Miracles and wonders: personal cancer meds

More evidence that the world of medicine is changing in a big way.

Michael Pellini fires up his computer and opens a report on a patient with a tumor of the salivary gland. The patient had surgery, but the cancer recurred. That's when a biopsy was sent to Foundation Medicine, the company that Pellini runs, for a detailed DNA study. Foundation deciphered some 200 genes with a known link to cancer and found what he calls "actionable" mutations in three of them. That is, each genetic defect is the target of anticancer drugs undergoing testing—though not for salivary tumors. Should the patient take one of them? "Without the DNA, no one would have thought to try these drugs," says Pellini.

Starting this spring, for about $5,000, any oncologist will be able to ship a sliver of tumor in a bar-coded package to Foundation's lab. Foundation will extract the DNA, sequence scores of cancer genes, and prepare a report to steer doctors and patients toward drugs, most still in early testing, that are known to target the cellular defects caused by the DNA errors the analysis turns up. Pellini says that about 70 percent of cases studied to date have yielded information that a doctor could act on—whether by prescribing a particular drug, stopping treatment with another, or enrolling the patient in a clinical trial. 

This is only the beginning.

Is the medical system actually working?

I frequently write about breakthroughs in medicine and suggest that innovation, not government-run healthcare, is the answer.

There now seems to be some evidence that this is true.

New data show that health spending over the past several years has been normalizing toward the rate of general inflation, rather than growing higher and higher, as had been the case almost continuously since the 1970s, J.D. Kleinke writes in The Wall Street Journal.

This moderation in the growth rate of spending predates the national recession. And it puts the lie to the claim that we need government to put the brakes on an "out-of-control" health-care system. The moderation has been driven by cumulative improvements in medical care and by insurers, and by marketplace disciplines on the demand for medical care. Consumers are finally getting more involved in managing and paying for their own care.

Contrary to the perennial doomsaying, the health-care system is—almost in spite of itself—getting better, Kleinke says.

A generation of breakthrough drugs for chronic disease, mental illness, HIV and cancer were developed in the 1980s and '90s at great cost. Dozens of these drugs—like Zocor for heart disease or Zyprexa for schizophrenia—are now widely available, many in generic form. There are now countless electronic ways of telling patients about them. And health insurers are driven by their own evolving market disciplines to make sure patients start taking them and keep taking them in the cheapest available versions. 

Combine all these new medicines, information channels and business compulsions with the slow, steady transfer of economic responsibility for health care—from corporate and government bureaucrats to consumers and their families—and suddenly health-care starts to look almost like an actual market.

Just in time for the whole thing to get swallowed up by Washington.

Stop reading this and ...

... go out right now and buy yourself some Vitamin D3.

Most people in America are seriously vitamin D deficient or insufficient, Patrick Cox writes. The same is true for Canada and Europe, and the implications are staggering. Cox is a columnist for Agora Financial. His conclusions, he says, come from his job as a tech investment adviser, which requires that he survey thousands of the most recent scientific studies.

Simply put, unless you are one of the few people with optimal serum D levels, such as lifeguards and roofers in South Florida, you can cut your risks from most major diseases by 50 to 80 percent. All you have to do is get enough D. It also means we can significantly reduce both health care costs and the staggering national deficit by taking a few simple steps.

Sensible sun exposure and vitamin D3 supplementation would do far more for our national health than the current health care bill. Even better, the benefits to society could be achieved without spending hundreds of billions of dollars. If an “Army of Davids” took it upon itself to spread the word, they could achieve what government is apparently incapable of achieving.

You need to read his whole article, but here are some excerpts:

Optimal vitamin D serum blood levels, attained through sunlight or supplementation, dramatically reduce the risk of many diseases other than bone maladies. Many of the most serious are ameliorated by an astonishing 50 to 85 percent. These diseases include cancers, from breast and colon to deadly melanoma skin cancers. [Read the full article for an explanation of skin cancers.]

This is not the end of the list, though. The big killers and most expensive diseases respond similarly to adequate D. I’m talking about hypertension, cardiovascular disease, and stroke. So do type 1 diabetes, type 2 diabetes (to a lesser extent), rheumatoid arthritis, peripheral vascular disease, multiple sclerosis, dementia, autoimmune diseases, and apparently even viral diseases such as H1N1 and AIDS.

