Science or Pseudoscience: Ancient Chinese Calligraphy Ink and Cancer Treatment

When it comes to reading about cancer cures in the media it is usually good advice to be pretty skeptical. Sometimes the story lends well to skepticism – like this one recently covered in a few outlets where it was proclaimed that scientists had found a cure for cancer in ancient Chinese calligraphy ink. It’s a story that has everything – including lasers. Here is a romantic idea that the cure for cancer might lie in an ink that is produced from plants and has been handed down between generations as a way to share writing and art. The proposed treatment is billed as non-invasive and specific only for cancer cells – could this really be science?

I was particularly suspicious when I saw that the representation of the story on Natural News, a prominent proponent of pseudoscience, looked a lot like the story on Science Alert which is typically more of a reliable source on science stories. So I did some digging into the data for this finding.

The paper that was covered in the media is titled “New Application of Old Material: Chinese Traditional Ink for Photothermal Therapy of Metastatic Lymph Nodes” and was published in the journal ACS Omega in August 2017. The researchers were based in Shanghai distributed across various institutes at different hospitals or universities. They had been working on a relatively new cancer therapy called Photo-thermal Therapy (PTT).

Photo-thermal therapy (PTT)

In cancer treatment, PTT is the use of specific types of nanoparticles to generate cell damaging heat specifically at the tumour sites. Scientists take a material that can be stimulated with light – typically infra-red – causing the generation of heat and subsequent tumour cell death. The problem is that many of these nanoparticles are toxic or expensive so in order to make the treatment as efficient and effective as possible, we need to find just the right material.

Hu-Kaiwen

Hu-Kaiwen (Hu-ink) is an ink that has been used by calligraphers in China for hundreds of years. It’s derived from plants, is mostly made up of carbon and it is black in colour which the materials used for PTT tend to be. So scientists got to wondering if it might be useful for PTT.

Firstly the authors of this study looked at the stability of the ink. They diluted it in different things including water and saline and made sure it was stable when stored over time. They looked at the structure of the ink and noticed that it typically forms small aggregates of 20-50nm in diameter – nanoparticles. They confirmed that the core component of the ink was carbon and they stimulated different concentrations of the diluted ink with infra-red lasers and tested the temperature. They found that Hu-ink was more efficient at converting light into heat than most other PTT materials reaching temperatures of 55°C after five minutes irradiation.

Hu-ink for PTT in cancer cells grown in the lab

In research we use cell models of cancer which we refer to as cancer cell lines. These are cells that have originally been taken from patients with different types of cancer but are grown and stored artificially in the lab. We use them so we can test things out on cells that behave like cancer but aren’t in a human body before we move on to doing tests in living organisms. The researchers in this study used some cancer cells originally derived from colon (SW-620) and colorectal (HCT-116) cancer. First they treated the cells with just the Hu-ink and the cells tolerated it really well proving that the ink solution itself wasn’t toxic. Then they treated the cells with the ink and combined it with irradiation with the infra-red laser.

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HCT-116 cells treated with Hu-ink and infra-red compared to HCT-116 cells treated with infra-red only. Image modified from the paper.

The image above is part of a figure taken from the paper itself. There are three images of HCT-116 colorectal cancer cells. In the top image, the cells were treated with only the laser for five minutes. They were not given any Hu-ink. In the middle image the cells were treated both with the Hu-ink at a medium dose for two hours and the laser for five minutes. In the bottom image the cells received a high dose of the Hu-ink for two hours and the laser for five minutes. The red cells are cells stained with a marker of cell death. The green cells are living cells. You can also see that the dead cells are much smaller than the living cells. In the top image where cells did not receive any ink – all of the cells are alive. In the bottom image where the cells had a high dose of ink – all of the cells are dead. In the middle image with a lower dose of the ink, there are some living cells and some dead cells. In other words – when you treat cancer cells with both Hu-ink and infra-red, the cancer cells die.

Hu-ink for PTT in mice

The researchers wanted to be sure that this technique was safe in living organisms and that it was able to kill cancer cells in living organisms. So they took mice with cancer of the lymph nodes and injected Hu-ink into the tumour which they then irradiated with infra-red. After an allocated treatment time, they removed the tumours from the mice and measured them.

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Lymph node tumours taken from mice treated with Hu-ink and infra-red versus control treatments. Image modified from the paper.

