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A Cancer Society Newsletter for people affected by cancer SUMMER 2011



CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Editorial The cancer community within New Zealand is a small one. So it was sobering news to hear at the beginning of this year, that Palmerston North had made the decision it would be unable to deliver care to certain cancer patients. Their struggle with too few oncologists finally meant they had to cut services. It highlights how much strain our cancer services are under.
The Support and Information Services of the Cancer Society, (whilst not in any way able to offer treatment) can, however, make a big difference to the experience for anyone undergoing cancer treatment. Information helps Focus on bowel function empower people, assists decision making and reduces fear. Our latest booklet – Bowel Cancer and bowel function: Getting stronger Practical advice - is an example of useful advice around a subject many find difficult to talk about. Meeting other Wounded warriors and healing heroes people and discussing similar issues concerning each How to motivate yourself to change 5 other contributes to normalizing what is happening and Keeping the main thing the main thing developing resilience. People find that having a safe place After cancer diagnosis, moving beyond our fears 7 & 8 to discuss what is happening for them or those around them, can aid in them having better direction and resolve. Treating hot flushes The services are offered to anyone affected by cancer – Pal iative care extends life patients, family/whanau and friends. Recycled wigs and turbans 8 As a new year starts we have much to celebrate in the Wellington Division. We have been able to respond New library dvds & cds to an increasing demand over the last few years by the addition of another Cancer Information Nurse to CanLive - a nz cancer retreat 10 our team and CanTalk (minus the pages showing the Getting the most from your drs appointments 11 Wellington services available) is now available on the Library Update 12 Cancer Society's National website – www.cancernz. Whats on in our centres 13 org.nz. However, we are most delighted and proud that Fiona Pearson, our Manager of Support and Information CanSupport networking groups 14 & 15 Services, was awarded the Order of New Zealand for Other supportive services 16 services to the Cancer Society. Professor John Carter CanSupport programme 17 & 18 at Wellington Hospital was given the same New Year Honour award for services to oncology. We congratulate Free services available them both for this well-deserved recognition of their work. Enjoy this issue. Sue Corkill, EditorContact: Sue Corkil , Cancer Society Wel ington Division 52 Riddiford Street, Newtown or email: suec@cancersoc.org.nz regarding any information in (or contributions) to the CanTalk Newsletter. This CanTalk newsletter is compiled and edited by the Cancer Society Wel ington Division.
Disclaimer Many of the articles in the publication are sourced from overseas. The inclusion of these items does not imply that procedures, treatments, or tests reported herein are approved of, or available in NZ. These articles are for discussion purposes only. The views and opinions expressed here are not necessarily those of the Cancer Society of NZ.
CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Focus on bowel functionThe thought or mention of bowel cancer elicits the cringe factor, and it's not difficult to understand why, when the bowel and its contents are one of the western society's socially taboo subjects. It's just not something the general population wants to talk about. Right from birth we are taught that our bowel habits are to be managed in private by the individual. This taboo helps explain the difficulty that people with a change of bowel habits or concerns about their bowel have in visiting, and expressing bowel symptoms to them.
Partly because of this taboo, bowel cancer doesn't have the high profile that other cancers such as breast cancer have, yet bowel cancer is one of the most frequently diagnosed cancers and the second highest cause of cancer death in New Zealand. In 2007, 2890 people were The gold standard for diagnosis of bowel cancer diagnosed with bowel cancer and 1252 people is a colonoscopy. The histology results will assist died from it. We know the earlier bowel with determining the type and staging of the cancer is detected the greater the cancer. CAT scans and MRI scans success rate of curative treatment and it Signs to watch for: (magnetic resonance imaging) are is exciting to hear of the impending pilot often used to detect spread to lymph screening programme. It is important • rectal bleeding nodes and to other organs, e.g. liver to talk about the issues around bowel • mucous discharge and lungs (metastases).The staging cancer - and lessen the awkwardness • lower abdominal of the cancer is the cornerstone to around discussion involving the bowel. developing a treatment plan.
• pelvic cramps The commonest form of bowel cancer While surgery remains the main begins in the inner lining of the bowel treatment for bowel cancer, treatment as a benign pre-cancerous adenomas may also involve neo-adjuvant (given (i.e. a lump that is not a cancer) which before the surgery) radiotherapy and over time changes to become an • loss of appetite chemotherapy; and at times further adenocarcinoma (cells that are cancer). adjuvant (extra) chemotherapy can The incidence of bowel cancer is known take several months. Treatment can to increase with age. Some of the risk result in the reduction, thickening and factors are thought to be a low-fibre diet, too scarring of the colon which will affect much red meat, minimal dietary variety, and the absorption of fluids from the motion, which lifestyle risks such as obesity and smoking. The in turn inhibits the formation of a soft-formed absence of a population screening programme bowel motion. The rectal storage capacity may be and the fact that the alert signs tend to be very reduced and the colon flora and mucosa may also non-specific are contributing factors that inhibit be altered. Sphincter and nerve damage occur early detection. Things to watch for are rectal occasionally and for others, pelvic floor weakness bleeding or mucous discharge, lower abdominal can lead to diminished control. The colon motility pain or pelvic cramps, feeling of incomplete or movement may be also be affected, disrupting emptying of the bowel, pelvic pain after moving the timely passage of a bowel motion. Exhaustion bowels, a loss of appetite, tiredness, or weight from the lengthy treatment leaves some people feeling disempowered, vulnerable and with a sense of lack of control.
Throughout this process the person with bowel continued on page 3



CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Many parents find it very difficult to know how to talk about their cancer and its issues with their children. A new tool just developed by Skylight is a welcome resource.
New Cancer Society staff pictured from left to right; Virginia Lee, Janet Stephens, and Rita Klus. Getting Stronger is a resilience-building board We welcome our new staff. Virginia Lee is the game for young people (8-14yrs) who are facing new coordinator of the CanSupport Programme tough times. This innovative game developed for the Wellington Support and Information team. by Skylight encourages young people to open She is taking over from Sue Corkill who is moving into the Cancer Information team whilst retaining editorship of CanTalk. Virginia has worked the last 14 years in palliative care as senior social worker at Mary Potter Hospice and comes from the community team in Porirua. Rita Klus is our new administration assistant. She is no stranger to the Cancer Society as she is also a facilitator of our Living Well programmes. And our new receptionist with the cheerful smile is Janet Stephens.
