I never took psychology in school and it is definitely one of my weak points. I am not good at using psychology, since I am ignorant of even the very basic tenets. I read a book called “On Success” by famed investor Charlie Munger, who talked about how important psychology is in business and management. After reading what he had to say, I really felt like there was a huge hole in my education.
Munger, who was self-taught in psychology, came up with his own list of human tendencies or behavioral patterns, one of which he calls the “Reward and Punishment Super Response Tendency.” This is the first on his list of twenty-five human tendencies, in recognition of how important incentive and disincentive is to human behavior. Munger summarizes the issue with a famous quote from a Soviet worker: “They pretend to pay us and we pretend to work.” Munger says that the most important rule in management is to “get the incentives right.”
He describes how Federal Express at first struggled to get packages shifted rapidly between aircraft at the central hub each night. Everything they tried did not get the task accomplished quickly enough. Then someone had the brilliant idea to pay the night shift by the shift, rather than by the hour, and let them go home early if all the planes were loaded. That simple and elegant solution worked.
Munger talks about what he calls “incentive-caused bias” that leads to immoral behavior. His example is a surgeon in Lincoln Nebraska who removed “bushel baskets full of normal healthy gallbladders”. This medical fraud was rationalized by the surgeon, who believed the gallbladder was the source of all disease. He was well paid to exercise his talent, whether the patient needed the gallbladder removed or not. HE was eventually removed from the medical profession and rightly charged with malpractice.
Incentive-caused bias is prevalent in every business and profession. Bad or immoral behavior, according to Munger, is “intensely habit forming when well rewarded.” We have certainly seen many examples of this in recent years. Enron’s manipulative accounting misdeeds, Bernie Madoff’s gigantic Ponzi scheme, the whole residential mortgage debacle, are examples of immoral behavior well rewarded. In my profession, it’s the insurance salesman who’s only and every answer to making an investment recommendation is an annuity that pays a high commission.
It appears to me that poorly designed incentives and controls are at the core of bad behavior in every case.
There’s an old saying that says, if the only tool in the draw is a hammer, every problem looks like a nail. We keep banging away at cancer, using chemo, radiation and surgery without getting significantly better results. Could it be that alternative treatments are less lucrative than the orthodox treatments and therefore not pursued? Are cancer patients the unwitting victims of incentive-caused bias by the medical profession?
Munger muses that the cash register was a great moral instrument when it was created. It ended the inventor’s employees from stealing him blind. Widespread incentive-caused bias in all human endeavors causes Munger to distrust professional advice, especially if it is good for the advisor. How would Munger feel if he were a cancer patient?
I got to thinking about this incentive-caused bias in relation to cancer treatment. It makes me wonder if drug companies, insurance companies and the medical industry as a whole, are properly incented to do what is best for patients. Certainly that should be the goal, but incentive-caused bias may make some treatment alternatives more attractive than others.
What is the equivalent of the cash register when it comes to treating cancer? The role of government regulation should be to ensure that the medical industry does what is best for patients. Maybe we should start by examining the incentive-caused bias in medicine. Reform needs to ensure that we get the incentives right.
Monday, May 31, 2010
Tuesday, May 25, 2010
Is the War on Cancer Over?
I watched a CBS 60 Minute story tonight about phthalates, a chemical that resides in nearly everything made of plastic that needs to be soft and flexible – shower curtains, beach balls, rubber ducks, to name but a few. These chemicals, which are used in thousands of everyday items, are allegedly linked to deformity in male genitalia, congenital hernias and changes in the hormonal balances of men. But is it really any surprise that chemicals (of any sort) in our environment have a potential negative impact on our health or our progeny?
The experts that accuse phthalates of having potential to do harm cannot say anything definitive about the toxic effect of these chemicals without “more data”. And, of course, the chemical manufacturers that make these substances deny there is any linkage to birth deformities, even though data proving this does not exist. Last year congress, “split the baby”, so to speak, by banning certain phthalates from use in toys.
When I was a kid, it seemed like we were a nation that had all the answers. John Wayne and the Lone Ranger persuaded me that the good guys in white hats always prevailed. Right won over might, usually just in the nick of time.
