I have been attempting to do this with biology and medicine, seriously for about 5 years now. Not by actually repeating experiments, but in trying to understand the original evidence, and see if I agree that it was interpreted correctly. Of course this is nearly impossible as biology is too broad and complex for one person to understand all of the details.
It’s a confusing mess, but I think I am still learning a lot. Even if I come to agree with most of the mainstream ideas, I’d like to think I’d then understand them more deeply, in a way that is more functionally useful.
For much of medicine, there really isn’t any biological basis or evidence to review. Much of modern medicine involves covering up symptoms with drugs proven to do this, without understanding the underlying cause of the symptom.
Much of modern medicine involves covering up symptoms with drugs proven to do this, without understanding the underlying cause of the symptom.
What, really? There certainly is a lot of that approach around, but it’s not what I think of when I think of modern medicine, as opposed to more traditional forms. Can you give examples?
Most of the ones I can think of are things that have fallen to the modern turn to evidence-based practice. The poster-child one in my head is the story of H. pylori and how a better understanding of the causes of gastritis and gastric ulcers has led to better treatments than the old symptom-relieving approaches. (And I’ll tell you what, although Zantac/Ranitidine is only a symptomatic reliever, it was designed to do that job based on a thorough understanding of how that symptom comes about, and it’s bloody good at it, as anyone who’s had it for bad heartburn or reflux can attest.)
When I think of modern medicine, I think of things like Rituximab, which is a monoclonal antibody designed with a very sophisticated understanding of how the body’s immune system works—it targets B cells specifically, and has revolutionised drug treatment for diseases like non-Hodgkin’s lymphomas where you want to get rid of B cells. So much so that for some of those lymphomas, we don’t have very robust 5 year survival data, because the improvement over traditional chemotherapy alone is so large that the old survival data is no use (we know people will live much longer than that), and Rituximab hasn’t been widely used for long enough to get new data. In the last 25 years our understanding of cancer has gone from “it’s mutations in the genes, probably these ones” to vast databases of which specific mutations at which specific locations on which specific genes are associated with which specific cancer symptoms, and how those are correlated with prognosis and treatment. And as a result cancer survival rates have improved markedly. We don’t have “A Cure For Cancer”, and we now know we never will, any more than we can have “A Cure For Infection”, but we do have a good enough understanding of how it happens to get much better at reducing its impact.
Even modern medical disasters like Vioxx are hardly a result of a lack of understanding the underlying cause, but more us learning more about other complexities of human biology. Admittedly we don’t yet fully understand how pain works, but we do know enough to know that targeting COX-2 exclusively (rather than COX-1 as well, which looks after your gut lining) would be safer for your gut. This is understanding down at the molecular level. It turns out in large scale studies that they are safer for your gut, but of course they’re not very safe for your heart, so we’ve stopped using them. And actually doing the full-scale research on modern rationally-designed drugs like Vioxx suggests that similar old drugs (that we never bothered to test) have the same effect on hearts.
You’re right, we do understand the pathophysiology of many diseases, and those are the ones that have been mostly eradicated. The major chronic diseases that remain are very poorly understood such as type II diabetes, cancer, cardiovascular disease, and alzheimer’s.
I spend a lot of time reading about ‘alternative’ ideas about these diseases, and many seem promising, but aren’t taken seriously by the mainstream. It’s definitely possible that they’re ignored for a good reason, but I haven’t been able to find the reasons yet. This is the biggest problem I’ve found with trying to be ‘critical of everything.’ In very few instances do I find myself quickly understanding and agreeing with the mainstream view. Instead, the more I read the more my opinion seems to diverge from the mainstream view. I have made an effort to discuss these issues personally with specialized experts, so they could help point out factors I may be missing, or not understanding correctly. I am a PhD candidate in the life sciences, so I have the opportunity to meet with research professors at my university in person to help clarify my understanding.
Here are two example theories, regarding cancer and cardiovascular disease in particular.
1) The idea that cancer isn’t initiated by genetic mutations, but that mutations are a downstream phenomena that results after damage to the mitochondria occurs.
This stems from the initial observation by Warburg, that lack of control over glycolysis is part of the cancer cell phenotype. This phenotype can be triggered by a large number of factors which inhibit mitochondrial respiration including hypoxia. Later it was found that the mitochondria in cancer cells undergo a phenotypic change, where the cristae structure is lost. Nuclear transfer experiments have shown that a ‘mutated’ cancer nucleus placed into a healthy cell cytoplasm does not exhibit a heritable cancer phenotype. Conversely, a healthy nucleus placed into a cancerous cell cytoplasm does exhibit a heritable cancer phenotype.
Here is a review article covering the evidence for this hypothesis:
More evidence for this hypothesis includes the observation that active thyroid hormone levels (T3) are inversely correlated with cancer mortality rates in the general population. T3 is a key regulator of mitochondrial respiration:
2) The finding that treatment for hypothyroidism drops cholesterol levels significantly, and virtually abolishes cardiovascular disease without the side effects seen from statins. The late Broda O. Barnes was an experimental endocrinologist and a clinical doctor, and he extensively documented this phenomena in his books and publications.
