Been a quirky week here in Cancer Land (copyright, trademark). But then, it’s been something of a quirky week in the world at large.
But before we go there, let’s check in on a recently-reported archaeological finding. 3,000 years ago what is now Sudan northeast Africa was part of the Egyptian empire. At that time, human beings lived under considerable environmental stress. Water was polluted by human and animal waste, and may have been saline during dry seasons as evaporation left minerals on the irrigated soils. Almost all social interaction took place around smoky open-hearth fires. Parasites and diseases were chronic, universal, and endemic. Nutrition was sketchy. Ingested food and water came with baggage of solids and filth. So it’s not a surprise that a 30 year old guy entombed with his family and some grave goods had cancer. What IS surprising is that his cancer wreaked so much havoc on his physiology that his skeleton is riddled with obvious tumors [1].
Sternum bone from the Egyptian cancer guy showing destruction wrought by his tumors [2].
If you take a moment to check out the photos at [3], you’ll be amazed. By the time this guy died, his entire skeleton was riddled with invasive tumors. I’m having a little trouble projecting from my own experience of 3 tumor sites, which were seriously painful enough, to this guy, who seems to have basically been a dead tumor walking for what must have been years.
Ouch. But the lesson for us is clear. Cancer has been part of the human condition for pretty much as long as humans have been human. Which makes it all the more remarkable that science in our time is closing in on a full understanding of the origins, mechanisms, outcomes, and treatments for cancer. We will soon have the ability to chisel cancer away from our bodies. In the not-too-distant future, we’ll be able to sculpt human beings into physiologically robust specimens and leave cancers on the studio floor with the marble dust.
Anyway. My own physiology at this point is an odd amalgam of outcomes, sort of a weighted-average of the effects of disease and its treatment. And it is not a stable, finished product. My body continues to change, with the processes of response to cancer and cancer treatment overlaid on the more mundane aging processes of a 61 year old person.
In general, the daily production of mucous in my beat-up mouth and throat seems to be declining. Which I take as a very good thing. It is discomfiting for me to undertake something as simple as a trip to the grocery store to fill out a shopping list. I have to find corners to hide in periodically as the need to mop up body fluids pouring from various orifices is too disgusting to subject my fellow shoppers to.
However, while the decline in production of goo is most welcome, for some reason this week I started to hack up considerable quantities of fresh blood. This is scary enough on its own to me, and takes that social interaction in the “Cookies, Crackers, Snacks and Soft Drinks” aisle at the supermarket to a whole new level.
Anyway. I need spring to get here so I can get my butt out of the recliner and into the woods. I know more minute and repetitive details about mysteriously lost airplanes and the uncomfortable condition the people of the Ukraine find themselves in than is healthy.
And health, after all, is the key objective. With a little luck, by the end of this week I’ll be able to take my shiny new 50X optical zoom lens out to the riparian ecosystems of the Patuxent River to document this year’s return of the environment from its (unusually cold and snowy) winter shut-down. Expect quirky photographs of birds, salamanders, and other wildlife to begin appearing with this weblog. And, as always, make sure you Rock the Hell On (copyright, trademark). Live ‘em while you got ‘em is the bottom line lesson of cancer. And spring is the perfect time to crank up the volume on the processes of life!
Notes
[1] http://www.cbsnews.com/news/3000-year-old-skeleton-found-riddled-with-cancer/
[2] http://www.livescience.com/44269-oldest-metastatic-cancer-skeleton.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Livesciencecom+%28LiveScience.com+Science+Headline+Feed%29
[3] http://www.livescience.com/44261-photos-ancient-egyptian-skeleton-cancer.html
I began to travel overseas in the early 1990s, just as the Cold War was winding down. Economic and social conditions were in a state of flux worldwide as nations and peoples adjusted to new realities. In some places—particularly the non-Russian chunks of the Soviet Union—square pegs got to reconfigure the round holes they’d been stuffed into, and things got more comfortable. Elsewhere, people who had settled into cozy niches found themselves adrift, and a certain amount of shape shifting took place. China, where, oddly, I began my foreign travel adventures, was in this boat. With the Soviet Union reduced to rubble, and capitalist Japan ascending, China started to loosen the duct tape wrapped around its socioeconomic plumbing.