Focus on bowel function - cont'd from page 2 up and gently begin first conversations around cancer will find their thoughts and focus are sensitive topics. At this stage six topics and not only about the bowel cancer but also the cards accompanying them have been developed management of their bowel emptying process. but new topics will be added regularly. Topics Bowel cancer and its treatment will often require include: When a family member has a serious changes to diet or the addition of medication, and illness or injury; When someone close to them bowel habit retraining in order to develop a ‘new has died; When a family member has a mental normal'. For some this will involve a diversion of illness; and, topically, When the young person the bowel motion via a stoma on the abdomen is affected by a natural disaster. The game and into a small disposable pouch. is intended to be used with a professional or support person who the child feels comfortable For most this will be temporary but for a small with and it comes with full instructions on how to group this will be permanent. This is a big use it safely and effectively with a young person. change in body image. For those with bowel Each topic area was selected based on the latest cancer, developing a new normal in bowel research, statistic indicators and from Skylight's emptying can be supported with the release of own experience with families and professionals. the Cancer Society's new booklet Bowel cancer It is colourful, durable, well tested and engaging, and bowel function: Practical advice. While not taking about 20-30 minutes to play. likely to be a coffee table favourite it is hoped the practical advice the booklet offers will be helpful. Available from Wellington Cancer Society library or order Maria Stapleton,Colorectal Clinical Nurse Specialist, online at Skylight Shop: www.skylight.org.nz. Mid-Central Health, Palmerston North Sue Corkill



CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Wounded warriors and healing The concept of resilience was referred to in this presentation and several others at the conference, Wounded Warriors and Healing Heroes: Building as being important in coping with the uncertainties strengths-based patient-centered partnerships and difficulties of cancer. Resilience seems to be in cancer care.This was the title of an inspiring a mix of individual traits such as ‘hardiness', a presentation I heard at the Clinical Oncological tendency to view life with optimism and hopefulness, Society of Australia's annual conference held and external things like social support. Practical in Melbourne in November last year. Often things like regular exercise, avoiding cigarette presentations at conferences focus on the difficulties smoking and heavy alcohol consumption, healthy and downsides of treatments, or responses to eating (i.e. lots of fruits and vegetables and lower- cancer. However, Matt Loscalzo from the fat foods), and learning stress-reduction techniques can help achieve a sense Department of Supportive Care Medicine of control and build resilience. Getting at the City of Hope Medical Center, enough rest, learning how to effectively California took a different and welcome deal with emotional stress, and reflecting perspective, affirming the strength with on the spiritual aspects of life can also be which many people living with cancer face their situation. Listening to Matt Loscalzo's presentation affirmed for me the value of the support While he confirmed the research showing that many services offered by the Cancer Society in helping people with cancer face disabling distress at times, people explore new coping strategies and draw he reminded us that the majority of patients and on their inner strengths. Our services such as families are able to adapt to the many challenges the Cancer Information Helpline, the Living Well of having cancer. He spoke of the remarkable programme, Cancer Connect, workshops, support strengths people often have in the face of adversity. groups and many others give people a place to He described how, even with what may be seen to phone, visit or email, ask questions, find up-to-date be limiting disabilities, many people simply ‘make the information, connect with others and find practical best of things' and get on with life. Loscalzo posed the challenge to health professionals Julie Holt that while we need to respect where people are at, Cancer Information Nurse, Cancer Society we have an obligation to offer wider options to our patients than those they may have thought about. He A snail was run over by a turtle.
encouraged us to challenge limitations our patients The snail ended up in the hospital and his may think they have, and help them to focus on friends came to visit him. One of them asked their strengths. Then he says ‘people can truly live "What happened?".
a life with opportunities, interests and meaningful He said "I don't know, it all happened so fast".
CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Starting the change process How do you have that conversation with yourself to start the change process? What do I need to do to improve my health? Write down all the actions you need to take – listing them in order of priority.
Rate how important each change is for you (on a It is good to remind yourself of all the positive How to motivate yourself to changes you have made in the past. List these to remind yourself that you have had successes in change before.
We've all made those resolutions to exercise more, Talk about these changes you want to make with lose weight, stopping smoking, cut back on the someone you trust.
take-a-ways or whatever with great conviction only List the small steps you can take to build your to find that our enthusiasm for maintaining this confidence for this change.
change wanes after a short time.
Where will you start? How will you start? When will you start? The more specific you can be the better.
Often we can feel two ways about something. On Rate how confident you are that you can do this (on the one hand we want something to be different and a scale of 1-10). Low confidence rating means you yet on the other hand, we struggle with the work need to plan more fully with more support.
or effort that is required to make the change. If Having worked the above you are experiencing out and made a plan, it ‘Willingness creates the ability to accomplish ambivalence, take heart is then important to think things. It is a choice; therefore be willing to believe.' - you are already on the about how you will hold the road to change.
Corrianne Simpson, who trains health professionals It takes 66 days on average to change an action in motivational interviewing technique for smoking into a habit. Staying motivated in this time can be cessation and other life-style changes at the Cancer very difficult and so it helps to gain support from Society, says ‘It's not about what you should or ought to do; it's about what you want to do. We all know that we can do more or less of certain How will you keep on track? behaviours, and it is moving from knowing that to Who will you get to encourage you? doing something about it which is important.' How will you celebrate your successes? How will you pick yourself up if you strike a set-back? And as Dr Anthony Grant from Sydney University's Who can I go to if I get stuck? Coaching Psycology Unit says ‘If you wait until you feel positive before you change .you'll wait forever. Taking these steps will definitely make a difference Act now and you'll feel good' (Sunday Star Times to you staying motivated. Sue Corkill Join a breast cancer dragon boat team A breast cancer dragon boat offers an environment of friendship, fun and physical activity and is a real challenge to most who join. Breast cancer survivors paddle in Auckland, Bay of Plenty, Taranaki, Waikato, Wellington, Wairarapa, Blenheim, Christchurch and the West Coast. Make 2011 the year you take up this challenge! CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
fridge. Last year my catch phrase was - the main thing is to keep the main thing the main thing. Now, at the start of another year I have decided that rather than set 12-month goals I am better to take each goal, break it down into smaller pieces, achieve success, then focus on the next part of the goal. Managing my goals this way will help me to focus my attention and accommodate changes in my health.
