Brian Koffman's Awesome Transplant and CLL Adventure

Spiritual Discrimination

2012-02-17T16:08:00.000-08:00

Spiritual Discrimination « Daat Elyon

http://daatelyon.org/2012/02/spiritual-discrimination/

Februray 17, 2012

Every morning, we begin our day with the following prayer:

“Blessed are You, O Lord our God, Who gives the rooster understanding to distinguish between day and night.”

The attribute of discrimination is a great blessing. Discrimination is a power of the mind. It is the capacity to look at any situation and analyze its component parts – to distinguish between day and night, right and wrong, good and bad, true and false.

The ability to discriminate is one of the distinctive characteristics of a human being. It is the key to our growth and evolution. It is only by discriminating that we can learn to make conscious choices in our life. As the Dhammapada states:

“A wise man calmly considers what is right and what is wrong, and faces different opinions with truth, non-violence, and peace.” ^[1]

Discrimination is essential in our relationship with others. We live in a world of appearances where the outer façade often belies the person underneath. Sometimes a person with a beautiful exterior is ugly inside, while an individual who outwardly looks ragged and unappealing is inwardly shining with light. It is important for the spiritual aspirant to learn to discriminate between a saintly appearance and true holiness.

Discrimination also plays a role in determining the activities in which we invest our energies and the surroundings in which we spend our time. Not all situations that are pleasant are spiritually beneficial. Some situations that appear congenial on the surface may have a negative spiritual influence. Some of the groups which call themselves spiritual actually have nothing to do with the life of the Spirit.

Our inner growth lies in learning to differentiate between platitudes and real spiritual truths, between sentimentality and true compassion; between the attitude that says “everything is the same” and an inclusive consciousness that embraces all of humankind.

People often become confused when trying to reconcile the spiritual truth that “all is one” with the harsh reality of our physical world. When asked about this conflict, Annamalai Swami, a disciple of Sri Ramana Maharshi, gave his students the following analogy:

“I once went for a walk near the housing board buildings. There was a sewage trench on one side of the building. I could smell the stench of the sewage even though I was a long way away. I stayed away from it because I didn’t want to be nauseated by the bad smell.
“In circumstances such as these you don’t say, ‘All is one. Everything is the Self,’ and paddle through the sewage. The knowledge ‘everything is the Self’ may be there, but that doesn’t mean that you have to put yourself in dangerous or health-threatening places.
“When you have become one with the Self, a great power takes you over and runs your life for you…If you are not in this state, then use your discrimination wisely. You can choose to sit in a flower garden and enjoy the scent of the blooms, or you can go down to that trench I told you about and make yourself sick by inhaling the fumes there.” ^[2]

A developed sense of discrimination is an essential part of the equipment of any serious spiritual seeker, without it all of our efforts may be in vain. Positive intentions and a desire to be good are not enough; we must also be able to see ourselves, and the world around us, with clarity. Otherwise, God will not take the chance of putting His powerful energies into our hands.

There is yet another level to the process of discrimination. In the spiritual life we seek to know not only what is good and bad, but also what is real and unreal; what is the Self and the “not self”. Here, discrimination is more than a capacity of the mind; it is a property of the soul.

Through the intuition, we learn to discriminate when the higher or true Self is at work and when the lower or “not self” is pushing itself forward; to differentiate between our own desires and God’s Will. People often believe that they are serving the Will of God when really they are only fulfilling their own wishes. It is a natural tendency to assume that what we want is what God wants as well. It is rarely the case that this is so. God’s plans for us often demand that we undertake actions that we do not wish to pursue. It is a real test of our humility when we need to put aside our own desires and accept what God wills instead.

In this case, discrimination means an honest appraisal of our abilities combined with a rock bottom assessment of where we are in our spiritual journey. It means differentiating between dreams and reality. It demands a willingness to sacrifice our illusions in return for a real job for God.

The attribute of discrimination has a great transforming power. Rebbe Ephraim of Sadilkov, the grandson of the Baal Shem, teaches that a person who has discrimination is able to completely change his nature:

“For the form must be like the one who made it: Just like the Maker of All created the natural world through wisdom, as it is written, ‘you made them all with wisdom’ [Psalm 104:24]… so a man of discrimination and true wisdom can create for himself a whole new nature…
“For example, if he was born with an angry and lustful nature, if he is a man of discrimination, he can change his nature and conquer his anger… as is written in Proverbs: ‘The discrimination of a man makes him slow to anger.’” (19:11) ^[3]

Rebbe Ephraim believed that the transforming power of the attribute of discrimination reaches beyond our own individual selves. He teaches that a tzaddik (enlightened soul) who has bound his mind to God can “change all natures – both physically and spiritually – for the good and for a blessing.”

The discrimination of a tzaddik has the power to influence others and help them to break free from their attachment to wishful thinking and illusion. By shining the light of commonsense into a situation, he shatters superstitious practices, ideas and beliefs. When his clear radiance is cast on that which is evil, it exposes the ugliness and lifelessness that lies at its core. And when it shines on that which is good, it reveals the vitality and inner beauty for all to see.

A holy person is the very embodiment of truth. Contact with a holy person purifies and uplifts the sight of those around him or her. Their minds become loosened from material confusion. They see the world with a new clarity. They begin to understand the true purpose of their existence, to intuit what is real and what is not.

Sri Ramakrishna used to tell his householder devotees:

Haven’t you seen the trees on the footpath along a street? They are fenced around as long as they are very young, otherwise cattle destroy them. But there is no longer any need of fences when their trunks grow thick and strong. Then they won’t break even if an elephant is tied to them. Just so, there will be no need for you to worry and fear if you make your mind strong as a thick tree-trunk. First of all try to acquire discrimination. Break the jackfruit open only after you have rubbed your hands with oil, then its sticky milk won’t smear them.” ^[4]

The faculty of discrimination is an essential element of our spiritual equipment. It instills within us the higher awareness that we need in order to live upon this material plane. It enables us to pursue the lofty life of the Spirit, while immersed in the tumultuous existence of this physical world.

Important discriminating essay. But I want more.

You say: "Through the intuition, we learn to discriminate when the higher or true Self is at work and when the lower or “not self” is pushing itself forward; to differentiate between our own desires and God’s Will. People often believe that they are serving the Will of God when really they are only fulfilling their own wishes."

