Who to Trust? Reading Medical Articles with A Grain of Salt

How much faith should we put in published, peer reviewed studies which show that a drug, vitamin, surgical technique or medical device produces a favorable result?

We certainly want to believe that a conclusion based on raw data generated in a properly designed test by objective scientists must be true and is therefore reliable.

A recent article in The New Yorker -- "The Truth Wears Off “ -- by Jonah Lehrer reminds us of the perils of putting all our faith in scientists who, like the rest of us, are fallible. Scientists, especially medical researchers, he contends, tend to select their data to confirm a preconceived thesis, especially if they want to publish their study in a prestigious journal

Once a "truth" gets established – e.g, cardiac stents work, PSA tests save lives, Vitamin E is good for you, hormone replacement therapy for menopausal women works, second generation anti-depressants are effective, etc -- it's hard to un-establish it. Few journals put priority on publishing studies that show that a drug or device had "no effect," a phenomenon which Lehrer calls "publication bias."

The writer's point is not that our medical journals are rife with scientific fraud. In the real world, scientists struggle with making sense of their data. If there are anamolies that don't seem to follow a pattern, they might get tossed out. Like anyone else, a researcher is wired to want to disregard what he or she doesn't want to see, or can't explain.

Once Touted, Now Doubted Vitamin E and D megadosing Cardiac Stents Hormone Replacement Avastin for Breast Cancer Baycol, Fen/Phen,Bextra Thalidomide for morning sickness Mastectomy PSA test Lobotomy Extra Pleural Pneumonectomy

As Lehrer observes: "The problem of selective reporting is rooted in a fundamental cognitive flaw, which is that we like proving ourselves right and hate being wrong." Quite simply, it feels good to prove a hunch. It feels even better, he notes, when the researcher has a financial interest in the outcome, or stands to advance his career.

The answer, Lehrer argues, is in properly designing studies and making sure the data are both transparent and rigorously gathered, even if they contradict the hypothesis. Moreover, before publishing, the scientist should lay out on the front end what's a sufficient level of proof. He also suggests the use of accessible databases (something near and dear to Dr. Cameron and the Pacific Meso Center).

Bringing the subject closer to home, for many decades now US doctors have been quick to tout the extra-pleural pneumonectomy (EPP) as the best treatment for mesothelioma. Studies, mainly out of the Brigham and Women's hospital, have been published to prove the point. Several years ago, a big clinical trial, financed by Eli Lilly, showed that the chemotherapy drug Alimta was superior to doing nothing. Alimta went on to become the "front line standard of care" for pleural meso patients.

As you read up on the treatment options available, and listen to experts, it’s wise to stay on guard. Ask yourself, was the research based on selective reporting (aka, "cherry picking" the patients who did well but casting out those who didn’t)? Have the data been made available for review? Have the conclusions been validated elsewhere? Was the clinical trial randomized? Were apples compared to apples (if that’s even possible!).

Note that there has never been a clinical trial in the US in which pleural mesothelioma patients were randomly selected for either an EPP, a Pleurectomy/Decortication, or no treatment. Putting the ethical morass aside (I don’t think a patient would be eager to participate in a trial in which he was forced to do nothing or have his lung amputed), even if there was a well designed study, clearly surgical technique could not be 100% replicated, and every patient is different (genetics, age, sex, staging, pre-existing conditions, tumor cell type, will to live, etc).

In the end, we wind up making choices based on trust. Do we trust the doctor and his team? Do we trust the "science" on which he bases his opinions? Does he admit what he doesn't know? Does he follow the current fad or stubbornly cling to a one-size-fits-all strategy? Does he have passion without the in-your-face zeal ? Does he have a possible conflict of interest where, for example, he's got an irrepressible financial or career incentive to push one flavor over another?

Has your doctor tried to maintain “neutrality?” Radical surgery will transform the patient’s life irreparably. Has your doctor tried to suppress his own bias, anger or elation in recommending a treatment? Has your doctor truly explained whether an option first, does no, or at least very little, harm, balanced against the prospect of measurable benefit?

It’s not easy for a surgeon, or anyone, to “go Swedish” and consciously set aside biases. One thing is for certain, you’re not getting a fair shake if your doctor tells you he’s going to cure your mesothelioma. There is no proven cure for mesothelioma, period. At best, with an enlightened strategy, orchestrated by the an honest and caring medical team, meso patients can buy valuable time.

As WC Fields used to say: Trust your fellow man, but always cut the cards.

Roger G. Worthington, Esq.
December 15, 2010

Is EPP The Answer?

For years in the US the conventional wisdom taught that if you have pleural mesothelioma and you want to survive, you better have your lung taken out.

A new study from the UK has debunked that theory.

Doctors in the UK recently published the preliminary findings from the Mesothelioma and Radical Surgery (MARS) study, a randomized trial in which one group of participants would receive chemotherapy, then extrapleural pneumonectomy (EPP), then radiotherapy. The second group of patients would receive other types of aggressive therapy, but would not receive EPP.

Significantly, the study did not contain an arm for patients to choose or undergo the surgical alternative to the EPP, known as the Pleurectomy/Decortication, which removes the tumor only and spares the lung.

The goal of the trial was to determine whether EPP in conjunction with adjuvant chemotherapy and radiotherapy offered benefits to the patient in terms of life expectancy and quality of life, as compared to other standard therapies. The study also assessed the benefits compared to the surgical risks of morbidity or mortality.

