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Tuesday, September 14, 2004

The President as Homecoming King

Mark Graber

The Framers anticipated the President would be a distinguished American who would rise above party to ensure a faction-free politics. No contemporary politician fits that description in large part because the unforeseen rise of the two-party system in 1800/1828 made most original intentions obsolete. John McCain probably comes closest. John Kerry can at least point to a solid to good long career in public service. George Bush led an undistinguished existence until the 1990s and has demonstrated no capacity as president to rise above party.

The twentieth century presidency pioneered by Theodore Roosevelt emphasized an executive sufficiently immersed in policy to govern the administrative/welfare state. By this measure, Kerry fares quite well. Good faith disagreements exist on the merits of what Kerry would do as President but no one thinks he is uninformed or uninterested in the major issues of the day. Bush is a disaster when judged by the T. Roosevelt model of the presidency. Outside of his election, major league baseball, and possibly the oil industry, he exhibits little knowledge or interest in the details of any policy, from health care to the Sudan.
The best way to think of the Bush presidency is that the United States is in the process of transitioning from the president as policy leader to the president as homecoming king. The metamorphous began under Reagan, is fueled by the modern media, and is being perfected by Bush. The main responsibilities of the president as homecoming king is to cheer lustily for our team. In every way, the president must communicate that our nation is number one (whatever that means), has no serious flaws, and is capable of overcoming any obstacle. Bush does this well. Kerry rather poorly.

Consider how recent events highlight the presidency as homecoming king. Only partisan Democrats care that Bush used family connections to limit service during Vietnam. Past achievement, after all, is a qualification of the presidency envisioned by the Framers. The homecoming king must be well liked, but need not have a record of any achievement. By comparison, Kerry has been damaged by revelations that he complained of atrocities during Vietnam. Of course, everyone knows American soldiers in Vietnam did commit atrocities and war crimes. The only serious issues are how pervasive was such behavior (both then and in Iraq) and what can be done to limit future atrocities. These questions are matters for a president expected to exhibit policy leadership. The homecoming king never acknowledges that our team has any faults (or what faults exist are to be blamed on a few individuals).
Bush fell from grace only once during the campaign, when he indicated that the war on terrorism could not be won. Had we been in the era of the Roosevelt presidency, a sensible debate might have followed on how terrorism could best be contained over the long run. As we move to the era of the president as homecoming king, such statements must be recanted. Presidents must assert that our team will fully triumph over all foes. No nuance is permitted in public. That everybody knows such triumphs are utopian matters not in the least.

As a fan of high school and college football, I like homecoming kings and queens as much as the next person. A reasonable case can be made that they serve national purposes. Witness the English monarchy. But England also has a prime minister, who acts as a Rooseveltian policy leader. Elections are more about policy than popularity. The greatest danger in the presidency as homecoming king is that public debate over policy in the United States is rapidly being reduced to who can cheer the loudest for the home team.

Comments:

George W. Bush, America's Homecoming King, prepared for this title by majoring in cheerleading at Andover and at Yale. I recall the cheer, "Boola, Boola ..." to which we used to add "up your goola" in my Roxbury (Boston) days. Reason is of course not required for cheerleading. I doubt that a sports team is encouraged by cheerleaders, especially males, with or without megaphones or pyramids.

Bush's National Security Strategy (2202) states in effect that the U.S. is the #1 military power and the #1 economic power in the world and will do whatever is necessary (whatever this means, in addition to preemption) to maintain these positions. This is also the mindset of a bully. No walking softly for George W while he waves the big stick.

Hopefully the voters will wake up and provide him with a Crawford, TX permanent homecoming.
 

I found a few of the statements in this post rather curious (i.e., the expectations of the framers and Rooseveltian vs. homecoming king presidentship). My response is too lengthy to post as a comment but can be read here.

Regards,

Roger Mitchell
e-mail: rsm@cstone.net
blog: well-versed.blogspot.com
 

This argument is truly baffling, and in places outright bizarre. The Framers did not anticipate a “faction-free politics” – quite the contrary, their entire system was designed, as Madison made clear in Federalist #10, to make government work in spite of factions! It was, of course, assumed that Washington would be the first President and he was widely seen as being above factions, but I’d like to see some evidence that the Framers thought this above-faction posture of the Presidency would continue after Washington.

Kerry has certainly been in government a long time, but he has compiled a twenty-year record of hard-core isolationism and consistent voting against defense and for high taxation. That may make him popular in Massachusetts and in faculty lounges but can hardly be described as “solid to good public service.” Bush certainly had an undistinguished existence prior to being President, but the same thing is true of many of our greatest Presidents, such as Lincoln, Truman and Reagan.

