Category: Health

Cancer 1.7 Million Years Ago in Human Ancestor

(p. D3) Carcinogens abounded 1.7 million years ago in Early Pleistocene times when a nameless protohuman wandered the South African countryside in what came to be known as the Cradle of Humankind.
Then, as now, ultraviolet radiation poured from the sun, and radon seeped from granite in the ground. Viruses like ones circulating today scrambled DNA. And there were the body’s own carcinogens, hormones that switch on at certain times of life, accelerating the multiplication of cells and increasing the likelihood of mutations.
That, rather than some external poison, was probably the cause of a bone tumor diagnosed as an osteosarcoma found fossilized in Swartkrans Cave, a paleoanthropological trove northwest of Johannesburg. A paper in the current South African Journal of Science describes the discovery, concluding that it is the oldest known case of cancer in an early human ancestor.
. . .
The seemingly small number of malignant tumors reported by anthropologists is probably an illusion. The only cancers that can be found in long-decomposed remains are those that originated in the skeleton or somehow left a mark there. They include cancers that spread from other organs or, like myeloma, could scar the skeleton in other ways. For most ancient cancers, the evidence rots away. Mummified bodies are rare, but here, too, an occasional cancer has been found.

For the full story, see:
Johnson, George. “RAW DATA; After 1.7 Million Years, a Bone Cancer Diagnosis.” The New York Times (Tues., AUG. 23, 2016): D3.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date AUG. 22, 2016, and has the title “RAW DATA; The Known: Cancer Is Really, Really Old. The Unknown: How Common It Was.”)

The academic article mentioned in the passage quoted above, is:
Edward, J. Odes, S. Randolph-Quinney Patrick, Steyn Maryna, Throckmorton Zach, S. Smilg Jacqueline, Zipfel Bernhard, Augustine Tanya, Beer Frikkie De, W. Hoffman Jakobus, D. Franklin Ryan, and R. Berger Lee. “Earliest Hominin Cancer: 1.7-Million-Year-Old Osteosarcoma from Swartkrans Cave, South Africa.” South African Journal of Science 112, no. 7/8 (July/Aug. 2016): 1-5.

“Giving Peas a Chance”

(p. C1) Thank heavens Gregor Mendel was a lousy priest. Had he shown even the faintest aptitude for oratory or ministering to the poor, he might never have determined the basic laws of heredity. But bumbling he was, and he made a rotten university student to boot; his failures drove him straight to his room, where he bred mice in secret. The experiment scandalized his superiors.
“A monk coaxing mice to (p. C4) mate to understand heredity was a little too risqué, even for the Augustinians,” writes Siddhartha Mukherjee in “The Gene: An Intimate History.” So Mendel switched — auspiciously, historically — to pea plants. The abbot in charge, writes the author, acquiesced this time, “giving peas a chance.”
Love Dr. Mukherjee, love his puns. They’re everywhere. I warn you now.
. . .
Many of the same qualities that made “The Emperor of All Maladies” so pleasurable are in full bloom in “The Gene.” The book is compassionate, tautly synthesized, packed with unfamiliar details about familiar people.
. . .
But there are also crucial differences. Cancer is the troll that scratches and thumps beneath the floorboards of our consciousness, if it hasn’t already beaten its way into the room. The subject immediately commands our attention; it’s almost impossible to deny, and not to hear, the emotional clang of its appeal. In Dr. Mukherjee’s skilled hands, the story of this frightening disease became a page-turner. He explained its history, politics and cunning biological underpinnings; he traced the evolving and often gruesome logic underlying cancer treatment.
And in the middle of it all, agonizing over treatment protocols and watching his patients struggle with tremendous existential and physical pain, was the author himself.
There are far fewer psychological stakes in reading about the history of genetics. “The Gene” is more pedagogical than dramatic; as often as not, the stars of this story are molecules, not humans.
. . .
But any book about the history of something as elemental and miraculous as the gene is bound, at least indirectly, to tell the story of innovation itself. “The Gene” is filled with scientists who dreamed in breathtakingly lateral leaps.
Erwin Schrödinger in particular was one visionary cat: In 1944, he hazarded a guess about the molecular nature of the gene and decided it had to be a strand of code scribbled along the chromosome — which pretty much sums up the essence of DNA.

