Cancer
Two new breakthrough cancer drugs were the subject of quite a few news stories last week, including a Scott Gottlieb editorial in The Wall Street Journal. Still, I imagine that most people wonder what the fuss is all about. So here is my layman-to-layman explanation of the war on cancer.
We have spent an enormous amount of money on cancer research with very little to show for all the effort. Here is what Gina Kolata wrote in The New York Times:
Since the war on cancer began, the National Cancer Institute, the federal government’s main cancer research entity, with 4,000 employees, has alone spent $105 billion. And other government agencies, universities, drug companies and philanthropies have chipped in uncounted billions more.
Yet the death rate for cancer, adjusted for the size and age of the population, dropped only 5 percent from 1950 to 2005. In contrast, the death rate for heart disease dropped 64 percent in that time, and for flu and pneumonia, it fell 58 percent.
With the exception of a few cancers (e.g., testicular — think Lance Armstrong — and certain kinds of leukemia), we have basically been buying time — putting off the inevitable for a few months or years. All too often, we have been delaying death by cancer rather than curing the disease.
Why so little progress? Some researchers believe we have been using the wrong model. We’ve been trying to combat cancer the way we fight an infection initiated by the common cold. But cancer is very different from ordinary infections and colds.
Suppose you have strep throat. Your doctor prescribes an antibiotic and the drug immediately goes to work fighting it. Let’s say the antibiotic manages to kill 95% of the germs. That’s enough damage to allow your body’s natural defenses (white corpuscles) to take over and complete the clean-up job.
Now suppose we try to fight a cancerous tumor the same way. Let’s say that through chemotherapy and/or radiation therapy, doctors manage to kill 95% of the cancer cells. In this case, the white corpuscles won’t be able to pull off the clean-up, however. Once cancer cells multiply and become lethal, it’s an all-or-nothing proposition. As long as even a single cancer cell remains, it will eventually multiply again. And it will continue multiplying until the fight must be initiated all over again. Eventually the cancer will metastasize (spread all over your whole body), which is a virtual death sentence.
Unlike ordinary germs, therefore, in fighting a carcinogenic tumor you have to kill (or remove) every single cell. If even one cell survives, the cancer will return and become lethal again.
Strange as it may seem, cancer appears to disable the human immune system in much the same way as a fertilized egg in a woman’s womb. Why doesn’t the body’s immune system treat a fertilized egg as a foreign invader and try to attack and kill it? Because somehow the immune system is turned off. Cancer cells are able to do much the same thing. Although the ability of women to carry a fertilized egg is pro-life and cancer is anti-life it seems likely that both phenomena act in the same biochemical way.
Somehow, cancer turns off our body’s natural defenses. Many researchers believe the most promising response, therefore, is to find a way to turn those defenses back on. By way of encouragement, consider that “nearly everyone by middle-age or older is riddled with…cancer cells and precancerous cells” that do not develop into large tumors. Somehow our body’s natural defenses are keeping them at bay. Could those same defenses be employed to take on more challenging tasks?
That is a good way of thinking about the two new drugs that were announced last week. Rather than fight cancer the way we fight ordinary infections, fighting cancer by liberating the body’s natural immune system seems to have much greater promise.
According to a December 2008 issue of the Journal Nature, “[e]ach day, the human body eliminates billions of unwanted cells by apoptotic suicide. Apoptosis provides an important barrier against cancer…”
Mutations allow some cells to avoid apoptotic death, resulting in cancerous tumors. An area of promising research is the development of pro-apoptotic receptor agonists, which may eliminate apoptosis blocks that prevent cancer cells from self-destructing.
Very interesting piece. I have never seen the war on cancer described this way. If your right, we have wasted a great deal of money pursuing the wrong kind of solutions.
How about the American Cancer Society. How much money do you think they have wasted?
Tom, the American Cancer Society has been spending it’s money lately on trying to promote socialized medicine. I guess they have given up on finding a cure.
For as much money as we’ve spent researching the fight against cancer, there should be something to show for it. Perhaps the American Cancer Society should leave the field and let someone else take up the fight?
And do you know how much money pharmaceuticals and doctors make on cancer drugs. I have had cancer twice — it metastasized. The second time I elected for surgery and the oncologist was so mad he refused to see me any more. He wanted to use chemotherapy. It has been 6 years and the cancer has not returned. Hmmmm
Sounds like there is a big racket out there — with a lot of people profiting on this illness. Maybe it’s in no one’s self interest to find a cure.
Based on research by T. Collin Campbell in the “China Study” and confirmed by Dr. John McDougall and others in practice, a diet without dairy, meat or fish will keep those cancer cells from turning on in the first place. Not a happy prescription for Texas beef eaters and ranchers, but evidently there is some merit to it.
Donna, let them eat quiche. Without the eggs, milk or cheese, of course.
Obamacare threatens to End the War on Cancer – not with a Bang but a Whimper.
I realize that anecdotal information is only a weak sister of statistics (being an eoonometrician myself). However, my father died from prostate cancer in 1978. Only the finger test was available when he got it in the middle 1960s. My brother and I both were diagnosed with prostate cancer in the early 2000s with PSA tests and biopsies. Both of us had radical prostatectomies, and neither of us has had a recurrence after 6 and 4 years, respectively. Progress? Anecdotally, I’m urging my 46-year old son to get regular PSA tests.
