TIME Cancer

It’s Unlikely Tobacco Company Will Pay $23.6 Billion

Based on the industry's track record, the second-largest tobacco company probably won't pay the billions in damages it owes to a Florida widow

Big Tobacco took a hit on Friday when a court ordered the second-largest tobacco company in the U.S. to pay damages to a Florida widow who had sued them for her husband’s smoking-related death. However, it’s unlikely that the company will pay full price for its negligence.

Although the verdict will likely stand, tobacco company R.J. Reynolds says it plans to appeal the $23.6 billion that the jury determined it owed widow Cynthia Robinson. Based on the industry’s track record, that will likely result in them paying far less.

Robinson’s husband, Michael Johnson, began chain-smoking when he was 13-years-old and died at the young age of 36 in 1996. A decade after her husband’s untimely death, Robinson took the cigarette-makers to court, saying they were not forthcoming about the extremely harmful effects of their product, suing them for not informing the public that smoking was addictive. And almost another decade later, she proved her case.

Unsurprisingly, R.J. Reynolds, whose holding company Reynolds American Inc. recently announced a $27 billion deal to buy out rival Lorillard, contested the verdict. “Regardless of the rhetoric surrounding this case, the damages awarded are grossly excessive and impermissible under state and constitutional law,” said Jeff Raborn, vice president and assistant general counsel for R.J. Reynolds Tobacco Company in a statement sent to TIME. “We will file post-trial motions with the trial court promptly, requesting that the verdict in the case be set aside. We are confident that the law will be followed and the punitive damages verdict will not be allowed to stand.”

Raborn is probably right.

“It is quite likely, bordering on certainty, that the amount of punitive damages will be reduced, though it is unclear how much,” says John Banzhaf, a law professor at George Washington University known for his successful litigations against the tobacco industry. There’s not a lot of dispute among the legal community that the verdict will be reduced–probably substantially. Prior verdicts against Big Tobacco demanding billions in court have been reduced to millions–something the industry, which spends about $23 million on cigarette marketing each day, can pay off rather comfortably. In 2009, Phillip Morris failed to overturn a $79.5 million punitive-damages ruling in the U.S. Supreme Court, and business continued as usual.

“This doesn’t set a legal precedent, but the result of this verdict has people asking how much money will it take to deter tobacco companies? Previous verdicts against tobacco companies have been treated as just the cost of doing business,” says Richard Daynard, a law professor at Northeastern University who specializes in tobacco control. So far, no verdict has changed the economic fundamentals of the industry. But this time, the industry might being feeling less confident.

“I think this is the first time in many years that tobacco companies are going to have to start thinking about really doing something different,” says Daynard. After all, it’s likely we will see many more cases like Robinson’s land similar verdicts in Florida, and it’s possible that similar lawsuits will start to pop up nationwide.

Robinson’s case is one of thousands of lawsuits referred to as an “Engle progeny,” which was developed after a $145 billion verdict in favor of a class action lawsuit led by Dr. Howard A. Engle, a Miami Beach pediatrician. The award was voided in appeals court, under the finding that individual smokers could not make up a class. Though the tobacco industry did not have to pay the award, which was the largest punitive damages payment decided by a jury, the decision opened the floodgates for individual cases to head to Florida court with the support of the Engle case, which proved that the tobacco industry knew cigarettes were addictive, and failed to warn the public.

“The [Robinson] case indicates that juries, when a case is properly presented, are willing to sock it to tobacco companies,” says Banzhaf. “They are angry as hell at these tobacco companies, and when an attorney presents a strong case, they are willing to hit them, and hit them hard.”

Banzhaf says the case will likely motivate attorneys in other states that are less gung-ho to take on Big Tobacco. Lawyers in states like New York, California, and Washington with good tobacco control track records, he said, are likely “salivating” at the future possibilities.

Banzhaf believes that the public is finally grasping the health implications of smoking and is now willing to punish those that profit from it. The numbers seem to support this claim: smoking rates are down 2.8% since 2005 according to CDC data, and smokers can be charged up to 50% more under Obamacare. “Clearly the public is angry. But the courts have to allow damages that are substantially higher than ordinary damages,” says Banzhaf.”Hitting them with $16 million is pocket change.”

It will be no surprise if the final bill for R.J. Reynolds is significantly lower than what the Florida jury determined to be sufficient, but it’s encouraging for the pending cases. “About 70% of Engle cases that have gone to verdict have gone in favor of the plaintiff,” says Daynard. “There are thousands more of these cases pending. Any of them could produce a jury verdict like this because it’s the same misbehavior.”

