Only One Party Supports Voting, Jobs And Helping ALL People

-by Tracy B Ann

When I was diagnosed with breast cancer I chose the treatment I felt had the least side effects. I declined Chemo, Radiation and a nasty drug called Tamoxofin. It may indeed help with breast cancer but it’s been proven to cause other types of cancer. Umm..., no thanks.

I did consent to two surgeries though, I mean, I had a malignant tumour in my body, of course I wanted it out. During surgery blue dye was injected into me to trace the cancer. Had it spread anywhere? Particularly lymph nodes?

Turns out it had, so 2 lymph nodes were removed and sent to pathology. They came back 95% and 98% cancerous which led to my having another surgery so more lymph nodes could be removed to be tested. Of these, only one had a tiny % of cancer. That was good.

The Lymphatic System seems to me to be a pretty fragile system and one that defies the laws of gravity. It flows from the bottom up and is sensitive to any blockage in it’s path. Missing nodes create a huge problem and sometimes major blockage. When that occurs, as it did in my case, the arm that had the nodes removed begins to swell, and swell, and swell. This is a condition called Lymphedema.

There aren’t a whole lot of ways to treat it so it’s best just to prevent it. As I studied everything I could about it, I was advised to call the American Cancer Society for suggestions. Seriously, I should have just discussed the matter with my cats.

Some of the suggestions were fine; never sleep on that side again, always wear gloves when gardening, avoid any cuts or scrapes, always wear a compression sleeve, avoid heavy lifting or repetitive movements. Okay, maybe I could do some of that. Then I described my jobs. The things I do for a living. Neither of which I can wear a compression sleeve while doing, both which require heavy lifting and repetitive movements.

The American Cancer Society’s advice? Oh, I’d just need to get a different job. Well, all righty then. Sounds easy enough. Except, I’ve spent over 20 years building a great clientele, and I don’t really know how to do much else that pays a decent wage. Yet, my job is becoming increasingly difficult for me to perform well.

Which makes me think of voting in an odd parallel sort of way. It can be very hard to vote and that’s on purpose. Take an absentee ballot for example. In the old days you just asked for one to be mailed to you and it was. Today in some states, you have to prove you won’t be home to vote and have your ballot sent to an address far, far, from your polling station. Otherwise you’d better show up in person.

In North Carolina if you want to vote by absentee ballot you have to have it notarized or signed by 2 registered voters. WTF? But ok, say you want to vote in person but are disabled. How easy is that going to be? Depends on where you live.

In Tennessee we vote on computers that are one height fits all. So if you are in a wheelchair and can’t see that high, tough. If you don't have the use of your hands but can read a ballot and then tell someone who you want to vote for, too bad, no one can go in the booth with you to help. If you are nonverbal but have other ways to communicate? Sorry, there’s no ballot for you.

Who do you think cares? I know one group that does not give a fuck and that would be the Republican Party. It’s possible that they are delighted that large groups of people are prevented from voting, from registering to vote and from finding well paid jobs. I don’t know that for a fact but I do know that only the Democratic Party, the progressive side of it, is doing anything about making voter registration easier, accommodating disabled voters, or creating a living wage for folks without them having to work their asses (or in my case, arms) off.

That’s the party I’m voting for. I find my Democratic candidates by going to the website 90for90, started to honor Dr. Fergie Reid, an old black dude who was advocating for fair voting and equal rights for all back in the Jim Crow days. He’s still doing it too. I pick my candidates from the 90for90 Face Book page or website because these are the folks that support Voting for ALL. I’m convinced that’s the only thing that’s going to make the world a better place, make my life a little easier, and maybe even help me find a job that accommodates my disability and pays the mortgage.

It’s not just political candidates I find on 90for90 either. There are unions, organizations and business that I want to support because they support voting. This guy, Jeffrey Joseph is a 90for90 supporter, which would be enough right there for me to support him. I also totally relate to his view of the big job search. Life just shouldn’t be this hard and I think with progressive Democrats in charge of government at every level, life will get easier for ALL.

Do Republican Politicians Cause Cancer In The States They Run? Oh, Absolutely

Do you ever listen to crackpots like Trump, Carson, Fiorina, Cruz... ranting and raving, just lying their asses off, and wonder who the hell is stupid enough to listen to these people-- let alone vote for them? Or wonder who's stupid enough to sit and listen to Hate Talk Radio and Fox "News" all day, not as a lark but as a source of "information?" Take a look at this chart of the dozen most obese states-- the states where people, literally, eat themselves to death.

Most of the serious diseases that kill Americans or at lest debilitate their lives substantially-- diseases like cancer and diabetes-- are correlated with obesity, but being a conservative in 2015 means you probably don't believe that, the way conservatives didn't believe that smoking tobacco correlated to disease and cancer just a few decades ago. Those states have among the highest death rates from cancer of any states in America. And they drive up the costs of health care for the rest of us. States, from worst to least bad:

• Kentucky 201.2 deaths per 100,000 residents
• Mississippi 200.0
• West Virginia 191.1
• Louisiana 190.5
• Oklahoma 189.6
• Arkansas 188.6
• Tennessee 187.9
• Alabama 184.8
• Indiana 184.2
• South Carolina 179.0
• Texas 160.6
• North Dakota 150.7

Every one of these states is what you would call a "red state." They all voted overwhelmingly for Mitt Romney against Barack Obama in 2012, Oklahoma, for example, giving Obama only 33% of its vote, West Virginia 36%. And except for West Virginia, all of these obese states have very backward Republican governors. And except for Kentucky-- which has a split legislature-- all these states have gigantic Republican majorities in both houses of their state legislatures. None are friendly towards environmental laws nor towards any kind of consumer protection legislation and almost all of them have-- for sick ideological and political reasons-- refused to expand Medicaid to help their citizens afford health care.

By way of comparison, states where normal people live don't have these large cancer deaths to add to their woes, according to the CDC. California's rate is 151.0; Colorado's is 143.7; Connecticut's is 152.0; and Minnesota's is 155.6. Now factor in these charts below of the top 5 state's in each category and see what you come up with-- aside from a certainty that all of these states will keep electing conservative Republicans who will keep enacting policies that will kill them and their children at a much higher rate than normal states do. They serve the interests of what Bernie calls "the billionaire class," especially the most viciously predatory billionaires like the Koch brothers.

That all said, I want to share an article by Sam Stebbins and Tom Frohlich from USA Today with you that explains that although the cost of healthcare in the U.S.-- covering a wide range of areas, from medical practitioner salaries and costly medical procedures, to pharmaceutical products and hospital administration-- is the highest in the world, the outcomes are certainly not the best. They start with a simple fact: "countries spending the most on health care today allocate between 8.9% and 16.4% of their total gross domestic product (GDP) to health care costs... The United States spends about $8,713 per person on health care annually, by far the most of any country in the world. By contrast, many countries, including Turkey and India, spend less than $1,000 on health care per person annually."

