Prose To Go

If you're a veteran with low-risk prostate cancer, you can't get treated at the VA hospital in Philadelphia. That's because the program was suspended last year after Dr. Gary D. Kao botched radiation treatment at the hospital, operating with virtually no outside scrutiny. He blew 92 of 116 cancer treatments for over six years and kept it quiet, according to a New York Times investigation.

The surgeon spoiled a prostate cancer patient's radiation-seed implant by placing them in his bladder. Under federal rules, regulators checked into the error, but Kao merely rewrote his surgical plan to show he'd implanted 40 seeds in the prostate. The patient had to undergo a second procedure but Kao failed again, embedding seeds into the rectum. Kao again rewrote the surgical plan and regulators didn't complain.

No one knows for sure if the failures caused any deaths.

Every accredited hospital has peer review, or colleagues examining each other's work; this didn't happen at the Philly hospital. Three regulatory agencies, including the Joint Commission that accredits hospitals and the Nuclear Regulatory Commission, which regulates the use of all nuclear materials, did not intercede.

Veterans officials said that Kao no longer works at the Philadelphia hospital and would not return. They also admitted they had failed to supervise the unit.

"I’m not easily shaken,” said Dr. Leon S. Malmud, chairman of a nuclear commission advisory committee, in May. “But this is a very anxiety-provoking story."

If that unit were at a university, the feds would have suspended the program while conducting an investigation. In May 1999, the government temporarily shut down federally funded research on humans at Duke University Medical Center, one of the nation's largest and most prestigious medical research institutions, after investigators decided that Duke could not guarantee their safety.

The Duke federal license suspension to conduct human research was probably the largest ever in terms of the number of studies, people affected and the dollars at stake. Back then, Duke received about $175 million a year from the federal government for medical research.

Earlier in 1999, problems emerged at the Los Angeles VA Hospital, sparking concern that federal protections for human research subjects were inadequate or poorly enforced.

Each university performing research has an Institutional Review Board. The board reviews all proposed human research to ensure it's scientifically and ethically suitable and meets all federal regulations.

Investigators found that Duke's board wasn't keeping enough written documents, explaining how it decided to allow studies to continue.

Perhaps the feds have too many agencies overseeing this vital research. The government should devise a streamlined system, possibly based at the National Institutes of Health or the Centers for Disease Control, to regulate all research institutions. Otherwise, mistakes will continue and critically ill people can't benefit from the latest treatments.

A new American Cancer Society study debunks the myth that rural people don't get tested for cancer as early as their urban counterparts. African Americans, however, still have a greater chance of being diagnosed with a later-stage cancer.

The first part is no surprise, really. Cities are filled with pollution. If you're a smoker, you might as well concede that sooner or later you'll be dealing with cancer, heart disease or emphysema. Secondhand smokers are probably at higher risk in a city, too.

In a small town, you're more likely to know your neighbors and a doctor who can refer you for testing. Many people in small towns still live near or with their extended families who will look out for each other.

 The intriguing question is why aren't African Americans getting tested sooner? Obviously, if they are poor, they are less likely go to a doctor for regular check-ups.

Another ACS study found that while white women get breast cancer more often, black women are more likely to have it before they're 40. They are also less likely to survive it. While 90 percent of white women survive at least five years after diagnosis, blacks have a 77 percent rate.

The difference is mainly attributed to early detection. 

African Americans face several barriers to health care, including inadequate access, lack of health information and misconceptions about screening.

Some Emory University researchers initiated a public awareness campaign in Atlanta. Trained advocates visited churches, workplaces and health fairs to discuss misconceptions about breast cancer screening and encourage regular mammograms. Cancer survivors helped people diagnosed with breast cancer get treatment, assisting them with financial needs and support services. Most important, the survivors encourage women to keep their doctors' appointments.

The model could be duplicated in any major city, researchers say. Why wait for the program to come to you?

Why not spread the word at your church or office? When you get a mammogram, let your coworkers know and ask if they've had one. You could make an appointment together. Some women even make an afternoon of it, renting a limo and going for drinks afterward. It only takes 3 minutes to get tested.

That 3 minutes is miniscule compared to how many months or years might be cut from your life if you don't get tested. Think about it.

You might have watched him on "Oprah" June 9. Grant Achatz is the revolutionary chef who spent three years trying to get his tongue cancer diagnosed.

He went to dentists and at least one doctor who told him not to worry about it. It was a sore that didn't heal and the pain was excruciating. For three years, he listened to the experts tell him it was nothing. Finally, he saw an oral surgeon who did a biopsy.

