Lab Rats : cancer

Cancer care from the heart

Seema Singh — Fri, 17 Jul 2009 11:20:00 GMT

It may sound a little over the top but what do you call it when a private, for-profit hospital founder and a heart surgeon insists on keeping the radiotherapy cost at his new hospital lower than the government hospital in the city.

That is the story of the new 1500-bed cancer hospital that two entrepreneurs in Bangalore - Dr Devi Shetty and Kiran Mazumdar-Shaw helped launch today-Mazumdar-Shaw Cancer Centre. Kiran has invested her personal wealth (she is quick to tell everybody, ‘Biocon has nothing to do with this') and wants to see a whole new paradigm of cancer treatment evolve in the country, which is "not impulsive but comprehensive and planned according to each patient's need".

Tall order there...cancer is estimated to kill more people than heart attack in a few years.

It's also taking economy of scale to new limits-if Shetty could do it with heart treatment, why not with cancer? That was Kiran's condition, says Shetty, who agrees that it's easier to lower costs (with high volumes) in cancer as the recurring cost is less than in cardiac surgeries where implants cost a lot.

In cancer the cost accrues primarily due to expensive equipment which can cost up to Rs 30 crore each. "Most of the machines need to be maintained round the clock so we'll undertake therapy 24 hours-I can provide radiotherapy to poor patients at 2 am," he says, explaining how he plans to bring the cost down.

In his characteristic style Shetty said ‘no patient will be turned away".

We'll keep a track of how this venture progresses...

For a disease that signals only morbidity and bankruptcy for the not-so-privileged families, this venture, which intends to have satellite services in different locations since Shetty's hospitals anyway run one of the largest telemedicine programmes in the world, can bring some hope.

For now, it's free screening season at MSCC.

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Hulaballoo over conflict of interests in cancer research

Jacob Koshy — Wed, 13 May 2009 10:59:00 GMT

Let's say you read a brilliant research articled, and at the bottom a tiny asterisked note that says: "The author received funding from xyz company for this research." Would you be put off, or discard the just-a-few-minutes-ago-brilliant work as "compromised," "doubtful,"or worst of all "biased?"

A paper published in the latest issue of Cancer, says that nearly 29% of research papers on cancer research published by top journals noted a 'conflict of interest.' That means about 513 of the 1534 of the research articles analysed was a) funded by industry b) had ATLEAST one author who was part of industry. That's dangerous, says lead author Reshma Jagsi, of the University of Michigan, Ann Abour. Industry funded researchers, according to her, will be biased in their analyses.

"In light of these findings, we as a society may wish to rethink how we want our research efforts to be funded and directed. It has been very hard to secure research funding, especially in recent years, so it's been only natural for researchers to turn to industry. If we wish to minimize the potential for bias, we need to increase other sources of support. Medical research is ultimately a common endeavor that benefits all of society, so it seems only appropriate that we should be funding it through general revenues rather than expecting the market to provide," she concludes.

Absurd, I say. Most useful, good quality research (involving professional scientists) is either industry or public funded. Why should publicly-funded research have a halo of objectivity, or accuracy anymore than industry research? Hypothetically, say a pharma company funds research that promotes one drug over the other. The drug, therefore, is either effective/ineffective/as good as state-of-the-art medication (if one exists)

If it's ineffective, the industry loses money in that research, the researcher loses credibility. Nobody funds him anymore. Career ruined.

If it's as good as state of the art, why bother analysing it--unless it is cheaper. If it's cheaper, great, else same as above.

If effective. Then it's just honest advertising. Nothing wrong with that, right?

Unfortunately, scientists are generally perceived as higher beings. Unkempt, passionate geniuses tirelessly pursuing the long, hazardous road to the 'truth.' Truth is they are people with jobs, like everyone else. With beliefs, biases and brains, to design experiments (akin to arguments) to prove or disprove what they 'think' is right or wrong.

Consider India where over 85% of our research is publicly funded. So by Jagsi's reasoning, stellar, unbiased research gushes out of our academia. Well if it is, where is it? Director's of labs here hold press conferences if their scientists publish in Nature or Science, considered the top journals in the world, i mean that's how rare they are.

Objectivity, bias, bad data are issues to be handled by the editorial boards at science journals. Research is only as good as the honesty and intelligence of the editors and peer-reviewing scientists. Being competitive, human beings themselves, they have their own epaullettes and skeletons.

