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Emperor of All Maladies: Lesson Three [What is Disease?]
Emperor of All Maladies: Lesson Three [What is Disease?]

Mukherjee describes oncologists' difficulty "lumping the lumps."

He cites the massive differences between a condition like Hodgkin's lymphoma and pancreatic cancer- both are termed cancer, but they couldn't be much different from each other in presentation, course, and prognosis. Calling them both cancer seems naive. But, lumping them together galvanizes support to attack their common roots. (All cancers share at least one common trait- they derive from a single aberrant cell from among the many trillions that make up our bodies.)

So here we are, stuck on the horns of the dilemma between splitting conditions into separate disease classifications so they can be understood, and lumping them together so that we can summon our collective forces against common roots.

Both approaches have their merits and limitations. I propose a unification.

Let's imagine that all disease is like a mountain range with tall, jagged peaks. Let's further imagine that modern viagra cialis online pharmacy pharmacy approaches the mountain range of disease from above, first encountering the tips of the tallest peaks. Delving into history, these would mainly be infections, but also trauma, problems with pregnancy, and a few degenerative complaints like arthritis and gout.

In order to learn about diseases, the very first step had to be characterizing them so that, as I pointed out in an earlier post, the conditions could be measured, and then the progress of certain interventions could be assessed. Returning to Hodgkin's lymphoma- until Thomas Hodgkin classified it and gave it a name, absolutely no real progress could be made in treating the condition because medicine didn't even know it was a problem.

In my analogy, Thomas Hodgkin found the tip of the mountain peak that is Hodgkin's lymphoma.

Pancreatic cancer was characterized by many people, but one of the earliest was Giovanni Margagni.

Now let us imagine medical science learning more and more about these two conditions, uncovering ever more of their respective mountain sides. Mountain peaks get broader as one approaches their bases, and the peaks of a range merge at their bases. So too, eventually, will the peak that is Hodgkins lymphoma merge with the peak that is pancreatic cancer, and the different teams of researchers will both be exploring the inner workings and pathology of cell division. These teams would eventually be joined by the researchers of all cancers who have followed the different trajectories that unregulated cell growth can take in different tissues and from different causes.

And now, please indulge me as I sweepingly describe the history of medicine in stages:

1. Medicine has not yet found the mountain range. There is no classification of diseases, just attempts to propitiate forces deemed beyond our control.

2. The first peaks are systematically described, measured, and experimented with. With a common understanding, success in treatment can be built upon, and some conditions are improved and cured.

3. Research unearths ever deeper root causes of disease, to the point we are at today where there is significant overlap between conditions. In this way, our treatment of one condition aggravates the overlapping systems inherent in other conditions. (The first, discrete conditions that medicine tackled, like strep throat, were cured without side effects. Today, cox2 inhibitors for arthritis can cause heart disease because somewhere this far down, inflammation and heart disease overlap.)

4. The next stage of medicine will largely abandon the traditional classification for a modern conception: it will reclassify (and therefore refocus research) around the root mechanisms of cell and tissue damage. I believe this will center around the processes of organ manufacture and transplant. After all, it doesn't matter what mountain peak lead to heart disease- if you can get a brand new heart, you're cured.

I think this unifies the current debate by preserving the need to both split and lump. We just need to change what we're splitting, and reexamine how to lump.

For a glimpse at my favorite candidates for root causes of tissue damage, see Aubrey de Grey's plan for Strategically Engineered Negligible Senescence.

If you want to stare slack-jawed in mesmerized disbelief, watch Anthony Atala display a kidney that he printed with a 3-D printer.

Travel Bite: Turkish Viagra

Turkish online pharmacy is a ubiquitous moniker for various kinds of dried fruits and nuts I saw throughout Istanbul's Spice Bazaar. Frankly, I don't know if there's any truth to its claim of increased prowess or longevity.

In fact, rather than combatting it, I think their Viagra actually promotes E.D. (Eating Double). I know that I can go for four to six hours.*

I'm not sure why some are referred to as Viagra and others aren't, but you'd think the generic brand would be cheaper.

