September 14, 2012 -- This past weekend, something rather unusual took place. Hundreds of people held a parade for science. We are all used to parades but you’ve probably never been to a parade that celebrates the single uniting thing that each and every one of us has in common on this planet: the science that has advanced our lives every waking and sleeping minute of every day.
It might seem like a no-brainer to hold a parade for science but unlike hitting that home run in the final inning of tied game, the benefits of science can be a lot less obvious at any single point in time. Science can be as abstruse and erudite as those words just used to describe it. Attempting to understand what scientists do can be like attempting to read a book written in a language you aren’t conversant in. And there are seldom those “home run” moments in science where the game is won in an instant. Science is an incremental game, one that plays on for years and decades, one that has no final score or victory, only degrees of winning.
That is why the parade that Michael Milken organized as a “Celebration of Science” was so important. It wasn’t your typical parade, with marching bands and cotton candy; it was a parade of ideas and innovation and the people who make it all happen strung together over the course of three days so that we could collectively give science its due. It was a reflection, a moment of thanksgiving, and a time to focus our sights on the future.
For those who could not attend this celebratory parade of science and the people who make it happen, here are a few of the highlights:
On Friday, Wall Street Journal readers woke to Michael Milken’s Op-Ed, “Investing in Science, Reaping Rewards.” He reminded the public that in about a generation, the cure rate for childhood leukemia has skyrocketed. (Just this spring a study was published in the Journal of Clinical Oncology showing that for the most common type of childhood leukemia the survival rate now stands at greater than 90 percent, up from just 10 percent in the 1960s.)
That alone deserves a parade, but Mr. Milken, the host of Celebration of Science, took a moment to remind us that we all have vastly more time on this planet thanks to scientific advances in the past decades. How much more time? Globally our time on Earth has doubled since 1900 and in the United States we can now expect to live to almost 80—a far cry from an average life expectancy of less than 50 years at the start of the 20th century. About an extra 30 years from the start of the last century to the end of this one! It’s a wonder we’ve not had a ticker tape parade for that fact alone.
Read more about increases in longevity here.
The parade was a multi-site event. At George Washington University, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, and basketball legend Magic Johnson spoke about the magnificent renaissance of life given to men, women and children affected by the AIDs virus. In the early days of this disease, even health care providers feared caring for those infected with the virus. Those infected faded away, often quietly, without friends or relatives at their side, lost in a sea of human capital wasted and a suspect eye cast at their lives. Life expectancy for a person with AIDS at the time of the outbreak in 1981 was often measured in months to years; today, in the U.S. a person with HIV can expect a lifespan that is roughly equivalent to those not infected with the virus. On Saturday, as the parade continued at the National Institutes of Health, researchers from around the world got to hear from HIV patients whose lives have been saved by science, such as Dawn Averitt Bridge who, because of the marvel of scientific breakthroughs, has not only prospered since being diagnosed with HIV in 1988, she’s given birth to two children that are HIV-negative thanks to drug therapy that prevents transmission of the virus from mother to fetus. Dawn founded the Well Project that focuses partly on HIV treatments aimed specifically at women.
Across town at the Mayflower Hotel, the focus was centered on prostate cancer. There the Prostate Cancer Foundation (PCF), a non-profit founded by Michal Milken, hosted an entire day devoted to the advances and challenges surrounding prostate cancer, the most commonly diagnosed cancer in men, apart from skin cancer. About a quarter of a million men can expect a diagnosis of prostate cancer each year.
There the day started off with speaker Jedd D. Wolchok, MD, PhD from Memorial Sloan-Kettering Cancer Center speaking about decades of knowledge progression in the area of cancer immunotherapy. The idea with cancer immunotherapy is that if you can get our own immune system to recognize cancer cells as a full-on threat and attack cancer cells in the manner it attacks foreign objects such as bacteria, therein lies an internal mechanism to prevent cancer from growing in our bodies. Wolchok reminded the audience that as far back as the late 1800s, a doctor named William Coley in New York recognized that a robust response by the human immune system to an acute bacterial infection had a significant and positive effect on cancers—namely it could shrink tumors dramatically. Cooley made a crude toxin as an anticancer drug that consisted of dead bacteria injected into cancer patients in the hope of stimulating their immune systems to thwart tumor growth.
Fast forward a century or so later, and out of Cooley’s thought process comes an FDA-approved drug known as Yervoy to treat malignant melanoma. But not just melanoma said Wolchok. The drug is a monoclonal antibody that blocks a part of the immune system that normally works to prevent the immune system from going into overdrive. The idea is to temporarily allow the immune system to go hog wild, and kill tumor cells. He showed impressive slides of patients whose tumors were eradicated with Yervoy and who bore the proud “tattoos” of activated immune cells left at the sites that were once cancer tumors. Yervoy is now in Phase III clinical trials from patients with advanced prostate cancer.
