Science Wooseum Revisited

Time for an update on the Science and Art of Medicine – Living Medical Traditions exhibit in the Science Museum, London!

If you’re not familiar with the backstory, do check out these posts or listen to my report in the Pod Delusion live 2nd birthday episode – go, make some tea and a sandwich while it’s on or something

Briefly, we’ve been trying to improve the Science Museum’s alternative medicine exhibit as there were some serious problems with it. It largely came across as promoting alternative treatments, even advertising practitioners and generally being worryingly uncritical, with no reference to the results of reliable studies (i.e. that most of the ‘treatments’ are no better than placebo and many carry serious risks) – and indeed no mention of the wonderous placebo effect at all.

I’ve highlighted some of the original displays and issues in this photo gallery, now with some new photos – though a lot of them are appallingly blurry, apologies – in this new set.

Important statement

We are extremely glad that the Science Museum has chosen to listen to these complaints and do something about them. To take a second look at something (that people have worked hard on and are likely proud of) with an objective eye, receive criticisms, consider them and make some changes – that is admirable, it’s scientific and what we might expect from such a great institution.

I think in summary, some very important changes have been made, which is excellent. But more could (and should) be done as it’s still far from the resource it could be (I’ll come back to this at the end*).

Proposed Changes

Last year the museum proposed some changes, based on discussions with Simon Singh and the rest of us. They decided the main sections to focus on were homeopathy and acupuncture – while I agree these were the ‘main offenders’, the whole gallery exudes quite a credulous vibe, but I am completely accepting that a total overhaul would take a lot of time and money so let’s look at these two sections for now.

Homeopathy

From the correspondence:

As you know, we are already proposing to make some changes, on the advice of trustees, to make it quite clear that we are describing specifically the Indian context. In general, as far as I can see, you share the sense of what changes out to be made. You have nonetheless expressed two concerns that we should like to address. We will therefore follow your suggestion and add a parenthetical observation:

Homeopaths believe that ‘like cures like’. This means that homeopathic practitioners will give a remedy – often highly diluted (to the point that a bioscientist would say it contains no active substance at all) – that produces the same symptoms as the illness.

I presume the focus is on India because of the resources available for the exhibit. I’m not sure why otherwise, given that homeopathy was invented in Germany and is used worldwide, to varying degrees of disaster (I’m not exaggerating – keep an eye out for Martin Robbins’ experiences of homeopaths in Africa for more in that vein).

The other strange thing here, for me, is bioscientist. What does that mean? Also, chemists, physicists and mathematicians all agree that the very idea of homeopathy is ridiculous and scientifically meaningless.

The homeopathic travel kit was proposed to be removed entirely but as you can see only the caption has gone – so now people just don’t know what it is. I suppose it would be odd if it were just an empty space? Some text has been removed from the panel and now simply describes the image of a woman preparing her ‘homeopathic treatments’ at a ‘baby clinic’ – which makes me sad in itself.

They have also, as Alex suggested, changed their wording – all cases of doctor have now been replaced with practitioner. This is a good thing.

Acupuncture

From the correspondence:

You have also raised the issue of acupuncture. Taking on board all the advice we have been given we cannot agree with David Conquhoun‘s suggestion that the advice of NICE should simply be dismissed. NICE set the national standard estabilishing whether a “clinical treatment [or set of clnical procedures] is considered highly effective, cost effective and safe, as well as being viewed as a positive experience by patients.” Whilst there may be good reasons for overturning their conclusion about the efficacy of acupuncture this process has to be achieved by debate in the public arena, and that has not yet happened.

Obviously I, and no doubt David, would dispute this, but I’ll just leave that there and move on.

The old board:

New text:

Painkillers alone just weren’t helping Stephen’s knee pain caused be osteoarthritis, so his general practitioner [GP] recommended acupuncture. Here’s his story.

