Thursday, October 22, 2009

"Six Diseases You Never Knew You Could Catch" An Article In The New Scientist Challenges Orthodoxy

Priya Shetty, writing for The New Scientist, sums up an emerging body of research, which argues that many diseases--including diabetes, schizophrenia, and some kinds of cancer--that were previously seen as caused by environmental, lifestyle, or genetic variables are, in fact, contagious. That's right, contagious.

Science is nothing if not counter-intuitive!

One such hugely counter-intuitive finding, now accepted as true, was that ulcers come from bacteria--that finding, of course, upset centuries of intuition and research. Yet that discovery won the Nobel Prize for Medicine in 2005 for Barry J. Marshall and J. Robin Warren, and should serve as a reminder that there are huge rewards for finding better answers.

The implications of these additional findings about contagion, now kicking around science magazines, are huge.

Why? Because for decades now, entire orthodoxies of thought, as well as costly policy, have been built up around alternative explanations for disease--and alternative solutions and treatments.

Consider the diagnostic-prescriptive "if-thens" of our current explanatory paradigms: If disease comes from environmental factors, then we need to clean up the environment. If disease comes from lifestyle, then we need to change our ways and live healthier. And if disease comes from our own genes, then we must reflect upon, in a way that John Calvin would recognize, our own innate flaws.

Much of the strength of the environmental and consumer-protection movement, for example, comes from fear--fear that chemicals in the environment and in additives are carcinogenic. Some journalist-activists have built whole careers advancing this argument. Devra Davis, for example, in The Secret History of the War on Cancer, argued that most, if not all, cancers were environmentally caused; she further declared that Richard Nixon's "war on cancer," begun in 1971, was thus a diversionary fraud, aimed at taking pressure off tobacco companies, asbestos manufacturers, and other corporate polluters. Indeed, the backlash against the scandal-plagued Nixon and "the war on cancer" has been so strong that the "big science" approach to curing disease has been out of political fashion for most of the last four decades.

This is not an argument in favor of laissez-faire on pollution. But it is an argument for a relentless focus on the actual causes of disease, as opposed to trying to harness medical imperatives into the service of other social and political objectives.

With the notable exception of the battle against HIV/AIDS, the political and popular culture has chosen to focus on the aforementioned trinity of environment, lifestyle, and genetics. The larger culture told us that cancer, for example, was "our fault," because we had polluted our environment, or because we did unhealthy things, or because, in a deep neo-Calvinist way, we had simply harbored cancer within us, predestined in our genes. And if any of these variables--environmental or lifestyle or genetic--were seen as decisive, the political pressure to seek cures in a laboratory was thus lessened.

Obviously many chemicals are harmful, and one assume that the cigarettes-cause-lung-cancer linkage is secure for all time, but who knows about many other cancers? And about many other diseases? And the same goes for obesity and genetic propensity.

Here at Serious Medicine Strategy, we take no daring stands on scientific truth or falsehood. The SMS view is that the needed answers--the needed cures--will emerge from a Kuhnian processs of scientific revolution, followed by yet more scientific revolutions.

The SMS mission is merely to make sure that those revolutions are fully debated, fully analyzed, fully disclosed--and yes, fully funded. It's the ever-flowing process of paradigm-shifting that ultimately showed us, for example, that ulcers come from a bacteria.

And of course, if we really want to "bend the curve" on healthcare costs, it helps to actually cure the disease. In the scheme of things, cures are cheap. By contrast, simply treating a disease is expensive, to say nothing of the cost of treating a disease following the wrong diagnostic paradigm.

So to that end, SMS offers this challenge to both the Obama administration and to Congress: Which leader will be the first to hold a public hearing on this contagion question--either within the executive branch, e.g. NIH, or on Capitol Hill? Obviously there's lots of scientific discussion going on among experts, but which government official or politician will air these topics for the benefit of the larger public? Don't the people have a right to know how their government resources are being used, and to be assured that the powers-that-be are constantly revising their priorities in light of new information? That's the Serious Medicine Strategy in action.

The fear we have here at SMS is that the notion of pursuing actual cures is "an inconvenient truth" to those who are committed to ideological positions on other topics, such as health insurance financing. Health insurance and healthcare financing are great, but ask yourself: In the end, isn't health more important than health insurance? You don't go to the doctor because you can, thanks to a government-insurance card, or even a health savings account. You go to the doctor to get better.

That's the purpose of medical science, and that's what the Serious Medicine Strategy is all about.

Here's the lead of Shetty's piece:

TWENTIETH century medicine was phenomenally successful at developing vaccines and antibiotics to fight infectious diseases, taming ancient scourges such as smallpox, tuberculosis and typhoid. In the 1960s and 70s, the prevailing view was that all diseases caused by microorganisms would soon be conquered, leaving only those caused by genetics, unhealthy lifestyles or ageing.

That idea now seems naive, not least because of the rise in antibiotic resistance. And there's another reason that no one even considered back then. A growing number of diseases that were thought to be down to genetics or lifestyle turn out to have an infectious origin.

Take stomach ulcers. Long thought to be triggered by stress, it emerged in the 1980s that many cases are caused by a bacterium called Helicobacter pylori. Now a short course of antibiotics is all that's needed to cure the condition, and in the west stomach ulcers are on the decline.

Since then, researchers have unearthed the unexpected infectious origins of several other diseases. In some the explanation is unique, but in others common mechanisms are at work. For example, several autoimmune diseases arise because infection with a microbe triggers an immune attack, which cross-reacts with similar molecules from the host, causing the immune system to attack human tissues. And several cancers may be caused by viruses, sometimes because they insert themselves into our DNA and disrupt the genes that usually stop cells multiplying out of control.

The idea that lifelong conditions such as type 1 diabetes and obesity could be caught as easily as a cold is spine-chilling. Yet it raises the tantalising possibility that they could be treated with antibiotics or antiviral drugs, or possibly even prevented with a vaccine. So which of the following illnesses will be next to go the way of stomach ulcers?

1. Obesity
2. Diabetes
3. Schizophrenia
4. Breast cancer
5. Obsessive-compulsive disorder
6. Prostate cancer

And the rest is here.

1 comment:

  1. In college in the early 1960's the student nurses we dated told us that the rates of cancer amongst medical personnel was higher than other professions. And at that time, they believed some cancers were viruses.
    So some of what you wrote doesn't come as a surprise.