In the twenty-plus years after my inaugural trip to China, I was privileged to visit extraordinary places in Asia, the Middle East, the Caribbean, and Europe. By the nature of my work, and personal preference when I had the chance, I spent a lot of time beyond the regular tourist haunts. In fact, as I bounced back and forth between the luxury of multi-starred hotels and the impoverished hinterlands and slums, things stirred in the corners of my brain (doesn’t happen often, I have to take full advantage of the circumstances when it does). The thing is, by 1990, electronic technology was universal. To a degree. I was often shocked to find, deep in the dark alleys or far out in the muddy peasant farms, television and computers. In China, there was a village of a dozen tiny cabins in the middle of endless rice paddies. The village goose had the job of driving off the water buffalo if the latter wandered into “town” looking to chow down on onions, turnips, tomatoes, and flowers in the little kitchen gardens. And in the little bodega purveying tobacco, alcohol, and other necessities, was a desktop Dell, running MS Windows and hooked up to the web. In the Philippines, a similar bodega deep in a flood-damaged neighborhood of improvised sheet metal and fiberglass shacks had a television running 24/7, people gathered around it at all hours.
Here’s the thing. The people in these communities struggle to subsist. There is next-to-no money, spotty schools, only the most basic medicine. And smack in the middle of the endless grinding poverty? Why, there’s a television or a computer showing life in the hygienic, overfed, safe, warm and dry world of wealth. What piqued at the corners of my mind was this: there are billions of people so impoverished that just living through the night is a victory. And right up in their faces is the constant electronic reminder of what life is like in the clean world. After two decades of observation, it dawned on me that the long-gone Cold War, and the ongoing Great Games of international politics, despite the frightening nature of their potential consequences, are not the most pressing dangers of the human ecosystem. The real tension is between the billions of people in tropical squalor, scraping by on next to nothing, and the millions of the rest of us here in the comfy temperate world, where the most universal problem is obesity.
For years and years, I struggled to understand why the billions of people in the impoverished tropics didn’t simply rise up, grabbing shovels and machetes on the way, and pour into the world of the wealthy, sticking our heads on pikes in the killing fields of the US, UK, EU, and other clean, wealthy, havens of civilization.
Well, it turns out that what was my personal nagging concern is beginning to manifest in the real world, right now. Several thousand people walked from sub-Saharan African hell to Israel, where nobody knows what to do about them. I just finished watching the (excellent) movie “Captain Philips”, where desperate Somalis have taken to piracy. The Washington Post this week ran a story about skyrocketing immigration from North Africa to Italy. Here in the US, we host millions of people from Central and South America who came because less-than-minimum-wage jobs here beat starvation and disease in their steamy homelands.
I don’t know where the world goes from here. But I believe the problem of pent-up global poverty is the single most important issue we have to come to grips with. Beating out climate change, industrial pollution, collapsing biodiversity, and the end of fossil fuels. It’s just gonna be nasty.
Like so many things in the fractal biosphere, there is an organismal analog of the ecosystem problem. And cancer is probably the best example. Cancers only appear after a complex sequence of cellular changes has taken place. Right up to the point where physiological dysfunction triggers actual cancer, the cellular changes are benign, or at least hidden. Very much like the grinding poverty of the tropical world, cancer doesn’t explode into action until a high threshold of physiological dysfunction is crossed.
Maybe we should, as a society, think a little bit about this analogy. Because the silent build-up of precancer conditions, when it hits that trigger, becomes an enormously dangerous problem.
And it’s one that, even as spring is coming here in the mid-Atlantic landscape, I continue to struggle with. For reasons I can’t fathom, I seem to have some kind of physiological cycle in my day-to-day health. I can go for a week or two or even three feeling almost healthy, almost comfortable, almost functional. And then, all of a sudden, I’ll have a stretch of days where I regress into uncomfortable illness. During the good times, when I take my meds, I feel powered up, sort of like some first-person shooter game where the characters can grab “power” modules as they plod through the hallways and alleyways of their digital world.
And when I have bad days, my medicines are really important, making the difference between being marginally functional vs. total collapse.
In any case, deep into my fourth year of cancer survivorship, I’m grateful for the simple fact that I’m here to experience good days and bad days. Because the alternative, which was dangerously close several times during my treatment, is that I ain’t here to experience nothin’.
So I’ll take those bad days. In fact, I’ll see your bad days, and raise you a couple good days. I’m alive. And, at least for the moment, that is just awesome. Hang in there, everybody. Spring is on the way. Remember the key lesson of cancer. You gotta live ‘em while you got ‘em. Rock the hell on!!!