That is the rub. How can you tell? From the mundane (Is the urge to skip exercise today my body saying you need to rest or is just being lazy?) to the profound (Will giving more charity to help those in need help them get going again or will it foster dependence?) What urges are divine and merciful and just are well disguised self serving drives?

How do you tell?

How we decide anything spiritual or material is where I am hanging out these days.

How do we sort it all out?

Pharmacyclics, Inc.

2012-02-13T22:21:00.001-08:00

As the wise man said, follow the money! I sure am. Almost a billion dollars. 975 million to be precise.

I was not smart enough to invest in the company when I saw this coming, but I was smart enough to jump aboard one of the last trials before the registration trials for FDA approval begin. Those will be double blinded so there is only a 50-50 chance of getting the drug, and more importantly, they almost always exclude transplant patients such as yours truly.

So it is this trial or maybe nothing for a few years. I didn't want to miss that boat to a safe harbor. My trial is in red in their financial report.

But do you think I really missed the boat to buy the stock? It's value has doubled over the last few weeks, but does it still have room to rise?.

From PRNewswire

SUNNYVALE, Calif., Feb. 9, 2012 /PRNewswire/ -- Pharmacyclics, Inc. (Nasdaq: PCYC) today reported financial results and recent developments for its fiscal second quarter ended December 31, 2011.

Financial Results for Second Quarter Ended December 31, 2011

The non-GAAP (Generally Accepted Accounting Principles) net income reported for the fiscal quarter ended December 31, 2011was $58.6 million, or $0.82 diluted earnings per share. This compares with a non-GAAP net loss of $6.1 million, or $0.10 loss per share, for the fiscal quarter ended December 31, 2010. See "Use of Non-GAAP Financial Measures" below for a description of our Non-GAAP measures. Reconciliation between certain GAAP and non-GAAP measures is provided at the end of this press release.

The GAAP net income for the fiscal quarter ended December 31, 2011 was $56.3 million, or $0.78 diluted earnings per share. This compares with a GAAP net loss of $7.5 million, or $0.13 loss per share for the fiscal quarter ended December 31, 2010.

At December 31, 2011, the company had cash, cash equivalents and marketable securities of $240.3 million, which compares with $112.3 million at June 30, 2011.

As previously announced on December 8, 2011, the Company entered into a worldwide collaboration with Janssen Biotech, Inc. (Janssen), one of the Janssen Pharmaceutical Companies of Johnson & Johnson, to develop and commercialize PCI-32765, a novel, oral, first-in-class Bruton's Tyrosine Kinase (BTK) inhibitor being developed for the treatment of Non Hodgkin's Lymphoma, Chronic Lymphocytic Leukemia and Multiple Myeloma, all of which are considered hematological malignancies. Pharmacyclics received from Janssen upfront payments totaling $150 million on signing the contract. In addition, Pharmacyclics will receive up to an additional $825 million in development and regulatory milestone payments, based upon continued development progress ($250 million), regulatory progress ($225 million) and approval of the product ($350 million), for total potential upfront and milestone payments of $975 million.

Pharmacyclics and Janssen will collaborate on the development of PCI-32765 for oncology and other indications, excluding inflammation and immune mediated conditions. Each company will lead development for specific indications as stipulated in a global development plan, with development costs shared on a 40/60 basis (Pharmacyclics 40% and Janssen 60%). The agreement includes plans to launch multiple Phase III trials of PCI-32765 over the next several years.

Following regulatory approval, both Pharmacyclics and Janssen will book revenue and co-commercialize PCI-32765. In the US, Pharmacyclics will book sales and take a lead role in US commercial strategy development. Both Pharmacyclics and Janssen will share in commercialization activities. Outside the United States, Janssen will book sales and lead and perform commercialization activities. Profits and losses from the commercialization activities will be split 50/50 on a worldwide basis. Development and commercialization activities under the collaboration will be managed through a shared governance structure.

"We have now formally kicked off our partnership with Janssen for the global development of our BTK inhibitor PCI-32765, and we are extremely pleased with the progress to date. The spirit of cooperation and alignment between the two teams is remarkable, and reaffirms what we believed so strongly when we signed the deal last year that the values of the two companies and their commitment to the potential of PCI-32765 are very much aligned," said Bob Duggan, CEO and Chairman of the Board. "Together we intend to launch broad and aggressive Phase III development programs that will utilize the best of both teams with unwavering focus on our shared mission. This is what patients expect and deserve from us."

Recent Developments & Highlights

Bruton's Tyrosine Kinase (BTK) Inhibitor for Oncology

Results from our Phase Ib/II trial of PCI 32765 in patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) (PCYC-1102-CA) were presented in an oral presentation at the American Society of Hematology (ASH) Annual Meeting in San Diego, California in December 2011. The trial included a total of 61 patients with relapsed or refractory CLL/SLL enrolled at two dose levels, 420 mg (n=27) or 840 mg (n=34). Oral PCI-32765 was administered daily until disease progression. Data was available from a landmark analysis of 12 months. With a median follow-up of 12.6 months in the 420mg cohort and 9.3 months in the 840mg cohort, the overall response rate (ORR), including PR and CR, for the 420mg dose level was 67% and for the 840 mg dose 68%, as measured by the 2008 International Workshop on Chronic Lymphocytic Leukemia criteria. The responses have been independent of high-risk clinical or genetic features. The estimated landmark 12 month PFS for the pooled cohorts was 86%. The safety profile of PCI-32765 was particularly notable for minimal off target toxicities. The most common treatment related adverse events reported in the trial were Grade 1 (mild) or 2 (moderate) diarrhea, cough, fatigue, and upper respiratory infections, and only 2 of 61 patients have discontinued study treatment due to adverse events regardless of relationship to PCI-32765. The company anticipates having further information on the development of a Phase III program of PCI-32765 in relapsed or refractory CLL/SLL patients in the second quarter of calendar 2012.