For the full review, see:
JENNIFER SENIOR. “Books of The Times; In Molecular Pursuit of the Genetic Code.” The New York Times (Mon., MAY 9, 2016): C1 & C4.
(Note: ellipses added.)
(Note: the online version of the review has the date MAY 8, 2016, and has the title “Books of The Times; Review: Siddhartha Mukherjee’s ‘The Gene,’ a Molecular Pursuit of the Self.”)

The book under review, is:
Mukherjee, Siddhartha. The Gene: An Intimate History. New York: Scribner, 2016.

Presence of Biomarkers Predicts Whether Checkpoint Inhibitor Works

(p. D1) A collaboration between an immunologist helping his stepmother fight cancer and the oncologist who treated her led to a discovery that could help many more patients benefit from a transformative new therapy.
A new class of drugs called checkpoint inhibitors works by releasing a molecular brake that stops the immune system from attacking tumors. So-called immunotherapy has been approved for several types of cancers and found to extend lives of patients with advanced disease for many years. The problem is that for most patients immunotherapy doesn’t work.
The researchers, from University of California, San Francisco, said they identified a unique type of immune-system cell that “robustly” predicts whether patients will respond to one of the medicines–an achievement has the potential to significantly expand the number of cancer patients who benefit from checkpoint inhibitors.
The new discovery is based on a high-tech analysis of melanoma tissue from 40 patients treated with a checkpoint inhibitor from Merck & Co. called Keytruda, which targets an immune-system brake called PD-1. Although researchers say it will take further research to determine its value in treating patients, the finding offers fresh insight into the complex relationship between the immune system and tumor cells.
. . .
(p. D3) The researchers analyzed results of a study involving Keytruda before it was approved. They looked at the CD8 cells that had infiltrated the melanoma tumors of 20 patients treated with the drug and found that if at least 30% of those cells were marked by PD-1 and CTLA-4, the patient responded to treatment. When fewer than 20% of the infiltrated cells had those markers, not one patient responded.

For the full story, see:
RON WINSLOW. “Road to a Cancer Advance.” The Wall Street Journal (Tues., Aug. 16, 2016): D1 & D3.
(Note: ellipsis added.)
(Note: the online version of the story has the date Aug. 15, 2016, and has the title “Chance Collaboration Yields an Advance in Cancer Treatment.”)

Lack of Control at Job Causes Stress, Leading to Cardiovascular Disease

(p. 6) Allostasis is not about preserving constancy; it is about calibrating the body’s functions in response to external as well as internal conditions. The body doesn’t so much defend a particular set point as allow it to fluctuate in response to changing demands, including those of one’s social circumstances. Allostasis is, in that sense, a politically sophisticated theory of human physiology. Indeed, because of its sensitivity to social circumstances, allostasis is in many ways better than homeostasis for explaining modern chronic diseases.
Consider hypertension. Seventy million adults in the United States have it. For more than 90 percent of them, we don’t know the cause. However, we do have some clues. Hypertension disproportionately affects blacks, especially in poor communities.
. . .
Peter Sterling, a neurobiologist and a proponent of allostasis, has written that hypertension in these communities is a normal response to “chronic arousal” (or stress).
. . .
Allostasis is attractive because it puts psychosocial factors front and center in how we think about health problems. In one of his papers, Dr. Sterling talks about how, while canvassing in poor neighborhoods in Cleveland in the 1960s, he would frequently come across black men with limps and drooping faces, results of stroke. He was shocked, but today it is well established that poverty and racism are associated with stroke and poor cardiovascular health.
These associations also hold true in white communities. One example comes from the Whitehall study of almost 30,000 Civil Service workers in Britain over the past several decades. Mortality and poor health were found to increase stepwise from the highest to the lowest levels in the occupational hierarchy: Messengers and porters, for example, had nearly twice the death rate of administrators, even after accounting for differences in smoking and alcohol consumption. Researchers concluded that stress — from financial instability, time pressures or a general lack of job control — was driving much of the difference in survival.

