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Archive for Basic Science

A brief note on killing cancer cells in a dish

I am taking the Memorial Day holiday off. I will return next week (or even earlier if something comes up that I can’t resist blogging about). In the meantime, here’s a general principle that needs to be remembered in cancer research:

I would also add to that list: So does bleach. So does acid. So does alkali. So does pouring the media out of the dish and letting the cells dry out. So do a variety of lethal poisons. So does heat. So does cold. The list goes on.

The point, of course, is that it’s very easy to kill cells in a cancer dish. What is difficult is selectively killing cancer cells in the human body while not harming normal cells.

See you all next week!

Posted in: Basic Science, Cancer

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Angelina Jolie, radical strategies for cancer prevention, and genetics denialism

I had been debating whether to blog about Angelina Jolie’s announcement last week in a New York Times editorial entitled My Medical Choice that she had undergone bilateral prophylactic mastectomy because she had been discovered to have a mutation in the BRCA1 gene that is associated with a very high risk of breast cancer. On the one hand, it is my area of expertise and was a big news story. On the other hand, it’s been nearly a week since she announced her decision, and the news story is no longer as topical as it was. Also, I’ve already written about it a couple of times on my not-so-super-secret other blog, making the division of blogging…problematic. So, if some of this is a bit repetitive to those who are also fans of my more—shall we say?—insolent persona, I apologize, but try to be patient. I will be doing more than just rehashing a couple of posts from last week (although there will unavoidably be at least a little of that), because there have been even more examples of reactions to Jolie’s announcement that provide what I like to consider “teachable moments.” I will start by asserting quite bluntly that in my medical opinion, from the information I have available, Angelina Jolie made a rational, science-based decision. How she went about the actual mechanics might have had some less than scientific glitches along the way (more about that later), but the basic decision to remove both of her breasts to prevent breast cancer associated with a BRCA1 mutation that she carried was quite reasonable and very defensible from a scientific standpoint.

One advantage of waiting nearly a week to write about this story is that it provided me with the opportunity to sit back and observe the reactions that Jolie’s decision provoked. One thing that I really didn’t expect (although in retrospect maybe I should have) is the pure denialism on display that genes have any effect whatsoever on cancer. I say “in retrospect I should have” because I’ve written at least a couple of times before about how quacks use and abuse the term “epigenetics” in the same way that they abuse the word “quantum” and how they seem to believe that wishing makes it so (through epigenetics, of course!) to the point where they believe that genetics is irrelevant to cancer. Indeed, they go far beyond that, asserting that, in essence, environment is all. From what I’ve been reading thus far, the second strongest strain of reaction to Jolie’s announcement (after revulsion at the “mutilation” of women that it represented to certain quacks) is pure denial that mutations in BRCA1 and BRCA2 genes portend such a high risk of ultimately developing breast cancer. This denial is often accompanied by conspiracy mongering about BRCA1 and BRCA2 mutations being a “conspiracy” on the part of the “cancer industry” and Myriad Genetics & Laboratories, the company that holds the patents on BRCA1 and BRCA2, to increase genetic testing and preventative mastectomies. Myriad happens to have a complete monopoly on BRCA1 and BRCA2 testing because of this patent and has been criticized for its high prices and stifling of competition. There is currently a case before the U.S. Supreme Court regarding whether human genes are patentable under the law. I’m not a big fan of Myriad, and I’ll tell you why later. (Not that it matters; I’m stuck with them for now.) My personal distaste for Myriad Genetics aside, this sort of conspiracy mongering is part and parcel of the quack approach to denying the significance of BRCA1 mutations.

This denial is usually coupled with confident blather that Angelina Jolie didn’t need to undergo “disfiguring” surgery to prevent BRCA1-associated breast cancer but instead could have achieved the same—or even better!—risk reduction if only she had used this magic herb or that miracle supplement and making certain “lifestyle” changes. It’s utter nonsense, of course, but it’s everywhere.

