Where We Are In The Fight Against Cancer
NEAL CONAN, host:
This is TALK OF THE NATION. I'm Neal Conan in Washington. There is good news on cancer. A group of leading health organizations, including the American Cancer Society, released an annual study which reports that death rates and new cases are down and could continue to decline with more screening and healthier diet and exercise.
But these gains are limited. Certain kinds of cancer are on the rise. Doctors don't know those causes and don't have effective treatments. We'll describe these findings in more detail in a moment, but we also want to explore what works, and the best ground where to wage the fight against cancer. Is it screening? Is it lifestyle? Is it treatments? Is it genetics?
If you have questions about the priorities in the war on cancer, give us a call. We especially want to hear from those listeners with direct experience as patients, doctors and other health-care professionals. Phone number: 800-989-8255. Email: firstname.lastname@example.org. You can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.
Later in the program, we'll explore the airborne catalog of consumer excess. What have you bought from SkyMall and why? Email us, email@example.com.
But first, we turn to Dr. Otis Brawley, chief medical officer for the American Cancer Society, with us today from Georgia Public Broadcasting in Atlanta. Nice to have you with us.
Dr. OTIS BRAWLEY (Chief Medical Officer, American Cancer Society): Oh, nice to be here, thank you.
CONAN: So some caveats for sure but overall, good news.
Dr. BRAWLEY: Yeah, we're very excited. You know, it's 1 and a half to 2 percent per year for a number of years. This translates into, for a man, you have a 20 percent decreased risk of dying from cancer in 2005 versus 1990. For a woman, it's about 12 to 13 percent lower risk of dying from cancer.
CONAN: And what is it that seems to be working?
Dr. BRAWLEY: A combination of things: lifestyle, people not smoking, some change in diet, some exercise, people getting the proper screening -screenings that work as opposed to some screenings that don't necessarily benefit us - and then improvements in treatment.
CONAN: You mentioned screenings as some that benefit us and some that don't. Obviously, there's - this is all mindful of the recent controversy over mammograms.
Dr. BRAWLEY: Yes, absolutely, absolutely. And the studies actually do show us, by the way, that we've had tremendous success in terms of decreasing the death rate for women in their 40s, and we do believe that mammography was a part of that. And that's why the American Cancer Society continues to recommend mammography for women in their 40s.
CONAN: Some good news in colon cancer, especially.
Dr. BRAWLEY: The colon cancer news was just wonderful. You know, we have decreased our colon cancer death rates dramatically over the last 20 years. And that, we can actually parse out as a combination of diet and exercise as well as screening, as well as improvements in treatment. And the message there - there's a lot of hope there because part of the message is half of all the people in the United States who should be getting colon screening are not getting colon screening.
It's about 50 percent of people over 50 are getting anything. And I'm talking about colonoscopy, stool, blood testing, sigmoidoscopy, any of those things. If we could push that 50 percent to 85 to 90 percent, we have the potential of saving at least 15,000 lives per year.
CONAN: Interesting, one of the findings was troubling in terms of an increase in particularly aggressive forms of colon cancer developed by people who are below the age of 50. Again, you have to ask: would earlier screening benefit them?
Dr. BRAWLEY: Well, we're not to the point where we have such a large number of people in their 30s and 40s with colon cancer to justify massive screening for people in their 50s. Remember, some of these screening tests are very harsh on people, and some actually cause hospitalizations and other things.
There are certainly some people who are from families that have a history of early colon cancer or who have a genetic predisposition to early colon cancer, who should be thinking about getting screened in -especially the 40s.
CONAN: Let's get some listeners involved in the conversation. We're talking about good news on cancer: fewer deaths, lower rates of diagnosis. Nevertheless, of course, it is still a major killer in different forms of - millions of Americans. Our guest is Dr. Otis Brawley, chief medical officer for the American Cancer Society; 800-989-8255. Email us, firstname.lastname@example.org. Ken's(ph) with us from Vicksburg in Mississippi.
KEN (Caller): Actually, it's Vicksburg, Michigan, but thank you for taking my call.
CONAN: All right, I apologize. There's a Vicksburg in Mississippi, too.
