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Why Cancer Attacks Some Tissues—And Not Others
Siddhartha Mukherjee is the author of The Emperor of All Maladies: A Biography of Cancer, winner of the 2011 Pulitzer Prize in general nonfiction, and The Laws of Medicine. He is the editor of Best Science Writing 2013. Mukherjee is an assistant professor of medicine at Columbia University and a cancer physician and researcher. A Rhodes scholar, he graduated from Stanford University, University of Oxford, and Harvard Medical School. He has published articles in Nature, The New England Journal of Medicine, The New Yorker, The New York Times, and Cell. He lives in New York with his wife and daughters.
Dr. Siddhartha Mukherjee: As you mentioned there are some parts of the body, some tissues where cancer is more infrequent and other tissues where cancer is more frequent. Dr. Schrag, give us a sense of why cancer often occurs in certain tissues and rarely occurs in other tissues.
Dr. Deborah Schrag: You know we don’t know the answer to that. We do certainly know that lifestyle factors are extremely important and have an enormous influence in terms of where cancers occur, so we know that exposure to hormones and the hormonal environment that people are exposed makes an enormous difference. This is true for breast cancer, prostate cancer. These remain two of the most common cancers among men and women. Of course smoking is also- remains an important issue. Now we know that we can’t- if we could modify folks lifestyle factors we would not be able to eradicate cancer, but just as Dr. Varmus was talking about how there are certain commonalities, there are certain common molecular mechanisms that go awry frequently, certain key patterns. We also know that with respect to behaviors, lifestyle, exposure there is certain commonalities, not enough exercise, too many calories and we have to work to exploit these and we really have to work to understand the interactions between the molecular events at the cellular level and the environmental exposures and lifestyle choices people make and how these factors interact.
Dr. Harold Varmus: Could I just add one point to that? The question you raised about some organs not having cancers. For example, the heart, that is what I would call a provocative question. Why shouldn’t there be a cancer there and it leads you to think about what cells in any organ are at risk of cancers and it’s very likely that the incidence of cancer in different tissue types, prostate versus heart for example, virtually every adult male at the age of 90 having some prostate cancer and heart cancers being virtually unheard of probably reflects how many cells are at risk of becoming a cancer in any single organ and the likelihood that those cells are exposed to some kind of oncogenic stress, whether it’s tobacco smoke or hormonal influence such as Debbie is referring to, but to me the remarkable variation not just among organs, but among organ types in different environmental settings, different locations represent one of the great challenges that I don’t think the cancer community has completely grappled with yet and to me this is an area of provocative research that we ought to be paying more attention to now that we have better tools for looking at genetics.
Deborah Schrag: So an interesting example that comes up for me all that time that I just don’t understand. We’re all born with 25 feet of small intestine, but yet we see only fewer than 5,000 cases a year in the United States.
Siddhartha Mukherjee: Contrast that with the large intestine...
Deborah Schrag: We contrast that with colon cancer, which remains one of our top cancers. Well you know there is 6 to 9 feet of large bowel and we have 150,000 cases per year. When we look at these cells under the microscope it’s all epithelial cells. I mean an intestinal cell in the small intestine and in the large intestine is molecularly not that different. The large bowel cells are a little bit more engaged in reabsorbing water than they are in reabsorbing nutrients, but we do not understand why there is this dramatic difference between the incidence of cancer in the small bowel, which there is more of and the large bowel. We haven’t answered that.
Harold Varmus: It brings up a very interesting new theme in cancer research. What is the role of the microorganisms we carry around with us? What is now being called the microbiome and of course the large intestine has trillions of bacteria and the small intestine has much less. That may well be that that is a driver of oncogenic change and of course the small intestine tumors, many of which you- as you mentioned, there are some. They are very frequently sarcomas, that is cancers of connective tissue as opposed to being epithelial and that is a very interesting example of that contrast.
Siddhartha Mukherjee: Why do virtually all men over the age of 90 develop some amount of prostate cancer whereas heart cancer is practically unheard of?
Researchers are using technology to make visual the complex concepts of racism, as well as its political and social consequences.
- Often thought of first as gaming tech, virtual reality has been increasingly used in research as a tool for mimicking real-life scenarios and experiences in a safe and controlled environment.
- Focusing on issues of oppression and the ripple affect it has throughout America's political, educational, and social systems, Dr. Courtney D. Cogburn of Columbia University School of Social Work and her team developed a VR experience that gives users the opportunity to "walk a mile" in the shoes of a black man as he faces racism at three stages in his life: as a child, during adolescence, and as an adult.
- Cogburn says that the goal is to show how these "interwoven oppressions" continue to shape the world beyond our individual experiences. "I think the most important and powerful human superpower is critical consciousness," she says. "And that is the ability to think, be aware and think critically about the world and people around you...it's not so much about the interpersonal 'Do I feel bad, do I like you?'—it's more 'Do I see the world as it is? Am I thinking critically about it and engaging it?'"
President Vladimir Putin announces approval of Russia's coronavirus vaccine but scientists warn it may be unsafe.
A new coronavirus vaccine on display at the Nikolai Gamaleya National Center of Epidemiology and Microbiology in Moscow, Russia.
Credit: Alexander Zemlianichenko Jr/ Russian Direct Investment Fund via AP
Medical workers draw blood from volunteers participating in a trial of a coronavirus vaccine at the Budenko Main Military Hospital outside Moscow, Russia.
Credit: Russian Defense Ministry Press Service via AP
A scientist in Sweden makes a controversial presentation at a future of food conference.
- A behavioral scientist from Sweden thinks cannibalism of corpses will become necessary due to effects of climate change.
- He made the controversial presentation to Swedish TV during a "Future of Food" conference in Stockholm.
- The scientist acknowledges the many taboos this idea would have to overcome.
Depiction of cannibalism in the Medieval ages.
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A report from the New York Times raises questions over how the teletherapy startup Talkspace handles user data.
- In the report, several former employees said that "individual users' anonymized conversations were routinely reviewed and mined for insights."
- Talkspace denied using user data for marketing purposes, though it acknowledged that it looks at client transcripts to improve its services.
- It's still unclear whether teletherapy is as effective as traditional therapy.
Talkspace.com<p>Former employees also questioned the legitimacy of certain interventions by the company into client-therapist interactions. For example, after one therapist sent a client a link to an online anxiety worksheet, a company representative instructed her to try to keep clients inside the app.</p><p style="margin-left: 20px;">"I was like, 'How do you know I did that?'" Karissa Brennan, a therapist who worked with Talkspace from 2015 to 2017, told the Times. "They said it was private, but it wasn't."</p><p>Other former employees said the company would pay special attention to its "enterprise partner" clients, who worked at companies like Google. One therapist said Talkspace contacted her for taking too long to respond to Google clients.</p><p>Talkspace responded to the Times with a Medium <a href="https://medium.com/@founders_22883/talkspace-founders-respond-to-a-new-york-times-article-78d6f5c45c59" target="_blank">post</a>, which claimed the Times report contained false and "uninformed assertions."</p><p style="margin-left: 20px;">"Talkspace is a HIPAA/HITECH and SOC2 approved platform, audited annually by external vendors, and has deployed additional technologies to keep its data safe, exceeding all existing regulatory requirements," the post states.</p>