The Zen of Bass

Imagining What's Possible for Patients

Dr. Susan Desmond-Hellmann explains her translational vision for fighting cancer during her recent keynote address to UCSF's breast oncology leaders. She describes 1997 to 2001 as oncology's golden years. Rituxan, Herceptin and Gleevec debuted and changed the face of cancer treatments. Dr. Desmond-Hellmann believes that academia can today play a critical role in introducing "the platinum age" of cancer drug development.

“Cancer research is too slow, too expensive, too inefficient and too uncertain...we need to understand earlier and with greater confidence what the best ideas are,” she says. Read the full article here.

New Clinical Trial Enables Rapid Screening of Breast Cancer Drugs

UCSF Chancellor Susan Desmond-Hellmann discusses the future of oncology drug development and adaptive clinical trial design and what it means to patients in an interview with Pharma Strategy Blog's Sally Church.  Here are excerpts from the post:

    "What's really neat about the I-SPY trial is that Laura Esserman, the PI of the trial, is a breast cancer surgeon here at UCSF and has added so much value to the project because she sees patients early and has a unique opportunity to offer neoadjuvant therapy. Patients are getting their primary therapy before they get surgery, so for imaging and biomarkers - either established or exploratory - it is a fantastic opportunity. The endpoint is pathological complete response, so you can see if the tumor has disappeared or not."

    "It's a fantastic rapid readout model so you can get answers much more quickly in a year, including pathological specimens, along with the answers from biomarkers and imaging, which are important. The FDA has allowed a master IND agreement for this study, so it will be possible to move agents in and out of the trial quickly. So if agent A looks promising it can be advanced quickly and more patients put on it, but if agent B looks toxic, it can be discarded quickly. It's not just a clinical trial but a experimental trial process that gives you a rapid readout of whether the agent works or not."

    "The hope is that you won't wasting time and money in phase III trials, but most importantly, patients experience on that molecule. If the answer is yes on I-SPY, you then have a biomarker hypothesis for that agent and can then do a more traditional phase III trial having increased your chances of success."

via www.pharmastrategyblog.com

Read about the i-Spy 2 adaptive clinical trial which was launched on March 17 in Washington.

Watch the video from the Biomarkers Consortium press conference:

The World's Most Powerful Innovators of 2009: UCSF Makes the List

UCSF’s Chancellor, Susan Desmond-Hellmann, MD, MPH,  was selected by FORBES as one of its 7 Most Powerful Innovators of 2009. You can read the story here. According to the article, Desmond-Hellmann’s  most influential innovations were  the blockbuster cancer drugs Avastin and Herceptin. What makes Desmond-Hellmann an innovator?

"Susan Desmond-Hellmann, a physician and cancer researcher, is a hero to legions of cancer patients. While president of product development at Genentech from 2004 to April 2009, she played an integral role in the selection, testing and development of Avastin, a colon cancer drug with annual sales of $9 billion, and Herceptin, a breast cancer drug with sales of $7.8 billion. In August 2009 she became the chancellor of UCSF, a powerhouse in medical research, where she aims to continue fostering innovation in health care and science".

UCSF's Elizabeth Blackburn Wins Nobel Prize in Medicine

Today, UCSF's Elizabeth Blackburn won the Nobel Prize in Medicine. Here's the video from the press conference held in San Francisco:

Mindfulness, Stress and Eating

How do you eat under stress?  For many, chronic stress gets under the skin, stimulates the appetite and influences what people eat -- often leading to the indulgence in sweet, high-fat foods. These foods tend to make you feel better in the short term, but in the long run can cause health issues. Chronic stress, in fact, has been shown to impair immune responses. Elissa Epel, PhD., an Associate Professor in the UCSF Department of Psychiatry, is testing new strategies to help people cope with stress, including the art of mindfulness.

According to Epel, being in the moment serves like a filter to help people better manage how they react in stressful situations. Epel and her colleagues are teaching mindful eating skills – such as the benefits of noticing each bite, how it tastes and how full one feels. The hope is the more mindful you are and the better you can manage and reduce stress, the less likely you are to overeat.

Here’s a video segment which goes into more detail:

Creating Designer Babies: Screening for Disease and Desirable Traits

Pre-implantation genetic diagnosis, or PGD, has been used to screen for genes that lead to diseases such as cystic fibrosis and cancer.  Now, the lab procedure that screens for diseases in embryos is being offered to create designer children. Two articles on the topic have appeared recently; they both address the medical and ethical implications.

Last month, the New Scientist reported that the first UK baby genetically selected to be free of a form of breast cancer caused by BRCA1 was born in London.  It was reported that the parents underwent IVF, and the resulting embryos were screened with PGD, where a small number of cells are removed and tested. Only embryos free of the BRCA1 gene were implanted. Five  embryos tested were found to be free of the gene and were implanted; one resulted in the pregnancy.

Gautam Naik reported in February 12 issue of The Wall Street Journal that LA- based Fertility Institutes, will soon help couples select both gender and physical traits in a baby when they undergo fertility treatment. Dr. Jeff Steinberg, director of the clinic, claims that trait selection “is a service” that he intends to offer soon.  According to Naik:

For trait selection, Steinberg is now betting on a new approach for screening embryos. It involves taking cells from an embryo at day five of its development, compared with typical PGD, which uses cells from day three. The method potentially allows more cells to be obtained, leading to a more reliable diagnosis of the embryo.

Many countries have banned the use of PGD for gender selection; it is permitted in the U.S. According to a 2006 survey by the Genetics and Public Policy Center at Johns Hopkins University,42% of 137 PGD clinics offered a gender-selection service.

