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by William H. Benson

June 2, 2016

     Beau Biden, the Vice-President’s son, passed away on Saturday, May 30, 2015, a year ago, of brain cancer. He was 46. In January, of this year, in his final State of the Union Address, President Obama announced that he was naming his Vice-President, Joseph Biden, to spearhead his “moonshot effort to cure cancer,” part of the president’s $202 million Precision Medicine Initiative.

     Two weeks ago, The New York Times Magazine ran a special series of articles entitled, “The New Anatomy of Cancer,” and a journalist named Sam Apple wrote a most interesting article.

     In it, Apple described “the Warburg effect.” A mid-twentieth century biochemist named Otto Warburg, who survived the Holocaust, noticed that cancer cells drawn from a rat tumor did not require oxygen to multiply. Instead, those cancer cells gobbled up “enormous amounts of glucose (blood sugar) and broke it down without oxygen,” which made no sense to Otto, because there was plenty of oxygen available. “The cancer cells,” he noted, “were ravenous only for glucose.”

     In a normal cell’s cytoplasm, glucose is converted into a form called pyruvate that then passes into the cell’s mitochondria, where it is burned in the presence of oxygen to create abundant amounts of energy. Scientists call this process “respiration.”

     But in a cancer cell, the mitochondria are by-passed, knocked out of the process, and the cell ignores the oxygen. Instead, the cell stuffs itself with glucose again and again. “Unlike healthy cells, growing cancer cells are missing the internal feedback loops that are designed to conserve resources.”

     This frenzied gorging upon glucose produces a waste product in the cell called lactic acid that passes into the liver, where it is broken down a second time to create more glucose. The cancer cells then gobble up the reconstituted glucose. This perpetual cycle will, at some point, overwhelm the host’s body. Scientists call this process “fermentation.”

     Healthy respiration vs. unhealthy fermentation.

     Apple said that the “positron emission tomography,” or the PET scan, “works by revealing the places in the body where the cells are consuming extra glucose.” In simple words, if you find the areas where there is a rapid uptake of glucose, there you will find the cancer.

     Warburg’s research was dropped from cancer textbooks with the advent of genetic research. James Watson and Francis Crick discovered DNA’s curving double helix structure in 1953, and the pursuit was on to discover the genetic mutations that lead to cancer’s several forms and structures. Researchers believed then that if they discovered the mutated genes, they would find the path to a cure.

     In recent days, Apple met with James Watson, now 88, who admitted that “locating the genes that cause cancer has been ‘remarkably unhelpful,’” and that “the belief that sequencing your DNA is going to extend your life [is] ‘a cruel illusion.’” In other words, an oncologist may know the specific mutated gene that causes a type of cancer, but that knowledge does not clear the path to a cure or a therapy. 

     Certain researchers today have renewed their focus upon Otto Warburg’s work on metabolism. One who has done so is Lewis Cantley, who has discovered a tentative connection between diabetes and cancer. Their commonality is “elevated levels of insulin, that is produced in the pancreas.” Insulin’s job is to tell cells to take up an excess of glucose, if detected in the blood. Cantley says that “cancer cells behave as though insulin were telling it to take up glucose all the time and to grow.”

     A drug of promise is “metformin,” a drug that diabetics now take to reduce their blood sugar. Apple says, “Diabetics who take metformin seem less likely to develop cancer than diabetics who don’t.” 

     In 2010, a young oncologist named Siddhartha Mukherjee published his best-seller, The Emperor of All Maladies: A Biography of Cancer, that won the Pulitzer Prize for General Non-Fiction the next year. Mukherjee says that he wrote his book in response to a patient’s complaint. “I’m willing to go on fighting,” he said, “but I need to know what it is that I’m fighting.”

     Mukherjee calls his work “a dismal discipline.” He describes his first meetings with new patients as “hyper-acute.” He writes, “It’s a moment when you get to erase everything that’s irrelevant and ask the most elemental questions—about survival, family, children, legacy.”

     The President’s Precision Medicine Initiative is a step in the right direction, but researchers know more is needed. One writer said, “Does anyone truly imagine prevailing without bringing the fight everywhere—without matching cancer in its inventiveness, its nimbleness, its sheer relentlessness?”

     “Relay for Life,” the American Cancer Society’s fund-raising program, occurs once a year. Let us run, not walk, at this year’s relay.