All of the 10 countries on the list spend at least 8.9% of their total GDP on health care. The difference, however, between the No. 1 spender, the United States, and the No. 10 spender, Canada, is quite large. Canada spent 10.2% of its GDP on health care in 2013, which amounted to $4,351 per person, while the United States spent 16.4% of its GDP that year, amounting to $8,713 per person.

According to Francesca Colombo, head of the health division at the OECD, "Higher health sector prices explain much of the difference between the U.S. and other high-spending countries." She added that the health care system in the United States is also fragmented and overly complex, with a larger share of uninsured individuals than is common among developed countries. While every country on the list has near universal health care coverage, only 88.5% of Americans are insured. However, under the Affordable Care Act, the U.S. uninsured rate is on the decline.

People living in the countries with the highest health spending also tend to have better health outcomes. For example, of the 10 countries spending the most on health care, seven have a lower infant mortality rate than the OECD average. Similarly, all but two countries on the list have a higher life expectancy than the OECD average of 80.5 years.

However, the relationship between spending and outcomes, and what causes good health is far from straightforward. A number of behavioral and lifestyle factors have a major influence on health outcomes. Colombo explained that "factors outside the health sector," including nutrition, alcohol consumption, and smoking "are important determinants of health outcomes."

Though the United States spends far more on health care than any other nation, life expectancy of the average American is only 78.8 years, lower than the OECD average and the lowest among the top spending nations. Lifestyle choices in the country may be partially to blame. Slightly more than 35% of American adults are obese, a higher share than in any of the 43 countries the OECD reviewed...

1. United States

• Health expenditure per capita: $8,713
• Expenditure as a pct. of GDP: 16.4%
• Obesity rate: 35.3%
• Life expectancy: 78.8

While higher health care spending generally leads to better health outcomes, this is famously not the case in the United States. The country, which is one of the world's wealthiest, spends by far the most on health care. The United States spends around $8,700 per capita each year on health care, more than double the OECD average and well more than second place Switzerland.

Despite the high spending, Americans are not anywhere near the world's healthiest. More than 35% of Americans are obese, one of the highest rate in the world, and exceptionally high compared with other countries spending the most on health. The United States is also the only top 10 country for health spending where the life expectancy does not exceed 80 years. Also, perhaps as a consequence of poor economic and social factors as well as the inefficient spending, adverse health outcomes such as infant mortality have increased in the United States. While in 2000, the incidence of infant mortality in the United States was lower than the OECD average, today it is higher.

2. Switzerland

• Health expenditure per capita: $6,325
• Expenditure as a pct. of GDP: 11.1%
• Obesity rate: 10.3%
• Life expectancy: 82.9

With universal health care for every citizen, Switzerland spends more on health care per capita than every country except for the United States. Higher spending in Switzerland is accompanied by better health outcomes. The national obesity rate of 10.3% is one of the lowest worldwide. A relatively low obesity rate likely contributes to the Swiss' perception of their own health. Nearly 81% of Swiss adults report being in good or very good health, a higher share than in all but six of the countries reviewed.

With more than 17 nurses for every 1,000 citizens, no country in the world is home to a larger concentration of practicing nurses than Switzerland. Switzerland also has a relatively high doctor to patient ratio with about four practicing doctors for every 1,000 residents. With a low obesity rate and plenty of health care providers, people in Switzerland can expect to live to be about 83, a higher life expectancy than in all but two of the 43 countries examined by the OECD.

3. Norway

• Health expenditure per capita: $5,862
• Expenditure as a pct. of GDP: 8.9%
• Obesity rate: 10.0%
• Life expectancy: 81.8

As in a number of other European nations, health care is universal in Norway. Through an agreement with the European Union (EU), all EU citizens are covered by the system, and undocumented immigrants are permitted free emergency treatment only. Due largely to Norway's centralized medical system, $4,981 of the $5,862 total per capita annual health spending comes from public sources-- the highest public contribution of all OECD nations. The high health care spending in Norway means more health practitioners. There are approximately four doctors and 17 nurses per 1,000 Norwegians, the fourth and second highest concentrations among countries reviewed.

As in other prosperous nations, Norway has a relatively high incidence of cancer at 318 cases per 100,000 people each year. However, this is largely due to the long life expectancy. Norway has one of the longest life expectancies in the world, at 81.8 years. Despite the high incidence, Norwegian cancer patients have relatively high survival rates.

4. Netherlands

• Health expenditure per capita: $5,131
• Expenditure as a pct. of GDP: 11.1%
• Obesity rate: 11.1%
• Life expectancy: 81.4

Residents of the Netherlands, except for conscientious objectors and members of the military, are required to purchase health care by a government mandate implemented in 2006. Only around 1% of country residents do not have insurance. The country's health care expenditure, which at $5,131 per capita trails only three other OECD nations, amounts to 11.1% of GDP, the second largest share after the United States. While residents are required to purchase health insurance, the cost is mostly covered by the government. Out-of-pocket expenses account for just 5.2% of the overall cost, the lowest such share among countries reviewed by the OECD.

Like most other prosperous nations spending the most on health care, people in the Netherlands-- even the elderly-- have a relatively positive perception of their own health. Nearly 60% of country residents 65 and over believe they are in good health, considerably higher than the OECD average proportion of 43.4%.

5. Sweden

• Health expenditure per capita: $4,904
• Expenditure as a pct. of GDP: 11.0%
• Obesity rate: 11.7%
• Life expectancy: 82.0

OECD nations spend an average of $3,453 per capita on health care annually. Sweden spends roughly $1,500 more than the average, the fifth largest sum among OECD nations. In 1970, Swedish citizens had a life expectancy of about 75 years, longer than citizens of any other country at that time. Although life expectancy in the Scandinavian country has increased since then to 82 years, Sweden now has only the ninth longest life expectancy as life expectancy globally has been on the rise over the past several decades.

Despite universal health insurance coverage, Swedes visit the doctor relatively infrequently. With an average of 2.9 physician consultations per person per year, people in Sweden see a doctor less often than people in most other countries reviewed. More than 81% of Swedish citizens report being in good or very good health, a larger share than in all but five nations examined by the OECD. This may partially explain the infrequent doctor visits in Sweden.

6. Germany

• Health expenditure per capita: $4,819
• Expenditure as a pct. of GDP: 11.0%
• Obesity rate: 23.6%
• Life expectancy: 80.9

Older people typically require more medical attention than younger people, and more than a fifth of Germany’s population is 65 and older, the largest share in the world after Japan and Italy. Germany spent roughly 11% of its total GDP on health care in 2013, or $4,819 per capita, each higher than all but a handful of other countries.

