Tuesday, May 31, 2016


It’s far more important to know what person the disease has than what disease the person has.  – Hippocrates 

Let me pull the thread that ties this bag of goodies together and unveil something that intuitively we all know to be true, yet we suspend disbelief and merge our dreams with our reality.

The bag as I call it is filled with loud and wondrous achievements and purports to advance the science of man and his life to greater heights through medical advancements.

You might have heard about the ongoing revolutionary breakthroughs touted in various journals and newspaper claims; human genomics, microbiome and of course targetable therapies and personalized medicine. Each of these headliners have the nectar to entice even the most discerning eye into the lull of vacant imaginary breezes.

But with an eye to reality all the “breaking news” and the “breakthrough” events that unfold daily on the television and internet scene are within the margin of error. Margin of error? you ask? Well there is no more breakthrough in medical science that falls in the outlier status, so to speak. There are small steps either side of the regression line within the safety of 1 or 2 sigma deviations. For sure, there are incremental pieces of information that advance thought a bit, but that is all. That is all!

Let me take the issue of the genomic revolution. Once proclaimed to bring cure all, for all diseases after the Human Genomic Project completed analyzing the DNA of the human genomic structure. Yet with time this revolutionary knowledge has given way to a certain but deeper and subdued understanding of the lack of knowledge that exists in our true knowledge sphere. Where once we thought that 100,000 genes existed and that one gene equated to one disease and that snuffing the bad protein/gene would eliminate the disease, such as cancer has now revealed a much more complex organizational network of messaging within the nucleus of the cell.

We have found more than 4,500 associations between genes and diseases but with varying degrees of success in harnessing the implied benefit. "Association," as any epidemiologist worth his salt would say, "is not causation." And if you were to swim deeper in these waters you might find that 75% of the medicines in use in oncology are "ineffective" based on a single study that the FDA took notice from. Bias aside, there is a some notional value in this exposition.  (http://www.fda.gov/downloads/ScienceResearch/SpecialTopics/PersonalizedMedicine/UCM372421.pdf. )

Whats more, in this complex cell’s genetic environment is the presence of viral genomic material that has some influence on the workings of the 1.5 -2% of the protein coding genes! Thus snuffing out cancer by retarding one specific gene or accentuating another’s activity is akin to the a kindergartner’s understanding of mathematics. Science has similarly unearthed a series of pathways that transduce signals from the surface of the cell to its nucleus programmed information for the nucleus to divide. These pathways interact in a myriad of ways and this knowledge of shutting down pathways from anchoring the cell surface receptors, has liberated information that blocking such pathway leads in the best case scenario, to a temporary relief from the growth of the wayward cell.

On the personalized medicine front, there are many a head winds that buffet the desired effect. While we tout individualized therapy, the chorus of population medicine continues to grow. How one size fits all, ultimately equates care for an individual with cancer is hard to fathom in many respects (except if you reside in an ivory tower silo). Individualized care means having complete or near complete information about the cancer before selecting therapy that targets the levers of the disease. Our knowledge of the genomic structure remains incomplete at best. We still have a small fund of knowledge about the 800 pound gorilla called the epigenomic structure that drives and modulates individual genes. Knowing that leads one to believe that we are quite a ways away from the promised land. It is impossible to constantly listen to the buzz and not call it a symphony. It is equally impossible to limit your thoughts to a certain movable threshold and never cry eureka. And yet in our daily grind the constance of this cacophony has exacted a prejudice and that is expecting excellence from mediocrity.

Using targeted therapy has yielded some initial results that are promising, but here again we are targeting the cell surface receptors that shut down the signal transduction pathways and given the cross-talk between the intracellular pathways, permanency of cure is not guaranteed in the least.

Yes we have made headway, but we have ways to go, as mentioned. So the next time you see the terms “Breakthrough Cancer Therapy!” or “Breaking News” on the television screen and fight breathlessly to listen to the talking heads, calm down and carry on. It is mostly hype!

The most egregious example of hype comes from California where a company named Theranos was to upend the diagnostic workup of blood testing via a single drop of blood in a Direct to Consumer mechanism. The premise it turns out was hyped and now a $9 Billion book valued  company awaits criminal complaints. The future possibility of such mechanism cannot be denied, but for now the hype has traumatized 890,000 individuals with falsified test results and possible unnecessary harm through imposed faulty decision making.

This hype in spin is all consuming. The more the “scientists, agencies, journalists and experts” involved in carrying out their own personal spin, the faster the merry-go-around spins.

Progress is made in steps and not in giant leaps. Even the first step on the moon by Armstrong was made possible by a series of very small steps in physics and mathematics.

Converting cancer into a chronic disease in the next 20 years, of that I am confident but as yet not sure, of curing cancer; I am less. Cancer as we know is not one but many diseases with an underlying breakdown of the principles of functional physiology. The breakdown differs in different organs and in different individuals and therein lies the difficulty.

In the meantime, it will behoove us all to take the daily dose of breakthroughs with a grain of salt. Calm down, take a chill pill and carry on with our finite lives.

Can all cancer be cured?
Hope, as they say, springs eternal.

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