Teaching Kids V. Treating Cancer: What Have We Learned Since 2003?
Posted: February 20th, 2012 | Author: Michael Goldstein | | 6 Comments »
Pru started her oncology training in 2003. I asked her: What has your field learned about breast cancer since 2003? To keep it simple, just tell me about chemo — ignore radiation treatment and surgery advances.
(Cautionary note: this is undoubtedly my highly inaccurate translation of what she said. Do not use this blog for medical advice. Or financial advice. Though I do think Groupon is overvalued).
Pru replied something along the lines of:
I can think of three big advances that help oncologists treat breast cancer patients.
In 2003, if a woman received chemo for breast cancer, she’d probably get “AC.” Adriamycin and cytoxan.
In 2012…
1. About 70% still get AC as their chemo.
But if AC fails, we have much better 2nd, 3rd, 4th, and 5th line options. Taxotere, for example. That’s a big deal. Xeloda. Even a bigger deal. Chemo in a pill.
2. There’s an amazing test called OncotypeDx. It costs about $4,000 a pop. Became available in 2004 or so.
We learn more about the breast tumor than we ever knew before. By understanding the genetics, we know how likely the tumor is to come back. And if it’s likely, we can do something.
For example, we might treat tiny tumors that we’d otherwise ignore. Or the patient might take Tamoxifen, a hormonal treatment.
3. My breast cancer work over the last couple years is in cancer genetic counseling and prevention. This type of work isn’t widespread yet. It’s new.
Most oncologists are busy just treating cancers, not meeting with women who have no cancer. And insurance companies are just getting up to speed on counseling. Obviously if it’ll save them money through prevention and early-stage detection, they’ll start to fund and even promote it. Or so we hope.
The process starts with a conversation. If a woman has a family history of breast cancer, we talk about the risks, which depend on how close the relatives were, how old they were when they got breast cancer, is she of Ashkenazi Jewish descent, and so forth.
Then we can do a test. It’s for the BRCA mutation. We send the sample to Utah. There’s one company in the world that can analyze the genome, called Myriad. $3,000 or so per test.
In the population I’m testing, there’s a 10% chance of BRCA mutation. And if my patient has that mutation, she’s very likely to get breast cancer. But it’s much better for us to learn that early.
a. She can get surgery before any cancer appears; have her breasts removed. This is more popular in Europe than in USA. And when it happens in USA, women more often want to combine a liposuction procedure and plastic surgery so they still have breasts.
b. Even without surgery, a BRCA+ woman can take Tamoxifen before any cancer arrives. This could cut the risk by 50%.
There are risks of side effects. But often patients have a somewhat irrational fear, based on reading random stuff on the internet and following news stories that don’t put things in perspective.
For example, it’s true that Tamoxifen increases your risk of uterine cancer as a side effect. So you’d think – “Well that is scary. I don’t want to protect against breast cancer and cause a different cancer.” However, the risk is roughly 0.2%, or 1 in 500. Would you trade a 50% reduction in the chance of getting breast cancer for a 0.2% chance increase of getting uterine cancer?
c. In any case, Tamoxifen still scares people. That’s why I’m excited about a new drug, being developed right down the road at Mass General. Paul Goss is leading the work. Exemestane. Cuts breast cancer risk by 65% in older women who are higher risk without (so far) side effects beyond hot flashes.
Hmm.
What has our field learned about teaching since 2003? I can’t think of much. Can you?
Let’s see. We do have some new buzzwords.
“Data-driven” teaching. It does happen well in a few schools. Thanks to folks like these guys and Paul B. In most schools, though, it’s just a buzzword that annoys teachers. Same is true of “differentiated instruction.”
“Inverted classroom” is a new way of teaching. That’s the idea that kids watch videos at home to learn the basics, and then the teacher leads problem-solving the next morning. I haven’t yet heard of it in high-poverty schools, but who knows.
What am I missing here?
I’m not talking ed policy, I’m talking the day to day job of teaching: choices made, methods used. Do we have any concrete advances in teaching?