V J Gupta, of the fake Himalayan fossils fame, used public funds. As did tarnished stem cell rock star Hwang Woo-suk. So much for 'honest, objective' non-industry funded research.

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Religious belief + cancer = Prolonged life?

Seema Singh — Wed, 18 Mar 2009 05:55:00 GMT

Several scientific studies have studied the effect of religiosity on cancer survival, sometimes even on the risk of getting certain cancers.

A new study in today's JAMA (Journal of the American Medical Association) shows that cancer patients, with strong religious belief, and hence positive religious coping, are about three times as likely to receive intensive life-prolonging care (such as mechanical ventilation or cardiopulmonary resuscitation) than those with low level of religious coping.

This may be a strong indicator of the type of treatment received at end of life, say Andrea C. Phelps of Beth Israel Deaconess Medical Center in Boston and colleagues.

For patients facing a life-threatening illness, religious coping, such as through prayer, meditation and religious study can offer patients a sense of meaning, comfort, control and personal growth, say many experts.

"Positive religious coping has been widely associated with improved psychological adjustment to stressors including serious illness," the authors write. "These results suggest that relying upon religion to cope with terminal cancer may contribute to receiving aggressive medical care near death."

Researchers suggest that clinicians should recognize and be sensitive to the influence of religious coping on medical decisions and goals of care towards the end of life.

The killer and traumatic disease that cancer is, several studies have looked at if and how religion plays any role in cancer patients' life. This meta analysis of 17 studies in the last 40 years in the September 2008 issue of the European Journal of Cancer was undertaken to verify earlier results which showed significantly lower risks for certain cancers among members of Christian religious communities than in general population.

But it found that in studies in which adjustment was also made for healthy habits, no reduction in risk for cancer was observed. Its conclusion: "The Most important factor in the correlation between membership in a religious Christian community and risk for cancer is the healthy lifestyle inherent in religious practice in these communities."

This applies to other religious communities as well -- all religions, in their original undistorted form, preach healthy practices, right?

Bottom line: the cliché ‘faith can move mountains' can be interpreted in many ways; one can choose to have faith in oneself, a supreme being (God, if you will), Nature... The outcomes in disease management are positive.

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Treat your doc as god, but for heaven's sake ask questions

Seema Singh — Mon, 23 Feb 2009 05:35:00 GMT

Let me start with an anecdote.

Some three years ago, while researching for a story on clinical trials, I visited some hospitals in the city meeting doctors who ran human trials of new (also some old drugs for new indications) drugs. In each case I found several patients, not necessarily poor but visibly uninformed, relying totally on their doctors and soaking in their words as gospel truth. "You know the best," was the clichéd patient response.

Today, a new report in the journal Cancer (April 1 issue) says that when cancer (colorectal) patients seek out health information from the Internet and news media, they are better off in getting the latest, and by some stretch, the right treatment. I wonder what happens to people who don't have the (right) information?

Colon cancer is a good example where over screening and diagnosis can do more harm than good. "These findings emphasize the importance of exploring patient influence on physician prescribing patterns and understanding the impact of information seeking on cancer outcomes," the authors from the Dana-Farber Cancer Institute. Boston, and Universty of Pennsylvania write.

The findings can apply to breast cancer treatment in India. We are witnessing an explosion of screening centres, along with most existing diagnostics centres and hospitals providing "Women's executive health check up" or some such scheme, which invariably offer an X-ray without a physical examination. (A simple examination can rule out the need for an X-ray in normal cases with no family history.)

So, what's the way out? Does the onus lie on patients to be more informed or does it lie with the medical fraternity to spend more time and money on patient education and counseling?

For obvious reasons, it's difficult to expect the latter. Here's an example:

I once went to a doctor seeking medication for an allergy. To my mind, I explained everything reasonably well: "I am allergic to heat and chill. I get rashes. If you want to see I can climb stairs to the third floor, rashes would come; alternately, I can put my hand in front of the AC outlet in your cabin." Even before he could think, I did the latter and, wow! red rashes were all there for his close examination.

I elaborated further: "If I take Allegra-180 mg, I am fine for a week; if I take 120 mg, the effect lasts only 2 days. And I know I am not allergic to milk products, as I stopped them for five months and found no relief."