For the full commentary, see:
SANDEEP JAUHAR. “When Blood Pressure Is Political.” The New York Times, SundayReview Section (Sun., AUG. 7, 2016): 6.
(Note: ellipses added.)
(Note: the online version of the review has the date AUG. 6, 2016.)

The commentary quoted above is distantly related to Jauhar’s book:
Jauhar, Sandeep. Doctored: The Disillusionment of an American Physician. New York: Farrar, Straus and Giroux, 2014.

Greenland Shark Likely to Have Lived to at Least 272 Years Old

(p. A11) The mysterious Greenland shark lives at extreme depths in dark, icy waters, which have long protected it from scientists’ prying eyes.
But now, an international group of researchers has estimated the dark brown cartilaginous fish may live as long as 500 years–which would make it the longest-living vertebrate on the planet.
The work, published Thursday [Aug. 11, 2016] in the journal Science, “offers the first hard evidence of how long-lived this poorly understood shark species can be,” said Steve Campana, a shark expert at the University of Iceland in Reykjavik, who wasn’t involved in the study.
. . .
. . . the 11-person team of researchers turned to math models and radiocarbon dating, a technique typically used to date fossils. They focused their work on the eye lens nucleus of each shark, a structure that stops developing at birth and therefore serves as a rough proxy of birth date. They measured the levels of carbon-14 in the tissue, which animals stop accumulating when they die.
The oldest shark in the study, which measured more than 16 feet, lived an estimated 392 years, according to the scientists. Because the study had a margin of error of 120 years for that fish, the researchers concluded the sharks could live up to about 500 years.

For the full story, see:
DANIELA HERNANDEZ. “Enigmatic Shark Can Live for Centuries, Study Says.” The Wall Street Journal (Fri., Aug. 12, 2016): A12.
(Note: ellipses, and bracketed date, added.)
(Note: the online version of the story has the date Aug. 11, 2016, and has the title “Mysterious Greenland Shark May Live Hundreds of Years, Scientists Say.” The online version included several additional sentences, interspersed through the article, that were not included in the print version. The sentences quoted above, appeared in both versions, but the formatting of the quotes above, most closely follow the print version.)

The research article reporting findings discussed above, is:
Nielsen, Julius, Rasmus B. Hedeholm, Jan Heinemeier, Peter G. Bushnell, Jørgen S. Christiansen, Jesper Olsen, Christopher Bronk Ramsey, Richard W. Brill, Malene Simon, Kirstine F. Steffensen, and John F. Steffensen. “Eye Lens Radiocarbon Reveals Centuries of Longevity in the Greenland Shark (Somniosus microcephalus).” Science 353, no. 6300 (Aug. 12, 2016): 702-04.

Traveling Health Volunteers Often Do Harm

(p. D3) Tens of thousands of religious and secular institutions now send hundreds of thousands of health volunteers from the United States out into the world, generating close to an estimated $1 billion worth of unpaid labor. Volunteers include experienced medical professionals and individuals who can provide only elbow grease; between these extremes of competence are the hordes of students in the health professions, among whom global volunteering has become immensely popular.
. . .
Students may take advantage of the circumstances to attempt tasks well beyond their expertise. Seasoned professionals may cling to standards of practice that are irrelevant or impossible to sustain in poor countries. Unskilled volunteers who do not speak the language may monopolize local personnel with their interpreting needs without providing much of value in return.
Problems may lie with the structure of a program rather than the personnel. Volunteer projects may be choppy and discontinuous, one set of volunteers not knowing what the previous group was up to, and not able to leave suggestions for the next group. Medications may run out. Surgery may be performed with insufficient provisions for postoperative care.
Even well-organized programs may undermine hosting communities in unanticipated ways: For instance, a good volunteer-based clinic may sap confidence in local medical care and, providing free services, threaten to put local physicians out of business.
. . .
A few studies on the long-term effects of short-term good works are ongoing. In the meantime, “there is little evidence that short-term volunteer trips produce the kinds of transformational changes that are often promised,” Dr. Lasker finds.

