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Still seeking the elixir of life? Just don't expect it at the
Independent on Sunday, The, Jan 1, 2006 by Tom Shakespeare
You will know it has been a busy time for breakthroughs, if you have been paying attention. On Wednesday, we learned that mega doses of vitamin D could halve the risk of cancer. Before Christmas, Mayo clinic researchers reported that green tea might cure leukaemia. In Alabama, research with eye-cell implants reduced twitching in Parkinson's patients by up to 48 per cent. And in San Diego, a study has identified the genetic mechanism by which insulin metabolism is disrupted by high fat diets, causing type-two diabetes. The worried well will feel a wee bit better about our future.
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It is not all good news. The San Diego research was conducted on mice, and scientists are a long way from proving that it's relevant to humans. There were only six patients in the Alabama study, and four in the Mayo research. Meanwhile in Holland, a clinical trial has proved conclusively that bee stings are not a cure for multiple sclerosis. And we also learned that Professor Hwang Woo-suk faked his stem-cell research breakthrough in Korea. The news value of medical breakthroughs can go down as well as up.
The quest for miracle cures has a long history. Five hundred years before Harry Potter, alchemists were busy searching for the philosopher's stone that promised eternal life as well as gold, while the masses resorted to holy relics or herbal remedies to combat disease. It took a while for doctors themselves to deliver concrete benefits. The germ theory discoveries of Pasteur and Koch in the late 19th century, the invention of aspirin in 1897, followed by the development of sulphur drugs and then pencillin, made biomedicine pre-eminent. Now the West's cultural obsession with youth, health and longevity dominates both news and lifestyle coverage and drives biomedical research and investment. In America, 15 per cent of GDP is spent on health care, while only 6 per cent is spent on education. California alone is investing $3bn in stem-cell research, when there are more than three million illiterate adults in the state. Gene therapy and stem-cell research are the new elixirs, throughout the industrialised world.
Most of us are sceptical about visits to Lourdes, television evangelists, or even the reported miracles of the late John Paul II. But when it comes to rational scientific medicine, disbelief is often suspended. Disabled people are very familiar with this fascination with pioneering medical technologies. Researchers have been promising to make the crippled walk and the blind see for 50 years: the late Christopher Reeve was the most recent high-profile disabled person to have his expectations raised. But many disability rights activists would prefer to see immediate action to remedy inequality and social exclusion, having become frustrated with the promise of cures which are always 'five years away'.
In other words, it is risky to put our faith in the magic bullet. Social history proves that the major advances in health have always come from improvements to living conditions, not as the result of scientific drugs or treatment. Moreover, we live in an age where drugs are becoming less, not more, effective. Yes, you did read that last sentence correctly. Let me explain.
First, over-prescription and the rise of drug-resistant bacteria are steadily undermining the power of antibiotics. Meanwhile, tuberculosis is on the rise in the developing world, where 98 per cent of deaths caused by it occur. Similarly, antiviral therapies are currently effective against HIV, but it is inevitable that the virus will evolve into new and resistant strains.
Second, many pharmaceutical therapies are so toxic that they cause as many problems as they solve. For example, some of those treated successfully with chemotherapy for childhood cancers have been shown to be at raised risk of adult tumours.
Third, thanks to medical research, scientists now know more and more about less and less. With the rise of pharmacogenetics and personalised medicine, treatments are likely to be more specific and more effective, but they will benefit fewer people. This phenomenon also generates economic dilemmas: a 50 per cent cure rate for a disease variant that affects a tiny proportion of the population does not look attractive to global pharmaceutical companies, which claim it can cost $800m to bring a new drug to market.
Fourth, new preventative treatments such as statin and aspirin might be miracles, but they are not cures. Taking your daily pill will certainly reduce your risk, but it won't solve the problem or make you immune. For example, many people who take statins will still die from a heart attack.
Fifth, most common diseases are multifactorial: they are caused by complex interactions of genetic predisposition, diet, infection, lifestyle and working conditions. This makes it highly unlikely that a single pharmaceutical agent would be able to solve the problem.
Our contemporary obsession with the miracle cure obscures the simple fact that we all have to die of something. For example, over the past 30 years, the incidence of breast and lung cancer has doubled. The good news is that there are now many more effective treatments, and survival rates from cancer have increased: 10 years ago, the five-year survival rate for breast cancer was 73 per cent; by 2001, it had increased to 80 per cent. Now, two-thirds of women with breast cancer will survive for 20 years. Despite this success story, increasing numbers of people will be killed by cancer " because of their success in escaping death from other causes.
