The Education of Jer-Yuan Tsai

I use this title for the post to remind me to read “The Education of Henry Adams” one of these days.  I went to Boston for a five-day continuing education course of Primary Internal Medicine: Principles and Practice.  It may be exaggerating if I say it had a grueling schedule, but sitting through a 7AM to 6PM daily talk is taxing and exhausting.  The famous New England Journal of Medicine (N.E.J.M.) and Massachusetts General Hospital (MGH) Clinical Pathology Conference was conducted through the lunch while we ate.  The two-hour key note speech by Dr. Timothy Johnson, the ABC senior medical contributor was given on Wednesday evening.

One may wonder why I put myself through this tiring schedule while some of my classmates have retired.  I guess I am a “slow learner” and have to keep learning.  While making rounds in the hospital this morning a nurse asked me where I went last week, I said I went to Boston to get some education.  She said “are you feeling smarter now”; I said it may be too late for that in my case.  But I was enlightened and at times entertained intellectually.

It may take me several weeks to go through the material (a flash drive and two thick course books—see photos) to make notes that are relevant to my practice.  It may be a cliché to say to be a physician is a privilege, but this is an example of having the privilege of being a physician so that I can enjoy the intellectual talk or stay confused but at a higher level as a slide that ends the lecture, quoting Enrico Fermi, “Before I came here I was confused about this subject, but now having heard your lecture I am still confused, but at a higher level.”

Most of the lecturers come from MGH and Beth Israel Deaconess Hospital, some from Brigham and Women’s Hospital and a few from others.  Some are the UpToDate authors and contributors of the various national guidelines.  I certainly hope that Joy and Xiao consider themselves fortunate to be able to be with these great teachers on a weekly, if not daily basis.

哀Pad, 哀Pod, 哀Phone. i Thank You, Steve Jobs, jobs well done!

I do not know how iPad, iPod and iPhone are called in Taiwan, but today they should be called, 哀Pad, 哀Pod and 哀Phone.

哀  means sorrow, sad, grieve and mourn and has the same pronunciation as i.   i Thank you, Steve Jobs, jobs well done!

斯人也 而有斯疾也 (Such a wonderful person, such a dreaded disease!)

Steve Jobs died today and Dr. Ralph Steinman died last Friday—days before he was honored with a Nobel Prize in Medicine.  Both died of pancreatic cancer.  They might not have the same kind, but both have survived the disease longer than most with this terrible disease.  Jobs had pancreatic neuroendocrine tumor, a rare form of pancreatic cancers—less than 5% of all pancreatic cancers.  It is generally more indolent, but could be highly malignant despite it is called “tumor”, not “carcinoma”, it may be sort of "carcinoid" tumor.

斯人也 而有斯疾也 (Such a wonderful person, such a dreaded disease!)

斯人也 而有斯疾也 (Such a wonderful person, such a dreaded disease!)

 (Photos credit: Wall Street Journal)

“Lived just long enough to win a Nobel Prize” or “Lived just NOT long enough to know he wins a Nobel Prize”

Janice emailed me this morning saying Ralph Steinman “lived just long enough to win a Nobel Prize”, but the way I see it is that he “lived just NOT long enough to know he won a Nobel Prize”.  This is unprecedented, and I am glad the Nobel Prize Committee sticks with the original award and didn’t revoke it once they learned his death through a telephone call from the President of Rockefeller University today.

(Photo credit to the Wall Street Journal: Ralph Steinman’s family at the Rockefeller University today—what a wonderful gift of Ralph Steinman to his family—joy and pride at the time of sorrow.)

The students of immunology will learn the dendritic cells as the antigen presenting cells (APC) the first week if not the first day of the class.  Dendritic cells are the very front-line fighters or the soldiers on trench in our immune system to fight infection.  They engulf pathogen (an antigen) and present it to T lymphocytes.  This is the first step of adaptive immune response.  It took decades for the science community to accept it, only a man with strong conviction can persevere to eventually prove he is right.

Steinman discovered this back in 1973.  It took Nobel Prize committee 37 years to honor it.  Provenge, an immunotherapy for advanced prostate cancer that was based on dendritic cells.  It was developed by Dendreon, a Seattle-based biotech company that is unrelated to Steinman, and was approved by FDA last year.  It uses patient’s own immune system to fight the cancer.  The process begins with harvesting a patient’s immune cells, exposing it to a protein found in most prostate cancers and then give it back to the patient.  The month long treatment costs $93,000.

It is ironic that Dendreon announced it will lay off 500 employees because of slow sales of Provenge and its share price plunged more than 60%.  It was reported a few days ago that the managements are being sued for stock fraud as the management team sold $87 million of stock in the months before reporting disappointing sales of Provenge.

Dr. Steinman was also diagnosed with pancreatic cancer four years ago and had devised a tumor vaccine (immunotherapy) for himself, using his own discovery in addition to the conventional chemotherapy.  Whether it extended his life or not it is hard to say, but the average survival for pancreatic cancer is about one year only.

The following is from his obituary at NY Times on 10/3/2011.
"Dr. Steinman, who had been suffering from pancreatic cancer for four years, had been undergoing treatment using a pioneering immunotherapy based on his own research. Dendritic cells from his body were deployed to mount an assault on his cancer."

Appreciate Dr. Joseph Lister during the Listeria outbreak

I hope you haven’t been eating cantaloupes (the photo comes from a post at Sermo) these days and your refrigerator has none.  The current Listeria outbreak has been going on for nearly one month and FDA announced on September 14 that Jensen Farm in Colorado is the source of Listeria.  As of Sept. 29, there have been a total of 84 persons infected with Listeria monocytogenes in 19 states and 15 deaths have been confirmed.  Listeria can cause serious meningitis or encephalitis.

Listeria monocytogenes is named after Dr. Joseph Lister, a British surgeon, who first introduced antiseptic surgery using carbolic acid in 1865, the year when Civil War ended.  He published his article in Lancet in 1867.  The household product Listerine has been around since 1879; it is also named after him.

I am sure Dr. Lister’s story will be told in the recently released book, Invasion of the Body: Revolutions in Surgery (the history of the surgery).