Before I get to the reactions to Jolie’s announcement, let’s first take a look at what she did, why, and the science behind it.
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Posted in: Basic Science, Cancer, Medical Ethics, Science and the Media

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Undermining the regulation of stem cell therapies in Italy: A warning for the future?

Stem cells are magical.

At least, if you listen to what docs and “practitioners” who run stem cell clinics in various parts of the world, usually where regulation is lax and money from First World clientele is much sought after, that’s what you could easily come to believe. Unfortunately, it’s not just Third World countries in which “stem cell clinics” have proliferated. For instance, they are not nearly uncommon enough in Europe. The example that is most troubling right now is Italy, and the reason is that there is currently a law being considered that would greatly weaken the regulation of stem cell therapies, so much so that on Friday I saw something that’s fairly rare: a major scientific journal published a pointed editorial about this new law. Specifically EMBO Journal published a commentary by an international group of scientists warning about the path that the government of Italy is considering entitled Regulation of stem cell therapies under attack in Europe: for whom the bell tolls.

Stem cell quackery is a very popular form of quackery these days because, well, stem cells are so magical-seeming. You can now find stem cell treatments offered for autism (one of which, offered at a clinic in Costa Rica, I’ve discussed before and involves injecting “stem cells” into the cerebrospinal fluid of autistic children for a cool $15,000). Kent Heckenlively, the man who took his daughter to the aforementioned Costa Rica clinic for this treatment, is not alone in subjecting his autistic child to such unproven uses of stem cells. Just a couple of months ago, a broadcast journalist in the Philippines named Karen Davila took her autistic son to the Villa Medica Clinic in Germany, which offers variants of stem cell therapy. One is known as “fresh cell therapy” and involves harvesting cells from lamb fetuses and injecting them into the patient. The other is called fat stem cell repair therapy, which is claimed to involve harvesting fat from the patient’s abdomen or thigh and then isolating “stem cells” from them to be injected back into the patient’s body.
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Posted in: Basic Science, Clinical Trials, Legal, Medical Ethics, Politics and Regulation

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A Skeptic’s Guide to the Mind

In his first book, On Being Certain: Believing You Are Right Even When You’re Wrong, neurologist Robert Burton showed that our certainty that we are right has nothing to do with how right we are. He explained how brain mechanisms can make us feel even more confident about false beliefs than about true ones. Now, in a new book, A Skeptic’s Guide to the Mind: What Neuroscience Can and Cannot Tell Us About Ourselves, he investigates the larger question of how a brain creates a mind. There is no alternative to the scientific method for studying the physical world, but Burton thinks there are essential limitations to science’s ability to investigate conundrums like consciousness and free will. Brain scientists fall into error because:

…our brains possess involuntary mechanisms that make unbiased thought impossible yet create the illusion that we are rational creatures capable of fully understanding the mind created by these same mechanisms.

He has a bone to pick with neuroscientists. They are discovering fascinating information, but their interpretations often go beyond what the data can really tell us. They often draw questionable conclusions from imaging studies that could have other explanations. (more…)

Posted in: Basic Science, Neuroscience/Mental Health

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Uneasy Lies the Head That Wears the Flu

Infectious diseases (ID), as those who read my not-so-secret other blog know, is without a doubt the most interesting speciality of medicine. Every interesting disease is infectious in etiology. What is cool about ID is that it has connections into almost every facet of human culture and history.

I note that at some point I have gone from being the young whippersnapper to the Grandpa Simpson at my hospitals and am one of the few who has been around long enough to be a repository of institutional memory. I remember what it was like 20 plus years ago, when no one consistently washed their hands, when all S. aureus (S. aureui?) were sensitive to beta-lactams and we wore an onion on our belt, as was the style of the day. Oh the changes I have seen.

Besides remembering the not so good old days of my professional career, ID keeps me reminded of how the world used to be in the past. Medicine used to be about the epidemics that would routinely sweep across the world. Polio, measles, mumps, scarlet fever, rheumatic fever, tuberculosis and on and on. I occasionally see TB but thanks to modern medicine many of these scourges have mostly faded from medical practice in the US. Not a one, I might add, has faded due to the efforts of alt med practitioners.