Compared to the United States, Germans are very well insured. While slightly less than 89% of Americans are insured through both public and private avenues, nearly all Germans are insured on either public or private plans. The country’s universal health care system likely encourages preventative care visits. On average, a German resident consulted a physician roughly 10 times in 2013, more than double the consultation rate in the United States.

7. Denmark

• Health expenditure per capita: $4,553
• Expenditure as a pct. of GDP: 10.4%
• Obesity rate: 14.2%
• Life expectancy: 80.4

Denmark spent 8.4% of its GDP on health care in 1980, the most of any country that year. Since then, however, health care spending has increased in all OECD nations. So while Denmark’s spending increased to about 10.4% of its GDP, it now spends the seventh most on health care worldwide, both in dollars terms and as a share of GDP. While spending in the Scandinavian nation is near historic highs now, it will likely grow in the future as the population ages. The share of the country’s population 65 and older is projected to rise from about 18.3% in 2014 to nearly 23.8% by 2050.

Though Denmark is one of many OECD countries with universal health care, no nation’s government absorbs more of the cost. The Danish government covers about 84.3% of health care costs compared to an average of 36.9% of total health care costs across OECD nations.

8. Austria

• Health expenditure per capita: $4,553
• Expenditure as a pct. of GDP: 10.1%
• Obesity rate: 12.4%
• Life expectancy: 81.2

As in most countries spending the most on health care, nearly all of Austria’s 8.5 million citizens have health insurance. Though Austrian citizens have some unhealthy habits, health outcomes in the country are generally very good. While alcohol consumption in the Central European nation is the second highest among countries examined by the OECD, only 12.4% of adults in Austria identify as obese, a lower obesity rate than in all but 10 of the 43 countries the OECD reviewed. As was the case in all of the countries spending the most on health care, health expenditure and life expectancy has increased over the past several decades. Austria spent about 7% of GDP on health care in 1980. By 2013, health care spending had increased to 10.1% of GDP. Over the decades from 1970 to 2013, life expectancy increased by over 10 years from 70 to 81, a slightly faster improvement than the OECD average change.

9. Luxembourg

• Health expenditure per capita: $4,371
• Expenditure as a pct. of GDP: N/A
• Obesity rate: 22.7%
• Life expectancy: 81.9

In the small, affluent European nation of Luxembourg, health care spending per capita is among the highest in the world at $4,371. As is nearly always the case, the lion’s share of funding comes from the public sector. Just $762 of Luxembourg’s health expenditure comes from private sources. Luxembourg is quite wealthy. With GDP per capita of $91,048, country residents are the wealthiest in the world. From 2005 through 2013, Luxembourg’s economy contracted by 2.1%, however, unlike all other countries spending the most on health care.

Strong economic conditions and high health care spending help reduce health risk factors and improve medical treatments. Due in part to these improvements, the incidence of mortality from cerebrovascular diseases such as stroke in Luxembourg was reduced by roughly two-thirds since 1990. Only two other countries reported such a strong decline in mortality from cerebrovascular diseases.

10. Canada

• Health expenditure per capita: $4,351
• Expenditure as a pct. of GDP: 10.2%
• Obesity rate: 25.8%
• Life expectancy: 81.5

Canada’s annual health expenditure of $4,351 per capita is the 10th highest in the world. As a share of GDP, health care spending has increased steadily over the past several decades from 6.6% of total GDP in 1980 to 10.2% of GDP in 2013. This compares to an OECD average spending share of 8.9% of GDP. Increased spending in Canada has come with improved health outcomes. Average life expectancy in Canada went from 73 years in 1970 to nearly 82 years in 2013. This was not an especially large improvement compared to many other countries. However, like other wealthy countries, life expectancy in Canada has been among the highest for some time.

Canada is one of a majority of OECD countries with a universal health care system. Universal insurance coverage often increases accessibility to preventative care. As a result, Canadian citizens consult a physician roughly eight times annually on average, a higher consultation rate than in all but nine other countries. Frequent doctor visits may play a role in Canadians’ perception of their own health. Though the measure is somewhat subjective, about 89% of the country’s adults consider themselves to be in good or very good health, a higher share than anywhere else in the world except for New Zealand.

Iowa's Progressive Senate Candidate Tom Fiegen Endorses Bernie Sanders

On his website, Iowa Senate candidate Tom Fiegen explains that he supports Bernie Sanders "because he has demonstrated unconditional support for working people since he was mayor of Burlington, Vermont 34 years ago. He tells the truth." Feigen, who is running against somewhat doddering right-wing senator Chuck Grassley-- first elected, very narrowly, to Congress in 1974-- right after Nixon was driven from office (and just as the GOP was losing dozens of seats across the nation, including 2 in Iowa). Everyone, nationally, who was, like Grassley, first elected that day has either died or retired, including well-known politicians like Tom Harkin (D-IA), Chris Jim Jeffords (R-VT), Max Baucus (D-MT), Paul Tsongas (D-MA), Larry Pressler (R-SD), Henry Waxman (D-CA), George Miller (D-CA), Norman Mineta (D-CA), Henry Hyde (R-IL), Jim Oberstar (D-MN), Jim Florio (D-NJ), Abner Mikva (D-IL) and Paul Simon (D-IL)... except Grassley.

There are three Democrats running to replace him, state Sen. Rob Hogg, ex-state Sen. Tom Fiegen and ex-state Rep. Bob Krause. No Blue Dogs, New Dems or corporate whores in that trio. What drew our attention to Fiegen was his endorsement of Bernie Sanders and Bernie's platform and his commitment to run on those issues.

Fiegen shares similar stances with Senator Bernie Sanders, including repealing Citizens United.

“I want to fix the bribery of politicians in the guise of campaign contributions,” Mr. Fiegen said. “People throw around the reference to Citizens United, but the problem is much more systemic and ingrained than that.”

Mr. Fiegen cites an NPR story from 2012 about convicted lobbyist Jack Abramoff. In the piece, Mr. Abramoff explains how he donated $100,000 to Mr. Fiegen’s opponent, incumbent U.S. Senator Chuck Grassley, in exchange for allowing his client, Tyco International, to evade paying billions in taxes.

You can read Fiegen's whole endorsement statement here and you can contribute to his campaign here. I asked him to write a guest post on an issue most DWT readers are unaware of but that is of crucial concern to people in Iowa.

Water And Agricultural Poisons
by Thomas Fiegen

In farm country, we have a problem. A lot of us can’t drink the water because of the ag poisons in it, and more of us are dying of cancer caused by the same ag poisons.

