Speaker 1: Hey, welcome to Stuff to Blow Your Mind. My name
Speaker 1: is Robert Lamb and I'm Joe McCormick. And today we're
Speaker 1: going into the vault for an older episode of the show.
Speaker 1: This one originally published on July and this is an
Speaker 1: interview I did with Cat Arnie, the author of a
Speaker 1: book about cancer and evolution, last summer. This was an
Speaker 1: interesting interview, so we hope you enjoy it. Welcome to
Speaker 1: Stuff to Blow Your Mind, production of My Heart Radio.
Speaker 1: Hey are you welcome to Stuff to Blow Your Mind.
Speaker 1: My name is Robert Lamb and I'm Joe McCormick, and
Speaker 1: today we're bringing you another interview that I conducted last
Speaker 1: week while Robert was taking a break from work. That's right.
Speaker 1: Once a year, I like to bury myself in some
Speaker 1: sacred imported soil and allow my my body to break
Speaker 1: down and the reconstitute itself so that I can rise
Speaker 1: once more and be up to the challenges of podcasting
Speaker 1: in this day and age. Today we are going to
Speaker 1: be sharing the conversation that I had with the British
Speaker 1: geneticist and science communicator Cat Arnie talking about her upcoming book,
Speaker 1: Rebel Cell Cancer Evolution in the New Science of life's
Speaker 1: oldest betrayal, so a little bit of biographical information. Cat
Speaker 1: Arnie hosts the Genetics Unzipped podcast and she holds a
Speaker 1: PhD in developmental genetics from Cambridge University. She was a
Speaker 1: key part of the science communications team at Cancer Research
Speaker 1: UK from two thousand four to co founding the charity's
Speaker 1: award winning science blog and acting as a principal media spokesperson.
Speaker 1: She's also the author of Hurting Hemmingway's Cats, Understanding How
Speaker 1: Our Genes Work and How to Code a Human and
Speaker 1: she's written for Wired, The Daily Mail, Nature Mosaic, New
Speaker 1: Scientist and more, and presented many BBC radio programs. You
Speaker 1: can find Cat Arnie on Twitter at at cat Underscore
Speaker 1: Arnie a r in e Y and I should note
Speaker 1: that the book is coming out at different times in
Speaker 1: the UK in the US, so Rebel Cell can be
Speaker 1: found in the UK starting on August six, and then
Speaker 1: in the US. I believe it's coming out on September
Speaker 1: twenty nine, but you can go ahead and preorder it online.
Speaker 1: All right, Well, I'm I am in a rare position
Speaker 1: here because I am just like the listeners out there.
Speaker 1: I have not heard this interview yet myself. So I
Speaker 1: am excited, uh to to to listen in as she
Speaker 1: sheds light on this, uh, this fascinating topic. Cat Arnie,
Speaker 1: thanks so much for joining us today on the podcast.
Speaker 1: Thank you for having me. It's an absolute pleasure. It's
Speaker 1: a pleasure to have someone on the show who has
Speaker 1: not only written a great book, but you are actually
Speaker 1: a podcaster yourself. So you're so you're used to this
Speaker 1: whole game talking into the mic with alone by yourself
Speaker 1: in a room. Yeah. I've been making the Jannetix Unzipped podcast.
Speaker 1: I do have to say that through this time, we've
Speaker 1: we've deliberately made it a COVID free zone, so it
Speaker 1: is currently a COVID free genetics podcast. So that's been
Speaker 1: that's been a nice thing to do during during this time,
Speaker 1: I got to say I was listening to one of
Speaker 1: your episodes of the gene Lex un Zip podcast, the
Speaker 1: one about Maud Sly and Pauline Grows, which I thought
Speaker 1: was fantastic. Of course it connects to the book that
Speaker 1: we're going to be talking about today. So personal endorsement
Speaker 1: from me of your podcast. Don't really like it? Thank you. Yeah,
Speaker 1: it's really fun. We we alternate. We do sort of
Speaker 1: interviews with scientists who are working now in genetics. But
Speaker 1: I also really like to go back through those stories
Speaker 1: and dig out, particularly the untold women who were often
Speaker 1: they're doing the work, doing lots and lots of stuff,
Speaker 1: incredibly detailed observations and breeding experiments, and then basically didn't
Speaker 1: really get the credit for it, because until the middle
Speaker 1: of the twentieth century or later, women weren't really respected
Speaker 1: as a scientist. So it's it's just a wonderful expliration
Speaker 1: you come up with all these incredible people, although of
Speaker 1: in the early century lots them do turn out to
Speaker 1: be eugenicists, but different podcast I think, yeah, So I
Speaker 1: think maybe a good place to start when talking about cancer.
Speaker 1: Of course, your book is about cancer, and specifically a
Speaker 1: lot about the genetics of cancer. I wanted to maybe
Speaker 1: start off by talking about this strange kind of gut
Speaker 1: feeling or almost superstition that somehow, unlike other diseases, cancer
Speaker 1: is a modern synthetic, uh, some kind of perversion in
Speaker 1: some way against nature, and that it sometimes comes with
Speaker 1: this odd edge of moralism, that cancer is not just unfortunate,
Speaker 1: but it's somehow decadent and an indicator of something wrong
Speaker 1: with our age. Parts of your book indicate to me
Speaker 1: that you've come up against this kind of thinking a
Speaker 1: lot as well. What do you think this sort of
Speaker 1: thinking signifies. I think it's absolutely fascinating. Cancer is not
Speaker 1: a new disease, and that really became abundant clear to me. So,
Speaker 1: just as a little bit of background, I spent twelve
Speaker 1: years working at Cancer Research UK, the UK's biggest cancer charity,
Speaker 1: answering lots of questions from the public, and all the
Speaker 1: time this question comes up. It's like, why me, isn't
Speaker 1: it just a modern disease, Oh, it's all this stuff
Speaker 1: in the air, or it's stress. What what is it?
Speaker 1: And you start to look into what cancer really is,
Speaker 1: and it's it's ancient. It's hardwired into our biology because
Speaker 1: it's just cells doing what they're going to do. Cells multiplying,
Speaker 1: cells jostling for space, cells competing with the cells around them,
Speaker 1: obeying the processes of evolution. And so when you really
Speaker 1: start to look, it's not surprising that you find cancer
Speaker 1: going all the way back through human history, all the
Speaker 1: way back through the history of animal life on this planet.
Speaker 1: But at the same time, when people start to become
Speaker 1: aware of cancer as a disease. They start to ask
Speaker 1: questions about, well, where did this come from? Why has
Speaker 1: it affected me? You start to get the Greek as
Speaker 1: people like Hippocrates who were writing about cancers in their
Speaker 1: patients and saying, well, what has caused it? It must
Speaker 1: be the gods, It must be the humors. Something is
Speaker 1: out of whack in here. And then you start to
Speaker 1: get the slightly more religious thing of well it is
Speaker 1: it's fins visited on us. It is something to do
Speaker 1: with immorality, modern living. And then you bring up to
Speaker 1: today this we don't necessarily have such a strong religious
Speaker 1: view of it, but certainly the idea of almost wellness
Speaker 1: as a religion. You've done something toxic to yourself and
Speaker 1: that's why you you now have cancer, and you look
Speaker 1: back at the history of cancer as a biological phenomenon,
Speaker 1: and that's simply not true. You know. It's it's basically
Speaker 1: like the dark side of life, rather than anything that
Speaker 1: we have particularly brought on ourselves in our modern life. Yeah,
Speaker 1: that's one of the things I really loved about your
Speaker 1: book was the way you how you show cancer to
Speaker 1: be so fundamentally integrated with with with life itself or
Speaker 1: I guess, multi cellular life life um. And so so
Speaker 1: maybe we should focus on on a couple of these
Speaker 1: ideas in particular. One of them, I guess, is the
Speaker 1: idea of modernity, right, the idea that that cancer is
Speaker 1: something that was very rare until recently. You make an
Speaker 1: argument against and people have argued this, but you make
Speaker 1: an argument against this in the book, and you cite
Speaker 1: some both some reasoning about why a lot of cancers
Speaker 1: wouldn't necessarily show up in the kinds of remains we
Speaker 1: can examine, and then pointing out examples that we do
Speaker 1: find in fact in the human record and physical remains
Speaker 1: of human society and prehistory. Yeah, it's the classic thing
Speaker 1: in biology that you find what you're looking for, and
Speaker 1: people have not been looking for signs of cancer in
Speaker 1: ancient remains. And the thing about cancer is that that
Speaker 1: when you're thinking about ancient remains that we find mostly
Speaker 1: you're talking about bones, and particularly when you get very ancient,
Speaker 1: you're talking about fossilized bones. And not every cancer leaves
Speaker 1: its trace in the bones. So when you're thinking about
Speaker 1: cancers that affect the soft tissue, you may never see
Speaker 1: the traces of a cancer that killed someone. Also, you know,
Speaker 1: ancient remains don't turn up in beautifully aged, matched structured populations,
Speaker 1: so you can say, oh, this is exactly the population
Speaker 1: that was alive at the time. This is exactly the
Speaker 1: number of cancers in this population. I think some people
Speaker 1: have argued that the fact that cancers are rare in
Speaker 1: ancient humans is an argument that cancer was very, very rare.