Hmmm….aren’t even the most influential ideas of the past 20 years in teaching just codifications of old practices? Data driven instruction, differentiated instruction, backward planning, etc…
I’m drawing a blank on really NEW ideas, especially in the past 10 years. But I think that No Excuses charter schools have made valiant attempts at what we might consider the recombinant DNA of teaching – putting together a better mix of tried and true practices that when working in concert can raise the bar for low-income kids.
It’s like the checklist innovation in medicine or even something as simple as scrub procedures. Not rocket science or wildly innovative or flashy, but effective at reducing bad outcomes.
I just hope that we don’t stop there…because there is still a lot of work to be done to push our schools to the next level. I think the next frontier, at least for my school, is continuing to put the thinking on kids, getting them to be more independent and have more ownership of their own learning.
The problem with your metaphor here is that the parallel to learning about teaching is learning about doctoring, or perhaps healing. There is probably about the same amount of R&D in “teaching” and “doctoring.”
The parallel to changes in a specific type of treatment for a specific disease would be changes in the understanding of a specific type of learning problem, like dyslexia or dividing fractions. In dyslexia there is probably a lot of new research; in other specific areas there is a huge backlog of unimplemented research.
And notably, our current reform movement isn’t particularly interested in that kind of specific research, e.g., it is good enough to have the Kahn Academy, “no excuses” schools aren’t particularly interested in cutting edge special ed techniques or ELA methods.
Tom, good point as usual. Not parallel.
And I agree the reform movement isn’t particularly interested in specific research on any non-policy issue (whether teaching writ large, or “learning problems” as you’ve described them).
* * *
Paul, well said. I think our middle school needs to get to Brooke level, and meanwhile you at Brooke need to go to next frontier….
I agree that teaching kids and treating cancer are not parallel. I agree with Tom’s point–or what I interpret to be Tom’s point–that a lot of the health care system is not about improving the practice of doctoring. Rather, a lot of money is put into understanding the nature and biological mechanisms of diseases, and developing new treatments in the form of drugs and medical devices. And one can’t ignore the huge profits that companies are responding to. Health care is something for which there is an insatiable, and inelastic demand. We will pay whatever cost to gain our health and live as long as possible.
But there are still some parallels here. In education we don’t spend enough in research overall and almost nothing on development of high quality tools for teachers, such as curriculum and lesson materials. There is some “R” and not enough “D.” Moreover, curriculum “market” is totally inefficient. A few giant firms dominate educational publishing, and the curriculum adoption process is highly politicized and dominated by a few states Texas, California, etc. (though maybe the Common Core will change this). There is very little market pressure for publishers to up their game, and plenty of incentive to repackage old wine, and develop cr@p products, etc… Finally the ultimate users of the products, teachers, often have little market power. There is a reason, on the other hand, why pharmaceutical companies wine and dine doctors.
I would say that neuroscience and lots of high quality psych research has probably increased our knowledge of how the brain works, which has many implications for teaching and learning. But the weak link is in translating that into usable knowledge and tools for teachers. And I mean tools in the broadest possible sense, curriculum, assessments, lesson plans, pedagogical strategies, ways of representing concepts, etc.
Finally, the adoption of various tools, even if they are available is mediated by ideology and philosophy. I once asked some students if there was any evidence that would convince to use a literacy curriculum that I knew they strongly disagreed with. And several said, none whatsoever.
Here’s another question, you might ask Pru. Should doctors in any way be held accountable for crisis of obesity in the US? If some think that teachers ought to be solely held responsible for the education level of the population, why not hold doctors responsible for the health of the public?
Ed,
Great question.
Larry Cuban took it up last year on his blog.
See here
http://larrycuban.wordpress.com/2011/04/15/paying-doctors-on-the-basis-of-patient-outcomes/
and here
http://larrycuban.wordpress.com/2011/04/18/disturbing-but-alas-predictable-policy-outcomes-for-teachers-and-doctors-pay-4-performance/
Speaking of Larry Cuban, have you read his posts about Rocketship Charter schools?(http://larrycuban.wordpress.com/2012/02/13/i-saw-the-future-and-it-works-a-visit-to-a-hybrid-school/)
It is basically the hybrid school that works with predominantly low-income students.