Unfortunately, the tobacco industry can also produce the same appeals solution they’ve achieved successfully in the past.

TIME Syria

Cancer Wages Its Own War Against Syrian Refugees

A higher rate of cancer among Syrian refugees is forcing doctors, patients and humanitarian organisations to make difficult decisions about who does, and does not, receive care

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It was just before Syrian civilians started rising up against their government in 2011 that Fayhaa al-Dahr, 22, from the northern city of Raqqa, noticed a strange swelling in her neck. Doctors advised surgery to excise the tumors growing on her vocal chords, but even though Syria has one of the best government-subsidized medical systems in the Middle East, the operations and the follow-up treatment would be expensive.

To pay for al-Dahr’s care, her father sold some land than had been in the family for generations. When another tumor appeared, he sold more land. By the time the third tumor was taken care of, there was no more land to be sold, and the uprising had turned into a war that made it impossible for al-Dahr to travel to the capital for her chemotherapy appointments. When a rocket destroyed her home in December, al-Dahr and her family saw no choice but to take refuge in neighboring Lebanon. At least there, they believed, al-Dahr could continue her treatments. They were wrong.

Lebanon is host to some 1.1 million Syrian refugees, part of an exodus of 2.9 million seeking shelter from a war that has claimed more than 160,000 lives and has wrought untold damages to the middle-income country. Unlike refugees fleeing conflicts in Africa, where diseases of poverty such as diarrhea, malaria or cholera take their toll, Syrian refugees are afflicted with chronic and costly illnesses like diabetes, heart disease and cancer. The international humanitarian agencies that provide for refugees the world over simply do not have the funds to treat these diseases, leaving many, like al-Dahr, without access to proper medical care. Her cancer has metastasized, and she now has a tumor in her upper thigh so excruciating, she says, “I am living on painkillers.”

A recent study published in The Lancet Oncology journal documented a high demand for cancer treatments among refugees from the recent conflicts in Iraq and Syria, with host countries and refugee organizations struggling to find the money and the medicines to help. Cancer, writes Dr. Paul Spiegel, Chief Medical Expert at United Nations High Commissioner for Refugees (UNHCR), is likely to play a much greater role in refugee care going forward. “Cancer diagnosis and care in humanitarian emergencies typifies a growing trend toward more costly chronic disease care. Something that …. is of increasing importance because the number of refugees is growing.”

As it is, the UNHCR warned on July 3 that the organization had received only 30 percent of its $3.74 billion budget for Syrian refugee programs for this year, a shortfall that would see many vital programs, including health care, slashed.

Al-Dahr’s doctor in Damascus had warned her of the consequences of missing chemotherapy appointments, and when she first arrived in Lebanon, she did try to continue her treatment. But the costs—$1,900—were twice what she paid in Damascus. Her family was able to borrow enough cash to pay for one round in January, but when her Lebanese doctor called a few weeks later to remind her of her follow up, she knew she couldn’t afford another session. “He was very worried about me, and called several times to beg me to come, but there was nothing we could do and nothing he could do.” The doctor may have been willing to volunteer his time and expertise, but the drug and hospital costs are immutable.

“It’s a sad story,” says Dr. Dr. Elie Bechara, an oncologist in Beirut who works with other doctors to treat refugees pro-bono. “We are overwhelmed by these cases from Syria. Sometimes we are standing still, watching, and we are not able to help them. It is frustrating.”

Lebanon boasts some of the finest medical facilities in the Middle East, but nearly 90% are privately run, and most of them are for profit. UNHCR has spent tens of millions of dollars on treatment for refugees at private hospitals, but funds are limited. With the rising number of refugees — 1.5 million, a third of the Lebanese population, are expected to have registered by the end of the year — costs too will rise, forcing UNHCR to choose between funding emergency care and primary health clinics that can save thousands of lives and spending thousands of dollars to save one life.

Last year UNHCR covered medical treatment for 41,500 refugees in Lebanon, but each of those cases was judged on specific criteria: the cost of the intervention against the chances of a positive outcome. “It’s a horrible decision to have to make,” says Spiegel. “If there is a poor prognosis, we can’t go that route. It doesn’t mean the patients won’t get treatment—they may search elsewhere, and sometimes embassies or private donors step in—but we can’t afford to help where there is no hope.”

Palliative care, at least, is not that expensive, adds Spiegel. “We never say, ‘There is nothing we can do, go away.’ We just say we can’t treat the cancer but we will treat the consequences.” Al-Dahr falls into that category. Instead of chemotherapy, she gets painkiller injections at her local pharmacy, and she tries not to dwell on her illness. “When you don’t know what is going to happen, it is better to stay in the present,” she says. “Thinking about the future only brings more problems.”