Stephen is a retired clinical psychologist, but still enjoys walking and travel. His knee pain was severely restricting his day-to-day activity and he was considering a joint replacement. But he was anxious to avoid surgery of that kind because of concerns about complications and the variable success of the procedure.

His doctor recommended acupuncture – this is offered by his NHS GP surgery and administered by biomedically trained medical and nurse acupuncturists.

Fine needles were inserted into acupuncture points around Stephen’s knee and areas of local tenderness and left in place for up to 15 minutes. Each treatment led to greater and more prolonged relief of Stephen’s symptoms.

After four weekly treatments at first, Stephen now comes to the acupuncture clinic every 6-8 weeks for a ‘top-up’ which keeps his symptoms under control. Aside from reducing pain and the need for painkillers, the acupuncture has allowed Stephen greater mobility, which itself is important in managing the symptoms of osteoarthritis. As a result Stephen thinks his quality of life has improved.

The last sentence no longer says ‘…his quality of life has improved enormously‘. Finally, a new caption underneath:

Acupuncture has been rigorously tested by medical researchers for a variety of ailments. These tests have shown that acupuncture can relieve pain and this is why it is available as a treatment on the NHS. The NHS summarised its current judgement in a review published in 2010 on the internet at:

www.nhs.uk/conditions/acupuncture/pages/evidence.aspx

So osteoarthritis of the knee is cited as a condition for which positive evidence exists. Rheumatoid arthritis, on the other hand, has been shown to be unaffected by acupuncture treatments. What’s important to note is the qualification on this page:

this evidence does not allow us to draw definite conclusions…More research is needed to investigate whether acupuncture works for these conditions.

So I’m still not sure the exhibit expresses the weakness of the current evidence – but at least there’s a link.

Most pictures have been removed, as have captions suggesting GPs endorsed the treatment as effective. For some reason the (presumably fictitious) patient’s name has been changed from Ian to Stephen and he’s now suffering from osteoarthritis in the knee instead of shoulder/neck pain, presumably due to a quick read of the above link.

Mention of Stephen being a retired clinical psychologist is interesting. To me this would suggest an attempt to legitimise his choice of acupuncture as he was involved in medicine himself. Appeal to authority?

While Jonathan Freedman (top right of the old panel) no longer appears in the upper part of the new display, sadly the advertising for the St Albans clinic below remains.

Introductory Panel

Finally, another change that was accepted to be important was the wording that greets visitors on the first explanatory panel. The new is on the left (bit small, sorry) and the old on the right.

Thankfully, the following statement was added:

Contemporary research shows that many of the practices are, from a scientific point of view, ineffective.

And an important clarification has been made:

even today 40% of the population of China use Traditional Chinese Medicine clinics as their first (and often only) choice for healthcare.

Whereas before it was simply an argumentum ad populum – that loads of people use it, ergo it must work/be acceptable (bottom of the right-hand photo).

Other changes made & suggested

Most importantly, the awful interactive video display has been removed completely.

What is disappointing is that some of the things I would consider to be quite dangerous are still there. For example, this description of the herbal product Masturin, about which I can find no actual research, but oft-repeated claims of this nature:

DESCRIPTION

Uterotonic, specific for female disorders. Prepared from herbal ingredients like Saraca indica, Withania somnifera, Abroma augusta, Berberis aristata, Rauwolfia serpentina and iron acting solely on female reproductive system.

INDICATIONS

• Uterine tonic
• very effective in P.I.D.
• Relieves pain in Dysmenorrhoea

A herbal uterine tonic it tones up the nerves and ensures pain free and regular periods. Made from herbs

It worries me that this product is on display along with the claim that Joshanda ‘treats colds and flu’ – it’s this kind of uncritical exposure I take issue with. I know the anthropologists want to claim it’s about looking at culture but I really think you can do that in a safer, more informative way.

Also I was disappointed to see no changes to ‘Professor’ Shi Zaixiang’s board, relating to the claim that he was diagnosing and treating Ménière‘s disease. Also the acupuncture model at the start has not been adjusted so that it no longer claims ‘point BL-60 can be used to treat headaches‘.