DNA and Your Personal Health -- Is Too Much Knowledge Good?

In the coming era of consumer genetics, your DNA will have much to tell you about the biological bases of your health, your physique and even your personality. But will this knowledge really amount to self-knowledge? asks Steven Pinker in his article My Genome, My Self, which appeared in the January 11, 2009 issue of the Sunday New York Times.

We've entered the age of personal genomics -- where Pinker says "the plunging cost of genome sequencing — will soon give people an unprecedented opportunity to contemplate their own biological and even psychological makeups".  For example, 23andMe provides a genetic report card and directs customers to a web page which displays risk factors for 14 diseases and 10 traits. This page also provides links additional diseases and traits which according to Pinker, have iffier scientific substantiation.

This latest "do it yourself genomics" trend coincides with the new promise of personalized medicine - where drugs are being tailored to an individual's genetic makeup.  The downside to this trend ranges from dubious companies which prey on hypochondriacs, to insurance and ethical isues.

For now, the jury is out on the benefits of personal genomics. I like Pinker's concluding thoughts:

So if you are bitten by scientific or personal curiosity and can think in probabilities, by all means enjoy the fruits of personal genomics. But if you want to know whether you are at risk for high cholesterol, have your cholesterol measured; if you want to know whether you are good at math, take a math test.

The Internet is accelerating biomedical progress in understanding and treating disease. Personally, I believe in the potential of services like 23andme -- it empowers individuals to take control of their medical destinies and enables them to create virtual cohorts for clinical research and trials.  With tools like these, personalized medicine will evolve even faster.

Mindfulness Can Make You Healthier and Live Longer

Happy New Year -- is it resolution time for you? Alex Williams asked the question in today's New York Times. Research shows that many people who try to make major lifestyle changes, like losing weight, don't succeed. Why? They are "hard-wired not to change quickly," said Dr. Marion Kramer Jacobs. On the other hand, Alan Deutschman, the author of "Change or Die," says some strategies are more likely than others to bring positive results. Here are Deutschman's four steps to success:

1. Start with big changes, not small ones.
2. Act like the person you are trying to become.
3. "Reframe" the situation.
4. Don't do it alone.

  
Dr. Dean Ornish of UCSF  is more optimistic. He believes that by changing your lifestyle you can change your gene expression. In fact, his studies have shown that people who are motivated to make and maintain bigger, healthier changes in lifestyle also achieve better clinical outcomes and even larger cost savings for the healthcare system.

In his recent interview with Edge-The Third Culture, Ornish says  that if stress reduces telomerase (an enzyme that repairs and lengthens damaged telomeres, which are the ends of our chromosomes that control how long we live) and makes telomeres shorter, then stress management techniques, exercise and good nutrition should be able to increase these. 

Ornish later says that "the more inwardly-defined you are, the more you can quiet down your mind and body and experience more of an inner sense of peace and well being, the more empowered you are... people only have power over you if they have something that you think you need. The more inwardly-defined you are, the less you need, so the more powerful you become". And healthier too!

For more, check out this video from last year's TED Conference:

Milgram versus Burger: Why are People Still Willing to Inflict Pain?

Adam Cohen wrote an interesting opinion piece in today's New York Times about Professor Jerry Burger's recent pain infliction research.  Cohen asks -- why, forty years after Stanley Milgram's  "blind obedience" experiment -- are ordinary people still willing to inflict extraordinary pain on innocent strangers if an authority figure tells them to do so? The Milgram experiment's goal was to test man's willingness to do evil. Why for example, were the Nazis able to persuade ordinary Germans to execute mass genocide?

Cohen goes on to say that despite the fact that the world has changed significantly since 1963,  Professor Burger's results were nearly identical to Milgram's. Average Joe is just as willing to blindly follow orders to inflict pain today as he was four decades ago.  

Why? Professor Burger "believes that the mindset of the individual participant -- including cultural influences  -- is less important than the situational features" -- i.e., the authority figure taking responsibility for the decision to give the shock and then increase the voltage.

Cohen raises an important issue -- if this is how most people will behave, how do we prevent  more Holocausts, Abu Ghraibs and other examples of cruelty?  Burger believes that by teaching people about these experiments, they'll be better equipped to stop those tendencies within themselves and others. Unfortunately, I doubt that.

Read the full story here.

Life Lessons From Om Malik

Live as if you would die tomorrow, learn as if you would live forever - Gandhi 

Om Malik today shared some insightful lessons today in GigaOM. Simplify, empower others, live healthier and give of yourself are among his major themes. I encourage you to read the article. 

A year ago today Om suffered a heart attack that changed his life. He was treated at my employer, UCSF.  Since then, Om has become more mindful, is living healthier and has simplified his approach to living and working. 

Om's  article includes important lessons that can be applied to your personal or business life:

Lesson #1: Set simple goals
Lesson#2: Binary choices help make better decisions
Lesson #3: Simplification through elimination
Lesson#4: In your team you should trust 

He concludes the article with an appeal to help his favorite charity - UCSF. 

Last month, Om  gave me some advice on how we could help his readers learn how to become heart healthier via the web. So my Public Affairs team at UCSF (with help from the UCSF Medical Center web team) created a   heart attack prevention tips  page to support Om in his effort to raise awareness of (and  funding  for) UCSF. In today's article Om encourages readers to visit the page and "take a moment to check it out and see if you need to visit the doctor. Prevention, is much better than the cure."

I am thrilled to see the outpouring of positive feedback to Om's story. In fact, readers and influencers alike  (thanks,  Steve Rubel ) are now spreading his message through  Twitter postings.  

Happy holidays and best wishes for a happy and healthy New Year!