"Then he reattached it to Egan’s skull, using tiny metal plates and screws. Muizelaar hoped that inside Egan’s brain an infection was brewing.... The surgeons had no data to suggest what might constitute a therapeutic dose of Enterobacter, or a safe delivery method. The procedure was heretical in principle: deliberately exposing a patient to bacteria in the operating room violated a basic tenet of modern surgery.... For four weeks, Egan lay in intensive care, most of the time in a coma. Then, on the afternoon of November 10th, Muizelaar learned that a scan of Egan’s brain had failed to pick up the distinctive signature of glioblastoma. The pattern on the scan suggested that the tumor had been replaced by an abscess—an infection—precisely as the surgeons had intended...."
From "Bacteria on the Brain/A brilliant surgeon offered an untested treatment to dying patients. Was it innovation or overreach?"
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Interesting. Life as an experiment to survive by stopping one life process to preserve another life process.
Don't tell Planned Parenthood, but their business model is being copied.
Sounds like an episode of House
My girlfriend died of a glioblastoma multiforme tumor. Back then, it was impossible to stop.
Good news so far, and I hope everything works like the surgeons had intended.
I'm sorry to hear that, Allen.
Brilliant innovation. Unless he runs for president in the future, at which point it becomes insane, megalomaniacal overreach.
Shit for brains.
(Somebody had to say it.)
For those interested in the subject of neurosurgery and neurosurgeons, I can recommend Dr. Henry Marsh's "Do No Harm--Stories of Life, Death and Brain Surgery".
Marsh is at the end of his career, but was Britain's leading neurosurgeon. In an Amazon review of the book, an anesthesiologist wrote: "I read [the book] with a mix of amusement and rueful resignation. Dr. Marsh is a true representative of his species, the neurosurgeon. They are by turns kind, irritating, cocky, courageous, arrogant, brilliant, obsessive, awe-inspiring and lonely. They usually graduated at the top of their medical class. Their residency did not end until they were well into their 30's. . . .Even in a field of doctors, a collection of brainy nerds, they stand alone."
A neurosurgery residency at UCLA takes 8 years--and to get their you need med school, a year of internship, and a three year general surgery residency. So you are twelve years out of med school--and 20 years out of high school--before you are fully trained. It takes skill and courage--for one slip can have awful consequences.
But Schrot’s source was a microbe supplier in Virginia; once the Enterobacter crossed state lines, it would fall under the F.D.A.’s jurisdiction. In an e-mail on June 11, 2008, an agency official told Schrot that the F.D.A. could not approve the procedure without first seeing data from animal studies, showing how it worked and that it was safe. Schrot and Muizelaar abandoned the plan, and a few months later the boy died.
Bureaucrats exist to say No. It's Policy. Only if the long long list of tick boxes are all checked -- and that long list of tick boxes is developed by other bureaucrats, who do nothing but that -- will a bureaucrat be forced to concede that something can be done.
I would willingly let my kids have this procedure done if they wanted it (God forbid they get glioblastoma).
That said, the statistics of very small groups is very confounding for results such as these.
While clinically interesting the treatment by infection did not actually result in an improvement for the patient. The article does mention a treatment using a modified polio virus that does seem to work so perhaps the concept of treatment through infection might be sound in principle.
My nephew had an 18 hour brain surgery at the age of 12 - giant cell astrocytoma. He is now 22. He is also considered a miracle child at Vanderbilt where the surgery was performed - there were no lasting side effects from being under that long or having the walnut size mass removed. He is still at risk for other tumors. The surgeon still keeps in contact with my nephew/the family and personally did all of his check-ups; even after he moved to Florida, he asked my sister if she would bring my nephew in for his final "release" examine at 21. She did.
I did notice at the end the author cited another case as to the importance of regulators and regulation.
In that cited case, by that doctor's admission, sure.
As a rule, not necessarily. No mention of opportunity costs, either
These are people facing terrible odds.
I did a quick PubMed search on glioblastoma and enterobacter. There is not one reference.
Most attempts at treatment are using biologicals, immunotherapy. Glioblastoma is multifocal. It does not arise from a single focus as is assumed by traditional cancer research. Melanoma has a pretty good history of spontaneous cures that must be immunologically created.
New Yorker is a weird magazine that I don't trust in any fashion.
"Treatment through infection" could be called "Treatment by active biological agents" or "Treatment using anti-tumor microbes."
That way, when GMO organisms are used to eat tumors, they won't have as big a hurdle to public acceptance.