*I’m not saying that it should all be a total bloodbath (which is what many ‘skeptics’ might want) but it should reflect what the research has shown – more obviously and comprehensively. It should explore negative sides to these traditions (and more recent inventions) – for example, as my friend pointed out, the devastating impact of TCM on wildlife, making many species endangered and even extinct. Also, ideally (and for me most importantly), tieing in the placebo effect with modern medicine and how the discovery and development of the randomised controlled clinical trial has revolutionised healthcare.

The main thing that drives otherwise rational and caring people to submit themselves and others to quackery when they are vulnerable is ignorance – not of the wilful kind, but most people just don’t know how medicine works. Juxtaposition of alternative ineffective treatment modalities with confirmed effective medicine is the perfect teaching tool.

I’m not trying to be patronising. I am frequently upset by hearing of parents dragging terminally ill children around the globe chasing false hopes and subjecting them to invasive, pointless treatments that often cost them their life savings and cause the child a lot of pain when they could be doing fun things and enjoying what life they have with their loved ones.

What’s a shame is that available expertise hasn’t been utilised. I find this puzzling:

The suggestion that we consult Edzard Ernst is of course a valuable one. However there seems to be little disagreement about the facts (beyond the discussion in which we turn to NICE as an authority). Instead the issue which has been very helpfully brought out in these debates is whether the exhibit can be misconstrued.

I would say that consulting an expert in alternative medicine in constructing an exhibit about alternative medicine would be useful in tackling clarity and factual issues alike.

If anything can be done to make the general public more aware of what they can and can’t trust, medicine-wise, I’m for it. I think this gallery could play a part in that – but at the moment it isn’t. To be noted is that they are planning a ‘radical overhaul’ of medicine in the museum generally so more input from funders and visitors would no doubt be useful.

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To finish, there’s this hilarious comment in the TCM section:

You don’t have to be ill to need treatment

Well that just sums up alt med perfectly, doesn’t it!! (Also, lifestyle is important in medicine and wellbeing full-stop. Any doctor worth his salt will tell you that, and we hear it all the time; medicine IS holistic. Why do people think otherwise?!)

Burzynski

I think it’s time for me to say something on this subject. It is after all very closely related to my current… vocation (if one can call it that, being a PhD student still!) and impacting directly on some of my friends.

One of those friends is my co-host of our long-neglected podcast, Super Duper Woo-Fighting Duo (With Capes)! – Rhys Morgan.

Edit: even BoingBoing is on it this evening!

Background

Feel free to scroll down to ‘The Threats‘ and ‘Some Interesting Correspondence‘ sections if you know all this…

The subject is one Stanislaw Burzynski, based in Houston, Texas. He offers an experimental treatment (though to call it that is probably a bit generous) to cancer patients called “Antineoplaston Therapy”. These antineoplastons are claimed to be peptides (bits of protein – though they’re generally not, technically – see comment 11 for more) found in urine. When a difference between cancer patients’ and healthy individuals’ urine peptide profile was found, an assumption was made that cancer sufferers were lacking these protein chunks and therefore replacing them should be an effective cure. A list of his patents and publications can be found here. This NYT article is extensive and demonstrates the shocking wealth accumulated:

… the gross income of Dr. Burzynski and an institute he runs was $40 million from 1988 to 1994… he took home $1 million a year.

However, the theory itself is dodgy at best and years of tests have not convinced the worldwide medical community. Yet Burzynski continues to run his clinic, charging people tens of thousands of dollars with promises of efficacy and hopes of being cured – even if the patients have been given a few months or years by doctors elsewhere.

Edit: this is shocking – records show Burzynski threw random chemotherapy cocktails at people (those saying chemo kills; well, he certainly didn’t seem to do his research on it), failed to disclose pharmacy ownership conflict of interest, did not alter treatment despite scans showing no improvement... Texas Medical Board might finally be doing their job.

