I’ve got a really bad cold. Perfect timing. Didn’t ski yesterday. Legs fell off today. Twice. Within the first seven hours of being here, we’ve lost the each set of car keys twice, the condo keys three times, and the remote once. The remote is still missing. In the first two days, we’ve done four loads of laundry, gone grocery shopping twice, gotten two shoulder x-rays, suffered one head lac, harassed and/or physically threatened pretty much every single customer service representative we’ve come across, and fought amongst ourselves for about four hours total. Four double-blacks, seven blacks, a handful of blues, a whole lot of powder and powdery moguls—the worst kind—and five wipeouts. Five more days.

Taking a half day tomorrow to watch the Illini game. Go Illini.

Going skiing for the next week or so in Park City, Utah.

I’m not going to lie: I’m pretty damn excited. I haven’t been skiing for about 6 years, or since I was in really good shape. Here’s hoping my legs accompany me on the return trip. Also, here’s hoping there’s a return trip in my future. If my first experience skiing on a “real mountain”—which involved a tree, excessive velocity, the inability to stop, shattered brand-new goggles, and me—is any indication, it’s not looking good.

I came across a good online medical dictionary this morning, and it’s available from Merriam-Webster, the same Merriam-Webster of the regular old layman’s dictionary fame. It’s actually fairly competent as far as medical dictionaries go, which was a surprise to me. I had to refresh myself on the prefix “sial-” this morning, and sure enough it was in there with the definition, examples, and variants. I’ll definitely be using this great resource more often now, especially since it seems to work pretty well with only parts of words where most others fail.

Now all they need is a medical dictionary dashboard widget. Anyone know of one?

Another post is up at Medscape’s group medical student weblog, The Differential. Check it.

Graham has been keeping up with recent rants in the medical blogosphere regarding the apparent unpreparedness of medical students for the “real medical world,” and in particular how the business side of medicine works. Dr. Wes was the first, expressing his surprise when multiple students he was interviewing for residency didn’t know the difference between ICD-9 and CPT billing codes, or the difference between the numbers 99233 and 99244. (Thankfully he later blames this on the medical schools rather than the students themselves, but still. When I go on my residency interviews, I’m pretty sure I’ll expect it to be more about medicine than about business school topics or how to start up a practice of my own 10+ years down the road. That’s fair, no?)

Kevin MD chipped in with some support of his own, making the rather ridiculous assertion that all medical students should be required to get MBAs before starting medical school. Dr. Pho, I hope you’re joking. After all, I’m sure every MBA program in the country has extensive coursework in medical billing codes, not to mention the fact that most MBA programs won’t let you in without at least a few years of experience working in the business field. I bet MBA programs would love to make exceptions for premedical students and dilute their carefully-crafted class statistics with a bunch of green folks going through the motions of yet another prerequisite just for the chance to apply to medical school. Here’s a better idea: If you people think it’s so important that medical undergraduates know every intricacy of medical billing and starting up one’s own practice, take it to the medical schools. We only know what we’re taught, and I guarantee there are a whole lot of people in medical school who couldn’t care less about what the difference between 99233 and 99244 is, especially when they’re trying to judge whether people interviewing them for residency would be good to work with and under.

Dr. Wes, here’s a tip: You might consider assessing your interviewees in a more direct way rather than giving them a pop quiz and showing off how much more you know than they do. You’ve been in the real world for longer than they have—heck, you’ve been in it, period. They’ll like your program a lot better too, I’ll bet. I don’t ask people I interview for medical school how much they know about how to conduct clinical research or how to intubate someone because they haven’t learned that yet. You shouldn’t necessarily fault them for it, nor should you fault their undergraduate institution or premedicial studies as a whole. That’s why it’s called premedical studies, and that’s why it’s called medical school. And if they have learned that stuff, then great. They’ll be more prepared than the next guy.

