Wear sunscreen

As a relatively pale person of northern European descent, I find sunscreen to be invaluable. ug-leeI have absolutely no problem being the guy with the light bulb nose. It’s way better than the Rudolph nose later, and undoubtedly superior to developing skin cancer or even just unsightly sunspots.

Now that the weather is getting nicer, sunscreen sales will be increasing, but not everyone is happy about this. There are a number of quacks out there who will peddle false information about vitamin D. Some of them will go the even more egregious route of saying sunscreen doesn’t protect against cancer.

Don’t let these quacks fool you. Sunscreen absolutely protects against the rays of the Sun which can and often do lead to cancer:

Sun protection is essential to skin cancer prevention – about 90 percent of non-melanoma skin cancers and 65 percent of melanomas are associated with exposure to UV radiation from the sun. Furthermore, years of scientific research have provided compelling evidence that the daily use of sunscreen helps lower the risk of non-melanoma skin cancers. Most recently, in a rigorous study of more than 1,600 adults over the course of a decade, researchers determined that subjects applying sunscreen with an SPF of 16 daily reduced their risk of melanoma by 50 percent.

Unlike quack medicine, sunscreen is safe and effective. I foolishly got a sun burn last month, acting on the assumption that “Maine”, “April”, and “sun burn” were three things I would never have to use in the same sentence. I was wrong. I’ve been making it a point to protect my skin every nice day we’ve had since. It can be tedious, and it’s not always convenient, but cancer treatment is often pretty tedious and inconvenient itself.

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Stuart Scott

Every so often an icon emerges in the media. Usually, these people were never meant to be the story. We simply expected them to report the stories. If they did that, we would find ourselves discussing what they had told us, not giving a second thought to where we heard it. That is always good enough. That’s the job. But every so often one of these personalities will shine through the morass. Stuart Scott was one of those people. And now he has died at the age of 49.

Scott had been fighting cancer for the past 7 years. I had no idea this was his third bout with the disease. Hell, I had no idea he was ever even sick. Insofar as this was well-known news (and it was), I managed to miss it. Part of that is sheer chance. I simply didn’t happen to see the news stories. But most of that is because Scott never let it show. Looking back I can see some of the weight fluctuations now, but the strength of his personality always hid whatever physical weakness he may have been experiencing at a given time. He always said to keep fighting – fight, fight, fight – and he lived that. The images and tributes over the past day have made it wildly clear that he was speaking more than mere platitudes. He meant what he said and he lived it entirely.

I only ever mention a celebrity death here once in a great while. Sometimes it’s because I feel bad for the odd life the person had (such as when I mentioned Gary Coleman). Most times, though, it’s because I deeply respected the person (such as with Christopher Hitchens). This is like most times. Stuart Scott stood out as one of the good guys. There are a lot of sportscasters I like and I’ll be sad to hear if any of them die, but Scott’s passing is especially heartbreaking. I wish his family the best.

Here are two videos. One is of Rich Eisen giving his on-air farewell only 10 minutes after hearing of his friend’s death. The other is of Stuart Scott delivering one of the best speeches I’ve heard in a long time.

Don’t buy the alternative medicine cancer cure testimonials

Orac, that defender of all things good, has yet another excellent post about how quackery gets peddled. In this case, some of the promotion is done by the very people who will get hurt by it:

[M]any breast cancer cure testimonials involve either lesions that are not cancer, lesions where it’s unclear whether the cancer has changed, or, most commonly, stories in which the cancer has been removed surgically and the woman refuses adjuvant chemotherapy and radiation therapy, such as Suzanne Somers’ or Hollie Quinn’s breast cancer cure testimonial. In these latter forms of breast cancer cure testimonials, it was the surgery that cured the cancer, but naturally the woo-prone, having refused the adjuvant chemotherapy and/or radiation that decrease the chance of the cancer coming back, decide that it was the woo du jour that they chose that actually saved them.

