Happy Thanksgiving

It is Thanksgiving tomorrow and I have more to be thankful for than most.  I am married to "the Amazing Charlo" and have lots of kids around to spend time with and love, the newest is my granddaughter Kiparoo, who is only 7 months old, so she's new on my list of things I'm thankful for.  Am very happy and thankful for having a great team to work with every day at the Cancer Center, and am so very happy that we are doing good work and helping folks.

The Uncommon Thread is out and on sale, and The Hard Times is written and awaiting release in April or May.  I'm excited about our new adventure, China Grove, the literary magazine Luke Lampton and I are starting, this summer.  We are working on the first issue, had a great visit with he and his family in Magnolia and shot some photos of China Grove while we were down south.  Our premier issue is going to feature a new short story by Ellen Gilchrist from her upcoming collection due out in 2014.  We also have some previously unpublished communications from Eudora Welty on the occasion of the publication of her first book, so that's cool.  We have art by Scott Schisler of Virginia, Lesley Wilson, and Cindy McDaniel from here in Mississippi along with whatever dribs and drabs I can come up with as filler from the photo shoot in China Grove.  For those of you who aren't aware of China Grove, it was the setting for the Eudora Welty story "Why I Live at the P.O." and since Ms. Welty gives us our name it is fitting that we feature something by her in our premier issue.  Want to be a part of our new adventure?  We will be accepting submissions for poems, short stories, essays, and art.  We will be using Submittable, keep a eye on this spot and I'll put the details out as soon as they are available, or check in at Chinagrovepress.com.

Once again Happy Thanksgiving!    Scott

Obama Re-Elected or Romney De-Selected?

Everybody take a deep breath and calm down. Obama was and is our president, nothing has changed, America isn't sliding straight down into hell tomorrow, that should take eighteen months at least, just kidding. What will happen is nothing. We have a divided government and a president who did not win the popular vote. There will be two more years of gridlock and then a new mid-term election.

As we look to the future perhaps Republicans should consider who they run for office more carefully, perhaps both sides should take a big step towards the middle, perhaps politicians should get the ___ out of making pronouncements about reproductive issues, perhaps religion should actually be separated from matters of the state as our founding fathers suggested?

The Republican Party has spent billions of dollars shooting themselves in the foot with two inappropriate candidate pairings in a row.

It not enough to be not Obama, or not Biden, or not Clinton.  Candidates should have something distinct to offer.  I will try to say this without gagging, but being "a Maverick" was and is not a campaign, neither is being "Not Obama."

Wake up, redefine how as a party the Republican Party will serve the needs of all Americans and move on to the next election cycle with a plan that has a chance to win.

Halloween

Tomorrow's Halloween, instead of spooks and hobgoblins we have millions of friends worrying about power outages and flooding.  I want to take this oppertunity to encourage all of you with a disaster on your hands.  You'll get through it!  One step at a time, band together, work together.  Do what you can then sit a bit and rest, then go back to work.  That's how we did it down here in Mississippi after Katrina, and guess what?  It works.  We're praying for you and sending you power trucks and good wishes.  Chin up.

So Jesus has a wife and Muhammad needs to buck up-

With the presentation by Harvard Divinity of what they believe is an authentic ancient Coptic tract in which Jesus refers to himself as having a wife Christendom is forced to reattend to a debate that originated around 200 AD which is the question of Christ's celibacy.

Personally, I prefer a married Jesus. If he was sent to experience life as a living man on earth, he would have missed the real flavor of humanity without having experienced marriage. There is so much of good and sorrow that can only be known by a married man.

About 500 years later and 750 miles away Muhammad was having his own problems. Plagued by somewhere between eleven and thirteen wives, he was dealing with the problems of excess. Things went pretty well pre-Hijra, he had a wife fifteen years his senior, wealthy and inclined to support him. They had a happy monogamous relationship until her death twenty-five years later. Then the dam burst. Nobody's exactly sure who he married next, or how many, but suffice it to say there were a bunch of them, one of them only nine years old when the marriage was consummated. Now I know faithful Muslims are okay with that, and some of them feel like they need to kill non-believers who point out how screwed up this looks by modern standards. But they need to calm down and let old Mo fend for himself. If he can handle ten wives in the same kitchen a little humor at his expense 1600 years after the fact is nothing. If the truth offends him he needs to buck up and tough it out, and so do those who follow him.






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Butterfly in the Typewriter

Anyone with ties to New Orleans knows their Confederacy of Dunces, and it's Swiftian derivation. This new biography of John Kennedy Toole has me retreading it. Looking at the story as a manifestation of paranoid schizophrenia, reframes everything entirely, and refocuses our considerations of the causes of Toole's suicide. Worth plowing through the first chapter, which with it's irritating focus on the minutia of the Toole family structure and Toole's mother's predilections is difficult to push through. But do it anyway and you'll come away with new knowledge in what is the first non-fiction biography of Toole. Ignatius Rising was a alternative fiction attempt that was far too determined to push Toole's life into the boxes of the authors' own construction

Stuff is happening

New CT simulator on the horizon for the cancer center. Reviewed BC/BS of Alabama's policies on IMRT, much more reasonable than the national or Mississippi standards. Maybe we can get them to listen to reason if we can get a large enough voice.

