Friday, December 10, 2010

And this is why....

...we study tumor size and not metastasis... Tumor size is relatively easy to measure in experimental models and even in real patients. Prevention or inhibition of metastasis however, is very difficult to measure.  It is mainly for this reason (in my view) that we continue to plough most research funding into reducing tumor size rather than preventing migration of the cancer cells to new locations around the body. This is a great article (Why Scientists are so often wrong: the streetlight effect) on why science is often wrong. We look at end-points we can easily measure which may give us, at best, only a small piece of the picture and at worst, irrelevant findings. If we measure the measurable (and it is perfectly understandable why we would want to), then we must remember to re-insert the findings back onto the larger context. This is the value of the systems approach, which we have torn apart over the past 200 years in the name of Enlightenment. An over-emphasis on what we call things has led to an inappropriate level of categorization of data and terms which forces us to place something in one category when it might really belong in two or three or even in none. Medical diagnostic codes are a good example of this forced boxing which is done to allow communication between healthcare providers and insurers. The previous blog about cancer also illustrates the problem to some degree. We say a person has died from breast cancer when in actual fact they died from metastatic liver cancer for example. I have a friend whose disease sadly took this path. We remember her, and walk in her honor, to benefit all victims of breast cancer, but the liver and brain cancer that finally took her life is never mentioned.
Another example is appearing in the medical community at large. The pay-for-performance paradigm for doctors and hospitals depends on care professionals reporting certain elements that they are asked to report. Rewarding certain behaviors will ensure that they are reported more. It doesn't necessary follow that the patients are any healthier for it. For a balanced view of the implementation of 'quality' programs for health care see here. The author calls the programs 'garbage in, garbage out' or in other words, you get what you pay/ask for.  The whole system is forcing certain categorization that can make health data fairly meaningless.  For scientists and physicians alike, this should be cause for concern although, I must admit, there are no easy answers given that the system has evolved this way due to human nature.  Few are comfortable with ambiguities if a more concrete alternative is available, and the system does not allow the time for it anyway.  Perhaps in the future, it will.

Tuesday, December 7, 2010

My name is cancer and I like to travel.

As Elizabeth Edwards succumbed to cancer today, an article in Science News heralded the discovery of a switch that appears to be central to the ability of cancer cells to move or remain still.  Researchers at the University of Georgia say the misregulation of this switch may play an important role in the processes that allow cancer cells set forth on their malevolent journey around the body to find new places to spawn.  Cancer in situ, that is to say in a particular place, often remains fairly innocuous until it either grows large enough to disturb organ function, or acquires the ability to move and settle elsewhere.  Once it has spread its wings and become metastatic, it is very difficult to control and often leads to the rapid demise of its host. 

Today's new discovery could  lead to a better understanding of how and why cancer cells move and in the longer term, yield new approaches to treatment. Could it be possible that in some distant future we may be able to prevent metastasis altogether and come to view cancer as somewhat of an inconvenience rather than a fatal disease? 

Targeting cancer cells that are getting ready to move, or already on their way to some other place, is one approach but what about trying to understand what makes the new location they settle into so appealing?  Maybe we can make the environment around the body unwelcoming to the invading cells.  There are current approaches to preventing colonization of the cancer cells at the distant location.  Therapies are in development that disrupt the local signalling that is required for the cells to invade and colonize the tissues.  Studies look promising but the problem is far from solved.  Clinical studies with smart combinations will likely be required due to the complex nature of the cellular interactions and there is no better time to jump into these.  All of us have lost friends, family and colleagues to cancer.  In my case, every cancer death I have known to date has been due to metastatic disease. I would vote to divert the majority of funding for cancer research from limiting tumor growth to preventing effective metastasis. Maybe it's heading in that direction already. Any comments welcome...