The most effective treatment for professional arrogance among health care providers is years of experience. New doctors imagine themselves to be like knights of old, battling and defeating life-threatening disease if they attack with sufficient resources and vigor. Older doctors understand that a more appropriate description may be that they are more akin to medical anthropologists, watching patients' disease processes reveal themselves, and defy medical and pharmaceutical attacks.
A very recent report from the National Institutes of Health.indicates that Dr. David Solit, and his colleagues, of Memorial Sloan-Kettering CancerCenters has "...discovered a new way that melanoma cells may become resistant to treatment with vemurafenib (Zelboraf), a targeted therapy that has produced dramatic, if transitory, results for some patients with advanced disease." Solit discovered that resistant melanoma cancer cells "...produce a shortened version of the mutant BRAF protein that vemurafenib targets. The shortened protein—which is missing its middle section—is active even in the drug's presence, the researchers reported online November 23 in Nature."
The report indicates that there is some hope that vemurafenib, when combined with another drug (s) may overcome the resistance which has caused treatment response to be transitory. When one considers that a 1 cm. tumor mass may contain 10 to the ninth cancer cells, and there is a significant likelihood that there will be other treatment-resistant mutations among those cells, it becomes evident that therapeutic enthusiasm has to be tempered by hard cold statistics. In an environment in which a single mutation may confer a significant competitive advantage to the mutation-carrier cell and its progeny, one should be cautious about provoking curative expectations.
I hope that oncologists share the statistical likelihood of mutation vs. cure with patients when offering courses of difficult, expensive, time and resource-consuming treatment. Isn't that what "informed consent" is really about?
A very recent report from the National Institutes of Health.indicates that Dr. David Solit, and his colleagues, of Memorial Sloan-Kettering CancerCenters has "...discovered a new way that melanoma cells may become resistant to treatment with vemurafenib (Zelboraf), a targeted therapy that has produced dramatic, if transitory, results for some patients with advanced disease." Solit discovered that resistant melanoma cancer cells "...produce a shortened version of the mutant BRAF protein that vemurafenib targets. The shortened protein—which is missing its middle section—is active even in the drug's presence, the researchers reported online November 23 in Nature."
The report indicates that there is some hope that vemurafenib, when combined with another drug (s) may overcome the resistance which has caused treatment response to be transitory. When one considers that a 1 cm. tumor mass may contain 10 to the ninth cancer cells, and there is a significant likelihood that there will be other treatment-resistant mutations among those cells, it becomes evident that therapeutic enthusiasm has to be tempered by hard cold statistics. In an environment in which a single mutation may confer a significant competitive advantage to the mutation-carrier cell and its progeny, one should be cautious about provoking curative expectations.
I hope that oncologists share the statistical likelihood of mutation vs. cure with patients when offering courses of difficult, expensive, time and resource-consuming treatment. Isn't that what "informed consent" is really about?
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