The tragedy of science: we cannot fault the tiger for being the tiger

Vinay Prasad is a young researcher in oncology who recently published the post reproduced below on his blog. It is about how oncology has become a field whose main purpose is mainly to enrich companies and practitioners. The tragedy of these reflections is that they apply just as well to many other fields of science. And it is sad to think that science started as a disinterested search for truth, and then it was turned into an ideological shield for criminal activities. Correctly, Vinay Prasad says that we cannot fault corporations for aiming at profits (we cannot fault the tiger for being the tiger). But we can fault the whole health system built with the purpose of making money instead of helping patients. Vinay Prasad's most recent book (2020) is titled "Malignant". I am reading it. It was already rather dark, but not as pessimistic as his latest post. 

Here are some excerpts from Vinay Prasad's text, you can look at the complete text on his blog:

The Tragedy of Oncology

Vinay Prasad

Excerpts from https://vinayprasadmdmph.substack.com/p/the-tragedy-of-oncology

I started my journey into cancer medicine more than 10 years ago, and it has been joyous and tragic, fulfilling and frustrating, all at once and often on the same day. Recently, I returned from our latest conference, and I had a chance to think about that experience a few days later in the mountains of the Sierra Nevadas. My conclusion is grim.

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The tragedy in oncology is that we have dismantled the system that is meant to tell real innovation from pseudo-innovation. Almost no one understands the problem, even few care about fixing it, and instead most hope to fatten themselves of the riches, while the opportunity exists. Meanwhile, we have entirely lost sight of the goal— the purpose of our task. We have forgotten that this is about helping people sick and dying of cancer live long and live better. That goal is lost.

10 years ago, I believed that, as a younger generation swept through, reform would be inevitable. 10 years later, I see how naive I was. For every young person who understands the problem, there are 9 more salivating at the idea of becoming the next key opinion leader, eagerly going to advisory boards or pharma-sponsored dinners. Every young person who speaks out publicly is advised by colleagues or their boss to stop talking. Some are even told not to (or fearful of) retweeting critical content like mine or Aaron Goodman’s.

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Academic leaders. This category contains some massive failures. We have ‘leaders': who are pocketing 10s of thousands from Pharma and defending their (failed) products. What am I to think when the company behind Melflufen hires a leading academic to defend a garbage subgroup analysis at the ODAC? What am I to think when university after university enters into financial arrangements with companies? Pushing back on corporatism is impossible, when you are on the payroll.

Journals and professional societies. Many journals block critical commentary. Many organizations sell out their professional conferences to Pharma. These institutions are now so dependent of Pharma largess that they are powerless to say anything. Only a few voices inside these organizations keep them from toppling into complete advertisements.

Junior faculty. The vast majority are busy running uncontrolled trials that will not help anyone (most uncontrolled trials can’t even answer a useful question). Many have joined ad-boards, etc. Some are studying important topics but have nothing novel to add. An abstract on health disparities that shows… health disparities. Except the solution remains unclear, and the authors think all that is needed are more expensive, mediocre drugs. Cookie cutter projects is another weak spot. If you don’t have a novel idea, it’s ok to think for a while— rather than follow the path of least resistance.

Oncology press. A cottage industry of rag publications cover oncology. They are almost entirely funded by pharma or it’s ads, and they have no critical coverage. Even oncology podcasts are upwardly biased. This is not journalism, but advertisement.

The Industry. The group that I have the least quarrel with is pharma itself. We cannot fault the tiger for being the tiger. Instead, it is the aforementioned entities who have let their guard down. The tiger has a moral obligation to make profit. We were the ones who did not incentivize the right things.

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How will it end?

Internal reform is not possible. Too many people benefit from the status quo. Reform will come from government regulation— and must come from the USA— that tilts incentives to what matters. I will continue to write, podcast and publish on the flaws of cancer medicine, but going forward, I will spend more time strategizing on political solutions to this problem.

Meanwhile, I won’t forget the goal of oncology: to help people with cancer live as long and as well as possible, using as few drugs as possible, and, pushing for the best evidence to guide those choices. Perhaps we should all have to take that oath.

Holobiont Science: Stefania Consigliere on Bio-Anthropology

 

An image of the talk given today in Florence by Stefania Consigliere, who teaches at the University of Genova, Italy. A talk at a remarkably high level: an interdisciplinary romp on many facets of the modern crisis, touching individual health, the management of the pandemic, the cultural structure of our world, and how diet-based Chinese medicine is superior to our pill-based medicine. 

Note how the talk was given in the open, in a public garden, with all sorts of people attending. It would not have been possible to give it in a University: the bureaucratic rules would have prevented the general public from attending. And it is hard to see how a standard university department would have been able to stomach such a wide-ranging, heretic talk. It is sad to say that the Western universities have completely lost the role of keeper of knowledge and wisdom they once had. By now, they are completely self-referencing entities whose main purpose seems to turn smart people into idiots. 

What we did today is what I call "holobiont science." Science for human beings, with human beings, for the good of human beings. The people attending the talk were not scientists, they were a holobiont-like assemblage of varied people who wanted to learn something. And Stefania Consigliere did her best to transmit her knowledge to them. It is the same approach we took with a talk that Anastassia Makarieva gave in Florence a few months ago. No university, no bureaucracy, no permissions, no QR-codes. Just people getting together to learn. That's the definition I use for "social holobiont:" people collecting to do something together. 

I briefly intervened in the debate and I mentioned the concept of "holobiont" (Stefania had not used the term, but she had hinted at it using the concept of "symbionts"). And, you know? It turned out that several people in the audience knew what a holobiont is! Don't say that science does not progress!!