Although it is a favorite of academics (for rather obvious reasons), the policy wonk = good President hypothesis simply doesn’t wash. It would account for the successful Presidencies of Clinton, Bush I (in foreign policy) and JFK (if we count JFK as a successful President; most scholars think his term too short to judge). But it fails to account for the disasters of Carter and Nixon. More importantly, it fails to account for the most successful Presidencies of the modern era: FDR, Truman, Eisenhower and Reagan.

Moreover, it fails to account for the differing contexts that various leaders find themselves in: to assume that a policy wonk immersed in detail and “nuance” is always preferable is to assume that Neville Chamberlain was preferable to Winston Churchill. (Granted, this view was popular at the Oxford Union, but thank God the British people, like Americans, don’t take their cues from the professors).

Nor is the Theodore Roosevelt model accurately described as one based on a President immersed in policy. Rather, the model is one that advocates strong executive leadership (coming, as it did, after a long period of Congressional dominance). Are you trying to claim that Bush is not a strong leader? That would turn the usual criticisms of Bush (that he rammed through tax cuts for the rich, that he is taking away all our civil liberties, that he strong-armed us into war) on its head!

There is so much wrong, both conceptually and empirically, with your argument that it is hard to make any coherent sense out of it. In the end, I think it can only be seen as an endorsement of the rule by experts – professors and the permanent Washington bureaucracy (perhaps not surprisingly since bureaucrats and professors are the two groups most likely to claim “we know what’s best for you”). The claim is appalling as it is but becomes truly noxious when it is then coupled, as it most always is, with the argument that it is a claim for democracy.
 

I'm sorry, I can't even get past the first sentence...our framers agreed on the scope of the presidency's power?

What?
 

dave, you cannot equate a refusal to listen to any opinion that does not agree with his own with decisive leadership. bush cannot bring himself to admit that anything that he or anyone associated with his administration may have ever made a mistake. witness that ridiculous performance at his press conference. if you mean that the man makes up his mind and then never changes it, yes, he is consistent. does this equate with leadership? i think not. i think it equates with an obstinent streak that demeans the office of the presidency.

real leaders truly listen to all sides and all arguments. when was the last time bush listened to anything other than the conservative drum beat?

as for your problem with academics... while i agree that they often seem to have their heads in the sky. at least they are hearing, absorbing, listening and thinking, traits that seem to be completely lacking at 1600 pennsylvania avenue these days.
 

Dave wanted to see some evidence that the Framers thought the President could rise above faction. I suggest he look at the original provisions of the Constitution respecting the election of President and Vice-President, in which it was provided that the person running for President who won the most votes won that Office and the second, or runner-up, won the VP Office. This clearly did not contemplate party, or factional, politics. As for Bush being a homecoming king, the real problem is that the Homecoming King Has A Gun/Army/Air Force/Nukes/ etc etc.
 

No – I wanted evidence that the Framers anticipated that the Presidents would be distinguished Americans who would rise above party to ensure a faction-free politics, as Professor Graber claimed, not that a President could rise above faction. As I stated earlier, and as most everyone who has written on American politics and the Constitution has stated, the Framers certainly thought that a President could rise above faction – indeed the whole federal system was designed to try to make that happen regardless of who the President was. But that is a world apart from expecting a faction-free politics (I’m also not sure that the concept of “faction-free politics” even makes any sense – aren’t factions what make politics politics? “Faction-free politics” sort of sounds like “money-free economy”) or from expecting that the President would be a distinguished American who would be above party, as opposed to a politician who would be from one faction but forced (both in order to get elected and in order to govern effectively) to compromise and cut deals with other factions. It’s also not clear how Graber can claim in one sentence that the Framers expected the President “would rise above party” and then claim in the next sentence that party politics was “unforeseen.”

The only evidence of Graber’s claim that I can find is one sentence in Federalist 68 where Hamilton states that “there will be a constant probability of seeing the station [i.e., the Presidency] filled by characters pre-eminent for ability and virtue.” But that is only one sentence, and it doesn’t quite establish the claim Graber makes. Moreover, it was written by a Framer who actually preferred a monarchy (or at least a much stronger executive) and it was probably more a rhetorical reference to Washington than an actual expectation (remember that The Federalist Papers were written to convince people to ratify the Constitution). This seems like rather slim and unconvincing evidence. That is why I asked if he had any other evidence.