I can’t necessarily say whether learning this stuff prior to residency is useful or not. Neither Graham nor I have ever been residents or attendings, so perhaps we’ll come to our senses in a few years (or decades, in my case). Shadowfax jumps in with a more reasonable solution:

It’s not too hard to teach students some universal concepts about the business of medicine. A few lectures on contract law, some talks on professional negligence, maybe a bit on professional liability insurance, the difference between ICD-9 and CPT coding, a primer on various forms of reimbursement and how it is determined, the concept of Accounts Receivable, and some info on the RVRBS and how it relates to reimbursement. You hardly need an MBA.”

Hey, I’m fine with that. If you feel we need to know this stuff to be better at practicing medicine, then some coursework during medical school and/or residency wouldn’t hurt. I sure as hell have never heard of anything that Shadowfax mentions here, but I’m pretty sure I’ll need to have some understanding of it eventually regardless of what I do.

Looks like Bill Foster has some serious support. And growing.

This is one of the most impressive things I have ever seen. I am absolutely blown away. Abbie used to babysit for a kid who could do the date thing in his head, but he hadn’t gotten to powers yet. Once I gave him a quick overview of squares and quizzed him a bit, and five minutes later he’d moved on to cubes. Quiz over, since I didn’t have a calculator on me. Plus he was busy trying to figure out how the remote worked.

He was 5.

By the way, if you’re not watching these TED talks regularly, you should be. Subscribe to the podcast version here.

Our dog ate an entire loaf of banana bread and a whole batch of chocolate-coconut-butterscotch-almond bars off the counter this week. You try eating 4 bananas and a few kilograms of fat in 1.27 seconds and see how solid your bowel movements are.

I saw a few granby-somersault-kung fu moves in there, but they should definitely go with half-nelsons more often.

I just received this email from a staff member here:

Dear Chicago Colleagues,

Please forgive me for using your work emails this once. The current situation in Washington is negative toward science, and President Bush will veto the next appropriations. This will definitely hurt science.

As you know former Speaker of the House Dennis Hastert has stepped down, and a special election will be held in three months. Illinois 14th Congressional District has the chance to elect a scientist with stellar credentials in his place. Bill Foster holds a Harvard PhD and is a former Fermi lab physicist. Leon Lederman has organized a Nobel support group of which I am a member. Dick Durbin has endorsed Bill.

The grad and medical students students and faculty at UIC, NW, and UC have a great opportunity to contribute to an important congressional election in Illinois. Bill is in need of volunteers and donors. Is it at all possible for you reconvene the groups from NW, UC, and UIC that I met in Chicago? It would mean a lot to me if my Chicago friends could extend their help to Bill. This would be a big coup for science to replace Dennis Hastert with a card-carrying scientist.

Please let Bill’s team know directly.  I feel that we really need to get behind Bill!

Best holiday wishes,
[name]

So I looked into this Bill Foster guy, whom I’d never heard of before this. After perusing his site and reading up on him a bit more, I’d like to announce that I hereby endorse Bill “Scientist, Businessman, Democrat for Change” Foster in the upcoming elections, even despite the really cheesy tag line. Science has become somewhat of an afterthought in Washington over the past 7 years—hell, all rational decision-making has apparently become an afterthought—and this guy seems to have his head on straight and appears to be as fed up with the current administration as anyone, which is refreshing compared to the democratic Presidential candidates who tend to tiptoe around the subject of Bush’s shortcomings way more than they should (or could get away with), in my opinion.

Regarding the science thing, I think that if Mike Huckabee is elected President, which is looking like more of a possibility every day, as a scientist I will seriously consider moving to another country to pursue my work (sorry honey).

An engaged friend of mine just announced that two more of my friends just got engaged! Ahhh! The whole world is engaged!

I have to post these videos. This has to have been an incredible show. I wish I was there.

