Why diseases matter

I was 25 when I got very, very sick. After six weeks of illness, four doctors who had no idea what was wrong, and two weeks in hospital, I was finally treated for giardia diarrhea I had caught in the countryside two months earlier. It took months to feel back to my old self, and I had post-traumatic stress symptoms for years.

Once I got back to something like everyday life, I began to notice that our society’s views of illness did not match the reality in many ways. As I started to work at the Canadian Medical Association Journal and learned much more about illness, this view was reinforced.

The reality is that most illness – in Canada and certainly elsewhere – is a matter of bad luck. You are in the wrong place at the wrong time and you catch something. Or something in your body misfires. Or a remote relative had a bad gene.

On a public-health level, society can make changes to prevent disease: vaccinations, good sanitation and water treatment, advisories to wash your hands, and surveillance and screening programs. But at the moment that those systems break down and a person gets a disease, there’s really not much that can be done.

At the same time, health classes in schools do not teach much about disease causation or medical care. Many Canadians come from cultures (and I’m talking about my own here) that see illness as a failing, either of morals or self-care or stoicism. Others see illness as someone’s – either the patient’s or the doctor’s — “fault.” Still others see illness in superstitious terms, even in this day and age. Many Canadians still think little of medical science and still say “I’ve never taken a day off work sick.” Well, either they were very lucky or they were going to work with viruses and infecting their colleagues.

Sometimes I prefer the views of those from other countries where diseases are more prevalent and acknowledged as a fundamental part of human existence. I believe from my own experience and my work that disease, disability and death are part of what makes us human.

Back in Canada, there’s an inaccurate view among people who have not had serious diseases that they happen only to people with poor lifestyles or people in other countries. That is manifestly not true. If you think about it, either you or your friends and family members have been profoundly affected by diseases: heart disease, cancer, rheumatoid arthritis, multiple sclerosis, ALS, SLE, diabetes, etc., etc.

There are a lot of things said in the street, in the media and even in medical literature about what causes these diseases, but biomedical researchers working on them are much more circumspect. In many cases, we do not really understand how these diseases start, or the things we have been saying are turning out to be incomplete — or even completely incorrect.

My feeling is that we are at the beginning of a coming explosion of knowledge on diseases, which will transform prevention and treatment. Because how can you prevent or treat a disease until you understand what is causing it?

A new pipeline for antibiotics

When I was hired at the Canadian Medical Association Journal in 1991, it was because there were so many ads for drugs that they needed people to edit copy to keep the ads from bumping into each other. I joked that Prozac was paying my salary.

It turns out that was the crest of a wave of innovative drug discovery. Releases of novel drugs are less common today. Many of the new drugs are “biologics” engineered from DNA or proteins, many of which are for chronic conditions and diseases. And a lot of new drugs are so-called “me too” drugs, similar to other recently released drugs so that the manufacturer can grab some of the market. In this picture, there has been little new for pathogenic illnesses since the protease inhibitors revolutionized HIV treatment. It’s as if everyone has figured all the antibiotics have been found.

I recently covered the discovery of a new antibiotic for CMAJ. Several other media outlets had the story as well — it had been published in Nature. But I quickly realized that the particular antibiotic wasn’t the story. There had been some excellent features recently on “antibiotic hunters” who were scuba-diving in Greenland to find new antibiotics. Literally going to the ends of the earth. The reason for the extreme measures is that sources of antibiotics nearer to the lab had been “overmined” in the words of several researchers. The real story is that several research teams have figured out new ways to find antibiotics from old sources. There are lots of antibiotics all around us: we just didn’t know how to “tame” them, as the researchers call it. Some of the newly discovered antibiotics are coming from people’s back yards!

A lot has been made of the use of these novel antibiotics to overcome resistance, as this is a major problem in infection control. Bacteria and viruses adapt genetically very quickly, doing a kind of DNA juggling that other organisms can’t even do, swapping genes with other bacteria and reorganizing their own DNA. How can lengthy drug development cycles keep up with these fleet pathogens?

Yes, resisting resistance is one benefit of novel antibiotics. However, I think the molecules and pathways now being studied will go much farther than addressing resistance. If researchers can find thousands of potential antibiotics, some of them may be active against viruses — for which we still have very little –, cancer, and many chronic diseases for which we do not know the cause but which may be pathogenic. In fact, in a generation or two we may think of drugs in an entirely new way, as capable of curing illnesses minor and grave that today are accepted as incurable. A century from now, medicine may be as far ahead from today as it is today from our grandparents’ day.