KEN: Yeah. You know, your guest makes a very valid point that screening is important, but it doesn't catch everybody. And I'm a doctor myself, but my wife was diagnosed with stage IV colon cancer, with no risk factors, at age 48. Right now, she's doing acceptably well. She's still on chemo, but I'm very glad that you opened the program pointing out that screening by itself is not going to cure cancer. The lifestyle and primary prevention things are really critical if we're going to make further headway.
CONAN: And she is doing pretty well, Ken?
KEN: Well, she's got some - she's still got some metastases, and we're thankful for every sunrise, but she's at least - she's right now symptom-free.
CONAN: Well, we wish her continued good luck and blessings.
KEN: Thank you very much.
CONAN: Dr. Brawley?
Dr. BRAWLEY: Yeah, well, first, my best wishes for your wife. You are absolutely correct. Let's take breast cancer, for example, and I've been outspoken. I'm concerned that people exaggerate the benefits of some of these screening tests.
While mammography is the absolute best test that we have to give for the diagnosis of early breast cancer - and we advocate it for women over the age of 40 - half of women in their 40s in the United States actually discovered their breast cancer not through a formal breast self-exam done once a month, the way we used to advocate 20 years ago, but by simply being aware of their breasts and find - they usually find it while they're getting dressed or they're in the shower.
So half are discovered through mammography, half are discovered through people just being aware of their body, and both are to be encouraged. In the case of colorectal cancer, you're right, a large number of people, even in their 50s and 60s who get screened - large is - you have to have some perspective for that, but there are some people who get screened, have a negative screen, and will be diagnosed with cancer. But still, if you have a large population of people who get colon cancer screening, you're going to have a lower rate of colon cancer deaths. So these tests are by no means 100 percent, but they do save lives.
Diet and lifestyle are really important for preventing cancer as well. And that's something that people have not emphasized enough over the last 30 years.
CONAN: And Ken, you were quick to point that out, too. Thanks very much for the phone call and again, best wishes for your wife.
KEN: Thank you very much, and God bless.
CONAN: So long. And you keep talking about this combination of things. Yes, better screening. Yes, of course, better treatments but healthier lifestyle, stop smoking, that sort of thing. Does that suggest to you, Dr. Brawley, that as - if we are to continue to improve the rates of diagnosis and the rates of death, that it's not going to be any one silver bullet, even for any one specific cancer?
Dr. BRAWLEY: You're absolutely correct. And one of the things that I worry about a great deal is, our obesity rates in the United States have increased dramatically. You know, 35 percent of adults are either overweight or obese today. The number was 12 to 15 percent in 1970.
Obesity is actually the second-largest carcinogen in the United States. Only tobacco causes more cancer than obesity, and if we don't stem these obesity rates, we're actually going to have a tsunami of chronic disease, to include cancer, diabetes, heart disease, even orthopedic injury. So we really do have to focus on lifestyle.
CONAN: Joining us now is Dr. John Marshall, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at the Lombardi Comprehensive Cancer Center at Georgetown University here in Washington, D.C. And he joins us from his office. Good of you to be with us today.
Dr. JOHN MARSHALL (Director, Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University): Thanks for having me, Neal.
CONAN: And you wrote an op-ed in the Washington Post last month in the context of the fight over health reform, called "Fighting a Smarter War on Cancer." In the light of these studies, with which I'm sure you're familiar, how do we go about that?
Dr. MARSHALL: Well, we're sort of dealing with the other end of the spectrum. The discussion so far has really focused on keeping people out of our offices, keeping them from getting cancer in the first place or really, early detection so that they don't get cancer. But as Ken, our caller, pointed out, even doing all the right things, there are still plenty of people who are finding themselves with metastatic cancers. Fifty thousand people in the United States this year will die of colon cancer; 30,000, pancreas; 40,000, breast cancer. This is a huge number of people. And what we're doing in our world of cancer research is moving the bar small steps at a time. But I think we've not really recognized that we could be moving it a lot faster with a lot more unified approach.
CONAN: What do you mean by unified approach?
Dr. MARSHALL: Well, what we're doing now is, we're sort of treating everybody the same. So if you have a colon cancer, for example, we give everyone essentially the same drugs. Under a microscope, these cancers do look sort of the same. They're all what are called adenocarcinomas, but these kinds of cancers, even though they look the same, are incredibly complicated and incredibly different.