I grew up in an America that gloried in winning World War II. When I was a kid our nation was fighting communism and the cold war. We were the predominant economic power having invented and manufactured many of the world’s modern conveniences – the electric light, the automobile, the telephone, the airplane, the transistor, and the television. I was seven years old when John Kennedy inspired our nation to reach for the stars. In less than 10 years we landed on the moon. It seemed there was nothing we couldn’t do.
In my lifetime, America has always been the leading political, military, economic and technological power. It still is, but I have to say that, lately, my faith in America to get to the truth, figure out what’s right for the nation, and move forward with good public policy has been shaken.
I have a hard time fathoming that we could allow drilling in the ocean with deep water rigs and not have a contingency plan for a blow-out oil disaster, like the one unfolding in the Gulf. Are you kidding me? Isn’t it common sense that the government would require contingency disaster plans before issuing permits for offshore drilling? All I can say is that if they didn’t imagine this kind of thing could happen, they don’t have much of an imagination, which brings me to the topic of government sponsored cancer research.
Richard Nixon declared a “War on Cancer” in 1971, yet here we are nearly four decades later no closer to a cure than we were back then. In fact, no one talks about a cure any longer. Today, we only speak of treatments.
The basic approach to treating cancer has not changed in 50 years. The tools are new and improved, but the strategy is the same – search and destroy cancerous cells using chemotherapy, surgery and radiation. There is nothing new or radically innovative or imaginative in our approach, so it’s hard to see how the outcome will change. As my father use to say, doing the same thing over and over and expecting a different result is the definition of insanity. Perhaps it’s finally time to look at other approaches.
Someone recommended that I read Suzanne Somers’s book “Knockout: Interviews with Doctors Who Are Curing Cancer.” I purchased a copy to see what she had to say. The doctors she interviewed have interesting new strategies about curing cancer that does not involve search and destroy treatments. Why aren’t some of these non-toxic “cures” being seriously tested? First I need to find an oncologist even willing to read the book.
The experts that accuse phthalates of having potential to do harm cannot say anything definitive about the toxic effect of these chemicals without “more data”. And, of course, the chemical manufacturers that make these substances deny there is any linkage to birth deformities, even though data proving this does not exist. Last year congress, “split the baby”, so to speak, by banning certain phthalates from use in toys.
When I was a kid, it seemed like we were a nation that had all the answers. John Wayne and the Lone Ranger persuaded me that the good guys in white hats always prevailed. Right won over might, usually just in the nick of time.
I grew up in an America that gloried in winning World War II. When I was a kid our nation was fighting communism and the cold war. We were the predominant economic power having invented and manufactured many of the world’s modern conveniences – the electric light, the automobile, the telephone, the airplane, the transistor, and the television. I was seven years old when John Kennedy inspired our nation to reach for the stars. In less than 10 years we landed on the moon. It seemed there was nothing we couldn’t do.
In my lifetime, America has always been the leading political, military, economic and technological power. It still is, but I have to say that, lately, my faith in America to get to the truth, figure out what’s right for the nation, and move forward with good public policy has been shaken.
I have a hard time fathoming that we could allow drilling in the ocean with deep water rigs and not have a contingency plan for a blow-out oil disaster, like the one unfolding in the Gulf. Are you kidding me? Isn’t it common sense that the government would require contingency disaster plans before issuing permits for offshore drilling? All I can say is that if they didn’t imagine this kind of thing could happen, they don’t have much of an imagination, which brings me to the topic of government sponsored cancer research.
Richard Nixon declared a “War on Cancer” in 1971, yet here we are nearly four decades later no closer to a cure than we were back then. In fact, no one talks about a cure any longer. Today, we only speak of treatments.
The basic approach to treating cancer has not changed in 50 years. The tools are new and improved, but the strategy is the same – search and destroy cancerous cells using chemotherapy, surgery and radiation. There is nothing new or radically innovative or imaginative in our approach, so it’s hard to see how the outcome will change. As my father use to say, doing the same thing over and over and expecting a different result is the definition of insanity. Perhaps it’s finally time to look at other approaches.