For the full review, see:
ABIGAIL ZUGER, M.D. “The Folly of the Well-Meaning Traveling Volunteer.” The New York Times (Tues., APRIL 26, 2016): D3.
(Note: ellipses added.)
(Note: the online version of the review has the date APRIL 25, 2016, and has the title “Books; Book Review: ‘Hoping to Help’ Questions Value of Volunteers.”)

The book under review, is:
Lasker, Judith N. Hoping to Help: The Promises and Pitfalls of Global Health Volunteering, The Culture and Politics of Health Care Work. Ithaca, NY: Cornell University Press, 2016.

FDA Blocking Stem-Cell Therapies from Those With No Other Hope

(p. D2) Research is exploding into ways stem cells might be harnessed to cure diseases, mend damaged tissue, even grow replacement organs.
. . .
Jeffrey Weiss, a retinal surgeon in Margate, Fla., has treated about 570 patients with retinal and optic nerve diseases with stem cells taken from patients’ bone marrow as part of a study, and says that about 60% have had meaningful improvement. Patients pay $19,000 to $21,000 to receive the injections.
Shawn Rockafellow, a 31-year old truck dispatcher in Chandler, Ariz., started rapidly losing his vision in 2014 to a genetic disease and says he was told to accept that he was going blind. His mother read about Dr. Weiss’s work. Mr. Rockafellow raised the $20,000 fee on GoFundMe, a personal charity website, and had the treatment in both eyes in January.
After three months, the vision in his right eye went from roughly 20/1,000 to 20/400. After six months, it was 20/300. His left eye hasn’t improved as much, so he wants to try the treatment again. His regular ophthalmologist, Scott Markham, says “the fact that he’s not worsening is fantastic.”
. . .
Mark Berman, a Beverly Hills, Calif., cosmetic surgeon who co-founded a network of stem-cell clinics, says “fundamentally, all we are doing is a simple, surgical procedure. This is not witch-doctor stuff. We are repairing cell damage with people’s own stem cells.” He says the member clinics in 25 states have treated about 5,000 patients to date, with no significant adverse events.
SammyJo Wilkinson, a former dot-com executive, developed multiple sclerosis in 1995 and was confined to a wheelchair by 2011. She says her symptoms started to improve almost immediately after receiving a high-dose stem cell treatment at a Houston clinic in 2012. When the FDA blocked access to that form of therapy, Ms. Wilkinson went to Cancún, Mexico, for follow-ups. After a total of five treatments for $90,000, she says she has far less pain, can exercise and walk short distances with the help of a walker.
At the FDA hearing, Ms. Wilkinson, who founded a patient group called Patients for Stem Cells, plans to appeal for a faster approval process for stem-cell therapies and a registry to monitor patient outcomes. “Patients will never get these treatments if they have to go the traditional double-blind placebo-controlled trial route. That takes 10 years and $1 billion,” she says. “There’s got to be a middle ground, where you don’t shut off treatment, you just keep track of it.”

For the full story, see:
Beck, Melinda. “Stem-Cell Treatments Become More Available, and Face More Scrutiny.” The Wall Street Journal (Tues., Aug. 30, 2016): D2.
(Note: ellipses added.)
(Note: the online version of the story has the date Aug. 29, 2016, and has the title “Stem-Cell Treatments Become More Available, and Face More Scrutiny.” There are minor differences in wording between the online and print versions. The sentences quoted above, follow the online version.)

