Patient care and basic science: two sides of the coin
About 75 percent of cervical cancer deaths in the world occur in sub-Saharan Africa. The aftermath is a modern tragedy, says Dr. Darron R. Brown, professor of medicine, microbiology, and immunology at the Indiana University School of Medicine.
"Women are the backbone of society in these countries," he said. "They take care of the children, they run the household, they often run small businesses, they gather up firewood, they are responsible for finding water for the day. When a woman between the ages of 35 and 40 dies of cervical cancer, it really is devastating for the economy of her community and her country."
Cervical cancer is preventable, and it isn't a frequent killer of women in the United States because several billion dollars per year are spent on screening. Brown is part of a group of 20 to 30 people who helped develop Gardasil, a vaccine to prevent infection with HPV, the virus that causes cervical cancer.
"When women in sub-Saharan Africa, Southeast Asia and India, and South and Central America are infected with cancer-causing HPV, they are more likely to develop cancer because they do not have access to cancer screening programs," he said. "In the absence of screening, all we have is the vaccination against HPV. With Gardasil, we have the ability to prevent nearly 250,000 worldwide deaths a year from cervical cancer. We had 5,000 deaths in the United States in 2015, but we don't have to have any with the combination of vaccination of young women and screening of older women."
Brown, who also is an adjunct professor of epidemiology in the Richard M. Fairbanks School of Public Health on the IUPUI campus, has always been interested in biology and the life sciences. He said it seemed like being a doctor was the only thing he could do with his life.
"I started as a physician doing patient care," he said. "When I started a fellowship in infectious diseases in 1985, I enjoyed the research part and embraced it as much as I could. I became both a scientist and a physician as time went on, which was the most fulfilling of possibilities for me."
Brown said scientists shouldn't initially consider how research could be applied to a diagnostic test or a therapy, but explore the actual basic biology of a system as much as possible.
"If people thought about making a vaccine right away, no one would have truly characterized the different features of HPV and really studied its natural history and epidemiology," he said. "Only when all of the groundwork has been laid can anyone start to think about a commercial product. Until you've done the basic science of the problem, you're not going to be able to come up with anything to be developed into a therapeutic or diagnostic test."
Brown has been with the School of Medicine since 1989. He says he now sees more pressure put on physicians to see more patients, less time to conduct research, and fewer laboratories than there used to be.
"It's gotten harder and harder to get time to do the research, and it's harder to get the funding from outside of the university," he said. "If the trend continues, my fear is that 15 years from now, very few physicians will be doing basic research. There is nothing wrong with non-physicians doing science, but sometimes those of us who see and treat the patients have a better understanding about the problems needing exploration in the laboratory."
He has also seen that some physicians aren't driven by making a lot of money.
"If a physician's goal is to make a lot of money, they should go into the business world," he said. "A physician/scientist is not going to make as much money as someone who sees patients all the time. If you strike on something that has an application in the medical world, that's great, but don't go into it with that goal."
Brown said he admires doctors and scientists who have focused on preventative medicine in the vaccine world, especially the inventors of the polio vaccine, Jonas Salk and Albert Sabin.
"They were basic scientists, but they were also physicians," he said. "They saw children dying of polio, yet they focused on the basic science of the polio virus so when the opportunity arose, they knew enough of the basic science that they could make something to immediately prevent hundreds of thousands of cases of polio.
"I admire those guys, who could make a preventative vaccine that could eradicate polio from the world," Brown said. "That's an amazing thing, and they did it by focusing on basic science and taking care of patients, two sides of the coin that led to the development of the polio vaccine."