Someone recommended that I read Suzanne Somers’s book “Knockout: Interviews with Doctors Who Are Curing Cancer.” I purchased a copy to see what she had to say. The doctors she interviewed have interesting new strategies about curing cancer that does not involve search and destroy treatments. Why aren’t some of these non-toxic “cures” being seriously tested? First I need to find an oncologist even willing to read the book.
Sunday, May 16, 2010
FDA Approves Tarceva for Expanded Use
Ever since they suspended the clinical trial of the maintenance drug I was on, I have worried that am doing nothing to proactively prevent a recurrence. I feel like I am just waiting around for cancer to strike again. It makes me uncomfortable and anxious. I would rather take the fight to the enemy than do nothing. So I have been reading up on things I can do on my own.
One of the best things I can do is fight this disease with nutrition. Everything that I have been reading has led me to believe that the key to cancer-free health is good nutrition. Fruits and vegetables that are high in antioxidants are known to be beneficial. I am drinking POM Wonderful (pomegranate juice) nearly every day.
I was approached by one multi level marketer recently who recommended a drink called Xango, which is made from the mangosteen fruit. I tried a complementary bottle. It is better tasting than Mona Vie, which is made out of the acai berry, but I think they are in the same class of product – high priced juice drinks with potential (although unproven) health benefits. (I think I’d be just as well off with low-priced fruit juice concentrates from Publix.)
I’ve been complaining about our Food and Drug Administration for some weeks now because I don’t see them doing anything useful, (except creating roadblocks and obstacles to cancer research and fretting about innocuous fruit drinks that may actually be helpful.)
As they did for POM Wonderful, the FDA did put out warning letters to the makers of both Xango and Mona Vie to not make medical claims about their products in their advertising. But does that mean these drinks don’t have any medicinal benefit? No. What I think it means is that they don’t have any measured benefits meeting the FDAs scientific standards for a “drug.”
This is the same FDA that recently approved the chemotherapy drug Tarceva (erlotinib) as maintenance therapy for patients with locally advanced metastatic lung cancer, despite a nearly unanimous (11-1) vote AGAINST expanded use of the drug by the FDA’s own panel of experts who examined the evidence.
Why do you think the powers that be in the FDA overruled its own experts?
In the SATURN trial, nearly 900 patients with advanced non-small cell lung cancer received four cycles of first-line platinum-based chemotherapy. Patients were then split into two groups: one received placebo, and the other received maintenance Tarceva.
For patients on Tarceva, median progression-free survival (the time before the cancer progressed) reached 12.3 weeks, compared with 11.1 weeks for patients taking placebo. The Tarceva group lived only slightly longer, with median overall survival reaching 12 months for patients on Tarceva versus 11 months for those on placebo.
Sounds to me like Tarceva as a “maintenance drug” has as much benefit as POM Wonderful, Xango, or Mona Vie. Only Tarceva costs around $2000 per month, about 20 times more than high-priced medicinal juice!
Until now Tarceva has been limited to use for advanced lung cancer that grew or spread after first line chemotherapy. Tarceva, an oral drug, is known to work well for those people who have the EGFR (epidermal growth factor receptor) gene mutation, which is only about 10% of lung cancer patients with non-small cell lung cancer.
At the National Lung Cancer Advocate Summit a few weeks ago, some of us fighting for lung cancer research were dumfounded that the FDA would approve expanded use of Tarceva for maintenance therapy when we know that it does NOT work for most lung cancer patients.
OSI Pharmaceuticals, the maker of Tarceva, is surely pleased to now have approval to market their drug to a much larger universe of patients. It won’t be long before we see TV commercials for the approved use, no doubt, urging lung cancer patients to “ask your doctor about Tarceva.” It’s an abomination.
One of the best things I can do is fight this disease with nutrition. Everything that I have been reading has led me to believe that the key to cancer-free health is good nutrition. Fruits and vegetables that are high in antioxidants are known to be beneficial. I am drinking POM Wonderful (pomegranate juice) nearly every day.
