What’s bad is good?

[biopearl123]

Some great comments on the board so far. Thanks to those who read my post (hundreds) and to those who posted comments. I have a few thoughts to share. So to Kmall, a man with a VERY good memory. Yes that was an exact quote, more later. First a couple of thoughts pertinent to therapies in use today that may not be directly related to Imetelstat (but it’s the principle I want to discuss.) When I was a practicing cardiac electrophysiologist we used a TON of a medication called amiodarone. My esteemed colleague Steve K. called it our best worst drug. The side effect list was long but in the right hands and with stewardship from experienced clinicians it could be magic. It could stop salvo’s of ventricular tachycardia, tame runaway defibrillators, help intractable atrial fibrillation. And yes the list of side effects, well rather than list them here and believe me I know that list intimately, you get the picture. The point is most cardiologists would agree that getting approval from this FDA might be impossible today. Let’s move on to Adriamycin, also known as “the red death”. Its’ red, its intravenous. It is now in the world of political correctness (and I might add in that in that same world some physicians instead of being grateful for the privilege of practicing medicine, have used their medical status to publicly express nauseating political views that should justify their expulsion from this honorable profession), its called “the red devil”. Ok so we got away from the word death. Ok one more example close to home. 10 years or so (with a nod to our historian Kmall), Dr. T published his study in the NEJM. The AML treatment group, “group D” got Imetelstat EVERY WEEK in the highest dose. They all died. Well they were going to anyway with an incurable disease. The point is AML treatment with Imetelstat may actually turn out to be very “promising” once the harsh learning curve of the past is internalized and paid homage. One other personal note, when I was 47 I was diagnosed with Graves’ disease (a form of hyperthyroidism). It was treated with radioactive iodine. I had to live in a hotel , isolated and flush 3 times until I was no longer radioactive. My endocrinologist told me my risk of getting acute leukemia would be higher by about 1 in 1000. I took the risk. On top of that I have found myself in the radiation stream of the fluoroscope for many hours at a time doing complex EP procedures. This is just an expected risk in my profession (now lessened considerably by robotic and computer improvements, but we were men of iron or so we thought.) So far normal blood counts. In short risks must be taken to gain benefits and if a patient and their doctors agree the risk is worth it than may the benefits ring out. So what about these cytopenias that has everyone so concerned and why is Dr. P walking on egg shells? Fear of the FDA? A lack of true understanding as to the nature of the cytopenias themselves? Inexperience in managing Imetelstat induced cytopenias? (98% of heme oncs have that—soon to hopefully change. We know from Dr. S that when the malignant clone which has spawned many many daughter cells that the bone marrow is filled these abnormal cells, bad things happen. These cells must die to allow for recovery of normal cells that can repopulate the bone marrow. Well, hence the cytopenias that are “limited and manageable.” I have known some magnificent brilliant academicians who trained many brilliant and magnificent fellows who went out into the community and served selflessly. It is somewhat patronizing to think that a well trained heme onc doc in the community and well, around the world can’t learn to manage these cytopenias which may in fact represent “something bad, that’s good”. There will surely be a reaction to Dr. P’s editorial. It will be interesting to watch.