Questions for Anyone Interested In Breast Cancer

I have a dilemma and I’ve asked everyone I know to ask, so I’ve decided perhaps I’ll just toss my questions out to the rest of you Americans and ask you to think about them.  First a little background: I am a Radiation Oncologist from Mississippi.  Mississippi has the distinction of being the fattest state in the union.  This isn’t an opinion we’ve got years of statistics to back that up. 

Obesity is a problem on many levels but the one which I’m concerned about in this is that it predisposes to the development of breast cancer and, because obese women have obese breasts, complicates the delivery of adequate therapy to combat the cancer once it develops.  In my practice I have a lot of patients with breast cancer and large breasts or breasts that do not really exhibit ideal geometry for radiotherapy.  Now, despite this fact Blue Cross/ Blue Shield at the national level has decided that this is something that they are entitled to ignore.  That’s my first question: How are they able to do that?  If they are providing coverage in my state, how can they ignore the specific needs of patients in my community?

            The issue at hand is Blue Cross Blue Shield Association Policy # 8.01.46, which is a national policy that states:

Intensity-modulated radiation therapy (IMRT) is considered not medically necessary as a technique to deliver whole breast irradiation in patients receiving treatment for breast cancer after breast-conserving surgery, because the clinical outcomes with this treatment have not been shown to be superior to other approaches such as 3D-conformal radiation therapy, yet IMRT is generally more costly than these alternatives.

The problem comes when after a conformal plan is attempted, and because of breast size or anatomy/geometry the plan fails to meet what are considered to be adequate standards for dose homogeneity.  Dose homogeneity means that all parts of the breast get the dose they’re supposed to get, without unacceptable hot spots or cold spots inside the treatment volume.  Hot spots are areas of overdosage, which result in things like fat necrosis, pain, and swollen large red tender breasts, which do not get better over time.  Cold spots are areas that leave the patient vulnerable to tumor recurrence, what’s bad about that is pretty obvious.  These issues can frequently be overcome by switching to utilizing a different algorithm for treatment planning and delivery, IMRT.

BC/BS would have you believe that IMRT is somehow different than other forms of radiotherapy, that the effects of the given calculated dose is somehow fundamentally different.  But in fact the difference is equivalent to the difference in a set shot and a jump shot in a basketball game.  Scott Serota, the President and CEO of the Blue Cross/ Blue Shield Association is like a basketball coach that forbids the players that are actually playing the game from taking anything but a set shot to get their two points.  So question number two is for him: How do you think that kind of plan would work out in the NBA play-offs?  Hell, in the NBA play-offs the only thing at stake is money and bragging rights.  In the game we’re playing the stakes are human lives, or do you understand that?  Maybe it’s only a decision about money and bragging rights for you too?  In February of this year the Seattle Times published an article claiming that several BC/BS subsidiaries in their area were stockpiling billions of dollars in cash reserves, the highest they’ve ever had, while at the same time raising rates they were charging their beneficiaries, AND THEY WERE OPERATING ON WHAT WAS SUPPOSED TO BE A NOT-FOR PROFIT STATUS in the state of Washington.  Those claims are still under investigation by the state’s insurance commissioner.

This is the unfortunate mindset that permeates the company at this time.  From their origin in 1939 to the Tax Reform Act of 1986 BC/BS was considered a self-funding social welfare program and therefore tax exempt up to that point. After 1986 it was considered not-for-profit until the national corporation became a for-profit entity in 1994, but many of the individual component companies remain not-for-profit at the state level at the present time. 

At every level they have become more predatory.  They are well aware of the steps that they are taking.  Originally they denied coverage for IMRT for breast and lung cancer because it was deemed investigational and unproven.  When the Federal Employee Program (FEP) dictated that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity, BC/BS changed their classification of IMRT from investigational to “not medically necessary.”  Not based on scientific studies, but because they wanted to continue to hoard money.

Medicare, most other insurance providers, even poor little Mississippi’s Medicaid program all understand that IMRT is a tool in the fight against cancer.  It may be over-utilized by the unscrupulous if left totally uncontrolled and that is not what I’m asking for.  But using the appropriate tool, when needed, is what medicine is all about.  Sometimes you need a set shot, sometimes you need a jump shot, or a hook.  The person in the game needs to be the one to decide that.

Here are my last questions:  Who’s in charge of keeping an eye on stuff like this?   We need someone to keep an eye on any collection of companies, like BC/BS, which provides private health insurance to 99 million Americans and has already faced anti-trust litigation in several southern states, to be sure that they are acting in the interest of the patients they serve and not just their bottom line.

Where is the American Cancer Society? Where is the Susan G. Koeman Foundation?  Where are the celebrity breast cancer survivors?  Why aren’t all of you up in arms about this?  Is it because it’s only fat women from Mississippi?  Well, I’ve got a surprise for you, it’s not, it’s national, and it’s insidious.  You need to stand up.  You need to say something.

Mr. President and Mr. Romney this one’s for you:  What are you going to do about it?

Anybody got any answers?

Let me know.