In a nutshell, the MARS trial unambiguously debunked the popular theory that the EPP is the best surgical treatment for pleural mesothelioma patients.

Please read the abstract, as well as the comments by PD pioneer Dr. Robert Cameron of UCLA and the Pacific Meso Center.

Dr. Cameron has been treating mesothelioma patients for over 20 years. He is one of the innovators of the lung-sparing Pleurectomy/Decortication. He has has performed the procedure on over 300 patients in his career. It takes about twice as long as the EPP, is highly tedious, but the results have been worth it in terms of lower patient mortality, above average median survival, and improved quality of life. For more about Dr. Cameron's expertise, click here.

The MARS trial offered up sweet validation of Dr. Cameron's approach -- an approach that has not always endeared him to his pro-EPP surgical colleagues. He writes: "This most recent trial is even more proof that no one suffering from the ravages of mesothelioma should be subjected to the further indignation of a radical, debilitating and useless operation based on "selected" data.”

The take home message: there's no substitute for due diligence. Before consenting to a radical, lung amputating surgery, do your homework. Ask tough questions. And call Dr. Cameron.

December 8, 2010

A Holiday Message and Theological Response to “The Median Isn’t the Message” from Meso Survivor Pastor Charles Van Kirk

November 30, 2010

By John Caron:

A few days before Thanksgiving, I came back across the insightful and inspirational essay “The Median Isn’t the Message” written by Harvard and NYU evolutionary biology professor Stephen Jay Gould shortly after he was diagnosed with peritoneal mesothelioma in 1982.

In the essay, Professor Gould discusses his reaction to the median survival statistics of only eight months for patients diagnosed with his disease. Rather than resign himself to this fate, Professor Gould explained that statistics are merely abstractions which do not encompass the full range of variation and concluded that he should be in the favorable half of the upper statistical range because of his age, positive attitude, early diagnosis and the fact that he received the best available medical treatment. Professor Gould proved to be correct, surviving 20 years following his diagnosis with mesothelioma before passing away due to an unrelated condition.

I thought some of my mesothelioma clients would enjoy reading this timeless and optimistic piece and forwarded it to them along with a Thanksgiving greeting. Once such client was Thurl Charles Van Kirk, Pastor of the Rim of the World Community Church in Running Springs, California. “Pastor Chuck” has himself defied the statistics by surviving almost three years since his diagnosis with biphasic mesothelioma—and counting!

Knowing that Pastor Chuck received degrees in theology before serving 30 years as a Pastor, I was eager to receive his perspective on the evolutionary biology professor’s essay about statistics and survival. Pastor Chuck certainly did not disappoint.

Printed below with his permission is Pastor Chuck’s eloquent and thoughtful response culminating in a timely and valuable prayer for this Holiday Season.

Please enjoy and pass along to others.

Thanks again Pastor Chuck!

Dear John:

Thank you for the article, “The Median Isn’t the Message” by Stephen Jay Gould. It reminds me of a passage in Luke 16.8,

“…There was a certain rich man who had a steward, and
this steward was reported to him as squandering his
possessions.

And he called him and said to him, ‘What is this I
hear about you? Give an account of your stewardship, for
you can no longer be steward.’

And the steward said to himself, ‘What shall I do,
since my master is taking the stewardship away from me?
I am not strong enough to dig; I am ashamed to beg.

I know what I shall do, so that when I am removed from
this stewardship, they will receive me into their homes.’

And he summoned each one of his master’s debtors,
and he began saying to the first, ‘How much do you owe my
master?’

And he said, ‘A hundred measures of oil.’ And he said
to him, ‘Take your bill, and sit down quickly and write fifty.’

Then he said to another, ‘And how much do you owe?’
And he said, ’A hundred measures of wheat.’ He said to him.
‘Take your bill, and write eighty.’

And his master praised the unrighteous steward because
he had acted shrewdly; for the sons of this age are more shrewd
in relation to their own kind than the sons of light.”

Professor Gould shed some light upon a gloomy topic. Statistics, ah, in college I spent a year deriving formulas by hand just in case our computers crashed. Through all the exercise of tangent and co-tangent, designing experiments and penning down conclusions, never mind their significance; we learned that Professor Gould was right. Statistics can be so stretched. And there is that mystical point where truth gives way to lies and lies fade into truth. “It’s all relative? To what? To whom?” My answers came from the study of theology.

What appeals to me in the above scripture appears in its preface, “this steward was reported to him as squandering his possessions.” Professor Gould dazzles the reader with his understanding and definitions. But the point in Luke’s account is that there shall be a day of accounting where the mean and the median will be required for each of us.

Yes, attitude is everything. At times my hardest struggle is just to get up in the morning. Deep, throbbing pain in my side demands attention. So I pop some pain meds and lay back down pondering what heaven will be like when we receive new bodies that never break down, get sick, wrestle with illness or suffer!

So thank you again. I’ll be seeking to be in the distribution of those who thrive even in the midst and realities of diseased bodies. The steward was wise in how he finally got those uncollectible accounts to pay up. It wasn’t the full measure but something is better than nothing. I suspect his employer had been trying to receive payment for years from his debtors. This shrewd servant found a way to endear himself with his master and those who owed him money.

My prayer for you and yours this holiday season is that you make time to celebrate the little things, the kindnesses and tenderness afoot from strangers, friends and family. Perhaps we as sons of light might advance those in our sphere of influence to reconsider the glory of Christmas, the cheer of Thanksgiving and fulfill the goals our master bids us do in 2011.