Nutrition to Cure the Human Holobiont: the Right Path to Health?

 

Dr. Natasha Campbell-McBride explains her theory about nutrition as the origin of most maladies. It is a long video, but somehow I managed to hear it all.

 

In my life, I never was the kind of guy who looks for trouble. But, occasionally, I found myself in situations where I thought that a (very) rapid retreat was the best strategy (1). My genetic set-up seems to be geared on "run" rather than on "fight," and who am I to criticize my ancestors?  

But I can tell you that some members of a certain category of people seriously tried to kill me: medical doctors. I won't go into the  details, it is not the purpose of this post to smear medical doctors, even though I would have a few horror stories to tell you about myself and people I know. 

Apart from my personal case, if you want a truly blood-chilling example of medical malpractice, you can find it in Siddhartha Mukerjee's book "The Emperor of All Maladies." In it, you can read, for instance, how the standard treatment for breast cancer up to less than a century ago was to mutilate women in the most gruesome ways. And it was totally useless. There are other cases, for instance the idea of strict bedrest following a heart attack may have killed millions, worldwide, as reported by Dr. Bernard Lown (2). 

So, doctors can be very dangerous, at least some of them. But there is a category of medical doctors who stand apart from the rest because they are much less dangerous than the average: nutritionists.

The advantage of the nutritionist's approach to health is that it is difficult to kill someone by telling him or her to eat (or not to eat) some specific kind of food. True, some diets that have been proposed in the past are so terribly unbalanced that they can kill in the long run. You may wish to read Lierre Keith's book The Vegetarian Myth (2009) for an in-depth criticism of some extreme kinds of diets. But, overall, it is difficult to propose a diet, no matter how quixotic, that does worse than the current "standard" diet based on hamburgers and soft drinks. 

The nutritional approach stands in stark contrast with the standard medical approach. As I said, I am not here to smear medical doctors, but my experience with them is that their approach is to match your symptoms with a specific pill, and there you go. Next patient, please. Always busy, stressed, and overworked, that's about the most you can expect. 

The problem with this approach is that, as you get older, you tend to accumulate pills just like you accumulate fat in your love handles. And nobody can say to know exactly what's the cumulative effect of all those pills together. On this point I can tell you about my mother in law, Liliana, who turned 100 last year. At some moment, this winter, she seemed to be very sick and we were thinking she was going to leave us. When the doctor came, he agreed with us that the good thing to do was not to give Liliana more pills during what might have been the last days of her life, but to have her stop taking most of those she had been taking for years. 

The result was remarkable: in a few weeks, Liliana improved a lot and she returned alert and in reasonably good shape for a centenarian. That doesn't mean she will live to 110, but this little miracle was impressive. Liliana's case is not unique. I am told that it is a typical that when someone very old is taken off their usual medicines, they often dramatically improve. 

Now, please understand that I am no medical doctor, I am not recommending anything or anyone, and I am not telling you to take or not to take any medicine. I just wanted to propose that in the future medicine may well become something different than the current one. I started with the clip by Dr. Campbell-McBride not because I think she says something better than other nutritionists do. In fact, if you look at books written by nutritionists, you'll find a wide variety of approaches and I have the impression (just an impression!) that some nutritionists strongly disagree with each other. But this is typical of science in a phase of rapid progress. 

What impressed me in Dr Campbell-McBride is how deep and wide is the scientific basis of what she says. And her approach to try first to understand the natural mechanisms that lead to a sickness and the attempt to avoid approaches that may lead to worst side effects. Another good thing about her is that she was smeared in an article in the Daily Mail, where they even cast doubts on whether she was really a medical doctor. That is, of course, a badge of honor for her! Probably, she received this treatment because she is Russian, and Russians have to be evil by definition.

Dr Campbell-McBride never mentions holobionts in her book or in her book but, clearly what she is discussing about is the human holobiont taken as the unit to be cured: including the microbiota that makes the human organism function. Will that be the medicine of the future? I can't say that, but for sure the concept of holobiont is leading us to many new concepts and new ideas

 

(1). An occasion when I saw myself at the risk of physical violence was when I found myself surrounded by a group of screaming men in a Roma (Gypsy) camp, seemingly intending to beat the hell out of me. When I realized what was happening, the most angry one was too close to me to give me a chance to turn and run away safely -- the Roma are almost never armed, but you never know. So I could only stand and face him, as calmly as I could. But the situation quickly de-escalated. It turned out that he was angry at me just because I was the closest Gadjo he could find. His wife had left him and the social workers had taken his daughter away from him. Add to that a little alcohol, and he had gone bonkers for good and he was angry at all the Gadji, not without reasons, poor fellow. The other Roma were puzzled just like me, but it was soon clear that they had collected around me to protect me, not to harm me. Eventually, we even became friends. You may think I was lucky but, really, I knew what I was doing when I entered that Gypsy camp. I didn't expect troubles and I had none. In fact, a Gypsy camp is normally one of the safest places of the world. 

2.Dr. Bernard Lown died less than one month ago. A great man by all means: Physician, cardiologist, professor at Harvard University and a physician at Brigham and Women’s Hospital in Boston. He was the inventor of the defribrillator, proposer of many successful ways to help people suffering of heart failure. He was also the recipient of the Nobel prize for peace. You can read his thoughts at his blog that he kept until 2012. Lown died at 99 after a life full of activities and, I imagine, of great satisfactions. Gaia was gentle with this son of hers who did so much for his many brothers. May he rest in peace.