Here in Iowa, 60 cities and towns have nitrate levels in their water supply too high to drink. The community of Des Moines, Iowa spends over $7,000 a day to remove nitrate from the source of its water, the Raccoon River. Plus it is looking at new filtration equipment which will cost north of $140 million to replace the current system. Two of the Top 10 cancers in Iowa in 2015, thyroid and ovarian cancer, are directly linked to high nitrate in our water.

In addition to nitrate, we also have a problem with all the weed spray that we are being doused with by a few of our chemically addicted farmers. At the top of the list is glyphosate aka Roundup™. According to a story in April of this year by National Geographic, Roundup was invented in 1974. By 1987, we were applying 11 million pounds of Roundup in this country. Last year, it was up to 300 million pounds. Roundup is now so pervasive in our environment that 75% of the rain collected by the U.S. Geological Survey now contains Roundup. The National Geographic also sampled soybeans in 300 randomly selected bins across the Corn Belt and 90% contained Roundup. In March of this year, the World Health Organization, after a review of over 900 studies, concluded that Roundup is a causal agent for non-Hodgkins lymphoma. In 2015, non-Hodgkins lymphoma is also one of the Top 10 cancers in Iowa.

The Iowa College of Public Health has kept extensive records on Iowa cancer deaths by type and county since 1973.  In 1975, before Roundup was in use, and before corn on corn on corn to supply corn ethanol, according to the Iowa College of Public Health, we had 5,320 cancer deaths in Iowa. This year, after 40 years of medical progress in treating cancer, we will have over 6,400 cancer deaths in Iowa. That is an additional 1,100 cancer deaths per year.  My home town of Clarence, Iowa is 1,100 people. That is like wiping out an extra entire town of Clarence every year. How many more family and friends are we willing to lose early to cancer so that a few farmers can poison themselves and all of us with ag poisons?

I have visited 86 of the 99 counties in Iowa so far this year. The farm wives and widows get it. One widow, a survivor of thyroid cancer, told me how her husband had flu-like symptoms whenever he sprayed weeds on their farm. She told me that she could smell the chemicals on his clothes when she washed them. She knew something was not right, but she did not put her finger on it. Her husband died of non-Hodgkins lymphoma. She has had multiple tumors since her initial battle with thyroid cancer. She told me that she now knows that the ag chemicals they used was the reason she is a widow and has cancer. I have heard story after story like the one from this widow as I travel around Iowa. When I was a young boy in school, all of our bus drivers were retired 75 - 80 year old farmers. In my community today, we do not have many 75 - 80 year old retired farmers. They have all died of cancer and their wives have retired to town as widows.

Here is how we can fix the problem. First, we ban bribes of Congress under the guise of political contributions aka Citizens United. For too long chemical companies have been able to “buy” favorable legislation and regulations. Next, we need to amend and enforce the Clean Water Act to limit non-point sources of poisons. The next Farm Bill should also include not only a mandatory conservation requirement to quality for any federal subsidy or payment, but also a mandatory water purity requirement for ag runoff. We also need to amend the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) to remove the blanket immunity for chemical manufacturers and applicators, and instead impose strict liability for damages to people and property caused by ag poisons. Finally, we need to teach our farmers good and sustainable management practices to reduce and ultimately end their reliance on ag chemicals to grow crops.

We know how to grow food without chemicals. We have done it for centuries. If we are going to reduce and end needless cancer deaths in rural America, and survive as a species on this planet, we need to go back to growing food sustainably with limited or no chemicals. 

Again, please consider helping Tom Fiegen replace Chuck Grassley as the Senator from Iowa, something you can do at this special ActBlue page dedicated to progressives running for Congress who have endorsed Bernie Sanders.

Update from Howie

by Ken

Howie hasn't authorized me to say anything, but on July 3 he did share this information about the current stage of his treatment for mantle-cell lymphoma (a rare form of lymphoma) with his Facebook fans:

I'm in the hospital getting stem cell transplants to keep the cancer in remission. I was feeling pretty low and fatigued all day. But I just put on "Friday Night" by Brutalism and, man, I'm alive, I'm alive!! I hope I don't scare the nurses.

Back then he was on (by my reckoning) Day 5 of eight consecutive days of chemo treatments in preparation for the transplant, but on the afternoon of July 7 he posted (and got, at last count, 186 comments):

Stem cell transplants starting right now. Prayers welcome

Invoking prayers doesn't sound like Howie to me, but then, this isn't your everyday medical procedure. Just to clarify, since he began treatment for the lymphoma, he's known: (a) that the stem-cell transplant lay ahead if the rest of the treatment went well (which it did), meaning that making it this far is an extremely hopeful sign, and (b) that the procedure wasn't going to be pleasant -- to put it as mildly as possible.

As regular readers know, despite the fierce toll taken by the side effects of the previous treatments (though once they were completed, he got a measure of relief from them, as he has written, when he finally threw medical marijuana at them), his doctor kept assuring him that in terms of fighting the lymphoma, his was one of the most successful cases she's had.

Going into this round of treatment, he's had every expectation that its effects would dwarf everything that came before -- and while he's undergoing treatment he's without benefit of the medical marijuana. It appears that those expectations have been realized. However, even as he rattled off the horrors he's experiencing (Friday he wrote, "I know I haven't reached bottom yet but I'm headed there"), he says his doctor "still insists I'm in the top 1% of responses!" As you've noticed, through it all he has continued blogging (and keeping up with his blogworld contacts) and tweeting.

He's had a lot of faith in his doctor (she's a specialist in mantle cell, of which there aren't a lot), and thus far she's gotten him into remission. As he noted in his Facebook post, keeping him in remission is what the transplant is about, and the process clearly isn't for the squeamish. But at the other end, the doctor has given him reason to believe in an excellent outcome.

#

Primum Non Nocere

Over the last month or so, I've been doing a little blogging about the experience of going through chemotherapy. My doctor says the treatments have been working and I have just one more cycle of chemo before the stem cell transplants. So my doctor's very happy and I know I should be happy too. But what I'm dealing with on a day to day basis is different from what she's addressing. She's battling the cancer itself. I'm facing the side effects of the treatments. My world is a world of unrelenting pain and anguish. The side effects, as I've written about before, are a universe unto themselves.