Influenza still gives me pause. It is, as infections go, quite the tricky virus and it remains a difficult beast to treat and prevent. Which is a drag as it remains one of the more consistent causes of infectious morbidity and mortality. (more…)

Posted in: Basic Science, Epidemiology, History, Science and Medicine

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Doves, Diplomats, and Diabetes

In the past I have criticized evolutionary medicine for its tendency to rely on unverifiable “Just-So Stories,” but a new book has helped me appreciate what the best kind of evolutionary thinking can contribute to our understanding of medicine. Doves, Diplomats, and Diabetes: A Darwinian Interpretation of Type 2 Diabetes and Related Disorders by Milind Watve investigates diabetes from an evolutionary perspective, suggesting how it might have originated, why it persisted, and how it is related to survival advantages. Watve develops well-reasoned hypotheses that can be tested by examining their expected consequences. He believes it is impossible to understand metabolism without understanding behavioral ecology, and he makes a good case.

A reassessment of the evidence concerning Type II diabetes (T2D) reveals a number of paradoxes. Elevated blood glucose is the defining feature of T2D but controlling it doesn’t prevent all the complications of diabetes, and it doesn’t appear that elevated blood sugar could produce all the pathological changes of diabetes.  Insulin resistance is believed to be central to a cluster of deadly diseases in humans, but in other animals it has no adverse effects on health and even increases lifespan. Studying diabetes from an evolutionary perspective can shed light on such paradoxes. (more…)

Posted in: Basic Science, Book & movie reviews, Evolution

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Adventures on the Alimentary Canal

I write about a lot of depressing subjects, and sometimes a change of pace is welcome. Mary Roach, billed as “America’s funniest science writer,” has followed up on her earlier explorations of cadavers (Stiff), sex (Bonk), the afterlife (Spook), and survival on spaceships (Packing for Mars) with a new book entitled Gulp: Adventures on the Alimentary Canal.

Forget all that mythology about diet, detoxification, and 10-year-old hamburger accretions in the bowel. The reality of human digestive physiology is far more interesting and has the extra-added attraction of being true. And in Roach’s hands, often howlingly funny.  She is a hands-on investigative reporter who is ready to try anything; among other adventures she inserts her entire arm in a cow’s stomach. Her highly entertaining odyssey takes her to Igloolik to eat narwhal skin, to a dog food tasting lab in Missouri, to Minnesota to observe a fecal transplant, and to strange and exotic outposts at the cutting edge of science, populated by colorful characters. (more…)

Posted in: Basic Science, Book & movie reviews, History

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Comprehending the Incomprehensible

Medicine is impossible. Really. The amount of information that flows out the interwebs is amazing and the time to absorb it is comparatively tiny.

If you work, sleep and have a family, once those responsibilities are complete there is remarkably little time to keep up with the primary literature. I have made two of my hobbies (blogging and podcasting) dovetail with my professional need to keep up to date, but most health care providers lack the DSM-4 diagnoses to consistently keep up.

So we all rely on short cuts. People rely on me to put new infectious disease information into context and there are those I rely upon to help me understand information both in my specialty and in fields that are unrelated to ID.

Up and down the medical hierarchies we trust that others are doing their best to understand the too numerous to count aspects of medicine that no single person could ever comprehend.

If I want to know about the state of the art on the treatment of atypical mycobacterium or how best to treat Waldenströms or who knows the most about diagnosing sarcoid, there is always someone who can distill their expertise on a topic to the benefit of the patient and my knowledge.

Trusting others is the biggest shortcut we routinely take in medicine to wade through the Brogdignagian amounts of information that flood into medical practice. We have to trust other clinicians, the researchers and the journals that all the information is gathered and interpreted honestly and accurately. (more…)

Posted in: Basic Science

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Epigenetics: It doesn’t mean what quacks think it means

Epigenetics. You keep using that word. I do not think it means what you think it means.

