Cancer Diagnoses Survived

So, if you’ve talked to me at any point for more than about 10 minutes you know I’m a rabid cycling fan. I also happen to be a Lance Armstrong fan, which is not much of a given as you may think. Many people around the world have never accepted his comeback from testicular cancer at face value and have come to think of Lance as a drug cheat who’s just never gotten caught. It’s a mantle he’s worn throughout his career. 

Without going into the merits of that point of view, which is decidedly NOT the purpose of this blog, I sincerely hope that no matter what people’s historical opinions of Lance are that they can rally around his comeback today. To support that hope, some background:

This past September Lance announced his comeback to pro cycling. He described his rationale for doing so in a recent interview in Outside. In summary, he figured that by his coming back and racing on each continent he could focus dramatically more attention on raising funding for cancer research and prevention.  Further, he’s not taking any salary. His earnings go into the foundation. He’s got the money he needs to live on.

The metrics he’s looking to manage (from the Lance Armstrong Foundation) are pretty staggering:

CANCER STATISTICS

• There are more than 10.5 million cancer survivors living in the United States today
• This number has more than tripled in the past 30 years
• The number of survivors will grow as the population ages and progress against cancer continues

INCIDENCE AND MORTALITY

• 1.4 million Americans are expected to be diagnosed with cancer this year
• 560,000 Americans are expected to die from cancer this year, or more than 1,500 per day
• Nearly 1 in 2 men and 1 in 3 women will develop cancer during their lifetime
• Within the next decade, cancer is likely to replace heart disease as the leading cause of death in the U.S. It is already the biggest killer of those under the age of 85.
• Today 65% of adults diagnosed with cancer will be alive five years after diagnosis, up from 50% in the 1970s
• African-American men and women have the highest mortality rates for all cancer sites combined
• While dramatic survival improvements have been achieved in patients diagnosed with cancer at age 15 or younger and steady improvement has been made against a number of cancers common among those over age 40, little or no progress has been seen in the adolescent and young adult population. In fact, among those aged 25 to 35 years, survival has not improved in more than two decades.

CANCER COSTS AND INSURANCE COVERAGE

• The overall cost for cancer last year was $206 billion, which includes $78 billion for medical bills, $18 billion for lost productivity from the illness, and $110 billion due to lost productivity from premature death.
• 17% of Americans younger than age 65 have no health insurance coverage and 24% of Americans age 65 or older only have Medicare.

Why is Lance coming back? Because whenever he gets on a bike in a race, he’s making headlines. And when he’s making headlines, he can talk about cancer. And when he can talk about cancer in such a public way, he can dramatically affect the level of awareness of the statistics above. As an example, his first professional race of his comeback was the Tour Down Under in Australia in January. While he was there, he was able to gain a commitment from Australian Prime Minister Kevin Rudd for $3.8M in new cancer initiatives. Could he have gotten that commitment in more conventional ways? Maybe. But Lance could do it more effectively in the context of a media frenzy with lots of pictures of him on his bike.

Which, of course, is exactly the point. 

He’s even worked with Trek to create custom-painted bikes for his races, painted in the colors of his LIVESTRONG foundation and with icons related to his cause. Here’s his custom time trial bike, taken at this past weekend’s Amgen Tour of California prologue in Sacramento:

LIVESTRONG time trial bike

Ironically, this bike was stolen from the team’s truck later that night. Fortunately, it’s so utterly distinctive that it was recovered later in the week. The numbers painted on the frame represent the following:

• 1274 represents the number of days between his retirement and his comeback
• 27.5 represents the millions of people who have died of cancer in that time

It’s a wonderful example of a personal unit of measure and a person taking on a cause to manage that metric. No matter what you thought of him before, hopefully you can be a fan in the future.

 

To get involved…

Lance Armstrong Foundation

Severely-Burned Children Saved

Just about one year ago this weekend I had an accident.

I wasn’t feeling well; I had a sore throat and was very congested. Not being one that likes to take medications for such things, I made some herb tea in a teapot on the stove. The teapot whistled, and poured the water that had moments before been at a rolling boil into a large cup. As I was carrying this cup across the room to sit down in front of the television the handle of this cup broke free and I lost control of the cup. The boiling water, just under a quart if it, spilled over unto my left leg.

I’ve been hurt before. Lots of broken bones. Leg, arm, collarbone, shoulder. Dislocated an elbow once. None of those felt anything like this; this was a level above. To make matters worse the cotton pants I was wearing had a knotted drawstring so my leg was literally cooking in the water trapped in the cotton.

I eventually got the pants off and to the emergency room. They took one look at me and said “there’s nothing we can do for you here”. They put me on an ambulance and transferred me to the regional burn center at Santa Clara Valley Medical Center. That’s when my education began.

When I got to the burn center, the first thing that struck me was just how specialized the equipment and procedures are. High-coverage severe wound care isn’t like anything else. Patients are submerged, showered, scraped, scrubbed, and dressed several times daily. It’s profoundly uncomfortable, excruciating at times, and the larger the burn coverage area, the longer the patient has to endure it each day. For a patient with severe burns over 80%+ over his or her body, it’s an exercise in character and resolve that can last several hours a day.

The resolve is required not just from the patient, but from the would care nurse as well. They know what they’re doing is painful, but they know it’s also critical to affect the patient’s recovery. Even in the generally aseptic conditions of the burn unit, it’s common for there to be infections that can quickly become life-threatening. Once again, the larger the burn converage, the larger the risk of infection, the harder it is to fight, the higher the risk of mortality.

