Helpful Poisons

Cancer Research UK run the Race For Life evens, in which thousands of people from all walks of life, young and old, go out and run/walk to collect sponsorship money that’s donated to CRUK.

My boss – known in the building as one of the many PIs (Principal Investigators) who head the lab groups in the Institute we work in – went along with her 6 year-old daughter to go up on stage and thank people for participating.

I spoke to her about it a while ago and she told me how moved she was to see so many people come out to do their best on a Sunday morning, raising what money they can so enthusiastically. That she was very emotional surveying the sea of people in pink who had turned up to support each other and by raising that money, the scientists whose work aims to improve the treatments we have for cancer. That includes our lab. Plus the patients and their families who have to go through all of it.

Her daughter asked “why are all these people getting cancer?” – because they’re ill, she replied. I know I wouldn’t have understood such a concept at that age either so her determination is admirable.

What treatments we currently have are by no means ideal, although curing people of cancer does happen, contrary to popular belief. Sadly, googling that kind of thing will lead to lots of alt-med scam sites trying to tell people if they just eat raw peppers or rub hemp oil on themselves, their tumours will disappear. This is incredibly damaging for hopefully obvious reasons.

Tough Love

Many chemotherapeutic drugs do cause horrific side-effects that make people feel very ill (of course, they are already seriously ill, but often we don’t feel it just from the disease itself). That’s because chemo, generally, is a form of poison. Alt-med proponents will often try to use that fact to make medicine sound bad to people they want to convince to use alternative products instead – sadly, people fall for it sometimes and this of course can have the worst consequence.

It is designed to kill living cells – the cancer cells. Anything that’s capable of doing that is likely to be unpleasant – remember that awful hangover? Your liver cells weren’t happy about that night, certainly. Fortunately most of us drink sensible amounts and don’t end up causing liver cancer when we’re enjoying the effects of alcohol.

Therein lies the important element – sensible amounts. The thing about drugs is that dose is everything – we’re finding this more and more in our research and perhaps I’ll write something about that at a later date.

Chemo drugs are carefully researched so that doctors know how much to give – how much should kill off the cancer most efficiently, while doing as little damage to the rest of the person as possible. The reason it often makes people feel ill is that there will be some damage – off-target effects, as they’re known – to normal tissues.

Much cancer research currently focuses on developing different drugs that will be entirely tumour-specific, eliminating or at least drastically reducing side-effects.

The thing about cancer cells is that they grow too quickly, they’ve gotten around the normal checks and barriers cells have that tell them to stop growing. Most cells don’t grow and divide in adults, they’re stable – with obvious exceptions like the lining of the gut, which is constantly replacing itself, the womb lining during the menstrual cycle, hair follicles…

And this is where the chemo side-effects come in. We target cancer cells’ ability to grow and divide a lot with these drugs, which unfortunately also go for some normal, non-cancerous dividing cells. Hence the hair loss effect that’s commonly seen (not with all drugs) and other painful/unpleasant things.

Now we have other treatments, for example radiotherapy targeted very specifically at the tumour with highly-specialised machines designed to minimise off-target exposure. Since the radiation used is also what can cause cancer (by damaging normal DNA – this is why you need to wear sun cream!), you don’t want to hit normal tissues with it any more than you absolutely have to. This is another alt-med favourite, ‘Cancer treatment gives you cancer! They want you to come back for more!!’ – it’s conspiracy theory at its best. There’s truth in it, but it’s been distorted away from reality.

Cause, simplified

If you can damage cancer cell DNA to the point where controls do kick in to destroy the cells, that’s a good way to kill tumours. But also, as I said, DNA damage is what causes cancer in the first place – it can come from various sources; hereditary cancers are mainly or entirely (example) due to mutations, that are passed down from previous generations, in particular genes that usually control cell growth.

Sporadic cases of cancer occur when there’s too much exposure to environmental carcinogens – be it sunlight (UV), cigarette smoke, alcohol or a combination of many subtle things – in that case the normal DNA is damaged in places that are important for maintaining cells’ in-built anti-cancer controls.

These two distinctions and the explanations are extremely simplified but hopefully making sense (?).