Let's shift over to breast cancer as an analogy. In that disease, they look all the same under the microscope, but there are different diseases based on estrogen receptors, progesterone receptors, another receptor called HER2; or not having any of those receptors, a disease called triple negative - look all the same under the microscope but are clearly different cancers, respond to different treatments, have different prognosis.
And it's only recently that we've recognized that with breast cancer, which I think in large part is responsible for the increased cure rate. We've applied that science to patients in the stage 2 and stage 3 setting and are curing more women with breast cancer using that technology. Instead of exposing everyone to the same drugs, we're tailoring it to the individual and their individual cancers.
CONAN: But that involves, once it's been diagnosed, looking not just through a microscope but at somebody's genes down on the molecular level.
Dr. MARSHALL: Exactly right. And this is not something that is part of our routine care. Even though our science teaches us this is the right thing to do, we are not - really don't have the capability to do this on a wide space across our country.
CONAN: You also talk about how, in too many cases, there's not going to be a cure. There might be a treatment that might extend your life for a month or two months, and maybe not in all that great a fashion.
Dr. MARSHALL: It's interesting to note that, you know, most of the trials we're doing in patients in these settings are not even intended to cure the patient. And I often wonder if the patients are aware of this when they enter into trials. They're certainly hopeful that the new medicines will do better than the old, but all we're really even meaning to do is move the bar a little. And I think we need to get away from that old model, and we need to shift to a much more focused, targeted, personalized approach for patients with metastatic disease.
CONAN: We'll explore that a little bit more when we come back after a short break. We're talking with Dr. John Marshall, who serves as director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University. Also with us, Dr. Otis Brawley, chief medical officer for the American Cancer Society.
We want to hear from those of you with direct experience of this disease, as a patient or as a health-care professional. Give us a call, 800-989-8255. Email us, email@example.com. What's the best way ahead in the battle against cancer? Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
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CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. The good news on cancer: Overall rates of new cases are down. So are deaths from the disease. The downside: Some cancers are on the rise, and cancer deaths are still highest among black men and women. There's a long way to go.
Today, we're talking about the state of the war on cancer, what works and the best ground on which to wage the fight. Is it screening? Is it lifestyle? Is it treatment? Is it genetics? If you have questions about priorities in the war on cancer, give us a call. We especially want to hear from those listeners with direct experiences - patients, doctors or as other health-care professionals, 800-989-8255. Email us, firstname.lastname@example.org. You can also join the conversation on our Web site. That's at npr.org. And just click on TALK OF THE NATION.
And we're talking with two doctors who are experts, sort of at different ends of this specialty. Dr. Otis Brawley is chief medical officer for the American Cancer Society. He's also professor of hematology, oncology and medicine at the Emory University School of Medicine. And Dr. John Marshall, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at the Lombardi Comprehensive Cancer Center at Georgetown University, who wrote a recent op-ed for the Washington Post called "Fighting a Smarter War on Cancer."
Let's see if we can get another caller in on the conversation. Let's go to Brad(ph), Brad with us from Boston.
BRAD (Caller): Yeah, hi, how you doing, Neal?
CONAN: I'm good, thanks.
BRAD: Good, love the show. I was calling because about 10 years ago, I had an enlarged lymph node that turned out to be an indolent follicular non-Hodgkin's lymphoma that I've had now for 10 years. I was in my - I'm sorry, late 20s. And when I first went to my oncologist, the approach they were going to take was called the watch and wait. And, you know, when I first got in there, he said, you know, in five, 10 years, you know, they'll have some amazing thing that'll, you know, probably clear this up. And 10 years later, there's still the same treatment for the same cancer after a decade. So that's still really frustrating for me. I still have the cancer. I still go back every year and get checked up. It's still there, just sort of�
CONAN: Nevertheless, as scary as that C-word was when you first heard it, it's still there and it's - you're living with it, and you're not dying from it.
BRAD: Yeah, absolutely. And I mean, there's no - right now - cancer cure but - so that was sort of the first part of the frustration there, with how slow the progression is for some of us in finding, you know, therapies that could work to cure it.
And the other question I had was, I've heard recently that with other cancers, they're doing the same watch-and-wait approach that they're doing with mine. And I was just curious as to the, you know, the thinking behind that and what they have found out that could help those other people that maybe have colon or prostate cancer. And I'll take my answer off the air, thank you.