God Bless,

Charles Van Kirk

Mesothelioma: A Patient's Road Map

Patients diagnosed with mesothelioma find themselves at the beginning of a journey. Because of the rarity of the disease and the developing nature of the treatments, it is a journey that will take them on sparsely-traveled, out of the way back-roads. The kind of roads that are often difficult to navigate. Difficult, that is, unless you have a good road map.

The Pacific Meso Center has assembled a new brochure entitled: "Mesothelioma: A Patient’s Road Map" to help mesothelioma patients navigate the many roads before them on their journey to proper diagnosis, treatment and coping with their disease.

The Pacific Meso Center is a division of the Pacific Heart, Lung & Blood Institute ("PHLBI") which is dedicated to meaningful advancements in the treatment and prevention of mesothelioma. PHLBI is a 501 (c)(3) non-profit institution founded in 2002 by Roger Worthington and Dr. Robert Cameron, head of the Mesothelioma Program at UCLA Medical Center. Dr. Cameron serves as the Pacific Meso Center's Scientific Advisor and is the innovator of the lung-saving pleurectomy/decortication procedure for pleural mesothelioma.

To get your free copy of "Mesothelioma: A Patient's Road Map", please call us at (800) 831-9399 or email us at info@rgwpc.com

"So many of us need this kind of information because without it, it's hard to know where to start."

In February of 1999, Canadian Paul Douglas first heard the word ‘mesothelioma’ as it came out of his doctor’s mouth. At that meeting, his doctor told him "go home, do your paperwork you've got 3 to 6 months to live."

He was told about his treatment choices from chemotherapy, radiation and radical surgery. Surgery was his least favorite choice.

His ex-wife Linda had remained a good friend and she soon began surfing the Internet and “low and behold I found www.mesothel.com”. According to Paul, "Thanks to Roger Worthington's website Linda was able to access information on mesothelioma and clinical trails that were taking place across the U.S. Here in Canada the resources are not available for this type of research."

Paul took part in a clinical trial offered in Bremerton Washington. He began the trial in April of 1999. Nine weeks later his first cat-scan revealed "no tumors at all."

We followed Paul and his battle for the next 11 years! Over that time he helped dozens of people from all over the world facing this same battle. He shared his knowledge and support of others with joy and purpose. He helped others to fight as he did but most importantly, he offered them hope and inspiration.

In July of this year he reported to us that he and his wife Sharon had just returned from trips to Maui and Las Vegas.

Sadly, on October 20, Paul passed away due to a heart attack. His wife and family hope his message to keep fighting and never giving up will continue to live on.

Asbestos Bankruptcy Trust Update for October 22, 2010

Leslie Controls on the Fast Track to having its “Pre-Packaged” Bankruptcy Plan Approved­Could Begin Paying Claims by Early 2011

Leslie Controls, Inc., a wholly-owned subsidiary of CICOR International, Inc., filed for Chapter 11 bankruptcy protection in July 2010 citing overwhelming liabilities for current and future asbestos injury claims.

Since the early 1900’s, Leslie was a major manufacturer of industrial water heaters and steam control systems. Leslie was a large supplier of valves and other steam equipment to the United States Navy during World War I and World War II. Leslie’s products, which were often equipped with asbestos gaskets, insulation and packing, were responsible for exposing thousands of Americans to harmful asbestos fibers.

Upon filing for Chapter 11, Leslie received temporary immunity from all pending and future lawsuits brought by asbestos illness victims. Leslie will be entitled to permanent immunity upon certification of its bankruptcy plan by the bankruptcy court and approval by a Federal District Court. The one consolation to asbestos injury victims is the requirement that Leslie’s bankruptcy plan provide for the funding of a trust and a system for compensating claimants based on factors including the severity of their illness.

Leslie made substantial progress toward its emergence from bankruptcy when it obtained the asbestos claimant votes necessary for approval of its bankruptcy plan earlier this month. For the plan to be affirmed by the courts, bankruptcy law requires approval by at least 75 percent of current asbestos claimants. The vote on Leslie’s plan was completed on September 27, 2010, and on October 8, 2010 the balloting agent reported to the U.S. Bankruptcy Court that more than 75 percent of claimants had voted in favor of the plan.

Based on the progress to date, CIRCOR is targeting the plan’s affirmation by the courts and Leslie’s emergence from bankruptcy for the fourth quarter of 2010. Accordingly, it is conceivable that Leslie’s bankruptcy trust could begin processing claims by early 2011.

If the trust begins paying injury claims within a year of Leslie’s filing for bankruptcy, this would rank as one of the faster completions of this process among all asbestos bankruptcy trusts. By comparison, of the nine other companies which currently have proposed bankruptcy trusts pending approval, one has been in bankruptcy for over ten years, two over nine years, and another two over six years.

Leslie’s progress can be attributed to its use of a “Pre-packaged” bankruptcy plan. As compared to other bankruptcies, where the company files and thereafter begins negotiating a plan of reorganization with creditors, a pre-packaged approach involves negotiating a plan before the company files bankruptcy. Under a pre-packaged approach, the company is able to negotiate with creditors under less formal conditions, often behind closed doors, and deliver a plan of reorganization satisfying applicable rules at the same time the company files bankruptcy.

Check back often to Mesothelioma Bytes for breaking news about the Leslie Trust and other active and pending asbestos bankruptcy trusts.