I predict that other diseases will also be linked to vitamin D insufficiencies as more studies are performed. Even conditions such as autism and schizophrenia may be directly related to prenatal or infantile vitamin D deficiency.

I take 2,000 IUs of Vitamin D3 a day, a level I got from a pharmacist. I've had only one test for Vitamin D, and that was ordered by a urologist. Here's what Cox recommends:

The NIH’s current recommended dosage for vitamin D supplementation remains basically unchanged since it was established to prevent rickets. In fact, the maximum safe dosage of vitamin D3, the preferred dietary form, is currently 2000IU. This is extremely unfortunate because it takes about a hundred IU to raise serum blood levels by 1 ng/ml in a healthy adult. To get into the optimal range, 40 to 60 ng/ml, one would therefore have to take 4000 IU daily. It would take even more if you were obese, are taking certain medications, or have one of a number of medical conditions that degrade or prevent the creation of usable D. The evidence, incidentally, is that 10,000IU is entirely safe.

You should talk to your doctor, of course, but most doctors I know don't talk much about vitamins. Vitamins weren't part of their training. Read Cox' article and decide for yourself.

Eat your broccoli, boys and girls

And don't cook it too much.

Broccoli has been of particular interest to scientists because it contains the highest levels of certain glucosinolates, a class of phytochemicals that many believe may reduce the risk of prostate, breast, lung and colorectal cancer. 

When eaten as a raw or lightly-cooked food, enzymes in the broccoli help to break down the glucosinolates into two valuable compounds of intensive research interest -- sulforaphane and erucin. However,

A necessary enzyme called myrosinase is missing from most of the supplement forms of glucosinolates, a valuable phytochemical in cruciferous vegetables. Without this enzyme found in the whole food, the study found that the body actually absorbs five times less of one important compound and eight times less of another. 

Intensive cooking does pretty much the same thing. If broccoli is cooked until it's soft and mushy, its health value plummets. However, it can still be lightly cooked for two or three minutes, or steamed until it's still a little crunchy, and retain adequate levels of the necessary enzyme.

Eat your enzymes, boys and girls. 

You won't have to get sick

Dr. David Agus is a professor of medicine and engineering at the University of Southern California and co-founder of two personalized medicine companies. Here's what he sees in the near future.

The end of illness is near. 

Today, we mostly wait for the body to break before we treat it. When I picture what it will be like for my two children to stay in good health as independent adults in 10 or 20 years, I see a big shift from our current model. 

I see them being able to monitor and adjust their health in real time with the help of smartphones, wearable gadgets—perhaps like small, invisible stickers—to track the inner workings of their cells, and virtual replicas of their bodies that they will play much like videogames, allowing them to know exactly what they can do to optimize every aspect of their health.What happens when I take drug x at dosage y? How can I change the expression of my genes to stop cancer? Would eating more salmon and dark chocolate boost my metabolism and burn fat? Can red wine really lower my risk of heart attack?

From a drop of their blood, they will be able to upload information onto a personal biochip that can help to create an individualized plan of action, including both preventive measures and therapies for identified ailments or signs of "unhealthiness." (Other body fluids—like tears and saliva—might be routinely tested, too.) They would be on the lookout for problems like imbalances in blood-sugar control, a risk factor for diabetes, and uncontrolled cell growth, which could signal cancer. Their doctors won't just examine them once a year; they will continually monitor the next generation of patients, offering advice along the way.

And there's more. 

What is equally exciting is that this patient data will be added to a universal database that can be aggregated by powerful search engines like Google and constantly fed into new trials and experiments—speeding up our understanding of which drugs work best for which people. The database might show, for example, that people with a particular genetic profile respond to one type of cancer treatment but not another. As more people anonymously add their health data, this database would become more and more effective as a tool for preventive medicine.

Our health care "system" -- which wasn't designed as a system and doesn't operate as one -- is on its last legs.

Today, most people who are concerned about their health follow sweeping, general guidelines. If you want to lose weight, you are likely to pick a diet that advises eating more fibrous vegetables and cutting back on processed sugar. If you want to reduce your risk for cancer, you avoid tobacco smoke, exercise regularly and take early detection seriously.

