Will America become a culture without science?

Posted on October 29th, 2007 in Politics,Science by Robert Miller

As a basic scientist I have watched like a concerned parent as the world of biomedical research has been increasingly pressured to “come up with new miracle cures.” Part of this problem relates to the promises that NIH supporters made in their appeals to congress for support, predicting cures and relief for any number of diseases, with cancer at the very top of the list, since this is the public’s greatest fear and worst nightmare. Some of these promises have been delivered, or at least a significant down payment has been made. We effectively cure some leukemias that were fatal thirty years ago. But, this cure is through old fashioned chemistry that puts the patient through a debilitating and expensive treatment procedure that can itself sometimes lead to death from infection or other complications. The road to these improvements all came about from basic research, not trial and error by a doctor in a white coat. If there is a triumph of the last half of the twentieth century, it is that we have penetrated the basic functions of cells, tissues and genes, but when we did so, we revealed a complexity of these body constituents unlike anything we could have imagined. The famous neuroscientist J.C. Eccles (Nobel Prize 1963) used to claim that the brain only needs two neurotransmitters, one for excitation and the other for inhibition. According to his famous doctrine (long since buried) the complexity of the brain is through its connections, not the way in which those connections interact. But, what we learned over the last half of the twentieth century, as Eccles’ influence was waning, was that the brain has dozens if not hundreds of neurotransmitters and that each neuron can be in one of multiple different states that determine our functionality. In addition, the cells that we once thought represented the “glue” of the nervous system, the “glia” (glia in German means glue) now add to this complexity by communicating with nerve cells and, in some cases, controlling their sensitivity. The brave new world of the brain was its vast diversity of cellular states…a kind of decentralization of authority. What roles these cellular states play in creating our own multiple states of mood and function is now a major topic of study for the 21st century.

Periodically, we are forced, by shear public pressure, or the reaction to perceived pressure, to go in a direction that will generate a “quick fix” or a cure. Two major events in our lifetimes have forced this approach, bypassing basic science that might have altered the course or outcome and given us a better handle on “new cures.” To understand how this works, we have to go all the way back to Richard Nixon and his “war on cancer.” In that effort, he suppressed funding for other research avenues and enhanced the budget of the National Cancer Institute to carry out the research necessary to cure this disease once and for all. But cancer is highly complex and science works best if all frontiers are moving up the same hill. As it turns out, Nixon’s suppression of research in other areas, such as immunology, may have retarded a better understanding of cancer, because these other fields have provided insights that are invaluable for diagnosis and treatment. We now recognize that it is most unlikely to find a universal cure for cancer and we will more likely generate “cures” that need to be developed for specific subtypes of the disease. Perhaps someday, way off in the future, we may find a universal cure for cancer, but, if that is possible, it will only come about through basic science research. The tortoise will win this new race.
Now advance the clock into the 21st century past Nixon’s war on cancer: when AIDS first surfaced and the virus was identified, public sentiment and scientific efforts were channeled into finding a vaccine. Indeed when the identity of the virus was announced by NIH, the Reagan administration forced the scientists to announce that a cure, in the form of a vaccine would be available within a few years. Yet, more than two decades later, the most promising vaccine was abandoned recently by Merck, as it may have increased rather than decreased the risk of an HIV infection. Had we more vigorously pursued basic science research, which has now revealed new complexities of our immune system and hinted at new ways of developing treatments, we would have a more intelligent response and understanding of the disease. Now, with the collapse of vaccine trials, we need to know more about the lifestyle of this wicked virus.

The second arena of my concern are stem cells. When stem cells first surfaced as a cure for diseases, NIH sent out numerous requests for grant applications based on the injection of stem cells as trials for curing many if not most diseases, but specifically, targeting stroke patients and Parkinson’s patients, where lost nerve cell populations are part of the disease or outcome. At the time these announcements were made, I felt this “shotgun” approach would get us nowhere. Even if a short-term success could be registered, it seemed to me that the long-term consequences of injecting cells that “never die” (stem cells are, in principal immortal, like cancer cells) would likely lead to chronic conditions that would appear in the form of another disease, perhaps later on. Early on, I participated in stem cell research to show that proper manipulation of bone marrow stem cells could result in neurons that looked and functioned like neurons (that is, they generated electrical activity…nerve impulses). I felt that strategies such as that could eventually produce a refined, differentiated cell that might prove useful for treatment. But, the field of stem cell research surged ahead, hoping for miracles and immediately confronted a problem that was predictable: injecting fetal stem cells can lead to “teratomas” or a form of tumor generated by cells that are immortal and can produce any type of cell in the body. Depending on the local, chemical environment these cells might not divide at all, or might divide and never stop dividing, thereby creating a new uncontrolled problem for us.
We do not know if a vaccine can ever be produced to reliably protect us from an HIV infection. But, if we achieve that state, it will only be because basic science research exposed the means by which we can finally outsmart a very smart and lethal virus. Similarly, I am certain that one day we will find the use of stem cells (whether fetal or more tissue specific) to be an effective cellular replacement for lost or aging cells, but to date, that promise remains as just that–a promise.
The American public is oddly demanding. They don’t want to know the cause of anything, just give them the cure. And, unfortunately, all too often, medicine has made promises of cures, but couldn’t deliver because of the complexity of our biology. The same attitude can be seen in how we are addressing “terrorism.” The public is disinterested in knowing why people are terrorists, or if we might have had anything to do with it, but they want to be immediately free of terrorism, just like it was a cancer that needs to be cured. Today however, the American public is gradually being introduced to the need for their personal research, to take the thin veneer off of their perception of the world. Our medical care system is so broken and dismembered that when a patient gets confronted with a medical problem, many now believe that their physician is not giving them the proper diagnostic or treatment assistance, because he or she is being dictated to by the medical care system that is more concerned about profit margins than patient care. The vision of capitalist medicine finally arrived in America: doctors make money for their corporate overlords by withholding treatment rather than providing it. If we ever get a decent, single payer health plan without huge corporate profiteering, it will be created by the public demand to return to the old days….when they didn’t have to know anything! In the meantime, many Americans have learned how to use PubMed and even MeSH to learn more about their disease than their doctor knows, so they can either confront their physician with his/her ineptitude or make plans to visit Taiwan: I don’t expect that to change any time soon. Now, if we could just deal with terrorism in the same way, we might avoid ever having another Bush presidency and we might finally put a stop to the long line of “Blowbacks” that now confront our landscape.


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