Given the funding shortages, cases like al-Dahr’s are likely to become more common, says Spiegel. “Syria is our biggest and most expensive operation to date, and there is a question of how long donors will continue supporting it as things get worse. If we continue like this, there will be more like this woman who will not be able to receive treatment.”

Like a cancer patient with a poor prognosis, Syria is starting to look like a hopeless cause, and thus less likely to receive aid.

With reporting by Hania Mourtada / Anjar, Lebanon

TIME Cancer

Breast Cancer Drug Has a Surprising New Application, Study Finds

An early study shows that gel-based tamoxifen may be as effective as the oral drug, and have fewer side effects

Tamoxifen is a mainstay of breast cancer treatments: it blocks the effects of the female hormone estrogen on the breast, inhibiting estrogen’s tendency to encourage breast tissue to grow uncontrollably. Now, Dr. Seema Khan, professor of surgery at Northwestern University Feinberg School of Medicine, reports in Clinical Cancer Research that putting the drug in a gel, and applying it directly to the breast tissue, where it needs to work, may have merit.

Doctors generally prescribe tamoxifen for women diagnosed with early breast cancer, including very early-stage ductal carcinoma in situ (DCIS), to prevent recurrent growths. But the drug has also been linked to an increased risk of stroke, blood clots and cancers in other tissues, including the uterus. That’s why more women, including those who have not yet had cancer but are at high risk for the disease could benefit from the drug but are reluctant to take it.

MORE: Why Mammograms Are Less Effective Among Breast Cancer Survivors

Dr. Khan’s study was small—only 26 women—but it provides proof that the principle of applying tamoxifen directly on the breast may be worth investigating. All of the women were diagnosed with DCIS, which generally does not spread. But 30% of DCIS can recur even after surgery and proper treatment, so most women are prescribed tamoxifen. In the current study, about half of the women in the study were randomly assigned to take the oral form of the drug, while the other half were given doses of a tamoxifen gel to apply directly to the breast tissue for six to 10 weeks before their surgery. Khan analyzed the breast tissue after surgery to study markers for tumor growth, and conducted blood tests for levels of tamoxifen metabolites as well.

At the end of the study, the women in both groups showed similar decreases in tumor-related proteins, but blood levels of tamoxifen were five times lower among the women using the gel than those taking the oral pill. That, says Dr. Khan, suggests that the major side effects of the drug, which occur in the blood and other reproductive organs, may be largely avoided if women use the gel.

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

“Our study showed that applying the drug through the breast skin leads to high concentrations in the breast and low concentrations in the rest of the body,” she says. “The biological effect on the breast is consistent with the benefit of oral tamoxifen, so for that reason, we hope that this kind of approach would make preventive medication more acceptable to women with non-invasive breast cancer and how may be at high risk of developing breast cancer.”

Dr. Khan says that the breast may be uniquely designed for such transdermal therapy, since it is essentially an appendage of the skin, with its own internal lymphatic circulation. That may keep things applied to the breast skin within the breast tissue, and could explain the higher concentrations of tamoxifen metabolites she and her team found after the gel applications.

Still, she says that the small number of participants in the study means more research is needed to confirm the results. Right now, the gel version is not available. The company that provided the experimental doses for the study stopped making that formulation, so Dr. Khan is studying a related, similar metabolite called endoxifen that may have similar cancer-fighting effects on breast tissue.

If the strategy proves effective, it’s possible that cancer treatments, or at least breast cancer treatments, may become useful in preventing cancer as well, as more women at high risk who have yet to be diagnosed with the disease take advantage of them. Applying a gel with relatively few side effects may help more women to eliminate small tumors before they have a chance to grow. And if other types of drugs can be used on the skin as well, that could significantly broaden the therapies available to women looking for ways to prevent the disease.

“For high-risk women who need better prevention strategies, delivering the drug to the breast is a very desirable solution,” says Dr. Khan.

TIME health

Lessons From a Sun Worshipper

Jane Green Ian Warburg

A chance encounter led best-selling author Jane Green to her diagnosis of malignant melanoma.

As far back as I can remember, I have worshipped the sun. My skin is fair, but as the years have gone by, it has toughened and darkened. I now turn a rich golden brown every summer, but only after the first day of burning. I am relatively careful these days. I wear a sunscreen with at least SPF 30, even though I may not apply it as regularly as I could. And as for staying out of the sun during the hottest part of the day? That’s prime suntanning time.