This one is a song my college group did (and still does?). One of the more challenging pieces I’ve ever sung or even seen, but these people make it look easy. I still find it amazing that they lock the chords so well with the arrangement moving around so much. Believe it or not, I used to know the tenor and baritone lines in this song (and could switch back and forth between them):

This one gives me goosebumps every time I watch it. It’s a little sloppy in parts, but the rise and fall of the energy is amazing:

If you’re ever bored and have a few hours on your hands, go here. I guarantee you will not be disappointed.

The only slightly aged Old MD Girl, a fellow MD/PhD student, recently tagged me with a circulating “seven weird things” meme. Apparently the idea is to write about seven weird things about yourself? I’ll give it a shot. The hardest part of this will be limiting it to seven.

I am going to tag a few people to continue this tradition right off the bat before I forget: the lovely lady behind PetersDigest, the sage Dr. Robey at Hope for Pandora, the future trophy wife at Vanity Fairest, the Chicagoan of LivinginChicago, the red green pink-haired Island Med Student, the almost-done(!) Dr. VonB of MudPhud Adventures, and Doctor David, who unfortunately seems rather normal.

Let’s begin.

1. My absolute favorite album of all time is A Charlie Brown Christmas (iTunes link) by Vince Guaraldi and his gang. No, I’m not just saying that because it’s nearing Christmas…I’m not even sure if I can concretely say why in the first place. Part of it is that it reminds me of family time decorating for Christmas and having this album blasting throughout the entire house (as much as I hate decorating for Christmas—or anything…you just have to take it all down in a few weeks again!). Another part of it is that I love jazz music, particularly piano jazz, and I think Vince Guaraldi was an absolute genius.
2. I really, really—really really really—want a Smart. I can’t entirely explain it. People definitely think I’m weird when I disclose this. But they’re just so small and practical-seeming. You can park anywhere. You can save gas. I am a singular individual who drives 6 miles to work on occasion; why on Earth would I need anything bigger than that? Why would anyone? If your reply is “to haul stuff…”, shut up.
3. A pet peeve of mine is when cereal boxes are not opened properly. The box should initially be opened with the top flap toward you and the bottom flap away from you, and the left half of the inner bag should have its two sides cleanly separated so that no cereal gets caught in crevasses or escapes through holes into the bottom of the box. This ensures an easy opening of the box followed by a nice clean pour with your right hand. Are you writing this down?? I will admit that some brands of cereal have finicky inner bags that are difficult to open cleanly, and for these I try to make exceptions; generic-brand cereals and Raisin Bran come to mind.
4. When I was in middle school, 7th grade to be exact, I was kind of a loner. I was a new kid in school, commuting back and forth from the next town over, where we lived for several months while our new house close to my school was being finished. Okay, to say I was a loner is an egregious understatement; I was much better at kickball and 4-Square than I had any business being, and I wore sweats to school every day. (I previously attended a parochial school with a dress code…get off my back.) The other necessary piece of background is that my mom is a terrible cook (just ask her) and liked to use up the previous night’s week’s leftovers, of which there were many, by popping them in my lunch bag, along with any other assorted scraps within reach. Severely bruised and/or inedible apples were perfectly fair game, as were weeks-old bananas barely fit even for banana bread, grapes, asparagus, beef stew in a sandwich bag, slices of bread (or half slices when the other half was particularly moldy and didn’t make the cut), charcoal garlic bread burned beyond rational explanation that the dog opted out on, etc.

   Observe Equation 1.

   Eq. 1
   L×BF=1/FE

   where L=degree of lonerness, BF=bad food index, and FE=frequency of communal lunch eating with peers. As Equation 1 shows, as the degree to which one is a loner and/or the index describing the poor quality of food rises, frequency of communal dining decreases. This is known as the Ferguson youth principle, or the Ferguson value.With decreases in FE come increasing efforts to safely store one’s uneaten food, since throwing it out would be wasteful and disrespectful to one’s well-meaning mother, and actually eating the stuff was clearly out of the question. Usually the top shelf of a locker is the first location of choice, as this is not easily noticeable by fellow classmates, at least initially, and holds a fair amount of bagged lunches, especially as the fruits and vegetables soften, the meats are consumed by various bacteria and molds, and the lunches can be packed into this confined space that much more easily. And so for the first several weeks in residence at this new school, it went thusly. That is, it went thusly until after a while an enormous, undeniable stench filled my locker’s entire wing of the school and the locker in question had to be essentially emptied completely, wiped down with alcohol and/or bleach and/or 2N hydrochloric acid, and more or less fumigated. With direction from an ad hoc committee of various teachers and administrators. And with pretty much everyone in the school stopping their own locker business to observe, since this took place at precisely 2:25 in the afternoon on a Friday. That was not a good year for the ol’ social life.

