Thursday, December 22, 2016

On Science Research

Some people wonder why we haven't come up with a cure for type 2 diabetes yet. The paranoid among us often suggest that Big Pharma knows of a cure but is keeping it secret because type 2 diabetes is so profitable for them.

I acknowledge the flaws of Big Pharma, including huge salaries for those at the top and huge increases in the prices of life-saving drugs so that many people can't afford them. But I don't think there's a big conspiracy hiding a cure.

The fact is that the biochemistry underlying type 2 diabetes is complex, and adding to the complexity is individual variation.

For example, look at this figure printed in Nature. It's from a paper on mechanisms controlling insulin secretion. The figure shows the various pathways leading to or modifying to rate of insulin secretion. Each step had to be discovered through experimentation, often complex with the potential to give false results if something wasn't done correctly, or if some assumption proved later not to be true. If one group produced results that weren't accurate, those following up on that work would be basing their analyses on false results from the first group, so their analysis might be wrong too.

The New Yorker recently ran an interesting story about some stem cell research that was later questioned, and withdrawn, resulting in the suicide of the leader of the lab in which the research was done. He may have been innocent but couldn't deal with the stress of being associated with questionable research. The article illustrates how full of pitfalls this complex research can be.

Now look at the figure again and imagine different patients with defects in different parts of the scheme.

Seems almost impossible to understand in full, doesn't it.

But nothing is impossible. Eventually we'll sort it all out. We'll do genetic studies on all patients to find out where their metabolism is faulty and hence what sort of treatment would be the best. This won't happen next week. Maybe not in this century. But it will happen if we don't wipe out life on Earth before we get a chance to cure type 2.

In the meantime, our best approach is not to accept a one-size-fits-all approach to controlling diabetes but to find what works for us, including careful attention to diet, experimenting to find out which diet works best for each of us so our need for drugs is minimal. Then we need to work with our doctors to figure out which drug is best for us. Being active also helps. I think low-carb diets are best for most people and should be where they start on diagnosis. But some patients may have better success with other approaches. The important thing is to find out what works for you. You might have a defect that is slightly different from another person's and so you might need treatment that is slightly different.

For example, a recent study showed that some patients with glioblastoma (a brain tumor) benefit from a treatment that was shown in clinical trials not to work. That's because results of clinical trials are reported as averages. Some treatment may harm some patients, help some patients, and have no effect on some patients. If the harm canceled out the benefit, then the researchers would say the treatment was ineffective. But if you were in the small group that was helped, it would be worthwhile for  you.

 Until we know everything, which is unlikely ever to happen, I think we should support, at least emotionally, the efforts of the scientists who are trying to puzzle this all out. It's true that many are more concerned with their own careers than they are with helping patients, but the world isn't perfect. And I don't think it helps to rant that all doctors are money-grubbing opportunists, all drug companies are hiding cures so they can sell us expensive drugs, and all researchers are just trying to justify their next big research grant so they can fly to conferences at scenic beach resorts.

These accusations do apply to some people.  And I think we sometimes do need to rant, especially when we've just been diagnosed and have been given bad advice, or no advice at all, by the medical people we trusted to take care of our health. Or if we're shamed by medical people who think excess weight is our fault and is easy to lose. The internet gives us a chance to share our rants with other people who can understand where we're coming from.

But the internet also gives us a chance to share our successes and the results of any N = 1 experiments we've done. For example, an engineer has done some fascinating experiments correlating his fat intake with his lipid results from standard tests. The results are not what you'd expect, and maybe they'll lead to research in formal clinical studies with lots of people. Once we've gone beyond the ranting stage, the internet gives us a chance to contribute to the knowledge base that will eventually help others control this disease.

In the meantime, we need to understand that biochemical and biomedical research is complex and open to error, but headline writers want simplistic conclusions, like "Eating Food X Prevents Diabetes," when in fact some study showed that eating Food X was associated with a tiny reduction in diabetes rates in a specific population.

So hang in there. Keep testing. Keep an open mind. Be sceptical of popular press articles about diabetes. Don't expect perfection, but control as well as you can.

And enjoy the holiday season, which involves more than just food: the music, the companionship, the beautiful lights. The days are getting longer. Soon it will be spring (well, first we have to survive February, but at least it's short). Maybe this year someone will make a type 2 diabetes breakthrough. We can always hope.