Three weeks ago, my friend Sophie gave me two CDs by a singer named Eva Cassidy. I had never heard of this singer with an angelic voice, so I Googled her. I learned that years ago, when she was 30, she had had a small, dark mole removed from her back. It was a malignant melanoma, said the doctors, but they had caught it early and removed everything with surgery. Three years later, after experiencing pain in her hip, they found that the surgery had not removed everything; the melanoma had spread, and cancer was everywhere. She died at 33.

Some might call this a God moment. Had Sophie not given me those specific CDs, had I not been inclined to look up this singer, I wouldn’t have been thinking about moles. I would not, that night, have noticed, quite by chance, a small mole almost at the rear of my left calf, which seemed somehow not quite right.

It wasn’t very big, but it was uneven, and in the middle was a black splatter, like paint.

I went to my dermatologist, who expressed no concern, but her face had a grave intensity as she removed it to send off for a biopsy, and I knew the news wouldn’t be good.

She phoned three days later. I was on a train on my way home from a breakfast in New York. “Do you have time to talk?” she asked. “Cancer. Malignant melanoma.”

The good news is it’s a thin melanoma, under 1 mm, and it’s Stage I.

The bad news is that my thin melanoma has something called mitosis, which means the cancer cells are dividing and multiplying even as I write. My thin melanoma has already spread outside of the tumor and into the deep layers of skin. Without the mitosis, it’s a slam dunk. The mole is removed, and with it the cancer. With the mitosis, it becomes a slightly different beast, one that has brought sleepless nights filled with endless Internet searches, one that has a less predictable outcome.

I am under the best care at Memorial Sloan-Kettering, where surgery will remove the tissue and a lymph-node biopsy will reveal if it has spread, if in fact my Stage I cancer might be Stage III. Although unlikely, that possibility brings a level of uncertainty that is unfamiliar and frightening.

Melanoma is not the most common of skin cancers, but it is the most dangerous if not found in the early stages. Melanoma causes 80% of skin-cancer deaths. According to the Melanoma Research Alliance, more than 76,000 people in the U.S. are diagnosed with it each year, ­one every eight minutes — and roughly 9,500 die from it, ­one every hour.

Despite all the advancements in the medical world, the death rate from melanoma has remained static for 30 years, and the incidence is rising — it is the fastest-growing cancer in the world. When it is caught early enough, the cure rate can be 100%. (For more information on how to spot dangerous moles, visit the Melanoma Research Alliance.)

As AIDS was in the 1980s, cancer has become the plague we are all living with today. Five years ago, one of my best friends was diagnosed with Stage IV breast cancer. She died seven months later, in September 2009. Another friend has recently emerged triumphant after battling non-Hodgkin’s lymphoma.

I am Superwoman. I am the author of 15 novels, including one about cancer. I am not, however, someone who gets cancer. I am a sun worshipper who never thought it could happen to me.

There will be a lesson in this. I’m just not yet sure what it is. Recognizing the grace, kindness and generosity of those around me, or my own resilience and strength, perhaps. We shall see.

In the meantime, after the tears, I have taken to heart what Winston Churchill once said: “When you’re going through hell, keep going.” I plan to keep going. Hopefully for a very long time.

Green is the author of 15 best-selling novels dealing with real women, real life and all the things in between. She writes a daily blog and contributes to various publications including Huffington Post, the Sunday Times, Wowowow and Self. Her most recent novel, Tempting Fate, was published this spring.

MONEY Shopping

Sitting At Your Desk Is Killing You. Here’s What It Costs To Stop the Destruction

This could be you if you don't get up and move around during the work day. TommL—Getty Images/Vetta

Sitting all day is a real killer. Here's a few products to help you be more active at the office.

The science is in: Sitting at your desk all day is really, really, bad for you. Studies have shown long periods of sitting is bad for the elderly, drastically increases your risk of cancer, and now new research confirms that being a couch potato at work is hazardous to your heart’s health.

Worst of all, your daily (or weekly) trip to the gym isn’t enough to offset the damage that prolonged sitting can cause. As a New York Times survey of the scientific literature concluded:

It doesn’t matter if you go running every morning, or you’re a regular at the gym. If you spend most of the rest of the day sitting — in your car, your office chair, on your sofa at home — you are putting yourself at increased risk of obesity, diabetes, heart disease, a variety of cancers and an early death.

How can you avoid this death-by-lethargy? The key is not exercising more, but sitting less. Luckily for desk jockeys everywhere, there are plenty of products and services that promise to get you moving about during the work day. Here’s a quick survey of the market, and how much each solution will cost you.

