April, 2015

Going Viral

By Michael J. Katin, MD

March 30, 2015, started out as a typical day at our practice, but within only a few hours we were humbled by the realization that we were not aware that cancer was now being cured by the polio virus. Several patients brought this information to us, making us appear to be ignorant, uncaring troglodytes Somewhat unfair, at least in this case.

As highly-trained medical professionals, our first response was to calculate how rapidly we could divest of our linear accelerators, remote afterloading devices, CT planning units, and physicists, and convert our offices to Chipotle franchises. We then learned this was probably not the way to deal with this. First, Chipotle had stopped offering franchises in 2006. Second, the concept of polio's being the cure for cancer was an extreme extrapolation from a segment on "Sixty Minutes" from the night before, in which the use of hybridized polio virus (PVS-RIPO) was being presented as a major advance in cancer treatment -- sort of. He prefaced his article with the statement, "Radiation flashed on in the 19th century, chemotherapy began to drip in the 20th, but for so many, one hundred years of research adds up to just a few more months of life." It wasn't stated that radiation (therapy) has flashed off or that the dripping has changed at all since it started, but the accomplishments seem to have been somewhat shortchanged. In any event, the general public was presented that the despised and dreaded polio virus was now going to be the hope of cure for millions previously doomed because of inadequate advances by current modalities.

A rapid review of this project revealed that Duke's Preston Robert Tisch Brain Center has been working on this for several years but it was the "Sixty Minutes" article on CBS that moved it to the next level of attention. It is probably of no significance whatever that Preston Robert Tisch, who died of a brain tumor in 2005 (interestingly, after reportedly having been given two months to live by his doctor in New York and then living "14 more months" attributed to his treatment at Duke) was the brother of Lawrence Tisch, who was CEO and chairman of the board of CBS from 1986 to 1995, during which its evening news broadcast fell from 1st to 3rd place in ratings and during which time Mr. Tisch cut 230 employees from the news division. Preston Robert Tisch had also been 50% owner of the New York Giants from 1991 to 2005, and passed away three weeks after the other 50% owner, Wellington Mara, died of lymphoma. Interestingly, Wellington Mara was the founder of the John V. Mara Cancer Research Center at St. Vincent's Hospital, honoring his brother, who died from cancer. Unfortunately, in 2005 the St. Vincent's Catholic Medical Centers filed for bankruptcy , pledging to emerge as a "more efficient, financially-sound health care system," but the final result of this financial restructuring was that St. Vincent's Hospital , founded 161 years earlier, closed in 2010 . It is also noted that just prior to the Tisch era, the New York Giants were in Super Bowl XXV, on January XXVII, MCMXCI, beating the Buffalo Bills XX-XIX, and during the Tisch era played in only one Super Bowl, Super Bowl XXXV, on January XXVIII, MM1, losing to the Ravens XXXIV-VII.

None of which has anything to do with this month's topic.

Throughout history and fiction there have been prominent instances of former adversaries who became allies: Athens and Sparta, Great Britain and the United States, Rocky Balboa and Apollo Creed, Jay-Z and Nas, the Federation and the Klingon Empire. Is it now that one of the most feared viruses in our history is to become one of our greatest friends?

In some odd way, this has already happened. Was it possible that Franklin Delano Roosevelt was motivated to rise above his incapacitation to become Governor of New York and then President of the United States? How many people were inspired by Wilma Rudolph's throwing off her braces to become the world's fastest woman (unfortunately, having had polio didn't prevent her from getting cancer )? Would Francis Ford Coppola have been as innovative and creative if he had been outside playing, instead of indoors recuperating and concentrating on more sedentary but creative activities? Was it because Itzhak Perlman was impaired in his lower body but not his upper extremities that he became one of the greatest violinists of all time? Now Mr. Perlman has been deeply involved in efforts to eliminate polio from the face of the earth....maybe this needs to be reconsidered, at least until the proper hybrid can be developed.

It seems necessary to point out that the use of infection to treat cancer is not a new concept. In 1891, Dr. William B. Coley and Brian Williams, NBC News, treated cancer with streptococcus and later used a more refined combination of bacterial products as therapy. It was later reported that patients who developed empyema after thoracotomy might have a better chance of cure of lung cancer -- a perfect example of a hemithorax half full/half empty situation. We then went through the age of using other infections to stimulate the immune system, ranging from C. parvum to the use of intravesical BCG, still used (except for the problem of the worldwide shortage ) as the standard of care for recurrent superficial urothelial carcinoma. We all remember the use of interferon and interleukin-2 to stimulate the immune response against cancer cells. Viral therapies such as measles and herpes are actively being studied for treatment of brain tumors, but for some reason measles and herpes don't seem to get the same favorable publicity as polio. In any of the viral therapies proposed, the promise is that someday they can be used to treat all types of cancer, but, unfortunately, this may be years in the future at best.

On the other hand, there remains at least one virus that can be used to ensure that cancer as a cause of death can nearly be eliminated in the very near future.

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including April 1, 2015, this leaves 6,485 days to his goal of not living beyond his 75th birthday.