Also, for information on how asbestos bankruptcy trusts came to exist, how trust claims are processed and the current status and future outlook of these trusts, see our comprehensive guide to asbestos bankruptcy trusts entitled: “Asbestos Bankruptcy Trusts: The Good, The Bad And The Ugly.”

Study Involving New Chemotherapy Combination Shows Improved Results Over Cisplatin for Pleural Mesothelioma

To date, chemotherapy drugs used to treat mesothelioma have primarily included cisplatin, onconase, carboplatin, gemcitabine, navelbine and pemetrexed (Alimta). In some cases, these medications have been noted to stall the progression of mesothelioma tumors. Chemotherapy, however, has been shown to be most effective when combined with surgery, radiation, or other treatment modalities, known as multi-modal treatment.

Since 2004, the only chemotherapy regimen which the FDA has approved for pleural mesothelioma is cisplatin and Alimta. The approval, however, is limited to patients who are not surgical candidates.

A recent European study has monitored the results of cisplatin used in combination with a drug called Tomudex (raltitrexed) for pleural mesothelioma. The study has shown improved median survival rates for patients on the cisplatin-Tomudex combination as compared to cisplatin alone.

Tomudex is an injectable cytotoxic medication used to treat different forms of cancer. The medication belongs to a group of cancer-fighting drugs called antineoplastics. Tomudex combats cancer by preventing cancer cell growth, which in time leads to their elimination.

In the study, one group was treated with cisplatin alone and another group was treated with both cisplatin and Tomudex. The overall response rate for the cisplatin-Tomudex group was higher than the cisplatin group, 23.6 percent and 13.6 percent, respectively. Tomudex was shown to improve median overall survival by 2.8 months and Tomudex was associated with improved progression-free survival.

Professor J.P. van Meerbeeck (professor of Thoracic Oncology at Ghent University, Belgium) said, “Malignant pleural mesothelioma is a hard to treat, rare cancer with a poor prognosis. New treatment options such as a combination of cisplatin and raltitrexed, which improve patient outcomes with no detrimental effect on quality of life as compared to cisplatin alone are a welcome addition to our therapeutic portfolio.”

Tomudex is currently licensed for the treatment of pleural mesothelioma in Portugal, Czech Republic and Hungary. Additional licensing is expected across Europe in late 2010.

Please check back with Mesothelioma Bytes for future updates on the testing and approval of Tomudex in the treatment of mesothelioma.

"It is important for us to stay on top of the new discoveries in medicine connected to mesothelioma and your website does just that.”

"South Florida's changed so much," says Howard Ornstein, who relocated to the Sunshine State with his family in the 1950's. "Time was you could see straight to the water, but with all of the over building and high rise construction, Miami Beach is invisible unless you're on the front row."

The early days of South Florida bring back halcyon memories for Howard and his wife Roselyn. "Parkland is just like a little town, even though it's on the outskirts of Fort Lauderdale. Growing up our kids did everything, tennis, karate, horseback riding, the local football team…everyone knew everyone else."

Back in March of 2008, Howard was diagnosed with malignant pleural mesothelioma. In his search for treatment, he land his wife Roselyn left no stone unturned.

• Chemotherapy did a good job for awhile, but the Ornsteins were always on the look out for new treatments.
• In 2009 they visited the ITL clinic in the Bahamas.
• In 2009 they also visited with Dr. Robert Taub in New York.
• Howard took supplements made from asian mushrooms that he says, "help slow the progression of the disease." Howard also stated, "you have to be in the right frame of mind."
• He is in that frame of mind and has a pretty accomplice to help him enjoy it.

It is now October of 2010 and Howard is still going strong!

"I feel good, just a bit tired sometimes. My appetite is still good and Roselyn makes sure I clean my plate.

After his third chemotherapy treatment, Howard will undergo a CT scan and be evaluated for any further treatments.

Way to go Howard! Keep up the good work.

Worthington Law Firm Announces New Guide to Asbestos Bankruptcy Trusts

“Asbestos Bankruptcy Trusts: The Good, The Bad And The Ugly”

Since the early 1980’s, companies responsible for inflicting asbestos-related illness on hundreds of thousands of Americans have sought to limit or escape legal liability through filing Chapter 11 bankruptcy.

By filing Chapter 11, a company is given immediate immunity from lawsuits filed by the victims of its asbestos products. The company is then given many years to satisfy a number of legal requirements while the victims, many of whom do not have the luxury of time, are forced to wait. Upon meeting the requirements, the company is granted permanent immunity from lawsuits filed by all past and future victims, and is able to emerge from bankruptcy and continue doing business as usual.

The one consolation to asbestos illness victims is the requirement that the company pool assets and insurance proceeds and place them in a trust to compensate past and future victims. The trust establishes guidelines dictating the amount of compensation to be paid to claimants based primarily on severity of illness. While it is not necessary for victims to appear in court or provide testimony, the amount received from the trust is often far less than what would have been received if the company could be sued in a lawsuit.

Despite their many shortcomings, asbestos bankruptcy trusts are becoming an increasingly important component of the compensation available to victims of asbestos disease. This is due to a continuing decrease in the number of viable companies that can be sued in court and a continuing increase in the number of companies filing Chapter 11 bankruptcy.