The idea here is that the central mechanism of cardiovascular disese is a low metabolism which inhibits cholesterol clearance from the blood via reduced steroid hormone synthesis, and reduced bile synthesis. The pathophysiology of cardiovascular disease begins with a long residence time of cholesterol particles in the blood, resulting in their oxidation. This can be reversed by any strategy that restores a normal (higher) metabolic rate: a carefully designed diet and/or thyroid hormone supplementation.
I am not insisting that these ideas are correct, or are some sort of ‘well proven answer’ to these diseases. I’m just pointing out that they seem promising, but are relatively ignored. If they prove accurate, much of the mainstream research on these phenomena would seem to be barking up the wrong tree.
You might notice that both of these examples are essentially the same theory. This is an appealing concept to me: most age-related chronic diseases may be centered around a common process of age related impaired mitochondrial function and/or improper hormonal regulation of mitochondrial function. Insufficient chemical energy (ATP) to fuel normal biological function would have widespread consequences, and could present as a diverse array of seemingly disconnected symptoms. I’ll admit, this sounds somewhat like a modern molecular version of vitalism. However, unlike vitalism it makes specific testable predictions, and involves a very specific mechanism. It’s also consistent with the ‘free radical’ and ‘tissue peroxidizability index’ theories of aging, which involve (among other things) progressive oxidative damage of unsaturated fats (such as cardiolipin) in the mitochondrial inner membrane.
I think that for most autoimmune disorders the “modern medical” approach is to ameliorate the symptoms and that’s about it.
CVD, the main killer in the developed world, is rather poorly understood. Oh, sure, we know the details of how the atherosclerotic process works, we just don’t quite know what drives it. Or take a look at the metabolic syndrome—even the name (a syndrome is a collection of symptoms, more or less) gives it away. Can we treat it other than by prescribing a bunch of statins and saying “eat less”? Can we cure diabetes, a VERY widespread ailment?
And that’s even for diagnosable diseases. It’s hard to find statistics, but it seems that it’s not uncommon for people to be… suboptimal and the medicine just doesn’t know what’s happening inside them.
I have been attempting to do this with biology and medicine, seriously for about 5 years now. Not by actually repeating experiments, but in trying to understand the original evidence, and see if I agree that it was interpreted correctly. Of course this is nearly impossible as biology is too broad and complex for one person to understand all of the details.
It’s a confusing mess, but I think I am still learning a lot. Even if I come to agree with most of the mainstream ideas, I’d like to think I’d then understand them more deeply, in a way that is more functionally useful.
For much of medicine, there really isn’t any biological basis or evidence to review. Much of modern medicine involves covering up symptoms with drugs proven to do this, without understanding the underlying cause of the symptom.
What, really? There certainly is a lot of that approach around, but it’s not what I think of when I think of modern medicine, as opposed to more traditional forms. Can you give examples?
Most of the ones I can think of are things that have fallen to the modern turn to evidence-based practice. The poster-child one in my head is the story of H. pylori and how a better understanding of the causes of gastritis and gastric ulcers has led to better treatments than the old symptom-relieving approaches. (And I’ll tell you what, although Zantac/Ranitidine is only a symptomatic reliever, it was designed to do that job based on a thorough understanding of how that symptom comes about, and it’s bloody good at it, as anyone who’s had it for bad heartburn or reflux can attest.)
When I think of modern medicine, I think of things like Rituximab, which is a monoclonal antibody designed with a very sophisticated understanding of how the body’s immune system works—it targets B cells specifically, and has revolutionised drug treatment for diseases like non-Hodgkin’s lymphomas where you want to get rid of B cells. So much so that for some of those lymphomas, we don’t have very robust 5 year survival data, because the improvement over traditional chemotherapy alone is so large that the old survival data is no use (we know people will live much longer than that), and Rituximab hasn’t been widely used for long enough to get new data. In the last 25 years our understanding of cancer has gone from “it’s mutations in the genes, probably these ones” to vast databases of which specific mutations at which specific locations on which specific genes are associated with which specific cancer symptoms, and how those are correlated with prognosis and treatment. And as a result cancer survival rates have improved markedly. We don’t have “A Cure For Cancer”, and we now know we never will, any more than we can have “A Cure For Infection”, but we do have a good enough understanding of how it happens to get much better at reducing its impact.
Even modern medical disasters like Vioxx are hardly a result of a lack of understanding the underlying cause, but more us learning more about other complexities of human biology. Admittedly we don’t yet fully understand how pain works, but we do know enough to know that targeting COX-2 exclusively (rather than COX-1 as well, which looks after your gut lining) would be safer for your gut. This is understanding down at the molecular level. It turns out in large scale studies that they are safer for your gut, but of course they’re not very safe for your heart, so we’ve stopped using them. And actually doing the full-scale research on modern rationally-designed drugs like Vioxx suggests that similar old drugs (that we never bothered to test) have the same effect on hearts.