For this experiment they had three control conditions – NS (the tumours were injected with saline), NS plus laser (the tumours were injected with saline and treated with a laser) and Hu-ink (the cells were injected with Hu-ink). They had one test condition – the Hu-ink plus laser. The test condition is the only one that the authors predicted would have an effect on tumour size. And that’s exactly what they saw. Lymph node tumours treated with Hu-ink and infra-red were significantly smaller than the control conditions. They also saw that the surrounding tissue wasn’t damaged suggesting that the treatment is safe.

Study conclusion

This study is a proof-of-principle study. The authors have shown that this ink can be used in PTT therapy with a positive effect and in a safe way in mice and in the lab. It is a very small scale study and it is a single study. It needs replicating before we can be confident in the result and it needs to be studied on a larger scale and have many more safety tests before we could begin to think about using it in patients. But it is a really promising study. It takes a treatment we already use and aims to make that treatment safer and cheaper and more available to patients. It is a non-invasive treatment and it can be used in ways that reduces tissue damage to healthy tissue while targeting cancer cells for cell death. It’s a great example of some really cool science, using materials that have been available for many years and applying them to modern techniques.

It might seem far-fetched to say ancient ink can help us treat cancer, but really it’s just cool science!

Report: Attendance at a Pseudoscience Lecture on Gerson Therapy

On Tuesday the 15th of August at a Holiday Inn conference room in Liverpool two of my colleagues from the Merseyside Skeptics Society and I attended a talk entitled “Censored for Curing Cancer”. Also in attendance were around 70 members of the public – some of whom were cancer patients.

The talk had been promoted as a tell-all in spite of censoring and was open to any member of the public through Eventbright ticketing for £20 in advance or for a cost of £30 on the door. The speaker, Patrick Vickers runs the Northern Baja Gerson Centre clinic in Mexico where, as Patrick described it, “we’re treating advance terminal diseases. Not just cancer but virtually every single disease we’re successfully treating, and we’re doing it with Gerson Therapy”.

I heard about the talk through social media, the poster was shared around by alternative medicine proponents with promises of an “epic story of Hope and Truth” about an “effective alternative therapy for advanced degenerative diseases including “terminal” cancer”. This is quite a bold – and scientifically testable – claim about a therapy that, despite the therapy having been around since the 1930s has no sound scientific evidence to support its efficacy.

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Image taken from the Northern Baja Gerson Centre website – a photo taken of the room during the talk in Liverpool on August 15th 2017.

What is Gerson Therapy?

Gerson Therapy is an alternative therapy pioneered by Max Gerson in the early 1900s based on an intense regimen of 13 organic juices, taken precisely on the hour, every hour, and following a strict protocol and a minimum of 5 daily coffee enemas. In addition to this demanding regime, patients must take a huge list of supplements including doses so high of potassium that (again quoting Vickers) “if a medical doctor learned how much potassium we give patients every day they’d be frantic” due to the risk of cardiac arrest.

The Gerson diet is specifically devoid of any salt other than that found in the juices and the patients must take castor oil – four tablespoons every other day in the first month, with a tapered reduction over the first months – in order to ‘detox’ from supposed toxins. The patients also take supplements of pancreatic enzymes and stomach enzymes as well as crude liver extract and niacin.

If all of that weren’t bad enough, Vickers’ clinic in Mexico offers a range of “adjuvant” therapies including rectal ozone, hydrotherapy in which they supplement heated water with hydrogen peroxide (bleach) and laetrile (made from apricot kernels and containing cyanide). All of this first takes place at the clinic during a minimum 2 week stay but Vickers’ goes to some length to stress that most people decide to stay for 3 weeks. This costs patients $5800 (over £4000) per week plus travel to Mexico. Not to mention the hundreds of pounds they will spend every month to continue the protocol for up to three years (or indefinitely) after they have left the clinic.

It is important to categorically state that there is no good evidence that the Gerson Therapy will cure cancer. However one foundation of our medical system is the right to informed consent – it protects the right of any individual patient of the age of consent to make a decision on the treatment path they follow; it protects the rights of any patient to follow alternative therapies should they so choose. But the most important element of that right is the informed part. The content of Patrick Vickers talk was fundamentally against adequate information provided to patients.