Speaker 1: But I slightly feel the other way around. I feel
Speaker 1: like the fact that the more people start looking for
Speaker 1: cancers in human and animal remains from from way way back,
Speaker 1: the more cancers they start to find suggest that it
Speaker 1: was more common. We will never know how how common
Speaker 1: it was, because you can't do, you know, a lovely
Speaker 1: epidemiological study on the sort of stuff that you can
Speaker 1: get out of the ground. You get what you get
Speaker 1: and you get on with it, basically. But I do
Speaker 1: think that cancer is not an exclusively modern disease. I
Speaker 1: will say, certainly it is more common as we live longer.
Speaker 1: So another of the things I go into you later
Speaker 1: in the book is the idea that there's almost a
Speaker 1: sort of a shooting up point. After you have got
Speaker 1: to a certain age, your risk of cancer does significantly
Speaker 1: go up. So if you think about ancient populations when
Speaker 1: there were many, many, many more things that we're going
Speaker 1: to kill you, your chances of getting to an age
Speaker 1: where you could dive cancer before something else got you
Speaker 1: were smaller. So it's not surprising we find fewer ancient
Speaker 1: remains with cancer. But when you think about some children
Speaker 1: have been found with types of cancer that are very
Speaker 1: very rare in populations, and the fact that we have
Speaker 1: found them at all suggests that this is a disease
Speaker 1: that has always been with us, and it's not exclusively
Speaker 1: a confection of modernity. It's it's basically, you know, it
Speaker 1: is with us and always has been. And what about
Speaker 1: the part of the misconception that views cancer is something
Speaker 1: that is uniquely kind of human and maybe associated with uh,
Speaker 1: with the synthetic products of human industry and all that. Like,
Speaker 1: this ties into the idea that sharks don't get cancer, right,
Speaker 1: that there's a widespread belief that for some reason, animals
Speaker 1: that don't engage, you know, don't live in cities and
Speaker 1: drive cars and eat processed food and stuff, won't get cancer.
Speaker 1: But they do. Yeah, this really blew my mind. I
Speaker 1: can see over on my bookshelf. I'm so tempted to
Speaker 1: go and grab it. But there's a book where someone
Speaker 1: has gone through all the different species that have been
Speaker 1: known to have cancer in In some cases it's many examples,
Speaker 1: in some it's just a few, but it's pages and
Speaker 1: pages and pages. Is everything from like odd wolves to zebras,
Speaker 1: and almost every branch of the animal kingdom develops cancer.
Speaker 1: There are a couple of really weird exceptions. So one
Speaker 1: is comb jellies. Comb jellyfish don't seem to get cancer,
Speaker 1: never been detected. And also sponges really weirdly resistant to sponges.
Speaker 1: There's this guy in in Arizona, guy called Carlo Malei,
Speaker 1: who is zapping sponges with enormous amounts of radiation like
Speaker 1: that would kill a human, and they're just fine. They
Speaker 1: just shrug it off. So there are some species that
Speaker 1: are cancer resistant, but pretty much everything else, to a
Speaker 1: greater or lesser extent is and humans aren't even the
Speaker 1: most susceptible species. There are some that are much more
Speaker 1: susceptible to cancer than humans are. So this idea that
Speaker 1: it's it's just a modern disease, it's just a human disease.
Speaker 1: It just doesn't stack up. You know. Yes, there are
Speaker 1: things that we do in our modern lives that increase
Speaker 1: the risk of cancer, and our lovely living to a
Speaker 1: nice old age is a major risk factor. You know.
Speaker 1: Thank god we don't all die in childbirth and of
Speaker 1: infectious diseases before our tenth birthday. But you know, we
Speaker 1: are we are not, you know, unique and wonderful when
Speaker 1: it comes to cancer again, it's it is just part
Speaker 1: of life. There are some other interesting observations you mentioned
Speaker 1: in your book about what might create a specific propensity
Speaker 1: for cancer in certain species versus others. One that I
Speaker 1: recall is that you mentioned that it's cancer seems to
Speaker 1: be more prevalent in species that have been through a
Speaker 1: genetic bottleneck at some point in the relatively recent past.
Speaker 1: So like, if their breeding population was reduced to a
Speaker 1: pretty small number at some point, they tend to be
Speaker 1: more susceptible to cancer. Is that correct? Yes, so that
Speaker 1: does seem to be the case, which suggests that there
Speaker 1: are genetic factors at work, because if you shrink a
Speaker 1: population down to a very small what's called an effective
Speaker 1: breeding size, you've got quite a small population that's all
Speaker 1: breeding with each other. You do start to get a
Speaker 1: pile up of mutations being passed from generation to generation,
Speaker 1: which might be increasing the risk of cancer. One of
Speaker 1: my favorite species in this case is the Syrian hamster,
Speaker 1: which all the Syrian hamsters pretty much that in pets
Speaker 1: and and abs all over the world, are descended from
Speaker 1: one litter of hamsters, and they are incredibly cancer prone
Speaker 1: because they're just massively in bread um. But yeah, every
Speaker 1: every species, some more than others and some much less
Speaker 1: than others. So elephants very surprisingly, you'd think when you
Speaker 1: think about it logically, animals that are very very big,
Speaker 1: they have lots of cells, they live for a very
Speaker 1: very long time, you would think that elephants should be
Speaker 1: riddled with cancer by the time they die, but they
Speaker 1: are not. They are amazingly resistant and really long lived
Speaker 1: animals like bowhead whales, even some of the really long
Speaker 1: lived bats, brand bats that live for forty years, very
Speaker 1: resistant to cancer. So they have evolved mechanisms that enable
Speaker 1: them to live these very long, luxury lifestyles and be
Speaker 1: resistant to cancer. Whereas you have very small rodents, things
Speaker 1: that live fast and die young, why bother you know
Speaker 1: you're going to be around for a couple of breeding
Speaker 1: sea reasons and then near out and humans are kind
Speaker 1: of in the middle. You know, we live for many decades,
Speaker 1: we reach our childbearing years in between our sort of
Speaker 1: twenties to forties, hang around for a bit after, and
Speaker 1: then the risk of cancer does start to go up.
Speaker 1: So you know, this is when you put humans in
Speaker 1: the context of all of life, you start to understand
Speaker 1: how our evolution as a species is intrinsically tied to
Speaker 1: our as a species risk of cancer. But you do
Speaker 1: have to separate that from personal risk of cancer as well,
Speaker 1: and that's a that's kind of a bit hard to
Speaker 1: get your head around, so talking about evolutionary risks versus
Speaker 1: personal risks. So one of the most interesting ideas in
Speaker 1: your book that that you keep returning to is a
Speaker 1: framework for thinking about multicellular life through the analogy of
Speaker 1: a society, that a multicellular organism is a society of cells.
