Threw down a $20; might do more later.

<soapbox>In any other allegedly first-world country on the planet, this would not be necessary. Our medical system is an obscenity and an embarrassment.</soapbox>

Weird. When my mom recently went through chemo, they wouldn't let her take a multivitamin. But Kate's going to be taking "large number of supplements"? I don't get it.

@2: Most multivitamin pills contain iron. Chemo, besides killing cancer, also kills your immune-system and does serious damage to your mucus-membranes, like the ones that keep your stomach-acid from dissolving your stomach-sack. Most healthy individuals have no problem digesting iron in pill form but for someone who's undergoing chemo and is already at risk of ulcers it can be dangerous and certainly not recommended. "Supplements" can mean many things and not necessarily pills at all.

Kate's "My Gender Workbook" was the first book I read after leaving a psych ward after a period of severe, life-threatening depression. While the book didn't directly address my issues, it was so full of fun, compassion, and mind-blowing genderqueer ideas, that I found it to be a very healing read. I later got to meet her and have her sign that book (and 'Gender Outlaw'), and I found her to be just as warm and genuine in person as she is in her writing.

Of course I'll donate...headed there right now.

@6 - because if EVERYONE has access to the same level of health care, the wealthy might have to wait for theirs and that is NOT okay.

/sarcasm

I met Kate when she lived in San Francisco 20+ years ago. She's a wonderful person. I know of a great thing she did for a friend, but I don't want to violate that person's privacy. I wish her the best, and am sending a contribution.

Kate Bornstien is wonderful. She is a hero for trans people everywhere. I wish she is a Canadian. My mom is diagnosed with lung cancer, it is not curable, but she is getting a lot of care from our doctors and a public drug plan (Ontario Trillium Plan) that covers most costs of her life saving drugs. (which amount up to 30 -40 k per year)

By the way, my mom is a life time NON smoker.

That wasn't me? Being a former fed (TM?), I can confidently say that the healthcare plans offered to elected DC politicos (which are the same options offered to exec employees, i.e. bureaucrats) are NOT all that similar to single-payer options. Oh, they're good, and most Americans would do better under them than what they're typically offered, but there are still lots of premiums and co-pays and deductibles and exclusions such that an illness like this would cost the "beneficiary" a pretty penny to keep living. While under those "gold-plated" plans, as an example, I spent about a grand out of pocket on a root canal and crown, and when I landed in the hospital with a nasty case of norovirus, while I *could,* thankfully, go to pretty much so any hospital and be "covered," still had to cough up my $100+ co-pay before they'd hook the saline IV up to me to relieve my dehydration.

OTOH, at least I would have likely been paid for the time off. Beyond having relative generous paid leave, bureaucrats are a generous lot, and if you manage to exhaust all your paid leave (6-8 months will DEFINITELY do that), your coworkers will donate some time so that you continue to get paid while you recover. While I was there, we had 2 staff members undergo intensive treatment for SERIOUS cancers, and while they were out for long periods of time, they never missed a dime of pay because every last one of us donated some leave to them. Most of us felt that giving up a day or so of vacation so that our coworkers didn't have to try to figure out how to make ends meet when they were too sick to stand was really the least we could do.

As an Australian, I find it really, deeply shocking that US citizens can find themselves in this situation so easily. I have complete, almost free healthcare (there are sometimes small co-pays, but never in a public hospital) by virtue of being an Australian citizen. On top of that, I have the highest level of private health insurance available - that gives me a choice of doctors, hospitals, and allied health care including dentistry, physiotherapy, psychology, podiatry and free glasses - for $2600 per annum - and if you earn less than $180K per annum, even that is subsidised, by up to 30%.

Why aren't Americans storming the barricades to demand the same?

But Ms D, why on earth should colleagues have to donate time to others? Why not have proper long term, government supported sick pay? Gah.

@15 Because Big Business, especially Health Care, controls our government and many of the voting public are very ignorant of "socialized" medicine.

@15, me too. Actually, I went to hospital yesterday. I did have to pay $250, but that was my gap. Top specialist. Maximum of $500 per year and I could be (I hope not, unlikely in the near future anyway) in hospital for months and not have to pay more. As an Australian I see this as a right, not a privilege. I do pay for private, but socialised health means I could get this for free, although I would have had to wait a bit. Frankly I cannot see why Americans put up with their 3rd world system and spend trillions on defense. Particularly when the US has some of the best hospitals and specialists in the world........if you can afford them.

