Of scholars and bonds

Freedom to publish is another constraint.

______________________
not to mention that there is little overlap between reasearch areas of interest between DSO and Astar.

Looking for ideas….:-D
http://www.salzburgseminar.org/2007/sessionpages.cfm?GroupID=4025&IDEventTypes=144&IDEvent=1263

To do both. And also kidnap people.:-D

Harphoon,
You are a good soul.

Aaron, Dee & Starlet,

Wiping Out a Parasite, Not a Spirit of Adventure

Keith Aronowitz first noticed the crater on his elbow after returning from Bolivia. For a week or two, he simply ignored it. Then his friends began to worry.

“A buddy saw the hole in my arm,” recalled Mr. Aronowitz, a photographer and video editor, “and said: ‘Hey, you better see a doctor. That doesn’t look right.’ ”

O.K., he decided, I’ll see a dermatologist, and maybe I’ll even help her with the diagnosis. At the back of his mind, he was thinking of a recent National Geographic article. In it, the author also contracted a weird skin infection in South America. And it all started, the writer stated, with the bite of a sand fly.

When Mr. Aronowitz arrived at Madidi National Park ­ the same Amazon outpost visited by the National Geographic author ­ he, too, was bombarded by sand flies. Soon, their pesky bites left him covered in itchy bumps. Then came the elbow ulcer.

In Los Angeles, however, his doctor simply shrugged her shoulders when he proffered these clues. Instead, she handed him an all-purpose cream and glided off.

Another two months passed. The hole in Mr. Aronowitz’s elbow got bigger, deeper and juicier. That’s when he found me.

I’m a tropical medicine specialist who has seen plenty of exotic skin infections over the years. You could say my interest dates back to childhood. Growing up, I was always fascinated by the shallow scar on the cheek of my grandfather, a native of southern Turkey. “How’d you get it?” I asked him, touching the papery depression. “Oh, where I was born, everyone had this,” he replied. “First a fly bit you, then you got a sore. After a while it healed and never came back.”

Years later, as an infectious diseases trainee, I suddenly grasped my grandfather’s diagnosis. What he had was a classic case of “Old World” cutaneous leishmaniasis, also known as “Oriental sore,” “Baghdad boil” and “Aleppo evil.” I then spent two years studying immune responses to the common Middle Eastern blight.

First, the bite of the sand fly transmits the single-cell parasites. Then warrior lymphocytes flood the dermis, causing other cells sheltering the invading microbes to self-destruct. As the battle plays out and the good guys prevail, patients’ skin lesions slowly morph from volcanic nodules to thick-rimmed ulcers to patchy, irregular scars.

But certain cases of leishmaniasis acquired in South America are not so easily vanquished. After hearing Mr. Aronowitz’s story, I felt a little queasy. The region he visited harbors particularly nasty strains of leishmania that sometimes evade the immune system, later spreading like cancer to the nose, mouth and throat.

It was bad enough that my new patient had a ragged, crusty defect on his elbow. What if the parasite started in on his face? This was no longer a watch-and-wait situation ­ it was time to treat. Or try, at least.

My first choice was an antifungal drug that counters leishmania. Although the medicine bothered his stomach, Mr. Aronowitz faithfully downed the pills for two or three months. But when he stopped them, his elbow got itchy and red, and before long the sore was back.

Intravenous pentamidine ­ once a mainstay for AIDS patients with Pneumocystis pneumonia ­ was my next ploy. It bought my patient another year.

Now I was down to heavy-metal therapy. That’s right: the elephant gun for leishmaniasis is a toxic drug made from the chemical antimony.

Everything about the drug, Pentostam, is laborious. To procure it, I had to reach out to the Centers for Disease Control and Prevention in Atlanta and fill out piles of paperwork. Meanwhile, Mr. Aronowitz was outfitted with a semipermanent IV to receive the drug. A high price to pay for a few days in the rain forest.