You’re right, we do understand the pathophysiology of many diseases, and those are the ones that have been mostly eradicated. The major chronic diseases that remain are very poorly understood such as type II diabetes, cancer, cardiovascular disease, and alzheimer’s.
I spend a lot of time reading about ‘alternative’ ideas about these diseases, and many seem promising, but aren’t taken seriously by the mainstream. It’s definitely possible that they’re ignored for a good reason, but I haven’t been able to find the reasons yet. This is the biggest problem I’ve found with trying to be ‘critical of everything.’ In very few instances do I find myself quickly understanding and agreeing with the mainstream view. Instead, the more I read the more my opinion seems to diverge from the mainstream view. I have made an effort to discuss these issues personally with specialized experts, so they could help point out factors I may be missing, or not understanding correctly. I am a PhD candidate in the life sciences, so I have the opportunity to meet with research professors at my university in person to help clarify my understanding.
Here are two example theories, regarding cancer and cardiovascular disease in particular.
1) The idea that cancer isn’t initiated by genetic mutations, but that mutations are a downstream phenomena that results after damage to the mitochondria occurs.
This stems from the initial observation by Warburg, that lack of control over glycolysis is part of the cancer cell phenotype. This phenotype can be triggered by a large number of factors which inhibit mitochondrial respiration including hypoxia. Later it was found that the mitochondria in cancer cells undergo a phenotypic change, where the cristae structure is lost. Nuclear transfer experiments have shown that a ‘mutated’ cancer nucleus placed into a healthy cell cytoplasm does not exhibit a heritable cancer phenotype. Conversely, a healthy nucleus placed into a cancerous cell cytoplasm does exhibit a heritable cancer phenotype.
Here is a review article covering the evidence for this hypothesis:
Cancer as a metabolic disease: implications for novel therapeutics http://carcin.oxfordjournals.org/content/35/3/515
More evidence for this hypothesis includes the observation that active thyroid hormone levels (T3) are inversely correlated with cancer mortality rates in the general population. T3 is a key regulator of mitochondrial respiration:
Thyroid hormones and mortality risk in euthyroid individuals: The Kangbuk Samsung Health Study. http://www.ncbi.nlm.nih.gov/pubmed/24708095
2) The finding that treatment for hypothyroidism drops cholesterol levels significantly, and virtually abolishes cardiovascular disease without the side effects seen from statins. The late Broda O. Barnes was an experimental endocrinologist and a clinical doctor, and he extensively documented this phenomena in his books and publications.
The idea here is that the central mechanism of cardiovascular disese is a low metabolism which inhibits cholesterol clearance from the blood via reduced steroid hormone synthesis, and reduced bile synthesis. The pathophysiology of cardiovascular disease begins with a long residence time of cholesterol particles in the blood, resulting in their oxidation. This can be reversed by any strategy that restores a normal (higher) metabolic rate: a carefully designed diet and/or thyroid hormone supplementation.
Here is a good introduction to this idea:
The Central Role of Thyroid Hormone in Governing LDL Receptor Activity and the Risk of Heart Disease http://blog.cholesterol-and-health.com/2011/08/central-role-of-thyroid-hormone-in.html
I am not insisting that these ideas are correct, or are some sort of ‘well proven answer’ to these diseases. I’m just pointing out that they seem promising, but are relatively ignored. If they prove accurate, much of the mainstream research on these phenomena would seem to be barking up the wrong tree.
You might notice that both of these examples are essentially the same theory. This is an appealing concept to me: most age-related chronic diseases may be centered around a common process of age related impaired mitochondrial function and/or improper hormonal regulation of mitochondrial function. Insufficient chemical energy (ATP) to fuel normal biological function would have widespread consequences, and could present as a diverse array of seemingly disconnected symptoms. I’ll admit, this sounds somewhat like a modern molecular version of vitalism. However, unlike vitalism it makes specific testable predictions, and involves a very specific mechanism. It’s also consistent with the ‘free radical’ and ‘tissue peroxidizability index’ theories of aging, which involve (among other things) progressive oxidative damage of unsaturated fats (such as cardiolipin) in the mitochondrial inner membrane.
I think that for most autoimmune disorders the “modern medical” approach is to ameliorate the symptoms and that’s about it.
CVD, the main killer in the developed world, is rather poorly understood. Oh, sure, we know the details of how the atherosclerotic process works, we just don’t quite know what drives it. Or take a look at the metabolic syndrome—even the name (a syndrome is a collection of symptoms, more or less) gives it away. Can we treat it other than by prescribing a bunch of statins and saying “eat less”? Can we cure diabetes, a VERY widespread ailment?
And that’s even for diagnosable diseases. It’s hard to find statistics, but it seems that it’s not uncommon for people to be… suboptimal and the medicine just doesn’t know what’s happening inside them.