That’s why it’s still a numbers game – you’re not 100% certain to develop cancer even if you do things that do involve carcinogens and they may well have damaged your DNA, the point is that particular damage may not have occurred in places that affect the cells’ anti-cancer controls. Only if it occurs in genes that regulate cell growth in some way will it then possibly lead to cancer. Even then a number of other changes will need to occur in that population of cells that are now growing more for cancer to take hold.

Thing is, once you have some damaged cells that are growing more frequently, there are more chances for further DNA damage to happen as cells replicate. As the population gets bigger, the likelihood of the changes occurring in ‘bad’ places (i.e. further reducing the barriers and promoting growth) only increases.

So it’s a question of risk. It’s a gamble, if you want to smoke, for example. For me it’s absolutely not worth it – why spend money on something that does nothing but make you a drug addict (sorry, but that’s the case, for those who don’t insist it’s just a social thing and I can quit whenever I want) and increases the chance of your lung cells becoming irreparably damaged to the point where you may well lose a lung, or indeed your life? ‘Cool’ is very subjective, and those things don’t fall within my list.

At least the liver has alcohol dehydrogenase – but it’s still a question of dose, and ADH doesn’t apply in oesophageal, pancreatic or other cancer types.

Everything in moderation

Sure, we can’t obsess about everything every minute of the day – but there are sensible and easy things to be done to protect yourself and your family – for me, that’s completely worth it. Once you’ve watched a loved one die of cancer, whatever form, whether they had a hand in its occurrence or not – well, I don’t need to say more.

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The people who get up and raise money for institutes like ours all over the country, and the world, do contribute to the medical establishment’s ability to treat cancer. They deserve all our thanks.

Cancer is immensely complicated, we don’t fully understand it yet, but the more everyone does know, the better we can cope with it.

Maybe one day we’ll look back in wonder that so many lost their lives to such a thing; as we look now at little cuts and grazes when bacteria killed so readily, before we understood their existence and found (relatively) simple ways of dealing with them.

This seems a nice future to hope for.

Complementary Responsibilities

I’ve just stumbled upon this article via the Twitters. It’s a blogpost by the Leukaemia and Blood Foundation about some complementary therapy workshops (by @drshaunholt) in New Zealand.

I just want to take some bits from their post and add my own comments as it’s raised an issue in my mind that maybe isn’t condsidered too often in the various ‘communities’ of relevance; medical, skeptical, patient-centred and so on.

Who has responsibility for complementary therapy education?

That’s the question I’ve been pondering, admittedly since about 10 minutes ago so apologies if this isn’t very well-formed.

The therapists?

An obvious candidate would be the provider of said ‘therapy’. However, since we have the unknown quantity of deliberately misleading, fraudulent individuals who are simply out to make money, this is an unwise group to rely on.

This by no means includes everyone working in the ‘field’ but I think we can safely assume that asking a chiropractor if you should pay them to crack your spine because it hurts will result in a resounding “Yes!” in most (but not all) cases.

The patients?

This is the group that most skeptical activities seem to focus on. Sense About Science, for example, aims to arm the public with the tools to ask the right questions and protect themselves against potentially damaging offers of hope, sometimes where none really exists.

We often talk about the people who read the papers and believe poorly-worded articles. People who forsake validated medical treatments in favour of something their mum’s friend’s brother’s daughter recommended and DEFINITELY WORKED. This is another goal of SAS, to address poor science reporting in the media – also mentioned by Dr. Holt.

We’re keen that fewer people allow themselves to be misled and taken advantage of – and I continue to believe this is an important mission, if one that usually feels somewhat futile. If you know your stuff and can be assertive, you can stand up to a barrage of nonsense and come out of difficult situations largely unscathed, and without lining the pockets of charlatans.

What about healthcare professionals?

Here is a group of people oft ignored in this complementary confusion. Regarding the aforementioned Dr. Holt, the blog states:

Shaun is not afraid to tell it like it is. He has had well-publicised battles with both the chiropractic and homeopathic communities due to the lack of evidence that these treatments are effective in helping cancer patients.

Excellent. We need more of these. The diagnosis of a serious illness has to be one of the most traumatic experiences anyone can go through. Healthcare professionals are the ones to break this news and to offer advice and support as people take it in and make their choices about what to do next.

