next year. But, alas, the Persians came:
This admirable practice has now fallen into disuse and they have of late years hit upon another scheme, namely the prostitution of all girls of the lower classes to provide some relief from the poverty which followed upon the [Persian] conquest with its attendant hardship and general ruin.
If you haven't read Herodotus, I highly recommend him. Very readable and endlessly fascinating.


Monday, August 11, 2003


hope

This was a difficult week. It amazes me how quickly things can change. Last Tuesday, early evening, I felt pretty good. Then over the course of two hours of net-surfing on the computer, a significant pain --sharper than any I had experienced before-- developed in my abdomen. At about the same time, I began to lose my appetite and generally feel really miserable. This continued for two days when, mercifully, the pain let up; but the misery remained. Yesterday, my appetite began to return, and today, I continued to slowly improve. But without any treatment to keep them in line since early July, it is clear that my tumors are running amuck.

Help is on the way, though. I talked with my new doctor at Penn this past Friday and he sounded really optimistic about the program I'll be starting on August 26. Incredibly optimistic, even. The treatment is quite new and stems directly from a genetic breakthrough made last summer. Scientists in the U.K. published an article in Nature documenting their discovery of the link between a particular mutation and melanoma. As it turns out, this mutation was already known about for other reasons and a drug had already been developed (by the Bayer corporation) to inhibit that particular mutation. The Nature article led researchers who had been using the Bayer drug to treat other cancers to consider this drug for advanced melanoma. This guy at UPenn started a trial about a year ago doing just that: treating melanoma patients with the inhibitor drug and standard chemotherapy. The results have been impressive: over 50% of patients have responded; a handful have shown complete responses. I would be more than happy with this, but my doctor went on at some length to argue that those who did not show responses received smaller initial doses of the drug (this was a phase I trial so they were experimenting with the dosage), and that those who have not shown complete responses are typically early on in their treatment and could be on the path to a complete response. This was an important point: according to him, the responses with this treatment are fundamentally different from the usual responses seen from other more conventional treatments. Typically a patient will see a response (tumors shrink) and then, after a while, the disease starts progressing again. In this case, it looks like once a patient's tumors start to shrink, they continue to shrink, albeit slowly, until they are gone. This is very good.

The results from the phase I trial were presented in June at the American Society of Clinical Oncology meetings in Chicago, and since then he's been adding patients from the initial ten up to an eventual 60 in what is now a phase II trial. It looks like a big breakthrough. I'm lucky to be among the 60 patients in the trial. I'm number 26, to be precise.


Tuesday, August 05, 2003


on to Philadelphia

First of all, the MRI, as expected, was clear. As for the CT scans... Good news and bad news. The good news is that the disease in the liver looked relatively stable. The bad news is that there was considerable growth in a tumor in the stomach, and this, my oncologist said, was probably the cause of the recent abdominal pain. He concluded that, given the most recent scans, we had probably wrung as much out of the Temodar as we could and that we should definitely try something different.

I talked to a doctor from the NIH this morning and learned that because of the metal stent located in my bile duct, I am not eligible for any of their protocols. No surprise here, but we had to try. The really good news is that I will get a crack at my next best alternative: the trial at the University of Pennsylvania. This will be a lot more intensive then the Temodar, but it is also a lot more promising. I will talk to the doctor in charge soon and learn more about the details. I should start the treatment itself no later than Thursday, August 21.

My journey with metastatic melanoma began in St. Louis; then went to Nashville; from there to Bethesda; back to Nashville; and now to Philadelphia. Overall, I am pleased with today's news. Although the disease is once again progressing, we're doing everything right from our end: we went with the Temodar in the difficult month of April, which turned out to be just what we needed to buy us some time, and now, once we saw that the disease had stopped responding, we were able to make the move into a cutting-edge program. I've never visited Philadelphia, only passed through on a train...