I was approached by one multi level marketer recently who recommended a drink called Xango, which is made from the mangosteen fruit. I tried a complementary bottle. It is better tasting than Mona Vie, which is made out of the acai berry, but I think they are in the same class of product – high priced juice drinks with potential (although unproven) health benefits. (I think I’d be just as well off with low-priced fruit juice concentrates from Publix.)
I’ve been complaining about our Food and Drug Administration for some weeks now because I don’t see them doing anything useful, (except creating roadblocks and obstacles to cancer research and fretting about innocuous fruit drinks that may actually be helpful.)
As they did for POM Wonderful, the FDA did put out warning letters to the makers of both Xango and Mona Vie to not make medical claims about their products in their advertising. But does that mean these drinks don’t have any medicinal benefit? No. What I think it means is that they don’t have any measured benefits meeting the FDAs scientific standards for a “drug.”
This is the same FDA that recently approved the chemotherapy drug Tarceva (erlotinib) as maintenance therapy for patients with locally advanced metastatic lung cancer, despite a nearly unanimous (11-1) vote AGAINST expanded use of the drug by the FDA’s own panel of experts who examined the evidence.
Why do you think the powers that be in the FDA overruled its own experts?
In the SATURN trial, nearly 900 patients with advanced non-small cell lung cancer received four cycles of first-line platinum-based chemotherapy. Patients were then split into two groups: one received placebo, and the other received maintenance Tarceva.
For patients on Tarceva, median progression-free survival (the time before the cancer progressed) reached 12.3 weeks, compared with 11.1 weeks for patients taking placebo. The Tarceva group lived only slightly longer, with median overall survival reaching 12 months for patients on Tarceva versus 11 months for those on placebo.
Sounds to me like Tarceva as a “maintenance drug” has as much benefit as POM Wonderful, Xango, or Mona Vie. Only Tarceva costs around $2000 per month, about 20 times more than high-priced medicinal juice!
Until now Tarceva has been limited to use for advanced lung cancer that grew or spread after first line chemotherapy. Tarceva, an oral drug, is known to work well for those people who have the EGFR (epidermal growth factor receptor) gene mutation, which is only about 10% of lung cancer patients with non-small cell lung cancer.
At the National Lung Cancer Advocate Summit a few weeks ago, some of us fighting for lung cancer research were dumfounded that the FDA would approve expanded use of Tarceva for maintenance therapy when we know that it does NOT work for most lung cancer patients.
OSI Pharmaceuticals, the maker of Tarceva, is surely pleased to now have approval to market their drug to a much larger universe of patients. It won’t be long before we see TV commercials for the approved use, no doubt, urging lung cancer patients to “ask your doctor about Tarceva.” It’s an abomination.
Tuesday, May 11, 2010
Getting Back to Basics
When I was first diagnosed with lung cancer, I couldn’t contemplate any future or make any plans. As time has gone on, however, things have returned to normal and I am again thinking about what comes next and what our life will be like down the road a bit. I am feeling so well these days, it is hard to imagine that I could relapse at any time.
Yoko and I are making travel plans for this summer. She has to return to Japan to attend her mother’s seven year memorial service in August. It’s customary in Japan to remember loved ones who have passed on the third and seventh anniversary of their death. So, Yoko and Jessie are going to Tokyo together at the end of July.
We decided that Yoko, Moe and I will drive to Blue Ridge, Georgia the week prior to her departure. We’ll spend a few days together in a mountain cabin. Then, at the end of the week I will drive Yoko to Atlanta so she can catch a plane to Tokyo.
I’m going to return to Blue Ridge by myself while Yoko is gone and try to finish a screenplay I started years ago. A few weeks of uninterrupted effort is all I need to finally finish the job.
We decided to make a dry run and fly to Blue Ridge this weekend to check out cabins and become familiar with the place. When we return in the summer we’ll take the car, but for this short weekend trip we decided to fly.
I have to say I am glad I don’t travel by air as much as I once did. I can’t stand the hassle and intrusion of airport security, the mobs of people, the delays and stress of making connections, the screaming babies who are invariably seated near you, and the airlines’ consistently poor service. On this latest flight the “meal service” offered was a bag of salted peanuts. Yippee.