Standing Desk

Cost: $20-$1,497

The most obvious way to prevent the problems of sitting is to, well, stand. A standing desk is pretty much the same as a normal desk, but much taller, and usually adjustable. The idea is that by standing you’ll be more active—flexing your legs, fidgeting, moving around, shifting your weight, etc—and therefore avoid the complete stasis that makes sitting so damaging.

Standings desks run the gamut from virtually free to obscenely expensive. If you don’t want to spend any money at all—something standing desk advocates actually recommend for newcomers—you can just use a sufficiently high counter top or table. As long as your new workstation meets a few ergonomic requirements (this graphic from Wired is very helpful), you should be all set.

If you like the standing desk lifestyle (and the ability to literally look down on your seated co-workers), it might be time to splurge on the real thing. On the low end, there’s a $20 IKEA hack for the DIY type. A good mid-range product is the $400 Kangaroo Pro Junior, an adjustable (if small) option with a special mounting for your computer monitor.

The top of the line is the NextDesk Terra. At almost $1,500, the Terra is not for anyone on a budget, but it certainly offers some great features. In addition to great build quality, Terra’s electrical motor allows you to easily adjust its height using a small console on the right corner. It also remembers three different heights, allowing for sharing or an easy transition back to sitting position. All this was enough to impress the Wirecutter, which picked the Terra as their favorite standing desk.

Treadmill Desk

Cost: ~$700-$1,500+

Standing desk not hardcore enough for you? Try combining it with an actual treadmill. Surprisingly, these contraptions aren’t that much more expensive than a standing desk, with some options coming in around $700. Consumer Reports recommends the LifeSpan TR1200-DT5, which retails for $1,500.

Treadmill desks are a great way to remain active while working, but try not to go overboard with the exercise (especially if you can’t wear gym clothes to work). Business Insider’s Alyson Shontell walked 16 miles in one day on a treadmill desk and described the experience as less-than-enjoyable.

Office Yoga

Cost: Classes start at $250 a session

Yoga is a great way to de-stress while also getting some needed exercise. The problem? You can’t exactly break out the tights and yoga matts in the middle of your office without getting, at the very least, some weird looks from everyone nearby.

Or at least that’s been the problem until now. A company called Yoga Means Business offers offices group yoga classes that don’t require a change of clothes. YMB’s signature class is the 30-minute method, which features 15-20 minutes of standing and stretching and another ten minutes of meditation and breathing. Half an hour isn’t too much time, but it’s a great way to get out of your chair and be active for a little while during the work day.

In terms of cost, YMB’s classes are free—assuming you can convince your company to pick up the charge. Each 30-minute session starts at $250 and YMB recommends two sessions per week. If yoga isn’t enough, you can also book an appointment with an office fitness expert. Larry Swanson, a Seattle message therapist and personal trainer, offers appointments where you can learn exercises, posture awareness, and other strategies for staying active during work.

Apps

Cost: Free

If all these fancy desks and yoga classes sound like too much, you can make yourself more active using only a smartphone or tablet. StandApp, available for both iOS and Android, allows users to set custom break intervals and then alerts them when its time to get out of their chair. In addition to these periodic reminders, StandApp also has video guides for various office-compatible exercises and tracks how many calories you’ve burned by getting up more often.

Posture Sensor

Cost: $149.99

If you are going to sit for a while, it’s important to have good posture. The LumoBack posture sensor straps around your waist and tracks how your sitting or standing. If it detects you slouching, the device vibrates to let you know you’re doing it wrong. The LumoBack also integrates with your iPhone to track your steps and how many times you stand per day, making it useful for anyone who wants to make sure they’re not sitting for too long.

Get a New Job

Cost: ????

At the end of the day, the problem is your modern work life. Most white collar jobs require sitting behind a desk for 8+ hours instead of moving around. On the other hand, jobs in manual labor offer plenty of opportunities for exercise. Maybe you’ll have to take a pay cut (not always, many manual jobs have pretty great compensation), but you’ll probably be healthier for it. And you can’t put a price on your health, right?

TIME Religion

Quitting the Cancer ‘Battle’

cancer
Getty Images

Watching my wife deal with morning sickness while I was laid low by chemo­therapy, I realized that I had the easier job. All I had to do was die

PatheosLogo_Blue

This article originally appeared on Patheos.

I am not a hero. After my last post, some readers wanted to know how I arrived at my attitude toward cancer, which is to be found somewhere between a religious person’s submis­sion and the cordial host’s welcome. A better question—one my oncologist and I wrestle with at every appointment—is why most cancer patients tumble into a bottom­less slough of despond.

