Drug Dilemma
Beryl Lieff Benderly does an excellent job of summarizing the current state of the environment for access to experimental cancer drugs in “Experimental Drugs on Trial.” A bigger issue that Benderly does not discuss, however, regards how the U.S. Food and Drug Administration and other regulatory agencies evaluate medicines for terminal disease states, particularly cancer.

Built into the evaluation process is the assumption that the truly sick individuals allowed to participate in clinical studies generate treatment data that are directly relevant to earlier-stage patients. Although this may be the case in many situations, it is used as a truism that is perhaps unprovable. The difficulty in evaluating the health of a terminal cancer patient makes it very hard, in my opinion, to demonstrate the real benefit that a drug may show in a relatively healthier patient.

We then encounter the ethical dilemma of whether to permit earlier-stage patients, who have more established treatment options, to use an experimental drug that has at least the potential to help them more than current (and painful) chemotherapy and radiation treatments. If we could find a way to allow earlier-stage patients access to experimental medicines that is ethical and that helps society as a whole, we might speed cancer drug development immensely.

Joe Senesac
Houston

Political Wilderness
In “Conservation for the People,” Peter Kareiva and Michelle Marvier make the case that, because conservationists have not been able to build strong political support for protecting areas based on their biodiversity value, focus should instead be given to protecting areas that provide immediate benefits for people.

As in other political and social movements, failure to build support for a goal does not mean it should be abandoned. If the movements for abolition or civil rights had adopted Kareiva and Marvier’s approach—making available to black Americans only such freedom and equality as whites saw as being in their near-term material interest—we would still be living with Jim Crow.

The authors drag out many straw men in making their argument, including the nonexistence of “pristine wilderness.” Wilderness need not be pristine to sustain all native species in healthy populations, including top predators—animals essential to healthy ecosystems that some find  “inconvenient.” Wild places are essential because people’s ability to manage nature successfully is limited. Experimentation with different approaches to conservation is fine but not at the expense of efforts to protect the lands and waters vital to the full range of biodiversity.

David Johns
School of Government
Portland State University

Michael E. Soulé
Professor emeritus
University of California, Santa Cruz

Pillow Perception?
In explaining their different theories of what brain activity matches up with specific conscious experiences in “How Does Consciousness Happen?” Christof Koch and Susan Greenfield each describe their views on why an alarm clock induces “consciousness” in a sleeping individual. Both fail to consider several factors in their assessments, and I feel that a better understanding of where “unconsciousness” ends and consciousness begins is needed.

For instance: Why is it that a person can sleep peacefully through many “common” sounds yet suddenly wake to the slightest  “uncommon” noise? When I awaken to such sounds, I am more fully “conscious,” or acutely aware of my surroundings, than if I am suddenly woken from sleep by the shrill call of the alarm clock. Furthermore, many people invariably awaken a few minutes before their alarm clock sounds.

1 Comments

1. 1. Go Yoshida 03:41 PM 3/9/08

   To be sure there is a dilemma of whether to permit earlier-stage patients, who have more established treatment options, to use an experimetal drugs or therapy for clinical trial, difficult-to-treat patients have resistance even to standard therapy.
   That is why patients with malignancy are not good for clinical trials.
   In any way, physicians have to keep in mind not to cause selection bias when analyzing the outcome of clinical trials.

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