5. I am a very slow reader. There are a few reasons for this: 1) I have fallen asleep; 2) I am paying too much attention to whether the grammar is correct that I have either stopped reading entirely or have been merely skimming over the past few pages paying more attention to the sentence structure and comma usage than to the actual content of the book and so must turn back several pages every page or so; and/or 3) I can barely read in the first place. I also have very poor memory about things I read, especially over the long term. I can barely remember what I’m supposed to be researching. Wait, where am I?
6. I have (some) gray hair, and I like it. Richard Gere, I’m coming for you.
7. I can sleep anywhere, anytimeaaasdffffffffffffffffffffffffhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

The most recent of my posts is up on The Differential, Medscape’s group medical student weblog. Go check it out.

Welcome once again to the Cancer Research Blog Carnival! I’m pleased to be hosting the fourth edition. There were a ton of great submissions, so without further ado, let’s get started.

Sure, smoking is bad for you, but could it also be bad for businesses? Devon Carlson at Ask The CareerCounselor thinks so, and she’s citing some data to back it up:

[A] study of more than 14,000 workers found that nonsmokers took an average of 25 sick leave days per year while their smoking colleagues who took 36 sick days annually.
…
“According to the Centers for Disease Control and Prevention, employee tobacco use costs companies an estimated $167 billion annually. In other words, for a company that employees 10,000 people, if just 20% of those workers smoke that company spends over $15 million per year on healthcare and other costs associated with the habit.”

Now, I’m no mathologist, but it seems to me that companies should have at least some interest in reducing smoking prevalence among their workers. It’ll not only save lives but also save them a nice chunk of change in the end. It’s a win-win.

Keith Robison over at Omics! Omics! offers a nice overview of the VEGF-targeted therapies that are currently in use and introduces us to a relatively new treatment known as VEGF Trap:

VEGF-Trap is a pastiche of carefully chosen protein parts: pieces of two different human VEGF receptors plus a bit from a human antibody (IgG1) constant region.”

When this protein construct latches onto free VEGF, its binding to its receptor is inhibited, which in theory reduces tumor-induced blood vessel formation. According to a recent study investigating the efficacy of this therapy, precise dosing via comparison of free vs. “trapped” VEGF in the bloodstream may be employed, in contrast with typical dosing schedules based on body weight, age, etc. that are often highly variable from individual to individual.

VEGF-Trap forms stable, inert, monomeric complexes with VEGF which remain in circulation. By measuring the amount of free and VEGF-complexed VEGF-Trap in circulation they can measure VEGF levels and identify a dose which ensures that maximal trapping occurs.”

Walter, the genius behind the fantastic Highlight Health, blogs about recent papers in Cancer Research that presented some alarming news about one common treatment for prostate cancer: We may be shooting ourselves in the foot. (Or the crotch?) It appears that androgen deprivation therapy, thought to slow growth of cancerous prostate cells and halt progression of prostate cancer, may also be upregulating Nestin, a protein that appears to play a role in metastasis:

[The reseachers] examined Nestin gene expression in prostate cancer samples from 254 patients that encompassed the entire clinical spectrum of the disease, from untreated localized tumors to lethal metastatic cases. Increased levels of Nestin gene expression were found exclusively in lethal cases following androgen deprivation therapy.
…
“…another study in a genetically engineered mouse model of human prostate cancer demonstrated that prolonged exposure of the mice to reduced levels of androgen accelerated prostate tumor development compared to mice exposed to physiologically normal levels of androgen.”