In order to aid in the understanding of how asbestos bankruptcy trusts came to exist, how trust claims are processed and the current status and future outlook of these trusts, we have assembled a comprehensive guide to asbestos bankruptcy trusts entitled: “Asbestos Bankruptcy Trusts: The Good, The Bad And The Ugly.” Click here to review this helpful resource and continue to visit Mesothelioma Bytes for the latest news on asbestos bankruptcy trusts.

If you have any questions, or would like to learn more, please contact us at info@rgwpc.com or 1-800-931-9399.

“Your firm really cares about my well-being.”

In April of 2009, Kathy first noticed she was having difficulty taking deep breaths. She met with her family physician who performed several tests including a chest x-ray. The x-ray revealed a pleural effusion.

In June of 2009 she underwent a left-sided thoracentesis with pleural biopsy in Wenatchee, Washington. Immunohistochemical staining of the biopsied tissue resulted in a diagnosis of malignant mesothelioma. Upon learning of the diagnosis, she met with an oncologist in Wenatchee who recommended that she consult with Dr. Eric Vallieres in Seattle, Washington.

In July of 2009 Kathy met with Dr. Vallieres and his staff at the Swedish Medical Center where they discussed her eligibility for the extra-pleural pneumonectomy. Dr. Vallieres felt she should first undergo chemotherapy treatments using Alimta in conjunction with Cisplatin. A CT scan taken before the third round revealed a reduction in the size of the tumor.

As a result of this favorable response and after subsequent tests, Kathy underwent surgery on her left lung on October 5, 2009.

Kathy completed her 28 day cycle of radiation at the end of January.

In March Kathy returned to her job full-time. While she loves staying busy, she and her husband were ready to take a vacation after the challenging year they have had. They recently returned from a relaxing trip in Cabo San Lucas, Mexico and are feeling recharged for the season ahead. Meanwhile, Kathy has been faithfully keeping up with her physical therapy appointments several times a week to help regain strength and mobility on her left side.

Kathy last saw Dr. Vallieres in May and is seeing him again later this October. Her doctors have been monitoring a small spot on her spine that is most likely benign. However if the spot turns out to be more serious, she has already consulted with a radiologist on how to treat it. She recently learned about the relatively new CyberKnife treatment which is a non-invasive, non-surgical method of delivering radiotherapy to very targeted areas.

It’s hard to believe a year has gone by since Kathy’s EPP surgery! She continues to be very appreciative of the Worthington Law Firm. “I feel your firm really cares about my well-being and are experts about mesothelioma treatment.”

Locating Financial Assistance for Cancer Patients Doesn't Have to be so Hard

Coping with cancer and its aftermath both physically and emotionally is a challenging process that taxes all those involved, including the ones at risk and their loved ones. However, don't let the financial burdens unduly increase stress. There are many sources for financial assistance, which cater to a range of people and their situations.

Always remember, don't be silent about this real need! Thirty minutes of research could save thousands of dollars and unnecessary turmoil, but try to exhaust all resources. Talk to doctors, family members, neighbors, and others in the community about your concerns.

The U.S. National Cancer Institute is a comprehensive home base with important information and sources for all types of cancer. Below is a direct link to seeking financial assistance for a range of needs including local programs and support groups, Spanish speaking centers, oncology social workers who can provide pertinent information, assistance for women and children, volunteer organizations, Medicaid and Medicare, help with prescription drugs, tax deductions, transportation, and much more.

• Financial Assistance for Cancer Care: http://www.cancer.gov/cancertopics/factsheet/support/financial-assistance The Patient Advocate Foundation established in 1996, is dedicated to helping patients and loved ones in a variety of sources. Below is a direct link to information on prescription drug assistance.
• Patient Assistance Programs: What Every Oncologist Should Know: http://www.patientadvocate.org/news.php?p=281

Good starting places for additional links to financial help are:

• Links to 17 other sites: http://members.tripod.com/~cancer49/index-10.html
• Frequently Asked Questions: http://www.cancercare.org/get_help/pwc.php
• An article about others fighting cancer and its debt: Conquering Cancer, but Way Behind on the Bills: http://www.cancerinsurance.com/English/Collaterals/NY_Times_16NOV1997.html
• National Catholic Charities Web Site: http://www.catholiccharitiesusa.org/.
• United Way : http://www.unitedway.org/
• American Cancer Society links to funding: http://www.cancer.org/docroot/res/res_0.asp
• Drug Assistance through National and International Cancer Supportive Care Programs: http://www.cancersupportivecare.com/drug_assistance.html

"Aid and Attendance" is a monthly pension benefit that the Department of Veterans Affairs offers. Applications may be submitted online at www.vabenefits.vba.va.gov/vonapp/main.asp or learn more about what your local VA has to offer at www.va.gov. Claimants for the "Aid and Assistance" benefit must be incapable of self support and in need of regular personal assistance. For more information, call 1-800-827-1000.

“I’ve been exposed to asbestos, do I have meso?”

Discovery of New Biomarkers May Lead to Test for Early Detection of Mesothelioma

We hear the question countless times from newfound friends, “I know I have been exposed to asbestos in the past, is there any test out there that can determine if I have cancer or mesothelioma?”

Until a few years ago, there was no such test. However, recently several doctors and clinics have researched ways of determining the existence of mesothelioma markers in the blood.

In 2005, new developments using a blood serum marker were used to detect cancer in a longitudinal study in Libby, Montana.