Encouraging a distrust in medical professionals

Even before beginning his talk, Vickers seeded distrust in medical professionals: he prefaced his 90 minute lecture with:

“I promise you, by the time you leave here today you will know more about cancer and reversing advanced degenerative disease than any medical doctor on the planet”.

To say this is hubristic is an understatement: a trained oncologist in the UK must undergo many years of training before they earn their specialism and must keep on top of the most up to date research in order to treat their patients to the standards expected by the NHS. This is not something that can be taught during a three hour public presentation. Even my own expertise in cancer research has taken five years to cultivate and I don’t have any responsibility to individual patients.

Compared to his later comments, Patrick’s insinuation that he can convey a complete understanding of one of the our most complicated range of diseases in the space of a single lecture might actually be one his more relatively mild transgressions – elsewhere in his presentation he advised a breast cancer patient to come off her Tamoxifen, told a set of parents that they should not take part in the immunotherapy trial they’d been offered, and told a blood cancer patient that she needed to be weaned off any medication she was taking if she were to undertake Gerson Therapy because it is “incompatible”. All of this “advice” was given with absolutely no understanding of the circumstances of those patient’s cases, since they were simply patients asking questions in the Q&A session after the talk, and the extensive patient history a medical professional with a duty of care would have needed before offering any advice was not be forthcoming in that setting.

Local media coverage

There was (at least) one patient in the room who might have been well known to Pat Vickers, however. Sean Walsh, a singer from Liverpool is a patient of the Northern Baja Gerson Centre clinic who has recently returned to Merseyside following his stay in Mexico. I first became aware of Sean when his story was hailed in the local media as an uplifting success because he survived longer than the 8 months his team of haematologists had predicted despite, eschewing their advice for his treatment and instead undergoing Gerson Therapy. The Liverpool Echo published a story about Sean headlined “Man with cancer beats 8 month prognosis despite shunning hospital treatment”.

At the time, I and my colleagues at the Merseyside Skeptics Society, along with a dozen cancer researchers from the University of Liverpool and North West Cancer Research, responded with a letter to the paper asking that they acknowledge their responsibility to not publish potentially dangerous information as though it were true despite the lack of evidence. The letter was published in the print edition of the Liverpool Echo.

LiverpoolEcho-Letters-20170227

What’s the harm?

According to Vickers’ seminar, should a patient decide to attend the Northern Baja Gerson Centre they would be taken off any conventional treatment they are already taking and weaned off any medication. He told the audience that it takes 3-6 months before a patient is ready to go on the full protocol due to an apparent risk of “chemotoxicity”, and then a further 6-12 months for the tumour to be “destroyed”.

He also recommend that patients on the treatment ought to have no scans in the first 6 months – a staggeringly dangerous message when a patient is stopping all conventional therapy and will have absolutely no indication of what the potentially lethal effect on their cancer during this crucial time period.

In my opinion, the danger of this lecture is threefold. Firstly, Vickers is directly claiming that Gerson Therapy will cure cancer. He says so categorically, and frequently. Not only is this dangerously untrue, but it almost certainly breaks the 1939 Cancer Act, which prohibits an “offer to treat any person for cancer, or to prescribe any remedy therefor, or to give any advice in connection with the treatment thereof”. The Act serves to protect the basis of informed consent fundamental to our medical system.

In addition to this, Vickers claimed that the media, the government and all of the medical professionals are lying about cancer treatment, stating, “It is important to know who is lying to you, how they’re lying to you, why they’re lying to you and when they’re lying to you”. He is promoting a potentially deadly distrust in the scientific consensus on effective cancer treatment, and what’s worse is that he makes these claims at a time when cancer treatment success has more than doubled in the UK in the last forty years. Scientific progress is huge in this area and promoting this distrust could have disastrous consequences for patients.

Thirdly, he is telling patients that the “only” way to cure cancer is the Gerson Therapy, and the only way to do this successfully is to spend thousands of pounds on a clinic stay, organic produce, juicing equipment, coffee enemas and supplements. Not only are some of these treatments dangerous in themselves, but the crippling costs can make the last few months of a patient’s life intolerably difficult, and the complicated and specific regime can make those last few months of a life unbearably miserable. To subject patients to that, on top of insisting that they have a three week stay in Vickers’ expensive clinic, often away from their family at a crucial time in their disease progression, is astonishingly irresponsible.