I use a notebook to write down each goal. Around every two months I will set aside time Keeping the main thing the for a progress check and adjustment if needed. It's like completing a jigsaw puzzle. Instead of focusing on the finished product I focus on each part, linking it to the next part until the whole "We can do whatever we wish to do provided our picture is formed.
wish is strong enough. What do you want most to do? That's what I have to keep asking myself, One of my goals this year is around exercise. in the face of difficulties". My goal for the next two months is to exercise three times a week. Anything from Around about this time last year I started to 10 to 45 minutes is success. implement my New Year's resolutions. Setting goals helped me to feel as if I was getting on With the goal defined I then with life after a diagnosis of advanced cancer. considered what needed to It was exciting.
happen to make the goal a reality. With my exercise Soon after, I had a fall and everything goal I thought of all the changed. I was bitterly disappointed and ways I could build exercise felt that I was losing control. Suddenly the into my day without really needs of my body were prioritised above all realising it, such as parking other decisions in my life. It took a long time 10 minutes walk away from to accept that I could still have control and work and using the stairs instead of the lift. I achieve some of my goals. added motivators such as buying new shoes and adding music to my iPod so that I wouldn't get Throughout the year the cancer continued to bored when walking.
spread through my body. As the fatigue and pain spiked and receded, I began to understand It's about 6 weeks into my exercise goal and the importance of measuring my goals not by I am succeeding. My goal is realistic and feelings, which fluctuate depending on pain and achievable despite fatigue and pain. The goal energy levels, but by achievements. Once a goal requires some effort but not too much to be has been achieved it cannot be discounted or disheartening. I don't beat myself up when removed. This change in thinking has started to energy or the inclination to exercise is lacking. change the way I talk about myself. Rather than I have hope that the following day I will be say how I am feeling, I now say how I am doing. exercising again.
Looking back over 2010's resolutions, I see that William Lock sums up my intentions perfectly: despite the many days and weeks when I was "I can tell you how to get what you want: You've exhausted, tearful and frustrated, I have in fact just got to keep a thing in view and go for it and achieved most of my goals. never let your eyes wander to right or left or up I have found it useful to have a catch phrase or down. And looking back is fatal". to help me focus. I have it written down in prominent places such as my diary or on the CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
After cancer diagnosis, moving beyond our fears Cancer requires clear sight. But many people with cancer will tell you that their view of life is blurred by uncertainty and fear. They are uncertain of the technical details left to medical experts and fearful of a process that can feel like life at the roulette wheel. How can we learn to live with uncertainty? How can we move beyond our fears? life around certainty; you have built it around If you can focus on the uncertainty, the fears will values, priorities, and purpose. You look both ways before crossing the street. You button up your Much of our life is certain: the sun will rise in the overcoat when the weather is cold. You give advice, morning, the news will come on at 8 a.m., birds will hoping others will learn from your mistakes. Every fly, and the highways will hum with traffic. Today day is a series of choices, a series of questions will be pretty much like yesterday; the assumptions that you answer by going to work, by taking out the from last week will carry over into garbage, by hugging or kissing or this one. These truths reassure us fighting or walking away. that we live in a constant, certain, We don't see things as they are. We see them as we are. – Cancer is, of course, an uncertainty, Anaïs Nin However, there are deeper truths we a list of unanswerable questions: easily overlook. Change is constant. Can this be cured, stopped, Friends come and go. We are born, we live, and stalled, delayed? Can I tolerate we die. Our time here is limited, and even our most the treatment? Will my family survive this ordeal, trusted beliefs are vulnerable. These truths connect whatever the outcome? us to deeper reality. They remind us that we have always lived with uncertainty.
You cannot know for certain the answer to these questions, but you can live without those answers. A cancer diagnosis doesn't make life uncertain; Your task is to optimize, to do your best. Your it merely reminds us of what has always been the responsibility is the same as it was on the day you case.The fear that cancer provokes is, first, the were born: to make the most of fear of having our immense certainty each day. People will tell you disproved. To put it simply, the first A cancer diagnosis doesn't to fight, don't give up, hang in loss is the loss of an illusion – the make life uncertain; it merely there; some will tell you to keep illusion of certainty.
reminds us of what has always a smile on your face, always be This illusion has probably served you been the case. Dr John Wynn positive, be an optimist. I won't tell well. Our illusions support our life and you these things, because they relationships. How could you put your don't answer or even address the most important head on the pillow at night without knowing that morning will come? But part of this illusion – that tomorrow will be just like today, that you will always The most important questions are: Who am I? be healthy – does not help you. It gets in the way What am I doing here? What is my purpose? What when the things we take for granted are threatened meaning do I create each day? and we are unprepared for the truth. The doctor says, "You have cancer." And the illusion comes Whatever you do, you are making a statement of crashing down.
priorities and purpose. This is true if you are tucking in your child at bedtime. It is true if you are sitting in This news is frightening if you have no plan, no a chemotherapy infusion suite. It is true when you techniques or strategies, for living with uncertainty. run a marathon, watch TV, listen to a friend. It is You've done it all your life. But you do know how to true when you reach out and ask for help. It is true live in an uncertain world – you have not built your Continued on page 8 CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Treating hot flushes After cancer diagnosis: Cont'd from page 7 Hot flushes are recommended to be treated with if you act from fear or from love, with certainty or non-hormonal pharmacological medications in breast cancer survivors. There has been some concern that certain antidepressant Coping with fear does not mean never being afraid. drugs (selective serotonin reuptake inhibitors or It means acting with integrity even when you are SSRIs) could interfere with the CYP2D6 isozyme afraid. It means that your fear does not make the pathway, resulting in decreased tamoxifen decision for you. You choose.