Doctor David tells us about an exciting new drug that is being used in treating a type of soft tissue sarcoma and offers up a few reasons that this is totally awesome.

In addition, he gives a really nice review of the different types of cancer vaccines out there:

A peptide vaccine is most like the flu shot—a patient is injected with a piece of a protein that comes from a cancer cell in the hopes that this will trigger the immune system to respond to the protein and kill whatever cells (cancer cells in this case) have the protein… A dendritic cell vaccine, in contrast, involves taking immune system cells from the patient, putting the piece of protein that is being targeted by the vaccine into these cells in the lab, and then injecting the manipulated cells into the patient.”

Good stuff to know. The research in this area is booming. Why not, after all, let your body attack cancer for you?

Good thing we have these vaccines, too, because as Ian York writes on his blog Mystery Rays From Outer Space, it’s commonly thought that overt cancers have already escaped surveillance by the immune system:

The present model is that the immune system is just one checkpoint (though probably a fairly significant barrier) that the developing cancer cell must overcome. That means that by the time we can detect a cancer, it’s already been selected to be immune resistant. The cancers that were susceptible to the immune system were killed off when they were just a little cluster of cells, long before there was anything we could identify.”

Cancer vaccines, then, just give the immune system a little nudge.

As a follow-up, Ian also has a two-part series on cancer immunity in-depth: the three Es of cancer immunity (elimination, equilibrium, and escape), and another looking more specifically on the balance between tumor cells and the immune system. Together they’re a very nice explanation of a fascinating paper.

Abel Pharmboy over at Terra Sigillata highlights an unfortunate state of governmental and financial affairs for lymphoma patients that may prevent them from receiving a highly effective treatment, radioimmunotherapy. He quotes a recent Newsweek article that sheds light on the situation and also adds his own commentary:

‘What if they found a cure for a cancer that afflicts half a million people, but a combination of stupid bureaucrats and greedy doctors kept patients from getting it?

‘It’s the kind of scenario that seems like the province of conspiracy theorists or alternative-medicine wackos–but is actually happening right now with a proven treatment for certain common types of non-Hodgkins lymphoma, the sixth-most frequently occurring cancer in the United States.’

[The Newsweek author] does a fabulous job in describing the whole backstory on the potential loss of a truly disease-altering therapy that is among the most effective drugs in producing long-term cancer remissions.”

Deplorable.

Kamel of Bayblab fame (the godfathers of this prestigious and ubiquitous carnival) recently wrote about a novel drug currently in clinical trials that may abrogate the effects of commonly mutated players in cancer by encouraging cells to “ignore” nonsense mutations:

The p53 gene is mutated in over 50% of human tumours and of those mutants, almost 8% are nonsense mutations. Research has shown that reactivation of p53 has therapeutic potential in mouse models of cancer, leading to growth arrest and regression of tumours.”

(Incidentally, the Bayblab crew will be discussing these carnival inclusions in greater depth on the next episode of the wonderful Bayblab Podcast. Be sure to check it out.)

Finally, Matthew Zachary, the force behind I’m Too Young For This, tells us the emotional story of his battle with medulloblastoma and also tells us what he thinks of the word that gets thrown around all too often:

‘Cure’ has unfortunately become nothing more than a catchy, exploited, arbitrary and abstract health marketing term that has lost all sense of meaning and purpose — and I am not alone in this sentiment. Perhaps someday down the road a ‘cure’ may take the form of individualized genetic vaccines, which enable our bodies to manage cancer cells more effectively and prevent them from spreading. But we’re still going to get cancer. It just won’t be nearly as life threatening or life altering as it is today.”

Word to your mother. This is good reading.

That’s it! Hope you enjoyed the fourth edition. Look for #5 in early January.

Want to host a future edition? Get in touch with these folks.