When my doctor decided to add a drug called bortezomib (velcade) to the chemo cocktail, she told me there was a 3% chance I could wind up with nerve damage (peripheral neuropathy). 3%... good odds. I mean that's like 97% chance you won't get neuropathy. But I was one of the 3%-- and the neuropathy is far more horrible than I could have ever imagined reading about it. A good friend of mine just happens to be a specialist in neuropathy. He's written the scholarly papers about it that other doctors read. And he's been advising me. His advice doesn't make me very hopeful. The most commonly used commercial drugs that are used to treat it have poor track records. Each of them has about an equal chance to lessen the pain by 50% as it does to make the condition significantly worse. Those are bad odds. Other drugs haven't been studied thoroughly enough, primarily because it isn't profitable for Big Pharma. Yesterday he sent me a NYTimes article by Austin Frakt and Aaron Carroll, If Patients Only Knew How Often Treatments Could Harm Them. It's certainly a lesson this patient has been learning-- and fast.

If we knew more, would we opt for different kinds and amounts of health care? Despite the existence of metrics to help patients appreciate benefits and harms, a new systematic review suggests that our expectations are not consistent with the facts. Most patients overestimate the benefits of medical treatments, and underestimate the harms; because of that, they use more care.

The study, published in JAMA Internal Medicine and written by Tammy Hoffmann and Chris Del Mar, is the first to systematically review the literature on the accuracy of patients’ expectations of benefits and harms of treatment. They examined over 30 studies that assessed whether patients understood the upsides or downsides of certain treatments. To a great extent, patients didn’t.

In the 34 studies that assessed understanding of benefits, patients overestimated their potential gain in 22 of them, or 65 percent. For instance, a 2002 study published in the Journal of the National Cancer Institute asked women who had undergone prophylactic bilateral (double) mastectomy to estimate how much the procedure reduced their risk of breast cancer. On average, the women thought they had reduced that risk from 76 percent to 11 percent, an absolute risk reduction of 65 percentage points.

For the more than 80 percent of the women in the study who did not have a BRCA genetic mutation-- which drastically increases the risk of breast cancer-- the real risk before surgery of developing breast cancer was 17 percent, meaning they greatly overestimated their risk reduction. Even the women with a BRCA mutation overestimated their risk reduction, but to a lesser extent.

Another 2012 study published in the Annals of Family Medicine asked patients to estimate the benefits of screening for bowel and breast cancer, and the use of medications to prevent hip fracture and cardiovascular disease. More than two-thirds of patients overestimated the benefits of medications to prevent cardiovascular disease, and more than 80 percent overestimated the benefits of medications to prevent hip fractures.

Further, 90 percent of patients overestimated the benefits of breast cancer screening, and 94 percent overestimated the benefits of bowel cancer screening. The researchers also asked the patients to estimate the minimum reduction in bad outcomes (like fractures or deaths) they would need to achieve to find the treatment worthwhile. For three of the four studied interventions, the minimum benefit patients would accept was higher than the actual benefit.

In the 15 studies examined in the systematic review for which harms were a focus, patients underestimated potential downsides in 10 of them (67 percent). For example, a study published in 2012 in the Journal of Medical Imaging and Radiation Oncology asked patients to estimate the risks associated with a CT scan. A single CT scan exposes a patient to the same amount of radiation as 300 chest X-rays, and carries with it a 1-in-2,000 chance of inducing a fatal cancer. More than 40 percent of patients underestimated a CT’s radiation dose, and more than 60 percent of patients underestimated the risk of cancer from a CT scan.

Why do patients err in assessments of risks and benefits? One reason could be that what they know is driven by the messages they hear. Doctors, direct-to-consumer ads and the media can skew our perceptions. They tend to focus on the benefits, but rarely quantify them. Health care centers, screening advocacy programs and pharmaceutical ads all push us to talk to our doctors about getting treatment without talking about actual gains.

Doctors also aren’t always good at communicating risks. A 2013 study published in JAMA Internal Medicine found that fewer than 10 percent of patients were told about overdiagnosis and overtreatment associated with cancer screening, even though 80 percent of patients wanted to know about harms.

This study, and others, indicate that patients would opt for less care if they had more information about what they may gain or risk with treatment. Shared decision-making in which there is an open patient-physician dialogue about benefits and harms, often augmented with use of treatment decision aids, like videos, would help patients get that information. However, a majority of patients still report that they prefer to leave medical decision-making to their doctors.

It might also be the case that some patients would use more of certain types of care if they had more information. Many chronic conditions remain undermanaged and undertreated in the United States. It’s possible that people with these conditions who had more information would use more care, which could raise spending for these patients but make them better off.

There’s also an argument to be made that people who overestimate the benefits of medicine to treat some conditions are more likely to take it regularly, which might lead to better outcomes, in some cases, than would occur if these patients were better informed.

Regardless, even though some patients may benefit somewhat from being ill informed, it seems wrong to argue that we should keep them in the dark. Many of the studies in the systematic review show that people report that they would opt for less care if they better understood benefits and harms. Improved communication could better serve patients and might improve the efficiency of our health system if patients focus on getting the types of care for which the benefit outweighs risk of harm.

It’s also possible that unrealistic expectations of care help patients cope with disease or provide them with some sense of control. Feeling hopeful about one’s future is not to be dismissed. But those unrealistic expectations don’t come cheap. We should at least consider the price that we pay for being uninformed.

Ready For The Chemotherapy Side Effects?

I went to college in the middle sixties. My friends and I marked the passage of time in many ways and one involved the release of new albums by our favorite bands-- the Beatles, Stones, Pink Floyd, Who, Airplane, Big Brother, Dead, etc. When we got wind that a new Stones album, for example, was coming down the pike, some of us would shop around for the finest LSD to commemorate the event. When Between the Buttons came out in February 1967, many of us had heard it already because the U.K. company had released it a month early in the hope of stacking up some heavy import sales from America. The American company had a smart defense: two tracks that weren't included on the British release... and big ones: "Let's Spend the Night Together" and "Ruby Tuesday."

By 1967 Dean Tilley had already kicked me off the campus as a danger to other students and I was living in a house in lovely Setauket. I came to consciousness after a full night of non-stop Between the Buttons listening in a tree next to my bedroom where the turntable was set to play side one over and over. Satisfying experience! I climbed down from the tree, got in my car, drove to the campus barber shop and had my head shaved. Hippies didn't do that then. But my girlfriend, Chris, was a model and she kept her head shaved for wigs and I loved how her head felt so... what the hey.

Since then, I've grown my hair and beard out from time to time and I've kept them close-cropped as well. I don't spend much time looking in the mirror and don't obsess over how I look. When I was diagnosed with mantle cell lymphoma and decided to treat it with chemotherapy, I didn't think a lot about the side effects of the treatment. I knew-- intellectually-- they could be brutal. "Could be" often means "but probably not for me." Roland, my best friend and primary caretaker and guide through this mess, seemed most concerned that my hair would fall out. He lives in dread of cancer because of his own hair. Roland takes good care of his appearance and looks fit and at least a decade younger than he is. Losing his hair is as unthinkable for him as it is uninteresting for me. No one who sees me knows if my hair is out because of the chemo or because I shaved it. I don't know either.