Speaker 1: Could you explain this way of thinking in and some
Speaker 1: of the implications that extend from it. Yeah, this really
Speaker 1: really blew my mind when I started to understand this. So,
Speaker 1: this idea of cells as a society, it goes about
Speaker 1: quite a few decades. A lot of things I discovered
Speaker 1: while I was researching the book are quite old ideas
Speaker 1: that have got you know, subsumed or left behind in
Speaker 1: this this rush to just understand cancer as a purely
Speaker 1: genetic disease. But the idea is that cells and organisms
Speaker 1: and individuals in a species, they live in societies, and
Speaker 1: there are rules of societies at every single level. You know,
Speaker 1: things like do the job you're meant to do, don't
Speaker 1: take more than you need, clean up after yourself, all
Speaker 1: these kind of things. There are rules to societies that
Speaker 1: make societies work productively. And you start to look around
Speaker 1: at groups of cells that are in tissues and in
Speaker 1: organs in your body. You look at societies like ants
Speaker 1: and bees. You look at colonies, you look at troops
Speaker 1: of chimps and herds of deer, and you look at
Speaker 1: human societies and they all work in the same way.
Speaker 1: And this particularly an idea that I was influenced by.
Speaker 1: There's a researcher in Arizona called Athena Actipis, and she
Speaker 1: works a lot on social cooperation and cheating, and the
Speaker 1: idea that cancer cells basically cheat in society. They are cheaters,
Speaker 1: They take more than they need, they produce waste, They
Speaker 1: proliferate out of control, they don't die when they're meant to.
Speaker 1: They are not good cells. Now, if every cell in
Speaker 1: your society was doing that, it would just be you know,
Speaker 1: mad Max style dystopia. Nothing would work, Your body would
Speaker 1: not function. But you can get away with being a
Speaker 1: cancer cell and cheating and keeping going and keeping going
Speaker 1: because to a certain extent, cheaters do prosper. And it's
Speaker 1: the same in many animal societies. So one of the
Speaker 1: lovely examples that I found was these cape honey bees.
Speaker 1: So this just wonderful examples. So cape honey bees, they
Speaker 1: have a classic honeybee population structure. You have the queen,
Speaker 1: and you have all the workers, the female workers, but
Speaker 1: the queen is the only one who gets to reproduce,
Speaker 1: and so all the workers are busy doing all the
Speaker 1: work in the hive, and the queen's just cleaning around
Speaker 1: basically like ah ha um, and you know, popping off
Speaker 1: to reproduce when she feels like it. But there is
Speaker 1: a genetic change, single genetic change that means that these
Speaker 1: worker bees can become queens and they start to just
Speaker 1: sit around, you know, cleaning it up, and eventually the
Speaker 1: hive starts to collapse under the weight of all these cheaters,
Speaker 1: and it's just a single genetic change that enables them
Speaker 1: to do this. And actually some of these queens will
Speaker 1: go off to other hives and start to infect them
Speaker 1: and turn them into cheaters as well, and it's almost
Speaker 1: like a bee cancer, I suppose, because ultimately it leads
Speaker 1: to the destruction of the hive. And you say, well,
Speaker 1: why would the bees have this, Why would it be
Speaker 1: so fragile that one genetic change can disrupt it like this?
Speaker 1: And it turns out that where the bees live it's very,
Speaker 1: very windy, So there's a risk that if you just
Speaker 1: have one queen and that's all you get, your queen
Speaker 1: could get blown off course and you might lose he
Speaker 1: totally and then your hive would collapse anyway. So the
Speaker 1: ability to flip into queen mode it's really useful for
Speaker 1: the bees for their evolutionary survival, but it comes with
Speaker 1: a risk. And it's the same with cells. So we
Speaker 1: need to be able to make new cells. You need
Speaker 1: to regenerate millions of cells in your body every day,
Speaker 1: millions of cells in your skin, your blood, your bowel.
Speaker 1: You need to be able to heal yourself. If you're wounded,
Speaker 1: you need to be able to grow from one cell
Speaker 1: into an adult human. Cells need to reproduce, they need
Speaker 1: to do stuff. Flip side of that is that they
Speaker 1: can sometimes go out of control because it's the same
Speaker 1: mechanisms that make cells grow and multiply in the right
Speaker 1: way that they kind of harness and hijack when they
Speaker 1: decide to cheat and grow out of control in the
Speaker 1: wrong way. So that's interesting. You're sort of showing how
Speaker 1: cancer is one side of an evolutionary balance where on
Speaker 1: one hand, you've got you know, as your ability to
Speaker 1: do something good goes up, the risks associated with those
Speaker 1: same genes that code for that also go up. So
Speaker 1: we know on one side what the downside is. We
Speaker 1: can see tumors and cancer. And you're saying that the
Speaker 1: the the goods that make those risks worthwhile are basically
Speaker 1: being able to proliferate quickly in in cell growth. And
Speaker 1: this would have to do not just with growth in youth,
Speaker 1: but in healing and things like that. Yeah, exactly, And
Speaker 1: you see this. This starts to explain the differences across
Speaker 1: species because if you if you cut a mouse, mice
Speaker 1: heal amazingly fast. Their cells just basically knit themselves back together.
Speaker 1: It's it's absolutely incredible. Um. One of the stories that
Speaker 1: I discovered when I was talking to a researcher in
Speaker 1: Santa Barbara who's trying to work with the animals in
Speaker 1: the zoo to understand their cancer risks. She's she went
Speaker 1: to the zoo and said, can I get a little
Speaker 1: bit of skin from your giant tortoise? And they were like,
Speaker 1: hell no, we cut a tortoise. It takes a year
Speaker 1: to heal, and tortoises live for a very long time.
Speaker 1: They're incredibly cancer resistant, but they the flip side of
Speaker 1: that is that they don't heal very easily. So humans
Speaker 1: again somewhere in the middle. We don't heal as fast
Speaker 1: as mice. We live much longer than mice. So there's
Speaker 1: there's all of this stuff is a trade off about
Speaker 1: the evolutionary journey that your species has taken. And one
Speaker 1: of the things that I sort of took this to
Speaker 1: its logical conclusion, and I was like, if there's aliens,
Speaker 1: aliens would get cancer. There's very unlikely that they would
Speaker 1: not if they obey the general rules of evolution, And
Speaker 1: this idea that, like cells, organisms living in a society
Speaker 1: behave according to the rules of that we know make
Speaker 1: a good society. I don't think there's any reason why
Speaker 1: aliens wouldn't get cancer. She's like, that's a bit of
Speaker 1: a that was a bit of a sort of late
Speaker 1: night thought. I think, because all that's necessary is that
Speaker 1: they exist by cell division, right, I mean that's pretty
Speaker 1: much it. Yeah, yeah, exactly if you have cells and
Speaker 1: your cells are doing cell division, and also if you
Speaker 1: have evolution by natural selection, which is basically the engine
Speaker 1: that drives cells to to proliferate and be selected for
Speaker 1: and to keep going, and species to keep proliferating and
Speaker 1: keeping going, then yeah, you probably could get cancer. And
Speaker 1: that's what we generally see across the entire animal kingdom. Well,
Speaker 1: thinking about aliens getting cancer makes me think of another
Speaker 1: interesting part of your book, would was about difficulties in
Speaker 1: classifying what appears to be some form of uncontrolled cell
Speaker 1: growth in animals, or even not animals, other organisms that
Speaker 1: are very different from us. So can you look at
Speaker 1: what's going on in a clam and say that it
Speaker 1: has cancer? Yeah? Probably, But what about a mushroom or
Speaker 1: in an algae or something yeah, this was This was interesting. So,
Speaker 1: you know, what is cancer and when is cancer is
Speaker 1: an interesting question. And when you get to more organized animals,
Speaker 1: and particularly mammals, we define invasive cancers as cancers that
Speaker 1: kind of break through the sort of molecular I guess
Speaker 1: you'd call it like saran wrap that's around your organs
Speaker 1: and your tissues. They break through this membrane, and that's
Speaker 1: what we call invasive cancer. But really, you know, the
