My friend sent me some musings (from Whole Health Source) on how our immune system is able to control cancer in our body.

At our recent MSTP summer retreat, we heard from Dr. Robert Darnell, MD, PhD, who is doing research on paraneoplastic syndromes (i.e. diseases that occur in conjunction with neoplasms/cancers). He focused on a set of neurological diseases, in which an individual experiences a sudden and rapid (<1 week) decline in cerebellar function. They wake up one day feeling a little dizzy. Within a day or two, they can barely stand, they have tremors & muscle spasms, loss of memory, et al., so they go see a neurologist. It turns out that the underlying cause is autoimmune dysfunction. These people actually have a small cancer somewhere else in their body that their immune system has kept under control for years. It is well-known that everyone develops cancers naturally; some people are just better at fighting them or controlling them than others. At some point, the cancer (in what seems to be a stochastic process, with our current understanding) starts producing a set of proteins that are only found in the cerebellum – a part of the body which the immune
system does not normally see. So these patients start producing antibodies to this “foreign” protein, and, if these antibodies penetrate the blood-brain barrier (which also does not happen very often), then the patient’s immune system starts attacking the cerebellum.

It’s this kind of research that makes me wonder what my genetic background is capable of. My dad has psoriatic arthritis (a genetically-linked autoimmune disease; a combination of psoriasis and arthritis), so there is a chance that I have those genes. But, even if I do, my genetic background (i.e. everything else in my genome) will affect how/when/if this disease manifests itself.

The immune system is one of the most poorly understood systems in human clinical biology, and yet it appears in every subspecialty of medicine. There are very few treatments that robustly improve immune
function. When someone has a skin disease (e.g. psoriasis or eczema), or asthma, or joint pain – all of which have an autoimmune basis – we just shoot them up with steroids, which provide temporary relief and
unacceptable side effects.
My dad found that his psoriatic arthritis can be controlled in 2 ways: infliximab and flax seed fiber. Infliximab is an antibody that binds, and thereby decreases, TNF-alpha – a key molecule that is secreted in
inflammation (and inflammation is a manifestation of an immune system flare up). He found that infliximab can control his disease for a few months, and then he starts getting flare ups (rashes, joint pain) again. At that point, he switches to hefty doses of flax seed fiber: a few tablespoons of freshly ground flax seeds every morning. Flax seeds are an incredible source of 18-carbon polyunsaturated fatty acids (specifically, a high ratio of omega 3s relative to omega 6s). Fatty acids – both saturated and unsaturated – are the substrates for several families of inflammatory signalling molecules, but the body has a harder time converting omega 3’s into inflammatory molecules (it converts saturated fats and omega 6’s relatively well). Consequently, keeping your adipose tissue well-stocked with omega-3 fatty acids can bring about an anti-inflammatory physiological state. Salmon also has a hefty dose of omega 3’s relative to omega 6’s (I think the ratio is even higher than flax seeds, but today’s fish also carry heavy metals and toxins). Omega 3’s are found in sprinklings throughout nature: whole grains (oats, wheat), nuts (almonds), olive oil, seeds (kiwi fruit seeds), milk fat, etc. Given the average American diet (bleached/processed grains; protein & saturated fat from land animals; highly processed dairy products), I think it’s no surprise that this country is a hotbed of autoimmune dysfunction.

This is an excerpt from an email I sent to my friends, who then suggested blogging my frustration:

Before I actually came to medical school, I used to think that medicine & science were very noble pursuits. But now I’m here and it seems so mundane and trivial. The public perception of science/medicine is very different from their actual practice. I’ve had the same thoughts about science/medicine since college.
Medical school and graduate school haven’t changed them, and I don’t think getting a PhD is going to change them either.

