Book review: The Demon Under the Microscope, By Hager

As human beings, we have relatively short memories; we have largely forgotten what life was like barely 90 years ago, when human lives were far too often cut short by relatively simple infections (by today's standards). Most of us have lost touch with the time when epidemics of "childbed fever" meant that almost all women giving birth in the hospital would die from infection; when a simple blister on the toe could lead to deadly, incurable bacterial sepsis.

Hager's book is an excellent reminder of how far we've come. It is largely narrative history, written with the aim of communicating the processes and ideas that led to the development of sulfa (the world's first true antibiotic), rather than a straightforward chronological account.

Hager begins right at the start, when microscopic world was first discovered, and how it led to the development of germ theory. He carries us through the development of antiseptic use and serum therapy, moving us from a time where surgeons merely placed their instruments on any convenient table, to a period when theatres were constantly filled with aerosolised antiseptic blown from a bellows.

The real start of the show, however, is Nobel Prize winner Domagk (and of course his much neglected chemists), who led the clinical research that culminated in the discovery of the antimicrobial properties of sulfa. Their pains and toils are remarkably communicated by Hager, giving us a definite sense of disappointment after years of unfruitful research. At the same time, due credit is given to other parties involved in the discovery - including French researcher Forneau.

The stories doesn't just stop at the discovery of sulfa - Hager also gives us an account of how the FDA and a haphazard medicinal drug market was transformed overnight into a well organised, highly vigilant industry.

All in all, this is a fantastic book - not just for an insight into the discovery of sulfa, but the ideological and scientific struggles surrounding the idea of a antimicrobial "magic bullet", and the challenges that sulfa placed forth to the world - that of the need for careful, well designed and executed clinical drug research. Most of all, this is a book that reminds us of where we've come from, where we are now, and raises question of where we are headed, in our constant battle with the microscopic enemies in our midsts - an issue particularly pertinent with worrying trends in bacterial resistance.

OK, lets get this out of the way

There's been a post circulating around on FaceBook, entitled "Scientists Cure Cancer, but No One Takes Notice". To be honest - it's unproven science at best, a load of rubbish at worst. Here's why:

1. The author of the article doesn't know what he/she is writing about, and scientific terms are thrown around in a nonsensical manner. For example, mitochondria are NOT cells - they are cell organelles (little organs in the cell). Sure, there is a theory that a million gazillion years ago when we all lived in a soup that they were infective bacteria, but that's a separate story. A more significant error is the fact that glycolysis does NOT produce lactic acid - it is an essential cellullar process that provides pyruvate, the substrate used for the cell to generate energy. Shut off glycolysis, and you kill ALL cells, period. Lactic acid is produced via a different mechanism (more on this later).

2. The original research paper proper (from the website) dates back to 2007, and is more a hypothesis than anything. What the original researchers are suggesting is this: cancer cells grow at very high rate, and and hence have high energy needs. Most of this energy has to be produced via anaerobic respiration (probably due to ineffective angiogenesis), hence producing lactic acid in the process. To maintain the high energy requirements, the rate of pyruvate production has to increase (so glycolysis needs to occur at a faster rate).

The researchers propose to use DCA to suppress glycolysis, thereby cutting down the rate of anaerobic respiration. This essentially cuts off the energy supply to the cancer cells and kills them. The theory is that other cells are not AS affected because they are much more energy efficient (aerobic respiration) than cancer cells, and thus do not require high rates of glycolysis.

Sounds like a good theory, and explains why cells such as lung cells are not damaged in early experiments. However, there are other cells that are pretty energy demanding - such as neurons - which may explain why DCAs side effects include neurotoxicity. Also, the researchers also seem to be proponents of the Warburg hypothesis - that lactic acid is the cause of cancer - an idea that has fallen out of favor due to genetic discoveries.

3. Some good results are seen in vitro, but the real test of a drug is in vivo. DCA has so far gone through Phase 1 and 2 testing - which means that it seems to be relatively safe, and that there seems to be the possibility of benefit from the drug. However, there are no Phase 3 study results available (which is where we get REAL information on whether the drug actually has a benefit, and how great a benefit/harm).

IE: The science behind this hypothesis ranges from reasonable to rubbish, and DCA as yet is unproven in cancer treatment and actually has significant known side effects. I wouldn't be asking any doctor to prescribe this for me, anytime soon.