I think that you to take a historical perspective when you look at the progress or the lack of in treating cancer. First, all medicine only extends life. That todays cancer treatments extend lives by 2, 3 5 or 10 years, many with good quality of life, is tremendous progress. Divide that 100 billion dollars of research over those additional years and the 10s of millions of people whose lives were extended, suddenly 100 billion dollars is no longer excessive. Compared to the defense budget over the past 40 years (remember the “war on cancer” was declared by Nixon in 1971) that 100 billion dollars is a rounding error. Lastly, it took 100 years from Pasteur’s germ theory to the first effective treatment of bacterial infections, Flemming’s discovery of penicillin.
Please, will at least one of you tell us IF you have had any type of Cancer? Sounds to me as if you want ALL research stopped to try and cure Cancer. The present administration wants all research for ALL diseases stopped. If you have one of those diseases, just sit or lay around until you are Gone, seems to me what they want. Now that is how the phrase “Death Panel” was referred to.
Maggie sez: ” The present administration wants all research for ALL diseases stopped”
That’s an out and out lie, and you know it. NIH funding is at an all time high, despite the budget cutting demands of the uber Austrians that seem to dominate this discussion group.
Artk makes a good point. Extra years of life are worth something — even if they only stave off the inevitable.
I’m with Artk. I’ll take the extra years of life. Over time, small improvements add up to big advances. And cancers differ. We have had significant success in combating some types.
Childhood cancer used to be a death sentence. Now the odds of surviving (depending on the type) are nearly 85%. The drugs used to treat childhood leukemia have not changed much in the past 30 years or so. Increased survival is mostly due to better knowledge of how the drugs should be administered.
John, as you know, I am an oncologist and I have a different take on one of your points. Heart disease is the leading cause of death in the US, but what I call the “law of Adam” has not been suspended. Said another way, everyone still dies. If scientific advances and life style changes suddenly decrease the number of deaths from the number one cause of death in this zero sum game of life then perforce deaths from the number two cause will rise. For example, men no longer routinely die of heart disease in their 50s so they now live to die of prostate cancer in their 80s.
Good point, Dr. Brooks. But the game is not zero sum. If we cure cancer, yes, we will surely die of something else. But in the meantime we will have significantly more years of quality life. That means there is a positive payoff from medical R & D.
Yes,
Ionizing radiation of 10 rad (hormetic dose)
(usual background just 0.4 rad, rem, c Sv )as presented 6/13/2010 by Howard Maccabee PhD MD and
Hyperbaric O2 as presented by Dr Maxfield, also at this meeting of Doctors for Disaster Preparedness have both shown impressive, repeatable cancer prevention and cure.
Howard Long MD MPH Pleasanton CA
A few points.
1. The paradigm on cancer treatment is changing. Yesterdays cure may be today’s poison, but we did the best with what we had at the time.
2. I do not know many oncologists that make money from chemo meds. Maybe from the office visits and procedures, but no longer from the chemo.
3. Any organization that gets in bed with the federal govt, gets screwed, as well as corrupted. Just look at the AMA.
I graduated from med school (MD) in 1953. Physicians have accepted being employees with that mentality–not as providers responsibile to their patients. Because the insurance co will pay for a procedure–Xray, lab etc, it is ordered without any mental input as to the necessity. Interestingly, many electro shock treatmtnts are ordered for the elderly–because medicare will pay for it! Please tell me how a “shock” could do anything but damage an already compromised brain!
I was first licensed to practice in PA in 1954 and am currently licensed to practice in AZ (since 1965)
I’ve been a country MD with big black bag, babies etc
(first woman MD seen by my patients); I’ve been in regular office practice and in HMOs; I’ve worked in county health dept clinics, in alcohol, drug and mental health programs.
We must quit being lead like sheep by the drug company lies and realise that nutrition, lifestyle changes and alternative medicine approaches are preventative and VERY cost effective. Of course, the provider would have to do some research, complete physical exams, extensive histories and, most of all, be really interested in his/her patients.
Sara Reynolds MD AZ license #4413
I didn’t really voice my anger at the control “Big Pharma” has over my colleagues.
Sara Reynolds MD
How can I get out of this? I’ve finished my comments for now
I am fascinated with the idea of the liberation treatment to cure MS. From what information I can accumulate about places that offer treatment, I can only find one vague list duplicated on a dozen websites. Is there a better way to find treatment, per say in North America. There are places that offer Liberation Treatment for the United States that no one knows about, such as Liberation Treatment Now
I see the rightwing-nuts are everywhere with their “Obama did it Bullshit” You freaks must be tools of the scumbag insurance bastards that are pissed that the Gov.t is taking away their power to deny healthcare to the poor and make UNHOLY PROFITS from the misery and suffering of the sick! Well, why don’t you cowards take your patron saint’s advice and exercise your second amendment rights cause I would damn sure enjoy an excuse to exercise mine! And having spent a year in VietNam with the 101st I’m sure I’ll be pissing on your rotten corpses! Death to all republiscums! Obama is a failure but I believe a Mr. Grayson from Fla. is just the ticket to rollback all of the rightwing filth that is destroying America!Bring it on cowards!