Proper and diligent wound care, enduring through the pain of it, and performing it expertly and compassionately, means survival to burn patients.

Some statistics that I didn’t appreciate until I spoke to these nurses (from the  National Burn Repository 2007 Annual Report):

• There were 178,ooo burn cases in the US in 2007
• Of those 178,000 cases, 21.4% were children 15 or under. 9.4% were in the 5-15 age group.
• 40.3% of cases were burns from fire, 29.5% of cases were from scalding water. 
• There were 2,189 burn cases in 2007 that were more than 40% of body coverage. 
• For cases with 40-49% coverage, the mortality rate is 25.4%. For coverage 60-69%, that mortality rate nearly doubles to 47.3%. For 80-89%, it’s up to 71.9%. Over 90% is 81.2%.

Let’s back up on that last statistic. If a patient is burned on 90% or more of her body, there’s an 81.2% change she’ll die. When I was in the Santa Clara Valley burn unit, there was such a girl in the suite adjacent to me. A child, 4 years old. She had been playing with her cousin near the kitchen, when decided to see what was cooking on the stove. She pulled down the oven door, and to help herself up up to see what was up there, she pulled down on the stew pot on the front burner. 

She accidentally poured two gallons of boiling water all over her body.

Three months later, she was alive, despite a 90% coverage injury. She was not recognizable as a girl, but she was very much alive. All due to the care and treatment that she received from the nurses in  that unit.

What’s amazing to me is that I didn’t learn about the details of this case  from the nurses. I learned about it from a firefighter that came to drop off a basket of treats for the nursing staff. In his free time.

There are several ways to determine if someone’s a hero. Firefighters coming to drop off gifts of appreciation to you in their free time, well I have to say that about the very top of the list.

Millions of Vaccine Doses Administered

Not long ago there was an editorial in the NY Times commenting on the work of the Bill and Melinda Gates Foundation. Here are some quick stats (from the Foundation Web site and the article):

• Immunization is currently at an all-time high, but still 21% of children worldwide do not have access to vaccines that could prevent deadly diseases
• Every year, 2.4 million children die from preventable diseases despite the availability of effective vaccines
• Transporting vaccines is very difficult to do cost-effectively, because most have to be kept at a controlled, optimal temperature
• The Foundation’s goal is to increase the use of effective but underused vaccines and introduce new vaccines to prevent a total of 4 million deaths per year
• The Foundation has provided $107.6 million so far as part of the joint Glaxo initiative for malaria. Glaxo says it has spent about $300 million and expects to invest $50 million to $100 million more to complete the project. If all goes well, the vaccine could be submitted for regulatory approval in 2011.
• The number of children under 5 who die annually has been cut in half since 1960 

Of all the organizations I have looked into to date, the Gates Foundation most closely aligns with what I’ve been trying to capture in this blog. Here is an excerpt from Bill’s most recent annual letter:

“I love the work at the foundation. Although there are many differences [between the Foundation and Microsoft], it also has the three magical elements. First there are opportunities for big breakthroughs—from discovering new vaccines that can save millions of lives to developing new seeds that will let a farming family have better productivity, improve their children’s nutrition, and sell some of the extra output. Second, I feel like my experience in building teams of smart people with different skill sets focused on tough long-term problems can be a real contribution. The common sense of the business world, with its urgency and focus, has strong application in the philanthropic world.”

I strongly agree with that statement, in particular that there are parallels to solving hard problems in both business and philanthropy. There are certainly nuances that are different, but I have to believe that defining the problem statement, developing the approach, building the plan, and executing with urgency are all skills that directly port over from developing and shipping a product vs. developing and delivering a vaccine.

The main difference, which is the core point,  is that the factors you’re trying to optimize are much more meaningful in the philanthropy case. If you don’t make quarterly earnings, investors get mad and people get fired. Maybe. If you don’t deliver vaccines at the right temperature or at all, 2.4 million kids die. The contrast in urgency is so clear to me, yet so many people treat business as life and death.

Much better in my mind to do exactly what Bill is doing, in having two careers. First, spend time in the business word training and getting experience in getting things done, and generating enough personal wealth to ensure your kids are supported. Then, in your second career, transition and apply those developed skills into solving “real problems”, i.e. those that really do mean life and death.

 

To get involved…

Bill and Melinda Gates Foundation

Lifesaving Emergency Surgeries Performed

Here is a terrific story about a Baltimore surgeon getting out of the comfort of his office and applying time and talent to populations that would not otherwise have access to his skills. In this case, he encountered a 12-year-old boy in Haiti who had a massive tumor that required immediate surgery. This surgeon, Dr. Mojtaba Gashti, recognized the severity of the issue and rallied the resources and diplomatic process to get the boy into his operating room in Baltimore. Here’s a quote from the article that best wraps up the theme:

“The doctor looked into the boy’s big brown eyes and saw his own young son, an American teenager who wanted for nothing. His heartstrings tugged, his head spinning with thoughts of how best to help, Gashti decided he had to bring Osly to the United States and make him well.”

What also strikes me is that this physician would have had no way of knowing this boy had this need had he not taken the time to go to Haiti and look. The open question then is in what ways could more prospective patients be identified, and more effectively paired with the medical care that they require? How would a doctor such as Dr. Gashti quickly get patients like this out of countries and into the United States to get treatment. Does the infrastructure and communication pathway exist for such quick action, or did Dr. Gashti have to figure it all out on his own?

Food for thought if you’re a talented program manager, data mining specialist, or public relations professional. Obviously, for a physician this is a great opportunity for extended service as well.