Cancer biology. We know a lot, we don’t know quite a bit …

As we look at natural history in 513, it’s a good idea to remember that being a physician scientist involves having an open mind. We all have in our memories the standard picture of the rise and progression of cancer. One bad cells leads to two, then four etc. In pictures, a little ball of cells becomes a bigger and bigger ball. The message is that bigness is badness, and getting rid of the bigness is in some sense actually attacking the roots of cancer.

Pictures are not reality. This picture might reflect the underlying biological reality. But it might not. The facts we know are reality, and more than one picture might be compatible with the underlying facts. Take a look at this article in Science, which talks about circulating tumor cells and what they might mean. This ties in with an idea in cancer science that the important cells in cancer might actually be a small (actually tiny) subset of the tumor which are cancer stem cells.

The most important disease(s) is(are)?

Judging by television news, you might think that breast cancer is the only disease that exists. If we wanted to spend money on the disease or group of diseases that results (by a considerable margin) in the greatest lost of quality of life years the world over, denying young (and older) people of their lives and quality of life, we would spend our money on mood disorders, schizophrenia, and bipolar illness.

Psychiatry is often knocked by the rest of medicine as being relatively unscientific (ie its all about talking). But the psychiatric community has probably gone farther than most in putting (with some success) their discipline on a scientific basis. One of the remarkable things about psychiatry is the presence of a codified scientifically based diagnostic process. This is diagnosis at the RDC or gold standard. How this is done is quite a remarkable story in itself. Science has an ongoing series of article about the latest revision of the DSM. The articles so far are 1) Proposed Revisions to Psychiatry’s Canon Unveiled, 2) DSM-V at a Glance, 3) Behavioral Addictions Debut in Proposed DSM-V, and 4) Experts Map the Terrain of Mood Disorders.

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Alzheimer’s, Parkinson’s, ALS, Huntington’s: could they all be prion diseases?

An article in Science outlines the hypothesis that all these diseases are caused by prions. There is a UBC angle re Dr Neil Cashman’s work on ALS. Good medical/science journalism: priceless!

Great medical journalism at the New York Times

Being a scientist involves always having an open mind. Today’s New York Times has an article here by Gina Kolata about the work of Dr. Mina Bissell on the cause of cancer.

In 513, you’ll hear me say over and over that we don’t know much natural history of disease, and this is probably the source of a lot of “muddiness” in epidemiology. Here is a link to another Kolata article, in which results of a study on natural history of breast cancer suggest that some cancers go away spontaneously.