As a cancer researcher, I find it galling that this lecture can be hosted in a UK hotel with very little criticism. My concern is that information like this is at the very best, unethical and at the very worst leads to the unnecessary death of cancer patients in the region.

Cool science: using Zika virus to treat cancer?

Throughout the last two years there has been a great deal of news on the Zika virus – a virus spread by mosquitoes which was first identified in 1947 in Uganda. In a normal healthy adult Zika fever causes relatively mild symptoms or even none at all however the 2015-2016 Zika epidemic gave rise to widespread concern due to its propensity to cause microcephaly and brain defects in babies infected with the virus during development. The epidemic was declared over in late 2016 although there are still travel warnings to certain areas where the mosquitoes known to carry the virus are prevalent.

But research into this particular virus highlighted an interesting trait that we might be able to take advantage of – Zika has a preference for stem cells.

Zika and stem cells

The reason Zika virus is particularly dangerous in developing babies is that the virus causes damage in stem cells in the brain. A stem cell is a cell that isn’t yet programmed. They’re really important in development because when you create a baby you start with one sperm cell, one egg cell and these cells needs to combine, proliferate and then differentiate into all the different types of cell within the human body. Stem cells are unique cells that can be programmed or ‘differentiated’ into all sorts of different types of cells. Once a stem cell has differentiated it can’t turn back into a stem cell – a differentiated cell is committed to only ever being that cell type. The adult body has very, very few undifferentiated cells but a developing foetus has plenty. This explains the risk of Zika infection during pregnancy as Zika has been shown to target neural progenitor cells – a type of undifferentiated cell in the brain – that might lead to the microcephaly seen in babies infected with the virus during their development.

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Crystal structure of the Zika virus

Zika and brain cancer

Cancer stem cells are quite a complicated thing that I’m not going to try and do justice in this post because it’s a topic that deserves its own post. Scientists believe that some cancers do have associated cancer stem cells. How exactly cancer stem cells might contribute to cancer progression is far from fully understood. However, we do believe that the presence of cancer stem cells might contribute to cancer therapy relapse. This is particularly concerning in glioblastoma – an aggressive form of brain cancer, which has poor survival rates despite our best efforts. Without treatment, median survival is around 3 months from diagnosis. With treatment we are able to extend that survival to 12-15 months however the cancer usually recurs. Scientists believe this recurrence is all down to the presence of cancer stem cells.

The study

So here’s the clever part. Cancer researchers know we have a problem in treating glioblastoma. They also realised that Zika virus is a relatively mild virus, which attacks stem cells. The adult brain doesn’t really have stem cells – unless the adult has glioblastoma. Cancer stem cells in the brain lead to cancer relapse; Zika attacks brain stem cells. Maybe we can make use of these two pieces of information.

So, scientists did some experiments. Firstly, they took some glioblastoma cells from patient tumours and they grew them in a dish in the lab. Then they infected them with Zika virus. They looked at either glioblastoma differentiated cells or glioblastoma stem cells. And they looked at the infection rate. Over 48 hours, over 60% of the stem cells were infected and this increased over time as the virus spread. The differentiated cells were infected too but not as much. What was especially interesting was that the stem cells infected with the virus had severely reduced ability to multiply and they had an increase in cell death. This was specific to only the stem cells and didn’t affect the differentiated cells. The virus kills cancer stem cells and prevents them from spreading.

Next the scientists took some patient tissue samples – this allowed them to look at a whole mixture of cells in a slightly more normal context without having to infect patients. They infected the tissue samples with Zika and saw that cancer samples were infected successfully and the virus only hit the stem cells and not the other cell types in the sample. They also looked at some brain samples from epilepsy patients and the virus didn’t infect them showing that the virus really is specific for stem cells!

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Glioblastoma tissue sample (from the paper)

 

Finally, they used the virus to treat mouse models of glioblastoma. They took mice with glioblastoma tumours in the brain and infected them with the virus. They saw that the tumours were much smaller and the mouse had improved survival when they were infected with the virus compared to control treated mice. They went on to show that they got an even better effect when combined with other glioblastoma treatments.

Benefits

Current treatments have two problems when it comes to glioblastoma. Firstly, the cancer stem cells make recurrence almost inevitable. This could drastically improve average survival times. Secondly, all brain cancer treatments have to be able to cross the blood-brain barrier in order to get through to the cancer cells. The blood brain barrier is an important way to keep things out of the brain where they might cause damage but it also serves as a way to keep brain tumours trapped in and harder to treat. Zika is great at crossing the blood-brain barrier.

