Overcoming Resistance: The Case for Photodynamic Therapy

Towards the Light

At the corner of Blegdamsvej & Tagensvej, near Copenhagen University Hospital (“Rigshospitalet”) in Copenhagen, Denmark, stands Towards the Light, a large sculpture of 3 bodies straining towards the sun.  It was put there in honor of Danish scientist Niels Finsen who, in 1903, was awarded the Nobel Prize in medicine for his pioneering work in phototherapy in the treatment of disease, especially lupus & tuberculosis.  Finsen was more than just a scientist doing research – he had a dog in the fight. At only 42 and working from a wheelchair because of disease that attacked his internal organs, he was desperate to find a cure. Unfortunately, he died just one year later, at age 43.

His work though, lives on. No just in the Finsen Laboratory, named in his honor, at Copenhagen University Hospital, but also in the form of photodynamic therapy (PDT) for which his groundbreaking work paved the way.

Photodynamic therapy is the current form of Finsen’s phototherapy. It uses light-sensitive compounds that are exposed selectively to light, whereupon they become toxic to targeted cancerous and other diseased cells. Though relatively unknown, it is making strides into the worldwide medical community.

For example, in July of this year, the Vancouver General Hospital received an international innovation award for its groundbreaking infection control research from the International Consortium for Prevention and Infection Control (ICPIC) in Geneva. More than 5,000 patients were treated, reducing post-surgical infection by almost 40 per cent and saving the hospital $1.3 million in post-surgical infections and re-admissions. The research team, led by Dr. Elizabeth Bryce, competed against 40 international teams to win the prize. The hospital used a process called nasal photodisinfection (MRSAid) to kill harmful bacteria prior to surgery during a 12-month pilot project.

In the United States, the National Cancer Institute’s Factsheet tells us that PDT is used for certain kinds of lung and esophageal cancer, and that its researchers continue to study ways to improve the effectiveness of PDT, and expand it to other cancers of the brain, skin, cervix, prostate, cervix, stomach, and liver.

Yet despite this noble beginning, international recognition, and the endorsement of the NCI, PDT in its various applications remains very much underused. A case in point is its potential use in treating chronic sinusitis (CRS), one of the most common medical complaints in the United States, affecting up to 16% of the population. It is associated with over 13 million physician visits per year and an estimated aggregated cost of over $6 billion annually.

Moreover, the community of physicians who deal with CRS are not happy with current treatment options.  In a 2007 study published in The Journal of Allergy and Clinical Immunology, 202 doctors were surveyed from the US, UK, France, and Germany. 86% said they were generally unhappy withcurrent treatment; the same number wished for more options to treat the surgery refractory population; 91% reported they wanted a treatment proven as efficacious and safe; and, 88% of the respondents agreed that those patients with CRS refractory to surgery suffer from a severe and debilitating condition.

Indeed, in a separate study conducted in 2010 by the University of Pennsylvania, CRS sufferers were found to have worse quality-of-life scores than those suffering from chronic obstructive pulmonary disease, congestive heart failure, back pain, or angina.

The study summary concludes by saying that “… new therapies will undoubtedly play a greater role and change our treatment paradigms.” Such a PDT paradigm exists to treat CRS – it is called Sinuwave, and is vastly underutilized.

Surgeon Christian Betz from Munich’s University Hospital was interviewed by Optics.Org this past May about the under-utilization of PDT. He explained that “PDT is not widely accepted, because it does not fit the traditional way of thinking,” meaning that the vast majority of his peers are simply trained to use surgery when they see something in the body they want removed.

Rigid thinking sometimes dies a slow death, even in science. When Galileo said the Earth revolved around the sun and not the other way around he was thrown in jail. Nineteenth German doctor Ignaz Simmelweis found that you could reduce death rates in hospital obstetric wards from 35% to less than 1% by the mere expedient of doctors washing their hands. The reaction from other Western European doctors? They were offended by the implication that they were “dirty” and for decades went from surgery to surgery literally carrying the blood from the previous patient to the next one.  And of course there’s Darwin, whose mid-nineteenth century “theory” of evolution is still being contested, especially in parts of the U.S.

We are used to thinking of pathogens, bacteria especially, as having the trait of resistance. As it turns out, it is a trait shared by them and us – in both cases to the detriment of our species.







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