The post goes on to talk about a woman by the name Inger Hartelius who, after being diagnosed with cancer, was given a book by our old friend Andreas Moritz. Through that book and a desire to seek out alternative ‘help’, Hartelius found some other quack by the name of Robert O. Young. I’ve never heard of the guy before, but he apparently believes that acid is the root of all cancer. It isn’t and he is a quack. Unfortunately, Hartelius was able to find Young; now she has a testimonial:

My health is now much better than it was before, I sleep at night, my weight is stable, my lung capacity has grown – I feel so much more alive – which is hard to explain. I have no signs that I’m sick with cancer and now I know I am not going to die of this cancer.

I’m just going to point out what Orac points out in his post: She never says anything objective about her tumor. She doesn’t tell us if it has shrunk, if it is stable, if it has grown. She doesn’t tell us if it was removed during the biopsy, as is sometimes the case. She doesn’t tell us anything other than that she feels better. And that’s often how these testimonials go. We are given little information much of the time, and when we are given better details, it is often forgotten to attribute progress properly. For instance, some people will undergo surgery but forgo chemotherapy and radiation therapy, instead opting for some line of quackery. When they get lucky and their cancer doesn’t return (or when they give their testimonial prior to its return), they attribute their progress to whatever quack treatment they’ve been receiving. The reality is that the surgery is what got them to a better state of health. The alternative medicine just cost them more money.

WHO issues warning about tanning beds

This is from 2009 (though it should be from 1995), but I just came across it:

In July, the International Agency for Research on Cancer (IARC), a working group of the World Health Organization, added ultraviolet (UV) radiation-emitting tanning devices – tanning beds and lamps – to the list of the most dangerous forms of cancer-causing radiation. It joins an assembly of hazardous substances including plutonium and certain types of radium, as well as radiation from the sun.

The IARC report cited research showing that tanning is especially hazardous to young people; those who use sunbeds before age 30 increase their lifetime risk of melanoma, the deadliest form of skin cancer, by 75 percent. The authors also pointed to studies showing a link between UV radiation from indoor tanning devices and melanomas of the skin and eyes. Melanoma will kill an estimated 8,650 people in the US this year alone. And melanoma isn’t the only problem: people who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma. Squamous cell carcinoma kills an estimated 2,500 Americans a year.

I am absolutely convinced that people do not appreciate the tenacity and seriousness of cancer. There seems to be a it-won’t-happen-to-me attitude that pervades society. Or maybe quacks have lulled people into a false sense of security. Just take some garlic, laxatives, and a little black elderberry and you’ll be fine! For Christ’s sake. I recently developed a small splotch on my nose. It wasn’t a blackhead and it didn’t go away after a couple of weeks, so I made an appointment to get it checked out (alongside a physical). I figured it was nothing given its color and shape, but why take risks? It matters how quickly these things are identified. It turned out, as I figured, to be nothing more than a new freckle (probably a result of my time in Haiti or some of the nicer days we had not too long ago). I’m fine this time, but who knows about next time? I’m not somehow magically exempt from how biology works. Neither is anyone else. I am, however, exempt from a 75% increase in getting melanoma. Also, think about this:

Attack of the DNA robots

Whereas bombing raids in the early and mid part of the 20th century involved hardly any direction, any bombing that we do today is going to be highly precise. This so-called smart bombing has constituted one of the great military advances over the past several decades. It’s efficient, cost-effective, and saves civilian lives. Now keep that in mind as I move into the non-military world of fighting cancer.

In one form or another researchers have been working to create DNA carrying/laden devices for years now. The application potential is huge, but the area that has received some of the greatest focus has been cancer research. The drugs and treatments we have now are inexact and not always effective. Aside from often killing healthy cells, thus leading to weight and hair loss, general illness, and other negative side-effects, they don’t always kill every cancer cell. Even surgery can be a bad thing at times. Consider for a moment what tumors need. More than perhaps anything is a blood supply. (The same goes for your regular cells; your skin cells are too far from a blood source, hence why they are little more than dead keratin.) In order to get their supply of blood, tumors must induce angiogenesis, the growth of new blood vessels. They do this by releasing certain stimulators. They also release inhibitors, but not enough to overwhelm the stimulators. However, these inhibitors have no problem traveling through the blood stream. The result is often the suppression of secondary tumors, especially if they are nearby. So when a surgeon removes a primary tumor, those other, previously restricted secondary tumors will have a chance to grow. And that is no good, of course. In short, the more exact we can get in destroying cancerous cells, the better off we will be.