Having clued-up doctors has to be a priority if we’re to help people make sensible decisions for themselves and their families, that will avoid needless suffering and false-hope chasing.

This doesn’t just apply to cancer but to all manner of debilitating and/or potentially life-threatening illnesses:

It is completely understandable that cancer patients will do anything possible to maximise their quality of life and chances of recovery but it does appear that at times certain complementary therapies can interfere with medical treatment.

One of the most famous cases is probably St John’s Wort, a plant and its derived herbal products well-known for supposed anti-depressant properties. However, its active ingredient is also known to interfere with prescription drugs and if people are taken in by those purporting the benefits of ‘all-natural’ treatment approaches, it can lead to disaster.

Something that pro-CAM people will often argue is that there is a place for complementary therapies and patients should be informed of these and given access to them. This may be true to an extent,

Shaun’s research indicates that around five per cent of complementary therapies have real merit in helping address the symptoms and quality of life of cancer sufferers. These therapies include acupuncture, aromatherapy, meditation, art therapy, yoga, certain herbs and vitamins.

However, it should be made abundantly clear that these things are not alternatives, they are not treatments and they will not cure. As Shaun and the blog report lays out,

What must be stressed however, is that complementary therapies can not cure cancer, and it’s really important that patients do not delay seeking conventional medical treatment which may save their lives!

I would like to see a nomenclature change here; therapy can be be somewhat of a misnomer, since we would also apply this term to effective interventions – chemotherapy for example.

These are therapies in the sense that a cup of tea is therapy. Yes, there can be real, measurable benefits but it’s in a more general sense than the treatment of a specific problem in a known, targeted manner.

No one is suggesting we deny people access to lovely things like massages, foot rubs, mugs of tea, candles and fluffy pillows. God, I love candles – my university peers can attest to this (I filled my gigantic room with them and frequently pissed off my housemates with incense. But they let the kitchen descend into a hazardous-to-health state so much it’s not really possible for me to feel bad about it!).

The point is, while it’s good to support ourselves emotionally in difficult times with these little things that can make a big difference in day-to-day life, medical professionals should be clued-up on the associated dangers of fields that make claims bigger than what they can deliver. They should not be shepherding patients in the direction of ‘therapists’ without full explanations of the reality.

Homeopathy will not fix your RSI. Aromatherapy will not sort out your cataracts. Sure, doctors are largely intelligent individuals who won’t fall for any of this stuff, but an alarming number do not know what homeopathy is (or more importantly, isn’t), let alone be able to explain it clearly to someone who’s under considerable emotional stress and may well know nothing at all except hyped-up anecdotes from concerned friends and relatives.

As pointed out by Simon Singh and Edzard Ernst in Trick or Treatment, healthcare professionals hold a lot of responsibility in the drive to educate people about CAM and perhaps it’s time we teamed up with those who are already doing a fantastic job to spread their knowledge so that more doctors can help their patients with these  decisions more effectively.

<3

OK I’ve mostly avoided mentioning anything about today’s date but a few people scuppered the plan as expected. Oh well. Happy greetings-card-marketing day

I’ll stop being miserable now, let’s talk science!

People ask me what I do quite a lot. I work in a  Cancer Research centre in a group called the ‘Cell Adhesion and Angiogenesis lab’, which is a mouthful.

Cells, for anyone who is unaware, are the building blocks of the body. One single bacterium is a cell; they’re unicellular organisms. We mammals are multicellular; our bodies are made up of lots of individual cells. Those cells obviously have to stick to each other and to the non-cell elements of the body (bones and all the other inter-cellular stuff) or we’d fall apart!

So that’s what cell adhesion is – how cells stick to and interact with each other and their environment.

Angiogenesis is the growth of new blood vessels from pre-existing ones.

All the body’s cells need oxygen and food to stay alive. They also need to get rid of waste products like carbon dioxide. The blood carries oxygen (via haemoglobin in the red blood cells) and nutrients, so the blood itself needs to be delivered to all the body’s tissues, pumped around by the heart.

