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Skeptimedia is a commentary on mass media treatment of issues concerning science, the paranormal, and the supernatural.

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Immune system quackery

The threat of imminent immune system collapse is the calling card of quackery. - William Meller, MD

15 Jan 2010. In my review of Evolution Rx by Dr. William Meller, I praised and criticized the author. One of the praiseworthy aspects of the book is the way Meller debunks the many myths dispensed by so-called "alternative" healers. One of the more popular myths has to do with the immune system. As Meller notes, there seems to be an endless array of products, postures, and therapies claiming to boost or stimulate the immune system. Allegedly, stimulating the immune system will "fend off infection, cancer, and even old age." Sounds good, but it's nonsense.

Our immune systems very rarely break down, except when we starve, undergo intensive chemotherapy, or face an immune-system assassin such as HIV. These are life-threatening emergencies, not occasions to take an alleged immune "stimulant."

....Rather than being weak, it is far more common today that our immune system is overactive.

What is the immune system? Meller calls it "the body's homeland security." The immune system is a system of cells and proteins that are "scattered throughout the body — in the blood, lymph nodes, bone marrow, spleen, and even appendix." It's "made up of white blood cells and the tissues that make and harbor them." Immune cells try to protect the body from foreign invasions by such things as germs. Immune cells attack and dispense with the offenders. The security forces created by the immune defense system are called antibodies, "highly specific proteins programmed to recognize and remember a specific virus or bacteria forever." Yes, forever.

Our immune system never rests. In the mouth and gut it neutralizes germs that hitchhike in on food. In the lungs it screens the air we breathe. In the skin it wards off invaders trying to enter through dirty cuts and scrapes. The fact that we get so few infections, despite countless daily exposures, testifies to the vigilance of our immune forces.

One of the ways that our overactive immune systems can cause trouble is to attack things that aren't really a threat, such as plant pollen or animal dander. We call such attacks allergies, the focus of chapter 3 of Meller's book.

[new note: Immunotherapy is a cancer treatment aimed at boosting the immune system with drugs. For example, "immune system cells in the body normally make small amounts of interleukins as a way to communicate with each other. Different interleukins make parts of the body's immune system more or less active." A drug like Aldesleukin or Proleukin is used to treat skin melanomas and kidney cancer and is "being studied for use against some leukemias, lymphomas, and other cancers, as well as some other diseases." These drugs "cause the body to make more of certain immune system cells, prompts immune system cells to be more effective, and causes the cells to make more of some other cytokines {a family of proteins}." Dendritic Cell Therapy is another type of immunotherapy used in the treatment of certain cancers. (See update below for more on boosting the immune system with science-based medicine.) [/new]

allergies

"An allergy is an overactive immune response to common substances, such as a bee sting, pet dander, or pollen. Some foods and medicines can also trigger allergies." According to Meller, most people who think they have food allergies actually suffer from food intolerance and do not involve the immune system at all. Fewer than 5% of Americans have food allergies, although 30% think they are allergic to some food or other. What's the difference between a food allergy and an intolerance? As noted, the former involves an overactive immune system; the latter isn't immune related.

The immune system doesn't forget. If you're allergic to something, the antibodies that were created by your immune system to attack what it responded to as a threat will always be activated when the allergen is present. "Once you are allergic to something, you will always be allergic to it." Also, allergy symptoms are limited: "red and itchy eyes, stuffy nose, sneezing and wheezing, hives, very rarely swelling of the intestinal lining." Unfortunately, many of these symptom are also the symptoms of a common cold. "The point of most of these symptoms is to try to expel the offending allergens from the body by crying, sneezing, coughing, or flushing it out." Other symptoms of allergies include itchy mouth, lowered blood pressure, faintness, a tightening throat, and trouble breathing.

How do you know if you have an allergy? "If you react rapidly and predictably every time you come in contact with a substance," then you are allergic to the substance. If your reaction to a substance takes an hour or more, you're probably dealing with an intolerance. Also, "most allergy symptoms will be at least partially relieved by antihistamines." The symptoms of food intolerances such as gas, vomiting, bloating, and cramps will not respond to antihistamines. Food intolerance symptoms are often dose-related: the more you eat, the worse you feel.