Later that year, results from a study conducted by researchers at New York University (NYU) School of Medicine revealed the mesomark assay, the world's first and only in vitro test for monitoring mesothelioma. This program was developed by Fujirebio Diagnostics, Inc. It was an effective way to measure proteins within the blood that reflect changes in disease. The findings represented a major milestone in the management of mesothelioma, as the test hoped to enable doctors to more accurately monitor patients for treatment.

This week, the biotech company Somalogic announced at the Fourth AACR International Conference on Molecular Diagnostics in Cancer Therapeutic Development a new technology that could allow doctors to identify mesothelioma in patients before they show visible symptoms.

Scientists tested 357 serum samples from patients diagnosed with mesothelioma or lung cancer. The results were compared to controls consisting of subjects exposed to asbestos, high-risk smokers, and those with benign lung disease. If this technology proves reliable it could be used in a screening process for people with a history of asbestos exposure

Rachel Ostroff, Ph.D., of SomaLogic in Boulder, Colorado said "Detection of these aggressive cancers at an earlier stage would identify patients for early treatment, which may improve their survival and quality of life."

Knowing if and when the enemy will strike always helps in developing a battle plan for victory.

We will update this story when the results of the next round of studies are published.

Phase II Study of IMC-A12 in Patients With Mesothelioma Who Have Been Previously Treated With Chemotherapy

IMC-A12 for Mesothelioma

IMC-A12 is a new cancer treatment that has not yet been approved by the U.S. Food and Drug Administration

It is an antibody that is designed to block the effects of a protein called Type I Insulin-Like Growth Factor (IGF-1R). IMC-A12 blocks the receptors in cells that respond to IGF-1R, which are thought to play an important role in helping cancer cells to grow and divide.

Researchers are interested in determining whether IMC-A12 is an effective treatment for individuals who have mesothelioma that has not responded to standard chemotherapy.

The objective if this study it to evaluate the safety and effectiveness of IMC-A12 treatment in individuals with mesothelioma who have previously had chemotherapy.

Individuals at least 18 years of age who have been diagnosed with mesothelioma that has not responded to chemotherapy are eligible.

Eligible participants will be screened with a full physical examination and medical history, blood and urine samples, and imaging studies.

Participants will receive IMC-A12 once every 3 weeks (21-day cycle), and will be evaluated before the start of each new cycle with blood tests and imaging studies if needed.

Treatment cycles will continue for as long as needed, unless severe side effects develop or the disease progresses.

This study is currently recruiting participants. This study has been verified by National Institutes of Health Clinical Center (CC), June 2010

Contact: NCI Referral Office 1-888-NCI-1937 ncicssc@mail.nih.gov

Phase II Study of IMC-A12 in Patients With Mesothelioma Who Have Been Previously Treated With Chemotherapy

IMC-A12 is a new cancer treatment that has not yet been approved by the U.S. Food and Drug Administration

It is an antibody that is designed to block the effects of a protein called Type I Insulin-Like Growth Factor (IGF-1R). IMC-A12 blocks the receptors in cells that respond to IGF-1R, which are thought to play an important role in helping cancer cells to grow and divide.

Researchers are interested in determining whether IMC-A12 is an effective treatment for individuals who have mesothelioma that has not responded to standard chemotherapy.

The objective if this study it to evaluate the safety and effectiveness of IMC-A12 treatment in individuals with mesothelioma who have previously had chemotherapy.

Individuals at least 18 years of age who have been diagnosed with mesothelioma that has not responded to chemotherapy are eligible.

Eligible participants will be screened with a full physical examination and medical history, blood and urine samples, and imaging studies.

Participants will receive IMC-A12 once every 3 weeks (21-day cycle), and will be evaluated before the start of each new cycle with blood tests and imaging studies if needed.

Treatment cycles will continue for as long as needed, unless severe side effects develop or the disease progresses.

This study is currently recruiting participants. This study has been verified by National Institutes of Health Clinical Center (CC), June 2010

Court Rejects Pfizer’s “Bad Faith”

Court Rejects Pfizer’s “Bad Faith” Attempt to Limit Liability to Asbestos Victims

Many of our clients, as well as thousands of other victims of asbestos disease, were exposed to asbestos products manufactured by a company called Quigley. Because of legal maneuvering on the part of Quigley's parent company, pharmaceutical giant Pfizer, Inc., these families have been forced to stand in line and wait patiently for the justice they deserve. Here's the latest in Pfizer's lawyers attempt to delay, obfuscate, duck, bob and weave.

Earlier this month, a New York bankruptcy judge rejected the latest attempt by Pfizer, Inc. to shake off an estimated $900 million worth of asbestos damages through a Chapter 11 bankruptcy plan for its Quigley unit, which manufactured asbestos containing products from the 1940’s through the 1970’s.

Judge Stuart M. Bernstein refused to confirm Quigley's fourth Chapter 11 bankruptcy reorganization plan on the grounds it would run out of money within five years of paying claims for asbestos injuries and was unfair to some of the most seriously injured asbestos claimants. Judge Bernstein found that Pfizer, the architect, funder and chief beneficiary of Quigley's Chapter 11 plan, engaged in "bad faith" vote manipulation and should not enjoy the benefit of a confirmation ruling that would shield it from damage claims arising from Quigley products.

A maker of “Insulag”, “Panelag” and “Damit” refractory products for iron, steel, power generation, petroleum and other industries, Quigley was acquired by Pfizer in 1968. By 2003, it was out of operation, facing $1.2 billion worth of claims for asbestos damages, with more expected in future decades. In 2004, Pfizer filed for Chapter 11 bankruptcy protection on behalf of Quigley, part of what Judge Bernstein found was a bad faith scheme to "divide and conquer" law firms that represent people with asbestos injuries.

