Respectful Insolence

I just have time for a short take today. (If you need more, fortunately, Bora has posted the 33rd Meeting of the Skeptics’ Circle for your edification. Yes, my preamble was just an excuse to plug the Skeptics’ Circle one more time.)

In the comments of yesterday’s post about a medical student who is a young earth creationist, Karl asked a most interesting question:

I hope that you saw “House” last night (on FOX, of all places). A 15 year old faith healer shows up in the hospital. At one point he touches a patient who has been dignosed with terminal (Liver?) cancer. The cancer shrinks. House spends 45 minutes trying to figure it out, all the while arguing with everyone else that there has to be a rational explanation. At the end, he figures it out (amazing, considering that this show is on FOX).

I don’t know whether this show is in reruns or whether you will ever be able to see it, but there is a synopsis at http://www.tv.com/house/house-vs.-god/episode/633814/recap.html.

The explanation is that the boy has Herpes and that that particular version attacks cancer cells – when he touched her he passed the virus to her. So, the questions are 1) Is that valid? and 2) If it is, why isn’t that knowledge being used as a tool in combatting cancer?

Fortunately for you (and for me, because I’ve only managed to catch House a few times this year and missed all but the last 20 minutes or so of last night’s episode, but, more importantly, because it means I don’t have to write nearly as much), Scott has already taken this question on at Polite Dissent. (Of note, each week Scott reviews new episodes of House for medical content. It’s well worth checking out.) I’ll add my two cents below the fold.

Herpes virus can indeed be oncolytic (capable of lysing tumor cells). Indeed, weakened versions of the herpes simplex have been widely tested in preclinical tumor models (animal models) as cancer therapy because of its ability to preferentially infect and lyse certain kinds of tumor cells. The bottom line as I see it is that it’s theoretically possible for a herpes infection to cause temporary tumor shrinkage. However, in the brief time I took to look for them, thus far I’ve been unable to locate any case reports of this ever actually happening outside the context of clinical trials using herpes virus as an experimental treatment for cancer. (If anyone is aware of any studies or case reports showing tumor shrinkage due to herpes infections acquired outside the auspices of a clinical trial designed to test the activity of herpes against tumors, please chime in in the comments.)

So what cancers have oncolytic herpes viruses been tested in? Well, they’ve been tested in a variety of preclinical animal models in many different tumor types, for one thing, and have shown promise in these models since 1991. Here’s a report of a study describing the use of a weakened herpes simplex virus to treat pediatric neuroblastoma in mouse models, in which the virus nearly completely dissappeared.

But what about humans? Last summer at the European Society for Medical Oncology, there was a report of a phase I trial done at Memorial Sloan-Kettering Cancer Center using herpes simplex to treat colorectal cancer metastatic to the liver, although apparently it hasn’t yet been published in a medical journal. Other altered herpes viruses are being used in clinical trials as treatments for glioma, melanoma, head and neck cancers, astrocytomas, and glioblastomas. Herpes viruses modified to express immunomodutors such as GM-CSF are being tested against breast cancer, head and neck cancer, and melanoma. There are also a number of different kinds of oncolytic viruses other than herpes in preclinical development for cancer therapy.

It would not surprise me if one of these oncolytic herpes viruses is approved by the FDA for treatment of specific cancers sometime in the next five years or so, maybe even sooner.

Comments

  1. #1 Urinated State of America
    April 27, 2006

    It’s an odd coincidence that you make the prediction about therapeutic use of oncolytic viruses, and phage therapy (used for many years in Russia) being increasingly mentioned as a solution to antibiotic resistance.

  2. #2 tgibbs
    April 27, 2006

    For me, the last straw with House was the episode that asserted that there were specific antidotes for different organophosphate poisons, which is (a) false, and (b) stupid, because organophosphates all phosphorylate esterase and it’s the same esterases.

    Of course, I was already fairly annoyed with House because of the horrible example of medical ethics he sets for medical students, not to mention that in most of the episodes he seemed to go off half-cocked and nearly kill his patient before finally figuring things out in time for the final commercial

  3. #3 Hank Barnes
    April 27, 2006

    The explanation is that the boy has Herpes and that that particular version attacks cancer cells – when he touched her he passed the virus to her.

    cough, cough,.. bullsh%t,..cough, cough

    Hank Barnes

  4. #4 Bronze Dog
    April 27, 2006

    I don’t watch this sort of thing, but the explanation certainly sets off a few red lights in my head. But, as weird as it sounds, it seems there’s some promising angle to it, or at least some grain of truth. I’ll wait until Orac blogs about a Phase III trial or something, though.

  5. #5 Laura
    April 27, 2006

    It is really interesting that there may be some truth to the idea. I watched the episode but dismissed it at first. I am curious though because herpes viruses tend to emerge when the immune system is suppressed (like shingles in the elderly, and CMV in AIDs patients as well as Type I and II infections) could that in itself affect the liklihood of this being a successful treatment? I mean a cancer patient likely already has an impaired immune system from the cancer or chemo where I think introducing a new infection could be problematic. Any thoughts?

  6. #6 TheRidger
    April 27, 2006

    The point of House is not the medicine.

    I blogged about this episode – the boy’s attitude. As I admitted, the boy was fictional, but recognizable. And then I discussed the whole “lying to people to bring them to God” tack.

    If you’re interested, you can check it out.

