Merkel cell carcinoma log, day #637. I’m participating in the 4th annual Merkel cell carcinoma conference (MCC4) in Boston today. Most of the top people in the field are here. Had a roundtable conversation with a group of patients and advocates and got the conversation started about all the shortcomings and pitfalls our little band of patients faces: No interest by pharma in truly rare cancers (the numbers don’t work); egotistic oncologists resistant to change; ignorance among primary care docs and dermatologists; punishing rounds of delays and denials by conflicted payers. And we’ve all been the lucky ones, surviving close to 2 years or more. Imagine how angry and confused patients are if they don’t respond to immunotherapy? If they never had a chance to figure out for themselves how to work the system to their advantage as best they can? And it’s not just Merkel cell. Many of us have been shocked by how fragmented the entire oncology system is. Time for a revolution. Way past time. For us and all the millions more cancer patients to come.