CONAN: Dr. Brawley, can you help us out here?
Dr. BRAWLEY: Yeah. First, I share your frustration, I understand. Lymphoma, by the way, for your listeners, there are a number of different kinds of lymphoma. Some are very aggressive and fast-growing and ironically, we can actually cure those quite easy sometimes, whereas some of the more slower-growing ones take 15, 20, 30 years to actually cause a problem. And we've found that our drugs don't work very well in those lymphomas, and the best thing to do is to watch them and not treat them until the patient gets in trouble.
Most commonly, watch and wait is applied to prostate cancer. Prostate cancer is very much like Dr. Marshall described. Prostate cancer was described under a light microscope in the 1840s in Germany, by a pathologist. And our definition of what prostate cancer is has not changed, even though we've entered the molecular area of treatment, of diagnostics and other things. And we've actually found that a large number of the men who we diagnose with localized prostate cancer have what looks like cancer under the microscope but genetically, it's never going to leave their prostate. It's never going to metastasize and cause hell and havoc.
And what we actually were doing by doing lots of radical prostatectomies, as we were doing in the early 1990s, was we were curing a lot of people who didn't need to be cured. Yes, they had cancer, but they didn't need to be cured because they were never going to be bothered by it. And we cured it with surgeries and radiations that had a lot of side effects.
So now, many of us advocate that a man with prostate cancer be watched very frequently, and if the cancer is growing, then we treat it. If it's not growing, we just continue to watch it.
CONAN: And that's a practical application, Dr. Marshall, of what you were talking about.
Dr. MARSHALL: Yeah, absolutely. I mean, trying to decide - could I tell you right from the beginning that you're not going to die of that cancer? Could I characterize your cancer right from the beginning and tell you what's going to happen, versus just letting time pass and let it tell us what's going to happen, if you will.
Brad, our caller, you know, his lymphoma may stay quiet for some time, but we all recognize that one day down the road, it's probably going to change its stripes and become more aggressive. And of course, everybody's sort of watching and waiting to then treat that and trying to develop newer medicines, and his frustration is right.
But I sort of push back: Why aren't we all a little more upset about this? If - why are we accepting our lot in life, if you will? When we look at other examples - and I think the two most striking ones are AIDS and children with cancer. And when AIDS came out, there was an incredible advocacy that grows out of the population that was fighting AIDS. And there was a demand, a pressure, a march on Washington to say, we're going to have to solve this. It changed the NIH funding approach. It changed, really, how we did business. It changed the culture of those patients to where if you weren't involved in a clinical trial, if you weren't part of the solution, you were part of the problem.
The same has been true in pediatric oncology for many years, where kids go on clinical trials much more often than adults do, a huge gap. Sixty, 70 percent of children go on to clinical trials with cancer, whereas only 5 percent of adults. Why will a parent put their kid on a trial but not go on it themselves? It's a cultural thing. It's an anger. It's an anxiety. It's a pressure that says we've got to do it. And we don't have that same sort of feeling, that same sort of urgency, if you will, in the world of patients with metastatic cancers.
CONAN: All right. Here's an email question that I think goes to Dr. Brawley. Travis(ph) in Las Vegas asks: I'm very interested in hearing more specifically what type of preventive measures in diet and lifestyle can be used to avoid getting cancer.
Dr. BRAWLEY: Well, the first thing I would recommend is avoid smoking, avoid any kind of use of tobacco. You know, two out of three people who utilize tobacco either die of a heart attack or a cancer related to the tobacco.
Next, try to stay thin. Try to keep a body mass index of 25 or below, normal height, normal weight. Try to eat five to nine servings of fruits and vegetables per day, and also try to exercise. We think of exercise as preventing coronary disease or cardiac disease, but exercise also prevents cancers as well.
I'd also recommend people try - not to abstain from alcohol but to not use alcohol to excess. Those are the major things on a start to living a life where you lower your risk of getting cancer. We can go further on and say, you know, avoid a large number of charred meats and that sort of thing, but basically five to nine fruits and vegetables, get some exercise and don't smoke. That's the beginning.
CONAN: Let's go to Marie(ph), Marie with us from Nashville.
