Gorgeous Grandsons

I cannot help but be the proud grandad in publishing these two videos of Thomas (7 months) and James (3 years and 7 months) respectively bouncing and scooting. The voiceover is from their lovely mum Hiva. My hope is to get to the UK in early July to spend some time with these boys, their parents, and their aunt, Catherine.

How's that for fast?

On Saturday I gave a keynote address to the New Zealand Labour Party conference. The picture suggests a receiving of the holy spirit in an act of rapture. Despite this being the "day of the apocalypse", I am in fact gesturing to indicate that the world economy is 500 times bigger than our own. Having berated the centre left and centre right for lack-lustre commitment to government investment in science and innovation, I was followed on the next day of the conference by Party Leader Phil Goff promising, if elected, to commit an extra $160 million per annum (~0.1 % of GDP) to the R&D sector, to be paid for by including agriculture in the Emissions Trading Scheme. Of course, it's a long way between making a promise in opposition and being able to act as government, but the Labour Party proposal now puts serious heat on the government, which has, despite announcing its budget last week, come up with no ideas whatsoever for economic growth.

http://www.stuff.co.nz/business/5037261/Innovation-needed-to-boost-economy

http://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=10727326

The cancer is back

I haven't said much about the state of my health recently. About 6 weeks ago I was alerted to a sudden change when my CEA reading leapt from the previous plateau of 5.2 ng/ml to 9.3 ng/ml over a three week period. I had no doubt at the time that this was real and probably indicated that some residual cancer cells had gone through angiogenesis to get their own blood supply enroute to becoming tumours. After discussing the matter with my oncologist we decided to wait another two weeks for a second reading, and in the meantime consult with the Sydney team of David Morris and Winston Liau.

That second reading, which I obtained last week, showed another rise to 14.3 ng/ml. You can see from the graph that the exponential growth represents a doubling period of three weeks, as fast as I have experienced during the rapid tumour growth phase of 2009.

My options are now somewhat limited. Given the early return of the disease, further peritonectomy/HIPEC surgery is not advised due to a likely poor prognosis. The full range of FDA-approved chemotherapy drugs shown to be effective in colorectal cancer, I have already sampled, namely Oxaliplatin, Capecitabine, Irinotecan and Avastin. The remaining drugs, Cetuximab and Panitumumab are only effective for KRAS gene wildtype (60% of the population), and sadly, I am mutant (40% of the population).

If the disease progresses at this rate, and based on experience in 2009/2010, I will have cm size tumours in a matter of 6 weeks, just about the time I had planned to fly with Miang to the UK to begin a 3 month sabbatical. Clearly we have some major issues to grapple with.

Next week I will have another PET-CT scan. If we can locate the site or sites of the tumour the potential for resection will be considered, a possibility, for example, if there were a single tumour acting as the source of the rising CEA. I have to say that this seems unlikely.

Interestingly, the rise in CEA started 3 weeks upon cessation of Capecitabine adjuvant chemotherapy. I could go back on to Capecitabine soon, or I could try hitting the cancer with the triple cocktail of Avastin/Irinotecan/Capecitabine, which caused a dramatic reduction to a plateau of 8 ng/ml, during 2010. But I am up against evolution and natural selection. All my new cancer cells have experienced those drugs before and it is not at all clear that they would respond a second time.

It's hard to find much good news here, but I am a master at seeing the silver lining in the clouds. I do have confidence in the CEA as a marker for the disease well in advance of radiological indication or physiological symptoms. That means we can at least track the responsiveness to treatments quite sensitively.

After our last discussions, my oncologist and I think the next step may be to try Capecitabine alone, to see if we can stabilise the disease for a while, to give Miang and me some time in the UK with the family. The triple cocktail can be kept in reserve for later use.

The future of cancer therapy is undoubtedly to be found in better understandings of the immune system, and how it can be assisted. My good friend Graham Legros, immunology expert and Director of the Malaghan Medical Research Institute, gave me a tutorial recently. One thing is clear. The immune system is immensely complex and its provocation may well produce beneficial effects. I am considering that, on the basis that I may be "n=1", worthless as medical evidence, but significant given my singular life.