All our blood vessels are lined with a particular cell type, called endothelial cells. These guys are the main focus of our lab work, but not the only cell type involved in angiogenesis – indeed, we’re not sure what some of the cell types are exactly, or how they all work together – but that’s what research is for!

When new blood vessels are needed (e.g. to heal a wound, during the menstrual cycle, in development etc.), endothelial cells ‘wake up’ from their usually sleepy state in response to various cues from the environment – not all of which we understand – and grow and move to form new vessels.

This process is normal and necessary, but tightly regulated - switching off the response is just as important as switching it on – but it can go wrong, as the existence of more than 70 angiogenesis-related diseases shows.

The case we are particularly interested in is of course cancer – tumour cells are

Blood vessels green, tumour red.

growing out of control so they want as much oxygen and nutrients as they can get. Solid tumours (i.e. all cancers except those of the blood) entice blood vessels to grow towards and into them, waking up nearby endothelial cells.

We want to understand how that process works; the field is relatively young, having really got going in the 80s when a major protein was discovered that causes endothelial cells to grow; vascular endothelial growth factor (VEGF), which again is another research focus in our group.

As I said, we don’t even know all the cell types involved, how they interact, what they respond to – all things we need to learn about if we’re going to make decent cancer drugs.

This is why we can’t just use computers as a lot of anti-vivisectionists like to suggest; you can’t put into a computer program what you do not know about.

Anyway, back to the researching; we do an experiment quite a lot, called the aortic ring assay. The aorta is the major blood vessel that leaves the heart. We put little rings of aorta into collagen (one of the components of the ‘stuff’ outside cells I mentioned) and see how many tiny vessels sprout from them. I’m writing a paper about it at the moment actually, not that we invented the technique or anything.

This can give us information about how endothelial cells respond  to various treatments and how angiogenesis is affected; whether we’re altering some genes (making them more or less active than normal) or adding some drugs to the rings’ food.

We can look at different cell types and how the sprouts look; long/short, few/many, straight/tortured, thick/thin – you get the idea.

The picture below is from one of my experiments late last year. The aortic ring  (bright central bit) here is on its side, with the middle of the vessel (the lumen, through which blood flows) pointing left/right relative to the screen so you’re looking at the outer wall. It’s about 0.5 millimetres across.

The colours show Endothelial cells, pericytes and fibroblasts and DNA in the nuclei - I can go into how one gets the colours if anyone’s interested, but otherwise you can just enjoy my serendipitous Valentine’s-themed image; I grew a heart from a  bit of heart. Sorta.

My boss says I'm just soppy; maybe she's right.

Thinking Outreach

Science communication seems to be getting more popular; that or as usual I’m just more aware of it so that’s what it seems like.

I do think, even if it’s not more popular, it’s a bit different. Science communicators of the past were often Robert Winston or Carl Sagan types; while often brilliant, typically not that inspiring to many groups of people, being fairly posh middle-aged white men.

We’re seeing more women in science and sci comms (e.g. in blogging), and more diversity generally, which is great.

If you’re interested in outreach (trying to get people interested in science generally) then have a think about coming to ThinkCon in March. http://thinkoutreach.org/ was set up by friend of Super-Duper Woo-Fighting Duo (with capes!), Andrew Holding.

I’m dabbling in it a bit myself – both on this site (see ‘communication‘ tag and the series of posts I did on the BSA SciComms conference last year) and elsewhere – a recent example being the following video. Don’t laugh too much.

‘Bleachgate’ and beyond

Hello!

So, I’m having a bit of a blogging holiday due to other things catching up with me at the moment but I hope to get a few posts out soon.

First, a few words on the ongoing MMS story.

Rhys has been notified that the WHO have now been informed of MMS and will be taking steps to warn the public internationally – fantastic! Have a listen to him on the radio today; from 9:10.

He also received an award at TAM last weekend (I encourage you to read some of the fantastic blog-based commentaries on the proceedings if you’re interested in the concept and might attend next year, and also look up QEDcon!) in recognition of his skeptical activism achievements.

So, on to the meat.

‘Bugs’ and Cancer

I was saying to Rhys the other day: the most annoying out of all Humble’s false claims, for me, is that cancer is caused by ‘a bug inside the cancer cells’.

