Michael Fossel Michael is President of Telocyte

June 18, 2016

Faster Horses?

Often, when problems seem intractable, we’re asking the wrong questions.

We want to get to the moon: how can we jump higher? We want to get to the stars: how can we make bigger rockets? As Henry Ford once suggested, people wanted a better way to travel, so they wanted to know how to breed faster horses. Wrong questions.

Aging, and its multiple diseases are no different.

Without realizing it, we start by assuming that we already understand aging, then can’t understand why nothing cures the diseases of aging. Small wonder that Margaret Chan, the director of the WHO, stated we should “give up the curative model” of diseases of aging. In her report late last year, she urged us to focus on inequity and prejudice. If we had focused on inequity and prejudice in 1950 when polio was rampant, we would still have polio. Everyone would have an equal opportunity to have leg braces or access to iron lungs and we would have laws to prevent anyone “micro-aggressing” against those with a limp. Good things in their own way, but would you rather have equitable iron lungs or would you prefer to have a cure for polio? Equitable disease or disease prevention?

The WHO believes in political solutions – social band aids – rather than medical solutions. Frustration is understandable: so many approaches appear so futile. We can prevent polio, yet it seems impossible to prevent Alzheimer’s disease. Small wonder that few of us truly believe that we can do anything substantial and innovative. Like people determined to jump higher and higher, in hopes of reaching the moon on muscle power alone, we celebrate the tiniest elevation increase. Eli Lilly and company celebrated a possible 3 month delay (as their Alzheimer’s patients still progressed to an intractable death), and their stock price jumped higher as well. Yet, no matter how high we learn to jump, no matter how we learn to “breed faster horses”, we are still asking the wrong questions. Small wonder success appears impossible.

What is Alzheimer’s disease? Is it merely a slow, passive accumulation of amyloid and tau tangles? Or are those merely the effects of some more important upstream cause? We treat the symptoms, we treat the effects, then become frustrated when the disease continues its slow sweep of souls into oblivion.

Yet if we could understand what underlies a disease like Alzheimer’s, we might yet reach not only the moon, but the stars. To do so will take a far better way to travel than merely “faster horses”.

In order to cure, we first need to understand.

 

June 7, 2016

Innovation in Medicine – It’s About Time

Filed under: Aging diseases,Alzheimer's disease — Tags: , — admin @ 2:11 pm

Everyone favors innovation and diversity, as long as you’re not innovative or diverse. This remark, snarky as it is, is also (heartbreakingly) accurate. We argue that we support innovation, but we fight to prevent innovative concepts or industries. The more innovative an idea, the more we actively resist, regulate, and revolt against that idea. Diversity too, is something we favor only in small doses, despite naïve protestations to the contrary.

It’s not really surprising. If I have devoted my entire life to perfecting the best possible leather equipage for a horse-and-buggy, then my idea of innovation is better quality leather, and I actively disparage the idea of a horseless carriage with its internal combustion engine. In the 16th century, prior to Copernicus, most astronomers favored “innovation” by looking for more precise epicycles in their models of a geocentric universe. In the last years of the 19th century, prior to relatively and quantum theory, most physicists favored innovation in making ever more precise measurements of the universe of classical physics.

Much the same could be said of medicine. In medieval Europe, the physician’s view of innovation in treating and preventing bubonic plague was to find just the right flowers and herbs. Innovation consisted of finding more highly scented plants, not in finding a vaccine. In revolutionary America, the physician’s view of innovation lay in tweaking the process of blood-letting to get just the right amount of blood loss and at just the right time. So much for medical innovation.

Yet there have been successes. If Salk hadn’t found a truly innovative approach to preventing polio in 1954, we would still be working on “innovative” approaches to better iron lungs, stronger leg braces, more effective rehabilitation exercises and other sub-optimal approaches to polio. Despite some successes in medical history – sterile surgical procedures, antibiotics, better hygiene, and vaccines all come to mind – we still aren’t particularly innovative. The FDA, for example, routinely turns down two thirds of all applications for “breakthrough therapy” on the grounds that the proposed therapy isn’t even vaguely innovative, let alone effective. Yet we continue to push a “new” statin, a “better” artificial joint, or a “more successful” heart transplant approach as being innovative, which they are not. We even see medical journals touting cost-saving methods as being “innovative”. Useful, safer, faster, or cheaper perhaps, but they are only incremental, certainly not innovative.

To actually prevent and reverse age-related disease would be innovative. It is also feasible, yet many physicians and researchers – despite protestations of how innovative they are in finding a more potent pain reliever, a statin with fewer side effects, a cheaper biphosphonate, or a more predictive gene for an age-related disease – still can’t quite bring themselves to be innovative or to think innovatively. To be innovative requires that – like Copernicus, Einstein, or a diverse group of innovators – we step back, we examine our assumptions, and, while looking at the same data that others are looking at, we see things that no one else has seen.

Innovation requires us to see the world as it is, not merely as everyone thinks it is.

 

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