[Ed. Note: Here is the latest from Dr. KSS, who writes about health, medicine and biotech stocks for the Irregulars. He has agreed to our trading restrictions, and his words and ideas are his own.]
Dedicated to Cynthia Chew Choon Hoon (1959-2013). In pace requiescat.
Imagine a day down the hallway of the future. You’re a happy Gumshoe Irregular, you’ve just turned 65, and last week, you had a routine check-up with your doctor. You feel great and are looking forward to a contented, ebullient retirement. It’s early evening. You and your wife are having gin-and-tonics on the veranda, watching the sunset. The lime in your drink is tart, zesty, and life is good.
But the phone rings. Your wife answers, ignoring your importunings that she ignore it. She beckons you. It’s your doctor, and he wants to speak with you. Can’t be good.
The doctor is still in his office going over labs and test results, and decided to call you rather than sending a letter. Last week, he drew a PSA and also examined your prostate. It seemed fine. But it’s your PSA that concerns him. It is now 4.5, not screamingly high, but up from last year’s level of 4. He wants you to come in again.
You imagine a device being shoved into your rectal vault, from which lots of needles will suddenly extrude and plant themselves painfully deep into your prostate gland, translocating germs from your rectum into it, causing bleeding for days on end…and you begin feeling dizzy. Your ears begin to ring, you break out into a cold sweat. Your worst fears are coming true, you begin seeing spots, and slide onto the floor. Little birds fly around your head.
“Hon?! Are you OK?,” your wife shouts.
“Hello……sir? Are you still there?” the doctor is shouting into the phone.
Your wife grabs the phone. “Doctor, my husband just fainted!”
“Is he OK?”
“Just dizzy and sweaty. He’s coming around.”
“I must have scared him. I told him his PSA is high.”
“Yeah, he mumbled something about prostate biopsies? I think that put the fear of God into him.”
“Prostate biopsies? I didn’t say anything about that.”
“Isn’t that what you are planning doctor?,” your wife asks.
“Well, no, not at all. I just wanted him to come back so we could draw blood, you know, to look for any prostate cancer cells. Prostate biopsies? No, we don’t do those anymore.”
Medical science fiction? Probably not. The lab test in question, looking at blood to find circulating tumor cells, is now making its first forays into prime-time, though as of yet it is to assess response to cancer treatment rather than in place of tumor biopsies. But that is likely to change, and in fact one tiny biotechnology company seems uniquely poised to benefit from this new science and this emerging “hot”new diagnostic trend.
Do you remember this scene from The Silence of the Lambs? Have a look. Clarice Starling is wrestling with the identity of a killer, and Hannibal Lecter, trying to act as her mentor, encourages her to think like Marcus Aurelius and mull the essence, the nature, of the killer.
Cancer is a killer. But what is cancer, in its essence? What is the nature of cancer? What distinguishes cancer from all other illnesses? What does cancer do that no other disease does? There’s an old word I love, quiddity, sometimes defined as that which answers the question, quid est? What is the quiddity of cancer?
Cancer spreads. It metastasizes. That is the most scary aspect of its nature. Cancer is like a flea that bounds from place to place in the body, and takes up residence easily at sites remote from where it started. Yes, cancer can extend locally, but it loves to end up at distant sites without leaving any crumbs for how it got there. How does cancer get to those places? Some will answer via the lymphatic system….that cancer goes to lymph nodes and from their more broadly into the body. But there is a better answer.
The fact is, cancer cells get into your bloodstream, and course around as if they were river rafting. And this idea is not a new concept. When they reach a rivulet, a capillary, a tight spot from which they can flow no further, they lodge. They take root there. Most of these attempts at colonizing, at metastasizing, provoke immune reactions that are deadly to the tumor cells.
Armand Trousseau (1801-1867): A Gregarious Master Clinician
Nineteenth-century France gave the world many fine physicians, including Dupuytren, Duroziez, and the astonishing Rene Laennec. But none were more remarkable than Armand Trousseau, an affable Paris internist.
On 27 June 1867, Trousseau died…to the shock of friends, patients, colleagues, seemingly to the surprise of everybody but one person: Armand Trousseau. He was 65. In January of that year, he had noticed something amiss in his left upper arm. One imagines him at a wash basin with a straight razor shaving around his bushy sideburns, and feeling a pang. He noticed a painful, tender, hot mass in his arm, a blood clot. The next day it had subsided and the mass and pain were gone. He knew what was coming, and knew he had at most 6 months.
The eminently likable Armand Trousseau, MD. Il a découvert et puis il l’a tué
Trousseau had many fine accomplishments—better treatments for COPD, malaria, pleuritis, goiter, yellow fever; he performed the first tracheotomy in France—and was also famously known as a patient advocate and a person who became so absorbed in listening to and studying patients at their bedside that he lost track of time. In Irving Stone’s fine historical novel about Sigmund Freud, The Passions of the Mind, he depicts a scene in which, at a teaching hospital bedside, the great Charcot extols the virtues of “see-ing,” of really opening one’s senses and studying patients, of even ignoring one’s education somewhat and letting bedside findings, primary observation, guide you in formulating disease and its treatment. Paracelsus admo