Also see here for his public record – makes for a disturbing read. Plus, they also have a range of ‘healthcare products’, unsurprisingly – glorious website full of scibabble nonsense words and indeed typos.

What’s happening?

Now, more and more people are starting to criticise this man and his practice and the tactics we have seen so many times before – legal threats, bullying, hoping to silence – are coming thick and fast. There is now a petition asking the clinic to release a concise, publicly-available review of all the clinical trial data it has accumulated over the years.

The turning point was this uncritical article in the Observer about a stricken family with a little girl suffering from a serious brain cancer. The family details their emotional struggle – one which many of us will sympathise wholeheartedly with – and the resulting search for hope, their sights landing on Burzynski’s clinic.

Peter Kay offered to do some benefit gigs to help towards their $200,000 funds goal for this ‘treatment’. These were on the 24th and 25th November last week, and tonight the Comedy Store in Manchester is hosting another with various acts. I also saw a tweet reporting that BBC 6 Music had run an advert for one of the money-raising events.

Many immensely generous donations have been made. It is heartening to see human kindness at work – but so very upsetting given the circumstances.

Here are some e-mails regarding the article that were not published (or at least, not fully) by the Observer – a lot of people are concerned by their endorsement and the lack of provision to challenge what was written. Obviously this is a sensitive issue, around a grief-stricken family, but many others will continue to suffer if this is not properly addressed.

Publicity around this man and his dealings has soared today, as a result of retweets from Stephen Fry, Ben Goldacre, Dave Gorman, Dara O’Briain and continuing valuable support from others such as Simon Singh.

Another friend of mine, Kat, has written a fantastic post for the Cancer Research UK blog – this is serious stuff and those of us who have watched people deal with such a terminal illness do not want to see them swindled, spending their hard-earned savings lining fraudsters’ pockets and losing precious time with their families and loved ones.

Some people who have been directly affected have set up their own website in the hope that others won’t follow in their footsteps: http://www.burzynskiscam.com/

The threats

So, regarding the bullying I mentioned. Rhys wrote a post in mid-August detailing his views of Burzynski, backed up with accounts of past occurrences – including this case:

“Dr. Stanislaw R. Burzynski, had defrauded the plaintiff and violated the terms of the health plan.
We agree that the defendant may not trick the plaintiff into paying for an unlawful, unapproved drug. We AFFIRM.”

and how the 30+ years of trials have yielded very little to support the claims made. Check out Quackwatch from way back in 1998 for more.

He had to take the post down at the beginning of this month but he has now published all the correspondence here – please do have a read (also on Google+, and I’m pasting it below (click ‘read more’ if you’re on the blog homepage and can’t see it) because his site keeps going down!).

His silence was broken because Andy Lewis started receiving his own threats after he wrote his criticism of the Observer article, Kay’s unquestioning support and the issue as a whole. Another here for your amusement. Also read more from The 21st Floor, David Gorski, scienceblogs (good comments), Peter Harrison and Zen Buffy – Josephine Jones is compiling a kind of I Am Spartacus! list for posts on the subject.

Some interesting correspondence

A friend sent me this link to a September 2004 letter to the editor of the academic journal Integrative Cancer Therapies (who have published quite a few of Burzynski’s papers) from a researcher by the name of Andrew Vickers. He takes issue with an article by Burzynski published in the journal in March of that year:

Burzynski SR. The present state of antineoplaston research.
Integr Cancer Ther. 2004;3(1):47-58.

I’ve downloaded and saved this paper if anyone wants a copy, get in touch on Twitter or in the comments so I can e-mail you.

The article cites 73 papers and articles, 38 of which have Burzynski as first author, and a further 10 have his name as one of the first 3 authors – probably he’s in the list somewhere with the rest – plus a couple have one Burzynski B. (presumably a family member). If you search his name in PubMed, 45 articles are returned.