Here’s a bit of visually artistic fun from the usually intense and buttoned-down world of cancer research. Bioengineers have created a mouse in which every cell in the animal has a receptor for a fluorescent dye molecule. When a disease protein called “Rac” is active, the cell fluoresces blue. When the Rac protein is inactive, the fluorescence changes to yellow [1].
Among the many entertaining activities that this bit of genetic engineering makes possible is observing drug efficacy in real time. Apparently you can see cells change from blue to yellow as chemotherapeutic pharmaceuticals reach malignant cells with the color-coded Rac receptor. The report says "You can literally watch parts of a tumor turn from blue to yellow as a drug hits its target. This can be an hour or more after the drug is administered, and the effect can wane quickly or slowly. Drug companies need to know these details -- specifically how much, how often and how long to administer drugs.
Immediately above is a microscope photo of mouse breast tumor tissue. The blue areas are where the Rac protein is active. These cells may proliferate in place, building a tumor one fluorescent cell at a time. Rac activity also indicates cells likely to move, and so spread the malignancy to secondary tumor sites. The yellow cells have slurped up some of the chemotherapy drugs, and their Rac proteins—and tumor activity—are constrained.
The report at [1] quotes researchers as saying “the great thing about this mouse is its flexibility”. Brings to mind a sort of “Cirque de Rodente”, with glowing mice, rats, squirrels, capybara, beavers, chipmunks, pocket gophers, porcupines, jumping mice, lemmings, woodchucks, pack rats, and voles on a huge stage, running inside those little wire wheel things, climbing up and down ropes hanging from the ceiling, doing little rodent gymnastics, maybe some rodent pyramids, etc., all to slick synthesized music under creative and dynamic stage lighting.
Maybe not as entertaining as the genetically engineered “glo fish” that are all the rage in the aquarium industry. But possibly more useful in the long run.
Immediately above are some fish whose genomes have been modified so their tissues fluoresce. Sold as “Glo Fish” in the aquarium trade.
Oh yeah. I suppose it was inevitable. Fluorescent glo fish sushi is, of course, becoming more widely available. Personally, I’ll suspend judgment on this development for the moment. I’m guessing if the fish is fresh, the fluorescence won’t hamper its culinary utility. But it may be hard to swallow. You can get an introduction to this particular sideshow to the midway of serious genetic engineering matters at [2].
Immediately above is some glo fish sushi. Yum?
Anyway. I met with my Palliative Care specialist, Dr. S, this week. Recall that his primary role in my medical team is to manage my medicines. I take quite a basketful of meds these days. I think I total out at something like 6 prescription products, with an additional 3 or 4 over-the-counter drugs. I’ve actually been feeling stronger and more functional in the past couple of weeks. Which suggests the drugs are working. Dr. S was happy. I’m sure at some point he’s going to suggest we reassess and work on cutting down the quantity and diversity of pharmaceuticals I ingest every day. Indeed, I experiment with this myself. Even though insurance covers drugs, the $10 co pay is not trivial when you’re slurping 6 drugs a day that need to be renewed every month.
Discussion of medications leads to a critically important quality-of-life issue I’ve been wrestling with. Those of you who know me well know that I love overseas travel, and that traveling well is perhaps my only innate skill. I’ve been trying to figure out whether I could travel safely, where “safety” means both my health and the health of my fellow travelers. So I asked Dr. S if there were any medical constraints on my ability to travel by air.
Dr. S’s jaw dropped and he unsuccessfully tried to suppress a look of horror on his face. When he pulled himself together so he could sound more clinical and less panicked, he said he thought air travel might be a stretch, since I am a walking public health hazard due to my need to incessantly choke up masses of sticky yellow mucous which is often adulterated with blood from my damaged throat infrastructure. When I pressed him to imagine that I could find a way to keep myself from being a high-visibility health threat to others, he admitted that there were no medical reasons that should prevent me from flying.
So there you have it. All my life, I’ve assumed that when and if I got to retire, I would be able to take my idiosyncratic approach to watching the flow of life around me on the road. Should it prove to be impossible for me to do that, I’m gonna be really bummed. But I’m not giving up. I’ll start pursuing technological and medical fixes for the icky slobbering necessitated by the tracheostomy infrastructure. And you can bet that, if I come up with viable solutions, I’ll be in the air and on the road as often as possible.
It’s good to have a clear goal in life. This one might be a challenge beyond my ability to meet. But it’s not impossible that I can solve the problem. In any case, I thank you all for being here for me. You have my gratitude and my love. Rock and roll, everybody. We ain’t gettin’ any younger. Live it while you got it!