Enter DNA nanobots.

I like to think of these as smart bombs of cancer cells. They are bits and pieces of DNA naturally self-assembled into a particular shape (the barrel in the background) that is prepared to deliver a payload. That payload (the purple/pink stuff) is attached to specific strands (the yellow/green stuff) inside the DNA barrel structure. This is all held together by strands of DNA which are programmed to recognize specific molecules on the target cells (in this case, cancer cells). When the DNA attaches to these molecules, it changes shape and opens up the barrel. The payload is then free to enter into the target cell, inducing apoptosis (cellular suicide). Experiments have shown that these DNA robots are able to avoid healthy cells during this process.

There are, of course, limitations to this technology. Take malaria, for instance. It would be difficult to target most strains (such as P. vivax and P. falciparum) because they get inside hemoglobin rather than attach to the outside of anything. That makes them effectively invisible to both our immune system and these nanobots. Strategies for fighting that disease will tend towards the sort of medications we’re using now combined with bed nets and efforts to destroy mosquito habitats.

Still, this is exciting. I say that about most cancer-related advances, but I don’t feel I’m ever overdoing it. Every little bit of progress is crucial, even the bits that don’t pan out. I have hopes for this one, though. Even if it doesn’t end up being pragmatic in application, it still has the potential to 1) increase our understanding of cancer and 2) be used in so many other ways. Three cheers for science.

Sources: Here and here.

How the future of cancer research is shaping up

There are two foundational concepts a person must understand before he can say he understands biology. First, all life has evolved from a common ancestor via natural selection. Miss this concept and one has no reference frame for anything within the entire field. It would be like trying to grasp physics without understanding gravity. Second, it’s all about shape. This can apply to many other fields, but it is an essential concept within biology. The molecules within living organisms are like pieces of a puzzle, or like keys and key holes. However one wishes to think about, biology really is about shape. Now with that in mind, I turn to some really awesome cancer research.

[Bruce] Levine and his colleagues designed a new gene that can be inserted into T cells to trick them into attacking cancerous B cells, the cause of chronic lymphocytic leukemia (CLL). The new gene encodes a receptor that, on one end, can bind to a molecule that’s unique to cancerous B cells. The other end of the receptor sets off a chain reaction when such a B cell is bound, eventually leading the T cell to destroy the cancerous cell. “Essentially, we’re converting T cells that would normally recognize other types of cells to be tumor specific,” Levine says.

In many ways, this is very much a basic immune response. The difference here is that gene transfer techniques have been used to modify the shape of the T cells to recognize particular cancerous cells, something which does not normally happen. As the article states, one patient went from having 170 out of 200 cells containing a cancer-causing mutation to having all signs of his leukemia vanish. The paper itself goes further and says tests showed 198 out of 200 cells to be negative for that mutation, which is within the normal range for such tests.

The insertion of these modified cells was not without complications. The cells themselves are without toxicity, but within two weeks the patient was experiencing a low-grade fever and chills, both of which intensified and required a short hospitalization. He also had tumor lysis syndrome, which could be expected – and is ultimately a good thing. It’s a common condition after certain types of cancer treatment (though it had not previously been reported in cellular immunotherapy). Basically, cell lysis is when a cell is destroyed and its contents spill out. Often, this constitutes a significant release of chemicals which cause a reaction. It can be quite dangerous, but then, so is cancer.

While this research is cause for a lot of excitement, I think, there also must be much reservation. The test subjects number a whopping three patients. Furthermore, they’ve only been tracked for approximately a year since treatment. It is fortunate that they still contain within them cells with the inserted gene – it’s self-propagating since it gets passed on with somatic division just like any other gene – but more time needs to pass before too much more can be said (not to mention the dramatic need for a much larger sample). There is also concern that there could be long-term deficiency of B cells in patients since the genetically modified cells do attack normal B cells as well as the cancerous ones. These are all things that can be clarified with continued research – and I’m confident “with continued research” is a phrase that is more than traditional lip service, in this case.