In a follow up to Wolchok’s presentation, Carl H. June, MD of the Abramson Family Cancer Research Institute at the University of Pennsylvania detailed his lab’s work on engineering the immune system’s T-cells to better attack cancer cells in the body. He discussed the progression of cancer therapies that started with the first wave chemical treatments to block cancer, the second wave of protein blockers and now the third wave anti-cancer immunotherapies such as Yervoy and others that are coming online. His work revolves around something called chimeric antigen receptors or CARs and this involves taking immune cells out of a particular cancer patient, using a gutted virus to engineer those immune cells to recognize specific cancer cells and re-introducing them back into the patient from whom the cells were taken. Currently there are several clinical trials of such engineered T-cells going on and next year one will start for prostate cancer patients. This is a strong advancement in the field of gene therapy after a series of setbacks that occurred in the 1990s.
Read more here, here, here, here and here about Dr. June’s gene therapy work.
Levi A. Garraway, MD, PhD—whose group has recently contributed to the creation of a thorough cancer cell line encyclopedia that will help researchers accomplish numerous things such as determine which cancer cells are best suited to treatment with a particular drug—discussed scientists’ increasing awareness of how cancer develops in the first place and that each of three major evolutionary pathways to cancer cell creation does not act independently of the others. Of course, understanding what causes cancers to develop will allow us to practice chemoprevention, either by lifestyle management strategies, or pharmaceutical or perhaps surgical interventions given at the right moment in time.
Howard Scher of Memorial Sloan-Kettering Cancer Center buttressed Dr. Garraway’s talk by underscoring that as we decode the genomes of each cancer we are moving inexorably toward a time when our cancers are not defined by the organ in which they originated but by the genomic profile or signatures they carry which transcend the confines of the breast or prostate or liver, etc.
Read more about cancer cell lines here.
IBM Watson joined the parade route at the Mayflower. This is the supercomputer that beat Jeopardy’s best-ever contestants last year. Experts from IBM, Memorial Sloan-Kettering and WellPoint, Inc. health plans all spoke about how such a “smart” computer as IBM Watson might change the way medical care is delivered here and around the globe. The idea is for a cognitive computer to do what human minds can’t—shift through the enormous compilations of data that have been collated in recent years so the best potential treatment options can be identified for a physician to consider. Mr. Dan Cerutti of IBM said that 90 percent of the world’s data has been created in the past two years and that 80 percent of that data is deemed “unstructured” meaning it has not been put the best possible use and sorted to those who could most benefit from it.
Harlan Levine, MD of the WellPoint insurance company deemed the use of IBM Watson in the clinical setting a whole new state of being for clinical care he called “clinical ontology.” Informational relationships would be built by IBM Watson that no human could gather in her or his brain but that humans could then add unique human wisdom to the equation to determine the best possible treatment for patients. No one mentioned Terminator 3—Rise of the Machines at the Q&A but concerns were expressed sotto voce about Big Brother and medical reimbursements that will have to be addressed before IBM Watson is widely implemented. Yet there is no doubt that as tens of thousands of molecular signatures to cancer are identified humans will need help to sort through this mountain of genetic data that is totally overwhelming medical science at the moment and much good could come from IBM Watson.
Read about IBM Watson here and about how it may change how health care is delivered.
Beyond a shadow of a doubt the utility of a new product on parade by DARPA scientist Jay Schnitzer, MD, PhD was an injectable material that works on non-compressible hemorrhage, such as the one that likely killed Princess Dianna in her car crash and is responsible for the majority of war deaths in the field of combat. The material is easily injectable into internal body cavities and then expands to staunch massive hemorrhages of, say, the liver or spleen. It is non-toxic and easily removed at time of the surgery that repairs internal damages. That got a round of applause as everyone in the room imagined soldiers coming home to their families and civilian accident death rates plummeting.
All in all it was easy to see at this parade that science saves us and that work now in progress will add years to our current life spans, increase our productivity and end the needless robbery of life that disease and accident causes. As men and women need less and less intrusive medical care, health costs will decrease and human productivity will increase.