Results from our Phase II trial of PCI 32765 in patients with relapsed or refractory mantle cell lymphoma (PCYC-1104-CA) were also presented in an oral presentation at the ASH Annual Meeting in December 2011. The interim analysis included a total of 68 patients accrued to this Phase II trial. PCI-32765 was administered orally at 560 mg daily until disease progression. 51 patients (31 patients had bortezomib-naïve disease, 20 patients had previously received bortezomib) had post-baseline tumor assessments and were thus evaluable for response. The ORR, according to the 2007 Non-Hodgkin's Lymphoma International Working Group criteria, was 69% (35/51 patients). ORR was similar in bortezomib-naïve and bortezomib-exposed patients (71% and 65%, respectively). At the time of this analysis 31 of 35 (89%) responding patients have ongoing responses with the median follow-up of 3.7 months. Consistent with previous trials of PCI-32765, the most common adverse events reported in this trial were Grade 1 (mild) or 2 (moderate) fatigue, diarrhea and nausea. Only 3 of 68 patients discontinued study treatment due to adverse events regardless of relationship to PCI-32765. The company anticipates having further information on the development of a Phase III program of PCI-32765 as a single agent in previously treated mantle cell patients in the second quarter of calendar 2012.

As of the end of December 2011 we enrolled approximately 400 patients into clinical trials evaluating PCI-32765. The ongoing Phase I/II program currently includes the following studies:

PCYC-04753: A Phase I of PCI-32765 in patients with recurrent B-cell malignancies. This study was designed to assess the safety and tolerability of PCI-32765. Patient enrollment is completed with 66 patients enrolled in the main portion of the study. Enrollment into the diffuse large B-cell lymphoma (DLBCL) activated B-cell (ABC) investigator-led cohort is still ongoing with the National Cancer Institute.
PCYC-1102-CA: A multicenter, open-label, single agent Phase Ib/II study of PCI-32765 in subjects with relapsed/ refractory or with treatment-naïve (65 years of age or older) chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). This study was designed to assess safety, tolerability, and efficacy of PCI-32765. Patient enrollment is complete, with 117 patients enrolled. An update on the relapsed or refractory patients treated on this trial was provided at the American Society of Hematology Annual Meeting in December of 2011. We intend to report an interim analysis of elderly treatment naïve patients at one of the upcoming scientific conferences mid-year 2012.
PCYC-1104-CA: A multicenter, Phase II study of PCI-32765 in patients with relapsed or refractory mantle cell lymphoma, including cohorts of subjects either previously treated with bortezomib or naïve to bortezomib treatment. This trial is active in several US and European sites and, as of the end of December 2011, had enrolled 95 patients. An interim report on this trial was provided at the American Society of Hematology Annual Meeting in December of 2011. We anticipate to complete enrollment of this trial in the first half of calendar 2012 and will report on updated study results thereafter.
PCYC-1106-CA: A multicenter, open-label, Phase II study of PCI 32765 in subjects with relapsed or refractory DLBCL. This study is designed to assess the activity of PCI-32765 in two genetically distinct subtypes of DLBCL, the activated B-cell (ABC) subtype and the germinal center (GC) subtype. This trial is active in several US sites and, as of the end of December 2011, had enrolled 30 patients. We expect to complete enrollment of all 60 patients within the first half of calendar 2012.
PCYC-1108-CA: A Phase Ib, multicenter, open-label, study of PCI 32765, in combination with bendamustine and rituximab (BR) in subjects with relapsed or refractory CLL or SLL. This trial completed enrollment with 30 patients. We intend to report an interim analysis of these patients at one of the upcoming scientific conferences mid-year 2012.
PCYC-1109-CA: A Phase Ib/II study of PCI-32765 in combination with ofatumumab in subjects with relapsed or refractory CLL or SLL is ongoing and enrolled 47 patients as of the end of December 2011. This trial has been expanded and will now enroll up to 70 patients and we are expecting to complete enrollment within the first half of 2012. We intend to report data from a subset of these patients at one of the upcoming scientific conferences mid-year 2012.
PCYC-1111-CA: A Phase II study of PCI-32765 in subjects with relapsed/refractory multiple myeloma (MM) is on track to start enrolling patients in Q1 of calendar 2012. Pre-clinical studies, both internally as well as through external collaborations, have suggested a potentially vital role of BTK in both malignant plasma cells and osteoclasts, which are involved in bone complications of this disease. The MM trial is expected to enroll 35 patients and we anticipate completing the enrollment by early 2013.

Factor VIIa (FVIIa) Inhibitor

A multicenter Phase I/II of PCI-27483 in patients with locally advanced or metastatic pancreatic cancer that are either receiving or are planned to receive gemcitabine therapy is currently ongoing. The Phase II portion of the study is enrolling and patients are being randomized to receive either gemcitabine alone or gemcitabine plus PCI-27483. The objectives are to assess the safety of FVIIa Inhibitor PCI-27483 at pharmacologically active dose levels, to assess potential inhibition of tumor progression and to obtain initial information of the effects on the incidence of thromboembolic events. This trial is active in several US sites and by the end of December 2011 enrolled 28 patients. Due to a paradigm shift in the use of gemcitabine alone for the treatment of pancreatic cancer enrolling patients onto this randomized study has been challenging. An interim analysis of the results of a subset of the patients enrolled is planned for the first half of calendar 2012.

Histone Deacetylase (HDAC) Inhibitor

Abexinostat (aka PCI-24781) is an oral histone deacetylase inhibitor that is being evaluated in multiple clinical trials by Pharmacyclics and our ex-US collaboration partner, Les Laboratoires Servier (Servier) with approximately 250 patients treated by the end of calendar 2011. Pharmacyclics has completed 2 Phase I studies using abexinostat as a single agent in patients with advanced solid tumors, and is currently conducting a Phase I/II trial in sarcoma patients (in combination with doxorubicin, an anti-tumor agent) and a Phase I/II trial testing abexinostat single agent in patients with relapsed or refractory Non-Hodgkin's lymphoma (NHL). In the sarcoma trial, co-sponsored by the Massachusetts General Hospital and Dana-Farber Cancer Institute, the Phase I dose escalation has been completed and the maximum tolerated dose in combination with doxorubicin has been established. The Phase II portion is currently being planned. In the single agent NHL trial, we are enrolling patients in a Phase II follicular lymphoma arm and expect to complete enrollment by the end of Q1 of calendar 2012. Our collaboration partner for ex-US markets, Servier has expanded its clinical development program of abexinostat and currently has six Phase I/II trials ongoing in Europe in lymphomas and solid tumors with abexinostat as single agent and in combination with radiation as well as other therapeutic agents. The Phase II portion of Servier's single agent lymphoma trial was opened in Q4 of calendar 2011 and is currently enrolling patients. Further analysis of these trials and any updates will be released by Servier.