Why quacks should be more cautious

One of the hallmarks of quacks is that they’re willing to latch on to any bit of science that shows even the most remote, most distant promise. One familiar quack did this for a preliminary study not too long ago. And other quacks do it all the time. They hear about some result which indicates some positive benefit from something – usually a berry or herb – and they go nuts. Forget that they reject just about everything else science has to tell us. If it fits into their paradigm, it must be true.

But of course they’re jumping the gun. Again and again a study will come out which shows promise for some substance that will help in the fight against this or that disease, but once a few more groups start taking a look, things fizzle out. Often studies will even get to the clinical stage, only to turn out to be failures. (“Failures” in the sense of not working, not in terms of science.) Companies usually are decent at protecting themselves from getting that deep if there is no benefit to be had, but they aren’t perfect.

I go on about this because I am currently reading a review article about the protein p53. It is a protein which is involved in tumor suppression. When it mutates, usually by missense mutation, it becomes involved in tumor growth by virtue of loss of function, though evidence strongly suggests that it also confers a gain of function in terms of cancer growth. I’ve written about other tumor suppressing proteins here.

I had to stop when I got to a section about post-translational modifications of the protein:

Post-translational modifications of p53 such as phosphorylation, acetylation or sumoylation have been shown to be essential in determining and regulating p53 activity in vitro. However, their effects in vivo remain difficult to assess. Sabapathy (S1) generated a ‘knock-in’ mouse strain replacing the serine 312 residue, equivalent to the human serine 315, by alanine (S312A) to abolish phosphorylation. This residue has been proposed to have a role in the regulation of p53 protein stability. p53S312A/S312A knock-in mice are viable, fertile and not –pre-disposed to spontaneous tumor formation. In addition, the p53S312A protein was found to be activated as efficiently as wild-type p53 and its turnover rate was not affected, suggesting that despite in vitro evidence this phosphorylation event may not be critical for in vivo suppressive functions.

Let’s get some of the terms out of the way. “Phosphorylation”, “acetylation”, and “sumoylation” all refer to the addition of certain chemical groups (such as phosphates) to the protein – it’s basically attaching stuff to p53. “In vitro” pretty much refers to the testing of cells in a test tube (or Petri dish, or whathaveyou) whereas “in vivo” refers to testing done on whole organisms. “Sabapathy” is a person, not a biological term. “Knock-in” refers to a type of genetic engineering. “Wild type” means the default protein, or the protein as it “normally” would appear, unmutated. (I’ve always found the term counter-intuitive.)

Now, presuming anyone is still with me here, the important aspect of the above excerpt is where it says, “In addition, the p53S312A protein was found to be activated as efficiently as wild-type p53 and its turnover rate was not affected, suggesting that despite in vitro evidence this phosphorylation event may not be critical for in vivo suppressive functions.” In other words, the genetically altered ‘test tube’ results showed that the addition of a chemical group was important, but further evidence showed otherwise. One thing this means, as all scientists know, is that we ought not jump the gun.

Another way to think of these results is to compare red hots dogs and apples. Each one is known to contain nitrites, which is a chemical compound linked to cancer. However, whereas red hot dogs have a small connection to tumor development, apples have no connection. Why? There is a complex interaction between meat and nitrites which results in the production of the actual carcinogenic compound. Apples, on the other hand, even if they did interact with other chemicals (probably ones within the body), have components which would help the immune system and thus help prevent cancer, at least to some degree. Or to use another comparison, tobacco cigarettes and marijuana contain a ton of carcinogens, but only one (cigarettes) has a causative link to cancer. Presumably some other chemical(s) in marijuana counteracts the carcinogens. But however the cancer is prevented, it happens through a complex interaction that needs to be studied. Lab results are wonderful and they’re a major reason why we live so healthy and so long today, but they aren’t the final word. In fact, we ought not think of anything within biology as being the final word. We have large scale statistical results that will be true in virtually all cases, but there are no hard and fast rules for how organisms will interact with their environments. We need to test and test and test – and science will always do that – but the real solution here is that we need to be sure we aren’t jumping the gun. After all, no one wants to be a quack.