Finally, it was showtime. Day after day for a month, the man with a hole in his elbow visited our hospital’s infusion center, patiently enduring ever-worsening aches and pains while the parasite poison coursed through his veins. He also underwent weekly blood tests and EKGs to make sure his kidneys, liver and heart remained healthy throughout the treatment.

Thankfully, this drug, Pentostam, was the charm; it cured Mr. Aronowitz’s infection with no lasting side effects. Four years later, his elbow is as smooth as silk.

Epilogue: Last spring, Mr. Aronowitz returned to the Amazon. This year, he recently told me, he’s planning another trip, to shoot a documentary about shamans.

He is philosophical about the danger.

“I don’t know why, but I’ve always been fascinated by the wild, green romanticism of it,” he said. “Sure there are insects and animals there. Maybe that’s why I like it.”

Since we’re friends, I can be frank. I’ll take my insects and parasites under the microscope.

—————————————————-
Claire Panosian Dunavan is a professor of medicine and infectious diseases at the University of California, Los Angeles.

April 29, 2007

Young, Gifted, and Not Getting Into Harvard

By MICHAEL WINERIP

ON a Sunday morning a few months back, I interviewed my final Harvard applicant of the year. After saying goodbye to the girl and watching her and her mother drive off, I headed to the beach at the end of our street for a run.

It was a spectacular winter day, bright, sunny and cold; the tide was out, the waves were high, and I had the beach to myself. As I ran, I thought the same thing I do after all these interviews: Another amazing kid who won’t get into Harvard.

That used to upset me. But I’ve changed.

Over the last decade, I’ve done perhaps 40 of these interviews, which are conducted by alumni across the country. They’re my only remaining link to my alma mater; I’ve never been back to a reunion or a football game, and my total donations since graduating in the 1970s do not add up to four figures.

No matter how glowing my recommendations, in all this time only one kid, a girl, got in, many years back. I do not tell this to the eager, well-groomed seniors who settle onto the couch in our den. They’re under too much pressure already. Better than anyone, they know the odds, particularly for a kid from a New York suburb.

By the time I meet them, they’re pros at working the system. Some have Googled me because they think knowing about me will improve their odds. After the interview, many send handwritten thank-you notes saying how much they enjoyed meeting me.

Maybe it’s true.

I used to be upset by these attempts to ingratiate. Since I’ve watched my own children go through similar torture, I find these gestures touching. Everyone’s trying so hard.

My reason for doing these interviews has shifted over time. When I started, my kids were young, and I thought it might give them a little advantage when they applied to Harvard. That has turned out not to be an issue. My oldest, now a college freshman, did not apply, nor will my twins, who are both high school juniors.

We are not snubbing Harvard. Even my oldest, who is my most academic son, did not quite have the class rank or the SATs. His SAT score was probably 100 points too low ­ though it was identical to the SAT score that got me in 35 years ago.

Why do I continue to interview? It’s very moving meeting all these bright young people who won’t get into Harvard. Recent news articles make it sound unbearably tragic. Several Ivies, including Harvard, rejected a record number of applicants this year.

Actually, meeting the soon-to-be rejected makes me hopeful about young people. They are far more accomplished than I was at their age and without a doubt will do superbly wherever they go.

Knowing me and seeing them is like witnessing some major evolutionary change take place in just 35 years, from the Neanderthal Harvard applicant of 1970 to today’s fully evolved Homo sapiens applicant.

There was the girl who, during summer vacation, left her house before 7 each morning to make a two-hour train ride to a major university, where she worked all day doing cutting-edge research for NASA on weightlessness in mice.

When I was in high school, my 10th-grade science project was on plant tropism ­ a shoebox with soil and bean sprouts bending toward the light.

These kids who don’t get into Harvard spend summers on schooners in Chesapeake Bay studying marine biology, building homes for the poor in Central America, touring Europe with all-star orchestras.

Summers, I dug trenches for my local sewer department during the day, and sold hot dogs at Fenway Park at night.

As I listen to them, I can visualize their parents, striving to teach excellence. One girl I interviewed described how her father made her watch the 2004 convention speeches by both President Bush and Senator John Kerry and then tell him which she liked better and why.