I realize I overuse that little joke, but I can’t help but think that virtually every time I see advocates of so-called “complementary and alternative medicine” (CAM) or, as it’s known more commonly now, “integrative medicine” discussing epigenetics. All you have to do to view mass quantities of misinterpretation of the science of epigenetics is to type the word into the “search” box of a website like Mercola.com or NaturalNews.com, and you’ll be treated to large numbers of articles touting the latest discoveries in epigenetics and using them as “evidence” of “mind over matter” and that you can “reprogram your genes.” It all sounds very “science-y” and impressive, but is it true?

Would that it were that easy!

You might recall that last year I discussed a particularly silly article by Joe Mercola entitled How your thoughts can cause or cure cancer, in which Mercola proclaims that “your mind can create or cure disease.” If you’ve been following the hot fashions and trends in quackery, you’ll know that quacks are very good at leaping on the latest bandwagons of science and twisting them to their own ends. The worst part of this whole process is that sometimes there’s a grain of truth at the heart of what they say, but it’s so completely dressed up in exaggerations and pseudoscience that it’s really, really hard for anyone without a solid grounding in the relevant science to recognize it. Such is the case with how purveyors of “alternative health” like Joe Mercola and Mike Adams have latched on to the concept of epigenetics.
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Posted in: Basic Science, Cancer, Evolution, Neuroscience/Mental Health

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Closing out 2012 with a bit of fun: Do you want some quantum with that pseudoscience?

today is the last day of 2012. As I contemplated what I’d write for my last post of 2012, I wondered what to do. Should I do a “year in review” sort of post? Naahh. Too trite and too much work. Should I just do what I normally do? There are, after all, many topics that are out there, some of them still holdovers from before the holiday season. I can’t get to them all, even between this blog and my not-so-super-secret other blog. I thought about it a minute, but then rejected that possibility. So I decided just to cover one of them. After all, when years begin and end are human constructs, and there’s nothing special about today other than that society has decided that it is the last day of the year, and tradition mandates that a significant proportion of the population will gather before midnight to get drunk and stupid. I’m boring that way, rarely doing anything on New Years Eve other than sitting in front of the TV with my wife and watching the ball drop in Times Square. Then I thought: Oh, what the heck? Why not take on something a bit…different for a change? Maybe even get a bit silly? At least I can finish off the year with a bit of fun. Who knows? I might even be able to be far more concise than usual? (Actually, that might be asking too much.) Besides, the topics I tend to take on here are almost always serious; so a little amusement would be good before diving into the science and pseudoscience that will certainly pop up in 2013.

If there’s one thing about “alternative” medicine, “complementary and alternative medicine” (CAM), or “integrative medicine” that’s always puzzled me, it’s just how gullible some practitioners must think their clients are. In some cases, they might know their customers every bit as well as a car salesman knows his clients or an author knows his readers, but in actuality most people who fall for alt-med are no more gullible than average. However, some words seem to impress more than ever, as promoters of alt-med scramble to appropriate impressive-sounding science terms into their woo. I’ve seen a lot of them. So has Mark Crislip.

Among the favorite real science term that quacks love to appropriate is “quantum.” I blame Deepak Chopra. Although I highly doubt he was the first promoter of alternative medicine and various New Age thought to use and abuse the term “quantum” as a seemingly scientific justification of what in reality is nothing more than ancient mystical thinking gussied up with a quantum overcoat to hide its lack of science, Chopra has arguably done the most to popularize the term among the science-challenged set. In Chopra’s world, the word “quantum” functions like a magical talisman that explains ™everything because in the quantum world anything can happen. Actually, I should clarify. While it’s true that many bizarre and wondrous things can be explained through quantum theory (such as quantum entanglement), it is not, as Chopra and his many imitators would have you believe, a “get out of jail free” card for any magical thinking you can imagine, and quantum effects do not work the way people like Chopra (say, Lionel Milgrom, who seems to think that homeopathy works through quantum entanglement between practitioner, remedy, and patient) would like you to think.
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Posted in: Basic Science, Health Fraud, Humor

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