Speaker 1: phenomenon of cells growing out of control is all over
Speaker 1: the place. You can see it in plants when they
Speaker 1: get gals. You can see it in in fungi. You
Speaker 1: can see it in all sorts of things. And what
Speaker 1: are the interesting quest ens is you know something like endometriosis,
Speaker 1: which is a condition where you get rogue tissue within
Speaker 1: the body and it's sort of it grows and its
Speaker 1: spreads and it bleeds and it's very very painful. It's like,
Speaker 1: but that's not cancer, it's not invasive. But actually, when
Speaker 1: you look at that kind of tissue, it has lots
Speaker 1: and lots of the kind of mutations and changes we'd
Speaker 1: expect to find in cancer. But that's not cancer, and
Speaker 1: that's in humans. So this this idea that mutations, it's
Speaker 1: not just what makes cancer. Uncontrolled cell growth is not
Speaker 1: just what makes cancer. It's it's sort of this this invasive, aggressive,
Speaker 1: evolving characteristic that really is what we can classify as
Speaker 1: as cancer. All Right, we're going to take a quick break,
Speaker 1: but we'll be right back. And we're back. So maybe
Speaker 1: we should shift to talking about the history of our
Speaker 1: understanding of the approximate causes or maybe better to say,
Speaker 1: the risk factors for cancer where it comes from, whether
Speaker 1: that's there's an hereditary component and an environmental component. Uh,
Speaker 1: there's a part in the book where you mentioned this
Speaker 1: thing that was called the Daily Mail Oncology Ontology blog,
Speaker 1: which I really appreciated because so the idea was this
Speaker 1: was an attempted list of all the things that either
Speaker 1: cause or cure cancer, according to the Daily Mail. And
Speaker 1: that made me say, I've got to admit something. I
Speaker 1: read a lot of science and medical news from my work,
Speaker 1: and I have all but completely turned off my recognition
Speaker 1: system for articles about, you know, new supposed causes or
Speaker 1: cures for cancer, because this was already like a cliche
Speaker 1: to the point of being a hack joke for comedians
Speaker 1: in the nineteen nineties. Is there something we should learn
Speaker 1: from this, like the way that we get this conditioned
Speaker 1: kind of numb reaction to these types of news stories. Yeah,
Speaker 1: that's we used to get a lot of that when
Speaker 1: I was at cancer a set k. You know, I
Speaker 1: think the stupid this one was that water gives you cancer,
Speaker 1: and also that turning on turning on the light at
Speaker 1: night to go to the bathroom gives you cancer. So
Speaker 1: you know this, this is really really frustrating. So there's
Speaker 1: kind of a couple of there's a couple of things
Speaker 1: to dissect because it's also comes down to like what
Speaker 1: what is actually the nature of cancer? And the way
Speaker 1: that cancer has been thought about for a very long
Speaker 1: time is according to what scientists like to call the
Speaker 1: somatic mutation theory of cancer. So this is this idea
Speaker 1: that cells pick up changes in their DNA and their
Speaker 1: genome that the instructions that they used to do what
Speaker 1: they do. They pick up these changes, these mutations, and
Speaker 1: that enables them to do more bad things. And then
Speaker 1: they pick up more and they do more bad things.
Speaker 1: So it's this gradual accumulation of nasty mutations turns nice,
Speaker 1: well behaved cells into aggressive cancer cells. And we can
Speaker 1: start to see some of the characteristic fingerprints that different
Speaker 1: agents leave in the genome. So we can see, for example,
Speaker 1: cigarette smoke or ultra violet light from the sun, we
Speaker 1: can see those characteristic fingerprints of damage in the genome.
Speaker 1: What that doesn't necessarily tell us because when you start
Speaker 1: looking closely at a cancer or even in fact at
Speaker 1: normal tissue, you start to see these changes and mutations everywhere.
Speaker 1: So this kind of simplistic model that it's a hit
Speaker 1: in this green and a hit in this green, and
Speaker 1: a hit in the stree and a hit in the
Speaker 1: street in a bang, that you've got a cancer cell
Speaker 1: is nonsense because loads of healthy cells such as peppered
Speaker 1: with mutations and loads of things do damage our DNA,
Speaker 1: and that's kind of like it's mostly fine. So it's
Speaker 1: a bit more of a sophisticated understanding of yes, there
Speaker 1: are things that damage DNA. A lot of them we
Speaker 1: know about, some of them we don't know about yet.
Speaker 1: Researchers are trying to figure out, you know, how do
Speaker 1: we match chuck these signatures of damage to things that
Speaker 1: are in the environment alas mostly the most single, most
Speaker 1: damaging thing you can do for your DNA is breathe oxygen,
Speaker 1: literally just being alive. The processes of life in your
Speaker 1: cells damage your DNA unfortunately. But then if all your
Speaker 1: cells are to some extent, you know, more or less
Speaker 1: messed up. Everyone's got a few mutations here and there,
Speaker 1: some more than others. What is it then that tips
Speaker 1: a cell into becoming a cancer cell? If everyone's a
Speaker 1: bit weird, what makes that cheating cell kind of slip
Speaker 1: the bonds of good society and really start going for it?
Speaker 1: And that really is is an evolutionary question that cell
Speaker 1: has involved the capacity to do that, And so I
Speaker 1: think it's it's far too simplistic to say, oh, well,
Speaker 1: you know your cancer was absolutely caused by smoking, that
Speaker 1: was it. It's like, well, that was a risk factor
Speaker 1: and it certainly didn't help, but there were many other things.
Speaker 1: And also many people who do smoke don't get cancer.
Speaker 1: So it's like we've got to be more sophisticated in
Speaker 1: understanding what makes normal cells become damaged and what makes
Speaker 1: kind of sad cells become really bad cells. Yeah, this
Speaker 1: is an important point about thinking about risk factors instead
Speaker 1: of causes. And I know that that's it's infuriating to
Speaker 1: people especially. I think if you don't have a lot
Speaker 1: of like training in a statistics oriented field, that it
Speaker 1: just doesn't feel very comfortable to think about, especially something
Speaker 1: that's a really important life and death issue like cancer
Speaker 1: in terms of probabilities. You want to know like what
Speaker 1: it was or what what did it? Yeah, exactly. I
Speaker 1: think the best analogy that I really came up with is,
Speaker 1: and this is spoilers. Now, if anyone's seen Agatha Christie's
Speaker 1: murder on the Orient Express where and I am this
Speaker 1: is a massive spoiler, but come on the books, like
Speaker 1: really older should have read. Now see the movie with
Speaker 1: Albert Finn's great But it's a murder, but all the
Speaker 1: people involved they all have a stab, so you never
Speaker 1: know who actually was the murderer. So it's it's kind
Speaker 1: of like this. So you know, we have lots and
Speaker 1: lots of genes that we know are implicated in cancer.
Speaker 1: There are lots of things that can damage our DNA.
Speaker 1: There are lots of things that can like improve the
Speaker 1: environment of our tissues or not. We know that things
Speaker 1: like you know, keeping keeping well and healthy and doing
Speaker 1: all the boring healthy living stuff that helps to keep
Speaker 1: your your body healthy, makes your cells more likely to
Speaker 1: fall into line. But saying exactly like it was that thing,
Speaker 1: you know it was, it was that sunny holiday in
Speaker 1: marbea in that damage that skin cell that gave you cancer,
Speaker 1: as I you know, that's that's simply not possible. So
Speaker 1: trying to say oh, it's this, Oh it's that, do this,
Speaker 1: don't do that, I think is it is not terribly
Speaker 1: helpful because at some point we've just got to get
Speaker 1: on and live and try and negotiate the risks that
Speaker 1: we're happy with taking. Right at the same time, you
Speaker 1: do point out how there are certain factors that increase
Speaker 1: your likelihood so far above the baseline that maybe at
Speaker 1: that point it even though you still can't quite say
Speaker 1: it's a cause, it's something closer to a cause. And
Speaker 1: one I think one common example given would be tobacco.
Speaker 1: Remember you mentioned another example in the book about uh,
Speaker 1: just chronic exposure dermal exposure to soot in chimney sweeps.
