A deeper understanding of science makes for better doctors — and better citizens. That’s the fundamental claim of my friend Bob Brunham, and it resonates with me. We’ve spent a lot of time walking around a small island in British Columbia, with Bob explaining science to me.

Most people have heard of mRNA vaccines, monoclonal antibodies, CAR-T and CRISPR. Very few could say what they actually are. Ninety minutes listening to Bob on this podcast will fix that.

Whether it’s Ebola, influenza, or cancer, science is driving improvement in survival and wellbeing. As Bob says, “In 1867, the time of Canada’s Confederation, the average lifespan was 40 years. In 1967, it was 72. Presently it’s 82. Between 1867 and 1967, science was introduced into medicine, medical education and medical research. And that made all the difference.”

Bob was head of the British Columbia Centre for Disease Control and is Professor Emeritus of Medicine at University of British Columbia. His research is in immunology, genomics, and epidemiology of infectious disease. He has a knack for explaining science in an understandable way. Here, he explains:

How B cells learn to recognize foreign invaders. In the context of the Ebola Bundibugyo outbreak in DRC, we explore the different types of ebola vaccines — viral vector and mRNA vaccines. We discuss the advantages of mRNA in the context of the very recent approval of the first mRNA influenza vaccine. We contrast these with protein vaccines (like hepatitis B) and whole-virus vaccines (like many childhood vaccines). We also talk about monoclonal antibodies.

How one T cell therapy targets lymphoma — and another takes lung cancer’s foot off the brake. In the context of lymphoma, we talk about CAR-T therapy, which engineers T cells to attack lymphomas. But this therapy doesn’t work well with solid tumours, which are harder to infiltrate and have a mechanism to put their foot on the brake of T cells trying to kill them. In the context of lung cancer, we talk about checkpoint inhibitors, like Keytruda, which takes the cancer’s foot off the brake, enabling the T cells to attack the cancer.

Hitchhiking on a protein turns off an elusive cancer growth switch. Many people have seen former Senator Ben Sasse discuss his pancreatic cancer, and a new drug he is on called Daraxonrasib. We talk about how small molecule drugs normally work and how the K-RAS protein, which is jammed in the ‘on’ position to drive tumour growth, has resisted this mechanism. K-RAS acts as a slippery ball with no druggable targets. Daraxonrasib gets around this by tagging along with a chaperone protein which does interact with K-RAS, flipping the switch and tamping down tumour growth. As Bob notes, talking about the role of chaperone proteins, “Evolution is cleverer than we are.”

How a bacterial immune system became a human gene editor. CRISPR was discovered studying bacteria and how they fight off viruses. Then researchers turned it into a powerful tool for editing human genes. It has been used in sickle cell disease and thalassemia because blood stem cells were accessible in the bone marrow. Recently, it was enveloped in lipid nano particles landing in liver cells to turn off PCSK9, lower cholesterol, and decrease risk of atherosclerosis.

Bob’s theory of medicine is that understanding science makes for better physicians. He explains it like this: “The evolved molecular components of the cell and how cells communicate with one another explain disease, explain therapeutics, explain prevention strategies — and physicians use that knowledge to diagnose, treat, and prevent disease.” He outlines a taxonomy of disease, by mechanism, that enables scientific understanding. He grounds this in evolutionary biology and the development of eukaryotic cells 2 billion years ago.

Understanding science also makes for better citizens. Judging from how vaccines have become a political wedge, and how scientists who led the COVID-19 response have been painted as heroes or villains, that is much needed today. Ninety minutes will not make you a scientist. But you will walk away understanding what these tools are and how they work. That is what Bob gave me, walking around an island. And that’s what he offers you here.

Disclosure: I wrote this blog myself; I used AI (Claude, Anthropic) to edit it.

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