What kind of kid doesn’t get into Harvard? Well, there was the charming boy I interviewed with 1560 SATs. He did cancer research in the summer; played two instruments in three orchestras; and composed his own music. He redid the computer system for his student paper, loved to cook and was writing his own cookbook. One of his specialties was snapper poached in tea and served with noodle cake.

At his age, when I got hungry, I made myself peanut butter and jam on white bread and got into Harvard.

Some take 10 AP courses and get top scores of 5 on all of them.

I took one AP course and scored 3.

Of course, evolution is not the same as progress. These kids have an AP history textbook that has been specially created to match the content of the AP test, as well as review books and tutors for those tests. We had no AP textbook; many of our readings came from primary documents, and there was no Princeton Review then. I was never tutored in anything and walked into the SATs without having seen a sample SAT question.

As for my bean sprouts project, as bad it was, I did it alone. I interview kids who describe how their schools provide a statistician to analyze their science project data.

I see these kids ­ and watch my own applying to college ­ and as evolved as they are, I wouldn’t change places with them for anything. They’re under such pressure.

I used to say goodbye at my door, but since my own kids reached this age, I walk them out to their cars, where a parent waits. I always say the same thing to the mom or dad: “You’ve done a wonderful job ­ you should be very proud.” And I mean it.

But I’ve stopped feeling bad about the looming rejection. When my four were little, I used to hope a couple might go to Harvard. I pushed them, but by the end of middle school it was clear my twins, at least, were not made that way. They rebelled, and I had to learn to see who they were.

I came to understand that my own focus on Harvard was a matter of not sophistication but narrowness. I grew up in an unworldly blue-collar environment. Getting perfect grades and attending an elite college was one of the few ways up I could see.

My four have been raised in an upper-middle-class world. They look around and see lots of avenues to success. My wife’s two brothers struggled as students at mainstream colleges and both have made wonderful full lives, one as a salesman, the other as a builder. Each found his own best path. Each knows excellence.

That day, running on the beach, I was lost in my thoughts when a voice startled me. “Pops, hey, Pops!” It was Sammy, one of my twins, who’s probably heading for a good state school. He was in his wetsuit, surfing alone in the 30-degree weather, the only other person on the beach. “What a day!” he yelled, and his joy filled my heart.

April 29, 2007

Chemotherapy Fog Is No Longer Ignored as Illusion

By JANE GROSS

On an Internet chat room popular with breast cancer survivors, one thread ­ called “Where’s My Remote?” ­ turns the mental fog known as chemo brain into a stand-up comedy act.

One woman reported finding five unopened gallons of milk in her refrigerator and having no memory of buying the first four. A second had to ask her husband which toothbrush belonged to her.

At a family celebration, one woman filled the water glasses with turkey gravy. Another could not remember how to carry over numbers when balancing the checkbook.

Once, women complaining of a constellation of symptoms after undergoing chemotherapy ­ including short-term memory loss, an inability to concentrate, difficulty retrieving words, trouble with multitasking and an overarching sense that they had lost their mental edge ­ were often sent home with a patronizing “There, there.”

But attitudes are changing as a result of a flurry of research and new attention to the after-effects of life-saving treatment. There is now widespread acknowledgment that patients with cognitive symptoms are not imagining things, and a growing number of oncologists are rushing to offer remedies, including stimulants commonly used for attention-deficit disorder and acupuncture.

“Until recently, oncologists would discount it, trivialize it, make patients feel it was all in their heads,” said Dr. Daniel Silverman, a cancer researcher at the University of California, Los Angeles, who studies the cognitive side effects of chemotherapy. “Now there’s enough literature, even if it’s controversial, that not mentioning it as a possibility is either ignorant or an evasion of professional duty.”

That shift matters to patients.

“Chemo brain is part of the language now, and just to have it acknowledged makes a difference,” said Anne Grant, 57, who owns a picture-framing business in New York City. Ms. Grant, who had high-dose chemotherapy and a bone marrow transplant in 1995, said she could not concentrate well enough to read, garbled her sentences and struggled with simple decisions like which socks to wear.