My intention is not to criticize other cancer patients. To be told that you have a disease which is going to kill you in the next few months or years is to be slammed by a violent and remorseless truth that nothing in experience prepares you for. At first you can’t even process what your doctor is telling you, because there is nothing to which you can com­pare the news in order to make sense of it—it is a monster from beyond your imagination. Denial, self-pity, panic, despair: these are the natural reactions.

I was diagnosed with metastatic prostate cancer in the fall of 2007. Just before Sukkot my doctor phoned to warn that an “opacity” had shown up on my chest X-ray during a routine physical examination. To the Jews, Sukkot is zeman simhatenu, the “season of our rejoicing,” but there was little joy in our sukkah that year. Our season was one of dread.

Average survival time of men diagnosed with metastatic prostate cancer is one to three years. Maybe ten percent live ten years. When you are first diagnosed, you obsess over the numbers. You vow, “I will be one of the ten percent!” Your vow, though, has no effect whatever on the outcome of your disease.

No matter how often you swear that you will fight the cancer, you are helpless against it. The journalistic convention in obituaries to praise the dead for their “coura­geous battle” against cancer is a lie designed to comfort the living and healthy. At best the cancer patient consents to treatment, although he must withdraw consent at some point and permit the disease to run its course. Or, as L. E. Sissman sang of the foreign country known as Hodgkin’s lymphoma where he lingered for a decade,

…I
Reside on the sufferance of authorities
Until my visas wither, and I die.

Cancer patients are betrayed by our culture’s dishonesty. Those who recover from the disease are hailed as “survivors”—a term appropriated from the Holo­caust—but while they are struggling with cancer and undergoing sometimes painful treatments for it, they are barely acknowledged. They are consigned to what Ralph Elli­son calls a “hole of invisibility.”

“There’s a possibility,” Ellison goes on to say, “that even an invisible man has a socially responsible role to play.” Not, however, as long as the servitude of cancer is described by the platitudes our culture favors—“fight,” “battle,” “survive,” or “suc­cumb.” Is it any wonder the cancer patient, who suspects the truth even if he dare not utter it to himself, ends in inconsolable resignation?

A friend of mine who has recovered from breast cancer points out that being a patient with a life-threatening illness is a release from daily, clock-managed, to-do-list responsi­bility. Cancer patients should embrace their freedom, she argues. That most fail to do so is a testament to their mortal terror of freedom.

My own view is somewhat different. Cancer permanently disfigures a person’s self-image, and neither the culture nor his curriculum vitae includes the materials for a recon­struction.

For half a century now, American culture has been a culture of self-fulfillment. Interests must be pursued, talents developed, desires expressed, needs met: the self is con­ceived as a string of imperatives. But cancer exposes these as arbitrary and extrava­gant. The staples of selfhood, it turns out, have been neglected.

A diagnosis of cancer might be the “rift or revelation” which, as the Romanian philosopher E. M. Cioran says, dries up illu­sion and begins the true self. And yet the exact opposite is what usually happens:

When you no longer believe in yourself, you stop producing or struggling…whereas it is the contrary which should have occurred, since it is precisely at this moment that, being free of all bonds, you are likely to grasp the truth, discern what is real and what is not.

If cancer patients are to be helped out of their despondency—if they are to face the reality of their condition, which to my mind is the only possible way to go on living with cancer—they must be helped to believe in themselves again.

But how? The literature, divided between breathless guides to “alternative” healing and triumphalist accounts of “survival,” is of small assistance. Perhaps my own history, though, might suggest a tentative first step.

My wife was pregnant with our fourth child during the initial months of my cancer. Watching her deal with morning sickness and a husband laid low by chemo­therapy, I realized that I had the easier job. All I had to do was die. She would be left alone with her grief and the emptiness where I once held her and we laughed together. As Dora Carring­ton cried to her dead husband Lytton Strachey in her diary, “Every day for the rest of my life you will be away.”

The self that lived for fulfillment may have collapsed like a pretense at the first word of cancer. This is not a loss, however, but a refinement. You are no longer defined by the interests you pursued or the desires you expressed: you are no more or less than the person whom your wife (or husband) and children love.

Your capacities may be diminished—you may not be able to dance with your wife, play catch with your sons, pick up your daughter—but they do not love your capacities; they love the person. And whether you accept the responsibility of being that person, or acquiesce as the cancer proves itself to be stronger than love, is a decision entirely within your command.