Conference Call and Webcast Details

Based on timelines of occurring events and availability of our key executives due to travel arrangements, a conference call to update our investors is anticipated to occur in the first week of March.

For further questions please contact Ramses Erdtmann, VP Finance at: 408-215-3325

Use of Non-GAAP Financial Measures

This press release contains non-GAAP financial measures, including operating and other expenses adjusted to exclude certain non-cash and non-recurring expenses. These measures are not in accordance with, or an alternative to generally accepted accounting principles, or GAAP, and may be different from non-GAAP financial measures used by other companies. The items included in GAAP presentations but excluded for purposes of determining non-GAAP financial measures for the periods presented in this press release are employee related non-cash expenses and the net amount of the therapeutic discovery project tax grant. We believe the presentation of non-GAAP financial measures provides useful information to management and investors regarding various financial and business trends relating to our financial condition and results of operations. When GAAP financial measures are viewed in conjunction with non-GAAP financial measures, investors are provided with a more meaningful understanding of our ongoing operating performance. In addition, these non-GAAP financial measures are among those indicators we use as a basis for evaluating operational performance, allocating resources and planning and forecasting future periods. Non-GAAP financial measures are not intended to be considered in isolation or as a substitute for GAAP financial measures. To the extent this release contains historical non-GAAP financial measures, we have also provided corresponding GAAP financial measures for comparative purposes. Reconciliation between certain GAAP and non-GAAP measures is provided below.

About Pharmacyclics

Pharmacyclics® is a clinical-stage biopharmaceutical company focused on developing and commercializing innovative small-molecule drugs for the treatment of cancer and immune mediated diseases. Our mission and goal is to build a viable biopharmaceutical company that designs, develops and commercializes novel therapies intended to improve quality of life, increase duration of life and resolve serious unmet medial healthcare needs; and to identify promising product candidates based on scientific development expertise, develop our products in a rapid, cost-efficient manner and pursue commercialization and/or development partners when and where appropriate.

Presently, Pharmacyclics has three product candidates in clinical development and several preclinical molecules in lead optimization. We are committed to high standards of ethics, scientific rigor, and operational efficiency as we move each of these programs to viable commercialization.

The Company is headquartered in Sunnyvale, California and is listed on NASDAQ under the symbol PCYC. To learn more about how Pharmacyclics advances science to improve human healthcare visit us at http://www.pharmacyclics.com.

NOTE: This announcement may contain forward-looking statements made in reliance upon the safe harbor provisions of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, including statements regarding our expectations and beliefs regarding our future results or performance. Because these statements apply to future events, they are subject to risks and uncertainties. When used in this announcement, the words "anticipate", "believe", "estimate", "expect", "expectation", "should", "would", "project", "plan", "predict", "intend" and similar expressions are intended to identify such forward-looking statements. Our actual results could differ materially from those projected in the forward-looking statements. Additionally, you should not consider past results to be an indication of our future performance. For a discussion of the risk factors and other factors that may affect our results, please see the Risk Factors section of our filings with the Securities and Exchange Commission, including our annual report on Form 10-K and quarterly reports on Form 10-Q. We do not intend to update any of the forward-looking statements after the date of this announcement to conform these statements to actual results, to changes in management's expectations or otherwise, except as may be required by law.

Pharmacyclics, Inc. Condensed Consolidated Balance Sheets (unaudited; in thousands)
		December 31, 2011		June 30, 2011
ASSETS

Cash, cash equivalents and marketable securities*	$	240,330	$	112,329
Other current assets		4,552		2,367
Total current assets		244,882		114,696
Property and equipment, net		2,528		1,312
Other assets		344		344
Total assets	$	247,754	$	116,352

LIABILITIES AND STOCKHOLDERS' EQUITY

Deferred revenue – current portion	$	8,041	$	7,000
Other current liabilities		14,404		7,268
Total current liabilities		22,445		14,268
Deferred revenue – non-current portion		71,174		-
Deferred rent		547		410
Total liabilities		94,166		14,678
Stockholders' equity		153,588		101,674
Total liabilities and stockholders' equity	$	247,754	$	116,352

* Marketable securities	$	10,116	$	24,572

Pharmacyclics, Inc. Condensed Consolidated Statements of Operations (unaudited; in thousands, except per share data)
		Three Months Ended December 31,				Six Months Ended December 31,
		2011		2010		2011		2010
Revenues:
License and milestone revenues	$	77,605	$	1,386	$	77,605	$	2,773
Collaboration services revenues		298		1,438		335		2,015
Total revenues		77,903		2,824		77,940		4,788
Operating expenses*:
Research and development		12,076		8,256		23,324		15,958
General and administrative		3,944		2,093		7,294		3,927
Total operating expenses		16,020		10,349		30,618		19,885
Income (loss) from operations		61,883		(7,525)		47,322		(15,097)
Interest and other income (expense), net		21		26		44		75
Income (loss) before income taxes		61,904		(7,499)		47,366		(15,022)
Income tax provision		5,651		-		5,651		-
Net income (loss)	$	56,253	$	(7,499)	$	41,715	$	(15,022)

Net income (loss) per share:
Basic	$	0.82	$	(0.13)	$	0.61	$	(0.25)
Diluted	$	0.78	$	(0.13)	$	0.58	$	(0.25)
Weighted average shares used to compute net income (loss) per share:
Basic		68,658		59,715		68,491		59,497
Diluted		71,725		59,715		71,312		59,497
* Includes share-based compensation as follows:

Research and development	$	1,701	$	1,267	$	3,239	$	2,961
General and administrative		675		671		1,301		1,149
Total	$	2,376	$	1,938	$	4,540	$	4,110

Reconciliation of Selected GAAP Measures to Non-GAAP Measures (1) (unaudited; in thousands, except per share data
		Three Months Ended December 31,
		2011		2010

GAAP net income (loss)	$	56,253	$	(7,499)
Adjustments:
Research & development share-based compensation(2)		1,701		1,267
General & administrative share-based compensation(2)		675		671
Therapeutic discovery project tax grant, net(3)		-		(586)
		2,376		1,352
Non-GAAP net income (loss)	$	58,629	$	(6,147)

Non-GAAP diluted net income (loss) per share	$	0.82	$	(0.10)

(1)	This presentation includes non-GAAP measures. Our non-GAAP measures are not meant to be considered in isolation or as a substitute for comparable GAAP measures and should be read only in conjunction with our financial statements prepared in accordance with GAAP.
(2)	All share-based compensation was excluded for the non-GAAP analysis.
(3)	Represents the therapeutic discovery project tax grant, net of related expenses.