Monday, August 04, 2003


Joyce's Wake

Several months ago, being in a peculiar mood, I decided to purchase James Joyce's masterpiece, Finnegans Wake. Before purchasing it, I was almost completely ignorant of the book and its reputation. I foolishly believed that it couldn't be more difficult than Ulysses, a book I had slogged through several years before. Here is a random paragraph from Ulysses:
Universally that person's acumen is esteemed very little perceptive concerning whatsoever matters are being held as most profitably by mortals with sapience endowed to be studied who is ignorant of that which the most in doctrine erudite and certainly by reason of that in them high mind's ornament deserving of veneration constantly maintain when by general consent they affirm that other circumstances being equal by no exterior splendour is the prosperity of a nation more efficaciously asserted than by the measure of how far forward may have progressed the tribute of its solicitude for that proliferent continuance which of evils the original if it be absent when fortunately present constitutes the certain sign of omnipollent nature's incorrupted benefaction. For who is there who anything of some significance has apprehended but is conscious that that exterior splendour may be the surface of a downwardtending lutulent reality or on the contrary anyone so is there unilluminated as not to perceive that as no nature's boon can contend against the bounty of increase so it behoves every most just citizen to become the exhortator and admonisher of his semblables and to tremble lest what had in the past been by the nation excellently commenced might be in the future not with similar excellence accomplished if an inverecund habit shall have gradually traduced the honourable by ancestors transmitted customs to that thither of profundity that that one was audacious excessively who would have the hardihood to rise affirming that no more odious offence can for anyone be than to oblivious neglect to consign that evangel simultaneously command and promise which on all mortals with prophecy of abundance or with diminution's menace that exalted of reiteratedly procreating function ever irrevocably enjoined?
Penetrable? Maybe...but it ain't Hemmingway. Now let's examine a random paragraph from Finnegans Wake:
Tholedoth, treetrene! Zokrahsing, stone! Arty, reminiscensitive, at bandstand finale on grand carriero, dreaming largesse of lifesighs over early lived offs all old Sators of the Sowsceptre highly nutritius family histrionic, genitricksling with Avus and Avia, that simple pair, and descendant down on veloutypads by a vuncular process to Nurus and Noverca, those notorious nepotists, circumpictified in their sobrine census, patriss all of them by the glos on their germane faces and their socerine eyes like transparents of vitricus, patruuts to a man, the archimade levirs of his ekonome world. Remember thee, castle throwen? Ones propsperups treed, now stohong baroque. And oil paint use a pumme if yell trace me there title to where was a hovel not a havel (the first rattle of his juniverse) with a tingtumtingling and a next, next and next (gin a paddy? got a petty? gussies, gif it ope?), while itch ish shome.
Zounds! What does a reader do when confronted with this? If you're like me, you read the back cover, the introduction, and a few random paragraphs; you flip the book over a few times in your hands to feel the weight, shake your head, mount the book deep in your bookcase where it can do no harm, and then enthusiastically return to your study of auction theory.

Then yesterday, while writing the post on Steve Levitt, I unconsciously gave it a Joycean title, "a portrait of the economist..." Later that evening before going to sleep, with Joyce still bouncing around in my subconscious, I realized that the internet would be perfect for reading Finnegans Wake, that every reference to every Dublin church, every Norse adjective, every Hindi abuse, could be quite painlessly presented in an annotated on-line version of the text. Shortly after that I concluded that most certainly this has already been done, and that tomorrow I would google it up. Sure enough, I was right. To begin your Joycean odyssey, go here for a comprehensive list of Joyce resources on-line. A complete on-line text of Finnegans Wake can be found here. Finally, for the real value-added part of the internet, go here for the text, complete with glosses of difficult words (although the page is a little slow). One more, make that three more links before I leave Joyce alone: go here for the Finnegans Wake society of New York web page, and through them, finally (I promise) to the one must-click link of them all: Mr. Joyce reading a passage from his text.

We'll meet again, we'll part once more. The spot I'll seek if the hour you'll find. My chart shines high where the blue milk's upset. Forgivemequick, I'm going! Bubye!