Lately I have become more acutely aware that our national life is changing and not for the better. Every day I wake up and things seem worse than they were before. Nothing is as it was and everything is more complex. Sometimes I wonder if simplifying and getting back to basics wouldn’t be better.
In Blue Ridge today there was a “classic car” show on Main Street. Most of the cars being shown were beautifully restored models from the 50’s and 60’s. I could look at the gleaming, chrome-plated engines and actually see how everything fit together and worked. I can’t say that if I look under the hood of a car today I could really tell what’s what.
The log cabin we are staying in has all the modern conveniences, but none of the clutter. We have no neighbors and at night it is perfectly peaceful. We’ve only been here two days and I already feel like we’ve stayed a week. Living in a rustic setting has made me nostalgic for the past.
Tonight I made a fire on the cabin porch and shared a bottle of wine with Yoko as the sun was setting. I was recalling the days as a kid when we chased fireflies, toasted marshmallows on an open fire, and lay in the grass to watch the night sky for shooting stars. We had no worries and life was simple.
I don’t often think about the past and what life was like when I was a child, but the uncertainty and complexity of the modern world has me yearning for those “good ole days”.
Our trip to Blue Ridge this weekend happily coincided not only with Mother’s Day, but Yoko and my 29th Wedding Anniversary and last night we watched a movie about divorce aptly called “It’s Complicated.” But really, it’s simple. Stay married!
Yoko and I are making travel plans for this summer. She has to return to Japan to attend her mother’s seven year memorial service in August. It’s customary in Japan to remember loved ones who have passed on the third and seventh anniversary of their death. So, Yoko and Jessie are going to Tokyo together at the end of July.
We decided that Yoko, Moe and I will drive to Blue Ridge, Georgia the week prior to her departure. We’ll spend a few days together in a mountain cabin. Then, at the end of the week I will drive Yoko to Atlanta so she can catch a plane to Tokyo.
I’m going to return to Blue Ridge by myself while Yoko is gone and try to finish a screenplay I started years ago. A few weeks of uninterrupted effort is all I need to finally finish the job.
We decided to make a dry run and fly to Blue Ridge this weekend to check out cabins and become familiar with the place. When we return in the summer we’ll take the car, but for this short weekend trip we decided to fly.
I have to say I am glad I don’t travel by air as much as I once did. I can’t stand the hassle and intrusion of airport security, the mobs of people, the delays and stress of making connections, the screaming babies who are invariably seated near you, and the airlines’ consistently poor service. On this latest flight the “meal service” offered was a bag of salted peanuts. Yippee.
Lately I have become more acutely aware that our national life is changing and not for the better. Every day I wake up and things seem worse than they were before. Nothing is as it was and everything is more complex. Sometimes I wonder if simplifying and getting back to basics wouldn’t be better.
In Blue Ridge today there was a “classic car” show on Main Street. Most of the cars being shown were beautifully restored models from the 50’s and 60’s. I could look at the gleaming, chrome-plated engines and actually see how everything fit together and worked. I can’t say that if I look under the hood of a car today I could really tell what’s what.
The log cabin we are staying in has all the modern conveniences, but none of the clutter. We have no neighbors and at night it is perfectly peaceful. We’ve only been here two days and I already feel like we’ve stayed a week. Living in a rustic setting has made me nostalgic for the past.
Tonight I made a fire on the cabin porch and shared a bottle of wine with Yoko as the sun was setting. I was recalling the days as a kid when we chased fireflies, toasted marshmallows on an open fire, and lay in the grass to watch the night sky for shooting stars. We had no worries and life was simple.
I don’t often think about the past and what life was like when I was a child, but the uncertainty and complexity of the modern world has me yearning for those “good ole days”.
Our trip to Blue Ridge this weekend happily coincided not only with Mother’s Day, but Yoko and my 29th Wedding Anniversary and last night we watched a movie about divorce aptly called “It’s Complicated.” But really, it’s simple. Stay married!
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