Speaker 1: I believe it was. Yeah, this was the first example
Speaker 1: of someone actually showing that something a substance in the
Speaker 1: environment could increase the risk of cancer. And this is
Speaker 1: an English surgeon called Percival Pot who had a purely professional,
Speaker 1: interest in the scrutums of young boys, purely professional, because
Speaker 1: he was interested in chimney sweeps in London. Now this
Speaker 1: was in there, and chimney sweeps were basically sent naked
Speaker 1: up the chimneys by gang masters to clean the chimneys.
Speaker 1: So they were exposed to a lot of soot, and
Speaker 1: they noticed that they started to get these cancers in
Speaker 1: their genitals, and they were called soot warps, and these
Speaker 1: were very very very nasty cancers, really horrible kind of stuff.
Speaker 1: And Pot realized that it was the soot that these
Speaker 1: boys were being exposed to that was causing these cancers.
Speaker 1: And he said, right, you know, we've got to get
Speaker 1: nice in Germany that all the chimney sweeps have these
Speaker 1: nice kind of tight fitting uniforms so they weren't being
Speaker 1: directly exposed on their skin. And he was like, right,
Speaker 1: we've got to get those in. Got to protect these boys,
Speaker 1: stop sending them naked up the chimneys. M Alas it
Speaker 1: took over a hundred years for people to actually change
Speaker 1: in Britain because the gang masters were like, no, those
Speaker 1: those uniforms are too expensive. It'll make our sweeps too expensive,
Speaker 1: you know, they're they're cheap, we don't really care. So
Speaker 1: that was really tragic that they managed to link this
Speaker 1: cause to these very horrible cancers, and there was something
Speaker 1: that everyone knew could be done that was helping in
Speaker 1: other countries and nope, nope, it didn't happen for a
Speaker 1: very long time. Um. But yes, that Percival part is
Speaker 1: kind of the father of this idea of external sources
Speaker 1: of carcinogenic chemicals, I think, but I think it has
Speaker 1: stuck in the imagination that like it's all external, it's
Speaker 1: all from from something you've done, or something you've got,
Speaker 1: or something you've touched or eaten or been exposed to.
Speaker 1: Well to go to the other side. So there's a
Speaker 1: part of your book where you explored I think we
Speaker 1: actually mentioned this earlier about your podcast episode about Maud
Speaker 1: Sly and Pauline gross and in the role, for example
Speaker 1: of the research of maud Sly in establishing that there
Speaker 1: is a hereditary component to cancer that I think at
Speaker 1: the time you say that, you know, the primary argument
Speaker 1: was about two different major theories of external causes, whether
Speaker 1: cancer was caused primarily by inflammation or by infectious agents
Speaker 1: and parasites. Is that correct. Yeah, So at the beginning
Speaker 1: of the twentieth century, the early twentieth century, there was
Speaker 1: this idea that cancer was either all caused by external
Speaker 1: things like certain things in the environment, or it was viruses.
Speaker 1: Mostly there were a couple of good examples in animals
Speaker 1: where you could take viruses exposed the animals to them
Speaker 1: and they would develop certain types of cancer. So the
Speaker 1: first one was a guy called Peyton Rouse who discovered
Speaker 1: a virus that caused cancer and chickens. So by the
Speaker 1: sixties everyone was just obsessed with the idea that it
Speaker 1: was viruses. And now you know, we really understand that
Speaker 1: there are families that are affected by multiple cases of cancer,
Speaker 1: that cancer can be to some extent influenced by the
Speaker 1: genes we inherit. But really this was a wast a
Speaker 1: completely separate, parallel strand running up through the first half
Speaker 1: of the twentieth century, and it was work in mice
Speaker 1: in families. In the podcast, we talk about the story
Speaker 1: of mord Sly who bred all these mice together to
Speaker 1: show cancer could be inherited, and then the story of
Speaker 1: Pauline and Gross, who was a seam stress who meant
Speaker 1: a scientist, and she said, you know I'm going to
Speaker 1: die young, and he mapped out all her family because
Speaker 1: so many members of her family were affected by the
Speaker 1: same types of cancer. And it took, you know, decades
Speaker 1: until they pinned down the particular gene fault that was responsible.
Speaker 1: But yeah, they're all these lines were like running a
Speaker 1: completely separate to each other until it all started to
Speaker 1: coalesce together in this understanding that you know, there are
Speaker 1: things that damage our genes. There are genes in ourselves
Speaker 1: that make ourselves replicate that that stop ourselves from dying.
Speaker 1: This is good normally, but they can go wrong. They
Speaker 1: can be mutated, they can be changed, we can inherit
Speaker 1: versions that affect their function. And it all sort of
Speaker 1: started to coalesce into this very sensible idea of of
Speaker 1: how cancer starts. But I think it just became very
Speaker 1: very focused on the genes and the cells just yes,
Speaker 1: single genes, shopping lists of genes and changes, and forgot
Speaker 1: to look at this broader picture of the environment in
Speaker 1: which cells are, the society in which they're living, how
Speaker 1: they can interact with each other, cheat, overcome expand push
Speaker 1: against each other. This more. I hate to use the
Speaker 1: word holistic because it sounds really kind of hippy dippy,
Speaker 1: but you know, it's it's part of our bodies. It's
Speaker 1: not an external alien thing. These cells obey the rules
Speaker 1: of our bodies to to a certain extent, they cheat
Speaker 1: the rules to another extent, but it's all kind of
Speaker 1: part of one piece. And we've just focused on on
Speaker 1: genes and molecules for the past couple of decades. I think, far,
Speaker 1: far too much. All right, we're going to take a
Speaker 1: quick break, but will be right back with more than
Speaker 1: all right, we're back. So you mentioned in the book
Speaker 1: that you believe that the future of our resistance against
Speaker 1: cancer and medical treatments of cancer are going to rely
Speaker 1: on quote shifting towards a new way of evolutionary and
Speaker 1: ecological thinking about cancer. So I assume there you're connecting
Speaker 1: to the ideas you were just articulating. But could you
Speaker 1: expand on what you mean by that. Yeah, So, as
Speaker 1: all the sort of strands of cancer research over the
Speaker 1: past that of one years started to coalesce on this
Speaker 1: idea that that cancer starts when cells pick up certain
Speaker 1: genetic mutations and they go out of control. And then
Speaker 1: we started to get to this idea that then well,
Speaker 1: the way you treat them if you find the molecules
Speaker 1: the genes that are making them go out of control,
Speaker 1: and you target them with drugs, and that's going to
Speaker 1: be the way we're going to cure cancer. And there's
Speaker 1: been so much, so much effort, money, research, time, patients, lives,
Speaker 1: in clinical trials have gone into testing these very molecularly
Speaker 1: targeted drugs, and you know, some in some cases there
Speaker 1: have been incredible success stories. So for example, a drug
Speaker 1: called gliveck for treating a certain type of leukemia is
Speaker 1: incredibly successful. It targets a very specific genetic fault in
Speaker 1: the cancer cells, and it is it was game changing
Speaker 1: and it continues to be game changing. But lots and
Speaker 1: lots of the other drugs that have been developed along
Speaker 1: these lines, they have not transformed survival in the way
Speaker 1: that we would hope they've They've eked out, you know,
Speaker 1: in some cases months, in some cases, you know, a
Speaker 1: few years. In one case, I saw a paper that
Speaker 1: said nine days increase in survival with this particular incredibly
Speaker 1: expensive targeted drug. And you're like, these are not cures.
Speaker 1: These these are these are the magic bullets that we
Speaker 1: were promised, and they are not cures. And in virtually
Speaker 1: all these cases, the campcer comes back. And why does
Speaker 1: it come back because of Charles flipping Darwin? You know,
Speaker 1: it's it's evolution. You hit something, you get rid of
Speaker 1: most of the cells that are sensitive, and you've still
Speaker 1: got a core of resistance because you've got so much
Speaker 1: genetic diversity in that population of cancer cells. And so
Speaker 1: they start growing again, and this time they're resistant to
Speaker 1: the drug. So maybe you try another drug, same thing happens.
Speaker 1: You get rid of the sensitive cells, you've still got
Speaker 1: a core of resistance, and they grow back, and eventually
Speaker 1: you run out of options. And there's time now to
Speaker 1: think about cancer in a much more evolutionary and ecological way,
Speaker 1: as you say, thinking about well, if we know that
Speaker 1: this process of evolution is at work, that if you
Speaker 1: get rid of the sensitive cells, the resistant ones come back, Like, well,
Speaker 1: why don't we try and approach this in a different way.