The problem with health care today is that we don't know enough about the body to practice preventive medicine actively. With limited knowledge, diagnostic medicine makes sense. If we don't know what we're trying to prevent or how best to do it, we have to wait for an obvious symptom to emerge in order to take action. At that point, we're usually treating a disease that has had ample opportunity to progress.

Read this twice and call me in the morning.

In the future we won't get fat

At the same that we're turning our health care over to bureaucrats in Washington, our scientists are offering a glimpse of the future of medicine. The future is not anything we know now in our so-called "healthcare system," which was not designed as a system and doesn't work as a system. And it's certainly not anything like what Mr. Obama imagines.

In their book Transcend, Ray Kurzweil and Terry Grossman, MD, write:

"We have exactly doubled the amount of the genetic data collected each year since 1990, and this pace has continued since the completion of the Human Genome Project in 2003. The cost of sequencing a base pair of DNA - the building blocks of our genes - has dropped by half each year from $10 per base pair in 1990 to a small fraction of a penny today. Deciphering the first human genome cost a billion dollars. Today, anyone can have it done for $350,000. But, in case that's still out of your budget, just be patient for a little while longer. We are now only a few years away from a $1,000 human genome. Almost every other aspect of our ability to understand biology in information terms is similarly doubling every year.

  

"Our genes are essentially little software programs, and they evolved when conditions were very different than they are today. Take, for example, the fat insulin receptor gene, which essentially says 'hold on to every calorie because the next hunting season may not work out so well.' That gene made a lot of sense tens of thousands of years ago, at a time when food was almost always in short supply and there were no refrigerators. In those days, famines were common and starvation was a real possibility, so it was a good idea to store as many as possible of the calories you could find in your body's fat cells.

"Today, the fat insulin receptor gene underlies an epidemic of weight prob­lems, with two of three American adults now overweight and one in three obese. What would happen if we suddenly turned off this gene in the fat cells? Scientists actually performed this experiment on mice at the Joslin Diabetes Center. The animals whose fat insulin receptor gene was turned off ate as much as they wanted yet remained slim. And it wasn't an unhealthy slimness. They didn't get diabetes or heart disease, and they lived and remained healthy about 20 percent longer than the control mice, which still had their fat insulin receptor gene working. The experimental mice experienced the health benefits of caloric restriction - the only laboratory-proven method of life extension - while doing just the opposite and eating as much as they wanted. Several pharmaceutical companies are now rushing to bring these concepts to the human market."  

Learning how exercise works

Exercise protects against a host of illnesses, from heart attacks and dementia to diabetes and infection. How it does so, however, remains surprisingly mysterious. But a paper just published by Beth Levine of the University of Texas Southwestern Medical Centre and her colleagues sheds some light on the matter.

Dr. Levine and her team were testing a theory that exercise works its magic, at least in part, by promoting autophagy. This process, whose name is derived from the Greek for “self-eating”, is a mechanism by which surplus, worn-out or malformed proteins and other cellular components are broken up for scrap and recycled.

Dr. Levine reckons that manipulating autophagy may offer a new approach to treating diabetes. And their research is also suggestive in other ways. 

Autophagy is a hot topic in medicine, as biologists have come to realise that it helps protect the body from all kinds of ailments. 

Autophagy is an ancient mechanism, shared by all eukaryotic organisms (those which, unlike bacteria, keep their DNA in a membrane-bound nucleus within their cells). It probably arose as an adaptation to scarcity of nutrients. Critters that can recycle parts of themselves for fuel are better able to cope with lean times than those that cannot. But over the past couple of decades, autophagy has also been shown to be involved in things as diverse as fighting bacterial infections and slowing the onset of neurological conditions like Alzheimer’s and Huntington’s diseases.

Most intriguingly of all, it seems that it can slow the process of ageing. Biologists have known for decades that feeding animals near-starvation diets can boost their lifespans dramatically.

A few anti-ageing zealots already subsist on near-starvation diets, but Dr Levine’s results suggest a similar effect might be gained in a much more agreeable way, via vigorous exercise. The team’s next step is to test whether boosted autophagy can indeed explain the life-extending effects of exercise. That will take a while. Even in animals as short-lived as mice, she points out, studying ageing is a long-winded process. 

But she is sufficiently confident about the outcome that she has, in the meantime, bought herself a treadmill.