Some cancers can be initiated by viral infections; when parts of the viral genome are incorporated into our own, as is the case with certain types of virus, some disruption of the DNA sequences in that cell can occur. If that disruption is in a particularly important place – like in the middle of a gene that makes a protein important in preventing cancer from developing – then this could initiate pre-cancerous cellular behaviour. However, for the most part, cancer is not to do with ‘bugs’ but with the genetics, damages and behaviours of our cells.

You certainly don’t treat cancer using the rationale that there’s something living inside your cell that needs killing off. The only bug-like things in our cells are the mitochondria, which are absolutely essential for cell survival – you certainly don’t want to kill them!

Anyway, to continue. There is a blog by the Phaelosopher (whom we have affectionately dubbed failosopher) that I found a while ago. This guy attends Humble’s courses and writes about MMS quite a lot.

There is also a regular commenter (a spammer, shall we say) on Rhys’ blog by the supposed name of Maria who today reveals on failosopher’s blog both that Princess Diana is alive and MMS reverses greying hair! We suspect she either is Jim Humble or may somehow be in his pay; she’s very enthusiastic that we take her personal doctor’s records that we can phone up to scrutinise any time as proof of MMS’ efficacy.

The Fungal ‘Hypothesis’

So, to the point – I come across a comment referring to someone’s friend who analyses cancer patient blood samples, finding that they all have candida; a usually fairly harmless yeast that we all have as part of our natural flora, sometimes causing a bit of thrush if you’re healthy, but can be more serious if for example you are immunocompromised (see wiki for more there).

This person therefore concludes that candida always causes cancer and refers to this site on that very ‘hypothesis’.

I just watched some of the video featuring ‘Dr’ Tullio Simoncini below, but have to run and will finish it later – listen to it! It’s clearly just that freaky tactic of chopping up audio and stitching it together to say what you want, much like the clichéd old newspaper-cuttings ransom note.

Ridiculous.

The lumps are always white

As evidence for their claim that cancer is always white and therefore caused by this white fungus (yes, albicans is Latin for white), they show formaldehyde-fixed tissue. Well, that’d be because when you leave things in formaldehyde for ages, the pigment goes. Plus, tumour cells aren’t usually pigmented, no – except for melanoma, which is nice and black because of the melanin. Blood vessels colour them, but tumours come in a variety of hues. As a quick Google Images search or conversation with a surgeon (but not for the feint-hearted) will show.

The standard scary-theory dramatic music is in the background.

I can’t begin to describe the absurdity of this video. Standard correlation/causation mix-up, pathetic scaremongering. If you do watch it, don’t worry – if you’re feeling a bit itchy down there you can just take some clotrimazole and all will be well.

Metastasis Mixup

The latter part of the video, from around 8 minutes, is particularly worrying.

It suggests that metastasis is not cancer cells leaving the primary tumour (which it is and has been repeatedly demonstrated in the lab and in the clinic) but bits of fungus that are dislodged by ‘conventional surgery’ and chemotherapy exacerbates the development of distant metastatic tumours.

This is yet more damaging anti-medicine propaganda.

This Simoncini fellow is bad, bad news. And guess what he’s peddling as his cure-all?

Oh! Sodium Bicarbonate.

Post-script edit:

Via @rbhinkley - Simoncini was prosecuted back in 2006 (yay!). Google translate aids us with the original Italian text:

‘…date back to 2002, three deaths have prompted the prosecutor to accuse the oncologist Tullio Simoncini of manslaughter and aggravated fraud. The first death, February 8, Massimo Civetta, 34, killed by a tumor of the gut. On March 1, adenocarcinoma ended the life of Maria Grazia Canegrati, Milan, and on November 15, Grace Cicciari, Milazzo. The bicarbonate-based care has cost the medical radiation from the Order. [awaiting better translation of that last bit]

and from earlier in the article:

the oncologist, in exchange for 400 euro, tried the ‘miracle’ with a base injection of sodium bicarbonate, mixed with water, piercing the tumor mass. The effect was not as hoped: the following evening, February 8, 2002, the young man died with a perforated bowel, in excruciating pain.

And hopefully we’ll see far more miracle-peddling quacks who prey on gullible and desperate people go the same way.