More on that matter later no doubt.

Melbourne weekend

I am surrounded by sisters, Jeanine on my right and Mary, in the pink, on my left.

The occasion was Mary's 60th birthday, and we are in Melbourne, Mary's home. Jeanine, Miang and I travelled over for a few days to share in the celebration. It was a delightful weekend, with scores of friends turning up on the Sunday in a surprise party organised by Mary's husband Tom. But Mary's biggest surprise was the appearance on Saturday morning of Mary's daughter Rebecca, who had flow down from Brisbane to wish her Mum a happy birthday.

During our difficult times last year, these two sisters helped Miang and me immensely. I was so glad to be able to share this time with them.

Remote Rangitikei

On the weekend of 6 May, our friends Chris and Delwyn Clark introduced us to a new part of the North Island, the inland gorges of the Rangitikei river. The river, which rises in the central plateau mountains, cuts its way through papa (clay) country, deepening at a rate of about 4 mm per year. Over tens of thousands of years, the river has created deep gorges, in places 180 m below the surrounding bush and farmland. It is a superb trout fishing river.
Chris and Delwyn organised a weekend together at Tarata Lodge, a farmstead with outlying lodges, overlooking the gorge. The farm is accessed by driving about 22 kms inland from Utiku, just south of Taihape. The route takes you over "Gravity Canyon" the deepest bungy jump in the North Island.

This series of photos shows us on our 3 hour rafting trip down the gorge, and finally, the view from our lodge "River Retreat", topped off with Miang in the hot tub on our verandah.

It was an idyllic weekend, with walks on the farm inspecting the chickens, Llama, goats and rabbits, being entertained by Lodge host and possum-trapper extraordinaire, Steve, and with delicious meals in the farmhouse provided by Steve's wife Trudi.

Steve is full of wonderful tales of the bush and river. He is a "catch and release" fly fisherman who seems to know nearly every fish in the river. The hospitality of Steve and Trudi is really exceptional. Miang and I were so grateful to Chris and Delwyn for bringing us to this place.

If you want a break with a difference, and at extremely reasonable prices, check out Tarata Fishaway Lodge on the web. It is a gem.

Clinical Trials

Look what you can do without any medical training whatsoever. A couple of weeks ago I opened the new Clinical Trials Unit at Wellington Hospital and for my efforts got a plaque on the wall. For that privilege, I had to entertain the guests for about 20 mins. Extracts of my speech follow.

"One of the decisions a cancer patient has to make is whether or not to take the advice of all the well-meaning friends and family members who prescribe cures so numerous that they would fill several lifetimes attempting to try them out.

Amongst the more benign are various fruit or vegetable concoctions, reiki, acupuncture, meditation, prayer and just thinking nice thoughts. And at the other extreme are vegan diets, the swallowing of hydrogen peroxide, and the excessive consumption of apricot kernels, with accompanying risk of cyanide poisoning. And these remedies are just what my friends have suggested!

As a scientist, I guess I instinctively gravitate to what some people call conventional medicine. There have been many wonderful discoveries in medicine. There have been antibiotics, vaccination, chemotherapy and the aspirin. But the possibly the greatest medical discovery, greater than all those things, is the randomized, double blind, placebo-controlled test. You get see if the treatment actually made a difference.

That’s it. That’s how scientific medicine has to work. It sounds simple once you grasp it, but it actually is rocket science. And it is rocket science because of human complexity, and especially because of that measurable phenomenon, the placebo effect. And when you design the test, carry out the study without bias, and then analyse the statistics properly, you get real evidence.

By the way, in my own scientific profession of physics, we seldom do statistics. Unlike the infinite variability of biology, and human patients in particular, atoms are atoms are atoms. Ernest Rutherford, who was never one to mince his words, said, “If your experiment needs statistics, you ought to have done a better experiment.”

He was referring to physics. But in biology, n=1 simply won’t do. And in drug trials, hundreds or even thousands of patients are the norm..........