Virtually all cancer survivors who have had toxic treatments like chemotherapy experience short-term memory loss and difficulty concentrating during and shortly afterward, experts say. But a vast majority improve. About 15 percent, or roughly 360,000 of the nation’s 2.4 million female breast cancer survivors, the group that has dominated research on cognitive side effects, remain distracted years later, according to some experts. And nobody knows what distinguishes this 15 percent.

Most oncologists agree that the culprits include very high doses of chemotherapy, like those in anticipation of a bone marrow transplant; the combination of chemotherapy and supplementary hormonal treatments, like tamoxifen or aromatase inhibitors that lower the amount of estrogen in women who have cancers fueled by female hormones; and early-onset cancer that catapults women in their 30s and 40s into menopause.

Other clues come from studies too small to be considered definitive. One such study found a gene linked to Alzheimer’s disease in cancer survivors with cognitive deficits. Another, using PET scans, found unusual activity in the part of the brain that controls short-term recall.

The central puzzle of chemo brain is that many of the symptoms can occur for reasons other than chemotherapy.

Abrupt menopause, which often follows treatment, also leaves many women fuzzy-headed in a more extreme way than natural menopause, which unfolds slowly. Those cognitive issues are also features of depression and anxiety, which often accompany a cancer diagnosis. Similar effects are also caused by medications for nausea and pain.

Dr. Tim Ahles, one of the first American scientists to study cognitive side effects, acknowledges that studies have been too small and lacked adequate baseline data to isolate a cause.

“So many factors affect cognitive function, and the kinds of cognitive problems associated with cancer treatment can be caused by many other things than chemotherapy,” said Dr. Ahles, the director of neurocognitive research at Memorial Sloan-Kettering Cancer Center in New York.

The new interest in chemo brain is, in effect, a testimony to enormous strides in the field. Patients who once would have died now live long enough to have cognitive side effects, just as survivors of childhood leukemia did many years ago, forcing new treatment protocols to avoid learning disabilities.

“A large number of people are living long and normal lives,” said Dr. Patricia Ganz, an oncologist at U.C.L.A. who is one of the nation’s first specialists in the late side effects of treatment. “It’s no longer enough to cure them. We have to acknowledge the potential consequences and address them early on.”

As researchers look for a cause, cancer survivors are trying to figure out how to get through the day by sharing their experiences, and by tapping expertise increasingly being offered online by Web sites like http://www.breastcancer.org and http://www.cancercare.org.

There are “ask the experts” teleconferences, both live and archived, and fact sheets to download and show to a skeptical doctor. Message boards suggest sharpening the mind with Japanese sudoku puzzles or compensatory techniques devised to help victims of brain injury. There are even sweatshirts for sale saying “I Have Chemo Brain. What’s Your Excuse?”

Studies of cognitive effects have overwhelmingly been conducted among breast cancer patients because they represent, by far, the largest group of cancer survivors and because they tend to be sophisticated advocates, challenging doctors and volunteering for research.

Most researchers studying cognitive deficits say they believe that those most inclined to notice even subtle changes are high-achieving women juggling careers and families who are used to succeeding at both. They point to one study that found that complaints of cognitive deficits often did not match the results of neuro-psychological tests, suggesting that chemo brain is a subjective experience.

“They say, ‘I’ve lost my edge,’ ” said Dr. Stewart Fleishman, director of cancer supportive services at Beth Israel and St. Luke’s/Roosevelt hospitals in New York. “If they can’t push themselves to the limit, they feel impaired.”

Dr. Fleishman and others were pressed as to why a poor woman, working several jobs to feed her children, navigating the health care system and battling insurance companies, would not also need mental dexterity. “Maybe we’re just not asking them,” Dr. Fleishman said.

Overall, middle-class cancer patients tend to get more aggressive treatment, participate in support groups, enroll in studies and use the Internet for research and community more than poor and minority patients, experts say.

“The disparity plays out in all kinds of ways,” said Ellen Coleman, the associate executive director of CancerCare, which provides free support services. “They don’t approach their health care person because they don’t expect help.”