absorption. A multicentre, randomized cross-over trial conducted by Dr Louise Bordeleau and her team found that citalopram (or Effexor, a SSRI Dr John Wynn is medical director of the division of currently funded by Pharmac) demonstrated only PsychoOncology at the Swedish Cancer Institute and a weak inhibition in the pathway.
clinical professor of Psychiatry at the University of Washington School of Medicine in Seattle, WA. This However, venlafaxine (another SSRI) and a drug article was originally published in Coping® with Cancer called gabapentin - commonly used to help with magazine, September/October 2010. neuropathic pain and seizures - were equally effective in reducing hot flushes without affecting Recycled wigs and turbans tamoxifen absorption at all. However as neither venlafaxine nor gabapentin are yet funded We'd like your help! We would welcome any new in NZ for this use, Dr Richard Isaacs (www. or second-hand wigs, turbans or scarves that are researchreview.co.nz) suggests that citalopram in good condition to add to our Wig and Turban remains a reasonable first-line choice, with the Apparel Service. This service allows us to help other two drugs better considered as second-line many people who unexpectedly need head- Journal of Clinical Oncology 2010; 28(35):5147-52. http://tinyurl/22nct9q Please contact Naena Chhima on 389 0083 or simply drop them in at 52 Riddiford St, Newtown.
Palliative Care extends lifeA non-blinded, randomized, controlled trial involving 151 patients who had newly diagnosed metastatic non-small-cell lung cancer found that those patients who received palliative care immediately upon diagnosis had significant improvements in both quality of life and mood. Not only were they happier, more mobile and in less pain but, despite many of them not opting to have aggressive chemotherapy as their disease progressed, lived nearly three months longer than the group that didn't receive early palliative care Useful website for Gynaecological Dr Jennifer S Temel, an oncologist and lead researcher at Massachusetts General Hospital, Boston, said that ‘doctors and nurses traditionally www.gynaecancersupport.org.au offers a see palliative care as something extended to a comprehensive overview of the many emotional hospitalized patient in the last week of life.It and ongoing physical issues that face many shows that palliative care and cancer care aren't women, their families and carers following a mutually exclusive'.(New York Times 18/8/2010). diagnosis of a gynaecological cancer. Much of the Reference: New England Journal of Medicine 2010; emotional support will be of interest to others too.
363:733-742 Aug 19 2010 CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Worrying makes holes in my head and the useful bits keep falling out My mind gets holes in it And the wind blows my thoughts in disarray The more I anxiously scramble to keep my thoughts in order The more my brain leaks the goodness leached and lost The Cancer Society
I want to mend my mind Invites you to the… and plug up the holes with faith and trust and belief SURVIVOR
conviction, passion and certainty Then my mind can find solutions CELEBRATIONS at Relay
my fretting thoughts would never have found And I might even think of something If you have had a cancer diagnosis, whether it was recent or in the past, we invite you to join us I hadn't thought of before at our upcoming Relay For Life event.
Relay For Life is a remarkable and moving overnight team event to raise funds for the Cancer Society while joining together to: Printed with permission from ‘Follow Yourself Home; word remedies to heal and inspire' 2007. Celebrate and acknowledge cancer survivors Remember loved ones lost to cancer Fight Back against a disease that takes so much New library dvds and cds Lung Cancer: Understanding, Managing, Living,
Cancer Council Australia, Peter MacCallum 17 Relay For Life events have now been Hospital, and the Australian Lung Foundation, 2009. launched around New Zealand. From Northland The Treatment Options in Early Prostate Cancer
to Dunedin and everywhere in-between, there's by Professor Roger Kirby and Stephen Langley, a Relay coming to a town near you. As it is one Oncura UK. Good basic guide, includes interviews of the main fundraisers for the Cancer Society, with men who have had treatment for prostate cancer, we are thrilled that so many people of all ages and their doctors.
and fitness are once again banding together to Celebrate, remember and fight back! Guided Meditations by Stephanie Dowrick and Tony
Backhouse, Australia, 2007. CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
and causes and solutions for cancer in our modern day lifestyle.
A typical day at the retreat would start with a warm lemon juice, 30 minutes meditation before breakfast. Breakfast includes porridge or muesli, dairy-alternative milks and yoghurt, wholemeal spelt toast, herbal teas or dandelion beverage.
The morning session may be about ‘The Power of The Mind' and discusses ‘How to use your unconscious mind as a healing tool for cancer and how to be in control of your Canlive - a nz cancer retreat own healing journey'. It looks at the work done by Bruce Lipton and his book ‘The Biology What do an ex-GP now cancer patient, an ex-Publican of Belief", where he has scientifically proved and a Counsellor have in common? They facilitate that the largest influence on body cells is their Cancer Healing & Well Being Retreats under a special environment and they can be changed given licence from The Gawler Foundation of Australia. The another environment. The session would be Canlive Charitable Trust is based in Wanaka.
split with a chi gong session and morning tea.
Lunch may consist of baked potatoes with an Dr Helen Brown was a hard-working GP avocado dressing and salad. Then a and mother of two, when she developed a long break for exercise or rest.
brain tumour. Helen was given little or no The afternoon session may be on hope by the medical system and came to ‘Healthy Emotions', the healing impact of realize that the system she had believed in joy, laughter, humour, and gratitude, and so much could only do about 25% of what the transforming quality of forgiveness to was required and the other 75% was up to self and others.
her. Helen says the only place she found There would be a meditation session in hope was The Gawler Foundation. Not the evening before dinner. Dinner may false hope but a realization to make the best of what consist of vegetable strudel with basil yoghurt you can with the life you have. Helen is coming up a 5- sauce followed by cheesecake with blueberries year survivor.
and a raspberry couli.
In the evening a video would be shown called Stew Burt and his wife Liz were very busy publicans ‘The Joy's of Stress' which teaches us to laugh running a pub each. The Gawler Programme changed at ourselves and let go.
their lives forever and couldn't have prepared them better for the final outcome. It was Liz's dream to have a Gawler type programme here in NZ.