—

Moving on to Andrew’s letter regarding the paper cited above, it’s reasonably short – again if you want the PDF, get in touch, but I’ll paste it here with minimal commentary at intervals.

“Editor:

I read with interest Dr Burzynski’s recent review of research on his technique for treating cancer.1 I have several serious concerns about the scientific quality of his article. The first results presented by Burzynski concern glioma. It is claimed that 7% of 62 evaluable patients had a minor response. However, no fraction of 62 rounds to 7%: 4/62 is 6.45%, 8/62 is 8%*. There is also no fraction of 62 that rounds to 36%, the proportion given for objective response.”

So we can be fairly confident that he’s fiddling numbers from the get-go? * It has been pointed out that this is a mistake: 5/62 is 8%. Presume this is just a typo on Andrew’s part – the point remains.

“Burzynski goes on to report preliminary results of clinical trials on colon cancer conducted at the University of Kurume Medical School in Japan. He claims that the “survival rate of more than 5 years” on antineoplastons was 91% compared to 39% in the chemotherapy control group. Burzynski states that “the study was randomized and compared the results of treatment in 19 patients on . . . chemotherapeutics and antineoplastons [with] 56 patients who received . . . chemotherapy alone.” Yet the reference cited (reference 68) is to a case study. Moreover, a 91% survival rate for 19 patients is impossible, as it corresponds to 17.3 patients.”

 Again some weird numbers coming out, and reference to an article claimed to be about a trial, yet is in fact a study of one case.

“Burzynski also reports a single-arm study of 16 patients with liver cancer in which it is claimed that patients had longer recurrence-free intervals on antineoplastons than off. The citations supporting the claim include a case report and a lab study. Furthermore, the figure illustrating the results shows “time to recurrence [statistic not stated] in patients given antineoplaston AS2-1 after standard chemotherapy compared to control group.” This is despite there being no control group in the study.”

Again no reference to actual trials, but to a single case and lab-based work. Plus a lack of controls (so no valid comparison/conclusion can be made).

“There are several other serious shortcomings of the article. Survival data are presented in bar charts: the techniques for presentation of survival data (such as Kaplan Meier) are well established and were developed specially to deal with issues such as censored data; bar charts are unable to incorporate these features of survival data and are therefore considered inappropriate. No number presented in the text (eg, proportion surviving 5 years) is presented with a measure of uncertainty, such as a standard error or confidence intervals.”

 No reputable clinical study would discuss survival using bar charts. Kaplan-Meier curves have been standard for years. Also he’s presented no statistics for confidence in these numbers.

“I am aware that Burzynski is presenting preliminary data, and I have made no comment or criticism concerning the failure to present inference statistics. Nonetheless, even for a preliminary report, I see no excuse for the use of idiosyncratic and highly inappropriate techniques of presentation, failure to incorporate basic statistical estimates, citation of studies in support of statements when those studies have no bearing on the referring statements, inclusion of obvious mathematical errors, and citation of data for nonexistent control groups.”

He cites Burzynski’s study, to which he is referring, at the end of the letter.

—

Burzynski then wrote a reply! In the same month as Vickers’ letter was published (emphasis mine):

Reply to Vickers 

“Editor:

After reading Andrew Vickers’s letter, one may wonder  why the Assistant Attending Research Methodologist  of the prestigious Memorial Sloan-Kettering  Cancer Center would argue about 0.5% of minor  response and statistics that were not required, while  entirely missing the big picture: a proof of concept  and data on efficacy of antineoplastons in Food and  Drug Administration–supervised clinical trials involving  more than 200 patients. Vickers’s many arguments about unimportant issues obscure the realities of the data that we have presented, which indicate remarkable results in cancers for which chemotherapy and radiation are ineffective.