Quigley is one of many companies that resorted to Chapter 11 protection in order to get a reprieve from asbestos injury claims, and gain bargaining advantage with plaintiff's firms. Asbestos bankruptcy plans are generally designed to shield a company from product liability lawsuits by diverting the claims to a trust funded with cash, stock, insurance proceeds and other assets earmarked to cover the anticipated cost of current and future injury claims.

According to Judge Bernstein, Pfizer's $216 million contribution to the Quigley bankruptcy trust was far less than the benefit the company would obtain if the Quigley Chapter 11 plan was confirmed: immunity from more than $900 million in product liability claims.

Judge Bernstein’s ruling will force Pfizer into renewed negotiations if it wants to preserve its immunity from personal injury claims brought by persons injured by Quigley’s asbestos products. At the time it filed for bankruptcy protection in 2004, Quigley had been hit with 411,100 asbestos personal-injury claims. Experts estimated another 261,567 lawsuits would be filed in the coming decades.

If new plan is not approved, the Chapter 11 bankruptcy could be dismissed, allowing all of the pending and future lawsuits against Quigley/Pfizer to proceed.

Dr. Cameron: "A Blessing"

When Patricia Crawford was initially diagnosed by doctors at Kaiser Permanente, they tried to steer her into having her lung removed using the radical lung-amputating extra-pleural pnuemonectomy (EPP). She was not made aware of the lung-sparing pleurectomy-decortication (P/D) surgery and probably would've consented. But, thanks to the diligence and curiosity of her children, who logged onto the internet and discovered Dr. Robert Cameron, she sought a second opinion.

Undaunted by the lack of a formal referral from Kaiser Permanente, Patricia set up an appointment with Dr. Cameron. She knew that Kaiser's vast bureaucracy would either delay or reject the referral, but time was short. She decided to pay for the consultation herself and worry about coverage later.

Dr. Cameron talked with her extensively about her surgical options. He explained the differences between the EPP, which removed the lung, and the P/D, which spared the lung. He explained to her that the P/D provided the same tumor clearance as the EPP with a lower risk of mortality.

He also explained to her the adjuvant use of radiation as well as immunotherapy and chemotherapy. Patricia ultimately chose to undergo the pleurectomy/decortication at UCLA on January 10, 2008. (For more information on the differences between the EPP and P/D, click here) The doctors at Kaiser, who recommended the EPP, had not even mentioned the PD as an option. Patricia is thankful that she found Dr. Cameron. "He has been a blessing."

Beware of “Madison Avenue” Meso Lawyers

Nowhere to Hide

It’s late at night, you’re dozing off with the TV on, the screen goes dark and is soon filled with words in white lettering, as an all too serious narrator begins reading: “If you or a loved one was diagnosed with mesothelioma, call the number on your screen now…”

Now it’s morning, you’re settling in with a cup of coffee, your eyes are on the newspaper but you’re listening to CNN when, once again, the all too familiar voice beckons: “If you or a loved one was diagnosed with mesothelioma, call the number on your screen now…”

Now you’re up and dressed. Before leaving the house, you flip over to the Weather Channel for a quick check of the forecast, but before you can get your “Local Weather on the 8’s”, you’re forced to once again endure the barely human voice: “If you or a loved one was diagnosed with mesothelioma, call the number on your screen now…”

You’re at an intersection waiting for the “Walk” signal when your view is eclipsed by a large bus pulling over at a nearby bus-stop. On the back of the bus is a large rectangular sign with the image of a man with a weathered face and stoic expression, wearing a hard-hat, next to which you see the text: “If you or a loved one was diagnosed with mesothelioma, call 1-800…”
These days there’s no escaping “Madison Avenue” meso lawyers and their seemingly limitless advertising budgets.

“Scorched Earth” Campaign for Meso Victims

So who are these “Madison Avenue” meso lawyers who are saturating our airwaves, billboards and bus placards with their distasteful attempts to reach the one out of every 103,000 Americans who will be diagnosed with mesothelioma this year?

Typically, they are national firms which, curiously enough, don’t even specialize in the handling of mesothelioma cases. Instead, many of these firms handle a wide array of cases including pharmaceutical cases, tobacco cases, securities fraud cases, Chinese drywall cases, mold cases, medical malpractice cases and various forms of class action cases. Many of the firms have only recently jumped on the “mesothelioma bandwagon,” adding these cases to their diverse practices.

Talk the Talk and Walk the Walk

Any law firm with a large marketing budget can hire an advertising firm to produce a slick (usually not-so-slick) TV commercial and run demographic studies on the times and channels to run the commercials where they will have the best chance of reaching their “market.” But does possessing the so-called savvy to market legal services the same way others market “male enhancement” products qualify a law firm to represent a family struggling with mesothelioma?

In order to effectively represent a family afflicted with mesothelioma, a law firm must have the knowledge and experience necessary to quickly educate the family about the full extent of their medical options and assist them in getting prompt attention from the physicians who have developed an expertise in the treatments they are interested in (See our article “Should Lawyers Advise Their Clients on Treatment Options” Published in Asbestos Magazine).

