Chapter 09: The Challenge of Defining

Title

Chapter 09: The Challenge of Defining "Cure" in Oncology; Views of Research Approval Processes

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Description

In this chapter, Dr. Alexanian talks about the difficulty in defining "cure" when discussing cancer, and notes his own publication on the topic: Alexanian R, Delasalle K, Wang M, Thomas S, Weber D. Curability of multiple myeloma. Bone Marrow Res 2012:916479, 2012. e-Pub 5/2012. PMCID: PMC3366198. [The recorder is paused for about 3 minutes.] Dr. Alexanian talks about how MD Anderson's research approval processes get in the way of research and addressing patient needs. He admits, "I'm a bit of a rebel." He tells an anecdote about providing drugs to patients.

Identifier

Alexanian_R_01_20140415_S09

Publication Date

4-15-2014

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Overview; Overview; The Researcher; The Clinician; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Critical Perspectives on MD Anderson; Offering Care, Compassion, Help; Patients; Cancer and Disease

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Raymond Alexanian, MD

So I say, well, someone’s got to come up with a definition of cure. What will it be? So I says, “I think I’ll do it. So let’s call ‘cure’ someone who has not relapsed after twelve years,” and that’s the definition. It may change.

Tacey Ann Rosolowski, PhD

Interesting. Yeah, I mean, I hadn’t really thought about that question, but it is a question. How do you know when you cure somebody?

Raymond Alexanian, MD

How do you know when you’re cured of any disease?

Tacey Ann Rosolowski, PhD

Yeah, yeah.

Raymond Alexanian, MD

And I think, now, you can quibble. What do you call somebody who’s in, like, complete remission for twelve years and dies of something else? Is he cured? How about if he’s in complete remission for five years and dies of something else? Okay. So you can get into little word games and semantics. So I say if you’ve gone in complete remission twelve years and die of something else, then you’re cured, because no one else has died of myeloma after twelve years. But at five years, the prospect of dying from myeloma is higher because you haven’t reached that milestone.

Tacey Ann Rosolowski, PhD

That milestone, yeah.

Raymond Alexanian, MD

And I think the same thought processes have gone for leukemia and lymphoma and other conditions.

Tacey Ann Rosolowski, PhD

Right.

Raymond Alexanian, MD

I’m going to stretch for a minute.

Tacey Ann Rosolowski, PhD

Sure.

Raymond Alexanian, MD

How are we doing?

Tacey Ann Rosolowski, PhD

We’re doing fine. I’ll pause the recorder. It is exactly 11:30.

[recorder is paused] (end of first audio file)

Raymond Alexanian, MD

—is that there’s no design. You’ve got to get away from that, and I think you’ve seen that with others.

Tacey Ann Rosolowski, PhD

Yeah, yeah.

Raymond Alexanian, MD

All of this is just by chance, and the individuals have to have a certain minimum of ambition for their own careers and also kind of commitment to humanity to some extent—to a big extent, I think. You can’t just say, “I’ll do it and maybe it’ll help somebody.” You have to have some commitment to humanity.

Tacey Ann Rosolowski, PhD

Well, just the way that you’ve told the stories, you know, that the patient need drives—

Raymond Alexanian, MD

It drives, right.

Tacey Ann Rosolowski, PhD

—drives what the researcher’s is doing.

Raymond Alexanian, MD

There are many circumstances I faced where there’s a—and this is what troubles me even now. There are effective programs that could be applied to a difficult patient, but, “Well, we don’t have the approvals, we don’t the protocols, we don’t have the drugs. We can get all these if you wanted to work on it right now.”

And I say, “Look. This man’s in the room here,” or woman. “We’ve got to deal with this now. We can’t wait for a year.” So I’m a little bit of a rebel in the sense that I will bypass, deliberately bypass requirements I think I can get away with if I’m going to help a patient, that if I can get a drug somewhere, somehow, and I have this drug, “Sir, I’m putting this on the table here.”

And the nurse said, “Look. You haven’t heard anything here.”

“I’m leaving the room. If you want to steal this, I don’t know anything about it. But take it in this way. Watch for this side effect.”

So that’s why I’ve broken a lot of rules here. Do you like to hear that? I mean, you can—

Tacey Ann Rosolowski, PhD

Yeah.

Raymond Alexanian, MD

You can put it in now and you don’t have to save it for fifteen years.

Tacey Ann Rosolowski, PhD

You can decide. You can decide.

Raymond Alexanian, MD

No, no.

Tacey Ann Rosolowski, PhD

You want to stretch your legs a little bit or do you—

Raymond Alexanian, MD

I tell you what. I think I’d better go, because I have to get some copies done. Do you know how to make copies here of anything in the library? I have an office, a secretary who can do it.

Tacey Ann Rosolowski, PhD

I’ll turn off the recorder. So we’re finishing up with our interview session now, and the time is 11:36. Thank you, Dr. Alexanian.

Raymond Alexanian, MD

Yes, thank you.

Chapter 09: The Challenge of Defining

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