Speaker 1: Why don't we try not to knock them all out?
Speaker 1: Why don't we try and balance these populations, keep them suppressed,
Speaker 1: keep them under control, much in the way that say
Speaker 1: a farmer would try and control the pests in his crop,
Speaker 1: rather than completely trying to nuke them all from orbit
Speaker 1: or eradicate every single last grasshopper, you know, and understanding
Speaker 1: the ecology the tissue biology, So you know, are you
Speaker 1: actually causing more damage to tissues by treating with drugs
Speaker 1: or radiotherapy or surgery. How can we minimize that so
Speaker 1: that it doesn't encourage cells to to cheat even more
Speaker 1: in a damaged environment. So it's this this idea is
Speaker 1: starting to come through, But I think I think it
Speaker 1: does take a bit of a subtle and sophisticated understanding
Speaker 1: of cancer as an evolutionary process within the tissue environment
Speaker 1: of the body, rather than just like these are some
Speaker 1: rogue cells that have gone wrong and they're growing out
Speaker 1: of control, and we just need to hit them with
Speaker 1: enough magic bullets and they'll go away. You know, the
Speaker 1: classic cure for cancer that we've almost been sold it's
Speaker 1: I don't think it's it should look like that, um
Speaker 1: because we tried that and it's not really working. So
Speaker 1: I think we need to try a different approach. This
Speaker 1: way of talking about tumors is reminding me of something
Speaker 1: you mentioned earlier in the book actually, which I thought
Speaker 1: was really interesting image that stuck with me. The idea
Speaker 1: of a hypothetical hyper tumor. I'd never considered this before,
Speaker 1: but the idea that a tumor can get a tumor. Yeah.
Speaker 1: So again, it's the thing that really jumped out at
Speaker 1: me researching this book is that cancer is a microcosm
Speaker 1: of evolution. It's it's a crucible of evolution. A dumpster
Speaker 1: fire of evolution is probably the best way of putting it.
Speaker 1: Cancer is a dumpster fire of evolution, Thank you, um.
Speaker 1: But yeah, everything, every innovation of life that you see
Speaker 1: on Earth, cancer can evolve because you have a very large,
Speaker 1: genetically diverse, popular lation of cells that have got lots
Speaker 1: of opportunity to try stuff out. So you know, it's
Speaker 1: not surprising that even within a horrible cheating atmosphere of
Speaker 1: a cancer you might get some really really badass cells
Speaker 1: that will start proliferating even more and actually suppress the
Speaker 1: original tumor by just out competing them in a Darwinian sense.
Speaker 1: And then there's some really wild things that I discovered.
Speaker 1: So the most crazy innovation is that a guy is
Speaker 1: a guy called Kenneth Pienta in Baltimore has discovered that
Speaker 1: cancer cells have invented how to have sex. This this
Speaker 1: really blew my mind. Because the implications are massive. Here.
Speaker 1: We have this idea that cancer cells they just they
Speaker 1: reproduced basically by splitting into that's fine, you know you
Speaker 1: have one cancer cell, it becomes two, it becomes for
Speaker 1: all of that kind of thing. There's no transfer of
Speaker 1: information between cells and after that. But he's discovered with
Speaker 1: these prostate cancer cells that they fuse together and become
Speaker 1: resistant to treatments. And then they start kind of budding
Speaker 1: off little cells that are resistant to treatment. And you're like,
Speaker 1: what you know that looks like sex, I mean for
Speaker 1: a very poor value of sex, but that you know,
Speaker 1: that's the biological process of Sex's two cells fusing together
Speaker 1: and and creating more. And you're like, whoa, because that's
Speaker 1: a way of genetically combining forces. And again it's an
Speaker 1: evolutionary innovation. Sex has evolved on this planet multiple times.
Speaker 1: You know, it's not unheard of. And if you have
Speaker 1: enough rolls of that dice, as might happen in in
Speaker 1: a cancer you know, weird, weird, weird, our stuff is
Speaker 1: going to happen in there. Um. It's just it really
Speaker 1: is mind blowing. Every innovation of life. Cancer cells, you know,
Speaker 1: at some point somewhere might have a go at. And
Speaker 1: so when I realized this, when I realized that, you know,
Speaker 1: cells can have sex, cells can do all these kind
Speaker 1: of crazy evolutionary things. They can smash their chromosomes out,
Speaker 1: they can glue themselves back together. It's all kind of crazy.
Speaker 1: And then I started learning about the thing that was
Speaker 1: just really incredible. So, right, imagine there's a disaster movie happening. Right,
Speaker 1: you know what happens in a disaster movie. Everything's going wrong.
Speaker 1: You've got the guy and you've got the girl, and
Speaker 1: what do you do when your world's ending, right, You
Speaker 1: have sex basically, So that's like a last ditch attempt
Speaker 1: for cancer cells to try and come up with some
Speaker 1: kind of evolutionary innovations that are going to get them
Speaker 1: out of trouble. But then there's one more thing that
Speaker 1: happens at the end of a disaster movie, right, you
Speaker 1: leave the planet. Sure, yeah, and like and cancer cell
Speaker 1: do this, and this is absolutely incredible. So so this
Speaker 1: is where we get to infectious cancer, the idea that
Speaker 1: it could actually be contagious. Yeah, so this is this
Speaker 1: is kind of spooky and scary because it's a very
Speaker 1: medieval idea that cancer is contagious. That you catch it
Speaker 1: from someone. And I will say that in certainly in humans,
Speaker 1: there's no contagious cancers that we know of. But the
Speaker 1: first example was the Tasmanian Devils. So this was back
Speaker 1: in the nineties nineties. The Tasmanian Devils, they're all in Tasmania,
Speaker 1: Southern Australia. They're very cute animals, but like they're evil.
Speaker 1: They're very you know, they're they're placid more or less
Speaker 1: around humans, but they absolutely hate each other. So when
Speaker 1: you get to Tasmanian devils together, they're just like, really,
Speaker 1: go for it now, biting each other's faces. And researchers
Speaker 1: started to notice that these animals were getting big tumors
Speaker 1: in their faces and in some cases it was killing them,
Speaker 1: and that they're already endangered as it is, and this
Speaker 1: cancer started sweeping through the populations and I was like,
Speaker 1: oh no, what we're going to do. And a woman
Speaker 1: in Australia, she was working for the for the government
Speaker 1: in a hospital. She's she was looking at cancer samples
Speaker 1: from humans and looking at the chromosomes. It was a
Speaker 1: way back then of identifying the kind of cancer you
Speaker 1: might have. And so she started looking at these Tasmania
Speaker 1: devil cancer samples. Now, the thing about human cancers is
Speaker 1: every human cancer is a one off. It's a unique
Speaker 1: evolutionary event. It starts in you, it grows a new
Speaker 1: it evolves in you, and it it dies in you
Speaker 1: one way or the other. When she was looking at
Speaker 1: these devil cancers, like they're all the same from every animal.
Speaker 1: The chromosomes were absolutely the same, and it's like, that
Speaker 1: does not happen. That is that? And she was like,
Speaker 1: this is a contagious cancer and uh. And eventually they
Speaker 1: kind of pinned it down and it said, yes, it
Speaker 1: was cancer cells transmitting from one devil to another through
Speaker 1: that mechanism of biting and fighting and scratching. So it's
Speaker 1: a you need with a contagious cancer. You need to
Speaker 1: have a mechanism of transfer to get the cells from
Speaker 1: one organism to the other. So with the devils, it
Speaker 1: was it was biting and fighting. Um. And then there
Speaker 1: was another cancer, contagious cancer, which were allowed to talk
Speaker 1: about dog genitals. Oh yeah, just I just did so. Yeah,
Speaker 1: so there's a dog genital cancer called canine venereal tumor
Speaker 1: as CTBT and so yeah, it's again when when dogs
Speaker 1: have sex. It's not pretty, but they get kind of
Speaker 1: tied together in the the gentleman and lady department, and
Speaker 1: that can cause some injury. So again you have a
Speaker 1: mechanism for cancer cells to try its fer from one
Speaker 1: dog to the other. And this cancer it transmits through populations.