@9, other countries pay far less of their GDP and have better health outcomes because EVERYONE is treated and they do rationalize care. There are far fewer MRI machines, far fewer hi tech, yet folk live longer. And far more Canadians go back to Canada then come to the US for health care. Facts, geeze the conservative movement's life would be easier without them!

Nice empathy display too!

U.S. also sucks at disability income benefits.

In most other countries, if you are disabled (which would include cancer treatments), the supplemental income includes a housing allowance that somewhat scales to your housing / mortgage / rent costs (with caps).

A little known fact of the US -- unless you are disabled or work with people who are (which I did back when I was a student) is that SSI is a very, very small amount of your income and it has to cover everything -- you might also get a smidgen for food stamps. Not enough to live on though. So unless you have supplemental disability insurance you are screwed.

And supplemental (private) insurance (that is affordable) only covers 2/3 of your pre-tax income. Although tax free, it's still not much. You could say "but buy private insurance" but the reality is private insurance that would cover all the things that TAX SUPPORTED health and housing and income replacement benefits in Europe, Australia, Canada, etc. would cover, is so prohibitively expensive that the middle class cannot afford it.

I would counsel Kate B. to consider palliative over aggressive treatment given that her cancer has, from Dan's description, reached stage IV.

My personal best to Kate B., and I don't mean the following to sound heartless -- so a preamble that I have lost several close loved ones to terminal cancer in the past decade, one of whom fought to the end with every measure possible, two of whom went the palliative care route once stage IIIc (one case) and stage IV was reached, it is a very unpleasant road either way.

If we look at Steve Jobs, even limitless money doesn't help. When cancer returns so aggressively, especially lung cancer, the science suggests that there is little hope. I would not criticize anyone for trying the 1% chance that the treatment will work and I think it should be paid for, but I would counsel friends, loved ones and myself to abandon aggressive cancer treatment in such cases and opt for palliative care that focuses on quality of life and accepts that this is end-of-life.

Although my 3 family members all died, the two who went the palliative route had a much better time, and research suggests this is true in most cases. Although all three suffered miserably for the final 3 months (I would prefer euthanasia at that stage if it were me), the palliative care family member was the one who lived longer than the stats, and the one who went aggressive had a very rough 24 months of surgeries, numerous complications, revision surgeries, massive chemo, massive side effects -- incredible suffering from the treatment.

The others were spared most of this and went about their lives, only suffering greatly at the end. Docs in the US don't help either, they were wonderful, caring people, but for them my family member who went aggressive was labeled a treatment "success" because her cancer responded for a time -- even though her total lifespan from detection to death was exactly the same as if she had had no treatment after the reoccurrence. So, beware, docs in the USA define success as cancer reducing even if it kills you in the same amount of time, later bouncing back more quickly to kill a weakened body, and they do not consider quality of life or total months-in-agony in their definition of successful outcomes.

@21 BTW, I did read that Dan said "the cancer is curable" but I don't trust US docs. That's what they told my mother who died horribly after aggressive treatment. They were good docs, and it's true, her stage IIIc was curable -- in about 1% of cases.

Of course, as one would predict, she was the 99%. They were honest about this, but again, their counsel was "it's curable, we should treat aggressively" not "it's a really, really long shot that you will live more than 5 years and you might, 1% chance; if you take aggressive treatment there's a 99% chance you'll die anyway as quickly, and a 100% guarantee that you will suffer horribly from the treatment." That was the science but they don't phrase it that way. Instead they focus that "most treatment is a success." See my comment above, docs define success as the cancer responding, not months after metastasis or age at mortality from the cancer, which are more reliable than months after detection, as early detection can artificially inflate the apparent benefits of tx.

To follow on with my own @22, when I asked her lead oncologist the question this way "in what % of cases is mortality postponed by treatment beyond that which it would have been without aggressive treatment" he told me accurately, about 1%.

