Friday, January 27, 2012

I do work for a variety of companies outside of my usual work, all involved in some way in therapeutics or nutrition, or the like.  In general, much of what these non-medical companies are doing is developing regimen's of 'discipline,' whether it be ingest something, wear something and/or do something, that have an underlying commonality that is unspoken.  All of these kinds of 'clothes' are cut from fabric laid out thousands of years ago.  At least the Greeks had fairly elaborate criteria and mechanisms for self-discipline that rest (and still do) on a tautology of sorts.  The Romans continued these 'arts' and elevated them, and the practitioners.  The basic presumption is that men should resist that which is natural, but animal like, in order to achieve a higher human existence.  And the 'governing" of the self was the same degree to which a man could be fit to govern a wife, a family, a business, and ultimately empires.  Those who were fit to govern would be recognized by their ability to govern their own natural urges.  I understand the impulse to discipline here, the notion of creating order from chaos (and I do also understand the order in chaos...), but there aren't any data that support this.  Lots of crappy leaders were  likely regimented and loads of dynamic, effective leaders are personal train wrecks.  For those who don't get to (or won't, you undisciplined lot) read Foucault's 3 volume History of Sexuality, the wonderful observations he conveys are subtitles for the political theater of our day (and sad as it is).  The game is played out around these ancient ideas of discipline, at least until the unfit are weeded out.  Of course, they are only unfit on the grounds of self-discipline, and specifically self-discipline in sexual affairs, with damaging, but not fatal, chinks for ethnic, financial and social affairs.  But the dismissal of potentially outstanding leaders due to thousand year old imperatives is probably not a very intelligent algorithm.  But it is one that has infiltrated much of our sense of excellence.  Maybe we can just start to look for excellence itself?  Maybe that would be a better indicator of potential?  Just an idea...

Thursday, January 19, 2012

Don't let the facts stand in the way of a good story...


The graphic (thanks Nature) is a linear representation of a way to think about how tumors develop blood supplies.  It is, of course, not actually what happens, but a way of thinking.  And that way of thinking has produced lots of attempts at intervention.  Of course, the interventions are not just applied to thinking, but to bodies.  And therein lies the trouble.  Recent work (http://www.sciencedirect.com/science/article/pii/S1535610811004478) has demonstrated what was likely a fairly obvious outcome.  Very popular (meaning blockbuster) anti-angiogenic drugs have been demonstrated to slow tumor progressions.  But hypoxia (lack of oxygen) is a primary driver in cancers becoming metastatic.  So primary tumors may not grow as swiftly, but metastatic tumors appear more frequently.  Of course, that was not part of the thinking.  But again, this is a real system, a complex biological web, not a thought experiment.

I remember the almost fever pitch of effort promoting Judah Folkman (pioneer of anti-angiogenic therapy) in a poorly disguised effort to deliver a Nobel Prize to him before he died.  It generated a simple, fatally-flawed logic of how to treat cancers by denying blood supply.  So we have another of the common, killer beliefs about medicine and science.  Killer, sadly.