.....Finally I want to make some very personal remarks, based on my own experience. You have a beautiful hospital, and yes, I know, you need more capital equipment. You have dedicated professional staff, staff who I suspect are overworked and probably underpaid, but the standard of care they give, at least in my experience, is mostly excellent. You have superb IT systems-just visit an Australian hospital at random and see the file boxes and cartons of documents all over the place. Take a blood test, a radiological image, and it is there at the physicians demand. People might call me Paul Callaghan, but I know my true identity. It is EYD7212. When I flash my neutropenic alert card at Accident and Emergency, and utter the magic words EYD7212, they know to whip me past the Courtenay place casualties and straight to the intravenous drip line through the double doors.

But there is also a culture here that we should not take for granted. The personal kindness and care that I have had here has been remarkable. In the Blood and Cancer centre, and what a marvelous place that is, I get to sit among the comrades, greeted by staff who know you personally, who, when asked the cost of the drugs they are pumping into you, feign complete ignorance and unconcern. The district nurses call you at home to check that you are coping well, and they smooth the information flows with the oncologists. And then there are the nurses on the wards. How can anyone be bored for a moment in this hospital, especially with the theatre of the consultants rounds? And what consultants! They have taken the time to talk through difficult issues, treating their patient, at least this one who wanted that, as worthy of an informed conversation, and when asked, they were prepared to partner with other hospitals or the private radiologists and consultants, and all with the help of the cancer society and its programmes that are able to address broader patient needs over and above what can be provided in the busy operation across the road. I have been incredibly lucky.

There is much to be proud of here, and in the profession you practice. And speaking personally, I have come to like the eccentricities of medical practice. The idiosyncracies of surgeons particularly-what a craft that is, beyond contemplation, no double blind placebo-controlled stuff there. Just daring and skill and fearless opinion. I should know, my son is one.

And then there are the oncologists with their difficult role in patient dialogue, telling it tough, -no sugar coated pills there. Thank goodness I know about right-skewed survival statistics (let’s face it, the lower bound is zero, they can’t tell you that you will die yesterday, but of course the upper bound is decades), so bugger the median I say, I’m aiming for the right skew, but bless ‘em, no oncologist will give you false hope by pointing to its existence.

For my first course of chemotherapy, and just to get me started, my oncologist referred me to adjuvant online so that I could read the data for myself. I’ve been a fan for clinical trials and their data ever since. Oxaliplatin, Capecitabine, Irinotecan. Cetuximab, Avastin, I’ve read them all. And for each there is an evidence base for efficacy based on clinical trials.

It doesn’t mean they will work for every individual and that fact is honestly declared, but the fact it that each one has passed a Kaplan-Meier analysis gives me that confidence that it is worth trying it, that it won’t unduly harm me, and it might actually do me some good.

That’s more than can be said for apricot kernels and hydrogen peroxide."

http://tvnz.co.nz/health-news/cutting-ribbon-research-4147548/video

New Zealand High Tech Awards Dinner

On Friday night Miang and I attended the New Zealand High Tech Awards dinner in Wellington, where Magritek was a finalist in the category "High Tech Exporter of the Year-under $5 million per annum". I was filling in for CEO Andrew Coy who was overseas making sales. Sadly, we didn't win, but we had an enjoyable evening out.

The next day Miang and I headed up to the Rangitikei river where we were staying in Tarata Lodge for the weekend. More on that in the next blog.

I am in the midst of a hectic round of speaking engagements relating to the "New Zealand prosperity" theme. One of the more remarkable of these involved a visit to Christchurch on Tuesday last, where I spoke to university students and also appeared on the inaugural "City Life" programme for CTV, the local television company that lost so many of its staff in the building collapse on February 22nd. They were naturally very interested in the result of the HEKE project, and I was able to announce that the 2011 March repayments from overseas NZ ex-students were $2 million higher than last year ("better than a cake stall"), and that the increase from February to March was significantly greater in 2011 than 2010. Whether this is a result of the campaign, I cannot tell. Only three days following the launch of the campaign on 29 March fell in that month. Once Inland Revenue supply with the 2011 April figures we will have a better idea.

Some blog followers have noticed that I have been a bit silent lately, and in particular, have said nothing about my health situation. I have to admit, there has been some discouraging recent data but I am holding off reporting more until we get a clearer picture. Meanwhile I am feeling well.