The year was 1889 and a physician by the name of Dr. Stephen Paget was studying postmortem data on patients that had succumbed to breast cancer. He noted that there were patterns of metastasis that could not be explained by the previous belief that cancer cells migrate “downstream” or to the closest organ. He described this as “the seed and the soil hypothesis”. The seed representing the migrating cancer cell and the soil representing the organ with a microenvironment best suited for that cell to grow and become a secondary foci of cancer. The answer to this hypothesis and the alternative mechanism of spread was true and true. We currently know that some primary cancerous tumors become hypoxic (develop low blood oxygen) and send exosome vesicles to other sites to create pre-metastatic niches. The easiest way to state this is the seed sends fertilizer to the soil it would like to inhabit.
You may be wondering why I am discussing such a topic when more urgent medical issues are at your doorstep. As I thought about the topic of the seed and the soil for a different post, I began to look at the phrase through the lens of living in the world of COVID 19. If we were to consider the virus itself as the seed, what do we know about the soil that when planted, it thrives?
We know that a fertile soil is found with age and underlying health conditions in order of decreasing incidence: hypertension, obesity BMI >30), chronic metabolic disease (hypothyroidism, diabetes mellitus), asthma, Chronic Obstructive Pulmonary Disease (COPD), cardiovascular disease, neurologic disease, renal disease, immunosuppressive conditions, gastrointestinal and liver disease, blood disorders, and rheumatologic/autoimmune disease.
One thing that stood out in this list and also in recent epidemiologic studies is that obesity and especially severe obesity (>40 BMI) is the second greatest independent risk factor other than age for hospitalizations, morbidity, and mortality. In some studies it doubled the risk of mortality. As we consider all risk factors we must consider the obesity epidemic our country faces and especially with our children. Now more than ever, we must be vigilant with our children at home more often and sports activities are decreased or even cancelled. We must consider their diet and plan activities that encourage exercise. I would call upon the educational community to include this among the hours of time that they communicate with children and their parents. There will rarely be a more captive audience nor reason for change.
However, I would like to return once more to the seed and the soil and its relation to the original hypothesis from Dr. Paget. While we understand some aspects of the fertile soil, perhaps there are also microenvironmental, even genetic factors that we should also study which create a fertile soil? As scientists race to catch up with the seed and perhaps soil, what can we do in the meantime? What are the factors which make for a healthy body but statistically an infertile soil for the seed, COVID 19?
I would like to first make very clear that none of the factors that I mention have been proven specifically for prevention or treatment of COVID 19. However, the concept is that we are creating a soil that is healthy for our bodies and unhealthy for any pathogen that would attack it. Each of these mentioned have been studied and proven to have a positive effect on immunity.
I chose this photo of a beautiful Rwandan woman named Sharon. She is the mother of my daughter’s sponsored child Esther and the mother of five. She is the only one to care for them except for her loving neighbors who help when they can. Two months prior to this photo she had struggled to provide good food for her children, however, with a little assistance with seed and some soil she proudly shared the fruit of her labor. You give a woman a hand up and she will not only feed her family, she will feed her neighbor’s family too. This is why I love Rwanda!
Change lives at www.africanewlife.org