For decades, much of the pipeline of medical innovation has flowed from West to East. Now a string of companies are attempting to upend that trend with new drugs and products tailored to Asian bodies and lifestyles.
Many of the researchers focusing on Asia have a simple starting point: Diseases and their cures can sometimes work differently in different populations, and a one-size-fits-all regimen tailored to the West isn’t sufficient. The approach is cropping up most often in cancer care in Asia, home to tumors that are rare in the West.
The shift is part of a broader trend sweeping through the global health-care industry called precision medicine, which seeks to tailor treatment to a person’s specific genetic makeup and circumstances, including the ones commonly shared among people of the same ethnic group or culture.
Photo: AFP
照片:法新社
The prevalence throughout Asia of stomach-infecting bacteria which can lead to cancer-causing inflammation is one factor that makes gastric cancer more common in the region. But research suggests it usually takes even more culturally specific traits, like the aggravating diet of salty and fermented foods common in northern China, the Korean peninsula and Japan, to turn that inflammation cancerous.
Northeastern Thailand, meanwhile, is the global center for an obscure disease called bile duct cancer. Rare in the West, researchers have traced its prevalence in certain parts of Southeast Asia to a fermented fish dish called koi pla beloved by the area’s Lao people. The cooking process for the dish often fails to kill an inflammation-causing parasite called the liver fluke, and the infection can eventually lead to bile-duct cancer.
By controlling for both ethnicity and gender, researchers over the last decade have established that a particular cell mutation that causes lung cancer even in non-smokers is much more common in Asian women than anyone else. This discovery has since opened the door for two multinational pharma companies to develop and bring to market therapies that specifically target these parts of the cell, and so have proven to be particularly effective in Asian patients.
And when it comes to breast cancer, just diagnosing it in the first place can be harder because research shows Asian women are more likely to have denser breasts than Caucasians. That can obscure the tumor on a mammogram, leading doctors to miss it entirely or sometimes mistakenly identify one that isn’t there. A host of start-ups have sprung up to tackle the problem.
All these differences have led to postulation of an “Asian phenotype,” a distinctive way Asian people’s genes are expressed because of biology and environment. Where traditionally the health-care industry would seek approval for new products in the West before bringing them to Asia, now more firms are planning to go the other way for some diseases.
(Bloomberg)
數十年來,醫學上的創新大多由西向東傳遞。不過就在最近,多家藥廠開始試圖反轉這個趨勢,為亞洲人的身體與生活習慣量身訂做出新藥物與醫療產品。
聚焦於亞洲的許多研究人員有著很簡單的出發點:疾病以及對應的治療藥物有時候會對不同族群造成相異的效果,所以專門為西方人打造「一體適用」的治療方式是不夠的。這類情況最常發生在亞洲的癌症治療照護中,因為亞洲是許多西方少見腫瘤的發源地。
轉向亞洲可說是席捲全球健康照護產業的「精準醫學」大趨勢底下的一部分。精準醫學試圖根據一位患者特定的基因結構和生活環境──包括相同族群人種或文化所共有的生活習慣──來量身訂做治療方式。
亞洲盛行一種感染胃部的細菌,可能導致引發癌症的發炎反應,是造成胃癌在這個地區更為普遍的因素之一。不過,研究也顯示,這類發炎要轉為惡性,經常會跟文化上的某種特定特徵有關,例如在中國北方、韓國、日本等地普遍流行高鹽份和發酵食物的飲食習慣,會讓發炎惡化。
另一方面,泰國東北方則是罕見疾病「膽管癌」的全球集中地。在西方相當少見的這種疾病,盛行於東南亞的特定地區,研究人員追溯到該地區寮國人相當喜愛的一道發酵魚料理:「koi pla」。這道菜餚的烹煮過程經常無法消滅肝吸蟲這種會造成身體發炎的寄生蟲,感染最後可能就會導致膽管癌。
藉由控制種族和性別等變因,研究人員在近十年來還確認出某種特定的細胞突變會導致非吸菸者罹患肺癌,而且特別好發於亞洲女性族群。這項發現從此為兩間跨國藥廠公司打開大門,得以開發並推出療法,將標靶特別設定於細胞的那些部分,而且證明該療法確實對亞洲病患特別有效。
在乳癌方面,研究則顯示亞洲女性的乳房組織密度有很大機率會比高加索人種來得高,因此光是最初的確診就已經相對困難。因為密度高的組織在乳房X光攝影片上可能會遮蔽腫瘤,使得醫生可能完全沒發現,或有時候誤認出實際上並不存在的腫瘤。目前已有多間新創公司特別為解決這類問題而興起。
上述提及的這些差異衍生出一種「亞洲顯型」的假設,也就是亞洲人受生物學或環境因素影響產生的獨特基因表現方式。傳統上,健康照護產業將新商品引進東方前,會先在西方國家尋求該商品的核可,不過現在有更多公司打算反其道而行來對付某些特定疾病。
(台北時報章厚明譯)
Rice is an essential ingredient in Taiwanese cuisine. Many foods are made of rice, adding more variety to our cooking, such as rice cake, or “gui.” Wagui is made by steaming rice flour batter in a bowl. The term “gui” refers to a type of food made from rice, while “wa” refers to a bowl. The pronunciation of “gui” in Taiwanese Hokkien is similar to the word for “nobility” in Chinese, so it is common for people to prepare various types of gui, including wagui, as offerings to the gods or ancestors,. 米是台灣重要的主食,用米製成的食品十分多元,豐富我們的飲食,如米做成的「粿」。粿的意思是米做成的糕點,碗粿是將在來米漿倒入碗中蒸熟,因而得名。粿因為音同「貴」,因此碗粿等粿食常用作供品祭拜神明和祖先。 nobility (n.) 高貴,高尚;貴族 offering (n.) 供品 While Taiwan may not be
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