The elevENth of Marc Fest’s 12 Most Useful Things

At the end of this series, which doth surely approach, I’ll give you the link to all 12.

11. Think better.

Mindmapping is the use of highly visual diagrams to help with generating ideas, structuring complex subject matters and facilitating group conversations, to name just a few extremely useful applications. In other words: it’s a thinking aid. I’ve tried out various programs that help in creating mindmaps, including Freemind (free as the name implies) and MindJet Pro. None of them are as intuitive, powerful and fun as iMindmap, created by the inventor of mindmapping, Tony Buzan. I can’t recommend this enough. You might also want to check out Buzan’s books on memorizing techniques.  iMindmap Elements, $99.

DCTH

Down more yesterday and may fall further – but that may be an opportunity.  Guru says: 

I just listened to the Jeffries presentation.  The data are great.  Isolated Hepatic Perfusion – the current treatment method – is a 9-hour open-liver procedure that involves 4 days in the ICU and 15 days total.  Delcath’s PHP method is a 2-hour procedure, no ICU, a day or so in the hospital total.  Can be repeated up to 6 times.  Here is one doctor’s assessment (“there’s no question that it works”).
 

There were 92 patients in the trial:  half in the treated, half in the control.  The control was "best alternative care":  radiation plus chemotherapy, surgery, whatever the doctor thought was "state of the art" among approved therapies for patients with melanoma metastatic to the liver.  Delcath has an SPA (“special protocol assessment”) with the FDA for the primary endpoint of "hepatic progression":  the time before the tumor in the liver starts growing again.  According to Delcath, the FDA insisted on the crossover – allowing patients to switch from the control group to Delcath’s therapy.  The group that did not cross over comprised 22 patients.  Why didn't they cross over?  Because their disease progressed to the point where they were not eligible for the Delcath procedure or they died. 

The data show about a five-fold increase in time to hepatic progression, p < 0.001.  [P = probability it could just have been random chance and not the effect of the procedure.  The smaller that number, the better.  It needs to be under 5% or less – .05 – for the FDA to accept it.]  They also show a three-fold increase in time to overall progression, p < 0.01.  And they show a difference in tumor shrinkage:  34% among those treated with Delcath’s procedure versus just 2% in the control group, p <0.05. 

[There was no statistically significant difference in surival between the two arms.  The median survival in the arm of patients who started on the Delcath treatment was 298 days.  The median of those who never crossed over to the Delcath treatment was 124 days.  The median of those who did cross over was 398 days.  However, these "crossovers" are counted as part of the control arm, because that's the arm they started in.  Those patients who cross over are healthier than those who don't – they lived long enough even to be considered candidates for crossover.  Thus, they are expected to have the longest survival of all subgroups and they did.  The crossover increases survival among those who crossed over, thus increasing the median survival in the "control" arm and reducing any survival difference that might be seen between "treatment" and "control".]

There were three "treatment related deaths":  2 neutropenic sepsis and 1 death from melanoma.  The incidence of mortality from neutropenic sepsis on the melphalan label is 3% to 10% and these 2 cases are right in the middle of those numbers.  Obviously, Delcath’s procedure didn't cause neutropenic sepsis.  The third death came from a patient who entered the treatment arm with 95% of the liver covered with melanoma.  Died within 30 days.  You can't say the procedure killed him. 
 
Delcath will complete filing for approval in October 2010.  They are well funded this year.  However, to get to approval in 2011, they will need to raise another $30-$50 million. 

 
Bottom line:  the procedure worked great and will get approval.

☞  I bought more yesterday at prices ranging from $8.88 to $9.36 . . . with money I could afford to lose.

AND IF YOU CAN’T GO A DAY WITHOUT POLITICAL DEBATE . . .

David D.:  “In attempting to refute Sheldon Richman, you wrote, ‘But, just for the record, no liberal I’ve ever met believes “government is the source of all things wonderful” or that “nothing good happens without government.”’  Actually, I think this *does* describe most liberals I’ve met.  None will say it directly but it follows from the actions they promote.  They want things like ‘single-payer health care’ and ‘hate crime laws’ and Social Security and welfare; all of these say clearly that healthcare, peaceful living, basic services and a good retirement are only possible through government.  I’ve never seen a liberal demand *less* regulation of something unless it is what they want to do in a bedroom.  I’d say the liberal goal is to set up an external authority that they can use to enforce their vision of how people should interact.  That requires government and regulation since people are notoriously unpredictable and tend to act as they feel necessary not as someone else might feel.”

☞  Oh, my.

<< I've never seen a liberal demand *less* regulation of something unless it is what they want to do in a bedroom. >>

In addition to opposing government regulation of the bedroom, liberals over the years have not been particularly keen on blue laws or Prohibition or dress codes or regulation of speech (see: ACLU) or of marijuana (see: NORML) – and perhaps least keen of all on government regulation of women’s bodies (see: NARAL).  It’s mainly regulation of corporations you’ll find liberals keen on – the tobacco industry, say, which long held that smoking was safe and that handing out cigarette samples to high school kids should remain legal.  Are child labor laws favored by liberals?  Sure!  And worker-safety regulations, consumer regulations, environmental regulations – and for good reason.  Indeed, enlightened corporate CEO’s favor these things, too, because without them, they are disadvantaged if they spend the money not to dump their chemicals in the river and their competitor doesn’t; or if they pay their workers a minimum wage and their competitors don’t; or if only they allow family and medical leave. 

Not to say regulation and red tape can’t get out of hand.  But liberals recognize that, too.  The Clinton/Gore “reinventing government” initiative had many successes, and the Obama team will have them as well.  Wherever you see a better way of doing things, by all means chime in!

<< [Liberals] want things like ‘single-payer health care’ and ‘hate crime laws’ and Social Security and welfare; all of these say clearly that healthcare, peaceful living, basic services and a good retirement are only possible through government. >>

Well, single-payer is more efficient and would make us more competitive and prosperous, so you shouldn’t rule it out.  The hate crimes law is of special significance in a nation as diverse as ours that – rightly – protects hate speech.  And Social Security is hardly “a good retirement.”  Like welfare (which is now “welfare to work”) it’s a bare-bones social safety net.  You can propose that America, alone among industrialized nations, jettison all its social safety nets.  But most Americans want one.