It's just not the way he phrased it until I asked that question, the way he initially phrased it was, "aggressive treatment usually is successful and we see a response" and "I recommend aggressive treatment because it can be cured." I don't fault my mom for taking the 1% chance but I don't think she every really realized that it was a 1% chance, she latched on to the "it can be cured" and "most of the time treatment is a success" (cancer temporarily reduces). Again, the physicians were superb and genuinely caring people, it's just that medicine in the US is biased to aggressive treatment. The two loved ones who took palliative care were in other countries where the physicians have a different culture, they only recommend to treat aggressively when the odds are in favor of prolonging life. This is also in part why the US spends so much on healthcare, it's not that docs are cruel but that they are trained to define success differently than in other countries. Indeed, the aggressive oncology treatment can hasten death at the very end because the body is so damaged from all the procedures, toxic chemicals, radiation, surgeries.

A final comment on this thread, since I've lived through this personally as well as having studied it professionally, I want to share my experience for readers who may one day face similar decisions: age of patient at progression of cancer.

Stephen Jay Gould was in this circumstance -- he had a usually lethal cancer but at a younger age, and when he dug into the stats, the % cure rate / 5 year mortality for early age patients was much higher. However, later in life, another cancer came, at an age where the % cure rate was low, and indeed he died in a more "typical" time, relatively young.

Complicating matters is that % cure rate is defined differently in different studies. Common ones are 2-year survival, 5-year survival, and age-adjusted mortality -- the latter is especially useful but rarely used as it's most complex, and subtracts out the effects of accidents or non-cancer (or other disease related deaths). 5 year and age-adj mort. reduces the illusory benefit of earlier detection of either initial carcinoma or subsequent metastases.

Again, my best personal hopes for anyone in this situation.

@20-24: I had similar thoughts. Even if the treatment was free, would I want it? In advanced cancers, (much less a second cancer!) there is often there is a choice between, say, a good quality of life for 9 months and then a year of decline, assisting by palliative care. Versus starting really, really unpleasant treatment immediately which will (1) leave you with no energy, (2) cause you to look and feel horrible, (3) take all your (and your family's) time and attention to focus on commuting to treatments and appointments and taking a multitude of drugs on schedule. And all of that pain and grief and distraction might mean you die in 2 years anyway, only slightly extending your life.

Many oncologists act like White Knights out to slay the Evil Dragon of cancer. And can forget that the evil dragon resides in the patient whom they should be more focused on. It's perhaps natural to do so - they often can't save the patient, but they can beat back the cancer for while so they consider extending life 6 months to be a success.

I'd treat my mother or myself with the compassion that anyone would show their sick dog: Does the day hold more joy or pain? And call it quits at the transition point. Then the strategy becomes how to best extend that point in time and, yes, in advanced or aggressive cancers, that is often simply palliative care.

@25 One more thought (I promise the last I don't want to hog the thread) -- this is why I am in favor of actuarial based decision making as in the UK.

Either a patient gets treated or not, and leaving it up to each MD and patient based solely on clinical judgment is not the best way -- the data are so complex no MD, who focuses on caring for individuals, can ever stay up on all of it, nor can a patient or her/his family. Everyone including the MD is hoping for the 1% success, and MDs do see dozens of such cases over the course of their careers.

As I understand it, the US healthcare reform left in data analysis, but the Republicans with their "death panel" lie took out the part to pay physicians for their time in providing information to patients about end of life options. What a crazy, stupid, evil thing to do. And of course in the US, health insurance denials are not based on actuarial decision making at all but on profit. I would call this pure evil, and often coming from Christian conservatives.

The same benefits of actuarial data analysis applies for decisions on treatment other than cancer -- hip replacements, open heart surgery, organ transplants, most major medical procedures. I've taken in my own decisions to ignoring what US physicians say and asking "what would doctors in England do?"

Delta35: +1 on "actuarial based decision making". Both on an individual basis and society wide.

The USA's first attempt at national health-care reform by the Clintons got shot down in part because it would be "rationing health care". Well, duh. If you aren't going to ration, I won't support it, because there is no way you could afford giving everyone every treatment they might request. Pick a number, say, $100,000 per quality-adjusted-year-of-life. Preventative care? Vaccines? Setting a broken arm? At $1,000 / QAYL? Those get paid for. A quadruple bypass in an 82 year old? At $3,400,000/QAYL (and for some cohorts, negative(!))? No, it is not covered. You want it, it is own your ticket.

The Fundies have developed this irrational fear of big government, but they've long had an above-average fear of death (hence the appeal of an afterlife). To acknowledge that there are times when, sorry, but you're just going to die (and find out if your particular sect was right about what it takes to be saved) is a step they can't take with any grace. I haven't had any secular friends go kicking and screaming to an early death from cancer or whatever - they played the hand they were dealt more calmly. But I've seen some very in-denial religious types go to ridiculous lengths to extend their pain as long as possible.