He gave me a weird look, as if saying, ‘you know a tad too much about your allergy'. "Here are some medicines (just a mix of anti-histamines), try them," he said, looking pretty unsure. I, though, was sure not to try them.

I walked out thinking, I did know a bit about my disease but I knew nothing about its treatment. And that's why I went to him!

"Allergy is Allah-ki-marzi" had said a family doc and I thought it better to leave it at that.

Bottomline: Not all diseases can be left entirely to God or doc, so, if possible, please go informed (to the doc, of course) and ask questions!

PS: What does your experience say?

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Finally, cancer clues in urine!

Seema Singh — Wed, 11 Feb 2009 14:38:00 GMT

For long, the traditional and modern systems of medicine have locked horns over the possible role of urine in cancer treatment. While the former continues its tradition, the latter is applying tools of modern science to test it, finally inching towards a non-invasive cancer diagnostic.

A team of US researchers has found a molecule (rather, a panel of small molecules called metabolites) that is produced by the body's metabolism, and can be used to diagnose the type of prostrate cancer. Known as sarcosine, the molecule could be associated with prostrate cancer invasiveness and aggressiveness. The team reports the work in Feb 12 issue of Nature.

Since sarcosine is detected in urine, the findings suggest it could lead to a simple, non-invasive urine test that would help doctors determine which prostate cancers are slow-growing and which require immediate, aggressive treatment.

"Current biomarkers for detection or progression of prostate cancer are not as precise as we would like. Therefore, a more accurate indicator of cancer is of great interest," said Sudhir Srivastava, chief of National Cancer Institute's Cancer Biomarkers Research Group.

For co-author Arul M Chinnaiyan, Michigan Centre for Translational Pathology, Ann Arbor, "components of the sarcosine pathway could serve as novel avenues for therapeutic intervention." Last year, he had devised an experimental urine test that could detect prostrate cancer better than the PSA blood test currently used worldwide, which, besides cancer, also identifies men with enlarged prostrate glands.

One of the challenges in this cancer is that patients get over treated because physicians don't know which tumors will be slow-growing. Sarcosine promises to be a biomarker for the aggressive tumors.

Besides the academic research groups, a biomarker company, Metabolon Inc., was involved in this. Chances are the bench- to-bedside translation research will begin soon.

In 2002 in India, the then S&T minister MM Joshi and CIMAP, Lucknow, scientists made a big splash when a US patent was obtained on a cow urine distillate that enhanced the activity of anti-cancer drugs. But as far as my knowledge goes, not much ‘translation' research has happened to further the finding! (Central Drug Research Institute in Lucknow also had a good lead in turmeric/curcumin - for anti-stroke properties-- but that too is probably delayed in translation.)

Notwithstanding the promising results, researchers say, "Results are preliminary at this point and will need years of further testing and development before this technology would be available for patients."

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Decoys in off-label drug promotion

Seema Singh — Tue, 28 Oct 2008 01:30:00 GMT

My hotmail inbox has, on average, one mail on Viagra discount sale every day. Well, the promotion these days is for Viagra's protection against bacterial infection! I haven't checked out the websites but from the subject line it looks like another off-label promotion of this blockbuster drug, fake or genuine I don't know.

Off-label use of drugs is legal, but its promotion by drug manufacturers is illegal. A new research in the open source journal PloS Medicine today shows how drug companies covertly promote off-label use of drugs.

Adriane Fugh-Berman, Georgetown University Medical Center, Washington DC and Douglas Melnick, a preventive medicine physician from North Hollywood, California argue that while off-label drug use is "sometimes unavoidable" and sometimes "demonstrably beneficial," it has also been linked with serious side effects. Off-label drug use, they say, "should be undertaken with care and caution due to the uncontrolled experiment to which a patient is being subjected".

Off-label use in India has its own story. While it's prevalent, even in children as this September study shows; Indian drug regulator has done a poor job in monitoring. The ongoing letrozole (anti-cancer drug used for treating anti-fertility cases) controversy amply proves this.

Read some more stories of off-label (mis)uses here.

Since even the stringent US FDA has come in for censure for its oversight of the promotion of drugs for off-label use, it's not surprising the researchers in this present study are calling for restrictions to off-label promotion of drugs to be strengthened.

"Companies that engage in off-label promotion should be heavily fined and their future marketing practices subject to increased scrutiny by regulatory agencies," they argue.

