Commentary in 2006

The high cell density, rapid growth rate and large population size of cancer are conventionally attributed to a pathologically high ratio of cell production to cell death. Yet these features might also or instead result from inappropriate cell movement, already understood to underlie invasion and metastasis. This integrating concept could induce a broadening of our existing anticancer pharmacopoeia, which, with mitosis as its predominant target, is now seldom curative.

It is astonishing that, in our times, a noncommunicable disease should have acquired the cursed label of pandemic, yet such is the situation for diabetes. The numbers speak for themselves, with up to 200 million people worldwide currently suffering from the disease and the prediction that this number will double by the year 2025. In addition to the decreased life expectancy and lower quality of life of individuals with diabetes, the disease and its associated complications are a major burden on national budgets.

Obesity and type 2 diabetes are urgent and extraordinarily complex health problems. The US National Institutes of Health (NIH) thus supports a broad and vigorous portfolio of research aimed toward developing effective strategies for prevention and treatment, and building the scientific evidence base for public policy decisions. Much of this research stems from the creativity of individual investigators. Above and beyond these studies, the NIH uses a variety of mechanisms, in consultation with external scientific and lay communities, to foster research in emerging disciplines, encourage new collaborative efforts and promote research translation from basic discoveries to clinical trials (from bench to bedside) and from clinical trials to medical practice and community awareness (from bedside to practice). These efforts encompass extensive research on obesity's many devastating comorbidities in addition to type 2 diabetes: cardiovascular disease (CVD), cancer, nonalcoholic steatohepatitis and other diseases and disorders. Given the topic of this month's special content, however, this Commentary focuses on obesity and diabetes, including CVD research associated with both.

Medical services in Japan are public. This health system ensures free access to medical facilities for all Japanese citizens under universal insurance coverage and, as a result, the life expectancy of the Japanese population has become the world's longest (mean, 81.8 years). The cost of medical services now accounts for 7.7% of the gross domestic product of Japan, and is the second lowest in the developed world, after the UK. In 2000, the World Health Organization ranked Japan's medical services as the most efficient in the world.

Overweight and obesity, the main drivers of type 2 diabetes, have long been regarded as health risks associated with affluence. Over the last decade, profound changes in the quality, quantity and source of food consumed in many developing countries, combined with a decrease in levels of physical activity among the population, have led to an increase in the prevalence of diabetes and its complications. Here, we present quantitative estimates of the epidemiological and economic impact of obesity and diabetes on developing countries. We provide the economic rationale for public policy action. We stress the importance of creating a roadmap to guide the development of comprehensive policies involving governments and private companies, and emphasize the need for experimentation in building the evidence while testing theories.