Science Ain't So Bad

SOMETHING FOR TYPE 1?

Sometimes my job sucks.

Occasionally, I hear from readers who say they’re sick.  “Science,” they say, “pah! Who CARES about ‘fascinating’ papers by science geeks ? I need a cure. Not a rat model.”

And- you know what? –  MISTER ScienceAintSoBad gets it.  He does. He knows “interesting” has to take a back seat to “it’s killin’ me.” How often do I find you a nice little pill to cure cancer? I don’t even have anything much for diarrhea.  I read through all kinds of crap about “breakthroughs”. Hah! Some breakthroughs! The mice feel better.  For humans? We’ll get back to you on that.

What a job!

Could be things are getting better. My last article, Alzheimer’s, Things Are Starting To Look Good, had little glitter balls of hope stuck all over it. And now  something about type 1 diabetes that could please you and add to my own optimism about less sick people to drag down Obamacare.  Seriously! It could happen faster than anyone thinks.

The Type 1 vs Type 2 thing

The thing about type 1 is that you can’t make insulin. The cells in the pancreas that  do this job get destroyed by the immune system  Without insulin your blood sugar climbs. If you don’t get yourself stabilized with supplementary insulin,  you won’t last. Even if you are a very good patient, you may have to work very hard at keeping your sugar level in a good range. If you are  lucky you may avoid some of the crappy complications but it won’t be easy. Type 2 usually comes on later in life and is because your body loses its ability to efficiently use the insulin that it produces. It’s not a lack of insulin; just can’t seem to use the stuff right. You wind up needing extra. You don’t want either type of diabetes but individuals with  type 1  often have a tougher challenge.  

What I saw was published in the journal Diabetes. (Dr. Jeffrey Bluestone, PhD and Dr. A.W. and Mary Clausen).  It’s about a drug called teplizumab which, in a very sophisticated way, keeps T-cells (the business end of the immune system) from going after the insulin producing cells on the pancreas. The strength of the results even surprised the scientists conducting the study; they were  “very excited by the efficacy”.

THE CATCH?

Well, here’s the thing. This IS exciting. (That’s what they said in the press release, right?) Great news. BUT these are only phase II trials on 52 kids under 15 years old. Half the kids did great. That’s why so much excitement. But what about the other kids? They didn’t do as well. The study says this might be because it works best where the insulin producing cells are still in fairly good shape. In other words,  where the disease hasn’t been active that long. But, come ON! These were teenagers with newly diagnosed disease. Obviously this part needs to be cleared up. Still. Such great results do justify moving right along to phase III. Great potential here.

By the way, this isn’t the only hope. There’s other research attacking the disease from other directions. That’s good. We don’t want to kick people under the bus just because they’ve been sick for a long time.

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Image credits: That’s mine.

THE GOOD

Life’s good, right? You’re very loved.

Money? Enough. Who needs more? Besides. Money’s not what counts. Summers are warm. Winters? Crisp. With snowball fights, skiing, and frosty branches glistening in front of the window.

It’ll always be like that. Nothing bad’s gonna happen. I Promise.

THE UGLY

Just in case my spell doesn’t work, here’s a resource. It’s for when somebody gets sick.

Very sick.

So sick that he or she runs out of options and the Doc, so optimistic and reassuring at first,  looks uneasy and emphasizes the need to be realistic. This is a place to go that’s out beyond the end of the road. Maybe it’s the next road. It’s called TrialsCentral.org . It was started  by Kay Dickersin  and a group from The Center for Clinical Trials and Evidence-based Healthcare at Brown University.

Couple of things to remember.

First, be sure you get yourself a second opinion. You’re not being disloyal. It’s a routine part of medicine. Your doctor won’t be the LEAST bit uncomfortable. He or she will be glad to make some recommendations. In fact, your Doc will also help you go over the possibilities for possible clinical trials.  You shouldn’t  feel you need to do this on your own.

Clinical trials are labeled as phase I, phase II,  phase III or phase IV. Phase I’s where they weed out the REAL stinkers. They’re looking at side effects and what can be tolerated. Mostly, they’re not looking for sick people anyway. Phase II’s where thing’s get a little more serious. They’re starting to figure out “efficacy” and trying to figure out what’s the right dose. Phase III’s where they get to spend lots of money recruiting subjects in trials in various locations around the country. These are the make/break tests that determine if it gets approved. The phase IV trials are kinda “tune ups” that’re done on drugs that are already out there.  (There are also “phase 0” trials – ultra cautious tests on a few people. A sanity check to make sure they’re ready to do the Phase I stuff).

STUBBORN ENOUGH TO LIVE

If you’re looking for a miracle (am I mixing metaphors?) you’re interested in Phase III trials.  But. remember, even in a phase III trial with a very promising drug there’s a good chance you may be placed in a control group, meaning that you don’t get the drug or its benefits. And trials are EXPERIMENTS. They’re risky. You might have a better (short) life if you just carry on.

But you’re a gambler, aren’t you? You’re not gonna go unless you HAVE to. And you’re damn well not gonna go without a fight. Well don’t  forget that you may be able to argue for “compassionate use” (single patient access), meaning screw the science, just the drug please. Not EVERYONE wants to give a life for science.