@27 Kind of a new thread so I'll reply to what you said, you are so correct. The fundamentalists are so afraid of death.

As an atheist, I think death sucks -- for the living, the pain of loss and grief, the pain of dying, and while we're alive, the existential angst of knowing the party will go on after you leave, as Hitchens so well said.

But I am not fearing eternal damnation. It's like Epicurus said, I don't need to worry about death itself because (to paraphrase) I won't exist anymore.

However, if you believe in an afterlife and hell, the agony of stretching out dying is nothing compared to the pain of eternal damnation, and the Christians think everyone's a sinner, right?

Plus I've seen "spiritual" types be more likely to take the long shots, not from a fear of death but from a vague hope that somehow some force would help them out. This was mom's case. Of course, to comfort her, I didn't try to change her mind or fight her -- I accepted her choice and supported her, and only very, very rarely, mentioned that I might be wondering if the additional treatments were helping.

I also asked her if she wanted me to let her know what the actuarial analysis of her treatment was -- and she said no, she didn't want to know the exact odds, so I respected that and never did tell her, and I can certainly see why some people prefer not to know. Unfortunately I wasn't very good at it as she did like to talk about her prognosis and every time she did say "I'm hopeful this will work" I just cried buckets and couldn't help myself, saying "yes it might" but thinking of the actual statistics. Still hurts even though years have gone by.

I do have to say that I am sometimes envious of the religious belief in heaven, in that it seems to provide a measure of comfort regarding grief that I do not have.

Have to agree that something doesn't add up here. If she has "lung cancer" (by which people usually mean either small cell or non-small cell, e.g, squamous cell cancer) and it has "was back," then unless we're talking about some very unusual circumstance, it's fatal. Lung cancer has one of the worst prognoses unless cured with the initial surgery, which in this case, it's not. The survival rate is <1% (see Wiki). See also Temel's 2010 article in the new england journal--all were dead by 3 years; half were dead by 1 (and they didn't have CLL on top of lung cancer). And you don't have to fly all over the world for chemo. Chemo comes to the hospital you're at. Regimens are published and protocolized and can be followed by oncologists locally after a consultation elsewhere (if such a thing is needed). Story needs more information, sounds erroneous. Not an opinion alone here, I'm a hospital physician who sees tons of lung cancer patients.

Troll, I have to recommend that you watch Kate Borstein's touching It Gets Better video and try following her one and only rule. If you can't bring yourself to watch it, here's the rule: Don't be mean.

Oh, and you sure as heck don't need cabs to go get medical care with a weakened immune system or not. First, if you're neutropenic from chemo, you don't get more chemo; you have to recover first. Second, a mask and some alcohol gel will be a lot safer than a cab drive, should it be a factor. If she gets an infection and its not the flu or a cold, she'd probably pick it up AT the hospital.

As somebody who watched a love one die of cancer, my heart truly goes out to Kate, who seems like an incredibly sweet human being. We need more people like her. I'm happy to have donated.

And trollboy, you have truly hit a new low here. Do yourself, and all of us, a favor.

Look in the mirror.

Quit wallowing in your own pathetic, unceasing bitterness. Stand up and be a fucking man, already.

The arguments about whether Kate will be able to "beat" this illness or not are really moot to my mind. Kate will eventually die as will we all. My donation was not given in any attempt to give her (or myself) immortality. It was given simply because she was helpful to me at some point in my life and I choose to return the favor. What goes around comes around.

"You can do whatever it takes to make your life more worth living."

If she lives in NY, why is she going to Chicago for treatment? The statement about supplements would make me think she is using the Block institute..... Thus the high cost etc.

@31: Kate had an aggressive form of lung cancer that was caught earlyish. The tumor was completely removed, but it unfortunately had already metastasized, invading her lymph system. She talks about it here. Conceivably, if the wayward tumor stem cells don't find anywhere friendly to land (or are suppressed in reproduction very early on) thanks to aggressive chemo and radiation therapy, they might simply die without resulting in further cancer, hence the possibility of a cure. Of course, they also might not, and Kate might be dying, on her way out, which would be very sad because she's awesome.