D. G. Myers is a critic and literary historian who taught for nearly a quarter of a century at Texas A&M and Ohio State universities. He is the author of The Elephants Teach and ex-fiction critic for Commentary.

Read more from Patheos:

TIME Cancer

The New Pelvic Exam Guideline Gives Women More Tough Decisions

Gynecologist practice
Gynecologist practice AydAn Mutlu—Getty Images

What's the "take-away" when no one agrees?

Last week, the American College of Physicians (ACP) released guidelines saying doctors can skip the pelvic exam for women who are not pregnant and have no unusual symptoms, spawning strong reactions from physicians and regular women alike.

The new recommendations set off a lot of strong reactions among physicians and women’s health groups, with well-respected experts in the field split on the recommendations. One doctor from Mount Sinai hospital in New York told me the obstetrics and gynecological community “will laugh at this.” But another expert, Dr. Eve Espey, the Family Planning Fellowship Director at the University of New Mexico told me that “there’s not good evidence to support an annual pelvic exam or an annual exam for that matter.” The American College of Obstetricians and Gynecology (ACOG) is standing by its position that it “firmly believe[s] in the clinical value of pelvic examinations.”

“This is causing such a buzz,” says Dr. Amir Qaseem, the director of clinical policy at ACP. “When we developed these guidelines, we asked: ‘If there was a benefit, it would be to catch ovarian cancer early.’ We did not find that. There is no impact on mortality or morbidity. Why would you do a test for the sake of taking a test?”

When asked about women who have no symptoms, but still have benign masses like ovarian cysts identified during physicals, Dr. Espey says: “Other than cancer, benign masses on the ovaries and uterus, like fibroids, are not important to pick up unless they cause symptoms. Women go to their graves never having known they had a problem.”

As a woman who has undergone her fair share of uncomfortable prodding—and even had surgery following an appointment where my doctor felt something—the suggestion that it was all unnecessary is not only surprising but aggravating. Calling up more experts only added to the confusion. “Women who have had no exam in years are putting themselves at risk for preventable and curable diseases,” says Dr. Linda Carson, a gynecologic oncologist at the University of Minnesota. “I have seen many examples of gynecological diseases that were only picked up by the exam. In the last week alone, I have treated two women with advanced vulvar cancer who did not have a [pelvic] exam despite seeing a doctor for other conditions.”

Dr. Peter Argenta, also a gynecologic oncologist at the University of Minnesota, says that while he applauds the authors’ efforts to review practices that have become routine, he questions their conclusions. “I am concerned that the take-home message may inadvertently be that pelvic exams are unnecessary,” he says.

“There are however, many benign conditions for which surgery is indicated, and for which earlier detection may lead to an easier and safer procedure,” he says. For instance, noncancerous masses that left untouched could result in ovarian torsion or rupture.

Ultimately, the new pelvic exam recommendations leave women with a lot of confusion and a “here we go again” situation when it comes to screening. Already, women nearing age 40 are faced with the dilemma of getting screened for breast cancer. In 2009, the U.S. Preventive Services Task Force (USPSTF) advised women to wait until they turn 50 to start yearly mammography screenings, instead of at age 40. The argument being that too many women are being over diagnosed, and undergoing unnecessary biopsies and surgeries. Still, groups like American Cancer Society firmly stand by their recommendations that women start at 40, and many women and doctors will still follow that guideline.

The medical community stands by the fact that patients and doctors should have a conversation about any treatment and test. And as patients, we should know our risks and history, and that should be factored into every medical decision we make.

TIME Diet/Nutrition

A Chemical In Coffee, Fries, and Baby Food Linked to Cancer, Report Says

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The research isn’t conclusive. But lab evidence suggests a type of chemical found in starchy foods cooked at high temperatures—as well as coffee and some baby foods—could promote the growth of cancer cells

The crispy brown crust that forms on your french fries or toast? Those are hot spots for a chemical called acrylamide, which forms when the sugars and amino acids found naturally in foods like potatoes and cereal grains are cooked at temperatures above 150 degrees. It’s present in cookies, crackers, coffee and some baby food that contains processed bran. And according to a new report from the European Food Safety Authority (EFSA), it’s a public health concern.

So should you worry?

Here’s what scientists know now: Lab studies involving animals have shown that diets loaded with acrylamide can cause DNA mutations that increase the risk of tumor growth and the spread of cancer cells. But studies involving people have produced “limited and inconsistent evidence” when it comes to the ties between acrylamide and cancer, the EFSA says.