What next?

We’re still such a long way from this being a useful patient treatment. In order to use this as a treatment we need to modify the virus in such a way that it will not spread from person to person and it will not cause the patient any harm. Currently virus work is always done in very specialised laboratories with expert training on how to prevent spread and with many, many precautions. If it were to be used as a therapy we’d need lots and lots of precautions to make sure it were safe. So far this has only been done in lab grown cells (albeit ones taken from patients mouse models of cancer. But it’s incredibly interesting research and a great example of how cancer research is so quick to develop and understand how we can take advantage of what we know about the disease and use that to treat it.

 

Please let me know in the comments if you’d like to see a post on any of the topics from this post – Zika virus, glioblastoma, stem cells?

If you found this interesting, please share it with three other people who might find it interesting too! Sharing cool cancer research gives us all a little more hope!

 

Image credit for the crystal structure of Zika: By Manuel Almagro Rivas – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=47941048

Cool Science: taking advantage of cancer cell biology for cancer treatment

One of the big problems when it comes to treating cancer using drugs is that these drugs flood the patient’s body and cause detrimental side effects when they reach areas other than the malignant tumour.  Cancer cells are derived from our own healthy cells – they’re hard to target specifically without also hitting our healthy cells. A lot of research goes into trying to get around this problem. I came across a particularly interesting study that I thought I’d share here.

Earlier this year Sofie Snipstad et al. published a paper in Ultrasound in Medicine & Biology titled “Ultrasound improves the delivery and therapeutic effect of nanoparticle-stabilized microbubbles in breast cancer xenografts”. This paper was particularly cool because of the rationale behind it. Nanoparticle delivery of drugs is something scientists have been working on for a little while. The premise is that you take your drug and you wrap it up inside a small protective bubble allowing the drug to travel to a specific site before it is released. Due to a quirk of cancer biology, this is particularly great as a cancer therapy. When tumours grow, they start to form their very own blood supply – only the blood vessels that they grow are more leaky than normal blood vessels. They allow slightly larger molecules to pass through from the blood vessel and into the surrounding tumour.  This means we can use nanoparticles to deliver cancer drugs specifically into tumour sites by allowing the particles to travel through these leaky blood vessels. But then we hit another problem – if the tumour blood supply doesn’t reach the very depths of the tumour then the particles are too big to get all the way through. You can treat the edges but not the very centre of the tumour. So, this paper worked on a special combination – they took a bunch of nanoparticles containing chemotherapy and they bundled them up together into microbubbles that can travel around the blood system easily and safely until they reach the tumour site. Then, the researchers used a focused shot of ultrasound to break up the bubbles and release the nanoparticles. This also served to allow gentle tissue massage by the ultrasound to allow the nanoparticles to distribute further throughout the tumour. Once in the tumour, the cancer cells start to take up the nanoparticles and inside the cell the drug is released and can kill the cancer cell from the inside.

Picture1Image: figure from the paper

Any microbubbles that weren’t in the tumour site and therefore not exposed to the focused ultrasound could be easily cleared from the body without releasing the drug which means the only cells targeted by the therapy are the cancer cells. This means we can hit the cancer cells with a higher, more toxic dose because the healthy cells are not going to be hit with the same dose.

The researchers in this paper were testing the optimal way of doing this in mice suffering with triple negative breast cancer – one of the more aggressive forms of the disease – with positive results. The mouse tumours took up the drug 2.3x better and there was no tissue damage identified. All of the tumours either regressed or else the mice went into complete remission. The authors described this as a “promising proof-of-concept study”.

New Study: Does chemotherapy promote cancer metastasis?

A little while ago my attention was drawn to an article published in July 2017 on a blog called The Mind Unleashed titled “Chemotherapy to Spread Cancer, Cause Lethal Tumours in Groundbreaking New Study”. The article reported on a paper published the same month in the journal of Science Translational Medicine. This article claimed that the researchers had “proven that chemotherapy causes cancer cells to spread throughout the body – to replicate themselves, making your cancer worse, not better”.

