May Thoughts II

As I mentioned in the previous essay, I thought that my work in law had ended on Dec. 31, 2006--when I finished teaching at Willamette University College of Law. But then I received a call in April from respected Portland death penalty defense counsel Mark Sussman. He was defending two people whom the DA wanted to charge with aggravated murder, a charge which in Oregon opens you to the imposition of the death penalty. The First Count of the Information submitted against the defendants was that they had murdered a man in order to get insurance proceeds (because the killed man and defendant were business partners, and they had reciprocal key man life insurance policies on each other). Receipt of insurance proceeds is a rather common motivation for "offing" people around the country, but the novel theory being pursued by the DA in Multnomah County, OR was that this kind of killing fit under the definition of one of the statutory aggravating factors making a person eligible for the death penalty. I don't want to go over my memo here, of course, but my point, argued at length by comparing statutes of dozens of states on this issue, was that the wording of the Oregon statute wouldn't permit such a expansive reading of it as the DA was trying to pursue (the Oregon law only allows "contract-type" murders or "murders-for-hire" as aggravating factors). The hearing on Marc's motion to strike this First Count will be held during the week of June 11. I was happy to be able to provide some legal research on this rather technical but important point.

Brain Tumors and the Law

Then, another possible legal issue has dropped into my lap. I received an email from a law student whom I didn't know but who contacted me because I had taught the insurance law class at Willamette for the past several years. He has been suffering from a recurring brain tumor since 1994. Successive surgeries and subsequent treatments had managed to get rid of the tumor on three occasions, but it kept coming back ever quicker. Finally, in 2006, he was admitted into the "blood brain barrier disruption" chemotheraphy program ("BBBD") run by Dr. Edward Neuwelt at Oregon Health & Sciences University in Portland. Dr. Neuwelt pioneered the BBBD treatment in the early 1980s and now has seen the BBBD "consortium" grow to six American members and two international hospitals. The theory of BBBD is quite simple. Brain tumors called "PCNSL" tumors (Primary Central Nervous System Lymphomas) have been historically very difficult to treat with chemotheraphy because the brain has a "barrier," called the blood brain barrier, which restricts access of chemicals to the brain and thus protects the brain. Thus, chemotheraphy often "bounces off" the brain wall or seeps through it only very irregularly. Thus, until the work of Dr. Neuwelt in the 1980s almost all hope of trying to eliminate brain tumors was placed in massive or whole-brain radiation therapy. But the downside of radiation therapy as applied to the brain is that it tends not only to shrink the tumor but to reduce the brain to mush (not the technical term). In addition, the tumors often came back and took the person away within a matter of months or (few) years.

Recognizing the problem with traditional therapies for brain tumors, Dr. Neuwelt devised a protocol wherein the blood brain barrier would be "relaxed" by intra-arterial infusion of a drug (Mannitol), and then, when the barrier was down, chemotherapeutic chemicals would bombard the tumor. This would be repeated in an intensive two to three day procedure. The patient would "rest up" for three weeks, and then undergo the next BBBD treatment. A year's worth of treatments comprised the regimen. Dr. Neuwelt discovered that the quality of life for recipients of the treatment was enhanced (i.e., their brains were unimpaired), even though survival rate wasn't appreciably improved over other therapies.

Well, a problem has now arisen because Medicare has decided to suspend reimbursement for this treatment. It had been reimbursed beginning in the the 1980s or 1990s and continuing until the past few months, but the fairly new administrator of Medicare's evaulator, an Oregon physician named Dr. George Waldman, decided that there weren't sufficient clinical trials to justify the reimbursement for this procedure under the Medicare statute. After a several-month-long procedure of collecting data and writing reports, he has decided that the procedure is too experimental, that it doesn't provide sufficient benefits for patients and is too costly for reimbursement.

At present I am trying to learn all I can about brain tumors, the language of cell biology, treatment for tumors, the review processes for treatments, whether a treatment is "experimental" or "accepted" and the criteria for all of these things. I feel privileged to have been brought into this very difficult issue for families as well as the medical community, and I look forward to studying/writing about it in the future.

Rescued by Words

I was actually minding my business studying words when all these requests came my way. But, since they have been on my desk, I haven't been as able to wander intellectually through the pleasant meadows of words as I was in the past. Yet, I try to prepare for the Senior Spelling Bee in June when I have time. I have lost so often there (placing 2nd twice and 3rd once) that they probably are feeling sorry for me at the Bee. I would like to remove their (and my) embarrassment/compassion by actually winning the Bee. But the competition this year will again prove to be tough. Excellent spellers from all over the nation will descend on WY in a month, and I still don't think I know all the words in the Collegiate (11th ed.). I have recurrent nightmares of being tripped up either by drug words or, especially, by foreign currency words. For example, ringgit stumped most of us last year. But there are words like renminbi, guarani, hryvnia, eyrir, xu, butut, cedi, filangeni, manat, ngultrum, ouguiya, laari, tugrik and groszy, for example. Then, there are tons of medical and drug terms in the Collegiate which are new to me. Perhaps not surprisingly, as I study more and more on brain tumors, I am running into drugs and treatments and other medical terminology that is new to me. So, there is some "overlap" here.

Three Other Areas

I have also been fascinated with the study of the Animal kingdom, posting essays on strange or interesting animals every once in a while. I was embarrassed by missing the spelling of one animal term in a spelling bee (guenon, pronounced guh KNOWN), and I vowed that I would just have to learn all the names of animals. It is a very Adamic thing to do, after all. But when you learn the names of animals, you really have to do it the "right way," i.e., by learning the Linnaean classification system, its changes over the years, and the ever more complex worlds of taxonomy and cladistics. So, I feel as if I am just "beginning" in this venture, though it is exciting to do so. Animals teach us so much about what it is to be human, I am convinced, that every moment spent trying to understand them yields a rich harvest of what it means to be human.

And then there is autism, and my friend's screen play (which I just received today) and Italian.... I think writing on these will have to await a later essay.

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