I, for one, love me some bacterially treated cheese and salami, and I deeply appreciate the "gut fauna" that digests my food in my expansive bdy midsection.
Branding, marketing, spin, etc., all have a role to play here.
With today's genetic engineering, why not breed a bacteria to selectively attack only the cancer cells in a specific human.
Has Schrot thought about running for President. He seems to be as qualified as Dr. Carson.
Asking the question "innovation or overreach?" is a very stupid framing. Any look back at medical history could be so framed. And we would all be worse for the exchange.
So long as there is informed consent and minimal chance of survival otherwise, any procedure that a doctor might perform should be between the doctor and the patient. The right to bodily control should not be infringed just because a person is ill.
This reminds me of our sandlot diagnosis (poking around the injured area, while asking 'Does ZAT hurt?) and treatment ("Rub some dirt on it and walk around").
"How being a shit head cured my cancer." Get Oprah on the line.
Gotta appreciate creativity being applied to tough, desperate situations.
If I had melanoma, I'd want an infusion of IVIG.
Well... some of me is sympathetic to what this surgeon did, but some of me is not. His treatments appeared to be sort of heavy handed. What I mean by that is: The Duke experiment's poliovirus was engineered to be as specific and discriminatory to the tumor tissue as possible (emphasis on "as possible"... the receptors being prevalent on tumors does not mean they're not found on not cancerous cells...). Whereas Dr. Muizelaar's method was just to infect the brain with Enterobacter, full stop. He was attempting to eradicate the glio by infecting nearly the entire brain itself, and that just seems a bit too broad a targeting, no matter what other evidence he was relying on.
True, not all treatments target specific cells, receptors, processes, etc. As a mild example, Acetaminophen (Tylenol) appears to have several mechanisms, and works on the nervous system to ease pain rather than work on the location of the body where pain is being experienced. This is of course in contrast to asprin, ibuprofen, other NSAIDs that do indeed disperse across the body, but only acts where prostaglandins are being produced. As another example, many chemotherapies - I'm thinking specifically neoangiogenesis inhibitors here - are also somewhat broad acting, and don't limit themselves to the cancerous tissue (although the argument with angiogenesis inhibitors is that tumors would be disproportionately affected since they require such a high rate of blood vessel creation). There are treatments out there that simply aren't as area, tissue, or effect limited as we'd like to think.
But that said, the general idea is still to try and limit effect to the problems themselves. I'm really not certain that just soaking a skull flap in bacteria-laced solution is targeting tightly enough. Maybe I'm wrong... but it feels less like modern, advanced medicine and more a harkening back to using Foxglove because isolating digitalis from it is too much work.
My paternal grandmother died of glioblastoma multiforme in 1947. My dad was 16. The treatment at that time was to cut out a piece of the skull so the tumor could grown without compressing the brain so much. She spent the last months of her life with tumor growing out of her head. Treatment has improved, but it's still a horrible, horrible disease. If I were diagnosed with that tumor, I would welcome innovative treatments like those discussed in this article.
This is a case of malpractice pure and simple. If the surgeon thought he had a new treatment it should have been tested first in animals and then been reviewed in an institutional review board to ensure he wasn't needlessly endangering a patient's life. Instead of being allowed to retire he should have been fired and possibly criminally charged for willfully harming his patients. There is absolutely no excuse for deliberately introducing a brain infection without even some animal data to suggest that it will work (and not kill the patient in the process). The article states that one of the surgeons involved said: "We were still struggling to get brain tumors in rats," which is ridiculous. There are straightforward models for brain tumors in mice and rats that are used by innumerable labs. If they can't even figure out how to grow tumors in a rat, let alone treat it safely with their proposed technique, then they clearly aren't capable of moving the proposed treatment to humans. This case absolutely disgusts me. This is the kind of medical adventurism that was a bad idea in 1800s and certainly has no place today. As background - I am a neurosurgeon who has done research on brain tumors, including implanting glioblastoma multiforme (grade IV astrocytoma) in rodents. I can't even begin to imagine what delusion these surgeons were working under to convince themselves that this was an appropriate action.
But there's a cost-benefit analysis. If the cost is that the untried treatment may kill you, but the tumor is already going to kill you, you may decide that there's not much difference in cost between undergoing the treatment or not. The benefits, on the other hand, are radically different. Don't undergo the treatment, live a few more days. Undergo the treatment, and there's a small chance that it will work, and you will be cured.
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