But approaching a doctor does not guarantee help. Susan Mitchell, 48, who does freelance research on economic trends, complained to her oncologist in Jackson, Miss., that her income had been halved since her breast cancer treatment last year because everything took longer for her to accomplish.

She said his reply was a shrug.

“They see their job as keeping us alive, and we appreciate that,” Ms. Mitchell said. “But it’s like everything else is a luxury. These are survivor issues, and they need to get used to the fact that lots of us are surviving.”

Among women like Ms. Mitchell, lost A.T.M. cards are as common as missing socks. Children arrive at birthday parties a week early. Wet clothes wind up in the freezer instead of the dryer. Prosthetic breasts and wigs are misplaced at the most inopportune times. And simple words disappear from memory: “The thing with numbers” will have to do for the word “calculator.”

Linda Lowen, 46, had a hysterectomy and chemotherapy for ovarian cancer 13 years ago, and says she still cannot recognize neighbors at the grocery store. “I had a mind like a steel trap, and I ended up with a colander for a brain,” said Ms. Lowen, a radio and television talk show host in Syracuse.

The other night, Ms. Lowen set out to find a good place to store her knitting supplies. She began emptying a cabinet of games that her teenage daughters no longer played. Meanwhile, she noticed a blown light bulb and went to find a replacement. That detour led to another, and five hours later she had scrubbed every surface and tidied the contents of eight drawers. But she still had no storage space for her knitting supplies.

“I have an almost childlike inability to follow through on anything,” Ms. Lowen said.

Solutions come in many forms for women whose cancer treatment has left them with cognitive deficits.

Sedra Jayne Varga, 50, an administrative assistant in family court in Manhattan, is part of a research study of the stimulant Focalin, which she said had helped. But Ms. Varga also plans to have laser surgery on her eyes so that losing her glasses will no longer be an issue.

Lu Ann Hudson, 44, a designer of financial databases in Cincinnati, relies on a key fob that sets off a beep in her car when she is looking for it in parking lots. Terry-Lynne Jordan, 43, who analyzes environmental incidents for an oil company in Calgary, Alberta, uses the calendar on her computer and voice mail messages to herself to remind her of meetings.

And Debbie Kamplain, a 32-year-old stay-at-home mother in Peoria, Ill., hired a $30-an-hour personal organizer to help her sell a house, buy another and get ready to move her family to Indiana next month.

But it is Ms. Kamplain’s 2 ½-year-old son, Daniel, who sees to it that she stays on task. Long before Daniel could talk, he would pull her over to the refrigerator if she got distracted while getting him a drink.

“Poor kid,” Ms. Kamplain said. “I say I’m going to do something, forget about it immediately, and he’s the one who has to remind Mommy about stuff.”

April 30, 2007
As Blogs Proliferate, a Gadfly With Accreditation at the U.N.
By MARIA ASPAN

UNITED NATIONS — The daily press briefing was routine. Marie Okabe, a spokeswoman for the secretary general, read a five-minute update on Somalia, Darfur and the Security Council’s actions, and about 30 journalists quietly listened.

In the third row, Matthew Lee tapped away at his laptop and scribbled on two notepads with the intensity of a graduate student at thesis time. When Ms. Okabe asked for questions, Mr. Lee, the resident blogger of the United Nations press corps, pounced, asking almost as many questions in 20 minutes as the other correspondents combined.

Mr. Lee, a well-known gadfly who often presses banks to revise their policies on mortgage loans to the poor, is the only blogger at the United Nations with media credentials, entitling him to free office space and access to briefings and press conferences. There had been a second accredited blogger, Pincas Jawetz, a 73-year-old retired energy policy consultant, but he was ejected last month on the grounds that he had distracted too many briefings with off-topic questions.

The United Nations is one of the only institutions of its size and importance that currently allow bloggers not affiliated with larger, more traditional media companies into the permanent press corps.