I spend my days studying seemingly relevant problems (obesity in mice), but – for most of science – the end results are usually miniscule, just a drop in the ocean. And I wouldn’t mind that aspect so much if I actually thought I was doing some good with my time, with my efforts. But I’ve had this nagging feeling since I started medical school (3 years ago) that the problems I am – or will be – addressing
simply are not that relevant….
As a physician, I will spend my time helping people feel better. When I applied to medical school, I had hoped to treat people in a particular way, developing therapies to address the underlying causes
- not simply treating the symptoms. But now I’m here, and I realize how much I am at odds with the system. Biomedical science – and the practice of medicine that springs from it – is rooted in reductionism,
and I don’t think it’s getting us anywhere. Sure, it’s given us vaccines and penicillin, but I think it has also reduced our awareness of complex interactions (namely between people and their environment).
One issue that illustrates the point – and the one that I care the most about – is food. Scientists and physicians have spent the last century whittling down the list of dietary necessities to a list of
vitamins and minerals, and then industry took these key ingredients necessary for life and started manufacturing foods. Half a century later, you have generations of people plagued by diseases of excess
(obesity, heart disease, diabetes).

Here’s another one: all those antibiotics that were developed in the past century have led to a decrease in infant mortality and an extension of life span. People were less likely to die of TB or pneumonia. Antibiotics became commonplace. They are still prescribed haphazardly for colds, stomach aches, etc. when there may not even be a bacterium to kill. Half a century later, you have generations of people suffering from autoimmune diseases (asthma, eczema, allergies, ad infinitum). One theory behind autoimmune diseases is that, during your development, your immune system was not exposed to enough foreign antigens, leading to an inability to distinguish between “self” and “nonself” tissues. So when you’re exposed to a mild irritant, you get a wide-spread flare up of some sort (rash, inflammation). And medicine doesn’t know what the hell to do about these disease: they just give you a f-ing shot of steroids. Eventually, science figures out where it screwed up (though it never admits it). It’s only now beginning to realize it’s shortcomings. It’s finding out that those basic list of vitamins & minerals are needed to live, but, to live WELL, you need alot more. There’s been a surge in the past decade of research on phytochemicals – plant chemicals – that benefit humans. Lycopene in tomatoes (for prostate cancer), lutein in green leafy vegetables (for your eyes), and all those compounds in green tea, soy, and turmeric that slow aging, prevent cancer, and make you lose weight. Unfortunately, the media construes this research in the simplest way: they keep publishing “updated” lists of foods you should eat.
And there are all sorts of things that we are currently doing that have had little forethought. For example, in vitro fertilization bothers me because (1) the people who get it are wealthy, (2) they have defective eggs/sperm/reproductive organs, and (3) they are contributing unnecessarily to overpopulation. The fact that science only caters to the rich and to the developed countries of the world bothers me…… it’s a big part of the reason why I feel that like I’m wasting my time. In regards to (2), recent research is finding that IVF leads to an increased risk of birth defects. We don’t have the data (yet) to examine what the long-term consequences to the gene pool are (due to IVF)….. my budding geneticist instincts tell me we are weakening our reproductive fitness.
As for (3), science/research caters to our selfish desires. The National Institute of Health drives research in this country, so that means science is funded by tax dollars, which means it caters to our personal interests. People want babies that look like them, that have their genes (regardless of the fact that we’ve exceeded the carrying capacity for the earth). So, money is given to scientists to develop In Vitro Fertilization. If people have heart disease because they have poor diet & exercise habits, then money is given to scientists to find “cures” for this “disease.” However, the disease is a consequence of your actions. If the pharmaceutical industry now comes in with a pill to fix it, then you are relieved of your responsibility, of your accountability. Then we, as a society, further fail to grasp the concept of cause-and-effect…… we then exercise even less self-discipline and less forethought, ultimately leading to the downfall of our civilization.
And THAT is how I feel about what I do.

Everything I see is a testament to how little we know, and how much faith we put in our limited knowledge. It bugs the crap out of me. I can’t help but feel that doctors and scientists are ruining the world with their arrogant belief in what they think they know. So I still feel lost…… and I don’t know what good I will do,
though I desperately feel that I need to do something.

There’s also the thought that I should just jump through the hoops, become a rich doctor, and then use my exorbitant income to fund projects/organizations that I believe in. But I don’t think I would be happy living vicariously….