The Three Legged Chair

February 8, 2012

an essay by Robert Kane Pappas

The political flap over the prominent and well-funded breast cancer advocacy group -Susan G. Komen for the Cure – cutting off financing for screenings at Planned Parenthood – was spoken about largely on a political Left/Right basis.  

In her New York Times essay on February 7th, Susan Love, M.D. poses a different and perhaps more basic question. Her view is that the real race in cancer is “finding its cause”; and she takes up the question of the efficacy of mammograms, laying out how according to British researchers, early detection saved one life for every 400 women between the ages of 50 and 70 who were screened regularly over a ten year period.  In terms of preventing deaths this is a tiny percentage. 

 Dr. Love explains that the underlying reason for this is that there turns out to be 5 or more types of breast cancer, some indolent, some virulent. The aggressive tumors have usually already spread by the time a mammogram finds them.  She concludes that early detection has its limits; the thing to do is to find the cause.

I have a few other ideas about this three legged chair of Politics, Medicine and Science. 

In the more than 5 years of investigation and filming molecular biologists and various researchers in connection with my forthcoming series on aging, “The New Fountains of Youth”, it has become clear that “cause” must be thought of in the plural, “causes.” Just as there is no one cause of aging, there is no one cause of cancer.

However in both aging and cancer research, the good news is that there are several nexus points (nexus genes), where scientists appear to be able to intervene. These genes control a cell’s – and hence the body’s – repair mechanisms. They inadvertently control aging, longevity, and speak directly to the question of the causes of cancer, and also, to the questions of why there are different types of tumors; why some women develop relatively harmless or curable versions of breast cancer, while others get the bad one.

 People with ‘good versions’ of these genes which control the cells’ repair mechanisms may get cancer, but they tend to get a type or degree of cancer that can be treated.

When I interviewed Nir Barzilai, M.D. Ph.D.,head of the Einstein Research Center on Aging,  for my series, he spoke of his study on several hundred centenarians and their children. Dr. Barzilai explained, in part, how they live that long. “Some of the centenarians look young, others, nothing will kill them, but they look old. A number of centenarians have never had a major illness, some of them smoked cigarettes for 90 years. Others get sick but they always get better.” They don’t have dementia or Alzheimer’s. 

The trick is that both groups of centenarians have good versions of certain nexus genes such as “telomerase.”  Their telomerase gene has certain mutations, which helps the gene do a good job of repairing the telomeres at the ends of each chromosome, which in turn keeps the cell intact longer when it divides. In fact, the centenarians have better versions of several key genes that regulate many cellular processes, including apoptosis, a process in which damaged cells commit suicide as opposed to becoming cancerous. This is one reason people with good versions of these genes survive cancer and live on for a long time.

To make a broad statement, the scientists have found that aging and disease are so closely related, that researchers now say that aging is the primary cause of all the major diseases. These genes control aging.  Control aging and you delay and ameliorate diseases. 

Nutrition and exercise have a strong impact on aging because they also influence these key genes. Environment and chronic stress impact aging genes. Some individuals have an inherited mutation, which increases the likelihood of developing this or that pathology. These ‘causes’ or “Risk Factors” influence the body’s repair mechanisms, causing it to age slower or more quickly.  These genes protect us from cancer.

Underneath all these factors, the primary cause of disease is aging. Tens of researchers have told me this. People who age more slowly either don’t get cancer or get manageable forms of it. This also applies to the other major diseases. They either don’t get them, or get milder versions of them.

Simple but true.

That’s the good news. Here’s the bad news.

The third leg of the chair of modern medicine and science is politics. In particular, GOP Politicians politicize common sense points of agreement with regard to medicine and science. Clearly, at a minimum, scientists will be able to keep us healthy and active longer. Economically,. prevention and delay of disease is obviously the answer. Every single scientist I spoke with said this.

The GOP will then talk about the budget deficit. Earth to the GOP – “Research Saves Money”, it’s infrastructure.

The business of politics and the politics of business influence both the scientific and medical chair legs. There is nothing good about creating wedge issues in areas where the entire population actually agrees. The mainstream media often discusses science and medicine in terms of conflict and sensationalism, or they play along with fools who try to make it a left/right thing – “ big government bad” –  hindering fruitful research in the name of balancing the budget (i.e., playing to voting groups).

Only 8 percent of research proposals are funded, which means 92% of them are not. The result is that scientists have to play it safer in order to get grants, which delays breakthroughs. To a man and woman, the researchers complained about this state of affairs.  And, other countries are in this game, they have scientists too. The political gamesmanship could export a blossoming industry.

What about the “private sector?”

The scientists say that large drug companies do little basic research work. Their primary concern is developing patentable drugs, having them approved by the FDA, and marketing them.

Moreover, major organizations like Susan G. Komen for the cure, groups which go after this or that disease, command major resources and funding, and tend to dominate what the media concentrates on and therefore what the public knows.

Several scientists argued that aging research goes after many diseases at once and should be more heavily funded than it is. The business and funding of science and medicine make this obvious solution much more difficult to achieve.

A couple of years ago Leonard Guarante Ph.D., head of the Paul Glenn Lab at MIT mused that he wasn’t sure what might happen if these discoveries produce a kind of silver bullet, ‘because various large organizations have a huge financial stake in the ‘status quo’ – from Big Pharma and the AMA, to large advocacy groups.

If we use our heads and avoid the easy labels and surface discussions, maybe we can get a fourth leg for that chair, design a better chair, make it cheaper, and create a new 21st century industry that could easily rival the computer revolution. I believe there is progressive high ground to be staked out here.

To the scientists, the answer is simple.

But the 3 legged status quo chair commands the narrative and the lazy media’s attention. Herein lies the problem.

In honor of today being the bicentennial of Charles Dickens’ birth, let’s have this important scientific discussion without politics. 

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