Thursday journal reading

A bit of this and a bit of that from the weekly medical journals.

Magic bullet? You have no doubt seen the typically breathless coverage of a report in NEJM this week about a man with metastatic melanoma whose tumors disappeared after an innovative immunotherapy procedure. In a pistachio cell, the researchers first took some CD4+ T cells from the patient. These are so-called "Helper T cells" which don't directly kill pathogenic cells, but call other elements of the immune system to do so. Think of them as artillery spotters. Anyway, the researchers then selected cells that responded to a protein displayed on the surface of the man's cancer cells, cultivated about 5 billion descendants of the selected T cells in the lab, and injected them into the patient. His tumors disappeared and he seems to be fine two years later.

What the teevee didn't tell you is that while this was a very informative experiment, this particular procedure will work for only a small minority of people with melanoma; specifically, those whose tumors display the antigen in question, and who have some other, as yet unknown lucky characteristics. In fact, not all of this patient's cancer cells displayed the protein in question. The researchers hypothesize that when those cells that did display the antigen died, they released other antigens which stimulated a broader immune system attack on the cancer. In any event, the bottom line is, every cancer is different, and while there might be a magic bullet for a particular cancer, it won't work for others. Progress in treating cancer remains slow, incremental, and oh yeah, expensive.

The power of wishful thinking: Jay Olshansky and Thomas Perls, in JAMA, report on widespread use of Human Growth Hormone (HGH), not only by body builders but also by clinics that purport to combat aging. In fact, the medical evidence is quite clear, HGH given to normally aging individuals does nothing to slow the effects of aging. On the contrary, the most likely effect would be to shorten the life span. Nevertheless, there are companies that give seminars to doctors in how to set up "anti-aging" practices and prescribe these drugs to people. This is called quackery. I commend to your attention Quackwatch, your comprehensive Internet resource for health frauds, scams, flimflam, bamboozlement, and bullshit. Before you believe anybody trying to sell you the miracle cure that "they" don't want you to know about, check it out at Quackwatch first.

Yes, there is a great deal wrong with medicine as actually practiced by people with M.D.s using FDA-approved drugs and devices. But it's not that they are hiding the truth from you in order to doom you to death from cancer or your child to autism. In fact, the main problem is that they're doing too much and might do better just to leave you alone. They don't necessarily know everything there is to know about relieving symptoms and helping you cope with your illnesses, so do go ahead and try the meditation and the yoga and massage and so forth if it appeals to you and you find that it helps. But don't expect magic.

Stayin' Alive: The World Health Organization has come out with its annual compilation of statistics, (warning: pretty big PDF) and it's chock full of fascinating info. Progress on UN goals generally, but slower than expected and with continuing immense inequalities. By 2030, they expect that 3/4 of all deaths will be from non-communicable diseases, a huge difference from the human condition as we have known it since we were chasing antelopes with sharpened sticks. They're expecting the 3rd leading cause of death that year to be COPD - i.e., tobacco. They're expecting the first and second leading causes to be heart disease and stroke, with tobacco obviously contributing to those as well although they don't say how much.

The merchants of death are still raking in the trillions. They are eeeeeeeevill.