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India's import: asbestos cancer

Seema Singh — Tue, 21 Oct 2008 03:40:00 GMT

To what extent can business interest blind nations to health disasters? We don't know yet. The way Canada and India (and some other developing countries) are conducting asbestos business, it's really difficult to believe if there's conflict of interest at all in Canada continuing to export asbestos, despite limiting its use within its own territory.

An editorial in today's issue of the Canadian Medical Association Journal says: "Canada is the only Western democracy to have consistently opposed international efforts to regulate the global trade in asbestos. And the government of Canada has done so with shameful political manipulation of science."

The 4-day Conference of the Parties of the UN Rotterdam Convention will begin on October 27. In the past Conventions, India and Canada have been instrumental in ensuring that "right-to-know controls" on asbestos have not been allowed.

Canada argues that its export trade need not be dangerous if the exporting countries practice safe use and put "regulations, programs and practices equivalent to Canada's ... in place."

Isn't that ridiculous? Canada thinks India, Thailand and Indonesia can succeed in managing asbestos safely when developed countries haven't succeeded in this; and hence have either banned it or moved to inexpensive alternatives.

On the other hand, India is "on the cusp of a devastating asbestos cancer epidemic" says a new report published on September 25 by a coalition of Asian campaign and research organizations, global union federations and the International Ban Asbestos Secretariat (IBAS).

Some highlights of the report:

* India is the world's largest importer of chrysotile asbestos, followed by China, Thailand and the Ukraine - the only countries importing more than 100,000 tonnes. India is Asia's second largest consumer of asbestos.

* Indian import duty on asbestos was slashed from 78% in 1995-96 to 15% in 2004. Lowering the cost of imported asbestos fiber means that dangerous asbestos-containing products are cheaper than safer alternatives.

* India does not operate a national cancer registry or record occupational histories with medical records, so the asbestos cancer epidemic is not officially tracked or recorded. There are no official statistics.

"The UK is now in the grip of its largest ever industrial disease epidemic, with between 5,000 and 10,000 estimated to be dying of asbestos cancers every year," says report editor Laurie Kazan-Allen.

When will India and Canada both rethink their positions?

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Cheers to red wine, this time for cancer

Seema Singh — Tue, 07 Oct 2008 09:12:00 GMT

Time, once again, to celebrate that wonder molecule in red wine called resveratrol. New research in today's issue of Cancer Epidemiology, Biomarkers & Prevention shows that moderate consumption of red wine may decrease the risk of lung cancer in men, particularly among smokers.

Lead author Chun Chao analyzed data collected through the California Men's Health Study from 84,170 men aged 45 to 69 years. Researchers measured the effect of beer, red wine, white wine and liquor consumption on the risk of lung cancer.

After making adjustments for age, race/ethnicity, education, income, body mass index, history of chronic obstructive pulmonary disease or emphysema, and smoking history, researchers reported a 60 % reduced lung cancer risk in these men.

You might have read several such reports in recent times on health benefits of red wine. But to add some rigour to readability, I dug into scientific literature. Here's what I found:

* In September, a study by the University of Pittsburgh School of Medicine reported that resveratrol, the natural antioxidant commonly found in red wine, may offer protection against radiation exposure when used with acetyl. The group studies small molecules that have radioprotective properties and which can be easily stored, transported and administered. "Currently there are no drugs on the market that protect against or counteract radiation exposure. Our goal is to develop treatments for the general population that are effective and non-toxic," said researchers.

* In July, a new report in Cell Metabolism showed that red wine ingredient wards off effects of age on heart, bones, eyes and muscle. Of course the study was on mice, which began taking resveratrol in midlife and yet showed cardiovascular benefits, greater motor coordination, reduced cataracts and better bone density. These benefits come without necessarily extending the animals' lifespan.

* In June, The Journal of Neuroscience reported the potential new role of red grape seeds in treatment of Alzheimer's disease. In the same month, researchers presented a new study at the 90^th annual meeting of The Endocrine Society's in San Francisco showing that resveratrol reduces the number of fat cells and may one day be used to treat or prevent obesity.

The list goes on -- multiple sclerosis, depression, strokes...

It's great news - both for medical science and wine drinkers. If I remember correctly the US FDA has even suggested the dosage -- one full glass/day for men, half of that for women. But mind you, the thing to remember is moderation!

Disclaimer: The wine glass photo is free & randomly picked from the web (to add colour to the blog), with no intended brand marketing.

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