Publication of my article titled “The Present State of Antineoplaston Research (1)”1 occurred at the same time (March 2004) as the printing of Vickers’s article, “Alternative Cancer Cure: Unproven or Disproven?”  in the March 2004 issue of CA: A Cancer Journal  for Clinicians. In his review article in CA Cancer J Clin, he made reference to only 2 articles on antineoplastons published since 1987. He failed to cite more than 40 of our publications and approximately 300 publications by other authors on antineoplastons and their derivatives. In his letter to the editors, Vickers criticizes reporting of results of the clinical studies conducted at our clinic and also at the University of Kurume Medical School in Japan.  The criticism of our report concerns rounding out percentages to the nearest number. That is why we reported 36% of objective responses instead of 35.5% and 7% of minor responses instead of 6.5%. In the article, I also presented the actual number of patients, allowing readers to make their own calculation.

Vickers objects to my presentation of survival data in bar charts. This objection is unjustified in the context of my review. Kaplan-Meier survival probability estimates are more appropriate for detailed reports describing individual clinical trials. In my review, which describes numerous past clinical trials, there was not enough space for these estimates. Also, one should not compare apples and oranges. We can easily produce Kaplan-Meier diagrams for our studies, but, unfortunately, they were not published for comparison studies, such as Prados et al.2 If Vickers reads our recent articles describing survival in antineoplaston clinical trials, published in peer-reviewed journals between 1999 and 2003, he will indeed find Kaplan-  Meier data. Our data on the proportion of patients surviving 5 years contain no uncertainty, since they are  not estimated but true survivals. The patients are either dead or alive after 5 years. No standard error or confidence intervals are necessary.

The final reports on the studies conducted at the University of Kurume had not yet been published at the time my manuscript was submitted to Integrative Cancer Therapies. Japanese researchers have published preliminary reports and case reports; these were listed as references. The Kurume researchers presented the summary of research data directly to me with permission for publication. I described these as “preliminary results” on page 55 without making any changes.  Those researchers are now preparing the final reports for publication.

In conclusion, I believe I have sufficiently answered  Vickers’s questions regarding the clinical trials conducted  by our clinic. Further details will be provided in a number of articles that are now in preparation for  publication.”

Make of that what you will – no further correspondence noted.

—

I’ll just paste the acknowledgements from the paper in question here as these names may be of interest, and comment that the figures are generally of very poor quality, for a 2004 paper:

The studies were sponsored by the Burzynski Research Institute and supervised by its Institutional Review Board (IRB). The membership of the IRB was in agreement with the FDA. The authors [just Burzynski, for the record] express their appreciation to Lucy Rorke, MD, professor of pathology and neurology, University of Pennsylvania, Children’s Hospital of Philadelphia, for review of pathology slides; Dieter Schellinger, MD, professor of radiology, chief, section of neuro-radiology, Georgetown Hospital, Washington, DC; and Joshua Pleasure, MD, M. D. Anderson Cancer Center, Houston, Texas, for evaluation of MRI and PET scans.

The following physicians at the Burzynski Clinic (BC) participated in the study: Robert I. Lewy, Robert Weaver, Marc Bestak, Maxwell Axler, Alonzo Peters, Benjamin Saling, Barbara Burzynski, Tomasz Janicki, Jaroslaw Paszkowiak, Vishnu Alapati, Dmitri Davydov, Vsevolod Dolgopolov, Barbara Drynia, Andrzej Himmel, Wojciech Iwanowski, Gabor Jurida, Mohammad Khan, Eva Kubove, Grace Ormstein, Joseph Nguyen, Mohammed Radmard, Basel Salhoot, Barbara Szymkowski, and Marek Walczak.

The following senior scientists (PhD), microbiologists, pharmacists, and engineers at the BRI and the BC participated in basic research: Robert Waldbillig, Majciej Klimczak, Elwira Ilkowska-Musial, Leszek Musial, Anna Baranowska, Piotr Kuligowski, Ryszard Madry, Donat Manek, Mike Mokrzycki, Andrzej Wieczorek, Anna Wisniewska, Kris Wisniewski, Irma Witkowska, Dennis Wright, and Iwona Zapedowski.

