In 1993, after four years of research, Napoleone Ferrara had a breakthrough while studying tumour-development in mice. He had discovered an inhibitor for tumour angiogenesis, the process by which cancer grows uncontrollably in the body.

Gordon Ide had identified that new blood vessel development was essential to providing oxygen and nutrients for tumour growth back in the early 1900s. Ferrara was first find to a molecular inhibitor for vascular endothelial growth factor (VEGF), a main protein involved in inducing angiogenesis.

Genentech, where Ferrara worked, immediately set about the lengthy process of clinical trials on a number of related cancers. Calamity struck in September 2002, when the drug, now called bevacizumab, failed to meet its primary efficacy endpoint of progression-free survival in a phase III breast cancer trial.

In 2004, they finally hit success. A trial consisting of 925 patients diagnosed with previously untreated metastatic colon cancer indicated that patients on bevacizumab had a median end-point survival time of five months longer than those without. This was the best result ever seen in a Phase III trial for any drug.

The FDA approved bevacizumab, now under the name of Avastin, for colorectal cancer treatment on 26 February 2004.

Unintended consequences

Autumn is here. The angle of light fall is different. The quality appears sharper perhaps because there is more moisture in the air.

Nature smells differently this time of the year. The fragrance of Table Mountain is unmistakably that of autumn.The smell is the sum total of all of natural olfactory molecules pumped out this time of the year by the varieties of fynbos. Add the smell of the earth and of natural decay. The most striking to us is the wonderfully medicinal aroma of buchu. The normal seasonal changes in their biochemistries prompt the expression of greater or lesser smells.

There is a website that gives instructions about how to make a house smell like Autumn. Take orange peels, marigold flower heads, dried apples, cloves, cinnamon chips, allspice and orange essential oils, cook them, dry them and stuff the stuff into sachets. I think it is safe to say that we are talking here of the smell of Autumn in North America.

So, there is as usual normal natural variation in the smell of Autumn. They all though signal to the human body to prepare for the coming of winter. As for all other organisms that must modify their lifestyles seasonally, our bodies respond powerfully and viscerally to these natural cues even though we may not be aware of them.

The smog of war

Lets start with the bad news: climate change and global warming are already affecting our health and it will get worse. How much worse requires research and assessment and we have not undertaken a comprehensive study. Few middle income countries have but that is no excuse for doing nothing.

Most European have completed what is known as a climate change health impact assessment. Heatstroke related deaths caused by very hot European summers prompted them to take action. As temperatures will rise we must expect more deaths due to heatstroke worldwide.

The raging fires in California, Australia, the Cape (the Cape of Fire Storms!) and elsewhere have tragically highlighted the need to adjust human settlement patterns and prepare better for the devastation they bring.

How does climate change and global warming affect the health of human beings? The 2004 International Comparative Risk Assessment examined health risks and they estimated that 166,000 deaths in 2000. They also estimated that the lives of individuals were shortened by 5,5 million years because of climate change factors.