Just a small footnote. (Well, I have to say this.) MisterScienceAin’tSoBad would never, knowingly, give you any bad advice or misinformation, but biomedical engineers don’t treat patients and don’t give medical advice. I do offer the very best information that I can but where your health’s at stake, you’ll want to verify anything you read here.

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Attribution for above image: By Anonymous [Public domain], via Wikimedia Commons

EndoBarrier is a plastic sleeve that gets inserted through your throat into your upper intestine.

It modulates the amount of food that’s absorbed which, in turn, tends to shed pounds which, as we know from other studies, tends to (really) turn off type II diabetes.

G I Dynamic’s device is smart and seems pretty benign (compared to tummy surgery) and, in fact, it does have the potential to be very helpful. An earlier article in OPNOTES describes the concept well.

The “Endobarrier” is probably a good thing.

But MISTER ScienceAintSoBad’s butt starts to itch when he reads over-the-top journalism (except his own) that describes stuff like a “15 Minute Cure For Diabetes.” AND for obesity.

EndoBarrier HAS been approved (in Europe).
And it SEEMS pretty safe.
And it DOES seem like an “easy install”

BUT the AMOUNT of weight lost is quite a bit less than with bariatric surgery

Not an unreasonable trade off.

ScienceAintSoBadRating = 7 .

Time will tell.

Cardiology: Seasoning.

Well.

Here’s the thing. About 25% of you are “salt sensitive”. Which means, if you eat too much salt, you could be at risk for high blood pressure (like you always heard), as well as heart failure, kidney disease, diabetes, cataracts, strokes.. on and on.

As if you didn’t have enough to worry about.

How can you tell if you’re salt sensitive?

Not that easy. A clue: low birth weight kids are prone to it.

If you’re in that group (salt sensitive, that is), you really SHOULD steer clear. Keep it off the table and out of reach. Learn other ways to enjoy food.

Or try exercise.

I’m sure you remember from your running days that you can get sick if you don’t have ENOUGH salt. Good hard exercise (done often enough) chews up the salt and may very well ALLOW you to indulge a bit.

Not such a terrible compromise, is it?

SALT AND HIGH BLOOD PRESSURE

I knew you would ask.

See, keeping extra salt out of your diet is such a standard part of government guidelines, that it is now the orthodoxy. EVERYBODY knows it’s true.

“But,” you may ask, “if one in four of us is salt sensitive, don’t we bias the results of the studies that all this stuff is based on?”

You would think.

What about those of us who aren’t sensitive – the majority?

Dr. Richard Fogoros, from the University of Pittsburgh, talks about the “Salt Wars” and concludes, conservatively, that you should “sell your salt shaker”.

Just in case.

MISTER ScienceAintSoBad, doesn’t want to lead you astray, but, given that most of us AREN’T salt sensitive, maybe a little common sense, based on your own medical history, your known inherited risk factors, and the advice of your Doc might give you license to “shake it”.

Just a little.

Anyway, all this stuff is a reminder that science is great ‘n all. But it doesn’t always lead us to clear answers.

The salt and pepper shaker image is from:

Medicine: Color changing lenses for diabetes.

Back to diabetes.

The primary way that diabetics check their blood sugar level (other than passing out, of course) is by analyzing a little blood. They say you get good at it.

So this new thingee from Jin Zhang at the University of Ontario should be very welcome, right? Contact lenses that change color, depending on your sugar level.

Elegant, easy, and convenient.

Have you ever TRIED to poke a lens into your eye? It isn’t the most natural thing in the world. My optometrist claims it’s cause I’m the wrong sex. Women, supposedly, have a contact lens gene. Or, anyway, are more used to screwing around with their eyes.

But for those who find lenses convenient or who already DO wear them, this may be a very appealing idea.

It’s not like I’m running out of 10’s or anything.

ScienceAintsoBadRating = 10

Medicine: Reversing Diabetes.

Remember the difference between Type 1 Diabetes and Type 2?

Type 1’s the type where the pancreas just can’t produce insulin, period.

Without insulin you die.

So. If you’re a “Type 1” you can plan on a regimented life of becoming an expert on your own body, carefully monitoring your glucose levels, eating with scrupulous exactitude, and self administering calibrated amounts of insulin.

With motivation, discipline, and luck, Type 1’s can have great lives. Like our new Supreme Court Justice.

But who wants to be a poster child?

Better to cure the disease.

Step by step, this thing’s going away. I really believe that.

But what if you’re waiting for a cure, watching the damage accumulate in parts of your body? Well, good news! A monkey in Virginia has seen his Type 1 diabetes reversed for a year.

Not a thousand monkey. Not a hundred monkey. Not replicated by other labs (yet). And, most certainly, not in humans. But, according to the article in the Roanoke Times, we may be a few years away from human trials.

MISTER ScienceAintSoBad is ‘sposed to love science.

He does. He does.

But it can be so SLOWWWWW.

This good work was done (mainly) at Revivicor, a small private company in Virginia. To Revivicor and a monkey that’s feeling so much better, ScienceAintSoBadRating = 9 .

(Hey. I’ll bump you up to 10 for a cure.)