I don’t think the original provisions of the Constitution respecting the election of President and Vice-President demonstrate that “this clearly did not contemplate party, or factional, politics.” Quite the contrary, the original expectation was that Washington (from Virginia) would be President and that the second-place finisher would therefore be someone from a northern state, such as New York or Massachusetts. My understanding was that this was intended precisely to bring some balance into the executive branch between different factions.

I remain quite astounded that someone with a PhD in political science, like Graber, could post the claim he did. (Actually I would be astounded if someone with even just a BA in political science were to make that claim). I think it is a damning statement on the quality of today’s academy. The interesting question is what explains Graber’s making the claim.

In part, I think it reflects the difference between a unit-level perspective (that looks at the people in the system and attributes their qualities to the system) and a systemic perspective (that looks at the structures of the system and its outputs and (normatively) tries to design a system that will work regardless of the people in it). The Framers were preeminently systemic theorists. I think part of the problem is that professors are so blinded by their hatred of Bush that they lose the systemic perspective that might otherwise be brought to bear if they were discussing a different President.

In part, I think it also reflects the “Golden Age Fallacy” of projecting one’s current preferences back onto historical reality. This fallacy is especially common in the media, but part of the reason we have academics is to counter this, not further it.

In part, it may also reflect the academic fad of communitarianism, which is distasteful of factions (and, indeed, of politics) and wants (as Lennon put it) “the world to be as one.” I think the Dead Kennedys had a sufficient rejoinder to that in Holiday in Cambodia. But then again, there were academics like Malcolm Caldwell who thought genocide was just fine.
 

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mesothelioma Mesotheliomais a form of cancer that is almost always caused by exposure to Asbestos In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart the pericardium (a sac that surrounds the heart or tunica vaginalis.
Most people who develop
mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing Mesothelioma Unlike lung cancer, there is no association between mesothelioma and smoking but smoking greatly increases risk of other asbestos induced cancer.Compensation via
Asbestos funds or lawsuits is an important issue in
mesothelioma The symptoms of
mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis, which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural
mesotheliomaSymptoms of peritoneal
mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal
mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
chest wall pain
pleural effusion, or fluid surrounding the lung
shortness of breath
fatigue or anemia
wheezing, hoarseness, or cough
blood in the sputum (fluid) coughed up hemoptysis
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
abdominal pain
ascites, or an abnormal buildup of fluid in the abdomen
a mass in the abdomen
problems with bowel function
weight loss
In severe cases of the disease, the following signs and symptoms may be present:
blood clots in the veins, which may cause thrombophlebitis
disseminated intravascular coagulation a disorder causing severe bleeding in many body organs
jaundice, or yellowing of the eyes and skin
low blood sugar level
pleural effusion
pulmonary emboli, or blood clots in the arteries of the lungs
severe ascites
A
mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs
Diagnosing
mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for
mesothelioma A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of
mesothelioma A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude
mesothelioma it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of
mesothelioma A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
There is no universally agreed protocol for screening people who have been exposed to
asbestosScreening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for
mesotheliomaThe level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening. Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells
Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[ Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
asbestos
is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven.
asbestos
has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and
asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer bronchial carcinoma). The Kent brand of cigarettes used
mesothelioma in its filters for the first few years of production in the 1950s and some cases of
. have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 may act as a cofactor in the development of mesothelioma.
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with
. exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of
. exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for
mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with
asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related
mesotheliomaExposure to
asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of
asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to
asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial
asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Family members and others living with
asbestos workers have an increased risk of developing
mesothelioma and possibly other asbestos related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to asbestosMany building materials used in both public and domestic premises prior to the banning of
asbestos may contain
asbestos Those performing renovation works or activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue
asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to
mesothelioma radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although
mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Radiation Therapy when given alone with curative intent has never been shown to improve survival from
mesothelioma The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy is the only treatment for
mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural
mesothelioma showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer.
mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The
mesothelioma tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs.
cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of . exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. . has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk o f asbestosrelated disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to
asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to
asbestos Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis
How is
mesotheliomadiagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the
cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is
.treated?
Treatment for mesothelioma depends on the location of the
cancerthe stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for
mesotheliomaThe doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural
mesotheliomaa lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Stereo Tactic Radiation Therapy also called radiotherapy, involves the use of high-energy rays to kill
cancercells and shrink tumors Radiation therapy affects the
cancercells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the
cancercells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat
mesotheliomaare given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation Therapy and surgery may also be helpful in relieving symptoms.
 

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