Reconciliation of Selected GAAP Measures to Non-GAAP Measures (1) (unaudited; in thousands, except per share data)
		Six Months Ended December 31,
		2011		2010

GAAP net income (loss)	$	41,715	$	(15,022)
Adjustments:
Research & development share-based compensation(2)		3,239		2,961
General & administrative share-based compensation(2)		1,301		1,149
Therapeutic discovery project tax grant, net(3)		-		(586)
		4,540		3,524
Non-GAAP net income (loss)	$	46,255	$	(11,498)

Non-GAAP diluted net income (loss) per share	$	0.65	$	(0.19)

(1)	This presentation includes non-GAAP measures. Our non-GAAP measures are not meant to be considered in isolation or as a substitute for comparable GAAP measures and should be read only in conjunction with our financial statements prepared in accordance with GAAP.
(2)	All share-based compensation was excluded for the non-GAAP analysis.
(3)	Represents the therapeutic discovery project tax grant, net of related expenses.

SOURCE Pharmacyclics, Inc.

RELATED LINKS
http://www.pharmacyclics.com

Happy Healthy Valentine

2012-02-13T14:34:00.000-08:00

This article is from LIVESTRONG, Lance Armstrong's foundation that I am hoping to connect with to do some patient and doctor education.

I point this one in particular as it features my same friend Dr. Larry Deutsch who did those great tapes on CLL and hypnosis.

A much bigger health problem in the USA than CLL is obesity and Dr. Deutsch offers a no gimmicks honest approach to weight loss that I think is spot on. That is what this article is about. It is just nice to see a a honest doctor who doesn't dress up the truth get the recognition he deserves. I hope a million people buy his lean book Calorie Wars: Fat, Fact and Fiction. There is nothing in it for me other than helping a friend and those who read it, as it does lay out the bare facts.

See http://www.livestrong.com/blog/blog/five-healthier-alternatives-to-valentine-u2019s-day-food-favorites/

Or read below:

By Dr. Larry Deutsch and Dr. Jeff Schweitzer

Just like love, losing weight can feel like a complex equation. But that doesn’t mean success is a lost cause. That’s because dieting—or the process of choosing what to eat—isn’t as complicated as it seems.

In fact, any good fat loss plan really consists of three simple rules:

Eat Less

Eat Well

Exercise

If you forget everything else and do these three things, you will see results. If you eat just a little bit less each day – for example, by cutting a half a piece of toast off of your breakfast plate, or taking a small handful of cereal out of your usual morning bowl – you will take the steps needed towards making change.

What won’t work? Self-deprivation. People who cut out every treat for the sake of a diet usually fall off track sooner or later, and sometimes wind up bingeing. So the key to long-term, sustained weight loss is to satisfy your needs without completely sacrificing what you enjoy.

On this Valentine’s Day, you can keep your relationship on track without derailing your weight loss plan. Here are five small changes you can make to indulge intelligently on the holiday of love, so you can get all of those traditional pleasures in a healthier way.

1. Instead of: A box of chocolates

Try: An edible fruit arrangement

Still a thoughtful gift for your loved one, most fruits are low in calories per gram because they have high water and fiber content. Chocolate is empty nutrition, a high energy density food, meaning the calories are more densely packed into the sweet than a piece of fruit. Timing may be everything on this one, so give your sweetie a fruit arrangement in the morning, when they’re more used to having those types of foods, rather than after dinner when they might be craving something richer.

2. Instead of: Chocolate covered strawberries

Try: Strawberries with light whipped cream

When you eat whipped cream, most of what you are eating is air. One or two tablespoons of light whipped cream typically have less than 30 calories and little to no fat. A little dollop on strawberries is a delicious alternative to dipping them in high-calorie, high-fat chocolate.

3. Instead of: Eating out at a restaurant

Try: Cooking dinner at home

At home you can control your portion sizes and what goes into your meals. At a restaurant, most people have more difficulty avoiding high-caloric food and giant sized portions. Plus, dining at home can be much more intimate and personal than eating out. Your perfect night in can offer just the right food, hassle-free parking, and no rude waiters.

4. Instead of: A cocktail

Try: Red wine

Alcohol may seem innocent but it’s loaded with calories. When you add in mixers, juice, sugar, and other ingredients, the calories can really add up. A glass of red wine, in moderation, is lower in calories and has been shown to increase levels of "good" cholesterol and protect against artery damage.

5. Instead of: Cookies or cupcakes for the little valentine in your life

Try: A smaller portion of their favorite treat

Putting your little one on the road to healthy eating can never start too early. When you enjoy a delicious dessert with your kids, cut down their portion size by about 10 percent. This little change will keep calories in control – and it’s unlikely that they’ll notice that an extra spoonful of icing is missing.

Follow these guidelines, and you and your loved ones can have a Valentine’s Day that’s just as delicious, but a little healthier. And over time, small changes yield big results.

Dr. Larry Deutsch and Dr. Jeff Schweitzer are the authors of the new book “Calorie Wars: Fat, Fact and Fiction.” Deutsch is a family physician and hypnotherapist with over 35 years of experience, while Schweitzer is a biologist and consultant who served at the White House during the Clinton Administration as Assistant Director for International Affairs in the Office of Science and Technology. For more information, please visit www.DrLarry.com or www.JeffSchweitzer.com

Sweet!

Have a happy healthy Valentine's Day.

And in the end, the love you take is equal to the love you make

2012-02-12T23:59:00.000-08:00

Let the music speak for itself. Old men can still rock.

Chronic leukemia can't stop this guy from still getting off for the millionth time on some amazing rock and rock music.

As I have been known to say: CANCER SHMANCER. Let's have a good time.

Enjoy. I sure did. From tonight's Grammy Awards

New Computer, New Engine, New Operating System, Same Old Me

2012-02-09T23:00:00.000-08:00

My cold is almost gone.