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I’ll paste Rhys’ post below in case his site is down.

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.

IgNobel Awards 2011

Sorry for the silence of late! I’ve been in Florida for the AACR conference in Orlando, plus some R&R in Miami. Resuming semi-normal service…

Before that I attended the IgNobel Awards tour show (and the pre-event, Improbable Research After Dark, which was excellent) and would like to share some of it with you because it was entertaining and educational; the top two aspects we nerdy types hope for from events, of course.

Marc Abrahams (centre of the photo, left) hosted the evening, which consisted of some background on the IgNobel prizes, some selected highlights from the actual awards shows and talks from some of last year’s winners.

To keep talks to time, 4 ‘volunteers’ would quack after each minute, culminating with non-stop quacking when the speaker ran out of time. This will make more sense later.

The Annals of Improbable Research is a bi-monthly publication. It includes original research such as the somewhat hilarious ‘Kansas is flatter than a pancake‘ study.

Firstly, a selection of the main prizes awarded in 2010:

1. Engineering - Whale snot-sampling helicopter

2. Medicine - treating asthma with rollercoaster rides (my Welsh colleague would love this, he went on so many while we were away!)

3. Transportation Planning – Japan/UK; slime mold planning rail systems

4. Physics - wearing socks outside shoes causes fewer slips and falls on ice in Winter. It’ll catch on, wait and see.

5. Peace - Swearing relieves pain! I knew it!!

6. Public Health – experimentally determining that bacteria stick to beardy scientists! From 1967, this study set the basic standard for microbiological lab safety methods.

7. Economics - to the companies who got us where we are today.

8. Chemistry - disproving “oil and water don’t mix”

9. Management - random promotion would increase organisations’ efficiency! Dubbed the ‘Peter principle’

10. Biology - a study of  fellatio among fruit bats. Yes.

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6 days after the 2010 awards (also the 20th ceremony), in Stockholm, the Nobel prize for Physics was awarded to Andre Geim for graphene; 10 years previously he received an IgNobel for levitating a frog with magnets!

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During the ceremony itself, one can traditionally win a date with a Nobel prize winner! A happy 91 year-old indeed…

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We were treated to a selection of old winners (there are approximately 200 in total now)

- 2000: dog vs. cat fleas’ jumping ability (dogs fleas win)

- 2007: the emergency bra – more on this later!

- 1965: a very scary patent for a rotating birthing table.

- 2003: homosexual mallard necrophilia. A love of duck sex-related stories is an ongoing joke amongst such eminent science writers as Mark Henderson, Ed Yong (parental advisory warning for that post!!) and others… So the quacking-timer setup had particular comedy relevance when Mark read out some of the original study at the Improbable Research After Dark event. I’m sure you can imagine.

- 2000: Australian patent office awards someone an innovation patent for… the wheel.

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The IgNobel institution has even been converted into a Manga story! Called ‘Geniuses without the glory’: Marc Abrahams points out that perhaps it should be the other way around?

Included is the inventor of karaeoke, who was awarded the Peace Prize for inventing ‘a new way for people to learn to tolerate each other’ – he didn’t patent it and has made no money from it!

Left: the infamous slime mold. Right: karaeoke action (Can’t Take My Eyes Off You) and the creator overwhelmed with emotion!

In 1995 there was a British IgNobel winner, and according to Marc:

Britain is the finest natural producer of IgNobel prize winners in the world

Research from Norwich on how cereal flakes get soggy in milk achieved the honour and the authors sent a video acceptance.

The Chief Scientific advisor to the government at the time telephoned Marc telling him not to give the award; he thought perhaps it was an ‘example of the famous subtle British humour’. Lots of other scientists cited a reputation for him being a nice guy. So Marc, assuming it was a joke, wrote him a letter.