Speaker 1: And there's a woman called Elizabeth Murchison who's in Cambridge University.
Speaker 1: She started studying the devils and then she started studying
Speaker 1: these dogs and they discovered that these cancer cells in
Speaker 1: the dogs have been around for thousands of years. The
Speaker 1: first dog with that cancer lived and died thousands of
Speaker 1: years ago, and it's gone all over the world. And
Speaker 1: that's like, it's like the oldest I don't know, it's
Speaker 1: like the oldest mammal. I suppose. It's just incredible. Um
Speaker 1: this they've worked out what kind of dog it was.
Speaker 1: It was, you know, a little kind of dog with
Speaker 1: like pointy ears and a sandy coat, and it's amazing.
Speaker 1: So when you're saying it's the oldest mammal, in a way,
Speaker 1: you're saying that the tumor is in a sense of
Speaker 1: part of that original dog. It is that dog. It
Speaker 1: is that dog's body exactly the tumor arose in the dog.
Speaker 1: It's got the genome of the oridge, an old dog,
Speaker 1: like seriously messed up, I mean, and these cancers are
Speaker 1: now evolving independently in different dog populations all over the world.
Speaker 1: But yeah, it's it's an incredibly long lived organism. I suppose,
Speaker 1: so that that was one devil cancer which was relatively
Speaker 1: recent a dog cancer, and then they found a new
Speaker 1: second devil tumor that had arisen even more recently. So
Speaker 1: that's very unlucky for the devils. And they think it's
Speaker 1: because again they're quite an inbred population, so with this
Speaker 1: this fighty bity mechanism of transfer, so you've got quite
Speaker 1: high probability that this might happen. And then there's all
Speaker 1: these weird shellfish that have cancer and seem to transfer
Speaker 1: it between each other by shedding cancer cells into the sea,
Speaker 1: which is just disgusting. Um. It has made me rethink
Speaker 1: my idea of swimming. But there's some really incredible examples
Speaker 1: of transmissible cancers in nature. And again I think the
Speaker 1: more we look, the more we're going to find. You know,
Speaker 1: each one of these papers just gets published and less
Speaker 1: and less impressive journal is more and more, more and
Speaker 1: more turn up. But there are some examples in humans,
Speaker 1: and I talk about a couple in the book. So
Speaker 1: there's one which is they're absolutely horrendous. Is a guy
Speaker 1: called Chester Southam who was in New York, I think
Speaker 1: in the fifties, and he was doing experiments on prisoners,
Speaker 1: mostly black prisoners in the US, people in care homes
Speaker 1: can existing cancer patients. People are very desperate and not
Speaker 1: consenting to these experiments properly, and he was putting cancer
Speaker 1: cells into them and in some cases they did developed humors.
Speaker 1: Mostly they didn't, which shows the human immune system will
Speaker 1: fight these cells off, but some of them did. And
Speaker 1: also there's a very sad story of a woman who
Speaker 1: developed melanoma. And at the time, this is around about
Speaker 1: the sixties, I think it was an idea that you
Speaker 1: could transplant some cancer cells into someone to get an
Speaker 1: immune reaction going uh, and then give that kind of
Speaker 1: blood back to the patient and it would help to
Speaker 1: treat their cancer. It's sort of an early idea immunotherapy,
Speaker 1: so basically getting someone's donor immune system to generate some
Speaker 1: antibodies to neutralize the cancer when you donated them. And
Speaker 1: so this woman's mother said all right, I'll do this.
Speaker 1: You transplant me with a bit of my daughter's cancer,
Speaker 1: I'll generate the antibodies, and then you can take my
Speaker 1: blood and give it to her. And unfortunately, the daughter
Speaker 1: actually passed away very quickly, and a few weeks later
Speaker 1: it was discovered that the mother actually did have the
Speaker 1: cancer growing in her and and then shortly after that,
Speaker 1: the mother passed away from the cancer that had killed
Speaker 1: her daughter. And you're like, it's rare. Um and probably
Speaker 1: because they were related, you overcome the problems of immune rejection,
Speaker 1: but you're like, oh, well, it could happen. Ah. And
Speaker 1: then there's the most absolutely disgusting one, which is this
Speaker 1: is really sad and awful but also gross. Um. So,
Speaker 1: there was a man who walks into an HIV clinic
Speaker 1: in Colombia complaining of feeling very unwell. And so he
Speaker 1: had HIV for a long time, so his immune system
Speaker 1: was very suppressed. He hadn't been taking his medication, and
Speaker 1: he was feeling very unwell. And they looked in his
Speaker 1: body and they found all these little nodules in his
Speaker 1: body and and they were like, well, these don't look
Speaker 1: like human cells. This is very weird, and well, maybe
Speaker 1: it's a parasite or something. And they gave him some
Speaker 1: some treatment, and he went away and and he came
Speaker 1: back and he's like, it's still no better, and there's
Speaker 1: more and more of these weird things. And they looked
Speaker 1: more closely, they got them analyzed, and it was he'd
Speaker 1: been infected by tapeworm, but the tape worm had a
Speaker 1: cancer and the cancer had infected the man. And you're like, whoa,
Speaker 1: that is a just the stuff of nightmares. Um. Be
Speaker 1: highlights how powerful the human immune system is at the
Speaker 1: best of times. And see it's like, oh my god.
Speaker 1: You know, also tape worms can get cancer, so it
Speaker 1: sort of highlights a lot of the principles at work here.
Speaker 1: And very sad for that man, but unfortunately he couldn't
Speaker 1: be treated in the time. Um and it's like, this
Speaker 1: is an incredible biological phenomenon really that we were only
Speaker 1: just starting to understand. Yeah, I mean, these are all
Speaker 1: just unbelievable examples. And and go in the column of
Speaker 1: you know, the case you make that we should shift
Speaker 1: towards that thinking of cancer in an evolutionary and ecological
Speaker 1: way instead of a purely molecular way. So if that's
Speaker 1: the dark side. What about thinking about cancer and an
Speaker 1: evolutionary and ecological way gives you hope? Do you see
Speaker 1: lines of research extending from that framework that give you
Speaker 1: hope for the future and of cancer treatment and and
Speaker 1: the fight against cancer. Yeah, so you know, you can
Speaker 1: get very sort of nihilistic about this, and I, oh, yeah,
Speaker 1: resistance always emerges. Evolution is is so powerful. But then
Speaker 1: I look at the kind of researchers that are really
Speaker 1: getting to grips with evolutionary therapy, and it's a growing bunch.
Speaker 1: It's all started, particularly I think from the Mopic Cancer
Speaker 1: Center in Tampa and Florida and a man called Bob
Speaker 1: Gattenby and his team there, and they are just really
Speaker 1: incredible people. So I mean, I'm a biologist, I am biased,
Speaker 1: I will say against mathematicians and physicists. But it turns
Speaker 1: out the secret the secret weapon in the war on
Speaker 1: cancer is as So there you go. So he's brought
Speaker 1: together all these mathematicians and biologists and they're actually doing
Speaker 1: evolutionary modeling on cancer populations, trying to understand the rise
Speaker 1: and the fall of resistant and sensitive cells, trying to go, okay,
Speaker 1: if if resistance is going to emerge when you treat.
Speaker 1: Can we predict how that's going to happen? How do
Speaker 1: we kind of let cell populations balance them cells out
Speaker 1: and stay in control rather than just you know, nuke
Speaker 1: it from orbit, which is kind of the conventional idea
Speaker 1: about cancer therapy. And so they've they've done a most
Speaker 1: successful clinical trial so far as in prostate cancer and
Speaker 1: it's it's an absolutely fascinating trial of an approach that
Speaker 1: they call adaptive therapy. And the way it works is
Speaker 1: you assume that within any cancer at any size, there
Speaker 1: are going to be sensitive cells to the drug and
Speaker 1: there's going to be resistant cells to the d and
Speaker 1: it's a drug called abiratarone that they use. And so
Speaker 1: what you do is you you also have to have
Speaker 1: a marker that will tell you how much tumor is
Speaker 1: in anyone's body at any given time. And for protect cancer,
Speaker 1: we have quite a good marker. It's called p s A.