The Democrats and Republicans allowed bloggers into their 2004 conventions. But the question of whether bloggers should be considered credentialed journalists is a relatively new one at the United Nations, in part, it seems, because the foreign policy debates here are considered mind-numbing to many Americans.

“Bloggers in the U.S. seem mostly concerned about domestic politics,” said Mr. Lee, one of about 200 full-time resident correspondents at the United Nations (another 1,500 have permanent credentials).

The day-to-day work of the United Nations, he said, involves passing “boring resolutions and delivering food. Nobody cares.”

Most of Ms. Okabe’s answers during a daily briefing made it into one of several daily posts on Mr. Lee’s Web site, innercitypress.com, which has covered everything from fire drills at the United Nations headquarters building to potential financial abuses at its agencies. He says that this site gets about 90,600 visitors a month. Another site he runs, innercitypress.org, which he calls “more openly advocacy,” gets 289,000 monthly visitors.

Mr. Lee is also well known in banking circles. This month, for instance, he took a break from his foreign affairs duties to attend a Citigroup shareholder meeting.

He established Inner City Press in 1987 as a print newsletter and turned his attention to the United Nations in late 2005. Today, Inner City Press operates as both an online nonprofit organization and as a Web site with the motto “investigative reporting from the inner city to Wall Street to the United Nations.”

Mr. Lee draws a distinction between his investigations at the United Nations and the criticism the institution faces from right-wing bloggers. “I end up getting a lot of dirt, not because I’m a right-winger, just because I write about the agencies,” said Mr. Lee, 41, who says he regularly works 13-hour days and lives on the money from several fellowships he won a few years ago.

Stéphane Dujarric, who was a chief spokesman for former Secretary General Kofi Annan, is now working for the department that oversees media accreditation at the United Nations. He said that guidelines for bloggers are a work in progress. The goal is to balance concerns about openness, security and professional standards with growing interest from online journalists, he said.

“New media is definitely a challenge to all organizations who accredit journalists, and I think we’re doing well in meeting that challenge,” Mr. Dujarric said. “Our priority is to make sure we provide an environment that is as open to journalists doing their work, as much as possible.”

For people without credentials — journalists or citizens — the United Nations posts transcripts and live Webcasts on its site. “We’re trying to make information about the U.N. as accessible as possible,” Mr. Dujarric said.

The debate over who should gain access to the inner sanctum came to a head last month when Mr. Jawetz, who follows sustainable development for his Web site called SustainabiliTank.info, did not have his accreditation renewed. The United Nations department of public information cited his Web site’s lack of “a substantial amount of original news content” as well as complaints from other reporters that Mr. Jawetz’s questions were “more consistent with that of a nongovernmental organization advocate.”

On March 29, his last day at the noon briefing, Mr. Jawetz created a scene by using the question period to read a letter informing him that his renewal request had been declined.

“I’m not covering everything, I’m writing about what is important,” said Mr. Jawetz, who said in an interview that his site published impartial journalism, not advocacy.

Although United Nations reporters and officials refer to Mr. Lee as the only remaining blogger, he is not the only member of the press corps who blogs. Joe Lauria, who covers the United Nations on a freelance basis for The Boston Globe, writes for The Huffington Post, a liberal-leaning blog; on the more conservative side, Claudia Rosett, a contributor to National Review and a former member of The Wall Street Journal’s editorial board, has a blog at claudiarosett.pajamasmedia.com.

And in the more distant blogosphere, the United Nations is a favorite punching bag for many political blogs like littlegreenfootballs.com.

“Bloggers, serious ones, do contribute to the spread of information,” said Tuyet Nguyen, a correspondent for the German press service DPA and president of the United Nations Correspondents Association. He said of Mr. Lee: “I don’t see any difference in what he’s doing and what we are doing.”

Mr. Lee is a bit like a bull in the carefully diplomatic china shop of the United Nations press corps. He has broken a few stories and irritated more than one senior official. He has printed gossip, rumors and what several officials called lies, and was once called a “jerk” by Mark Malloch Brown, the deputy secretary-general under Kofi Annan.

But he seems to have earned the respect of his colleagues: in December, he was elected to the executive committee of the United Nations Correspondents Association.