Notes
[1] http://www.sciencedaily.com/releases/2014/03/140313123131.htm
[2] http://www.glowingsushi.com/
My second round of cancer treatment started with 12 hours of surgery. After having surgeons up to their elbows in my torso for an entire long working day, there followed several other operations to remove additional chunks of my anatomy. During one of these slice-and-dice episodes, a medical-access port was run through one of the big veins in my shoulder down into the circulatory system near my heart.
Because this was basically an open tube from the hospital air to the depths of my thoracic cavity, the dressing at the top (shoulder) end had to be kept sterile. During a dressing change, the nurse who yanked up the tape sealing the hatch cover swore loudly. Then she hissed, told me not to move, and ran out of the room to find a doctor.
Doctor showed up moments later. Apparently what had happened was that the nurse felt the port tube, which features at the far (heart) end a metal needle, slip deeper into the vein. Which put my heart in immediate danger of having its hard-working smooth, aerobic muscles punctured. Which would have put me in danger of, well, dying.
Doctor yelled for the portable X-ray machine. While they set the apparatus up, I inquired about the relative risk of additional cancer induction via the radiation vs. the risk of being stabbed in the heart by the needle. The doctor looked at me funny. And explained, in the kindly and patient tone of voice reserved for those suffering from various post-traumatic stress disorders, that, yes, there is indeed a finite risk of inducing a new tumor with the radiation, but that risk was on the order of one-in-some-thousands, while the risk of being stabbed by a needle now squished down a major blood vessel to within millimeters of my heart muscle was on the order of one-in-ten.
No contest. Fire up the X-ray machine. See that, indeed, the needle has advanced dangerously close to my heart. Necessitating attendance by some sort of 24/7 on-call SWAT team who held me down, wadded me up with sterile cloths, and re-wired the port tube. The leader of the SWAT team was the only one who actually knew how to do this, but he very astutely talked one of his team members through the (intricate) process, quite successfully.
The next time we taught our risk assessment class, I used this episode as an example of comparative risk assessment. One among many examples, because, as we emphasized to the students, life itself is fundamentally an exercise in comparative risk assessment.
Let’s say you’re a shrew, and you’ve been foraging all night, and the sun’s coming up, and you have to decide whether it’s worth racing out onto the dewy lawn to rustle up one more earthworm before heading into cover for the day. The risk you run, of course, is that an owl, or an early hawk, or a weasel, or fox, or even the greenskeeper’s lawnmower, will find you out in the open. You have to balance your very real need for energy and nutrients with the equally real threat of BEING somebody else’s energy and nutrients.
Of course, we drill the students into recognizing the constant cascade of comparative risk assessment that makes up an average person’s day. Be late for class, or take the chance the campus bus won’t brake in time when we dash across the street? Trust the sterility of the processing, or skip the protein of a can of tuna? Slap together a peanut butter & jelly sandwich, or pass so you’re not exposed to the intensely carcinogenic aflatoxins? And on and on.
Radiation, of course, is a powerful source of cancer risks. Radiation damages cell components in various ways, depending on type and intensity. And certain of those cell damages yield tumorous outcomes.
And, once you’ve had cancer, your radiation dose per unit time rises enormously. In my case, over the 3+ years from my first diagnosis through my last treatment and post-treatment assessment, I had at least a dozen X-rays and, I believe, 4, possibly 5, PET scans with coincident CT scans. The PET/CT procedures are particularly interesting because there are two sources of radiation—the sugar molecules which are tagged with radioactive carbon atoms, and the X-radiation of the CT scanner.
It turns out, here in the 21st century, that we have surprisingly little quantitative information regarding the cancer risks associated with diagnostic radiation. In fact, as late as 2011 [1], an attempt to evaluate diagnostic radiation risks came with the caveat that "most of what we know about the risk of cancer for diagnostic radiation comes from an extrapolation of what happened with the atomic bomb in Japan.”
Yikes. Talk about “uncertainty” in risk balancing! Consider. To extrapolate from radiation-exposure outcomes at Hiroshima and Nagasaki, we first need to estimate the dose the dead and dying and chronically ill received. For that we have to make gross assumptions about the geographical chemistry of fission detonations more than a mile in the air at locations only generally approximated by the bomb sights [2]. We have no way to account for the vast number of parameters affecting subsequent dosimetry such as intervening structures, wind speed and direction, physical structure of the fallout, etc.
