A few days ago, I received a request from Brian Klepper, a friend and frequent contributor to our blog, to review a manuscript submitted for publication by Bill Bestermann, MD on the potential utility of metformin, a diabetes drug, in the treatment of cancer. Truth be told, I was a bit reluctant. Bill has contributed to our blog on the subject of diabetes and heart disease. He is a great proponent of the use of metformin in diabetes treatment. The drug is dirt cheap and is as effective, or more so, than the new-fangled (and much more expensive) drugs used by most physicians today.
There were two reasons for my reluctance to review the manuscript: First of all, Bill is an East Tennessee community doctor. How seriously do you expect an elitist West Coast physician and hard-nosed scientist to take the research of a community doctor from East Tennessee? Second, and more seriously, I worried that Bill suffers from what I call the Ph.D syndrome. I have spent a lifetime among scientists, mostly Ph.Ds. Over the years, I couldn’t help but notice how narrow or expansive their view of their field of research is. If you talk about a neurological disease, the compound I am working on shows great promise of curing it. Cancer? Funny, you should mention it; I tested my compound on 2 mice 3 weeks ago and lo and behold, they are still alive! And I might add that in the literature, there is extensive evidence that it positively impacts hypertension and stroke and diabetes, and… you get the picture. These scientists are not charlatans, rather they are true believers. Part of the problem, I think, lies with our educational system. We train specialists and sub-specialists, specializing is a sub-sub specialty, with no wider view of biology and its complexities and intricacies. As somebody once said, we know more and more about less and less. I have met molecular biologists who are intimately familiar with the DNA structure of Drosophila (fruit flies) but know close to nothing about their behavior, their food preferences, or their life cycle. In fact, they may not even know what the fruit fly looks like.
So, back to metformin and Bill Bestermann. My initial thought was that Bill is a passionate advocate of the drug because it is effective and cheap—how quaint. So, I hope you can forgive me if my first reaction was to roll my eyes. But my friend Brian Klepper was persistent and egged me on until I finally took the time to read Bill’s paper carefully. I have to admit, I was surprised (and elated) at the same time. The paper lays out in great detail how metformin, a diabetes drug, can affect tumor growth. Even more astounding, it describes the interconnected cellular signaling pathways that are affected by metformin in minute, scholarly detail. Whether the premise of the paper is right or wrong is immaterial— this paper is truly impressive.
What is truly gratifying is that a country doctor in rural Tennessee has applied himself to such a scientific pursuit. It reminds me of a book that I read as a teenager, The Citadel, by A. J. Cronin. The book tells the story of a young doctor, Andrew Manson, fresh out of medical school who arrives in a Welch mining community to provide care to the miners and their families. He begins to question the status quo and introduce a new type of medicine, one based on current evidence instead of based on personal preference. During his time in the mining town, Manson observes a connection between coal dust exposure and lung disease in some of his patients. That inspires him to do a research project that eventually proves that occupational exposure to coal dust can cause lung disease. Quite an accomplishment for a small town doctor working outsides the confines of a university medical school “ivory tower”!
The Citadel kindled my desire to become a physician and a scientist. And for that, I am eternally grateful. I believe that people like Bill Bestermann not only contribute to the advancement of medical science, but they also serve to inspire future generations of physicians. For that, I salute you Bill Bestermann, MD. Medicine, today, sorely needs more and more people like you.