Shot in the arm

When my turn in line comes, I will have no hesitancy about rolling up my sleeve and getting a shot in the arm.  My position on the benefit and potential risk of receiving one of the new mRNA-based Covid-19 vaccines is based on over 30 years of studying how we can use the immune system to treat cancer.  I’d like to summarize how this experience has influenced my perspective on taking the vaccine.

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Collaboration in isolation to address our mission

It’s Thanksgiving morning and I am sitting quietly at our kitchen table while my wife Teresa bakes some bread.  That is about the only thing usual about the holiday this year.  No big turkey.  No happy sounds from children and grandchildren running about.  We will be Zooming with the family shortly which is better than nothing, but certainly not the same as reading a book with a grandchild on your lap in front of the fireplace.  Nevertheless, we, like everyone else, are doing what we can to make the best of the current circumstances and look forward to the day, hopefully in the not too distant future, when we can be together again in person.

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Bringing out the best

Social media and the news these days are full of reports on how some people struggle to fill their days with meaningful activity. This has not been a challenge for HCCC faculty, staff, students and volunteers. The mission of Holden Comprehensive Cancer Center – “to decrease the pain and suffering caused by cancer in Iowa, surrounding communities, and the world through improved cancer prevention and treatment based on three interdependent missions of research, clinical service and education” – is unchanged. Needless to say, our approach to addressing this mission has been impacted significantly. We have adjusted to, and indeed thrived through, this challenge because of the remarkable members of our team.

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Managing the unmanageable – My e-mail inbox

I am no expert in organizational skills or efficiency. I have not taken a course or read any of the many books or articles describing how to manage the tsunami of incoming information that hits our e-mail inboxes every day. Nevertheless, I have, over the past few years, developed a system of managing e–mail overload that is functional for me. I am continually tweaking my system which is far from perfect and is tailored to my own needs. I do not see it as a model system for others to adapt. The reason I decided to share it is to help those who send me e-mails understand how you might get a more rapid and thoughtful response. In addition, it is a plea for suggestions. If you have identified other tricks to manage e-mail that might fit into this schema, please let me know!

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Who you get to work with…

I was sitting in the airport waiting for a flight recently (something I do all too often) when I overheard the beginning of what appeared to be a conversation between a grandfather and his teenage granddaughter about choosing a career. The conversation started with the grandfather giving thoughtful, if somewhat standard advice. First, the grandfather advised his granddaughter to pick a career that would provide enough financial return to consistently put food on the table. Second, he suggested finding a field that would not get boring even after many years on the job. Third, he recommended finding work that had meaning. I suspect the conversation went on from there but I had to leave to catch my plane.

This got me thinking about my own career choice and what advice I would provide in a similar situation. I agree with the points made by the grandfather, although I suspect I would have put them in a different order. There is another point I would have made that has been key to making my job so enjoyable through many years. That is to select a job where you respect the people you work with every day.

Many of us spend nearly as much time with our “work families” as we do with our real families. This includes time with co-workers in our own organizations who are above, parallel or below us on the organizational chart as well as interactions with colleagues from outside organizations. I have an extremely varied and extended work family. Within the Holden Comprehensive Cancer Center and the University of Iowa, this family includes

  • Doctors, nurses, pharmacists and other clinicians who care for cancer patients
  • Researchers with a broad variety of backgrounds who spend their lives conducting basic laboratory, clinical and community based research
  • Teachers and educators who train the next generation of care givers and investigators
  • Students who are starting their careers in patient care and research
  • Support staff and administrators who keep all our efforts and operations on track
  • Volunteers and advocates who donate their time, energy and passion

I also have the privilege of working extensively with colleagues from other cancer centers, institutions and organizations with overlapping missions.

These colleagues have varied skill sets and backgrounds, and are employed by different organizations, but share the same overall vision and passion. The members of my work family are not people who are driven by the desire to make as much money as possible, gather as much power as they can accumulate or gain celebrity. They are dedicated professionals who believe in the mission we all share which is to reduce pain and suffering from cancer.

We see eye-to-eye on some issues and disagree on others. Sometimes we are told “no” by a colleague after putting a huge amount of effort into a concept we believe is the right way to go, and other times we need to say “no” to a very reasonable and well thought-out request. We deal with incredibly challenging and, at times, heart-wrenching situations where we have to rely on each other for support and guidance. The only way to do this day in and day out, and still enjoy the job, is to respect and appreciate the colleagues we work with every day.

My own granddaughter is only 2 years old, but if I have the good fortune of being in an airport with her several years down the road having such a conversation, I will advise her to choose a career where she gets to work every day with people she respects.

Uncertainty in cancer. This time it’s personal.

I thought very carefully about whether or not to post this blog because it is, as the title suggests, quite personal. I decided in the end it was a story worth sharing.