Canlive courses in 2011 are 7 – 14 April and 29 Sept – 6 Oct. Email stew@canlive.org for application Liz Maluschnig MMCCA is a Counsellor, RN and forms. Or www.canlive.org for further information. Spiritual Director who has worked with cancer patients for 28 years.
Ed's note: www.helpyourselfheal.co.nz - offers information about a 12-week long Gawler programme Canlive runs an 8-day retreat based on The Gawler in Hawkes Bay. Model. The Gawler Foundation sends an auditor out each year to accredit the programme. Topics covered include: learning how to meditate and why this form North Island retreat: of relaxation is included daily in a cancer patient's life, a diet that helps the body to be a cancer unfriendly Strive to Thrive - Health Journeys at Lake
environment, the power of the mind in the whole Karapiro,Cambridge, with Dr Kieren Faull (a healing process, and effective pain management community psychologist). techniques. It includes Doctor / Patient relationships www.healthjourneys.co.nz or phone 0800 42 00 42 and how to get the best out of The Medical System, or email info@healthjourneys.org.nz CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Making the most of the appointment At the beginning of your appointment, tell your doctor if you have questions you wish to discuss. Be honest with your doctor - give accurate information about your symptoms or any new symptoms, responses to treatment, and how these are affecting you overall. As the doctor is responding to your questions, take notes, or ask the doctor or nurse to write in your patient diary Getting the best from your or notebook, or have your support person take notes for you. Some people take a tape recorder doctor's appointments along - ask the doctor's permission before tape recording him/her to make sure they are During diagnosis of a cancer, treatment and on into comfortable with the idea.
survivorship, one of the most important relationships you will ever have is with your medical team. As with If your doctor uses language that you don't any relationship, good communication and trust is understand, don't be afraid to ask to have it essential, so knowing how to prepare for a doctor's explained using simpler terms. Also tell your visit in advance will help you reduce anxiety and doctor if you have a hearing problem or English improve the quality of your health care. is not your first language.
Preparing for a visit to the doctor not only helps you to get your thoughts in order, but also helps you If your doctor suggests a new treatment or better understand what your doctor is talking about. medication, ask to have this explained to you in detail, outlining the benefits and any potential side effects. Remember you can ask for time to Preparing for the appointment consider before deciding on these. Most doctors would be happy to refer you to another specialist Take along a list of any medications you are if you would like a second opinion.
currently taking, including any extra vitamin, herbal, and other non-prescription medications. Ask your doctor to keep you informed about any List previous and current medical conditions, including family history. Include any allergies or new treatment options or clinical studies related reactions to drugs, and names of other doctors to your particular cancer. If you have used the treating you and other hospitals/clinics you attend. Internet to research related topics online before Bring copies of letters.
your appointment, add related questions to your list. Contact the Cancer Society to obtain lists of As you think about what questions you want to ask credible, relevant websites.
your doctor, write them down. Don't rely on your memory - putting questions on paper in advance Ask for advice on how you can manage your will ensure that you don't forget anything important. own healthcare between appointments. Find out Use the Cancer Society booklet - Questions you who should be your first point of contact for any may wish to ask, and leaflet - When you have queries, and where and how to source results of Cancer-Questions to ask your doctor. A family follow up tests. member or friend can also assist you. It can be helpful to have a family member or friend attend Treat your health appointments with you.
professionals as members of your team - all working to Leave early for your appointment, allowing time achieve the optimal outcome for unexpected traffic holdups and finding parking. Take a book or magazine, crossword puzzle or craft work with you. This will help pass the time Margot Wilson and keep you from getting anxious and frustrated about long waits.
Manager, Cancer Society Marlborough CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Library Update with Julie Holt Dr Susan Love's Breast Book 5th ed., USA, 2010. The
Cooking with Foods That Fight Cancer by Richard
definitive guide to breast cancer, updated for 2010. Beliveau and Denis Gingras, McClelland and Stewart, Covers a wide range of breast health and breast cancer- USA, 2006. Recipes to complement the popular book related information, with a good index to guide you.
Foods to Fight Cancer. Combines a wealth of Saving Jack: A man's struggle with breast cancer by
information with a diverse range of recipes and Jack Willis, University of Oklahoma Press, 2008. A candid very well-written account of a man's experience What Can I do to Help: 75 practical ideas for family
with "a woman's disease." Jack Willis is a journalist and and friends from cancer's frontline by Deborah
university professor who was diagnosed in 2005 with Hutton, Short Books, UK, 2005. A great little book for breast cancer.
family and friends of those with cancer with Guide for Women with Secondary Breast Cancer by
contributions by both health professionals, people with National Breast and Ovarian Cancer Centre, Australia, cancer and families.
2010. Comprehensive guide to secondary breast cancer, The Spare Room by Helen Garner, Australia, 2009. A
treatment and finding support with suggested lists of beautifully written novel about tough love, friendship questions to ask your doctor. and caring. Nicola, friend of the narrator Helen, has The Facts: Prostate Cancer 2nd ed., Malcolm Mason
advanced cancer. She comes to Melbourne to stay with and Leslie Moffatt, Oxford University Press, UK, 2010. Helen while she attends an alternative cancer treatment A small book packed with information, includes an excellent chapter of common questions and a good Finding the Words: starting a conversation when
your cancer has progressed by National Breast and
Patients' Guide to Cancer of the Stomach and
Ovarian Cancer Centre, Australia, 2010. A booklet Esophagus, Marc D Duncan, The Johns Hopkins
written to help women talk to their doctors, family and University, USA, 2011. friends about progression of their cancer. It outlines the value of palliative care services in helping to relieve Patients' Guide to Pancreatic Cancer by Nita Ahuja
symptoms and improve day-to-day life.
and JoAnn Coleman, The Johns Hopkins University, USA, 2011. You are the Best Medicine by Julie Aigner Clark,
HarperCollins, USA, 2010. A great resource for parents Anatomy and Physiology Made Incredibly Visual
with breast cancer, to help explain their diagnosis to Lippincott, Williams and Wilkins, USA, 2009. Uses their young children in a very supportive way. This is a hundreds of detailed and colourful photographs, story full of love and optimism.
diagrams, charts, and other visual aids to demonstrate the anatomy and physiology of each body system.
