June, 2018

Deja Reviewed

By Michael J. Katin, MD

We have successfully passed through the month of May, 2018, with a strange feeling that we'd already done it before. Time warps are probably real. This doesn't eliminate the need to pay one's rent on time or respond to any current annoying subpoenas, but still strange enough that it is worth going over all the events that seem astoundingly familiar.

It almost seems that we've seen everything before in some form or another.

For the fourth consecutive time, the NBA Finals will be played by the Golden State Warriors and Cleveland Cavaliers, and LeBron James will be in his eighth straight Finals. Interestingly, the most recent championship of Major League Soccer was a rerun of the previous year's championship contenders, with this time the Toronto Football Club Reds beating the Seattle Sounders Football Club to win the Philip F. Anschultz Trophy but, of course, you all knew that. Even more astonishingly, the past two championship finals of Major League Lacrosse were between the Ohio Machine and the Denver Outlaws. Whatever happened to parity?

There was yet another royal wedding in Britain, with millions of Americans getting up at some hideous time on Saturday morning to watch this event, nearly 242 years after the Declaration of Independence, and over seven years since the wedding of the much more pertinent (if that's the right term ) older brother. Angloroyalphiles will now have to wait for Princess Beatrice or Princess Eugenie to come through, although, without this incredibly anachronistic system, they would otherwise not even be known to exist.

Another event happening in May, involving forces more powerful than the Royals ever had, (possibly with one exception ) was the inauguration of Vladimir Putin as President of Russia. If you think you'd seen this before, you would be correct; this had previously been celebrated in 2000, 2004, and 2012, with the term of the President having now expanded to six years from four years, with the major difference now being the presence of Steven Seagal. The event went well despite some controversy over the election process, including a history of previous and recent American meddling in Russian elections.

This was also a month that saw a resurgence of Ebola in the Democratic Republic of the Congo, with 34 cases (2 confirmed, 14 suspected, and 18 probable) and 18 deaths (all both suspected and probable). Due to the Royal wedding this did not get the same kind of publicity as the previous Ebola crisis of 2014 when the end of civilization was predicted and a bowling alley in Brooklyn was shut down.

Basically, everything happening this year seems to have happened before This may be particularly significant in terms of the major oncology discovery of the year (with more than half of it yet to go!). Most physicians know that sildenafil has other uses beyond the most lucrative, and in fact it was originally developed for applications for hypertension and angina. It has also proven useful in preventing altitude sickness and in treating pulmonary hypertension in neonates. In 2010, researchers at Virginia Commonwealth University showed that the combining sildenafil with doxorubicin considerably enhanced (no pun intended) the occurrence of apoptosis in prostate cancer cells while at the same time reducing both short and long-term detrimental cardiac side-effects. Granted, this was done in athymic mice with tumor xenografts, but close enough. One would have expected human volunteers to line up and/or sales of sildenafil to increase, if that were even possible, but the role of sildenafil then hit a snag in 2014 when a study in JAMA Internal Medicine identified a relationship between the use of sildenafil and occurrence of malignant melanoma; this was later endorsed by certain legal firms. It is to be noted that the 2014 study was based on analysis of 25,848 male health professionals rather than on humans, that most items related to sildenafil use were self-reported.* This concern about the risk of melanoma cut down sildenafil sales by 0.00003% but now, in 2018, the proverbial tide has again turned. Ironically, the theme of this month's 2018 American Society of Clinical Oncology Annual Meeting is "Delivering Discoveries: Expanding the Reach of Precision Medicine." Thanks to researchers in Ottawa, a shotgun approach to cancer may turn out to be a winner. Lee-Hwa Tai et al., from the Centre for Innovative Cancer Research at the Ottawa Hospital Research Institute, showed that, in immunocompetent murine models, postsurgical metastatic disease can be dramatically reduced with the perioperative addition of sildenafil and.......influenza vaccine! ASCO might as well cancel June's meeting and direct its members to stop wasting their time on other projects and to concentrate on applications of this discovery. Leave it to Canada, our long-time best and closest ally, already renowned for innovation, to come up with the ultimate breakthrough in cancer treatment.

Wonderful that we're on such good terms with them.

*Extreme control was exercised in avoiding any crass and obvious comments, with one exception, on what should be a very serious and personal topic.

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. He has expressed that he does not wish to live past his 75th birthday. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including June 1, 2018, this leaves 5,328 days to his goal.