In other words, we have only the vaguest idea of what the 1945 radiation exposures were. Somewhat more subtle and credible attempts have been made to estimate risks of PET/CT procedures [3]. It is difficult to wade through the technobabble of such estimates to provide a simple summary. In general, it appears that the radiation exposure of a single PET/CT scan about equals the annual baseline or background radiation exposure for human beings. It is even more difficult to translate these exposures into estimates of cancer incidence associated specifically with the PET/CT procedures. Perhaps the best we can do is to go with the experts on this [1], and say that the likelihood of cancer attributable to PET/CT relative to cancers resulting from all sources is low but not trivial.
And, of course, the risk of excess cancers attributable to PET/CT is inversely correlated with age. Infants having such a procedure have relatively greater chances of contracting cancer than older people. Similarly, the more PET/CT procedures you have (at any age), the greater your cancer chances.
It all comes down to this. If you already HAVE cancer, or have been successfully treated for a type of cancer that is highly likely to recur, the risks of such cancer is always higher than the risk associated with the diagnostic radiation. This is similar to my SWAT team’s conclusion that the risk of being stabbed in the heart by a shiv in a major vein was greater than the risk of coming down with cancer at some later date from the diagnostic X-ray.
Finally, there is this bit of good news. Remember that risks of diagnostic radiation cancers is higher in younger patients. There are now procedures, using nano scale iron dust and magnetic resonance imagery (MRI), that can detect existing cancers as effectively as PET/CT scans [4]. This non-radiation procedure is most promising as a more benign diagnostic tool for young patients for whom radiation-based diagnostics are more dangerous.
Et voila! Problem solved! Well, sort of. There are of course the usual complications involved in bringing such an innovative tool into routine use. But it’s good to know that, at least for children, we may be able to diagnose without adding to their cancer worries.
Rock and roll, everyone. The lesson I take from my (ongoing) cancer experience? Pay attention to your comparative risks. But don’t let risk concerns hamper your quality of life. Live a rich and active life. Don’t give up ingested carcinogens (alcoholic beverages, peanut butter, barbecue), or physical carcinogens (air travel, sunlight), or crossing busy streets. Just try to balance things out so you as long as you can as well as you can. After all, you have a 100% likelihood of dying. Best to get as much good living under that constraint as possible!!!
[1] http://www.annarbor.com/health/candid-cancer-evaluating-radiation-risk-in-ct-and-pet-scans/
[2] http://inventors.about.com/od/astartinventions/a/atomic_bomb_2.htm
[3] Huang et al. 2009. http://pubs.rsna.org/doi/full/10.1148/radiol.2511081300
[4] Digitale 2014. http://med.stanford.edu/ism/2014/february/mri.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+NewsFromStanfordsSchoolOfMedicine+%28News+from+Stanford%27s+School+of+Medicine%29
Ooh. My respiratory infrastructure is INTENSELY sensitive to cold. Molly was coming up from D.C. for supper, and I wanted to make a couple of seriously luscious pizzas. Needed a run to the grocery store for fresh basil, cheeses, pepperoni, and other pie-construction necessities. So I fortified myself with a dose of dilaudid, grabbed a roll of paper towels for the car, and headed out.
Parked maybe 100 meters from the store door. When I got inside, I had to take three or four minutes to hunch over my cart, cough up some semi-gelid mucous, and relax the cramping muscles in my chest. Same routine when I got back out to the car. At least at this end I had the benefits of Molly Hatchet wailing on Flirting With Disaster and the rush of hot air from the vents with the temperature set on Deep Fat Fry.
Anyway. This is the first winter in a long time here in the Mid-Atlantic region (as we like to think of ourselves, when we’re in a geographically expansive mood) that has lived up to its billing. We’ve had snow on the ground for weeks, ponds are frozen over, and a long sequence of Canadian cold fronts has kept air temperatures well below long-term averages.
And of course this has unhinged the idiots at Fox “News”. Chris Wallace interrupted his routine reading of scripts from which all words of three or more syllables have been stricken to give a folksy commentary on climate change. He concludes that a global warming “case is difficult to make when the eastern half of the country is in the grips of a brutal winter” [2]. It’s hard to believe that, in the 21st century, with the information resources available via the World Wide Web, an entire communications organization like Fox can’t come to grips with the reality that the United States isn’t conflated as the world at large. And that the concepts of “weather” and “climate” actually reflect differing scales of environmental conditions.
