1096 words Sent Editorial Board 18.7.05

Prevention is the best cure : a 21st century prospect

by Luc Montagnier, M.D.*

Citizens of developed countries have enjoyed in the last century a continuous increase of their life expectancy. This is largely due to advances of modern medicine and improvement of well being. The trend is continuing now, although to a slower pace. Together with the reduction of birth rates, the resulting age distribution is leaning towards an increased percentage of people over 65, 30% or more in the coming decades. However, more and more chronic diseases are crippling this ageing population : cancers, arthritis and arthrosis, cardiovascular and neurodegenerative diseases bring more people to hospitals and retirement boarding houses. The improvement of medical care and of early diagnostic methods does not suffice to explain this spectacular increment : the incidence of brain tumours increases, and there is now in Europe five more times cases of Alzheimer disease than fifty years ago.

We should ask : is it an inescapable evolution linked to aging or are there medical solutions enabling us to counteract it ? In other words, can we leave healthy longer until we meet the genetic limitations of our life span ? I believe this is possible if the concept of preventive medicine enters our mind and if we act accordingly. Prevention campaigns have already shown their efficacy in reducing in men (not in women) the incidence of lung cancer induced by tobacco smoking. They are still too timid in combating bad nutrition habits leading to obesity, especially in children. Changes in behaviour need to be reached early in life, by education in high schools.

But preventive medicine should go far beyond, by trying to find the roots of chronic diseases. Their causes are multiple, some of them are depending on global environmental changes, which can only be controlled by measures at the global level : atmospheric and food pollution, increase exposure to radiations, occurrence of new infectious agents. But at the individual level, there is a common biochemical denominator resulting from the summation of genetic, behavioural and environmental factors : oxidative stress, which is defined by an unbalance between an excess of reactive oxygen species (ROS) and the antioxidant defences.

There are intrinsic factors for the generation of ROS : dysfunction of mitochondria, thymic involution favouring chronic inflammation and infections. In fact, recent studies indicate that some degree of oxidative stress as measured by a deficit in reduced thiol groups or by an increase of peroxidized lipids, does occur in all aging people, even in a healthy state. However it is much more pronounced in patients with chronic diseases, particularly with Alzheimer and Parkinson diseases. Linked with oxidative stress, there is a dysfunction of the immune system, which bears particularly on cell mediated immunity and on a shift from TH1 to TH2 responses : auto-immune reactions and expansion of latent micro-organisms will ensue, increasing oxidative stress and causing irreversible damages in cells and organs.

Two lines of research can bring up solutions : (i) to re-establish a normal redox status by appropriate supplementation of antioxidants, (ii) to reduce the role of chronic infection by micro-organisms. Up to now the use of antioxidant supplements (Vitamin C, Vitamin E) has been erratic and often not medically controlled, leading to counteracting, pro-oxidant effects and discouraging the medical community to learn more about this field. In fact, time has come for the rational use of antioxidative regimens, adapted to each person (there is gene polymorphism of our antioxidative enzymes), and monitored by measurements of parameters of oxidative stress in blood or urine (peroxidized lipids, oxidized DNA bases, level of reduced glutathion, etc.).

Rather than chemically synthesized products, natural mixtures (herbal) of antioxidants are likely to be the most efficient, their efficacy being assessed first by controlled clinical trials. At advanced stages of diseases, where irreversible damages have occurred, we can only hope a delay or stabilization of further deterioration by the restoration of a normal redox status, this benefit being added to that of classical specific treatments (including perhaps in the future stem cell regeneration). But the best use of antioxidative treatment will be a preventive one, before occurrence of disease.

The postulate, but this is a likely postulate, is that if someone has strong oxidative stress in his middle age, he is at risk of suffering later of cancer, diabetes, arthritis or neurodegenerative disease. Therefore an appropriate regimen (food + supplements) should be prescribed until biochemical monitoring shows disappearance of oxidative stress. Of course, this approach will be symptomatic and will not address the causes of potential diseases. Although we cannot act on the built-in factors (mitochondrial ageing, thymus involution) we may address the role of latent infections, particularly bacterial infections.

There are already examples of neurodegenerative diseases caused by the ingestion of bacterial neurotoxins, and the role of chlamydia and mycoplasms has been involved in the generation of atheroma plaques and arthritis. Moreover, because of the massive use (in medicine and farming) of antibiotics, the bacterial world is changing, giving rise to more resistant forms, inaccessible to antibiotics and antibody response, capable of staying latent inside cells for a long time.

Therefore a strong research effort should be undertaken in this field by seeking refined techniques of diagnosis and new ways of treatment. Identification of the infectious components of chronic diseases will also lead to a new approach of their prevention.

In conclusion, prevention of age-related diseases is the only way to avoid a disastrous end of life at the individual level and a likely collapse of social security systems at the societal level. It will imply profound changes in the mentality of individuals, medical doctors and policy-makers.

Each of us should consider optimization of his biological capital and accept regular check-up in specialized centers. Medical doctors should receive specific training on the prescription of anti-oxidants, and rather treat the patient than the disease, in an integrative way. Health authorities should promote the implementation of Centers of Preventive Medicine and take financial measures (bonus, tax reduction) to incite citizens to attend regular check-up. In addition more money should be spent in medical research for prevention than for treatment of diseases. Indeed the pharmaceutical industry should reorientate its research and development strategy towards preventive treatments and diagnosis.

Finally this approach will also benefit to the prevention of epidemics caused by new infectious agents : generally such epidemics first hit people with a depressed immune system, particularly the elderly ones. Restoring their immune system will also greatly contribute, in a inexpensive manner, to reduce mortality and morbidity.

Conflict of interests : Luc Montagnier is the uncompensated scientific advisor of several companies involved in the field.