In keeping with our goal of bringing you important medical issues for yourself and your family this week’s health tip addresses Oncology therapies. It may be important to each of us to understand the scope of options well before a loved one is diagnosed with cancer!
 
Our Wealth Tip addresses tools to guide your way through these times with new rules for investing. Did you learn anything from last month’s Collars article?

Jump around or read the entire issue.  Is any of this important to you?  We need to know if our efforts are worthwhile or should be re-directed.  We don’t really expect that every article will be of interest to every reader but there ought to be at least one important article in each issue that presses some of your ON BUTTONS.  Let us know if we are wasting electrons!!

Our intent is to publish smaller newsletters twice a month starting with this issue. Be sure to be in touch with Richard Gray, Editor, at rgray@fjmc.org with your articles, comments, appreciation and critiques. Each issue is brought to you by your editorial staff that includes:

• Richard Gray (Editor in Chief)
• Steven Mandel MD (Medical Editor)
• Gary Smith (Wealth Editor)
• Mark Druy (Publisher)

This HWR was sent out on , at approximately 10:15 PM (Eastern and prior to Shabbat).

HEALTH TIPS

Review of Systemic Therapies of Oncology
Dr. Wiliiam R. Grace, MD

The following are the various systemic therapies that are in the tool kit of medical oncologists today. 

• Hormonal therapies. These therapies consist of A) hormones such as estrogen, progesterone or testosterone used in the treatment of hormonally responsive breast cancer; or B) anti-hormones such anti-estrogen’s as Tamoxifen, Femara or Aromasin also used in the treatment of hormonally responsive breast cancer; or anti-testosterones such as Casodex, Zytiga or Ztandi which are used in hormonally sensitive prostate cancer; and C) false commands to the pituitary gland such as LHRH antagonists of which Lupron, Zoladex are examples which are both used in the treatment of hormonally sensitive breast and prostate cancers by telling the ovaries of women and the testicles of men that there is too much estrogen or too much testosterone in the body and would you please stop making these substances! These hormonal therapies are usually given orally, although the false commands to the pituitary are given by subcutaneous or intramuscular injection..

• Cytotoxic chemotherapy. These are the classic drugs which consists of metabolic poisons which hopefully poison the cancer more than they poison the patient. They are known to cause nausea and vomiting, hair loss, fatigue, sores in the mouth and suppression of blood tests resulting in anemia or insufficient white cells or insufficient platelets which are involved in clotting. These are the drugs which in the past had such a bad reputation and now can be given with many fewer side effects due to the development of powerful anti-emetics to prevent nausea and vomiting, cooling caps to reduce hair loss and growth factors to correct anemia, insufficient white cells and platelets. These anticancer treatments can be given orally although most are given intravenously..

• Targeted therapies. These are the newer agents which are developed in response to specific molecular abnormalities in the cancer cell and although most are given orally many are given intravenously. The production of the chemotherapy resistance gene, HER-2/neu, can be blocked successfully with Herceptin and Projeta making the cancer far more sensitive to chemotherapy. The oral agent Tarceva and the intravenous agent Avastin are used in the treatment of lung cancer that express the EGFR (epidermal growth factor receptor) mutation. There are many other targeted agents such as Gleevec which has revolutionized the treatment of chronic myelogenous leukemia making this disease potentially curable or chronic for many years.. 

• Immunotherapy. The immune system has 2 components. The first part of the immune system is chemical immunity where the production of chemicals (antibodies) which the body uses to fight bacterial and viral infections such as strep throat, tetanus or smallpox. The second part is the cellular immune system such as we see in kidney transplant rejection or the body’s immunity against tuberculosis. It’s this second part of the immune system that is useful in fighting cancer. It is felt that the chemical immune system covers malignancy early in its development preventing the body from developing an adequate cellular immune response to reject the cancer that results in its eventual growth to where it causes symptoms and discovery. The body has immune checkpoints or brakes to prevent cellular immunity from causing excessive inflammation in otherwise healthy organs as we see in disease state such as rheumatoid arthritis, Crohn’s disease and ulcerative colitis. These checkpoint brakes can be inhibited so that the bodies meager cellular immune response can be sent into hyper-drive and retard or eliminate the cancer. This comes sometimes at a cost of causing inappropriate inflammation in many organs such as the brain, lungs, liver, kidney or bowel. However, Oncologists today are learning quickly how to use these agents to increase the cure rate of cancer by combining them with chemotherapy, radiation therapy or targeted therapy to enhance the immune targets available to the body. This is truly an exciting new area of cancer therapy. Just look at former president Jimmy Carter who is alive and disease-free from once incurable metastatic melanoma!.

William R Grace M.D.
Grace Oncology, 945 Fifth Avenue, New York, New York 10021
Former Chief of Cancer Research and Medical Oncology
St. Vincent’s Hospital and Medical Center of Manhattan, New York
Former president of the New York State Cancer Society 

WEALTH TIPS

Some Greek Letters in Investing
Gary Smith, DVM

What style of investor are you Value, Trend, or Day Trader?  Little known indicators about stocks can be very valuable tools in helping make a decision on investing.  We have Alpha and Beta.

ALPHA

Alpha is used to measure performance on a risk adjusted basis. The goal is to know if an investor is being compensated for the volatility risk taken. The return on investment might be a better benchmark but still does not compensate for the assumption of the volatility risk.  Alpha is a little more complicated to understand.

We are going to spend more time on Beta as it is a more important indicator and is used by many to help make decisions on investments.

BETA

Beta is a measure of volatility of a stock versus the market.  It is very simple and by following the beta on a stock you are interested in you can determine the risk of the investment you are considering. A beta of “1” simply means a stock moves roughly like the market.  A beta above “1” means the stock is more volatile than the market, and a beta of less than “1” means the stock is less volatile than the market benchmarks.

So why is this important?  Let’s say you are value investor. Perhaps now you are even more worried about how markets are going to perform.  I expect that some day in the near future the markets are going to collapse. We do not want to put all of our money in the bank. We may want safe investments; investments that I call boring and unattractive.  These mostly are stocks that are wonderful boring companies that typically have low volatility and do not have huge moves either up or down.  They pay a nice dividend and do not go down much in really bad times.  So if the market tanks you will be fairly well protected on the downside.  Let’s take Coke, Waste Management and Altria as examples.  There are many stocks we can consider. 

For example -Waste Management is a very boring stock. Few people are interested in Waste Disposal. This is not a juicy stock but does have slow gains and pays about 2.5 % dividend. It is a company that grows its dividends every year like Coke, and constantly buys back shares. It recently raised its dividend 9.4%. During recessions Waste Management has had good success. It is a stock you can hold for many years with little to worry about.  It has a low beta of about 0.6 which means it has low volatility.

I am not suggesting you buy Waste Management but am merely using it as an example of a safe stock that historically has held up during the worst of times.  There are many of these types of stocks. I personally have Coke, Altria and several other lower beta stocks and ETF’s in my retirement account. The dividends to me are most important in all retirement accounts.

Research was done from the book “Boggleheads Guide to Investing” by Taylor Larimore et al, Warren Buffet and the book “Defying the Market” by Stephen Leeb.   I hope you enjoyed this issue.  We try to give you some tools to think about and encourage you do a little more research for your long term investment success.

This issue is prepared by a bunch of guys who are continuing to GIVE BACK to FJMC.  We invite you to also give back to FJMC through your participation and most importantly through donations supporting FJMC as Friends of FJMC.  Participate by clicking on “Become a Friend of FJMC” on www.FJMC.org or contact Gary Smith at gsmith@fjmc.org.

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