Tuesday, January 29, 2008

Cure

Our Labrador Berkeley turned 13 Friday. We baked a massive, celebratory dog biscuit, a certain-to-bomb-the-gut concoction of flour, water, corn flakes, grape nuts and oats. No fear … Berk inhaled and lived to bark about it. Berkeley is an old man battling myriad ailments, including a recently discovered mass in his chest. He’s soldiering forth.

Prior to baking Berk’s bone, I caught the tail end of Science Friday on NPR, including a piece about Dr. Judah Folkman, who passed away earlier this month. Until his death, he was Director of the Vascular Biology Program at Children's Hospital Boston. A central theme of his research was the idea of angiogenesis, the formation of new blood vessels. More on Dr. Folkman in a second.

Later Friday afternoon Dr. Nordquist from the UC Davis Veterinary Hospital called with test results from an exam of Berkeley’s chest mass. Sobering news: He has cancer (thymoma). Good news: It has yet to metastasize and is operable. He’s going in this morning to have the tumor removed.

Back to Dr. Folkman and the timely NPR piece. In 1971, Folkman published a paper in the New England Journal of Medicine arguing that angiogenesis was a key component in the growth of tumors. If a way could be found to limit the growth of blood vessels servicing a tumor, he reasoned, the tumor would be unable to grow. The idea has been incorporated into many different fields, and has led to the development of drugs such as Avastin (Bevacizumab), an angiogenesis inhibitor developed by Genentech.

Prior to, and during, Dr. Folkman’s research, oncologists were intensely focused on the cancer cell being the problem -- 99.9% of research and the resulting drugs that treat cancer pursued this path. Dr. Folkman’s insight: It’s not just the cell, but its relationship to its environment. Dr. Folkman saw a phenomenon when he finished his assigned job too early, got some cancer cells and tried to grow them in a special apparatus where they were testing blood supplies for the Navy. All cells stopped growing at the same time: They can’t grow beyond a certain size for a reason. He realized that if they can’t get a blood supply, they can’t grow.

Dr. Folkman was a surgeon. Normally surgeons do not don’t venture in to the cellular level. However, he considered himself a surgeon scientist. His idea, in the eyes of cancer specialists, seemed too simplistic and naive.

Dr. Folkman was a physician, which shaped his thinking about science. Bigger theme: Contemporary science is very reductionist … take a complex phenomenon and remove singular components. He started with a phenomenon – and studied it religiously – which is not typical of contemporary science.

A lot of things seem obvious after they’re established. Above all, Dr. Folkman was an observer of connections. He sought out and collected dots from various perspectives and tried to connect them in unique ways. In Dr. Folkman’s case, he looked outside traditional (99.9%!) cancer research and discovered a cure. Like many great innovators, Dr. Folkman did not create something from ether; he flipped conventional wisdom and combined elements of disparate knowledge to solve a problem.

I took Berk for a pre-opp run late yesterday. Along a creekside path, Berkeley met an 18-year-old black lab who was carted in a wagon by his parents. Though Berk's new friend could not walk, he was full of energy and spirit. The canines exchanged a few sniffs and barks (and perhaps a few sage musings about growing old), prior to heading in opposite directions.

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Post-script (29 Jan 08): This is a bit off track, but somewhat relevant ... I'm immersed in Robert Sutton's Weird Ideas That Work. An excerpt:

The process of finding new uses for old things is not always intentional. Accidental discoveries sometimes enable firms to serve unexpected customers. Viagra and Minoxidil are examples of such happy accidents. The discovery that Viagra usage was associated with penile erections in some men was initially given little attention by researchers from Pfizer when this "side effect" was first noted in clinical trials. The drug was originally developed to be a treatment for hypertension, and after that failed, it was tested as a treatment for angina. Once again the drug failed. But this time Pfizer researchers followed up on the side effect from their earlier study. They ran clinical trials of Viagra as a treatment for erectile dysfunction, which led them to discover a new application for this existing drug. Similarly, Minoxidil was originally sold in tablet form as a treatment for high blood pressure. A side effect of the medicine was unwanted hair growth. So researchers from Upjohn started examining if it could be applied to the scalp to increase hair growth in balding men. Significant hair growth was observed in more than half the subjects who used it, and Minoxidil is now marketed in the U.S. by Upjohn as Rogaine. Researchers at both Pfizer and Upjohn didn't anticipate these side effects, but both groups were creative because they were observant and persistent enough to find a new use for an existing medication. In the right hands, nothing succeeds like failure.

1 comment:

Lisa said...

I have to ask you how your lab made out after the thymoma removal. I was searching for info about thymomas in labs and came across your blog! We have an 11 1/2 year old lab that we are wondering whether to do surgery on. Don't know anyone who has gone thru it w/their pet. Thanks.