While people exposed to the chemical in an industrial setting have suffered from nervous system issues like muscle weakness or limb numbness, that has little to do with your diet. “That was through inhalation and skin exposure to high levels of acrylamide at the work place, not food consumption,” stresses Marco Binaglia, a scientist who helped draft the EFSA report.

Binaglia says that, for now, it’s not possible for him or other health scientists to make diet recommendations. “We’ve identified a possible model of action that explains how acrylamide could damage DNA in a way that leads to cancer-producing cells.” But more study is needed to produce specific dietary guidelines, he adds.

For example, Binaglia says the EFSA’s coffee research only looks at acrylamide content, and does not take into account all the other possibly beneficial chemicals and compounds found in your morning joe, for instance. “A lot of questions cannot be answered right now,” Ramos adds. Similarly, the American Cancer Society (ACS) says that, based on available research, “It is not yet clear if acrylamide affects cancer risk in people.”

Despite all the unknowns, if you want to reduce your potential risk by cutting out the chemical from your diet, the ACS recommends boiling potatoes, which results in less acrylamide formation than roasting or frying. They also suggest lightly toasting your breads—no dark spots.

And as for acrylamide in coffee, says Luisa Ramos, another researcher who helped draft the report: “It’s usually found at higher levels in light roasts because it forms during the first minutes of roasting and then degrades as the roasting process continues.”

Ramos says choosing darker coffee roasts may lower your exposure. And, for concerned parents, baby foods that don’t contain processed cereal grains should have lower levels of the chemical.

TIME Management

JP Morgan CEO Has Throat Cancer

Jamie Dimon told employees the disease is “curable”

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Investment banking firm JP Morgan’s CEO Jamie Dimon told staff Tuesday that he has throat cancer.

“The good news is that the prognosis from my doctors is excellent, the cancer was caught quickly, and my condition is curable,” Dimon, CEO of the bank since 2005, said in a note to staff.

Dimon said the disease will require about eight weeks of radiation and chemotherapy treatment, CNBC reports.

“I feel very good now and will let all of you know if my health situation changes,” he said.

Dimon steered JP Morgan through the financial crisis but met with controversy after the bank was involved in a scandal in 2012, leading to billions of dollars in losses and calls for Dimon’s ouster. The notoriously blunt bank chairman was criticized for calling the fiasco a “tempest in a teapot.”

[CNBC]

TIME Cancer

The Government’s Super Scary New Anti-Smoking Campaign

CDC

The CDC releases its next set of graphic ads to encourage smokers to kick the habit for good—or else

The newest phase of the Centers for Disease Control and Prevention’s (CDC) graphic campaign to persuade America’s 42 million smokers to quit—”Tips from Former Smokers”—launches today, and it’s heart wrenching.

Since 2012, the campaign has featured real former smokers dealing with serious health problems spawned by their addiction, and this round is bound to make smokers and non-smokers alike squirm. It’s an especially graphic campaign from the CDC’s tobacco office, which has not shied away from bold, conversation-starting efforts to curb smoking.

Here’s an example: Shawn provides tips on how to live with a hole in your neck. Amanda, meanwhile, smoked during pregnancy and gave birth to her baby two months early.

Here are the newest ads, which the CDC provided early to TIME:

Amanda, a 30-year-old who smoked while pregnant. Her 3 lb daughter spent weeks in an incubator.

Brett, 49, who lost most of his teeth to gum disease by age 42. He takes out most of his teeth on camera.

Rose, 59, whose lung cancer resulted in surgery, chemotherapy and radiation.

Shawn, 50, who breathes through the opening in his throat due to smoking-related throat cancer.

Brian, 45, whose smoking and HIV led to clogged blood vessels and resulted in a stroke.

Felicita, 54, who lost all of her teeth to gum disease by age 50.

Terrie, who died of cancer last September at age 53

Previously released ads ran earlier this year in February, and a CDC spokesperson told TIME that the “effort had immediate and strong impact.” During the last set of the ads’ nine-week run, they generated over 100,000 additional calls to the CDC’s quit line, 800-QUIT-NOW. On average, the CDC says weekly quitline calls were up 80% while the ads were on the air compared to the week before they began running. Preliminary estimates show there were nearly 650,000 unique visitors to the the agency’s website during those nine weeks.

The ads will be placed on cable TV, on radio, in print, on billboards, and in movie theater and online starting July 7. The CDC is also launching a social media campaign to support its tradition-media plays.

Of course, considering tobacco is a $100 billion market, and the industry continues to spend billions every year, the campaign is a drop in the pond. But it certainly stands out.

If you want to quit smoking, you can call l 1-800-QUIT-NOW or visit www.cdc.gov/tips.

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