Buy toxic chemicals and support breast cancer research! Not lying—just saw an ad on TV for weed killer and it had a pink ribbon logo on its packaging indicating, “A portion of every sale goes to support breast cancer research and awareness.” We have plenty of weed killer and a perfect lawn at our house, so I am no critic of the product. But have you noticed the pink ribbon logo on virtually every conceivable item or service?

How many times have you been killed for being the messenger with the bad news? You can often tell who is going to be angry when the CT scan shows recurrent disease. It is one of many things that are so stressful about being an oncologist. Let’s be honest; over the course of our career, we give a lot of bad news.

To my oncologist: You certainly were pleasant and compassionate. You also tended to minimize the gravity of the situation when my disease progressed. I know you’re not psychic, but when things are going badly, don’t be afraid to tell me you’re worried.

Recently, the US government released new “Sunshine” standards requiring more rigorous disclosure of potential financial conflicts of interest in medicine. Such new standards are driven by revelations of misdeeds on the part of pharmaceutical and device manufacturers.

When you start seeing a patient for the first time who has been treated elsewhere and the previous oncologist has not followed standard protocol, how do you present this new way of doing things without alienating the patient or sounding critical of the previous doctor?

My practice has been concerned that we physicians were not maximizing our “coding potential”; that is, we were not receiving as much remuneration for each cancer patient visit as Medicare permits under its guidelines. Therefore, the practice hired a company that specializes in teaching physicians how to get more. This company is part of a newly minted industry that does nothing else.

I see these tragedies unfold so often it has become routine for me now, yet don’t think that your life was less precious, that your death is less grievous, just because you killed yourself with cigarettes. It is not too late to change your future—listen to me!

It used to be so easy. Patients with ER-positive breast cancer got 5 years of tamoxifen. You could anticipate most of the side effects. No one showed up with an armload of internet downloads ready to debate the utility of hormone therapy, the risks, and metabolism or drug interactions. No more.

Most Americans are aware that technical experts from Consumer Reports magazine consistently rank televisions and automobiles manufactured by Japanese companies higher than their US counterparts, but I believe that neither Consumer Reports nor US physicians understand how much better lung cancer treatment results are in Japan.

As often as not, the decision whether to treat or deny treatment to any elderly patient with cancer is a result of an oncologist’s impression of the individual person’s ability to benefit from and withstand the side effects of therapy. And that decision is usually based on a clinical assessment that is far more intuitive than it is scientific.

My suggestion, as unrealistic as it is, would be to encourage the creation and maintenance of parallel groups of quality measures: one set to satisfy the reportable measures of quality that affect reimbursements and pay for performance, and a second set that would be developed by and adapted to each institution to measure and drive improvements in those things we felt were true measures of high quality care.

The reality is that new biological agents are often priced like a Ferrari, and patients who are covered under a pharmacy benefit are required to fork over not a fixed copay but a percentage of the pill’s cost, each and every month ‘til eternity or death, whichever comes first.

Reading the contents of the NCI Cancer Bulletin in recent years, I have become increasingly concerned by what I perceive as an irrational, pervasive, and persistent editorial bias against cancer screening.

Without naming drugs, because there are several that fall into this category, has anyone else noticed that many of the new cancer drugs show an infinitesimal improvement in progression-free survival or overall survival?

Much study has been done on how to promote the most important attribute physicians must have in order to fulfill their sworn duty: that of professionalism. For practicing physicians such frustrations as the insurance bureaucracy and the pressure to generate visits can erode that duty.

As is nearly always the case with international travel, and especially in a place so different from what we are accustomed to in the United States, the whole experience was delightfully eye-opening, both for those dimensions of medical care and education that struck me as remarkably similar, as well as those that seemed wholly foreign.

As I walked into my office last Monday I found my nurses giving me a peculiar look, one that I usually reserve for incidents like watching someone back into another’s car. The explanation for their solicitude was soon revealed by a stack of charts lying on my desk. During my weekend off, seven of our patients died.

It has been a year since Congress passed the Affordable Food Act, which mandates that all Americans have adequate insurance for the purchase of groceries. Needless to say private industry, always willing to fill a new need, has answered the call.

I have come to the conclusion that a successful systematic approach to earlier transitions from disease-directed cancer therapy to end-of-life and palliative care can only come from better communication in the context of more trusting relationships.

Would it not be advantageous for people fighting what I call the “vile coward” to take a break from its ugly face? With nothing but the best intentions in mind, I hereby proclaim that all patients have permission to take a vacation from cancer, to schedule a time where cancer is not allowed in the door.

“Personalized medicine” holds its promise only at the substantial cost of widespread use of the awesome tools of molecular science, and at a time of intense scrutiny of the costs and benefits of medical treatments, can we really afford it?

With National HIV Testing Day recently behind us and the 19th International AIDS conference happening later in July in Washington, DC, I would like to share some recent HIV/AIDS statistical, research, and policy highlights.

We’re now entering the fourth decade of HIV/AIDS awareness. Last year marked the 30th anniversary of the earliest report (on June 5, 1981) of what is now known as AIDS (acquired immune deficiency syndrome).

How will we deal with patients and families who, given their tremendous access to information, learn about and demand expensive (and up until now reasonable) treatments once we have recast them as too expensive to justify their marginal benefits? Are we prepared to engage in such discussions directly?

Learn how to help cancer patients and survivors ease into an exercise routine to promote overall wellness and combat fatigue.