Anyway. This simple-minded debate playing out on my laptop monitor reminded me to remind you that I think the entire climate change issue is being pursued down a long, straight, but ultimately dead-end path. Earth’s climate changes constantly, and it has always done so. Many factors impact climate, and the mix of parameters generating climate conditions at any one moment shifts and reshuffles and burps out new conditions for the next moment. Sometimes climate is controlled by geological forces, like volcanoes and continental drift. Sometimes it’s controlled by astronomy, via solar flares, sunspots, and proximity to asteroids with potential to devastate the biosphere at any moment. Biology plays an enormous role in the long, slow dance of climate conditions. The mixture of gasses in the atmosphere reflects photosynthesis, respiration, decomposition, and carbon storage.
Human beings are integral and dominant components of the present-day biosphere. It seems that we are now driving the climate car, having taken an off-ramp from the solar conditions that would otherwise have spun us into a long period of cooling. The net effect of our collective activities has established conditions for long-term warming of the biosphere.
And here’s where I think the entire climate change debate is focused on the wrong question. Climate always changes. Whether or not human activity is controlling climate, as opposed to solar conditions or geological processes is largely irrelevant. The real question is “are climate changes now underway likely to have good or bad outcomes for biology on earth”?
And the answer is surprising. In simplest terms, a warmer earth is a better earth. Biological productivity and biodiversity are tightly and positively correlated with long-term temperatures. Warming, especially if accompanied by increases in atmospheric loading of limiting plant fuel carbon dioxide, will increase global biomass. At the same time, biodiversity will be unshackled and evolutionary processes will explode, yielding enormous numbers of new and novel organisms. If this seems counterintuitive, given the apocalyptic forecasts of environmental organizations and academia, fire up a thought experiment. Where is biological productivity high—in the frozen wastes of the polar landscapes, or between the tropics? Where is biodiversity high—on the arctic tundra, where you can count the vertebrate species on your fingers and toes, or in the equatorial forests, grasslands, and oceans? What happened biologically and socially in the last period of climate cooling—the “Little Ice Age” that rocked the planet from the 1500s to the 1800s? What happened was massive disruption of human populations, hammered by starvation and disease, and setbacks in ecosystem conditions that the biosphere is still recovering from.
Yes, it’s true that people living at sea level are going to have a nasty time as water levels rise. And it’s also true that so-called “tropical” diseases like malaria and sleeping sickness will proliferate. But overall, as the biosphere warms, human and ecological entities will be released from climate constraints and prosper. Where did our fossil fuels—coal, petroleum, natural gas—come from? They came from the frantic productivity and biodiversity of a world warmed in the so-called “carboniferous” period.
Anyway. What does all this have to do with cancer, the nominal subject of this weekly bloviation? Simply this: the universe is complicated. Patterns and processes are often counter-intuitive. We have to think, and think expansively, before we act.
The National Cancer Institute publishes an annual report updating the status of cancer as a global phenomenon. This year’s report [the link is in reference [1] below] demonstrates that cancer deaths are falling worldwide, due largely to successful efforts to reduce tobacco use. However, it also shows that “comorbidities”—noncancer illnesses afflicting cancer patients—play a large role in determining cancer outcomes. In simplest terms, if you are diabetic, or have cardiovascular problems, or a host of other relatively common health problems, your cancer is going to be more severe and treatment is more likely to fail. Death rates are higher in people with multiple illnesses superimposed on their cancers.
From a public health perspective, this brings us neatly back to close the circle where we started on this rather rambling essay. Two lessons: 1) cancer is a lot more complicated when other illnesses are present; and 2) a healthier biosphere will make cancer less important as a cause of death, and easier to manage from a treatment perspective.
During the Little Ice Age, people were chronically ill all the time, all over the world. When bubonic and pneumonic plague squidged out of western Asia and challenged human physiologies in Europe, the combined effects of residual diseases (due to poor nutrition, exposure, and social proximity driven by the cooler climate) and Yersinia plagues were catastrophic.
A warmer earth is a better earth. And a warmer earth will make cancer less of a problem. So move out of that riverfront cottage and get to higher ground. Then embrace the global warming.
As always, I thank you all for being here. Without you, I would not be here. To enjoy this great, snowy winter. And the warmer world just past this snowy winter. Rock On, everybody!!!
Notes
[1] http://www.cancer.gov/newscenter/newsfromnci/2013/ReportNationDec2013Release
[2] http://thinkprogress.org/climate/2014/02/16/3297871/fox-news-discusses-climate-change-insanity-ensues/#
