Monthly Archives: June 2006

Secondhand Smoke: The Surgeon General’s Report

Twenty years ago, Surgeon General C. Everett Koop wrote, “The right of smokers to smoke ends where their behavior affects the health and well-being of others.”


Today, the current Surgeon General, Richard Carmona, MD, emphasized that statement and added evidence to the argument that secondhand smoke, or involuntary exposure to tobacco smoke, has severe health consequences. 


His report released this morning and titled “The Health Consequences of Involuntary Exposure to Tobacco Smoke” is thorough and hard hitting, with a clear message.


The evidence cannot be overlooked: secondhand smoke kills, secondhand smoke harms, and secondhand smoke has no safe limit of exposure.


And, according to the Surgeon General, the only effective strategy to reduce the adverse health effects of secondhand smoke is to remove it from our work, home, recreational and hospitality environments.  Anything less than a complete ban simply won’t work.


We have come a long way over the past four decades regarding our knowledge of the harms of cigarette smoking.  There likely aren’t many folks who aren’t aware of the dangers of smoking cigarettes, and for many who do smoke there are many who try repeatedly to quit.


We … Continue reading →

“Rational” Drug Development: Faster and Faster

I apologize for the lapse in recent postings.  Lots of travel and other obligations have kept me busy in other areas of responsibility.


This week should be more interesting, with the Surgeon General’s report on second hand smoke due out tomorrow.  Next week is some short vacation time for July 4th, but the week after that will be a busy one with the 2006 International Cancer & Tobacco Control Conferences in Washington DC.


Before I forget, if you have the opportunity, tune in to Discovery Health Channel tomorrow (Tuesday) evening at 9PM EDT.  The program is titled “Relay for Life: Giant Steps” and it talks about the importance of the American Cancer Society’s Relay for Life through the eyes of cancer survivors and their families.  I found it to be very moving, and I hope you will as well.


About 10 days ago the New England Journal of Medicine published two articles and an editorial about some exciting advances in the treatment of chronic myelogenous leukemia.


It wasn’t just the research that got my attention.  It was the implications attached to the research that were captured in the accompanying … Continue reading →

Gardisil and The Prevention of Cervical Cancer

The major health news today is that the FDA has approved a new vaccine which will prevent many cases of cervical cancer.


The vaccine, called Gardisil and developed by Merck, has been approved for administration to girls ages 9 through 26 who have not begun sexual activity.


In my opinion, this development is transformational for medicine and medical practice, and will have a substantial impact on the health of women in this country and elsewhere.


9710 women expected to be diagnosed with cervical cancer in this country in 2006, and it is expected that 3700 women will die from this disease. 


What is truly remarkable is that there are going to be over 1.5 million women in the United States who will be diagnosed with pre-cancerous lesions of the cervix that require the follow-up and possible treatments I mentioned above. 


The cost of treating cervical disease each year in this country is approximately $3.5 billion dollars, not to mention the loss of productivity and anxiety associated with these diagnoses and treatments.


Gardisil has the potential to reduce deaths from cervical cancer throughout the world, which is critically important since cervical cancer … Continue reading →

STAR Trial: Side Effects in The Uterus Are Key

Yesterday I posted a commentary on the STAR Trial presented at the ASCO meetings.


One of the issues that has received considerable attention in discussions about this trial is the importance of the increased risk of uterine cancer as a determining factor in which drug–raloxifene or tamoxifen—is a better prevention strategy for post-menopausal women who have a high risk of developing breast cancer.


But there is another factor that has received somewhat less attention, and that is the observation that the women taking tamoxifen had over twice as many hysterectomies during the trial compared to women who took raloxifene.  There was no clear explanation for this difference, according to the researchers.


Maybe I can shed some light on the reasons for this, and why this may be an important consideration for women who are contemplating taking one of these medications to decrease their risk of breast cancer.


First, a bit of background.


Tamoxifen is a drug that has been used for over 3 decades.  During that time, it has had a remarkable track record of helping women who had recurrent, hormone-sensitive breast cancer.  Subsequently, it has also proven effective … Continue reading →

Preventing Breast Cancer: The STAR Trial Revisited

Several weeks ago, prominent researchers announced the results of a large clinical research trial called the STAR Trial (for “The NSABP Study of Tamoxifen and Raloxifene P-2 Trial”).


This trial was designed to find out whether a drug called raloxifene, which is commonly used to prevent and treat osteoporosis, was as effective as a drug called tamoxifen in preventing breast cancer in women at high risk of developing this disease.


The enthusiasm of the researchers who spoke at the news conference that the “new drug” (raloxifene) was clearly superior to the “older drug” (tamoxifen) resulted in numerous articles and comments by experts that perhaps their excitement was perhaps a bit premature.


Yesterday, at the annual meeting of the American Society of Clinical Oncology, some of the questions about the trial were answered.


But I still don’t think we have a clear “winner.” 


We have known for about 7 years that tamoxifen, a drug that first became available in the mid-1970’s for the treatment of recurrent breast cancer, is effective in reducing the incidence of breast cancer by about 50% in women who have a high risk of developing breast cancer, based on a … Continue reading →

ASCO: Genes, Targets, and The Future

I am presently sitting in a lecture hall at the American Society of Clinical Oncology annual meeting listening to a presentation by one of the world’s experts on the sequencing of the human genome. 


The expert, Dr. Francis Collins, is discussing how much we have learned over the past several years about our genes and how they relate to cancer, and how much we will continue to learn about this topic over the next several years.


The progress we have made in this arena has been truly astounding.  And it is exciting to anticipate how much more we are going to learn in the near future.


The practical implication is that we will be able learn more about an individual’s cancer, and how to best treat that cancer with drugs specifically targeted to that cancer.  We may also learn which cancers have a good prognosis and which ones don’t, and then be able to determine whether or not an individual needs intensive therapy or will do well with observation alone.


Another highly regarded expert, Dr. Dennis Slamon, yesterday afternoon presented a review of his research that led up to the development

Continue reading →

ASCO: Breast Cancer and Targeted Drugs

So much can happen in a year, or so it seems when listening to the presentations currently underway at the annual meeting of the American Society of Clinical Oncology in Atlanta.


At last year’s gathering, the news that Herceptin (trastuzumab) reduced the recurrence of breast cancer after primary treatment in a select group of women whose tumors had a gene called HER/neu2 was greeted with unprecedented cheers and applause from the thousands of cancer specialists in attendance.


This year, the chair of the session which reviewed the current state of knowledge on the use of Herceptin and similar drugs as treatments for breast cancer in the adjuvant and recurrence settings made a startling statement.


The doctor, Eric Winer MD, noted that much progress has been made in this area over the past 10 years.  Looking forward, he noted, he anticipates over the next 5 or 10 years that we will be looking back at women with this particular type of breast cancer and realize that they will be the first group of cancer patients where our research resulted in an almost complete reduction in deaths from this disease.


That is a bold statement, … Continue reading →