Medical mission to Honduras. December 20, 1998-January 2, 1999.

This is the story of a team of medical professionals who responded to an appeal from Church World Services in New York to provide two weeks of primary care for Honduran people in areas devastated by Hurricane Mitch. It was a remarkable experience to see how a small team of changing physicians, nurses, and support personnel could function effectively although they had not known each other, or ever worked together before. Over a period of two weeks with two major holiday weekends and an unusual amount of time spent in travel, the team in seven working days provided primary care to about 500 patients ages 1 day to 82 years with limited medical supplies and no laboratory resources. The patients resided in rural villages, without electricity or running water, which could only be reached over poor rural roads. Full credit should be given to the Honduran CCD which provided support services for the dedicated, compassionate American volunteers, and to the Honduran villagers who patiently waited, often in the rain, to be seen. It is hoped that the medical services were as helpful to the recipients as the experience was to the team participants. There is little doubt that long run efforts of CCD and other non-governmental organizations (NGOs) are needed to stimulate overall improvement in the standard of living in rural villages. Future sustained development will take local leadership to stimulate interest in a better future by spacing children so they can have improved education and healthier living conditions.

What is being done about Delaware's high cancer death rate? (1988 through June 1997).

After more than ten years of studies of Delaware's high cancer death rates by Delaware's Division of Public Health, few of the recommendations to reduce the excessive number of cancer deaths have been understood or adopted. Although rural Sussex County's cancer death rate is higher than the other two counties (except for lung cancer), and Delaware has only a few more cancers per population than the national average, industrial toxins commonly continue to be blamed for the State's high cancer mortality rate. People are still not persuaded that over the long run, cancer deaths would be cut by adopting healthy life styles to: 1. Reduce exposures to tobacco (by far the most significant intervention), 2. Stick to low fat, high fiber diets, 3. Have regular screening for cancers with appropriate tests 4. Seek medical attention for early symptoms of cancer. This review is seeking to emphasize the importance of implementing the repeated recommendations to reduce cancer mortality in Delaware without asking for another study, and to stress that health behavior education at home and in the schools is a cost effective way to initiate the adoption of healthy life styles to reduce the risk of getting cancer and dying from it. Efforts in the schools should be continued by extending health promotion activities to workplaces, doctors' offices, and to the general public with a focus on senior citizens. Universal access to health care will be needed especially for the poorly educated with limited fiscal resources who are most at risk. Delaware needs action, not more studies, to reduce its high cancer death rate.

Why is health care reform faltering? Delaware's experience.

Many managed care plans propose short-term economics, without stressing quality, assuring universal access, supporting research, or caring for the poor. None provide much in the way of preventive services. In the absence of any major national changes to assure universal access to health services, local health care providers and state regulatory agencies need to be freed from many restrictive federal laws and regulations. Relief is needed from well-intended federal controls which have usually made the health care system more expensive 1) by applying federal anti-trust regulations to prevent physicians from self-regulation and working to improve the health care system, 2) by making it difficult for physicians to do office laboratory work for their patients' convenience, 3) by making "safe" drugs expensive because of FDA regulations, 4) by sequentially spawning PRO, PSRO, and now the Health Care Quality Improvement Program (HCQIP) to "assure quality control" (they probably have not paid for themselves), 5) by not using the RBRVS system (accepted by HCFA as a way to relate a physician's fees to the resources required to perform a service) to stimulate physicians to enter primary care practice, 6) by giving tax breaks for insurance costs to big corporations but not to small businesses, and 7) by protecting self-insured businesses from state regulations. States should be allowed to obtain waivers from ERISA (which incidentally would improve competition) so states could regulate health insurers, try such proposals as a single payer system, or at least restore community rating and equity. This should improve access to technological advances in prevention and health care for all. More commissions and studies and federal laws are not the answer. Health care providers should be able to work together freely to deliver efficient, cost-effective health care. States should be able to assure preventive services, clinical research, public health support, professional education and care for the poor.

The Community Clinical Oncology Program (CCOP) story: review of community oncologists' experiences with clinical research trials in cancer with an emphasis on the CCOP of the National Cancer Institute between 1982 and 1987.

PURPOSE: To review the growth of community physicians' involvement in National Cancer Institute (NCI) clinical research trials as a significant contribution to cancer control, and to show their impact, not yet fully realized, on cancer morbidity and mortality in the United States. DESIGN: Background information, based on the personal experience of participants, as well as a review of pertinent literature, portrays the evolution of the clinical research component of community oncology in the United States over the last 25 years. RESULTS: Data from Community Clinical Oncology Programs (CCOPs) I and II have been used to outline some of the results of this far-reaching program. CONCLUSION: The CCOP was introduced at an appropriate time to expand the clinical trial resources of the NCI, while at the same time helping community oncologists practice state-of-the-art cancer management found in the research protocols. This in turn provided improved resources to manage cancer patients, as most of them are treated in their own communities. CCOPs have also indirectly had a positive impact on the trial processes of the NCI cooperative groups and comprehensive cancer centers, and have helped to widen the scope and hasten progress in cancer-control research and practice.

Is better access to medical care needed in Delaware?

Improved access will require more primary care providers, a reduction in administrative red tape, and a clientele with healthy lifestyles who know how to use the system appropriately. Prevention is a necessary component of access even though it often takes years to produce results and is usually not dramatic or glamorous (the heart attack which does not occur is hard to measure). Over time, the health of Delawareans should show improvement through appropriate access to medical care, which should not only be cost effective but add to the quality of life.

Response of tumors to thermodynamic stimulation of the immune system.

Cytokines such as interferon, interleukin and tumor necrosis factor are natural body defense proteins which have been used individually in recent years to produce a few complete responses of some tumors in a few patients but their overall effect has been limited. The hypotheses is that a biologic stimulus such as endotoxin will stimulate the immune system in a more natural way and hence will be more likely to have an effect especially in the presence of a naturally produced fever than treatment from just one lymphokine. One of the side effects of current lymphokine studies has been fever usually spiking in nature but there has been no obvious effort to relate the extent of the fever to any tumor responses. Clinical experience has shown that increased temperature can enhance the results of radiotherapy and chemotherapy in some situations. Therefore it is logical to put this hypothesis to a test clinically. It is surprising that the combined effect of fever and lymphokine stimulation has not been reported aside from Coley's work, and it is only in retrospect that fever has been suggested to be essential to the tumor control noted. Most of the literature, animal and human, has focused on the destructive effect of temperature on tumor cells and not as part of an immune response to control tumor growth. Endotoxin is the pyrogen on which most current information is available. More effective and more available pyrogens may be developed later.

Results of a national survey of characteristics of hospital tumor conferences.

A descriptive survey of hospital tumor conferences, which are also referred to as tumor boards, was conducted by the National Cancer Institute in collaboration with the American College of Surgeons and Roswell Park Memorial Institute. The survey was done to assess the involvement of the tumor conference in the care of the patient with cancer and to lay the groundwork for additional studies of the conference. The data from the descriptive survey are based on questionnaires sent to 1,700 hospitals in the United States. The questionnaires requested information about frequency, attendance, composition, role of the chairman, agenda and other variables that relate to the format and purpose of the conference. From the results, we conclude that tumor conferences are an accepted and established institution for the multidisciplinary care of patients with cancer. They are a major source of consultation and education for physicians and for other professionals involved in oncology. Tumor conferences are conducted in a wide spectrum of hospitals and related institutions that vary in size and function.