“I know my place; it’s a supplement, it’s a sidebar on issues that everyone else cares about,” Mr. Lee said.

He said that he can devote his time — and Web space — to issues often overlooked by larger media. “It’s not like newsprint costs are going to kill me,” he said.

lkh,

See reply:-

“Thanks very much. We have in fact started studying this issue at NUS-NUH.

Our main problem is the slow recruitment of women who are willing to take part in this type of longitudinal study. They are usually traumatized by the whole issue.

Will keep you posted if we do come across something which can explain or predict who is at risk.

We are currently limiting our study to women on adjuvant chemotherapy for early stage breast cancer as it gives us a homogenous population with relatively good survival to do a longitudinal study.”
__________________________________________________________________

lkh SINGAPORE // May 1, 2007 at 10:22 am

wonders why there’s no pointed professional healthcare readily available to address this. Maybe its on the way.

Addtional comment:

Judy may have some clever thoughts on this given the project she is doing. I wonder if there are not some cognitative tests that could be specially designed (probably already are) and/or some imaging studies that could be useful. This area would seem to be amenable to prospective and post prospective evaluation, an unusual opportunity study before and after.

Each institute has core skills/technologies and primary research focus.
http://www.a-star.edu.sg/astar/biomed/action/view_institutes.do
http://www.a-star.edu.sg/astar/biomed/action/biomed_strategic_initiatives.do

Collaborate on common areas of focus.

One example: GIS on cancer gene sequencing, IMCB on cancer developmental biology, BTI on antibodies production, BII on gene Bioinformatics etc.

Drop a question line to Dr. Miranda YAP (miranda_yap@bti.a-star.edu.sg)

Tell her that I referred her to you.

——————————————
I am pretty sure BTI does more than antibody production. Basically makes biologics but i am not sure if u would consider a synthetic peptide, a biologic or a synthetic product…There are different ways of making it…Get a cell to do it or solid phase synthesis…which process r u referring to?

May 2, 2007
Chemotherapy and the Brain (7 Letters)

To the Editor:

Re “Lingering Fog of Chemotherapy Is No Longer Ignored as Illusion” (front page, April 29):

The treatment of many cancers has become more sophisticated and successful. Each year, the number of survivors grows, as many such individuals begin to live with essentially a chronic, treatable illness.

Yet in the survivorship journey, there are a number of both physiological and psychological obstacles one must deal with. In addition to the cognitive difficulties of “chemo brain,” many aggressive therapy protocols leave patients physically enervated, with chronic nerve problems, like peripheral neuropathies, impotence and infertility.

In addition, there are the arduous emotional sequelae that must be faced, such as having a life that will never be the same and living with what is called “the Damocles Syndrome,” always wondering if and when the “sword” will fall and the cancer will return.

On balance, what is happening in the world of oncology is most promising and hopeful. Yet as the article underscores, we must never forget that cancer always occurs within a dynamic living human being, one with robust physical and emotional needs. And those needs must never be neglected.

Roger Granet, M.D.
New York, April 29, 2007
The writer is a clinical professor of psychiatry at Weill Medical College of Cornell University.

•

To the Editor:

Your article about “chemo brain” brings up two points: post-chemotherapy neurotoxicity is just a part of a constellation of issues that we as oncologists are helping our patients cope with; and let’s stop using the term “chemo brain,” since many women find it offensive.

The American Society of Oncology is developing guidelines for cancer survivorship that will deal with these issues in a systematic, evidence-based manner. What we are doing at our hospital is going one step further and developing protocols that include preventive interventions at the time of initial diagnosis to see if we can attenuate the effects of chemotherapy, sudden hormonal changes and depression, which often coexist. We hope that our efforts can translate into refinement of those guidelines.

We must also remember that cognitive impairment affects men and children, too.

Anthony F. Provenzano, M.D.
Chief, Medical Oncology
Lawrence Hospital Center
Bronxville, N.Y., April 29, 2007

•

To the Editor:

It is one thing for physicians to ignore unfamiliar symptom constellations. It is another to project a lack of information (the “illusions”) onto patients and to diagnose “delusions.”