  7. #7 Ian B Gibson
    April 27, 2006

    Hugh Laurie (House himself) is from England (he’s been in Blackadder amongst other shows), so what amused me was hearing people saying he sounded so pretentious in his interviews with that obviously fake English accent!

  8. #8 epador
    April 27, 2006

    In 20 years of Oncology, I would have been happy to see just one cancer patient with herpetic complications (oral/esophageal/or type II areas) have tumor shrinkage. Not one I can think of (unless you count the concurrent use of effective chemotherapy or radiation).

    The only reason I liked House initially is the battering of TV doctor stereotypes. Now it rates below American Idol and Survivor in content and originality.

  9. #9 epador
    April 27, 2006

    And Geez o Peet, breaking into her apartment but not doing a complete physical exam on male admission, or at least once he’s febrile? Gimmee a break. If I were House I fire the lot of them for not finding the skin rash on admission. But then what would have the episode been about then?

  10. #10 decrepitoldfool
    April 27, 2006

    I assume the show has nearly zero medical content – all that guff is on a level with “reverse the polarity” or “induce a tachyon field”. It’s a comedy and I just enjoy the highly improbable characters including the main one. The writing is very sharp and acting first-rate.

    That god-shouting kid seemed pretty familiar to me. I knew quite a few guys like him and his father in Tennessee.

  11. #11 Karl
    April 28, 2006

    Thanks for the explanation.

    It seems to be an unfortunate fact of (TV) life that any program that attempts to display real behavior of any profession, always gets caught up in having to tell an interesting story rather than being very precise about the specifics of the profession.

    My father-in-law was a lawyer. He always complained about Perry Mason – said they got the law wrong. And I’ve read that complaint about one of my other favorite shows: Boston Legal. There are two other programs of this type currently running: Numbers. It would be interesting to hear what mathematicians have to say about that. And the CSI’s. What do the Forensic scientists think of that?

    Of course the prime example of this genre is the space travel (Star Trek) type. There has been much written about the fallacies of the science.

    In order to watch such shows, you have to suspend disbelief and enjoy them for what they are – works of fiction – with requirement to fit introduction, complication and resolution into one hour. What makes these programs fun to watch are the stories, the acting, the character development, and , in some cases, the philosophical or political points that they make.

  12. #12 atlheel
    April 28, 2006

    I mean, if you want real, accurate portrayals of medicine, watch Discovery Health, I don’t really see the point in berating primetime shows for their lack of accuracy when it comes to the finer points of exotic (or even not-so-exotic) conditions.

    But thanks, Orac, for letting us know this one was at least based in reality!

  13. #13 cfeagans
    April 28, 2006

    I work nights and Tivo a couple of shows I’ve found myself addicted to: NCIS, The Unit, Battlestar Galactica, and even House.

    I happened to watch both House and The Unit in the same evening and was disappointed at both for their introduction of “faith” as dilemas for characters. One of House’s doctors commented at the end (or something to the effect of), “it had to be just the right type of cancer, just the right type of virus, and they had to meet at just the right moment,” implying that God was still responsible. Wilson even comments to House that he is “just as God made [him].”

    The Unit dealt with an Army wife who was rejecting God and religious teaching to their daughter because a loss of “faith” and ended up commenting to her husband that she found herself “praying” for him at the end. Great episode other than the “faith” dilema.

    On a different note, I’m one of those that doesn’t watch House for the medical content… I just love hearing the House character say to others what I wish I had the nerve and tenure to say on a daily basis! The show is more comedy than drama for me.

  14. #14 RavenT
    April 29, 2006

    And the CSI’s. What do the Forensic scientists think of that?

    Although I can’t answer the question you asked, I can tell you that my friend, a chemist who serves as an expert witness, has observed some effect on juries from it. She says that juries have newly unrealistic expectations of what science can and cannot establish, and that, in her opinion, it’s TV shows like CSI that convey the idea that science always yields fast, immediate, decisive answers that they’re getting the expectations from.

    I guess nobody would tune in to find out how my other friend, a biologist, spent two days teasing through her results to find out at exactly what point the test tube rack in her immunoassays accidentally got turned around, reversing the results from then onward.

    But this is not a new phenomenon; when William Shatner did Rescue 911 back in the 80s, they showed CPR as always working. In reality, it works only a small percentage of the time; there are recorded instances when people who try it have actually been verbally abused when their efforts don’t bring the person back. I can’t prove it, but I think that behavior derives from unreasonable expectations of CPR’s effectiveness, based on shows like that. Now DNA analysis seems to be undergoing a similar fate.

  15. #15 Nina
    May 3, 2006

    Orac, you say:
    Here’s a report of a study describing the use of a weakened herpes simplex virus to treat pediatric neuroblastoma in mouse models, in which the virus nearly completely dissappeared.

    Should the last sentence be “in which the tumor nearly completely dissappeared?”

    I like House. And I also like Medium. So there you go!

  16. #16 Clark
    May 7, 2006

    Even if Herpes Virus isn’t eventually approved for Cancer treatment, it is very likely that some other viral treatment will be approved – e.g. Oncolytics is using a Reovirus (although they also hold a patent for a Herpes virus targeting the Ras pathway). And they have had some interesting results.

    BTW – the interesting thing is that it isn’t just that the virus kills the tumor, but that it appears to unblind the immune system to the cancer.