Precautionary Principle Slows Cloning Innovation

(p. A8) Dolly the Sheep started her life in a test tube in 1996 and died just six years later. When she was only a year old, there was evidence that she might have been physically older. At five, she was diagnosed with osteoarthritis. And at six, a CT scan revealed tumors growing in her lungs, likely the result of an incurable infectious disease. Rather than let Dolly suffer, the vets put her to rest.
Poor Dolly never stood a chance. Or did she?
Meet Daisy, Diana, Debbie and Denise. “They’re old ladies. They’re very healthy for their age,” said Kevin Sinclair, a developmental biologist who, with his colleagues at the University of Nottingham in Britain, has answered a longstanding question about whether cloned animals like Dolly age prematurely.
In a study published Tuesday in Nature Communications, the scientists tested these four sheep, created from the same cell line as Dolly, and nine other cloned sheep, finding that, contrary to popular belief, cloned animals appear to age normally.
. . .
Not only did many countries, including Canada and Australia, ban reproductive cloning in animals, but the United Nations banned all kinds of cloning in humans in 2005. Last year the European Union made importing food from cloned animals or their offspring illegal.
. . .
Now, based on results of this new study, researchers have confirmed what most scientists believed years ago: Cloning does not lead to premature aging.
. . .
Many scientists hope that changes in perception will lead to advances in reproductive technology that will enable us to provide food for a growing global population, save endangered species and develop advanced therapies.

For the full story, see:
JOANNA KLEIN. “Dolly’s Fellow Clones, Enjoying the Golden Years.” The New York Times (Weds., JULY 27, 2016): A8.
(Note: ellipses added.)
(Note: the online version of the commentary has the date JULY 26, 2016, and has the title “Dolly the Sheep’s Fellow Clones, Enjoying Their Golden Years.”)

Mather and Boylston Risked Much to Fight Smallpox

I enjoyed reading the book reviewed below. From the title, and from reviews, I had the impression that it would mostly be about the smallpox epidemic and the innoculation conflict. I was surprised that of equal, or greater, importance in the book is the role of James Franklin’s newspaper in laying the intellectual groundwork for the American Revolution. I learned from that part of the book too, but some might feel misled from the title about what the book was mainly about. (I think “fever” in the title is intended as a double entendre, referring both to a fever from smallpox, and a fever from the ideas of liberty.)

(p. A11) Inoculation was proposed by Cotton Mather, a figure much diminished in the 30 years since Salem. He had suffered a terrible sequence of tragedies, losing his wife and 10 of his children to accidents and epidemic disease. He had also been marginalized within the religious community by quarrels and scandals. But he had become an assiduous student of science, corresponding with the Royal Society in London and learning from its “Transactions” that inoculation against smallpox had long been practiced in Constantinople. Mr. Coss shows how Mather’s investigations led him to consult a source closer to home. His slave Onesimus, when asked whether he had ever had smallpox, replied “both Yes, and No”: He had been inoculated as a child in Africa, receiving a mild infection and subsequent immunity.

Inoculation was commonplace across swaths of Africa, the Middle East and Asia, Mr. Coss explains, but this inclined the doctors of Enlightenment-era Europe to regard it as a primitive superstition. Such was the view of William Douglass, the only man in Boston with the letters “M.D.” after his name, who was convinced that “infusing such malignant filth” in a healthy subject was lethal folly. The only person Mather could persuade to perform the operation was a surgeon, Zabdiel Boylston, whose frontier upbringing made him sympathetic to native medicine and who was already pockmarked from a near-fatal case of the disease.
“Given that attempting inoculation constituted an almost complete leap of faith for Boylston,” Mr. Coss writes, “he spent surprisingly little time agonizing over it.” He knew personally just how savage the toll could be. On June 26, 1721, just as the epidemic began to rage in earnest, Boyston filled a quill with the fluid from an infected blister and scratched it into the skin of two family slaves and his own young son.
News of the experiment was greeted with public fury and terror that it would spread the contagion. A town-hall meeting was convened, at Dr. Douglass’s instigation, at which inoculation was condemned and banned. Mather’s house was firebombed with an incendiary device to which a note was attached: “I will inoculate you with this.”

