On the NELSON trial

I remember that in med school years ago, we were taught that there were no data to support screening for lung cancer. Screening involves detecting the early stages of disease among individuals who do not yet manifest it completely in order to reduce deaths from such disease. Studies have proven effectiveness of mammograms for breast cancer and Pap smears for cervical cancer, but, until recently, no screening procedure was recommended for lung cancer, which remains one of the hardest cancers to treat, given its aggressiveness.

The NELSON trial, published in the New England Journal of Medicine in 2011, determined if performing low dose CT scan compared to chest X-rays, actually reduced mortality among men and women at high risk for the development of lung cancer—i.e., at least 30-pack year smokers. It looked into 53,454 persons for many years and looked into the rates of development of lung cancer among these people.

The study highlights the following results:

There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P=0.004).

That's 20% reduction in deaths—a clinically and statistically significant result.

In an ideal world, we'd request low dose CT scans in these subsets of patients, but in a country where much of health care is shouldered by patients, this may not be done at all, given the cost (at least Php 5000.00). Many questions arise from this trial: how often do we do CT scans? Do we get the same benefit if we screen non-smokers? We expect the answers to these in the coming years.

The best way to decrease lung cancer deaths is, of course, smoking cessation. If you haven't stopped smoking, please do so now—a friendly and urgent reminder.

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Whisperings and impulses to sin

In The Doctrine of Regeneration, Stephen Charnock argues that man cannot do anything to save himself.

Adam had the greatest advantages human nature, in a natural way, was capable of; he was created with a fullness of reason. But how long do we converse with sense, which fastens upon temptations before we come to a use of reason! After we are come to some smatterings of reason, and a growth in it, as we think, what whisperings and impulses to sin do we feel! What an easiness to embrace incentives, a deafness to contrary admonitions! What languishing, velleities, and palsy desires at best, for that which is good; a might most and darkness upon our understandings, irresolution in our wills? How can we with all these fetters be able of ourselves to put into a better state, and act against nature, which is impossible any creature can do but by a superior power!

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Broadway musicals greet us in celebration of the Nurses’ Week. Cheering for Team Medicine!

via Instagram

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There’s nothing quite like Christian hope. This was written on a wall, erected in celebration of the Mental Health Week.

via Instagram

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Kid writes

A boy writes the details on a raffle ticket at my favorite Dunkin' (not Dunkin' Donuts anymore), the branch in front of Taft Avenue where I often have coffee after alighting from the train, before seeing patients. The boy keeps asking his mother what to write; it is likely his first time, and his mother pushes him to write on. I hope he grows up to a smart man with excellent handwriting. Scenes like these warm my heart.

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Favorite time of the day

My favorite time of the day is dawn. I just took the photo a minute ago, straight from the balcony. An exciting week is ahead, with the Philippine Society of Medical Oncology (PSMO) annual convention beginning Wednesday, culminating in a fellowship night where I'll be dancing to the tune of Masskara Festival music. Praise be to God for another day, another week.

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Her father's stories

My friend's sister writes about her father's stories.

That I didn’t know much about my father comes as no surprise—I’m traditionally subservient, and I didn’t grow up asking a lot of questions.

Among my earliest memories of my dad was him coming home from a long flight and handing me a red umbrella as pasalubong. I vaguely remember my mother bringing me to the hangar and my father asking me if I still remembered him. I don’t know how these memories even exist, but they are there, as poignant as the aftershave my father wore that day.

You write beautifully, Ate Kate Pedroso!

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Dean Francis Alfar's short story collection

Next on my reading list: Dean Francis Alfar's A Field Guide to the Roads of Manila and Other Stories.

A Field Guide to the Roads of Manila is a map to the worlds of award-winning fictionist Dean Francis Alfar's imagination. The real and the unreal intersect in these fifteen stories of fantasy, science fiction and horror, and celebrate the wonder of speculative fiction.

The Palanca Awards of Literature are out! Dr. Ronnie Baticulon, a neurosurgeon from PGH, won an award for his essay. Congrats, Sir Ronnie!

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John Calvin shows the beauty of the gospel

After a year, I finished reading volumes 1-3 of John Calvin's The Institutes of the Christian Religion. I mostly read it in my Kindle during my morning commute to work, a ritual that affords me the chance to read works of literature outside of my standard readings in oncology. The Institutes now belongs to my list of favorite books of all time, along with Augustine's Confessions (which was often quoted by Calvin). Calvin's main thesis is justification by faith alone through Christ alone. It is the "alone"--the exclusivity of faith, the rejection of good works (or good works with faith), as a means to salvation--that creates the major doctrinal difference between Calvin's faith and Roman Catholicism. It is so big a difference that Protestantism came into being, a movement that was ushered in by a renewed meditation of what Scriptures had originally meant, a deeper understanding of the love and mercy of God through Jesus Christ, a humbling realization of the uselessness of good works, the depravity of man, and the holiness of God.

John Calvin, this (based on biographies) 27-year old, introverted, serious academic, so consumed with the love for God's Word, wrote thus:

For it states this to be the order of justification; that from the beginning God deigns to embrace sinful man with his pure and gratuitous goodness, contemplating nothing in him to excite mercy, but his misery; (for God beholds him utterly destitute of all good works;), deriving from himself the motive for blessing him, that he may affect the sinner himself with a sense of his supreme goodness, who losing all confidence in his good works, rests the whole of his salvation on the Divine mercy. This is the statement of faith, by which the sinner comes to the enjoyment of his salvation, when he knows from the doctrine of salvation that he is reconciled to God; that having obtained remission of sins, he is justified by the intervention of the righteousness of Christ; and though regenerated by the Spirit of God, he thinks on everlasting righteousness reserved for him, not in the good works to which he devotes himself, but solely in the righteousness of Christ.

That I am saved solely because of Christ, and not because of any good I have done, is the all-encompassing truth on which my life revolves.

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The Quiet Ones

The Quiet Ones by Glenn Diaz

My rating: 5 of 5 stars


The book takes us deep into the streets of Manila, its ambitions and dreams, even if it takes a crime to achieve them. The language is masterful, the characters so palpable you can hear them speak. This is a Filipino novel written in English, and a great novel, whichever way you see it.

Write some more books like this, please, Mr. Diaz!



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