As oncologists and other medical professionals, we deal with uncertainty all the time. We know that even when the path forward is clear, outcomes for our patients can vary. A real challenge comes when we need to make a recommendation despite having only limited data to help guide our recommendation. This can result in multiple reasonable alternative recommendations. The patient may present with a unique health problem or have personal desires and goals that impact our interpretation of how available data applies to that patient. Health care professionals have experiences with other patients with similar scenarios that impact our perspective. The discussion with patients and their loved ones often starts at a very basic level given their limited prior knowledge. These discussions are often nuanced and time consuming given the complexity of the issues at hand. They require us to balance all of these uncertainties as we communicate to our patients our recommendations among various choices, all with the understanding that our recommendations will impact patient decisions and ultimately their lives. Doing so effectively is a large part of the art of medicine.

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Breakthroughs and abuse

Technological breakthroughs often lead to both wonderful opportunities for advancement and potential for abuse. Nuclear physics and the internet are two undeniable examples. A third example was prominent in the news recently when a scientist in China, Dr. He, reported that he had genetically modified the DNA of twin girls using a very powerful new genetic tool known as CRISPR. The modification he claimed to have made (a claim that is unverified at present) is that he removed, or “knocked out” a molecule known as CCR5 that is known to be the entry point of the HIV virus into cells. His stated goal was to increase the ability of these girls to resist HIV, the virus that causes AIDS.

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In cancer research, people and pets are side by side

Earlier this summer, I had the opportunity to visit the Iowa State University (ISU) College of Veterinary Medicine to give a seminar and meet with some of the faculty, staff and students there. I was not quite sure what to expect. I have visited many “human” medical centers but had never visited a world-class animal hospital before. It was fascinating.

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Grateful non-patients

One of the great privileges of my job is talking to grateful patients and their families. It is hard to imagine anything more rewarding than hearing a heart-felt thank you from a patient impacted by cancer who has returned to a healthy, happy and productive life due to progress made possible by the research being conducted at Holden and delivery of state-of-the-art cancer care. Such conversations help many of us keep going despite the many challenges we face working in such a difficult field. In addition, support from grateful patients and their families provides us with philanthropic resources that are vital to accelerating progress in areas as diverse as pilot research projects, recruitment of new faculty, education for oncology nurses and patient amenities. Such grateful patients are vital partners in our efforts to reduce the burden of cancer even further.

Well, on second thought, I said “it is hard to imagine anything more rewarding,” when in truth I can imagine something more rewarding. That would be knowing that our efforts had prevented cancer from occurring in the first place. Solid research indicates reducing use of tobacco, encouraging healthy diet and exercise, increasing rates of HPV vaccination, limiting both natural and artificial exposure to harmful UV rays, testing and mitigating radon exposure and helping patients obtain screening for both pre-cancerous lesions and early cancers all contribute to reducing the burden of cancer by preventing it from occurring in the first place.

Cancer prevention and cancer therapy are alike in that we have considerable progress in both areas, yet there is much more we need to do. However, cancer prevention and cancer therapy are very different in that cancer prevention is unlikely to lead to grateful patients saying thank you. Individuals whose cervical cancer was prevented by the HPV vaccine or lung cancer avoided because they paid attention to anti-smoking messages they heard as teenagers are not cancer patients and go about their lives without ever knowing the impact cancer prevention efforts had on their lives. You and I, as well as our loved ones, may well have benefited from such cancer prevention efforts.

So, next time you think about our past, current and future efforts to reduce the burden of cancer, think about the vital role cancer prevention plays in that effort. If you see a scientist, physician or public health worker dedicated to cancer prevention, give them a big thank you. You never know whether you owe them a huge debt of gratitude. Those of us who are fortunate enough to not have been diagnosed with cancer should consider ourselves “grateful non-patients” who, due to cancer prevention efforts, did not develop cancer in the first place. Finally, support for ongoing cancer prevention efforts from both grateful patients and grateful non-patients is needed to assure we succeed in tipping the balance towards more grateful non-patients in the years ahead. It truly is hard to imagine anything more rewarding than that.

The War Metaphor

I often start talks I give on cancer research with a discussion of the war on cancer. To be honest, I have a very mixed relationship with this metaphor.

The concept of the war on cancer was first popularized in 1971 by President Richard Nixon and used in a more nuanced manner more recently by Vice President Biden. This metaphor emphasizes how working together against a formidable foe will improve our lives and those of future generations. It speaks to the need for immense dedication, focus, sacrifice and persistence to achieve a noble goal. The war on cancer implies a need for teamwork by multiple sectors of society, including civilly minded citizens, government, academia and the private sector. It also implies there is an identifiable enemy, and that total victory is possible. This last point is where the metaphor of the war on cancer starts to break down. In 1971 our knowledge of cancer was quite primitive. We thought of cancer as a single disease where a single approach to victory was possible. We now know that cancer is not a single disease but multiple diseases. Indeed, every cancer is unique and personalized approaches are required for success. In other words, in the war on cancer, there is no single and simple way to target and defeat the enemy.

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