This included (valid) points such as the fact that IgNobels can help get the public interested in and curious about science; plus scientists enjoy it!

The advisor wrote back angrily, telling him to stop giving the awards!! Even if the scientists do want them!

Marc then started talking to people, including Nature, The Times, Guardian, Reuters… stories started cropping up everywhere. A government official’s reaction like this could perhaps go some way to explaining public discomfort with science? It turned out to be a good controversy!

Now his ire is immortalised in Manga. He’s probably not too happy about that either.

The Speakers

1. Dan Bebber – slime molds and the Japanese rail system

Can we make use of biological networks to improve our network design? Is the simple combination of Mold, Agar and Oats better/more efficient than engineering companies?

Slime molds have been honed through evolution to make efficient networks. So the short answer is yes, they are at least as good at planning sensible routes from A to Z and all stops along the way.

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2. Elena Bodnar – on the super-innovative bra-mask, for which the UK is apparently a top customer! And the new male counterpart device, the emergency shirt.

We were even treated to a demonstration, in which one volunteer pleaded

If any of my students are here, don’t take photos!

When she was asked “Who would you save?” she considered it, made her choice and said “well, he is my boss”.

Sid donated his shirt for a demonstration of the Emergency Shirt (the actual specimen having mysteriously disappeared). He even wore the bra to preserve his modesty. For a while…

So far it’s available only in red and for cups B-D on ebbra.com – it’s just idea for now, but should expand to all sizes and more designs eventually!

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3. Matija Strlic and his chemical analysis of old book smell.

There’s also a ‘New Book Smell’ airfreshener for kindle! More than 200 chemicals (some toxic!) form these odours, as determined by Headspace analysis of 80 books.

Particularly due to volatile organic compounds that together produce a smell of vanilla ice and caramel! The actual use of this kind of research is in development of an artificial nose to assess and predict the rate of paper decay.

He passed around some ‘old book smell’ in a Duran bottle (sturdy branded lab glass)! It was surprisingly spot on.

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4. John Hoyland at New Scientist (who edits the Feedback feature)

Frootloopery is a favourite subject at NS; including ridiculous medical claims such as trinfinity8 that ‘transmits algorithms into body to combat ageing!’ for a mere $8,000.

Also the Denon AKDL1 cable, allegedly marketed at some point for $9,999.

Winner of the Amazon most-sarcastic-reviews! Highly recommend a read, very amusing.

Apparently it generated such comments as:

I put it in a glass of water, that started to turn a dark sort of colour.., my friend and I agreed it was the best red we’d ever tasted‘

Questionable marketing is also covered, including the use of ‘free’ (e.g. FREE TEXTS when you top up £10/month!),internet speed claims (Up to 8Mb/s! = 3 if you’re lucky), amusing signs (“simulated Virtual Reality” – eh?) and so on.

Chronic Woman Disease got the most lols. The fire extinguisher thing is probably an inflammatory translation phenomenon of some sort.

Also there is a Private Eye Colemanballs-style section for silly things people have said, such as one commentator’s gem:

time seemed to stop for 3/4 of a second

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5. Gareth Jones – fruit bat fellatio!

This article climbed to the 2nd most-viewed video on the PLOSone video site. They found that every 1 second of fellatio led to an extra 7 seconds’ copulation time! Also in some species, in terms of size, testicles > brain!

Science and Nature covered it as well (but didn’t publish it, he not-at-all bitterly pointed out).

Good point well made in the HuffPo

Question: What was the first most-viewed paper? Answer: a PLOS Medicine article about “why most scientific research is false” – fair enough then.

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Finally we were ‘treated’ to McGonagalls’s Tay Bridge Disaster poem, again, having read it at  Improbable Research After Dark as well.

The poem has probably ended up ranking as, a greater tragedy than the bridge incident itself.

Billy Connolly reads:

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Links:

The founder of the Irish skeptics explores the importance of the IgNobels in science communication in the Irish Times.

<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.