MARIE (Caller): Yes, hi.
MARIE: Hi, I was diagnosed in January with breast cancer, and I have three sisters who don't have cancer, but our difficulty has been with genetic testing and getting the insurance companies to pay for it. I tried through my insurance, my sisters tried through their insurance companies, and we could not get anyone to pay for the genetic testing. And that, to me, is a problem, I think.
CONAN: Dr. Marshall�
Dr. BRAWLEY: Can I ask how old you are, Marie?
CONAN: Oh, I'm sorry. Dr. Brawley, go ahead.
Dr. BRAWLEY: Yeah, can I ask how old you are?
MARIE: I just turned 50. I was diagnosed when I was 49.
Dr. BRAWLEY: Yeah, I would say that if you and your sisters are all in your 40s, whether you have a genetic predisposition to breast cancer or not doesn't matter. You all need to be screened anyway.
MARIE: Oh, that's how I was diagnosed, yes.
Dr. BRAWLEY: Yeah. So it may very well be that a genetic test may not affect how doctors treat you at all. It may have some implication for your children, but not for you or your sisters.
MARIE: OK, thank you.
CONAN: Thanks very much, Marie. Here's an email from Diane(ph): My friend with breast cancer in the U.K. sent vials of her blood to a lab in Germany, which tested it to determine which brew of chemo drugs would best suit her cancer. Do we do that in this country? And I have not heard of it here. Can either of you help me out here?
Dr. MARSHALL: Yes, I sure can. I'd like to go back to the previous woman and differ with Dr. Brawley. If she had a particular kind of breast cancer that can come with an inherited syndrome, we actually now have some new medicines which are particular to those patients - and has shifted our thinking. So the routine testing there is becoming more common in patients with metastatic disease because it's driving our different treatments.
And I would like to say the concern of not getting testing covered is really one of the key issues that we've got to undo to go forward. We - our insurance company's happy to provide us with our current medical care, but I would ideally argue that our current medical care is falling short. We can get expensive CAT scans and those sorts of things, and they don't really tell us much about the individual patient's cancer But this genetic testing is much more difficult.
To the second email, around chemotherapy profiling, if you will, yes, there are some centers, ours included, that are beginning to do this kind of work, to try and individualize, to make a treatment assignment, if you will, based on an individual's cancer. Now, it is still in its infancy, and there are some very interesting data that's emerging around this. And most of us feel that that is the way of the future: getting away from what we call empirical therapy - meaning just give the therapy and see if it works after the fact, after you've undergone the side effects and the like - instead to say OK, this is the right drug for you or the right combination of drugs for you, and this is where we're going to start. This is clearly how cancer medicine is moving, and we will see more of this in our clinical research.
CONAN: And do you think this is the most promising avenue to get - at least at your end of the business, Dr. Marshall - to get the better results?
Dr. MARSHALL: Yes, I do. I think if you can - instead of empirically treating 100 patients knowing you're only going to help 40, find the 40 first and do something different with the other 60, if you will. That's the way we've got to go forward.
CONAN: And, Dr. Brawley, you've been largely talking about the initial part of this, which is to prevent people from getting cancer in the first place.
Dr. BRAWLEY: Yeah. However, even with screening, we find people who actually have cancer and have it early, and then we treat them effectively. And all of these things are important. Treating cancer, once it's metastatic or once it's been found, finding cancer early as well as efforts to prevent the cancer - all three are important.
CONAN: Just a definition: Metastatic is cancer starts somewhere and then spreads to other parts of the body. That's, of course, when it's most dangerous.
Dr. BRAWLEY: That's right. That's right.
CONAN: All right. Let's continue on. And let's go next to Deborah(ph). Deborah with us from Hull in Massachusetts.
DEBORAH (Caller): Hi. Hi, thank you so much for taking my call. This is a great subject. I was just wondering what the doctors felt about - I was the primary caretaker for my father when he had cancer. I don't have cancer myself. But I was wondering what the doctors felt about detoxification of heavy metals and environmental toxins because it just appears that the cases of just illness in general, and allergies and autism and everything, is up. And what do you feel about these chemicals and environmental toxins that we're barraged with everywhere?
CONAN: Dr. Brawley, is that a contributing factor?