But there are other side effects-- and that's the chemo. My doctor's primary concern, of course, is using the chemo to kick the butt of the cancer. She says it's working-- and working very well. The day-to-day confrontation with the side effects, on the other hand... well, that's primarily my problem, the bane of my day-to-day. And it's not hair loss.




I don't want to turn this post into a pity session about the pain and anguish of chemo side effects. It's worse than anything I ever read, but I didn't read as deeply as I probably should have. Maybe if I knew in advance what was waiting for me-- as though there is any way to know; there isn't-- I would have chosen to try curing the cancer holistically with a naturopath. Too late now. I just want to bring up one side effect: neuropathy, a nerve disease related to one of the most virulent of the chemo drugs they were giving me: Velcade (bortezomib). As usual, the explanation starts with "every person’s experience with peripheral neuropathy can be as unique as the individual." So nothing definitive. My doctor told me that only 10% of the patients who mainline the velcade get neuropathy and only 3% of the people who get a fatty tissue injection get it-- and that I would be getting the fatty tissue injections. So a 97% chance of no neuropathy. Today neuropathy consumes my life, and I've learned it sometimes lasts forever and never goes away. Below are some of the symptoms, but keep in mind that they are happening simultaneously with other unrelated side effects-- like the pain from my broken ribs and the debilitating constipation and inability to eat as well as other recurring horrors.

At first, you may notice numbness, tingling, abnormal sensations, or pain in your feet.  Some people feel like they have socks on, even though they are barefoot. Over time, this feeling spreads to your legs and hands.

You may find it harder and harder to walk. Your legs feel heavy. You have to drag yourself up the stairs. You find yourself losing your balance, not being exactly sure where your feet are; so, you stumble into things or fall. To keep your balance, you are likely to widen your way of walking, and your walking becomes less rhythmic or fluid.

As for your hands, you think you have a good grip on something, like your keys, but they drop right out of your hands. In the worst cases, you can end up in a wheelchair. Some neuropathies can be fatal.

Peripheral neuropathy symptoms and signs can vary in how they begin. Some neuropathies come on suddenly; others gradually over many years. There are three types of peripheral nerves affected, and symptoms depend on these nerves and their location:

1 Sensory Nerves: affect sensation
2 Autonomic Nerves: affect internal organ functions; and,
3 Motor Nerves: affect muscles.

Many types of peripheral neuropathy affect all three types of nerves to various degrees, but some affect only one or two.

Here are some peripheral neuropathy symptoms and warning signs as described by patients:

Weakness in the Arms or Legs

Legs: Usually caused by damage to the motor nerves, leg symptoms often include difficulty walking or running; a feeling of "heaviness" in your legs; finding it takes a lot of effort just to climb the stairs; stumbling or tiring easily. Muscle cramps may be common.

Arms: In the arms, you may find it difficult to carry groceries, open jars, turn door knobs or take care of your personal grooming. A common frustration is dropping things.

Numbness, Tingling and Pain

Sensory nerves, when damaged, can cause various symptoms. Early on, there may be spontaneous sensations, called paresthesias, which include numbness, tingling, pinching, sharp, deep stabs, electric shocks, or buzzing. These sensations are usually worse at night, and sometimes become painful and severe.

You may also experience unpleasant abnormal sensations when you touch something, sensations called dysesthesias because they are caused by stimuli.

Or, you may find yourself feeling nothing at all, in this case experiencing anesthesia, a lessening or absence of sensation.

Impaired Sense of Position

When you lose the ability to “sense” or feel your feet, you may find yourself being uncoordinated because when you walk because you are not sure about the placement of your feet. Patients may find themselves walking differently without really knowing how or why they are doing so. Chances are they have either widened their style of walking (in an unconscious effort to keep their balance) or they may be dragging their feet.

“Glove and Stocking Sensation”

This phrase describes what doctors call a patient’s odd feeling of wearing stockings or gloves or slippers when, in fact, the patient’s hands and feet are completely bare.

Symptoms of Autonomic Damage

When it occurs, autonomic nerve damage can potentially cause: a drop in blood pressure and, consequently, dizziness when standing up; intestinal difficulties such as constipation or diarrhea; sexual dysfunction; thinning of the skin (with susceptibility to bruising and poor healing), and other symptoms.

And you may-- or may not-- live an extra 12-15 years into your 70s or 80s. Worth it? Let me mention Medicare Part D, Republican health care. Three doctors prescribed a lidocaine patch for me to help control the pain and to help ween me off the horrors of hillbilly heroin (Oxycontin), the drug Republican health care prefers to push to Americans since it prevents clear thinking. Humana is my Medicare insurance career. They refused to honor the prescriptions and wasted hours and hours of my time and my doctors' time making excuses for why they were refusing to cover the lidocaine patches, even though they are proven to work and Oxy is proven to work much less well.

Medicare is one of the most wonderful things America offers us as a people. Medicare Part D-- which was pushed through by Bush and the GOP and opposed by Democrats-- is an anti-patient system that is geared to fatten the bottom line of the big pharmaceutical companies that contribute so much to political campaigns. Since 1990, Big Pharma has given Republican congressional candidates $94,240,165 and given Democratic congressional candidates $70,327,235. Because of the connection, patients suffer and die. One day the Republican Party would like to turn all of Medicare into this type of a system. How ironic is it that the elderly are the ones they trick into voting for them?

One of my doctors said I shouldn't have used so much acid in the '60s

Good News On The Cancer Front

Some good news: last week I was back at City of Hope for tests after the interruption in my treatment caused by the broken ribs. Of course my oncologist is concerned about all the chemo side effects-- from the fainting that led to the broken ribs to the more mundane effects that plague patients in treatment, like constipation, weakness and fatigue, loss of appetite, neuropathy, etc. But her main task is the underlying disease-- the cancer. And that's where the good news comes in. Last night she e-mailed me-- I'm seeing her in person Tuesday-- that the tests last week showed continued improvement. I don't know how I'd have the strength to bear the side effects of the chemo if I didn't know it was working.

There's also some good news on the cancer front that isn't just about me personally. Over the weekend, writing for ThinkProgress Health, Sam Collins reported about Obama's ambitious plans to tackle cancer-- with Republican cooperation. Have you heard about precision medicine, an evolving type of medical research that tailors cancer treatment to the genetic makeup of a patient’s tumor? Obama referred to it in his State of the Union address, saying it will help "lead the United States into a new era of medicine” and he's announced a $215 million project that would help oncologists and researchers move away from the one-size-fits-all model of cancer treatment that all too often isn't the best we can do for patients.