Sunday, August 03, 2003


a portrait of the economist as a young man

I'm slightly embarrassed to admit that before reading this very nice article on Steven Levitt, I knew next to nothing about the most recent winner of the John Bates Clark Medal. Sure, I had vaguely heard his name, and in a previous post (scroll down to 'Life in a Red State'), I had even linked to his paper connecting Roe vs. Wade with the drop in crime. But otherwise, I was completely ignorant of his work. No more. The NY Times piece is a must read for all you economists out there, especially the young'uns. Excerpts:
... In Levitt's view, economics is a science with excellent tools for gaining answers but a serious shortage of interesting questions. His particular gift is the ability to ask such questions. For instance: If drug dealers make so much money, why do they still live with their mothers? Which is more dangerous, a gun or a swimming pool? What really caused crime rates to plunge during the past decade? Do real-estate agents have their clients' best interests at heart? Why do black parents give their children names that may hurt their career prospects? Do schoolteachers cheat to meet high-stakes testing standards? Is sumo wrestling corrupt?...

... At Harvard, Levitt wrote his senior thesis on thoroughbred breeding and graduated summa cum laude. (He is still obsessed with horse racing. He says he believes it is corrupt and has designed a betting system -- the details of which he will not share -- to take advantage of the corruption.) He worked for two years as a management consultant before enrolling at M.I.T. for a doctorate in economics. The M.I.T. program was famous for its mathematical intensity. Levitt had taken exactly one math course as an undergraduate and had forgotten even that. During his first graduate class, he asked the student next to him about a formula on the board: Is there any difference between the derivative sign that's straight up-and-down and the curly one? ''You are in so much trouble,'' he was told.

''People wrote him off,'' recalls Austan Goolsbee, the Chicago economist who was then a classmate. ''They'd say, 'That guy has no future.'''

Levitt set his own course. Other grad students stayed up all night working on problem sets, trying to make good grades. He stayed up researching and writing. ''My view was that the way you succeed in this profession is you write great papers,'' he says. ''So I just started.'' ...
He finished his PhD in 3 years. Grad students in economics--especially those who are insecure about their math background--often forget that we are studying to be economists; not physicists, not statisticians, and sure as hell not higher mathematicians. We flounder around for the first couple of years obsessing about how if only we could master measure theory, everything else would be easy, brilliant papers would pour out and our career would be secured. There is more to economics than technique; in fact the profession probably has a glut of skilled technicians. The success of Steven Levitt is evidence of the fact that what the profession still prizes most is raw creativity and good old-fashioned common sense.

Continuing in the economics vein, there is a very good article in yesterday's Washington Post discussing the economic trainwreck that is Argentina and how bubble-blowers on Wall Street might have contributed to the debacle. For someone like myself, who knows little about the crisis and little about monetary economics, the article is very informative. For those wanting to dig deeper, check out Delong's post on the article, and then Krugman's (from his personal webpage).


Saturday, August 02, 2003


scanned

I was rather painlessly ct scanned and MRIed yesterday. It's always nice to get them out of the way for a while. I won't know the results until this Tuesday. This is the first MRI of the brain since an all clear on March 3, so there is a hint of anxiety about these results; the existence of brain metasteses would take my case up a big notch in severity. However, I have not had any symptoms of brain mets so far: no headaches, no dizziness, etc., so I expect the MRI to be clear once again.

Still no word from the NIH. I called again yesterday and talked to the same helpful-sounding nurse that I had talked to on Tuesday. She said she would put another note on the doctor's desk and intimated strongly that he would give me a call that afternoon. No call, so I'll try again on Monday. I do need to find out one way or another about my eligibility, or possibility of eligibility, at the NIH before Tuesday afternoon.

Meanwhile, what pain I had been experiencing has gradually slackened. This is unambiguously good; but who knows what tomorrow will bring. Regarding my studies, I've decided to formally take this upcoming semester off. I'm in no better shape than I was when I started the last two semesters and had to pull out, so there's no reason to think this semester will be any different. If my health does remain stable or improve over the next few months, I can still--theoretically, at least--make progress on my own. What is hard to generate in circumstances like these is the motivation to press on towards long term goals when it's highly unlikely that you will ever see them realized. Hard, but not impossible.


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