Harris Finds His Feet by Catherine Rayner, Good
Books, USA, 2008. A picture book for younger children. Tell Me What to Eat Before, During and After
The story of a young hare who is introduced to his Cancer Treatment, Career Press, USA, 2010. Excellent
abilities to bounce and run, as well as to the wider world book combining practical advice with up-to-date by his wise old grandfather. A lovely book about family recommendations, on nutrition and cancer, written by a cancer dietician.
CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
What's on in our centres Living Wel Education programme - April & Sept Exploring Complementary Therapies with Dr Shaun Holt - 29 March Lymphoedema Awareness education - 3 March; 2 June; 6Oct Breast Cancer moving-on programme - 4-week course for those completing treatment and asking ‘What Now?' - March Grief recovery course Contact Cancer Society Wairarapa 06 378 8039 or email: enquiries@cancersoc.org.nz Blenheim / Marlborough Grief Recovery Course, starting Wed 16 March, 5.30pm - 7.30pm for 6 weeks Living Wel Education Programme - starts Wed 27 April, 6.30pm - 8.30pm for 6 weeks - Cancer Society rooms Grape Ride 2011 - Sat 2 April - Cancer Riders Survivors race. Riders have choice of completing either the 19km or 101 km course. Participants can be recovered or recovering cancer patients. www.graperide.co.nz Relay For Life - 5 & 6 March. Survivors reception starts at 2pm and the first lap at 4pm. Email: margotw@cancersoc.org.nz or phone 03 579 4379.
For futher information about these and other CanSupport programmes, talks and the local newsletter contact Margot Wilson 03 579 4379. Partners and Carers Support Group - starting 8 Feb Look Good Feel Better - 15 Feb Relay For Life Memorial Service - 3 March For futher information about these and other CanSupport programmes, talks, ongoing support groups for those with prostate cancer, breast cancer, lymphoedema, Lost Chord club and more, contact Linda Lucre 03 539 3662 or email: linda.lucre@cancernelson.org.nz Relay For Life Wellington: 26 & 27 March - Frank Kitts Park starting 4pm Wairarapa: 26 & 27 February - Queen Elizabeth Park, Masterton starting 4pm Blenheim: 5 & 6 March - Lansdowne Park, Survivors reception starting 2pm and Relay opening 4pm Join the Survivor Celebrations or join a team.
CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
CanSupport networking groupsJan - April 2011 Networking support groups provide the opportunity for people to discuss (in small groups) experiences and concerns with others who have cancer. All groups are facilitated, meet monthly and invite guest speakers at times. New members please contact facilitators before attending
so correct meeting addresses can be given.

Cancer Groups for all Kapiti CanSurvive Group
All these groups below invite support people as well as anyone who has had an experience with any type of 4th Tuesday of each month 6.30 – 8.30pm cancer. So come with a friend and join in.
Kapiti Rotary Room, Community Centre, Paraparaumu. Contact: Judy Dickie 04 298 8514 2nd Wednesday of each month, 5.30 – 7.30pm. Mareikura Support Group
Starting 9 Feb.
52 Riddiford St, Newtown. 3rd Friday of each month, 10am - 12 noon This lively group is for young adults in their 20s & 30s. Mary Potter Hospice, Warrimoo St, Paraparaumu.
Facilitated by Gay Dungey & Jenni Reeves Contact: Miriama 04 902 7095 or email: miriama@ Upper Hutt Evening Support Group
2nd Wednesday of each month, 7.30 - 9pm.
Japanese Support Group
Starting 9 Feb.
Silverstream, Upper Hutt Facilitated by Claire Laurenson and Hazel Neser 3rd Saturday of each month, 3pm - 5pm Porirua Cancer Support Group
Contact: Takako 027 403 09812 1st Friday of each month 10am - 12 noon.
Starting 4 Feb.
Takako is a cancer survivor keen to get a support group running for Japanese-speaking people who are 20 Ngatitoa St, Elsdon, Porirua. coping with cancer. The group will meet in her home Facilitated by Natalie Kini. and she is interested to hear from more people who Contact: Natalie 04 237 0110 or 04 237 6778 would like to join.
A linguistics professor was lecturing his class.
Hazel Neser co-ordinates all the Networking/ ‘In English,' he explained, Support Groups. Please contact her for ‘a double negative forms a positive.
any information about any group: In some languages, such as Russian, a double negative is still a negative.' or email: hazeln@cancersoc.org.nz ‘However,' the professor continued, ‘there is no language wherein a double positive can form a negative.' This page is donated by: A voice from the back of the room piped up Freestyle Total Print Production
CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Spirited Women
1st Wednesday of each month, 12noon-2pm.
Jacinta Buchanan co-ordinates and facilitates all Starting 2 Feb at the Cancer Society Rooms, Newtown.
the Wairarapa Networking/Support Groups. For Bring some lunch to share.
any information about any group: Guest Speaker: Dr Patries Herst will talk on
Contact: 06 378 8039 Nutrition and Immunity.
Facilitated by Elva Phillips & Catherine McCarthy.
Womens Support Group
Contact: Elva 04 475 7124 or Catherine 04 384 5154 3rd Wednesday of each month, 11am - 1pm Cancer Society - 140 Dixon St, Masterton Hutt Valley Breast Friends
Co-facilitated by Ngaire Potangaroa 1st Tuesday evening of each month, 7pm-9pm St Mark's Church, 58 Woburn Road, Lower Hutt Mens Support Group
Facilitated by Laurie Lawler & Catherine McCarthy. A group for men coping with any type of cancer. Contact: Laurie 021 837 281 Every 4th Wednesday, 12.30pm-2.30pm.
Cancer Society - 140 Dixon St, Masterton.
Co-facilitated with Brent Matthews.
Spirited Women - Kapiti,
Breast Cancer Shared Lunch

3rd Wednesday of each month, 12.30 – 2.00pm South Wairarapa CanSupport
Kapiti Community Centre, Paraparaumu. In partnership with Family Works Starting 16 Feb. Every 2nd Wednesday 1-3pm. Bring some lunch to share.