Because of a mesothelioma patient’s limited life expectancy, efforts must be made to bring the case to trial as soon as the court will allow. These efforts, not surprisingly, are met with great resistance from defense attorneys whose billable rates incentivize them to make the case drag on as long as possible so that the mesothelioma patient never sees his or her day in court. Again, meeting and overcoming these unique challenges requires attorneys who are experienced and have a proven track record in handling mesothelioma cases.

Are “Madison Avenue” meso lawyers up to these challenges?

Can a family struggling with mesothelioma afford to risk that they’re not?

Click here for the full article.

Dr. Cameron: "He clarified my options in lay terms"

Holger Lochheed is a 70 year-old retired hotel restaurant manager who lives with his wife Lynne in Mesquite, Texas. Holger was diagnosed with malignant pleural mesothelioma two years ago during a routine physical.

Holger recently reviewed a copy of the Pacific Heart, Lung & Blood Institute’s “Patients Road Map”, a brochure written to help mesothelioma patients navigate the many roads before them on their journey to proper diagnosis, treatment and coping with their disease. Here it Holger’s enthusiastic response.

Dear Mr. Caron,

Thank you for your letter and the "Patients Roadmap" brochure.

While the brochure is informative, short and to the point, it lacks the strong emphasis to seek out a specialist as early as possible.

My personal scenario is a case in point. After diagnosis, I was referred to a local Oncologist (a charming gentleman) who gave me 9 months to live and with treatment 3 years. His referral to a Thoracic Surgeon was even bleaker: an immediate operation followed by heavy radiation. Outlook: 2 years and "I'll try to save part of your lung".

Thank God your office referred me to Dr. Cameron. He clarified my options in lay terms.

I chose to do nothing.

So far this decision had stood me in good stead. I feel well and live the good life. Naturally I am under no illusions and know this could change at a moments notice.

Therefore, it is my humble opinion that the publication needs to put a MUCH STRONGER emphasis on the importance of seeking out meso specialists as early as possible.

Kind regards,

Holger Lochheed

California City Ignores Dangers of Asbestos, Approves Mountain Biking Facility on Asbestos-Rich Soil

Last month, the San Luis Obispo, California City Council approved a donor agreement with a mountain biking group to develop a recreation facility in a city-owned area with soil type rich with asbestos.

The group, Central Coast Concerned Mountain Bikers, hopes to build a bicycle skills course in the Stenner Springs Natural Reserve, a 363-acre area four miles north of San Luis Obispo. Much of the landscape of Stenner Springs is made up of serpentine soil, a type of material which state and federal governments have designated as a source of naturally occurring asbestos. Asbestos is known to cause lung cancer and mesothelioma, a cancer of the linings of the lungs that is nearly always fatal.

Though serpentine soil is relatively common in California, scientists and government regulators have recently stepped up efforts to study the effects of naturally occurring asbestos in dust and warn people of the danger.

In a study released in 2009 by the University of California Department of Agriculture and Natural Resources, dust from serpentine soil is cited as a potential cause of cancer. The study says, “People may inhale or swallow dust containing asbestos fibers. These fibers can cause cancer and other diseases by remaining in the lungs or traveling to the lining of the lungs or the abdominal cavity.”

The California Air Resources Board identified asbestos as a toxic air contaminant with no safe threshold level in 1986.

“In general, people are not aware of the dangers of serpentine soil,” said Toby O’Geen, a soil scientist at the University of California, Davis. “I wouldn’t make a trail over it unless they import trail material. If they are laying down bicycle trails over crushed rock and soil and don’t put down a layer of topsoil, the risk may be much higher.” He added: “There’s no way to know how much of a problem you have unless you take samples.”

According to Neil Havlik, natural resources manager for the city of San Luis Obispo, the city hasn’t tested for asbestos at the site. Havlik said the state air resources board only requires asbestos testing when a grading project is larger than an acre. “My guess is there is asbestos there, but it’s far below the threshold,” Havlik said, adding that the construction of the bicycle skills park won’t require much below-ground work. “Asbestos is a concern in certain circumstances,” he explained. “Our expectation in this particular project is that the ground disturbance is very minor.”

However, according to the environmental impact study that’s part of the project report, one of the few potentially significant environmental impacts of the project is “substantial soil erosion or the loss of topsoil.” Due to a fire in the area in 1994, the mineral soil under the future location of the bicycle skills area has been exposed, Havlik said during the council meeting.

According to the 2009 asbestos study: “No one knows how many fibers are needed to cause lung cancer or other diseases. Heavy and frequent occupational exposures are more likely to cause the disease than are nonoccupational exposures; however, a lifetime of exposure to low levels is also recognized as a potential hazard. Environmental health scientists have suggested that children have a higher risk of exposure than adults in the same environment due to their faster breathing rates, time spent outdoors, and greater time for disease to develop.”

The 84-page report detailing the city’s plans for the Stenner Springs area mentions asbestos only twice: “Serpentine carries the risk of asbestos. Be sure to patrol erosion areas, as these areas are subject to asbestos.”

Both the study and the federal government’s Agency for Toxic Substances and Disease Registry advise people living or working near naturally occurring asbestos to “walk, run, hike, and bike only on paved trails and pave over unpaved walkways, driveways, or roadways that may have asbestos-containing rock or soil.” They also advise that recreational activity in serpentine soil in outdoor areas be restricted to “outdoor areas with a ground covering such as wood chips, mulch, sand, pea gravel, grass, asphalt, shredded rubber, or rubber mats.”