You might try getting tested for allergies, but if the test is negative, you might still have an allergy. If it's positive, there may still be many things you're allergic to but don't know about. There are millions of things you could be allergic to, but common allergy tests check for fewer than 100 allergens.

In Meller's view, food allergies are rare and, in most cases, "are a careless fad diagnosis, spread through word of mouth and the media...." On the other hand, "respiratory and skin allergies [such as asthma and eczema] have greatly increased in the developed world over the past century," as have autoimmune diseases such as rheumatoid arthritis, lupus, multiple sclerosis, scleroderma, Crohn's disease, celiac disease, Grave's disease, and type 1 diabetes. According to the Center for Disease Control (CDC), 5-8 percent of the US population have an autoimmune disorder and 78.8 percent of them are women. Meller doesn't discuss the sex disparity in immune responses. He tries to explain the rise in respiratory and skin allergies, and the rise in autoimmune disorders in terms of differences between our way of living and the way of living of our Stone Age ancestors. I think it's apparent, however, that hormonal differences are going to be more important than the fact that we live in a cleaner world than Stone Age people, one free of worms and parasites, in trying to explain this fundamental difference between men and women.

Finally, Meller's advice to breast feed as the best defense against allergies seems sound, from what I've read elsewhere. But I don't know what to make of Meller's advice to feed infants small amounts of potential allergens to avoid allergies later, and expose our children to dirt, flowers, trees, and animals as a way of protecting them from later immune attacks. Some researchers, for example, think that overexposure to allergens is responsible for the increase in allergies. Unlike Meller, some think the increase in allergies is due to our world being dirtier and more polluted, not cleaner and more antiseptic, than the world of our ancestors.

[new] update October 2014

Since 2011 the National Cancer Institute has funded a network of twenty-seven universities and cancer centers across North America to conduct trials of immune therapies. Jim Allison, the director of the tumor-immunology program at Memorial Sloan-Kettering, has been involved in using T-cells to fight cancer. He introduced antibodies to a protein called cytotoxic T-lymphocyte antigen-4, or CTLA-4, which protrudes from the T-cell’s surface in some cases of cancer. The elimination of the antibodies allowed the T-cells to attack the cancer cells.

T-cells are a potent type of white blood cell that destroy cells infected with microbes that they recognize as foreign. The immune system uses a variety of white blood cells to fight disease. Some, like neutrophils and macrophages, engulf and chew up microbes. In contrast, T-cells attack the microbe from the outside, with a fusillade of enzymes. Cancers disarm the immune system, producing proteins that cause T-cells to either quickly become exhausted and die or blithely overlook the tumor.*

Jerome Groopman M.D. quotes a review in Nature (December, 2011) that said the antibody to CTLA-4 “provides realistic hope for melanoma patients, particularly those with late stage disease who otherwise had little chance of survival. More broadly, it provides clear clinical validation for cancer immunotherapy in general.” Maybe so, but when used on a real person the therapy contradicted "the popular notion that boosting the immune system is a 'natural' way to treat cancer, free of the harsh side effects associated with chemotherapy or radiation. The results of immunotherapy can include an attack on the skin, intestines, lungs, liver, thyroid, pituitary gland, kidneys, and pancreas. When T-cells are stimulated to an intensity that destroys cancer cells, they can also cause collateral damage to normal tissue."

Steven Rosenberg, the chief of surgery at the National Cancer Institute, has pioneered ... “adoptive cell transfer,” in which T-cells are taken from a patient’s tumor and given immune stimulants such as interleukin-2, which cause them to replicate. Then they are put back into the body. In the latest of three trials of patients with melanoma who underwent adoptive cell transfer at the National Cancer Institute, nine of twenty-five patients have been in complete remission for more than five years. Across all three trials, five patients who had received earlier, unsuccessful treatment with the antibody to CTLA-4 are in remission.*

One of those who went into complete remission suffered some collateral damage. " Along with the cancer, the manipulated T-cells attacked the normal cells with melanin, causing vitiligo, in which skin loses its pigment, and his hair to turn white." Small price to pay, I suppose.

Rosenberg believes that melanoma has a unique relationship with the immune system: there are so many mutations in the tumors that T-cells have an easier time recognizing them as foreign. This characteristic makes developing immune therapies easier. “An intense natural immune response just doesn’t exist for other kinds of cancers,” he said.

