How Do We Define “Cure”?

When I first went into neurology practice in 1972, my wife at that time suggested that my personalized license tag be “NO CURE” as it seemed that the prognosis for neurological diseases at that time was dismal. Obviously, she was being quite flippant. Scientific discovery over the last four (4) decades has transformed in many ways the term “CURE”. Since this blog is also being published on CureScience.org, a brief examination of the concept of “CURE” is warranted.

The concept of CURE is grounded in history. Having recently seen the movie, “Radioactivity”, it demonstrated that forethinkers in no small part, struggled against false beliefs to legitimize their theories. Many of these theories are now accepted concepts of modern times. Madame Curie fought to use her first x-ray machine to prevent unnecessary amputations in the wounded soldiers of WWI. Historically, Edward Jenner observed that milk maids who had cowpox were protected against smallpox. He performed an experiment where he injected substance from the wrist of a cowpox infected dairymaid into an 8-year-old boy. This later defined the term inoculation. The child became ill with fever but by the ninth day had recovered. He then took the bold step of injecting the substance from a smallpox infected individual into the child. The child did not get sick. Jenner concluded that as a result, protection against smallpox was complete resulting from the cowpox inoculation. However, he sent a communication describing this experiment to the Royal Academy of Science and it was rejected. He subsequently, published a small booklet entitled, Inquiry into the Causes and Effects of Variola Vaccinae, A disease discovered in some of the western counties of England. The book highlighted three concepts:

1. The origin of cowpox was a disease of horses transmitted to Cows.
2. The hypothesis that infection with cowpox subsequently protects against later infection with smallpox. He presented critical observations relevant to testing his hypothesis.
3. A discussion of the variety of issues related to smallpox.

The persistence of Jenner to prove and establish his theory ultimately established inoculation with cowpox as the preventative measure for smallpox. In the late 20th century smallpox was eradicated from the world. Thus, “CURE” of smallpox from the world resulted from prevention through inoculation of the worldwide population. CURE WAS LINKED TO PREVENTION.

The germ theory of disease is accepted and highlights that microorganisms (pathogens) invade humans and other animals, multiply and reproduce in their hosts, and cause disease. These pathogens include viruses, bacterium and parasites. Treatments have been developed: antibiotics for bacterial; antivirals for viruses; and antiparasitics for various parasites. The eradication of the organisms can constitute “CURE” in many cases. However, the primary means of combating the organisms is prevention. Common sense approaches such as washing hands and eliminating the consumption of raw meats are basic approaches. In pandemics, prevention towards “CURE” is through public health measures such as wearing masks and washing hands. This first line of defense combined with vaccine inoculation to neutralize the organism results in control of disease and can be considered a “CURE”. This is achieved through a combination of public health measures and inoculations. Because public health measures have been followed due to the COVID-19 Pandemic, influenza has disappeared this year and one can consider this event a “CURE” at this point in time.

This brief historical review highlights the need to understand the mechanisms and causes of disease. CureScience™ is devoted to unravelling the mysteries underpinning the complexity of disease. The modern challenge is to understand the causes of major disease emphasizing Autoimmunity, Neurodegeneration and Cancer. The challenges to CureScience™ are numerous and I am not sure that the word, “CURE”, is the appropriate term. Disease etiology is often multifactorial and includes the interactions of genetics, our immune system, and our environment which in many cases can be considered toxic. In terms of cancer, such as Breast Cancer, we have made huge strides in understanding the genetics and basic underlying mechanisms. This has led to numerous treatments that have contributed to long-term disease-free intervals. Do we cure breast cancer? If discovered early and treatment is complete, we may offer the concept of “CURE” with no lifetime reoccurrence. Primary brain cancer is far more challenging. It’s genetics, multiple pathways for cellular replication, and the lack of any underlying defined cause results in extreme challenge to CURE! Can “CURE” be defined as permanent disease-free interval with no reoccurrence of disease?

As it pertains to Werdnig-Hoffman Disease (Spinal Muscular Atrophy in neonates and toddlers) a clinical trial of inserting genetic material to change the genetic code of a particular absent enzyme resulted in a number of the children experiencing dramatic normalization of their gait at two years of age. When the results were presented at the plenary session of the Academy of Neurology, the authors received a standing ovation. This could be defined as truly a “CURE”. Will this be effective in all children with Werdnig Hoffman Disease?

In Neurodegenerative Disorders such a Multiple Sclerosis, “CURE” has eluded modern science to date. We have been unable to identify the antigen that causes the disorder. On the other hand, we have teased out the role of both the adaptive and innate immune system and their possible roles in both relapsing remitting and progressive disease. Basic research of the late twentieth century has paid off in unravelling the mysteries of the immune system and its interaction with our environment. Neurodegenerative dementias, likewise, are in the process of establishing the contributions of various protein and genetics in the development of Alzheimer’s Disease. This is not “CURE” but the science contributes to the overall understanding of the pathophysiology of disease. We must continue along this path with the faith that each little discovery supports and contributes to the overall approach that ultimately in the future will potentially achieve “CURE.” In the meantime, each discovery provides the potential for improvement in the quality-of-life for individuals in society.

Written by: Jay Rosenberg, MD

Keywords: CureScience, Cure, Prevention, Inoculation, Virus, Bacterium, Parasites