Field Notes #22: Good News Edition
Bright stories of hope around gentler cancer treatments, a cure for a disease that causes hair loss, and a Texas city making a difference for people who are homeless
Hello, friends! Happy Wednesday! I have three pieces of good news for you today, three “Field Notes” that offer hope. One is about new, more targeted and gentler cancer treatments; one is hope for a disease that can cause complete hair loss; and one is about a city in America that is making a bigger impact than other cities at housing people who are without homes.
All of these stories are also stories of people working deliberately to figure out and solve someone else’s terrible problem. This is what strikes me in my core — the scientists helping a someone’s hair regrow, the researchers figuring out how to match a cancer tumor to a therapy, the housing leaders navigating a bureaucratic maze to align organizations and ultimately get people into homes — none of them are likely suffering from this exact problem themselves at that moment. But they see someone else in trouble. They are doing the agonizing, tricky, puzzling work of figuring how to change our world for the better for other people.
1} “A turning point in cancer”
I was excited to read a flurry of recent studies around new cancer care, ways to use genomics to match a cancer to a specific treatment to extend life or even eliminate the tumors.
Eric Topol, a leading scientist (and a recipient of the Gold Foundation’s National Humanism in Medicine Medal), detailed the four recent studies in his newsletter Ground Truth, titling the post, A turning point in cancer.
He wrote:
The narrative has been incubating for many years, but in recent days we are witnessing some extraordinary progress in treating and monitoring cancer. The convergence of genomics of the cancer—be it from the person’s DNA or tumor directly or the blood (known as liquid biopsy)—matched with the appropriate therapy is leading to outcomes that are being described as “unheard-of” by expert oncologists. This represents the essence of individualized medicine, whereby understanding the unique biologic basis of a person’s cancer can lead to highly accurate and effective treatment, and also avoid the toxicity of classical chemotherapeutic agents.
Each of the four recent reports targeted a different cancer with different characteristics: rectal cancer, breast cancer, pancreatic cancer, colon cancer.
The results are incredible. For example, the rectal cancer study, “PD-1 Blockade in Mismatch Repair–Deficient, Locally Advanced Rectal Cancer,” was small, just a dozen or so people, but all of them had their cancer disappear.
“I believe this is the first time this has happened in the history of cancer,” study author Dr. Luis A. Diaz Jr. of Memorial Sloan Kettering Cancer Center, told The New York Times.
Those patients had a specific kind of tumor, marked by a deficiency in the “mismatch repair system,” a system that should normally be detecting and fixing any DNA mismatches or glitches. The patients received infusions of dostarlimab-gxly, a “programmed cell death receptor-1 (PD-1) blocking antibody.”
Check out this one image from the rectal cancer study, shared by Dr. Topol. (I’m hiding it in a link because it’s an endoscopy picture, the fleshy pink inside of us, pictures you may be familiar with from having a colonoscopy yourself. It might not be what everyone wants to see. But it is dramatic: The cancer goes from being visible and gross to being gone!)
None of this means that cancer will be eliminated tomorrow, but these studies are “future signs,” signs of more to come, signs of hope.
What’s striking to me, too, is that these seem to be gentler treatments.
They offer a route to not just eliminating cancer, but to erasing the often terrible side effects and complications from harsher chemotherapy, radiation, and surgery that often linger for the rest of survivors’ lives.
2} Reversing hair loss from alopecia areata
This is a Field Note about alopecia areata, a disease that can cause total hair loss — from head to eyelashes to nose hair. There was no cure or treatment, until a doctor noticed that a drug study in mice around a completely different issue had potential hope for the disease, which affects 300,000+ people in America. He offered it to one of his patients, a 25-year-old man, and his hair grew back.
This New York Times story (gift link) chronicles the drug, baricitinib, receiving FDA approval this week, and two more similiar drugs likely coming soon. All of them are “JAK inhibitors,” which “regrows hair by blocking the immune system from attacking hair follicles.”
The drug, which is made by Eli Lilly, was tested in two trials sponsored by the company. In a year, almost half of the participants had their hair grow back.
The stories of the people who have seen their hair grow back are all moving.
Here’s just one from The New York Times:
Christian Daniels, 27, a data center technician who lives in Peoria, Ill., said hair loss also affected his eyes. Without eyelashes, dust would get into his eyes and irritate them so much he began putting Vaseline on his eyelids.
Mr. Daniels’s hair started falling out when he was 25. Within a month, all of his body hair was gone.
Covid-19 was “a blessing in disguise,” he said, because he could work at home.
“I felt like my life had been put on hold,” he said. “I felt like the only thing that mattered was how to get my hair back.
The drug worked. Now, he says, “it’s almost like it never happened.”
Read the full story here.
3} Housing more people in Houston
Finally, here’s a good news story from Houston, Texas, about that city’s orchestrated effort to find new homes for people who did not have homes. Housing may not be top of the list when we think about our health, but it’s the foundation of health. How can we think about sleeping well, or eating well, or managing an illness, if we are without a home?
This article drew all sorts of emotions, both for its portrayal of the heartbreaking situation for so many people and of the path of efforts making a difference: How Houston Moved 25,000 People From the Streets Into Homes of Their Own (New York Times; gift link for me to you). As the subhead says, “The nation’s fourth-largest city hasn’t solved homelessness, but its remarkable progress can suggest a way forward.”
One in every 14 Americans experiences homelessness at some point, a population that is disproportionately Black. Eradicating homelessness would involve tackling systemic racism, reconstituting the nation’s mental health, family support and substance abuse systems, raising wages, expanding the federal housing voucher program and building millions more subsidized homes.
The goal in Houston and among other cities attacking the problem is different: to make homelessness only “rare and brief,” to cite Rosanne Haggerty, the housing advocate. Five states — California, New York, Florida, Washington and Texas — now account for 57 percent of the people experiencing homelessness. Not coincidentally, it is worst in those big cities where affordable housing is in short supply, the so-called NIMBYs are powerful, and the yawning gap between median incomes and the cost of housing keeps growing. Houston fits that description. The scale of its woes does not approach what is happening in San Francisco, New York or Los Angeles. But the progress it has made in housing people is instructive and replicable. It constitutes a fragile, compelling success.
Houston has managed to bring organizations together that were all working on a piece of this enormous problem and help them coordinate. According to the article, that has made all the difference.
During the last decade, Houston, the nation’s fourth most populous city, has moved more than 25,000 homeless people directly into apartments and houses. The overwhelming majority of them have remained housed after two years. The number of people deemed homeless in the Houston region has been cut by 63 percent since 2011, according to the latest numbers from local officials. Even judging by the more modest metrics registered in a 2020 federal report, Houston did more than twice as well as the rest of the country at reducing homelessness over the previous decade.
It’s worth reading and reminding us how there is so much work to be done to take care of our fellow humans. If you look for clues this week for how you can help, I bet you will see them.
To our journeys,
Brianne