In medicine, for every advance you make, it feels like you also can take a step back. For example, when I was a young oncologist, I never thought we would see a survival plateau in metastatic melanoma, but today we do. With the new immune checkpoint inhibitors for melanoma, we can generate long-term, cancer-free remissions in about a third of patients. In fact, in one trial, no patient has died in over 2½ years–which was once unheard of. I never envisioned this would be possible when I was holding the hands of patients dying of metastatic melanoma. This is a remarkable advance that is incredibly exciting. During my career, several other cancers–including many types of lymphoma, testicular cancer and chronic myeloid leukemia, to name but a few–have been essentially cured.
Metastatic melanoma was always considered the most chemotherapy-insensitive and radiation-resistant of all the cancers, and if you couldn’t surgically resect it, which often you couldn’t, the patient would die of the cancer. It turned out we were treating it wrong. Instead, we needed to unharness the patient’s own immune system to attack the melanoma and that has worked remarkably well. In fact, the 2018 Nobel Prize in Physiology or Medicine was given for this discovery to Texas’ own Jim Allison, Ph.D., who works at MD Anderson Cancer Center in Houston and is a close collaborator of many of our investigators here.
However, while we celebrate this great advance, we also face some dangerous reverses in medicine. Some hospitals face serious threats to drug-resistant bacteria, such as Klebsiella or Citrobacter which infect chronically ill patients who are often in the hospital for a long time. These patients can be colonized by these particular organisms and spread them to others in nursing homes and long-term rehabilitation hospitals. In addition, drug-resistant tuberculosis, while not common in the United States, is rampant in Russian, South Africa and Southeast Asia. It is only a matter of time before we see increases in drug-resistance TB here in the U.S. Given that these countries are only hours away by plane, health care is truly a global concern.
My friends in infectious disease tell me the world won’t end in a nuclear explosion but in the last soft cough of a dying tuberculosis patient. Thus, I may sound a bit dramatic, but the only hope for humanity is medical research. We must find new ways to attack these drug-resistant organisms, and we must meet them where they are–in nursing homes and in other countries–before they become invasive and resistant to treatment in our own communities.
Because the numbers of drug-resistant bacterial infections are relatively low in the United States and drug-resistant tuberculosis is much more common in other countries, there is little commercial incentive to attack these diseases. Therefore, federal research funding becomes extraordinarily important. Support of the National Institutes of Health is crucial for our country to beat these new invaders. It is only with such federal support that we can come up with novel agents that attack those novel pathways that can prevent these aggressive organisms from becoming rampant in the United States.
If we do not discover weak points in these aggressive organisms before they become widely extent in the U.S., which is long before such drugs would be commercially viable, then these drugs will become commercially viable at the expense of many lives.
Our plea is for all of our readers to rally around support for federal research funding in all areas of medicine before they become crises. Only then can we maintain the great medical advances of the previous generations. From this campus, we are proud to have the extraordinary strong global health efforts under Ruth Berggren, M.D., FACP, director of the Center for Medical Humanities and Ethics. This group of medical professionals sees firsthand the issues with drug-resistant organisms as they take physicians, students and trainees to 17 different countries where they participate in health efforts.
In addition, there is a global health fellowship in the Department of Emergency Medicine that allows our fellows to witness the effects of these drug-resistant infections when they travel overseas. These men and women grow as clinicians and educators while bringing health care to global populations. They are on the forefront of this battle, and their efforts can prevent such organisms from becoming crises here. Continuous vigilance and continuous diligence in translating medical research forward into all areas of the globe is our best hope in maintaining health here.
Robert Hromas, M.D., FACP
Dean, Long School of Medicine