Proponents of President Obama’s plan say that doctors can better predict a patient’s likelihood of developing cancer with a wealth of information at their disposal. Under the medical model of precision medicine, medical professionals conduct diagnostic testing on cancer patients and select therapy that’s closely tailored on their genetic content or a complex molecular analysis rather than the type of cancer. Tools used in precision medicine often include molecular diagnostics, imaging, and analytics software that deciphers the genetic sequence of ailments by drawing on a database of information from individuals with similar biomarkers.

So far, a handful of Republican lawmakers, including Sen. Lamar Alexander (TN) and Fred Upton (MI), have indicated their support for President Obama’s plan. Scholars at the conservative American Enterprise Institute have also expressed cautious optimism. The potential bipartisan initiative represents a rare example of collaboration across the political aisle-- a deviation from the gridlock Americans have seen when it comes to other issues like the federal budget, immigration, and abortion.

If approved by Congress, this multi-million dollar investment will be used to coordinate efforts between the National Institutes of Health, FDA, and the Office of the National Coordinator for Health Information Technology (ONC) to develop a voluntary national research group that will help researchers foster an understanding of cancers and ultimately create effective approaches to treatment. The funds will also help the ONC secure exchange of data across systems and allow the FDA to develop a regulatory structure that protects public health.

In addition to GOP politicians, the proposal also has some support among major players in the medical research industry.

“We commend the administration’s commitment to advancing the field of precision, or personalized, medicine,” John J. Catellani, president and CEO of Pharmaceutical Research and Manufacturers of America (PhRMA), wrote in a statement to ThinkProgress, in which he explained that between 12 to 50 percent of all compounds currently researched in the industry have the potential to be personalized medicines.

“The biopharmaceutical research sector is strongly committed to researching and developing personalized medicines, and ensuring patients can gain timely access to them. Recent advances in diseases such as cancer and cystic fibrosis are delivering on the promise of targeted treatments. These advances hold great promise in improving patient outcomes and controlling costs by targeting the right medicines to the right patients,” Catellani wrote.

The advancements that Castellani mentioned have ripened the opportunity for researchers across the country to collect the genetic sequences of cancerous cells and expand patients’ access to cutting edge technology that will help them get to the bottom of what’s causing their ailment. At Wake Forest Baptist Medical Center in Winston-Salem, N.C., for example, those who are covered by the state insurance plan MedCost can get their cancer diagnosed and undergo therapy that’s targeted to the genetic makeup of their tumor free of charge.

Dr. Boris Pasche, the director of the comprehensive cancer center at Wake Forest Baptist, told ThinkProgress that this type of research could increase the knowledge needed to effectively carry out the President Obama’s precision medicine initiative.

“Right now, we don’t have that centralized structure to put all that genetic data under one roof,” Pasche said. “First, we’ll use local storage facilities and cloud-based storage to put this together. For just one patient’s tumor, you’re talking about 650 gigabytes. We have to be thorough. If we have drugs that attack this Achilles heel effectively, we need to use them.”

Seems like common sense? Alas, common sense rarely comes into play around the healthcare systems and even personal healthcare decisions. A few days ago, the same Sam Collins did a piece on how preventable most cancers are. Perhaps as few as 20% of cancers are outside of human control and are all about genetics and family history.

Cancer-- which counts as the second leading cause of death worldwide-- often involves abnormal cell growth that spreads throughout the body, eventually crippling and killing the afflicted. While death rates have been on the decline in recent decades, it still poses a significant threat among smokers, the obese, and those with poor diets. Making matters worse, the number of Americans who know about the benefits of diets high in fruits and vegetables have declined by 10 percentage points since 2009. And more than half of Americans remain unaware about the link between alcohol and cancer.

On another level on the banishment of commonsense, let me end this with another personal travail. The doctor who was treating me for the broken ribs prescribed Oxy, which I hate. It clouds my mind, worsens the constipation, makes me feel like crap and doesn't even work that well in controlling the pain. A DWT reader suggested I try lidocaine patches, which she used when she broken her own ribs a few years ago. They are targeted just to the ribs and don't impact the mind at all. I asked my regular doctor to prescribe them for me and he did. As I've mentioned before, I'm a huge fan of Medicare, which is absolutely-- and quite literally-- life-saving. The one part of Medicare that sucks, though, is Republican healthcare: Medicare Part D, an anti-patient rip-off that is all about Big Pharma's profit margins. They turned down the lidocaine patches. Why? Who knows. Oxy is addictive and the lidocaine patches aren't so commonsense would indicate they would want to help patients keep away from the Hillbilly Heroin. But... helping patients doesn't usually go into the calculations around Republican healthcare.

Cancer Diaries III

When I checked out of Glendale Memorial Hospital, they set me up with a home care nursing service. A physical therapist comes twice a week and a nurse comes twice a week. My first impression was that it was, at least partially, a Medicare scam. However, the physical therapist is helping me rebuild muscle and regain my balance after two weeks of basically laying on a hospital bed, so I'm finding some real value there. I suppose I was put off when the first representative of the company came by and asked me to sign a bunch of papers without telling me what they were offering. In fact, he seemed offended that I would even ask. His only response to my questions about what they do was that Medicare was paying. I threw him out of my house. But they sent someone else-- someone better equipped to talk to someone for whom that isn't enough of an answer.

When it was time to think about having a nurse come to my house, a lot went through my mind. First and foremost, of course, was the experience I've had of the role nurses play in health care. The doctors map out a strategy but the nurses are primarily responsible for carrying it out. They are on the front line and the nurse is the one you deal with all day. Although these percentages are not really meant to be scientific, I found that about a third of the nurses I dealt with at Glendale to be absolutely beneficial to my well-being. There aren't words to convey my admiration for their dedication, patience and diligence. They made my experience of the hospital bearable and contributed significantly to whatever progress towards regaining my health I made. Another third, I found, were just doing their jobs. They might not have been incredible or life-saving but they were there and they didn't make things worse. Another third did make things worse. I didn't run across an angel of death but I did run into nurses who certainly weren't buying into the premise of hospitals being patient-centric.

I don't want to get into anything too graphic or hard to stomach, but I recall being desperate for a towel one day early on when I could barely breath, let alone talk. I begged the nurse for a towel. She insisted on having a debate with me about why I needed it. I nearly melted down.

