Sustainable MedicineNew Directions for Research

David Servan-Schreiber, MD, Ph.DClinical Professor of Psychiatry, University of

Pittsburgh

Lecturer, Faculté de Médecine Lyon

Current Model

The Tibetan Principle

• Myocardial infarction, Pneumonia, Appendicitis…

• CAD, Cancer, Diabetes, Depression, Arthritis...

Coronary Artery Disease

• Ornish, 1995 JAMA

– Treatment as usual

– Vegetarian diet + exercise + meditation + group support

Program

Control

Baseline 5 years later

Myocardial Perfusion 13 N PET Scan

A Story

Pittsburgh, late1992

Epidemic 1 -Evolution

SEER, 2003 NCI

Epidemic 2 - Distribution

Key difference = Lifestyle

0

20

40

60

80

100

120

140

160

15yo

25 yo

35yo

45yo

55yo

65yo

75yo

San FranciscoShanghai

For 100,000

Sasco, 1989 Rev Med Int

Prevention AND Treatment

• Lifestyle factors can cause or protect from cancer

• Can they affect treatment too?

Andersen et al., 2008 Cancer

Behavioral Changes and Breast Cancer

Intervention

Control

68% reduction in mortality

Nutrition

Mediterranean Diet

Eposito et al, 2004 JAMA

-18

-16

-14

-12

-10

-8

-6

-4

-2

0

2

Wt Waist Glc Insln T Chol Trigl BP CRP IL-6

Usual dietMed. Diet

Omega-3 / Omega-6

Feller et al., Jal. Am. Chem. Soc.., 2002

Duckett et al., 1993 J Animal Sci

Ailhaud et al., Prog. Lip. Res., 2006 – Simopoulos & Salem. NEJM, 1989

Omg-6 /Omg-3

x6

x10

x15

x20

Transformation of food chain

Saturated Fat

Omega-6 Fatty Acids

Omega-3 Fatty Acids

% Calories

10

20

- 4M - 10,000 1800 1900 2000

WW II

Leaf, A. and P. Weber Am. Jal. Clin. Nut. 1987

Evolution of Diet

Omega-6 fatty acids and mammary tumors

Carroll et al, 1975 Cancer Res.

Days post graft

Nb of tumors

0

10

20

30

40

50

60

10 20 30 40 50 60 70 80 90 100

110

120

Corn oilReg diet

Advanced Breast Cancer

Gago-Dominguez et al., 2003 Brit J Ca – Singapore Prospective 35 298 women

0

0,5

1

1,5

2

2,5

OM6-

OM6+

OM6+

+

0M6+

++

Breast Ca

Membrane Protection

Florent et al. Jal. Neurochem., 2006

Neuroneswithout anything

Neuronesexposed to beta-amyloid

Neuroneswith omg3

Neuroneswith omg3 exposed to beta-amyloid

Prevention: Framingham Study

Schaefer et al, 2006 Arch Neurol.

RR=0.53

Treatment: Omega-3 AD Study

Freund-Levi et al, 2006 Arch Neurol.

Omega-3

Placebo

Statins or Omega-3s?

-22%

-32%

Cardiac Mortality

Studer et al, Arch Int. Med. 2005

Statins or Omega-3s?

-13%

-23%

All Cause Mortality

Studer et al, Arch Int. Med. 2005

Flaxseed Project

5% flax seed in animal feed

• Meat, butter, eggs, cheese, milk balanced in omega-3s

• Impact on human biological parameters

(INRA, CHU Rennes, CHU Lorient)

Childhood Cancers - Europe

Steliarova-Foucher et al., 2005 Lancet

Organic vs Conventional Food

• 42 children 2 to 5 yo - Seattle, Wash

• « organic » children below EPA safety limit

• « conventional » children 4 x above

Curl et al., 2003 Env. Health. Persp.

Summary

• Many scientifically sound “complementary” and environmental approaches

• Which is the best medicine? Which is more “scientific”?

• No patent = no profits = no awareness

Sent: Thur. 02/28/08 5:40 pm

To: XXX

Great. Thanks. G is a great guy, say hi, and I will keep looking out for the good science he does. Even so, the chances of commercial success hinge on the patent life of a molecule, and we have our hands full with stuff that has that sort of potential.

Best,

XXX

Clinical Director, XXX

New Research Orientations

• 1. “Natural”/sustainable treatments

• 2. “Intellectual property” protection

• 3. Environmental interventions

The End