The New Straits Times, August 13, 2000
By Prof Dzulkifli Abdul Razak
AS the Book of Life unfolds through the Human Genome Project scientists say it will enable people to live healthier if not longer. The human genome comprises the molecular instructions for human development and function embedded within each of the cells in the body. The project thus is an attempt to configure the human genetic blueprint.
The project is expected to map out the entire human genome to almost 100 per cent accuracy by 2003. It will improve the diagnosis of diseases, leading to eventual replacement of therapies from the somewhat "hit-or-miss" methods currently in use.
Thus, not only will there be newer therapeutic approaches, but various forms of genetic predisposition will also be counteracted in ways not possible before. This is because now it is conceivable to localise and understand the role of genes better thanks to the Human Genome Project.
Last week, as the 11th World Conference on Tobacco or Health opened in Chicago, researchers reported that they have found a gene responsible for the spreading (a process technically known as metastasis) of cancer cells from their site of origin to other sites in the body. Basically, a gene guides the body to make a certain protein with a specific function in the body. Knowing the gene therefore, can lead scientists to find out what that gene does; in other words, what protein does it make and how does it affect the body?
If the protein representing the gene can be identified and isolated, and if that protein is not functioning properly resulting in certain disease, then a drug can eventually be developed to "fix" that specific gene or protein.
The new research about the genetic underpinnings of the metastatic process presents such an opportunity. Understanding ways to genetically restrict metastasis is critical, since it means that the spread of the disease can be controlled.
Malignant cells can have as many as 32 active genes that were not active otherwise, according to the research team led Richard Hynes, director of the Center for Cancer Research at the Massachusetts Institute of Technology.
These findings give new hope to cancer patients, in particular tobacco users who are often plagued with a number of tobacco-related cancers. Over time, there will be treatment to repair any defective gene and correct or replace damaged organs with genetically engineered cells.
One approach is through so-called gene therapy. It involves restoring the normal functioning proteins to the body, by inserting the correct gene. In other words, it means "putting in the right protein at the right time in the right place". By doing so the body can keep on making the needed protein as long as those cells live.
Realistically however, the time taken to turn the current findings into satisfactory practical solutions may be long. As a comparison some cite examples of the single gene that causes sickle cell anaemia identified some 50 years ago. Yet even today tens of thousands continue to suffer from this debilitating blood disorder.
One main reason for the delay is that the tools needed to replace or suppress a defective gene are yet to be effectively developed and tested. Similarly for non-genetic means to mitigate the destructive effects, using drugs for example. In addition they are not without risks and quandaries.
It is for these reasons too that we also greet another recent smoking-related study with greater hope. This one details why quitting the habit is still the most practical solution to date in preventing cancer and saving lives.
The study suggests that giving up smoking even late in the life eliminates most of the lung cancer risk, and the risk is decreased more than 90 per cent for those who quit before they turn 35.
Health experts have long said it is never too late to give up smoking. While previous studies have shown the effect on lung cancer rates can be dramatic, this new finding in the British Medical Journal gives clear indication yet of how beneficial it can be. Quitting smoking has halved the number of British lung cancer deaths.
Unfortunately this is not yet seen in many developing countries. Instead, in the poorer countries, the number of deaths from tobacco continues to soar.
In the developed countries people are becoming more conscious, and the governments more responsible, but their counterparts in the developing countries continue to be duped by promotions and advertisements, and lack political will. Thus, smoking deaths globally are on the increase.
Worldwide figures on smoking will soon be published in a book by Richard Peto, entitled Global Health in the 21st Century. The work also provides the first prediction of the number of tobacco deaths that will occur worldwide in the next 100 years if smoking patterns persist; one billion, compared to 100 million in the last century; and how many deaths could be avoided if people quit. "The message is that at any age, it pays to stop," says Peto of Imperial Cancer Research Fund based in London.
But this too will not be easy, not only because of the addictive nature of tobacco, but also due to the covert effort of the tobacco industry. Just last week, the World Health Organisation issued a report detailing "an ambitious, often covert effort by the tobacco industry to curb anti-smoking initiatives", according to an editorial entitled "An Ugly Move by Big Tobacco", in The New York Times (Aug 3).
The report said such a practice dated way back to the late 1980s through a strategy of having "ostensibly independent surrogates attack the credibility of international health organisations".
The aim is to "spin concern with smoking as a first-world issue not worthy of the developing world's attention".
The WHO report is based on tobacco company documents made available in the various lawsuits. It alleged the tobacco industry of creating bogus front groups and pitting other international organisations against WHO. Some consultants who served WHO also worked for the industry.
This report is deemed timely in view of the WHO-led negotiations to frame an international convention on tobacco control in October. The convention is an international treaty in which the signatory states agree to pursue international tobacco control. It is a useful tool for promoting co-operation and co-ordination of the international aspects of tobacco control such as tobacco smuggling, advertising, pricing and taxation as well duty-free sales of tobacco.
Anticipating the vast impact of such a framework, the beleaguered tobacco industry seems desperate to offset the adoption and implementation by WHO member states; desperate enough to resort to the "ugly moves" of the past.
The industry desires that national tobacco control policies, in as many countries as possible, remain weak so that and their citizens, especially the youth, are sitting ducks. In this respect, WHO exhorts all concerned to be wary about such possible tactics.