The insurance is in process for OSU. Life is on hold until I get an OK then a date to start.

The rate of paperwork expansion is ridiculous. Exciting new projects, but like an infant, they need a ton of nurturing before they can be left on their own.

My wife's Volvo has blown its third engine. This one lasted only 17 months, 5 months longer than the warantee. It happened when in the car poll lane of the 605 freeway so we have much to be grateful for. It could have been a much worse story. As it is, it is only money.

And I have almost finished a twisted migration from my good old lovable MACBOOK to a brand new sexy MACBOOK AIR (last year's model to save big money and wildly increase the difficulty of the process) and then upgraded that to LION. I have needed to learn to swipe in all kinds of new directions and have a new vocabulary of gestures.

These changes are not for the faint of heart, but they are most done, and my old computer sits forlornly by. As with an alcoholic, I needed to make a clean break, so all new emails and documents will live on my new virtual home. I suspect my white plastic laptop feels much like Woody from Toy Story. Life moves on.

It has been a challenging few days. I even went internet silent for a day, as both computers were in the shop for the migration. Talk about withdrawal. It was an act of cutting away the unessential that rivaled Yom Kippur. Went to bed early and read a lot. That's a good thing.

Amazing how I am so linked to this keyboard. It brings you to me and me to you, but it does pull me away from the flesh and blood right next to me.

Another cold, this time in Missouri, interfering with everything

2012-02-04T21:46:00.000-08:00

Fighting my second miserable head cold since Thanksgiving. All have occurred since I reduced my IVIg. Three trips across the country in two weeks was too much for me. Though my Missouri hosts could not have been kinder and my board meetings went well, I feel tired and achy and can't wait to get home tomorrow to my wife, my own home, and some great raw vegan food. And a good night's sleep.

The plans and effort to teach primary care providers about CLL and transplants is moving forward and I am proud of that work. That was one of the reasons for the trip to Springfield, as the medical eduction will be posted on Primary Issues, an online physician journal based here and then presented in live programs.

I am hoping to cover the ASCO (American Society of Clinical Oncology) meeting in Chicago with the same type of primary care perspective.

And I may be working on a new technology project to help cancer patients manage their care, and will be asking for your feedback soon.

And please don't forget about the audio files to handle to stress of CLL. They are really pretty helpful and I am hoping to raise some money for CCLPAG in Canada and LRF in the USA.

I need to get better soon to work on all these projects.

In Missouri

2012-02-03T09:52:00.000-08:00

Love the center of the country. Good people, but not much vegan food.

Back from Ohio

2012-01-31T18:27:00.000-08:00

To start, they know what a vegan is in Columbus and they actually know how to feed and nurture one, which is good thing, because it looks like I am going to staying there for the better part of three months starting sometime in February.

Yes, I was accepted in the trial of PCI-32765 and ofatumumab pending the insurance OK and the intake screening. That will happen sometime in the next few weeks, and the

I was very impressed with Dr. John Byrd and his team at OSU. Thorough, prepared, caring, smart and humane.

I must review pages of notes taken by my daughter, Heather who flew down from Chicago and her studying for the bar in Illinois (she is already licensed to practice law in NY) to be my scribe, second set of ears, and moral support for the whirlwind tour of this cold and windy central Ohio college town.

Over the next week, I will share what I learned, my decision process, and the next steps to get things going.

Right now I am still recuperating from the sleep deprivation of an alarm ringing before 4AM (1 AM Pacific time) to get to the airport on time for our flight home.

But it all going to be OK. They have good vegan food, a new drug that could save my life, and an NHL hockey team.

What more could I need?

Novel Therapies and Their Integration into Allogeneic Stem Cell Transplant for Chronic Lymphocytic Leukemia Biol Blood Marrow Transplant 18:S132-S13

2012-01-28T22:16:00.000-08:00

Dr. John Byrd is the lead investigator on the clinical trial NCT01217749 that is the reason I am flying to Columbus hoping to enroll to procure this exciting new therapy.

Anticipating the future, Dr. Byrd co-authored an important article (Novel Therapies and Their Integration into Allogeneic Stem Cell Transplant for Chronic Lymphocytic Leukemia Biol Blood Marrow Transplant 18:S132-S13) that articulate how the trial drug- PCI-32765 and other promising novel therapies may effect the time and place of transplants in CLL. It is a clear, thoughtful and accessible discussion that I strongly recommend.

On the eve of my departure for Ohio, I sent Dr. Byrd an email expressing how the uncertainty about the durability of the response to these new promising agents might be a good thing

Please tell me what you think.

Dear John,

Thank you for your thoughtful review of this important topic.

Implicit in your review of the evolving therapeutic paradigm for novel therapies and RIC HSCT in CLL is a shift in the calculation that each doctor and each patient must make when dealing with aggressive CLL .

Before the bloom of these new treatment options, an informed patient or hematologist could make a good faith calculation on what gives the better chance of PFS in five or ten years. Although it is always dangerous to compare data from one trial to that in another, and even more so to assume that statistics that are applied to a group can predict what happens to an individual, one could still study the Kaplan-Meier curves for a HSCT and any particular therapy and make at least a partially informed choice.

Now with the promise of the new treatments, the decision to consider a transplant has become more tricky for some. The K-M curves are known on the transplant side of the equation, but what the novel therapies will yield is based on extrapolation of very thin data. We are comparing a known to an unknown. Ironically, with the survival rates so poor for F refractory or 17p del disease, this "unknownness" is a source of hope for some patients and another reason for others with the aggressive or refractory CLL to consider a clinical trial over a more conventional route starting with chemotherapy and moving to transplant.

Thanks again.

Brian

What is implicit but not explicit in my letter to Dr. Byrd is how I myself employed precisely this hopeful calculus in my decision of the known versus the unknown.

As I leave tomorrow, I will keep you informed every step on the way.

Wish me luck.

It calls for snow in Columbus tomorrow.

Ice Hockey, Charity and Leukemia

2012-01-28T00:07:00.000-08:00

This is from the LA Kings web site and is a complete break from my teaching and reflections, but just a simple story that touches all my emotional triggers:

Every player on the Kings’ active roster contributes money to the Kings Community Corner, through which tickets are distributed to families who would otherwise be unable to attend games, and six players -- Bernier, Simon Gagne, Mike Richards, Dustin Penner, Scott Parse and Brad Richardson -- all personally purchase a set of four 100-level season seats, from which tickets are dispersed for each individual game, within the organization of the player’s choice.