I came upon this Viagra market on the side of the road in the remote region of Cappadocia in central Turkey. I sure hope Pfizer isn't planning a hostile takeover.

The landscape in Cappadocia is fascinating, to say the least, with churches and houses carved into immense volcanic rocks.

Maybe the demand for Viagra explains why there are so many cave hotels (love nests?) like this one in the town of Goreme. Hey, whatever gets you through the night. In my case it was fig, apricot, date, almond, pistachio, hazelnut and walnut.

*Warning: Dried fruits and nuts are not recommended for everyone. Talk to your doctor first and see if Turkish Viagra is right for you.

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Paul Walker in Men's Health Magazine
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Paul William Walker IV (born September 12, 1973) is an American actor. He became well known in 1999 after creating the spread offense in the hit film Varsity Blues. He is also known for starring in the surprise summer hit The Fast and the Furious and has since gone on to star in its sequels 2 Fast 2 Furious and Fast & Furious. His other successful movies include Joy Ride, Running Scared, and Eight Below. He is the cover guy for Men's Health Magazine in March 2010.

Going to Ghana?
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Going to Ghana?

Please don't be overwhelmed, but the the following is a summary of the vaccines and medications which are recommended for your trip. The more you know about your vaccination history, the less shots you may need to get.

  • Tetanus/Diphtheria/Pertussis (1 shot)---if your last one was more than 10 years ago.
  • Polio (1 shot) ---one time only needed as an adult.
  • Measles, (1 shot)--- if you are born after 1957, and you have not had 2 doses of MMR(measles,mumps,rubella) . Please note that measles is a live vaccine and it should not be given to pregnant women or to those with immunosupression.
  • Typhoid ( 4 pills)--- which are taken 1 every other day, and will be good for 5 years. If you have had a previous typhoid vaccination but in the form of a shot then that is only good for 2 years. Note that these purchase cialis should be refrigerated. This is also a live vaccine and should not be given to pregnant women or to those with immunosupression.
  • Hepatitis A ( series of 2 shots) ---if you have never had the series. The first one should be given 4 weeks prior to your trip. You will need a second shot in 6-12 months to be protected long term.
  • Hepatitis B---(a series of 3 shots ). The first 2 are given 4 weeks apart and the third is given in 6 months. You should get the first 2 shots before departure. This is especially recommended if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment.
  • Hepatitis A/B combination shot may also be given. This follows the same schedule as hepatitis B shots.
  • Meningitis vaccine (1 shot)---if you have not received one in the last 3 years.
  • Yellow fever vaccine (1 shot)---if you have not had one in the last 10 years. This must be administered at a Certified Center.
  • MALARIA PILLS, 2 most commonly prescribed are the following but only one is needed: MALARONE (atovaquone and proguanil hydrochloride)---taken one a day starting one day before entering the area and continue every day until 7 days after leaving the area.
    LARIAM (Mefloquine)--- taken one a week, starting one week before entering India and continuing for 4 weeks after leaving India. This is not recommended for people with depression. It has also been associated with vivid dreams.
  • Ciprofloxacin in case of traveler's diarrhea. If diarrhea occurs and if it is lasting more than 24 hours or it is associated with blood or fever then take one tablet of Cipro twice a day for 3 days.

  • Over the counter medications to consider depending on your needs are:
  • Imodium for diarrhea.
  • Diphenhydramine(Benadryl) for allergic reactions, motion sickness, and nausea.
  • Hydrocortisone cream for skin reactions.
  • Sudafed for congestion, especially if before a flight.
  • Acetominophen(Tylenol), Ibuprofen(Advil) or other anti-inflammatory medication.
  • DEET containing mosquito repellent.
  • Consider DEET permeated clothing, and wearing long sleeves and pants when outside at dusk or dawn which are feeding times for mosquitos.
  • See the Safe Food and Water page for a list of links.