Photo by RonAlmog via Flickr, under the Creative Commons license.
We celebrated the Jewish New Year last month and we have arrived into the year 5770. It is a little more than five and a half millennia since Genesis.
Denver’s annual Gem and Mineral show was held here in Denver several weeks ago. I had hoped to go Sunday but got caught up staining our deck and ran out of time. I was hoping to find a fossil for the office. It gives me pleasure to touch something that was alive hundreds of millions of years ago. Is the world 5770 years old or, as the geologists tell us, 4.54 billion years (109) years old? Or does it matter?
Much of the time it gives me pleasure to let these two different worldviews coexist in my mind. To paraphrase Whitman, “Do I contradict myself ?... I contain multitudes….”
We live in a world of plurality, where we coexist with people and cultures that see the world differently than we do and we learn to some extent or see the world from multiple viewpoints. Our modern view is informed by scientific principles, of hypotheses tried, proven or rejected. Yet retaining some part of other perhaps unscientific worldviews has its place. Doing so gives the world more dimension and makes it a more interesting place. I have no problem with the world being both 5770 years old and at the same time being unfathomably old.
Disregarding the newer scientific worldview in favor of other views may not be the best idea. We can certainly find examples of what happens when individuals cling too fixedly to a view that is wrong.
The first example that comes to mind is how South Africa’s former President Thabo Mbeki based healthcare policy on his opinion that HIV infection does not cause Aids. Current research suggests his denial and the policies it engendered are responsible for 365,000 premature deaths.
Or consider the slaughter of pigs in Cairo. Late last Spring Egyptian authorities slaughtered all the city’s pigs out of fear of the ‘Swine Flu.’ Never mind that the flu was spreading person to person already. The people raising the pigs were Cairo’s garbage collectors and without pigs to feed they now see no profit in collecting garbage. A little bit late, authorities in Cairo are wondering what to do with the garbage that has piled up on the streets since May.
An example closer to home; I wrote about the book Catching Fire several weeks ago. This is the book written by Harvard anthropologist Richard Wrangham who argues his theory that cooked food was the driving force in evolution of habilenes to homo erectus some 1.6 million years ago. One of my former newsletter readers did not like that I wrote about human evolution. She emailed asking to be removed from my mailing list writing, “I did not evolve from slime or from monkeys; I was created by God. I do not want to receive a newsletter from someone who believes otherwise.”
There is clear advantage to seeing the world in black and white, of having set and narrow views as to how things are. Unfortunately, these sorts of views limit scientists from exploring new ideas and more importantly for me, make the practice of medicine difficult. Although it is perhaps more comfortable and easy to stick with one’s view of the world undisturbed, it does not serve the care of one’s patients to hold so fast that we miss new developments.
These ramblings bring us to a study published in the August 19 issue of JAMA that suggests that estrogen may be a useful treatment in some types of breast cancer(1). Most breast cancer cells have estrogen receptors on their surface and when estrogen binds to these receptors it stimulates the cancer cells causing them to multiply. Tamoxifen has been used for 30 years to block these estrogen receptors. This is so basic an understanding after all these years that it is hard to imagine that estrogen might be useful in treating breast cancer. Yet it seems that at least in some breast tumors estrogen will also trigger apoptosis. Apparently in the years before Tamoxifen dominated treatment, estrogen like compounds, for example DES, were used to treat breast cancer. Somehow we forgot about this.
As many of us have sadly witnessed, estrogen blocking therapies used to treat women with breast cancer stop working after awhile. The tumors become insensitive to the hormone and grow without it. In this study, Matthew Ellis and colleagues report on their treatment of 66 breast cancer patients experiencing cancer relapse and showing no benefit from estrogen deprivation treatments. Half the women were given high dose estrogen, 30 mg/day and half low dose, 6 mg/day. After 24 weeks of treatment the tumors had stopped growing or shrunk in about one-third of the women in both groups.
The researchers say they found a way to predict which women were likely to respond. Using combined PET-CT scans with a tracer attached to glucose produced a specific reaction on the scan that predicted the responders with about 80% accuracy.
How many of us will be able to let go of the world view that estrogen is bad for breast cancer and how many will be able to see that, ‘estrogens effects on a tumor are not one-dimensional,’ but rather multi-dimensional? Can we let go of our long held view and adjust to this new information?
This is part of the reason why I keep the age of the earth variable in my mind. We need to stay flexible if we hope to keep up with the science.
1. Ellis MJ, Gao F, Dehdashti F, Jeffe DB, Marcom PK, Carey LA, et al. Lower-dose vs high-dose oral estradiol therapy of hormone receptor-positive, aromatase inhibitor-resistant advanced breast cancer: a phase 2 randomized study. JAMA. 2009 Aug 19;302(7):774-80.
