February, 2018
Developements
By Michael J. Katin, MD
Some people think life is dangerous and stressful in 2018, but this has to be considered paradise compared to living in the pre-antibiotic era. There was the constant risk of being attacked by wildlife or, worse, other humans, Any minor laceration from a farm implement, an insect bite, or a Scythian arrow wound could lead to amputation, death, or both. In 1793, the population of Philadelphia, then the capital of the United States, was reduced by over ten percent due to yellow fever. In the American Civil War more soldiers died of typhoid, dysentery, malaria or other infections than were killed in battle. The good news was that they didn't have to worry about MRSA or VRE. The bad news is that there weren't any antibiotics for the bacteria to be resistant to.
Even today, five types of infectious disease remain the five leading causes of death in Africa. In the United States, infections have been largely controlled due to the liberal use of antibiotics such as Keflex and Z-Paks, leaving us free to survive to die from cancer and heart disease. Or maybe not?
The connection of which most medical personnel are aware is that between Helicobacter pylori and MALT lymphoma. It turns out that the microbes that are crawling all over us as well as inside our bodies may have a lot more to do with our developing other conditions. Several years ago there was a flurry of interest in the connection between poor dentition and heart disease. This was not immediately embraced by the medical community since it would logically require that dental care be considered an important part of overall health management and would throw off all the CBO's projections on Medicare and Medicaid. As usual, it will be more acceptable to pay for conditions when they develop than to try to prevent them. In any event, if one is a mouse and if one is unfortunate enough to be deliberately infected with Porphyromonas gingivalis, Treponema denicola, Tannerella forsythia, and Fusobacterium nucleatum, that organism will be destined to have an increase in cholesterol and inflammatory processes invariably leading to atherosclerosis. Plus difficulty in consuming Purina garden recipe.
Now, if one of us were to consume a creature infected with Fusobacterium nucleatum, not only would it be prudent to floss frequently but just as important to have frequent colonoscopies. This bacterial species has been identified in colorectal carcinomas and even associated with a higher risk of nodal metastasis. That's not bad enough news. Last year Yu, Guo, and associates reported that this bacterium promotes chemoresistance in colon cancer!
But it's even more complicated! It may be that the mixture of bacteria in the digestive tract can affect the effectiveness of immunotherapy in treatment of melanoma! , as reported by Wargo et al. at the 2017 American Society of Clinical Oncology's annual meeting. The corollary is that having a certain diversity of bacteria or even a preponderance of certain types can lead to improved responsiveness to immunotherapy, with the thought that providing patients with the ideal cocktail of bacteria, so to speak, may improve their length of survival. You don't want Bacteroidales species, but load up with Faecalibacterium prausnitzii and you've got it made. Well, maybe not quite that simple. Possibly the most compulsive analysis of mouse poop ever written, "Exercise Prevents Weight Gain and Alters the Gut Microbiota In a Mouse Model of High Fat Diet-Induced Obesity," by Evans, LePard, Kwak, et al, from Midwestern University in Downers Grove, Illinois, found that exercise actually increases the proportion of Bacteroidales species in mice fed a high-fat (i.e., American) diet. If these mice, in the interest of economy, had been recycled to be used in melanoma research they would have been even more out of luck than they already were.
Are bacteria conspiring after all these years to go back on the offensive? It almost seems that way. In addition to contributions to heart disease, colon cancer, chemoresistance, and interference with effectiveness of immunotherapy, it has now been discovered that Methylobacterium bacteria are present in breast tumors as well as adjacent breast tissue, and more prevalent in hormone-receptor negative cases! As if that weren't enough, four genera, five families, two orders, and one class of bacteria are significantly increased in urine samples in cancer patients compared to controls. Ironically, years ago Virginia Livingston and associates claimed to have grown bacteria from cancer specimens and in 1969 proposed that Progenitor cryptiocides was the organism responsible for most human cancer. This was dismissed by the medical hierarchy but still persists in complementary medical literature. This occurred years after it was resolved that malaria was, in fact, not caused by "bad air " from marshlands, and leprosy was most likely not caused by sin, but both by microscopic organisms. So it goes.
For future reference, our office is going to be eliminating treatment with isotopes and linear accelerators and buying as many of these bad boys as we can get.
Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. He has expressed that he does not wish to live past his 75th birthday. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including February 1, 2018, this leaves 5,448 days to his goal.