Turrett House, 42 Fox Street, Featherston. Co-facilitated by Robyn Burns Contact: Judy Dickie 04 298 8514 Myeloma & Blood Cancer Support
Luncheon Meeting with speaker. 6th November, 12-2pm - 140 Dixon St, Masterton Partners and Carers Support Group
4th Tuesday of each month, 7.30 – 9pm, at the Cancer 1st Wednesday of each month, 1-3pm Society Rooms. The group invites speakers every second Cancer Society - 140 Dixon St, Masterton month and enjoys discussion, sharing experiences, gaining of perspective and support. See page 18 for Independent Wairarapa Support Groups
Contact: Paul Kane 021 029 88258 Wairarapa Breast Cancer Support Group
Multiple Myeloma Support 1st Monday of each month, 10am - 11.30am Red Cross Rooms, Church St, Masterton.
Facilitated by Doff Simmonds 06 304 9748.
This warm supportive group holds informal lunches 4 Wairarapa Prostate Cancer Support Group
- 6 weekly in rotation at Kapiti, the Hutt Valley and 1st Tuesday of each month, 1.30pm-2.30pm Wellington. All those coping with Multiple Myeloma Lansdowne Prebyterian Church Hall, Masterton whether they be patients or support people are invited. Facilitated by Robert Brader 06 370 8699.
Members are also willing to talk to any newly- diagnosed patient by phone or individual meeting.
Cancer Society Wairarapa supports these independent Contact: Hazel Neser 04 389 8421 (Wellington) or groups with resources and funding as required. Audrey Swallow 04 298 3117 (Kapiti) CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Other supportive services CanNow - Moving Forward Look Good . Feel Better Leigh Renai - Coordinator A free programme for women with cancer. Learn, through hands-on experience, techniques to help Information nurses offer a one-on-one programme restore your appearance and self-image during to promote wellbeing for women after early breast chemotherapy and radiation treatment.
cancer. Discuss your concerns, regain direction and Not to be missed – this is a real treat! energy after cancer. Contact us: 04 389 8421 or Contact the Cancer Society 04 389 8421 With Mary Brownlow The Silky Pil ow is a soft kidney-shaped satin pil ow which can be worn under clothing to protect An opportunity for cancer patients or those your body from knocks and assist with a close to them to express their feelings or fears comfortable night's sleep after surgery or through drawing, painting or working with clay.
radiotherapy. Also excel ent in providing a little extra support under the car seatbelt when in the Art Therapy is particularly good for children who car. Silky Pil ows are made by women of various have a parent with cancer. It al ows them to Inner Wheel clubs for those who have had breast express their fears and feelings in a very safe, surgery or treatment. We would like to offer them supportive way.
also to others who may like additional comfort fol owing abdominal, chest or bowel surgery. Fee: $25.00 waged or $10.00 if unwaged.
Free of charge.
Cal Fiona Pearson on 04 389 0053 Contact us at the Cancer Society – 04 389 8421 Bobbie-Joe Wilson Lymphoedema Assessment & Tuesdays between 9am-3pm Management Clinic – Loam Fees on a sliding scale of $15-$40 Learn how to successful y manage your lymphoedema with expert assessment and Relaxing, soothing massages to help both mind and body. Subsidised by the Cancer Society. and offered at the Cancer Society Rooms, This is a subsidised service offered by the Cancer 52 Riddiford St, Newtown.
Society, with clinics run in Newtown, Lower Hutt and Kapiti. A medical referral is required – contact Phone the Cancer Society on 04 389 8421 your GP, surgeon or cancer care team. Cost: to make an appointment Contact us at the Cancer Society – 04 389 8421 CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
CanSupport programme have received treatment anytime in the last 3 years. Also open to all those who are supporting people What does it do? with cancer including those from a distance.
It offers a wide range of exercise programmes, workshops and educative sessions which aim to assist people to be supported both emotionally and socially in Most sessions are FREE but costs do apply to their journey with cancer. some. You do need to enrol in all programmes as Our programmes are intended to be in addition to, and dates and venues may change. All classes have a supportive of, conventional medical treatments.
minimum and maximum size. To enrol: Contact Virginia Lee on 04 389 8421 or email: virginia.lee@cancersoc.org.nz unless an Anyone who is currently in treatment or those who alternative contact is given.
Living Well - education Partners and Carers Count Too Workshop - with Fiona Pearson & Virginia Lee Our Living Well programmes are for anyone coping Date: Starting Tuesday 22 March for 4 weeks
with cancer or survivorship. The programmes are Time: 4.30pm - 6.30pm
useful to those who have finished treatment as well Venue: 52 Riddiford St, Newtown
as those who are still coping with it. Support people To enrol: Contact Virginia 389 8421
and/or friends are warmly invited to attend also. Over the 6 weeks, topics such as: understanding what cancer is, nutrition, coping with emotions and When cancer strikes it uncertainty, relaxation skills, communicating with affects the entire family your health care team and issues around support - not just the person with are all discussed. These programmes are offered the diagnosis. It isn't easy throughout the year in different locations. being a support person, and this workshop will explore issues that face Living Well - Wellington with Virginia Lee and
partners, family members, Hazel Neser friends and carers. It will involve discussion Date: Starting Tuesday 8 Feb for 6 weeks,
and offers both practical coping strategies and Time: 5.30pm-7.30pm
emotional support.
