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Musings of a Cancer Doctor
Wide-ranging views and perspective from George W. Sledge, Jr., MD
Thursday, December 29, 2011
That’s a Wrap: 2011 in Review

I love year-end wrap-ups, the “best of” lists that tell me what I missed these last 12 months.  Some are fairly worthless -- I never see more than one or two of the movies Roger Ebert adores -- but others, particularly the book lists, give me months of pleasure.  And some lists actually instruct. Both Science and Wired have lists devoted to the top scientific breakthroughs of the year.  The Science lists tend to be more sciency (if that’s a word; if not, it should be) and the Wired list a bit techier, but both tell me what matters outside my little ghetto of oncology.

 

Science’s top breakthrough of the year was medical. Labeled “HIV Treatment as Prevention,” it documented the ability of antiretroviral drugs to prevent the transmission of the HIV virus (a quite amazing 96% reduction in the risk of heterosexual transmission), which implies the possibility of eliminating AIDS some day. Certainly this is both good clinical science and wonderful news from a public health standpoint.

 

The runners-up to the HIV/AIDS story were interesting as well:

(1)  an analysis of asteroid dust by a Japanese group;

(2)  the cool news that most of us are part Neandertal (as well as other archaic human species);

(3)  our improved understanding of the molecular underpinnings of photosynthesis;

(4)  a better sense at the makeup of the early universe;

(5)  the piecing together of the gut microbiome;

(6)  the first demonstration of an effective malaria vaccine;

(7)  the Kepler observatory’s first census of extrasolar planetary bodies (some deeply weird);

(8)  the increasing ability to tailor industrial molecules; and

(9)  the ability to delay the effects of aging through elimination of senescent cells (a piece of cake: purge cells expressing p16INK4a).

 

What many of these stories have in common is their reliance on technologies that were unavailable, or at least ridiculously expensive, even a short time ago. The Neandertal and microbiome stories depended on the existence of relatively cheap gene sequencing, barely a decade after the initial gene sequencing of a single individual for a $3 billion price tag.

 

The malaria vaccine reflects something different: the willingness of Bill Gates to fund scientific research affecting the common illnesses of the developing world, working in tandem with a pharmaceutical company (GSK) willing to make a big bet on something that will not benefit health consumers in the West.  Kudos to both.  Philanthropy continues to play an important role in science and medicine, a century after Rockefeller started pouring money into public health ventures.

 

The vaccine is only partly effective (a 50% reduction), but even without the vaccine malaria deaths have dropped by almost a quarter globally since 2000, and by a third in Sub-Saharan Africa. Like most public health advances, this has been largely ignored, even though it is transformative both for individuals and entire nations. The vaccine, widely used, could save huge numbers of lives and kick-start economic prosperity in some of the world’s poorest lands.

 

The astronomy stories also reflect the existence of novel technologies, both computational and optical, that have transformed our understanding of the universe in the past two decades. The ability of astronomers to predict the size and motion of planets 2000 light-years away is something fantastic and (dare I say it) otherworldly. My latent science fiction genes are upregulated whenever I read this stuff.

 

Are these really the top science stories of the year?  We’ll know in a decade or two.  There aren’t any cancer stories on the list, though I could make a pretty good case for new melanoma therapeutics being special enough to celebrate.  But we’re probably all missing things that later researchers, and society as a whole, will consider turning points in human knowledge.

 

The origins of scientific revolutions are frequently hidden in plain sight, as the history of science teaches us.  When Darwin and Wallace’s papers on evolution were first presented to the Linnean Society in 1858, the meeting’s attendees politely ignored them. The Society’s president noted in his diary that nothing of importance took place that year!

 

Closer to home, when a young Ernie Wynder presented his first case-control study linking cigarettes to lung cancer at the American Cancer Society’s National Cancer Conference 1949 meeting, he was asked no questions after his talk. Not one. The following presentation, on pulmonary adenomatosis in sheep, provoked a half hour of heated discussion. We’re not always very good at picking out what’s important.

 

Not all scientific breakthroughs are good news. Wired’s list includes a scary story:  investigators at two institutions generated a human H5N1 influenza virus, theoretically capable of rapid spread and high lethality. The US Government took the unusual step of asking that portions of the work not be published lest they fall into the wrong hands and result in the deaths of millions.

 

In H.G. Wells’ race between education and catastrophe, moral education frequently lags scientific progress. The Nobel Peace Prize, after all, is named after the man who invented dynamite.  How long before the next dictator or some mad mullah sitting on large pools of oil funds the lab required to rediscover and weaponize this killer flu? Or simple incompetence releases the virus on the streets of Manhattan or London or Beijing?

 

Once we know that something is capable of being made, it is rapidly reproduced, as the long list of countries with nuclear bombs shows.  You only need Fermi and Einstein and Szilard the first time around: after that fairly average scientists will serve to create death-dealing monstrosities. In reading this story I remember Yeats: “And what rough beast, its hour come round at last, slouches towards Bethlehem to be born?”

 

On a cheerier note, and defying death, comes the news (on both lists) that eliminating senescent cells prolongs the lives and improves the functionality of aging mice.  This cheered me up considerably.  All that is now required for me to live to a hundred and eighty is a drug capable of purging old, worn-out cells.  Molecular Draino, unplugging my clogged pipes of their cellular debris, will make me good as new.  Better than new, I trust, since “new” wasn’t that much to brag on. And this time I promise I’ll take better care of myself.

 

So goodbye to 2011, and welcome in the New Year, where new wonders await us. Can neutrinos really travel faster than light? Will the Chicago Cubs make it to the World Series? Anything is possible, even if everything isn’t equally likely.

About the Author

George W. Sledge, Jr., MD
GEORGE W. SLEDGE, JR., MD, is Chief of Oncology at Stanford University. His OT writing was recognized with an APEX Award for Publication Excellence in the category of “Regular Departments & Columns.”