One of the things about my two weeks in the hospital that I found so difficult was the sense of dependency. You are hooked up to machines and you can't get out of bed unless someone comes over and unhooks you. You need to go to the bathroom? You press a button on the side of the bed that alerts the nurses' station. The idea is that a nurse or an aide comes. Sometimes they do... sometimes it took over half an hour, sometimes considerably longer. One nurse who cared for me several times, Mary Grace, seems like a very dedicated person. She appears to be 100% focused on her patients and making their lives as bearable as possible in every way she can. I hope everyone I know, if they ever need a nurse, gets someone just like Mary Grace. I noticed that when she was my nurse, I never waited 30 minutes or 45 minutes. She came or she sent someone right away. Others... I got the idea that they had their own lives to lead and had their own worries and tribulations and that the problems a patient might be having were just somewhere on a priorities list, sometimes not very high on it.

More than one sympathetic staffer warned me that if I wanted to regain my health I should get out of the hospital as fast as possible. At the time, those suggestions seemed not just reasonable but they made perfect sense to me. A rather strange doctor inserted himself into my treatment inappropriately and insisted I start using two drugs I had never heard of. I ran his ideas past my oncologist who, though she's a pretty unflappable person, flipped out and told me not under ANY circumstances. When I told the doctor, he decided his best approach would be brutal manipulation... so he told me if I didn't do what he told me to, I could die. I was mortified to be treated that way and reported him immediately. Another doctor just shook his head sadly and said, "He means well..." He repeated it twice. The implication was that the doctor wasn't competent. Weak, debilitated and vulnerable, this is no way a patient expects to be dealt with by a doctor in a hospital. It helped me make up my mind that I had to get out of there as quickly as I could. I know these for-profit hospitals make their money based on procedures they can bill Medicare and insurance but this was absurd... and abusive.

I'm back under the care of my own doctor and her team now-- and her carefully laid out plan to get me healthy. I'm going to put this little series of posts aside for a few days, think more about it and start up again as I'm better able to focus.

Cancer Diaries-- Diagnosis

Yeah, its a big shock when your doctor first tells you that your diagnosis is cancer. BIG SHOCK. But I suspect that for most people-- certainly for myself-- it only happens once-- the shock, not the diagnosis. The second time you're diagnosed with cancer, the shock-- and the fear-- aren't as palpable, earthshaking and profound. I was diagnosed with prostate cancer around a decade ago, eventually chose to work with a doctor who treated it holistically rather than with traditional western medicine, and I've been in pretty good health since.

Actually, I haven't been in pretty good health since. I had a bunch of weird and disparate symptoms, unrelated to prostate cancer, that half a dozen "top" doctors were unable to diagnose for several years. I don't know if it's an unwillingness or an inability to listen but I found over the last few years that a series of male doctors pretty much ignored the specifics of my complaints. They were action-oriented and just wanted to treat whatever symptoms were apparent without even making a pretense of understanding why the alarm bells were ringing. This even included doctors at one of the country's highest-rated research hospitals. One told me he didn't have time listen to my whole story and that I should shut up and let him treat me. He treated me for the wrong thing, of course, and never got around to discovering the Mantle Cell Lymphoma that was growing inside me.

Now, Mantle Cell Lymphoma is a pretty rare disease. It wasn't "discovered" 'til the '80s and it wasn't named until the '90s and there are only around 5,000 diagnoses of it annually. But there has been tremendous progress in treating it and I suspect if doctors paid more attention to their patients' descriptions they would find a lot more cases, and a lot more quickly, than they do.

My family doctor, who had never heard of Mantle Cell Lymphoma when he called to tell me the test results showing I had it, suggested I go see two top specialists, one at Cedars-Sinai and one at City of Hope. And I did. And both seemed like excellent doctors who I felt I could trust with my care. But what do I know? The doctor at Cedars is an older man who was very reassuring that the disease was very treatable and that the course of treatment would be pretty easy and relatively non-invasive. The doctor at City of Hope is a woman and younger, although she's an expert in this particular lymphoma. She wasn't as reassuring that it would all be easy-peasy and her plan of treatment was a lot more difficult and painful than the one the doctor at Cedars was recommending. I didn't know how difficult and painful at the time, but I could sense that if I chose her, it wasn't going to be a walk in the park. I consulted friends in the medical field. Almost everyone thought I should get my treatment at City of Hope. And that's what I'm doing. As I explained yesterday, I started treatment late in October.

Here are some of the considerations that went into the decision to pick City of Hope. It wasn't just that the doctor there is a woman and the one at Cedars is a man. And if I was a bird and flew from my house to the two hospitals, Cedars would be much closer. But I'm not a bird, and I have to drive for treatment several times a week. Cedars is in Beverly Hills, practically right next door. Traffic is nightmarish, though, and it takes at least 45 minutes to get there from my house. City of Hope is in Duarte. People in L.A. might as well hear you telling them you're going to Omaha for treatment. It "seems" far off in the desert. Actually, there is NO traffic and it takes between 20 and 22 minutes to drive from my driveway to a convenient, free parking spot at City of Hope. Parking at Cedars is an entirely separate nightmare that must be contended with-- at a time when you want as little extraneous stuff to contend with as possible.

Starting with the lady at the parking kiosk, everyone at City of Hope seemed geared up towards one thing and one thing only-- making life easier and better for the patient. Like many of us, I've been hospital-adverse my whole life and my experiences at hospitals haven't been positive. They seem cold, bureaucratic, unfriendly and anything but patient-centric. City of Hope immediately intrigued me. It was very different from any other hospital I had ever visited.

City of Hope treats cancer, not infectious diseases. I've always feared going to the hospital for one thing and "catching" something and dying from that. Last week when I was in an ER cubicle in Glendale Memorial for broken ribs and a punctured lung, the guy in the next space had an infectious disease. I said something to the staffer who was treating me and he told me not to worry because there was a curtain between us (more or less). That didn't reassure me.

I soon started tuning into something else that I had never really been aware of: hospital protocols. Both Cedars and City of Hope are famous for extremely strict, solid protocols. Doctors and nurses suit up when they treat you. The standards for hygiene are daunting. Say you're about to get a drug administered to you by a nurse. Before that happens, another nurse comes to the room and checks that this is the order your doctor sent to the pharmacy and that this is the drug that the pharmacy sent to you, and then that you are actually you and not some hapless imposter. After nurse #2 ascertains all this, nurse #1 comes back in the room and administers the drug. I feel safer that no one's going to leave a saw in me.

The protocols at Glendale Memorial were considerably more lax-- at least in practice. The hospital didn't seem nearly as obsessed about hygiene, which wasn't comforting. And when the doctor put me into reverse isolation-- fear of pneumonia because of very low white blood cell levels-- some of the staffers outright refused to put on masks. One, who was wheeling me around on a gurney, was angry when I asked him to put on a mask and he kept coughing at me. Another, a tech from radiology, got angry at me and insisted there was nothing wrong with her. This isn't the kind of basic thing a patient should be forced to deal with.

The next thing I want to talk about is the nurses. I'll try to tackle that next time.