This is a frightening thought. Could it be possible that in treating cancer we are actually promoting its survival? As a cancer researcher I was very, very sceptical of this claim. Chemotherapy is a cancer treatment that has been available for a long time. It was first studied in the early 20th century and first administered in 1942. On the day of writing there are over 2.9 million papers referencing the term chemotherapy in the title, key words or abstract available on PubMed (a database for published, peer-reviewed material). We have done an incredible amount of research into different types of chemotherapy treatments and those that work are the only ones approved for use in the clinic.

That’s not to say we know everything about chemotherapy, though. The human body is a complicated thing, as is cancer. We might well be missing something. The most important part of research is to continually progress, to follow the science where it leads us in the most unbiased way possible.

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The paper in question is one reporting a study undertaken by researchers at Albert Einstein College of Medicine in the US. The authors were working on a particular chemotherapeutic agent called paclitaxel (brand name Taxol) in mouse models of breast cancer.

Paclitaxel is a drug derived, originally, from the bark of the Pacific Yew tree. It was first discovered by a screen on plant derivatives undertaken by the National Cancer Institute in the early 1960’s. After decades of research into the chemical – first isolating the chemical structure and later the mechanism of action – paclitaxel was approved by the FDA in 1992. Today, we make it from a precursor taken from the needles of this plant. We are unable to produce it entirely synthetically.

Paclitaxel works – it prolongs progression free survival and shrinks tumours. The mechanism of action is well established; paclitaxel binds to a protein involved in cell division thus preventing tumour cell replication. Consequently those cancer cells die and tumour size is reduced.

cancer cells, cell division, cancer research

There are, of course, side effects to any drug and paclitaxel does have a number of them. In particular, paclitaxel is not soluble in water so for treatment it must be diluted in a derivative of castor oil. This is not particularly well tolerated by the human body and patients must be co-treated with corticoids and antihistamines to prevent dangerous hypersensitivity reactions so research is ongoing into better ways of administering paclitaxel.

One avenue of research has been into a particular quirk of paclitaxel treatment. It has been identified by clinical trial that when paclitaxel is used prior to primary treatment (such as surgery) in breast cancer (known as a neoadjuvent therapy) the survival rate of patients is not increased beyond that of surgery alone. This is despite a reduction in tumour size when using paclitaxel as a neoadjuvent. If tumour size is reduced you might expect survival to be enhanced – there was a discrepancy here not currently explained by the available science.

The authors of this paper had a theory. They knew that paclitaxel treatment is associated with an increase in a particular type of immune cell called macrophages moving into the tumour site. They also knew that macrophages might be involved in metastasis. Therefore, they posited that perhaps the reason paclitaxel didn’t prolong survival despite shrinking the tumour might be because the tumour was able to sustain itself by travelling elsewhere in the body.

They investigated this question in a number of laboratory mice which suffer from breast cancer and are used as models of the disease in humans. The researchers found that there was an increase in markers for metastasis in those breast cancer mice treated with paclitaxel and an increase in circulating cancer cells in the bloodstream. And then they took it another step forward. The authors noticed that the increase in metastasis markers included an increase in a protein called TIE2. They had reason to believe that this was an important part of the problem so they co-treated the mice with an inhibitor against TIE2. This they showed reduced the markers of metastasis and the circulating cancer cells in the blood.

mouse model, science, laboratory, cancer research

The important conclusion of this study was not that paclitaxel might promote metastasis in mice with breast cancer. It was that this particular type of chemotherapy might have another negative effect we didn’t know about. It is important to know about this because now we can monitor patients for changes in their metastasis markers when they are treated with this type of chemotherapy and we can switch them on to a different form of treatment if necessary – or we can co-treat them with TIE2 inhibitors. The most important thing in medicine is to have as much knowledge as we possibly can. We shouldn’t be fearful of negative effects of good treatments – unfortunately to kill cancer cells in the body will have some negative effects. But we need to be aware of them and we need to manage them carefully and make sure we put the needs of patients first. Research like this helps us make informed decisions on treatment options. Of course it requires further research first in more animal models and later in humans but it a stepping stone to giving us important information that may well help us to save more lives.

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What worries me more is that blogs like The Unleashed Mind misrepresent the data reported and promote distrust in reliable medical research and the scientific method in general. Anyone communicating the findings of academic research has a responsibility to represent it accurately especially when that communication might well influence a patient’s decision when it comes to their health. A cornerstone of medicine is to give patients the opportunity to informed consent – we should all endeavour to present the information as accurately as is possible.

photo credit: ZEISS Microscopy