While Richards’ tickets go to Padres Contra el Cancer (Fathers Against Cancer), “Gagne’s Gang” is the Leukemia & Lymphoma Society (LLS), “Penner’s Posse” is the Salvation Army, and both “Parse’s Party” and “Richie’s Rascals” come from the After School All Stars.Although all the ticket recipients are fortunate to be treated by the athletes themselves, “Bernier’s Angels,” all CHLA(Chrildren's Hospital, LA) affiliates, receive something extra special.

So the scorer of the most famous goal in Canadian hockey history, Paul Henderson, has CLL and Simon Gagne donates his seats to Leukemia & Lymphoma Society.

Ice Hockey and leukemia and charity in the same story. I am starting to feel this is some special connection.

I love hockey and I am thrilled when I see stars give to help those with blood cancers. It just feels good and makes me proud of my home team.

Go Kings Go

Go LLS Go

Dr Adrian Wiestner Speaking to Primary Care Providers about CLL

2012-01-26T00:53:00.000-08:00

Many of you have seen this clip before.

I am reposting as it is the first in a series of interviews that when strung together should make the average primary care provider much more comfortable with the diagnosis and management of his or her CLL patient..

The reality is that many patients, especially CLL patients, who nearly always have enough time to learn about their disease before needing therapy are often more up to date on the latest than their primary care provider who may not see or recognize too many CLL patients.

I am trying to change that knowledge gap. This small pilot project will give you a sense of my other life in CME (continuing medical education) as a medical director. Primary Issues is the online journal for PCPs where I plan to publish these video snippets with the text and the questions to measure outcome that you see below.

I need your help first .

Tell me what you think works and what misses.

Tell me what I should be saying to your PCP.

Understand this clip is just the briefest opening to what is CLL. It is of course not the whole story. Drs Kipps, Pagel, and Wiestner will be talking more about diagnosis, symptoms, complications, treatment and the overall role of the local primary care provider in the patient's care.

I promise I won't post the same clip twice again, I just needed to start at the beginning.

Please email at bkoffmanmd@gmail.com or post your comment or suggestion. It will help me and may help others.

Because we are all in this together.

CLL Overview with Dr. Adrian Wiestner

PRE TEST QUESTION

Managing CLL is made difficult by the fact that:

1: It is the most rare of all adult chronic leukemia.

2: It usually presents in an aggressive fashion with B symptoms and white counts over 100,000 that need prompt attention.

3: It is nearly always asymptomatic, doesn’t progress, and any treatment other than reassurance should be avoided.

4: It may be very aggressive and symptomatic or it may be very indolent and asymptomatic.

Chronic Lymphocytic Leukemia or CLL is the most common adult leukemia in the United States, with approximately 15,000 new cases a year representing about 30% of all adult leukemia. The male to female ratio is 1.7: 1 and the average age at time of diagnosis is 70 years old, but it not unusual to find it in a 30 year old (Hernández JA, Land KJ, McKenna RW. Leukemias, myeloma, and other lymphoreticular neoplasms. Cancer 1995; 75:381). It is more common in Caucasians, and less common in Asia. These differences appear to be genetic as they persist when the ethnic population moves to America. Ashkenazi Jews may be at particularly higher risk (Leukemia. 1998 Oct;12(10):1612-7.Epidemiology and ethnic aspects of B cell chronic lymphocytic leukemia in Israel.Shvidel L, Shtarlid M, Klepfish A, Sigler E, Berrebi A).

What makes CLL so difficult for both doctor and patient alike is that about 25% of patients present with asymptomatic disease found incidentally on a routine blood count that may never need treatment, whereas up to 10% may present with rapidly climbing lymphocyte count and enlarging nodes associated with fevers, drenching night sweats, extreme fatigue and/or unexplained weight loss that demand immediate treatment. Others follow a course somewhere in between. CLL absolutely demands personalized care.

POST TEST QUESTION

Managing CLL is made difficult by the fact that:

1: It is the most rare of all adult chronic leukemia.

2: It usually presents in an aggressive fashion with B symptoms and white counts over 100,000 that need prompt attention.

3: It is nearly always asymptomatic, doesn’t progress, and any treatment other than reassurance should be avoided.

4: It may be very aggressive and symptomatic or it may be very indolent and asymptomatic. (CORRECT)

Delayed in Dallas: Lesson for travel and CLL

2012-01-24T16:21:00.000-08:00

Sometimes it seems being smart and having connections allows you to see the train wreck coming, but may not let you get off the train.

Still in Dallas trying to fly home from Orlando.

I was notified as we landed of the delay due to change of planes. That pushed back our departure just long enough to catch the start of the weather delay. Now we have been delayed three more times for mechanical issues. 10 or 15 minutes each time. I get test messages every 10 to 15 minutes with the latest update from American Airlines. But we all know that nothing on a plane takes 10 or 15 minutes, but they soften the blow with these mini delays until sometimes it's too late to do anything, to find another way home to the west coast.

I thought about taking a later flight out when I first heard of the trouble, but this flight was scheduled to leave two hours earlier so I gambled it was the better choice.

The joys of flying. I guessed wrong.

Sometimes CLL is like that. You might know that your FISH report is bad news, that the best option for a remission will whack your marrow, that infections are a significant risk, but what can you do?

You do your best is what you do.

Make a wise choice and hope for the good response without too much damage and keep moving forward. Sometimes you realize that maybe you didn't make the best choices, but you must forgive yourself and move on. How could you know, and even if you did know, it might not have made any difference.

The one advice I have for flying or tackling CLL is to keep your options open. Try to avoid the last plane home that night. Look at the departure schedule. Know your Plan B. Have your airline phone number on speed dial. And bring a few extra days of your meds just in case.

What about CLL?

Try not to close doors for future cancer treatments and try to walk through doors that open that might lead to a chance for a long healthy spell between decisions and delays. They may not stay open for long, so the timing of when to start therapy is always tricky. As I have said before, the best time to start therapy is a few weeks before you need to.

I will eventually get home. The mechanic is aboard. Maybe we can leave real soon? We were just ask to fasten seat belts so that's a very good sign.