Nothing's perfect, however. "Most targeted therapies quickly wane in their efficacy. A recently developed therapy for melanoma dramatically shrank more than half of tumors, but nearly all patients relapsed within a year. A study published in March suggested that as a cancer spreads in the body—from the kidney to the liver and the lungs—the mutations occur in non-uniform ways, so that DNA in liver deposits may differ from DNA in tumors in the lung. This protean progression means that a drug targeted to one mutation may not work against cancer cells throughout the body." The complexity of cancer makes laughable claims that cancer can be cured or prevented with selenium or black raspberry powder, advocated by quackaloons like Mike Adams and Joe Mercola.

"Tumors have mutated to escape the effects of radiation, chemotherapy, and targeted agents; the body’s immune responses may not be unique." (See Medical Dispatches APRIL 23, 2012 Issue of The New Yorker: "The T-Cell Army Can the body’s immune response help treat cancer?" By Jerome Groopman

See also Leukemia cell therapy yields extended remission by Denise Grady The New York Times.

An experimental therapy has brought prolonged remissions to a high proportion of patients who were facing death from advanced leukemia after standard treatments had failed, researchers are reporting. The therapy involves genetically programming cells from the patient’s own immune system to fight the disease....

The experimental treatment uses patients’ own T-cells, a type of immune cell. Researchers extract the T-cells and then genetically engineer them, using a disabled virus to slip new genetic material into the cells. The new genetic material reprograms the T-cells to recognize and kill any cell that carries a particular protein on its surface. Then the cells are dripped back into the patient, like a transfusion. The cells are also programmed to multiply, so that each one can yield as many as 10,000 more cancer-killing cells....

The treatment clearly does not work for everyone. Seven of the 30 patients died, including a few who had complete remissions at first and then relapsed. In three, the leukemia came roaring back in B-cells that lacked the target protein and therefore were not vulnerable to the treatment....

In July, the Food and Drug Administration designated the T-cell treatment a “breakthrough therapy” for relapsed and treatment-resistant acute lymphoblastic leukemia in adults and children. The designation recognizes experimental drugs “that may demonstrate substantial improvement over existing therapies” for serious or life-threatening conditions, and is meant to speed their development and review. Currently, the patients’ T-cells are processed at the University of Pennsylvania. But the drug company Novartis, which helped pay for the study, has invested heavily in the research, holds licenses to the technology and is expected to take over the cell processing. June, Grupp and some of the other study authors developed the technologies and may profit from them.

The first immunotherapy treatment approved by the US Food and Drug Administration (FDA) was interleukin-2 (IL-2) in 1992. IL-2 is a protein produced by white blood cells called T cells during an immune response. Taking high doses of it sends T cells into overdrive, making them more likely to recognize and attack cancer cells. There's been more frustration than success, however, since the initial positve results with IL-2.

Now the tide seems to be turning. Clinical-trial successes in the past five years suggest that a new generation of approaches has potential against several forms of cancer that resist conventional treatments. Some analysts predict that in the next ten years, immunotherapies will be used for 60% of people with advanced cancer, and will comprise a US$35-billion market.* [/new]

further reading

Boost Your Immune System? Posted by Mark Crislip on September 25, 2009, Science-Based Medicine "The immune system, if you are otherwise healthy, cannot be boosted, and doing those things you learned in Kindergarten health  (reasonable diet, exercise and sleep), will provide the immune system all the boosting or  support it needs....Those who say that that their product, for example probiotics, boost the immune system, point to studies such as these that show that in response to bacteria, cells of the immune system are activated, they are exhibiting the expected inflammatory response to a foreign invader. They call it boosting. I call it the inflammatory response."

I Can’t Eat That. I’m Allergic by Gina Kolata Doctors are diagnosing allergies where none exist and people are assuming that they have allergies when they do not....The word “allergy,” Dr. Glassner said, has come to connote any unpleasant experience with food. But unlike true allergies, which can kill, food intolerances are just uncomfortable. (Barry Glassner is a sociology professor at the University of Southern California and the author of The Gospel of Food: Everything You Think You Know About Food Is Wrong. )

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