A century ago acute infections were the leading cause of death. Science has now rescued us from massive numbers of deaths due to tuberculosis and influenza or even a simple case of staph from an untreated blister on our feet. And as Francis Collins, director of the National Institutes of Health pointed out during this spectacular parade in honor of science, mortality rates from stroke and heart attack have plummeted in this country. In fact from 1968 to 1996, there has been a 60 percent decline in stroke mortality. And in the past decade mortality from heart attacks decreased by a whopping 50 percent! And as Howard Soule, PhD, chief science officer at the Prostate Cancer Foundation reminded, the death rate of prostate cancer has decrease to 40 percent of what was once predicted. Hats off to science!
Read more here about stoke decline.
And here about heart attack mortality declines.
Bring on that ticker tape. We all have something to celebrate. But we are not done yet, not by far as all of us know. From the start of this century to 2030, the number of Americans with chronic medical conditions will likely increase by 37 percent. Drug use amongst juveniles for Type 2 diabetes increased 5.3 percent in 2009, and continues to rise each year. And while each of us most likely knows someone who is living with cancer as a chronic condition, each of us also likely knows a person robbed of precious years of their life to this disease or other afflictions such as multiple sclerosis or lupus or any of hundreds of ailments that shorten our lives and limit our ability to realize our highest potential.
At the finale of the parade that took place at the Mayflower Hotel put on by PCF, CEO Jonathan W. Simons, MD called forth the entire cadre of PCF Young Investigators (YI) and awarded each a medal for their efforts and accomplishments in the fight against prostate cancer. Here are just a few of those accomplishments:
- An immunotherapy presentation by a YI to a packed room at the American Society of Clinical Oncology (ASCO) this spring detailing the first cloning of immune cells that react to a specific cancer antigen from patients who were super-responders to immunotherapy. This work is an important stepping stone to next-generation anti-body based immunotherapies.
- The discovery of the most common genetic mutation in human cancers of solid tissue and a resulting urine test that quantifies the amount of genetic transcripts from these mutations. The test is being readied for the public as a means to stratify PSA-screened men as either high-risk for prostate cancers that demand immediate biopsy from men who might best be served by a less aggressive approach that regularly monitors men over time for indicators of progression.
- The development of a novel radiotracer that consists of a monoclonal antibody that targets PSA; this allows physicians to visualize sites of prostate cancer metastatic tumor spread, and importantly, differentiate between true metastatic lesions and benign lesions such as compression fractures. The novel radiotracer can also measure intratumor PSA levels which will inform treating physicians of that tumor’s unique response to a chemotherapeutic and thus allow personalization of treatment not only to an individual patient but to each of that patient’s discrete metastatic tumors, if they have more than one.
- The finding that a highly aggressive genetic form of prostate cancer, known as SPINK1 positive PCa, overexpresses proteins that are normally confined to the gastrointestinal organs. This, of course, opens the door to shutting down those proteins in the prostate gland with targeted therapies.
- The publication of a landmark paper that defined the interconnectedness of two major molecular driver pathways of prostate cancer, showing that these pathways (P13K and AR) regulate one another in a reciprocal fashion. This work informs researchers worldwide that for maximum therapeutic benefit, both of these pathways must be inhibited in men who have a mutated PTEN tumor suppressor gene.
- The development of agents to block both P13K and AR and solutions to acquired resistance to such drugs.
- An epidemiological study that suggests the importance of vitamin D in survivorship of prostate cancer and that one’s genetics may play a role in a man’s ability to make use of the vitamin D in his diet.
- Efforts to quantify exactly which men with co-morbidities should forgo prostatectomy because the surgery is more likely to end their lives than a slow-growing cancer. And the revelation that as repeat biopsy is performed the chance of finding relevant disease drops.
- The finding that copy number of a gene or genes is tied to aggressiveness of prostate cancer; this in turn can serve as novel biomarkers for relevant disease.
- Late phase clinical trials of a novel radio-immunotherapeutic drug against highly lethal prostate cancer cells. This targeted therapy will lessen damage to surrounding healthy tissue while eradicating malignant cells.
- The discovery that a group of proteins collectively known as Hedgehog may go into overdrive upon exposure to hormone therapy for PCa and fuel resistance to treatment, giving researches a new drug target.
- Cataloguing the entire RNA response to hormone therapy for prostate cancer that will give researchers an entirely novel panoply of drug targets.
It’s important to remember this is only a partial snapshot, a fraction of what these YIs are doing and producing each week in their labs.We’ve left out more than we’ve included, but an inclusive listing would require a month’s stay at this conference. But the parade for science continues every day, in their labs, in your homes, in hospitals across the world and in the quiet imaginings we all have for a better existence with far less suffering and pain.
As Michael Milken wrote in his Op-Ed: science matters and we all know it.