I am off to Ohio State next week for my clinical trial assessment. No direct flights I am afraid between anywhere in southern California and Columbus. I chose to fly through Phoenix to avoid weather. I am optimistic that route was a wise choice.

But my real optimism is reserved for my banging the door open to Dr. Byrd's trial with PCI-32765 and ofatumumab, That I am betting will turn out to be a sea change of a wise choice.

I am finishing this post 30,000 feet up in the air nearing home, so all is well.

How Doctors die

2012-01-21T10:50:00.000-08:00

All my recent upbeat posts on CLL begs the issue that we will all die. We don't get to choose when or of what we die, but he can chose how we deal with the process.

Just like life.

So a quick break from the nitty gritty of CLL to take a look at the nitty gritty of life and death, whether you do or don't have an "incurable" cancer and whether or not you are a doctor.

The following is a provocative article from Zocalo Public Square, an organization that explores a wide range of current and challenging topics in various forums. Good stuff and worth getting to know. Dr. Murray, the author of this article is a thoughtful assistant clinical professor at USC (where I taught for years as a clinical professor) and has written other articles that you can find at Zocalo Public Square.

How Doctors Die

It’s Not Like the Rest of Us, But It Should Be

by Ken Murray

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.

But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC.

Coping with Cancer: Living with Leukemia and Lymphoma

2012-01-19T16:21:00.000-08:00

Friends,

Like my hero, Chaya Venkat at http://updates.clltopics.org/ I have avoided selling anything through my website or promoting anything more than a bone marrow drive or a worthy charity.

I am now going break that rule to make a heartfelt sales pitch for a project that I was involved with in an effort to help fellow CLLers or those with other cancers.

For the last several months I have been working with my friend, Dr. Larry Deutsch an international renowned hypotherapist.

Like me, Dr Larry is a Canadian family doctor. Like me he teaches other doctors. Like me, Dr. Larry has needed to change the nature and scope of his practice because like me Dr. Larry Deutsch has CLL.

We have been collaborating on an audio file that uses his expertise and empathy and my knowledge of the disease from the inside out to help patients cope and maintain a calm sense of control with the diagnosis of leukemia and lymphoma in particular and cancer in general.

I believe that the MP3 that we produced is strong medicine. Larry is a powerful hypnotherapist with an important message.

Let me be clear. We are not promising a melting away of your cancer by a sheer act of will. We are not promising any cures. We are simply trying to build your confidence in dealing with a process that can often feel overwhelming.

Dr Deutsch did the heavy lifting on this project, but I am very proud of the part I played and very happy with the final result.

Please listen to a sample on this webpage.

Please download the MP3.

You will be glad that you did.

Every sale will generate a donation to CLLPAG in Canada and LRF in the USA, two important organizations that help the CLL and lymphoma community. I have worked with them both. Their conferences are first rate and important to many patients and caregivers, but they could do so much more with more support.

We all do so much better when we can get some help that allows us to slow down, and let go of the stress.

As I have been known to say, we are all in this together.

Hope my readers are OK with this bit of a commercial, but I am a believer in getting behind what you believe in and I do believe that how we cope with our cancer plays a role in how we do with our cancer.

I will publish more links to ASH videos over the next few days, and some stuff on 11q deletion, but tomorrow I leave for a conference on CME in Orlando for a few days.

What is CLL? Dr. Adrian Wiestner from the NIH gives an answer.

2012-01-18T23:42:00.000-08:00

This is pretty basic stuff for us experienced CLLers, but I think the clarity of the dual nature of CLL is particularly well presented.

It is a very short segment of a much longer interview at ASH 2011 with Dr. Adrian Wiestner who hails from the NIH and who has done and is doing very important research in CLL.

And is he is a great guy too.

Most primary care providers are clueless about CLL so I am putting together a program of videos and education programs to teach them how to better care for these patients. More to come.

Andrew Schorr interviewing me at ASH 2011

2012-01-17T17:28:00.000-08:00

My friend and fellow CLLer, the Seattle based journalist Andrew Schorr does a great service to CLL patients in particular and many others with chronic illnesses in general with his helpful interviews with the major researchers, often at the big medical society meeting. Here he takes a break from the "usual suspects" and interviewed me at ASH. (The American Society of Hematology) , 2011.

Check out his wide ranging website full of real dialogue with doctors and patients at http://www.patientpower.info/ to learn more. I am sure you will.

Unique Specimens I will be there, will you?

2012-01-15T13:27:00.000-08:00

Join my son Will for his annual Avanti show opening. Patty and I will be there and I hope you join us for a splendid time. I leave the next morning for OSU, so don't miss this chance to say hello and good luck, enjoy amazing art, eat great veggie food and reunite with fun friends of all ages.

Unique Specimens - 11 Curiosities Rendered in Bleach

An open invitation to fans, artists, enthusiasts, critics, intellectuals, press people, and every living member of the secret subculture of Orange County. Back to where it all started. The opening for my 6th Annual show at Avanti Cafe will be held on the evening of Saturday January 28, a free event as always. Vegetarian food, craft beer, and real art - it only happens once a year!

Join the event on Facebook for details (http://www.facebook.com/events/144525098995088/)

Hope to see you there!

-Will Koffman

Why I am keen on PCI-32765

2012-01-14T21:56:00.000-08:00

This very nice blog post deals with the business as much as the scientific aspects of the enthusiasm about Bruton's Tyrosine Kinase (BTK) Inhibitors, specifically PCI-32765 in CLL and other B cell lymphomas.

It is a nice simple introduction to how the BTK inhibitors work and outlines the little but promising data presented at ASH 2011. The blog does not mention the 89% progression free survival in CLL.

I suspect we still don't have the whole story. In fact, I am sure we don't.

What do you think?

Am I and many others over excited about this little pill when the evidence is still pretty sparse?

Probably, but there doesn't seems to be much downside, and the other options of doing nothing or using an established therapy sure have their own very real problems.

And I can always move onto those options later if PCI-32765 doesn't work out. Moving in the other direction is not a likely option.

I am not going there. I have every reason to believe that I will be part of the vast group of dramatic responders, especially since my disease is so concentrated in my nodes and my 11q deletion has pretty much done everything by the book so far, which means my clone should melt away in this trial.

Can't wait to get started.

I see Dr. Kipps in three days to go over my bone marrow biopsy and get his final blessing on my plans.