Dr. BRAWLEY: Well, it is a contributing factor, but I don't want to overemphasize it, you know? There are - much of the cancer that we're seeing today, we're seeing because people are living longer than they lived 50 years ago. Remember, cancer is a disease of people in their 60s and 70s, for the most part, and we've got more people alive over the age of 65 today than have lived in the history of the world. So the aging of the population has caused more cancer. Tobacco smoke and diet are the major causes of cancer. I will admit to you that some pollutants clearly do cause cancer. Cadmium, for example, in battery workers has been linked to an increase risk of prostate cancer. But the major things, if we want to combat cancer, are diet and tobacco.
CONAN: Deborah, thanks very much.
Dr. MARSHALL: May I throw one quickie in? I think what we have to remember, and this is something - when we hear news about a pollutant or something or tobacco even, most of the people exposed to whatever it is don't get cancer. It's a small subgroup that actually does. And so when we pass laws, when we change our lifestyle or diets, then people think, oh, I'm now protected from that. We have to remember these are population studies, and so there has to be some sort of cross between the genetics of the individual, the risk that the individual brings to the table, and then the exposure. It is those two things working together that then ultimately generate a cancer.
CONAN: We're talking about�
Dr. BRAWLEY: I would agree with that.
CONAN: Good news on cancer. Our guests are Dr. Otis Brawley, who you just heard, and Dr. John Marshall, who's on the phone. You're listening to TALK OF THE NATION from NPR News.
And let's get Vance(ph) on the line. Vance with us from Lowell - and I was going to say Massachusetts, but it says Michigan here.
VANCE (Caller): Yes, that's right.
CONAN: Go ahead.
VANCE: I was diagnosed in 2005 with renal cell carcinoma, had a right nephrectomy as well as it being removed from the inferior vena cava in the right atrium - cancer-free up until this past March. It has metastasized to my left adrenal gland with small spots in the lungs, and now, just last week, metastasized to the right femur.
CONAN: I'm sorry at that bad news.
VANCE: And just wondering what's on the horizon in terms of treatment of renal cell?
CONAN: Dr. Marshall, this is, I think, more in your area.
Dr. MARSHALL: Yeah. So, renal cell is an unusual cancer. It's on the one front, one of the few cancers where our immune system seems to have shown us an important role. There are some patients who can get, globally speaking, immunotherapy to enhance the immune system and have seen fairly significant responses over time. But it's a very rare subset of patients where that happens. Alternatively, this is a kind of cancer where the - what is called angiogenesis switch, or a blood vessel formation kind of gene is turned on within the cancers. And because we learned that, we actually had some drugs that did that - that targeted that function and has brought some newer treatments to patients with kidney cancer, the so-called targeted therapies are - or that have worked.
Now, they've not cured the disease. The immune approach in some patients was actually curative, but these newer drugs have not. And so because we finally got a toehold in kidney cancer, though, we are seeing a great uptick in research. And frankly, because kidney cancer doesn't have other viable options, if you will - not very many approved drugs for it -participation in clinical trials of kidney cancer patients is quite high because they look around and find no other real choices. And so there, we're seeing the bar move faster purely because of that trial participation.
CONAN: Well, Vance, we wish you the best of luck.
VANCE: Thank you.
CONAN: All right. Thanks very much for the phone call. And we'd like to thank our guests today and everybody who called and emailed. We apologize we could not get to everybody's question.
We just heard Dr. John Marshall, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at the Lombardi Comprehensive Cancer Center at Georgetown University, here in Washington. Thanks very much for your time, Dr. Marshall.
Dr. MARSHALL: Thank you for having me.
CONAN: And we also spoke today with Dr. Otis Brawley, chief medical officer for the American Cancer Society and professor of hematology, oncology and medicine at Emory University School of Medicine. Thank you very much for your time today.
Dr. BRAWLEY: Thank you.
CONAN: And he joined us from the studios of Georgia Public Broadcasting in Atlanta.
Coming up, SkyMall confessions: that dangerous combination of altitude and time. Slankets, marshmallow shooters - what is your favorite SkyMall product and why? Come on, fess up. Email us, email@example.com. Or you can call 800-989-8255.
I'm Neal Conan. Stay with us. It's the TALK OF THE NATION from NPR News.
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