For the full review, see:
MIKE JAY. “‘BOOKSHELF; An Ounce of Prevention; When Cotton Mather advocated inoculation during a smallpox outbreak, young Benjamin Franklin helped foment outrage against him.” The Wall Street Journal (Thurs., March 3, 2016): A11.
(Note: the online version of the review has the date March 2, 2016, and has the title “‘BOOKSHELF; When Ben Franklin Was Against Vaccines; When Cotton Mather advocated inoculation during a smallpox outbreak, young Benjamin Franklin helped foment outrage against him.”)

The book under review, is:
Coss, Stephen. The Fever of 1721: The Epidemic That Revolutionized Medicine and American Politics. New York: Simon & Schuster, 2016.

Fragmented Health Care Causes Polypharmacy Harms

(p. D5) Dr. Caleb Alexander knows how easily older people can fall into so-called polypharmacy. Perhaps a patient, like most seniors, sees several specialists who write or renew prescriptions.
“A cardiologist puts someone on good, evidence-based medications for his heart,” said Dr. Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “An endocrinologist does the same for his bones.”
. . .
“Pretty soon, you have an 82-year-old man who’s on 14 medications,” Dr. Alexander said, barely exaggerating.
Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults.
. . .
Ultimately, the best way to reduce polypharmacy is to overhaul our fragmented approach to health care. “The system is not geared to look at a person as a whole, to see how the patterns fit together,” Dr. Steinman said.

For the full commentary, see:
Span, Paula. “THE NEW OLD AGE; An Ever-Mounting Pile of Pills.” The New York Times (Tues., APRIL 26, 2016): D5.
(Note: ellipses added.)
(Note: the online version of the commentary has the date APRIL 22, 2016, and has the title “THE NEW OLD AGE; The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills.”)

Cancer Is Not Due to Modernity

(p. 1A) Scientists’ conventional opinion about cancer was that it’s a relatively recent phenomenon caused by the stresses of modern life.

Dietary changes, behavioral changes and man-made changes to our environment have subjected humans to toxins that contribute to cancers, they say.

But new findings from researchers at South Africa’s University of the Witwatersrand published in the South African Journal of Science challenge that assumption.

Paleontologists found a benign tumor in a 12 or 13-year-old boy specimen that dates back almost 2 million years.

More significantly, they also found a malignant tumor that’s 1.7 million years old on the little toe bone of a left foot.

Previously the oldest discovered human cancer was between 780,000 and 120,000 years old.

. . .

(p. 2A) “The evidence is out there that these conditions have been with us a long time and we’ve been kind of hoodwinked that cancer is a modernity,” said Patrick Randolph-Quinney, one of the study’s authors. “These things are ancient.”

The greatest predictor of cancer, the study argues, even in our ancestors, is longevity. The longer we live, the more chances something in our bodies goes wrong, the more chances that something is a tumor.

For the full story, see:
The Washington Post. “Ancient tumor upends notion of cancer as modern affliction; 1.7-million-year-old malignant growth is causing scientists to rethink diseases and human history.” Omaha World-Herald (Sat., JUNE 20, 2016): 1A & 2A.
(Note: ellipsis added.)

The scientific article mentioned above, is:
Patrick, S. Randolph-Quinney, A. Williams Scott, Steyn Maryna, R. Meyer Marc, S. Smilg Jacqueline, E. Churchill Steven, J. Odes Edward, Augustine Tanya, Tafforeau Paul, and R. Berger Lee. “Osteogenic Tumour in Australopithecus Sediba: Earliest Hominin Evidence for Neoplastic Disease.” South African Journal of Science (July/Aug. 2016), DOI: http://dx.doi.org/10.17159/sajs.2016/20150470.