Speaker 1: So you can look at someone's p s A level
Speaker 1: in their bloodstream and say, okay, that's a proxy for
Speaker 1: how much cancer is in their body. And so they
Speaker 1: start treating this these men with prostate cancer advanced prostate cancer,
Speaker 1: so they're there probably their their life expectancy is, you know,
Speaker 1: about eighteen months on this drug before it starts to
Speaker 1: get really gnarly for them. And and they treat them
Speaker 1: with this drug and it starts to work and their
Speaker 1: tumors start to shrink. And then the difficult bit is
Speaker 1: you wait till it's shrunk to half the size it was,
Speaker 1: and then you stop treating and you wait. So the
Speaker 1: idea is you've knocked down all the insitive cells, or
Speaker 1: as many of them as you. You feel the urge too,
Speaker 1: and there's still some sensitive cells there which are keeping
Speaker 1: the resistant cells in check. And then you wait and
Speaker 1: you wait for them to grow back. But because being
Speaker 1: resistant to the drug is kind of it's it's it's
Speaker 1: not very good for you, these cells are less fit.
Speaker 1: They struggled to grow as much. So it's the sensitive
Speaker 1: cells that grow back, and so you treat them again.
Speaker 1: And so you ride this kind of roller coaster of
Speaker 1: start the drug, let the tumor shrink, stop the drug,
Speaker 1: let the tumor grow. Start the drug, let the tumor shrink.
Speaker 1: And they have men who have been on this regime
Speaker 1: for four years, I mean gradually, in the end the
Speaker 1: tumor does the cancer does start to evolve because that
Speaker 1: population of resistant cells does start to get bigger, very
Speaker 1: slightly every time. But this is you know, if this
Speaker 1: was a drug and you were saying, I've gone from
Speaker 1: average eighteen months through to four years, you know, if
Speaker 1: this was a drug, the industry would just be throwing
Speaker 1: itself trying to to get this, you know, get this
Speaker 1: to the clinic, get this to work, get this to everyone.
Speaker 1: So that was that was a really powerful demonstration of
Speaker 1: an evolutionary therapy of understanding and accepting you've got these
Speaker 1: cell populations in there and they're kind of how to
Speaker 1: balance them. There are other sort of adaptive strategies, evolutionary strategies.
Speaker 1: This one called the Suckers gambit, which is where you
Speaker 1: treat cancer cells with a drug that you want them
Speaker 1: to develop evolved resistance too. But you know that for
Speaker 1: them to have evolved resistance, they have to have activated
Speaker 1: certain molecular pathways, they have to have gone down an
Speaker 1: evolutionary route in one direction, and then you hit them
Speaker 1: with another drug that they can't get out of, so
Speaker 1: you're sort of you you get them into a blind
Speaker 1: evolutionary end. It's like a double punch. Yeah, exactly. You know,
Speaker 1: there's there's lots of ideas out there about using the
Speaker 1: drugs we have, maybe even using drugs that are less
Speaker 1: less good I suppose less potent, less, less toxic, because
Speaker 1: you don't want to just nuke everything. You want to
Speaker 1: start thinking about how to balance cells, how to control
Speaker 1: cell populations. But this comes to the really difficult thing,
Speaker 1: which is the psychological element of this, because this is
Speaker 1: not the cure for cancer that we were promised. This
Speaker 1: is not the magic bullet, This is not eradicated from
Speaker 1: your body. There may be some approaches where we actually
Speaker 1: can and you know, the earlier you can diagnose cancer
Speaker 1: if you can treat it with surgery. Um, some cancers
Speaker 1: can be treated really effectively and cured at an early stage.
Speaker 1: But for cancers, once that evolutionary process has really kicked off,
Speaker 1: you have to approach them with an evolutionary mindset, and
Speaker 1: that may mean driving them to extinction with the right
Speaker 1: combination of sort of extinction events at the right time.
Speaker 1: But it's a it's not going to be this kind
Speaker 1: of perfect cure that I think people want, that we've
Speaker 1: been led to expect, and it certainly won't be one
Speaker 1: magic bullet drug that like, Yep, that's it. That's that's
Speaker 1: the cure. That's it. We can now sell this and
Speaker 1: give it to everyone because, as I said, you know,
Speaker 1: every every individual cancer is a is a one off,
Speaker 1: it's a special snowflake. It's an individual evolutionary event. So
Speaker 1: we need to understand that where is it going, what's
Speaker 1: it doing, what are what are the contingencies in there?
Speaker 1: And how can we either drive this cancer to extinction
Speaker 1: or drive it to a place where we can control
Speaker 1: it for the rest of someone's natural lifespan. And you know,
Speaker 1: that's not a cure for cancer, but to me, that's
Speaker 1: you know, I think that's getting there. Yeah, I really
Speaker 1: like that. Thinking of the body not like as a
Speaker 1: malfunctioning car with a part that needs to be replaced
Speaker 1: or fixed, but as an environment with natural populations within
Speaker 1: it that in the relationships between them need to be managed. Yeah,
Speaker 1: sort of tending the garden is the idea, but you
Speaker 1: can take the ecological thing further. There are different sorts
Speaker 1: of cancers, you know. Some are lush, exotic rainforests that
Speaker 1: are really going for it. Some are arid deserts, some
Speaker 1: are more like you know, kind of neatly tendered gardens.
Speaker 1: But we've got to understand what each person's cancer is
Speaker 1: really like and how it's behaving. Not just a shopping
Speaker 1: list of mutations that you can try and fire magic
Speaker 1: bullets at, but a much more holistic understanding and accepting
Speaker 1: that evolution is going to happen, always has done. That's
Speaker 1: why we're here, that's why the diversity of life is here.
Speaker 1: But if we can harness it and work with it,
Speaker 1: then I really think we can start to make some
Speaker 1: progress in in some of these most difficult advanced cancers. Alright,
Speaker 1: I guess we will wrap it up there. But again,
Speaker 1: the book is Rebel Cell. It's a fantastic reed. We
Speaker 1: we really think you'll like it. And also you can
Speaker 1: check out cats podcast, the Genetics Unzipped podcast. Is there
Speaker 1: anywhere else they should look for your work right now,
Speaker 1: Cat um, my first book, Herding Hemmingway's Cats, is available.
Speaker 1: I've got another book called How to Code a Human
Speaker 1: and you can find me at on Twitter. I'm Cat
Speaker 1: Underscore Arnie. Pretty much. Yeah, every everything's pretty much the
Speaker 1: al Right, Well, that does it. Thanks again to Cat
Speaker 1: Arnie for joining us for this discussion. Again, if you're
Speaker 1: trying to look her up. You can find her on
Speaker 1: Twitter at at k A T underscore A r n
Speaker 1: e Y. And if you're looking for her book, Rebel
Speaker 1: Cell Cancer, Evolution and the New Science of Life's Oldest Betrayal. UH.
Speaker 1: The UK version is coming out on August six. The
Speaker 1: US version is coming out on September twenty nine. You
Speaker 1: can pre order now, I believe, if not, keep an
Speaker 1: eye out for it, and you can also look it
Speaker 1: up on her website at Rebel Cell book dot com
Speaker 1: or check out her work on the Genetics on Zipped
Speaker 1: podcast at Genetics on zip dot com. It's just such
Speaker 1: a great book title. I just keep coming back to
Speaker 1: how much I love that book title. It really is
Speaker 1: great and uh, and it has some resonance throughout the
Speaker 1: book with some other themes and metaphors she discusses in there,
Speaker 1: such as the Society of Cells. So, Robert, I really
Speaker 1: do recommend you read it if you get a chance.
Speaker 1: I I really enjoyed this one, all right. I'll have
Speaker 1: to look forward in September. In the meantime, everyone out
Speaker 1: there would like to listen to additional episodes of Stuff
Speaker 1: to Blow your mind, Well, you can find us absolutely
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