The Most Critical Factor in Medicine? Human Bias
Oncologist and writer Siddhartha Mukherjee suggests that what doctors fight against isn’t so much disease — it’s their own biases.
In the summer of 2003, I finished my three-year residency in internal medicine and began a fellowship in oncology. It was an exhilarating time. The Human Genome Project had laid the foundation for the new science of genomics, the study of the entire genome. And it was nothing short of a windfall for cancer biology.
Cancer is a genetic disease, an illness caused by mutations in genes. Until the early 2000s, most scientists had examined cancer cells one gene at a time. But once we could examine thousands of genes in parallel, the true complexity of cancers became evident. The human genome has about twenty-four thousand genes in total. In some cancers, up to a hundred and twenty genes were altered — one in every two hundred genes — while in others, only two or three genes were mutated. (Why do some cancers carry such complexity, while others are genetically simpler? Even the questions were unexpected — much less the answers.)
The capacity to examine thousands of genes in parallel, without making any presuppositions about the mutant genes, allowed researchers to find novel, previously unknown genetic associations with cancer. Some of the newly discovered mutations in cancer were truly unexpected: it turned out the genes did not control growth directly, but affected the metabolism of nutrients or chemical modifications of DNA. If cancer cells were dependent on mutant genes for their survival or growth — “addicted” to the mutations, as biologists liked to describe it — then targeting these addictions with specific molecules might force cancer cells to die. The battle-ax chemical poisons of cellular growth would become obsolete at last.
THROUGH A NICK OF THE SKIN, I COULD SEE THE BIRTH OF A REVOLUTION IN CANCER TREATMENT.
The most spectacular example of a new drug, Gleevec, for a variant of leukemia, had galvanized the entire field. I still recall the first patient whom I treated with Gleevec, a 56-year-old man whose bone marrow had been so eaten by leukemia that he had virtually no platelets left. He would bleed profusely from every biopsy that we performed; an oncology fellow had to meet Mr. K in the exam room with a brick-size pack of sterile gauze pads, and press on his biopsy site for half an hour to prevent bleeding. Read the rest of the article on TED
Current medical treatment boils down to six words: Have disease, take pill, kill something. But physician Siddhartha Mukherjee points to a future of medicine that will transform the way we heal.