The use of psychiatric labels as default diagnoses (somatization, anxiety) carries with it some unimaginable penalties. These include harmful medical interventions; social stigma and loss of familial support; reductions in medical insurance coverage; and inability to qualify for disability.

Such misdiagnoses are also a disservice to psychiatry, a branch of medicine in dire need of positive signs for diagnostic validity rather than reliance upon an absence of data.

The phrase “I don’t know” leads to research, which ultimately provides answers. It also does no harm to the patient. Hippocrates had the right idea.

Barbara Rubin
Hartland, Vt., April 29, 2007

•

To the Editor:

You say breast cancer survivors complaining of cognitive difficulties after chemotherapy “were often sent home with a patronizing ‘There, there.’ ” You quote Dr. Daniel Silverman, a researcher at U.C.L.A., as saying, “Until recently, oncologists would discount it, trivialize it, make patients feel it was all in their heads.”

As an oncologist who has treated many such patients, I believe that both statements are unfair and that most oncologists have not been callous to patients with these problems.

It is no surprise that chemotherapy drugs with multiple other serious side effects can also affect cognitive function. The lack of successful therapy for this serious medical problem should not be misinterpreted as a lack of concern.

Bruce Bank, M.D.
Rolling Meadows, Ill., April 29, 2007

To the Editor:

I read your article about “chemo brain”; I would add that it isn’t just a breast cancer survivor’s lament.

I survived colon cancer and its related treatment in my late 40s, and it took me a year before I could play Scrabble or do the New York Times crossword puzzle! I’m male and, believe me, my ego has been thrown for a loop trying to recapture or even find the thread of what was once in my mind.

I’m glad to know that the professionals now realize that we weren’t crazy when we said, “I’ve forgotten how to balance my checkbook”!

G. J. McDavitt
Narragansett, R.I., April 29, 2007

•

To the Editor:

My father suffered similarly after receiving two doses of chemotherapy, when almost his entire memory was obliterated. He could not recognize my mother, my brother or me, remembering only his childhood and his one brother, who had been with him throughout.

While he survived exactly four months from the date of the diagnosis, what was worse was that he was truly with us only the first month because of chemo brain. I hope that attitudes, particularly those of oncologists, continue to change to recognize chemo brain as an all too undeniable reality.

Mohammed Askari Chandoo
Dubai, United Arab Emirates, April 29, 2007

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To the Editor:

As a medical sociology student, I was pleased to see that times are changing in regard to doctors’ understanding of patients’ memory problems after chemotherapy.

Doctors have significant power when it comes to legitimizing symptoms, and when they choose to overlook complaints, patients may suffer greatly, emotionally and physically.

It is motivating to see that advocacy efforts by cancer survivors have been successful in making doctors aware of the real experience of chemo brain, particularly since the patients in this case have a long history of medical experiences on which to evaluate their situation.

I hope that we continue to find shrugs replaced with nods as doctors begin to acknowledge the symptoms of diverse populations of patients without a fight. Many families are being negatively affected by this lack of acceptance of the experiences common to too many cancer survivors.

Erica Solway
Palo Alto, Calif., April 30, 2007

Dee and Starlet,

BTI (www.bti.a-star.edu.sg) is in the biologic “soup” development business.

A*BIO (www.a-bio.com) is the commercial scale spinout.

Complimented by CSL
(www.ices.a-star.edu.sg/ices/research_and_development/research_programme/chemical_synthesis.do)

New cancer drugs are expensive biologics.
Avastin is a monoclonal antibody for metastatic colorectal cancer treatment.
Scaling with multiples of 20,000 liter bioreactors lowers production cost.
Genentech will produce Avastin here by 2010 when the plant is ready and FDA certified.

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My impression was that it basically does lots of protein synthesis and does it the biological way and hence my point above…

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BTI focuses entirely on antibody production or does it produces synthetic peptides too?

lkh,
See http://www.physorg.com/news79282045.html