Venue: 52 Riddiford St, Newtown
To enrol: Contact Virginia or Hazel 389 8421
Living Well - Kapiti with Judy Dickie & Sue
Cancer Focus Talks Date: Starting Monday 14 March for 6 weeks
Time: 6.30pm - 8.30pm
Optimizing treatment outcomes - who, when Venue: Kapiti Community Centre, Paraparaumu
and why - with Dr Ruth Pettengell To enrol: Contact Judy Dickie 04 298 8514
Date: Friday 1 April
Living Well - Plimmerton with Laurie Lawler &
Time: 1pm - 3pm
Rita Klus Venue: Kelso Room, 52 Riddiford St, Newtown
Date: Starting Monday 4 April for 6 weeks
To enrol: Contact Virginia or Janet 389 8421
Time: 4.30pm - 6.30pm
Venue: St Barnabas, The Esplanade, Mana
continued on page 18 To enrol: Contact Virginia 389 8421
CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Cancer Focus Talk - continued from page 17 Date: Tuesday 22 March, 7.30pm - 9.30pm
Dr Ruth Pettengell is a senior lecturer in Guest Speaker: Assoc Professor David Lamb
Haematology and an honorary oncology consultant Topic: Prostate screening.
at St Georges Hospital, University of London, and we are delighted that she will be visiting NZ Prof David Lamb is a consultant radiation at the invitation of Roche to deliver a series of oncologist at the Wellington Blood and Cancer presentations to NZ Health professionals and Centre and in addition to many other research patients. Although her specialty is lymphoma and activities has had a leadership role in two large other blood cancers, her talk will be of interest to randomized trials investigating new treatments anyone going through cancer treatment. So don't for prostate cancer. This presentation will focus miss out hearing this high-calibre speaker.
on the latest information available from screening trials, and how this data will lead to, or has already resulted in, changes to official recommendations Eating for health regarding PSA testing of NZ men.
- with Barbara Ryan moving you to better health with the Lebed Method Date: Thursday 17 March - Wellington
Time: 7pm -9pm
Saturdays, 9.15am - 10am, St John's Church Hall
Venue: 52 Riddiford St, Newtown
To enrol: Contact Virginia Lee - 389 8421
Mondays, 6pm-7pm, 52 Riddiford St, Newtown
Thursdays, 10.00-11.30am, DanzPort,
Upper Hutt
Date: Friday 18 March - Kapiti
Costs: (Negotiable on individual basis)
Time: 11am - 1pm
$40.00 for 8 weeks. Free trial lesson offered
Venue: Kapiti Community Centre, Paraparaumu
To enrol: Contact Judy Dickie 04 298 8514
These weekly classes offer a gentle way of exercising that is ideal for those stil in treatment Barbara Ryan is a dietician in Blenheim who is and coping with fatigue. The exercises are well used to presenting in the Marlborough Living specifical y designed to work the whole body and Well programmes. She will lead a interesting and concentrate on opening the lymphatic drainage informative discussion around healthy eating, routes to move stagnant fluid.
understanding food labelling and helpful nutritional They comprise a number of enjoyable, yet slow and tips and is happy to answer all your questions easy movements that are done to music. Open to around nutrition.
anyone recovering from cancer surgery, cancer- related fatigue or lymphoedema.
Enrolment esssential: Prostate Focus Talks Contact: Di Graham 04 934 3083 (Johnsonvil e) PALS Support Group invites all those interested to Naena Chhima 04 389 8421 (Wgtn) the following talks at the Cancer Society: Kathyrn Clark 04 526 7370 (Upper Hutt) Date: Tuesday 22 Feb, 7.30pm - 9.30pm
Guest Speakers: Ian and Doreen Morrison
Topic: Prostate Cancer - a survivor's tale
Ian Morrison is particularly interested in ensuring men understand the need for early detection based on his own experience with diagnosis and treatment. All those interested in knowing how prostate cancer is diagnosed and treated from a patient's perspective are urged to attend. His wife will also talk about the issues a partner faces. CANCER SOCIETY OF NEW ZEALAND Te Kahui Matepukupuku o Aotearoa
CANTALK SUMMER 57 2011
Please add me to the CanTalk Newsletter mailing list Please remove me from the CanTalk Newsletter mailing list I have some questions/would like some more information - (supply daytime phone number or contact) I would like to receive my CanTalk Newsletter by email.
Please tick one of the following options Patient Other (please state) Cancer diagnosed with or cancer/s interesed in: Any comments on this issue: Send to Cancer Society - Wellington Division, PO Box 7125, Wellington 6242 ; Visit 52 Riddiford Street, Newtown, Wellington ,phone 04 389 8421 or email Sue Corkill - suec@cancersoc.org.nz Newsletters with local content are available in Nelson, Wairarapa and Blenheim Please contact your local Cancer Society office.
Nelson: 03 539 3662 Blenheim: 03 579 4379 Wairarapa: 06 378 8039 For Cancer Information and Support phone 0800 CANCER (226 237) or go to www.cancersoc.org.nz

Source: https://wellington.cancernz.org.nz/assets/Wellington/CanTalk-Second-and-final-version/CanTalk-57-Summer-2011.pdf

eprints.biblio.unitn.it

"MAY I BORROW YOUR FILTER?"EXCHANGING FILTERS TO COMBAT SPAMIN A COMMUNITY Anurag Garg, Roberto Battiti, Roberto Cascella Technical Report # DIT-05-089 "May I borrow Your Filter?" Exchanging Filters to Combat Spam in a Anurag Garg Roberto Battiti Roberto G. Cascella Dipartimento di Informatica e Telecomunicazioni, Universit a di Trento, Via Sommarive 14, 38050 Povo (TN), Italy.

Microsoft word - manuel-dtc paper.doc

BYPASSING THE GATEKEEPERS: Selling Prescription Drugs Directly to Consumers Manuel Vallée ABSTRACT: Prior to 1989 prescription drug manufacturers rarely used consumer advertising, spending less than $5 million between 1985 and 1988. The manufacturers' reluctance was largely due to physicians, which bitterly opposed their use of consumer advertising. However, by 1996, a mere seven years later, the situation had reversed itself, as drug manufacturers spent over $790 million on the marketing, despite continued physician opposition. Over the course of those seven years physicians lost their influence vis-à-vis consumer advertising, and explaining why is the central goal of this paper. Towards that end I address four questions: (1) Why were physicians opposed to consumer advertising?; (2) Why did this opposition influence drug manufacturers prior to 1989?; (3) Why did the opposition cease to deter the drug manufacturers in the 1990's?; (4) How did drug manufacturers work to overcome physician opposition? In the end I will argue that physician influence was diminished by two factors: 1) the Managed Care revolution circumscribed physician prescribing authority, which, in turn, weakened their influence over the drug industry, and 2) drug manufacturers studied physician opposition, which enabled them to deploy the ads in a way that was less likely to provoke physicians. Moreover, this work will contribute to the market sociology literature.