Stage 4 tongue cancer. In six months, without the radical removal of his tongue, mandible and part of his neck tissue, he'd be dead, experts said. Good Lord.

We're talking about a Chicago man recognized as one of our best chefs. Last year, Kim Cattrall announced that he won the James Beard Foundation's Outstanding Chef award, arguably the biggie for chefs.

Not only was he lucky to be alive and still tasting his creations, he'd won this fantastic award. He and his Alinea restaurant partner Nick Kokonos have baked a book proposal, Life, on the Line. I'm sure that's only the working title.

Since I was diagnosed with an earlier-stage tongue cancer at 27, I'd give anything to ghostwrite that book.

After his diagnosis, Achatz searched the medical community for an oncologist who would do chemo and radiation before removing his livelihood. On his fifth try and running out of time, he found that specialist at the University of Chicago.

His book will carry a take-home message for us all. Fight for your survival. Don't accept the usual recommended surgery if it can provide future survivors with an alternative. Never give up on what's most important for your mental and physical health. 

Hannah Powell-Auslam has had a single mastectomy and is undergoing chemotherapy. About 180,000 women this year will learn that they have the disease.

Hannah is only 10 years old. Her chances of contracting breast cancer were a little better than winning the California lottery: one in 1 million. She is one of only a few hundred children ever diagnosed with it.

Her family, who shaved their heads in solidarity, says that she is coping courageously. Like most children with cancer, Hannah has a positive attitude and isn't languishing in the pity pool.

Now the girl from Fullerton, Calif., is part of the Cancer Club, the one that everyone dreads. Most of us wouldn't wish cancer on her worst enemy, much less an innocent child.

Who knows why God chose Hannah to deal with the fatigue and pain that comes with chemo? Her parents would probably rather have the disease themselves than watch their daughter endure it.

Meanwhile, Hannah will emerge as a stronger person, one of about 11 million cancer survivors. When she is cured, she can thank God that she is young and resilient and gave it 110 percent.  

Doctors emphasize that parents should not insist upon breast self-exams and mammograms for pre-teens. There's no take-home lesson here.

It should make young girls think, however, about their bodies and informing their parents about abnormal changes. Hannah's diagnosis first began when she complained of itchiness in her chest; her mother found a lump.

Hannah's mother took her to the doctor and the cancer was detected early. She has excellent chances, as high as 90 percent, for a full recovery. Who knows, one day Hannah could celebrate her 100th birthday.

The way to beat cancer is to get tested early and often. Don't be afraid of this beast.

Read more about Hannah's journey at her family's blog. You go, girl!

The curious case of a 13-year-old boy living in Sleepy Eye, Minn., has probably caught your eye. Daniel Hauser has Hodgkin's disease, one of many types of lymphoma. His parents, Colleen and Anthony Hauser, have been resisting the state's efforts to force Daniel to undergo chemotherapy, citing religious reasons.

His mother even took the child and fled earlier this month after Minnesota child protection investigators and a judge determined the case to be medical neglect. The Hausers, who have eight children, are Catholics who believe in a "do no harm" philosophy espoused by American Indians known as the Nemenhah Band. This sect advocates natural healing methods.

Daniel has been called learning impaired and cannot read. He is completely dependent on his parents for guidance. He cannot vote, drive or marry legally.

Surprisingly enough, child neglect cases far outnumber physical abuse. Researchers estimate that as many as 80 percent of all cases reported are due to neglect, which includes not getting medical attention for an underage child.

Most states, of course, provide exemptions for families whose religious beliefs conflict with the child protection laws.

While the family should be able to decide what happens next, the fact is that with medical treatment, Daniel's survival chances are at least 90 percent. If he doesn't get the chemo and other recommended therapy, however, his chances are only 5 percent.

Psychologists say that Daniel, like many teens, is incapable of making treatment decisions. They say that Daniel is mostly focused on pleasing his parents. If he cannot read, how can he decide what to do?

While the adults in his life debate, Daniel is fighting a chest tumor pressing on his trachea, causing pain. He's probably having difficulty swallowing. He's running out of time.

Daniel had one round of chemo in February and needs five more, doctors say. What will happen if he doesn't get chemo? One thing's for sure. Alternative methods and prayers alone won't cure this illness; it's not going away unless he receives chemo, torturous as it is.

Chemo kills the good cells along with the bad. It's toxic but necessary if Daniel is to have any hope for survival.

Children survive cancer at amazingly high rates every day. They are resilient and have positive attitudes. Why won't Daniel's parents give him the best treatment available? What goes through their minds as they lie awake at night?

Painful and debilitating as it is, there's no question what will happen if Daniel doesn't receive chemo. He will die.