A few days ago, David Bowie died of cancer. This morning I learned that the actor Alan Rickman has died of cancer. You all know the rule of threes, right? It has been satisfied, because in his state of the union address Barack Obama announced that he was going to kill American biological research, with cancer. OK, maybe that’s a little strong: he was more devious about it. He announced a “moonshot” to cure cancer. It’s the same thing.
US President Barack Obama isn’t going quietly. He began his final year in office by announcing a “moonshot” to cure cancer in his State of the Union address to Congress on 12 January.
The effort will be led by vice-president Joe Biden, whose son Beau died of brain cancer last year.
“For the loved ones we’ve all lost, for the family we can still save, let’s make America the country that cures cancer once and for all,” Obama said in a soaring speech that otherwise offered few new proposals. Instead, the president spent most of the address looking back at his accomplishments over roughly seven years in office.
It’s not the “cancer” part of the proposal that is bad; it’s a terrible disease, and we should more to combat it. It’s two other words: “moonshot” and “cure”.
Everyone admires John F. Kennedy’s ambition in setting a specific goal for the space program, way back in the 1960s. It was smart to focus. But here’s the difference: we knew where the moon was. There it is, 380,000km away, in a predictable orbit around the planet, and we had these technologies to fire off rockets that already contained the basic principles we needed to get to the moon. It was a nontrivial effort, but getting from here to there was an already specified problem.
Where is “cancer”? Can you even define the problem? Do you see a solution that you can reach by just throwing a lot of money at it and telling a team of doctors to fix it?
No, you can’t. Scientists who study cancer will even tell you flat out that cancer isn’t one disease, it’s a multitude of diseases. It’s more like a pattern of collapse of a complex structure, and there’s a million different ways it can happen. A “moonshot” is a terrible metaphor for how to approach the treatment of cancer.
We don’t know where we’re going, so what we need is more support of basic research — mapping the cell and genome, puzzling out the details of signaling, looking for unexpected new technologies for manipulating cells. When I hear “moonshot”, what I hear is “earmark”: we’re not going to see an expansion of basic research, we’re going to see a bigger share of the money going to translational research. We’ll build even more hidebound institutions that demand their share of the budget and then allocate it conservatively to more fully explore the same old dead ends.
So “moonshot” gives me the heebie-jeebies. What about “cure”?
I will make a bold prediction. There is no such thing as a cure for cancer. We are embarking on a quest for Hy Brasil, or Shangri-La, or the Lost City of Atlantis. It misunderstands the nature of cancer to claim there might be a “cure” out there.
You might as well launch a moonshot to end entropy. Or to defeat aging. Or to cure the plague of multicellularity that causes us so many problems. You are made up of populations of cells that are dividing — and it is the nature of your existence that cells can’t be static, passive blocks — and with each division, they accumulate errors. Inevitably. Unless you plan to cure thermodynamics, too, you can’t avoid the gradual generation of tiny errors. And eventually, one or a few of those errors will cross a critical tipping point and turn a cell cancerous.
Well, actually, there is a cure that will prevent that otherwise inevitable fate: you could die of heart failure or infectious disease first, or get hit by a bus. That’s what history tells us. As we fight back other causes of death, as we live longer and longer, the probability of cancer increases, because it is basically the default failure mode for the cell.
Now I know that sounds cynical and defeatist, but I’m not. I think there is a lot of hope in improving cancer treatment — we can get better and better at stopping the progression of the disease, and repairing the damage it causes, and developing cheaper treatments with fewer side effects. These are broader and more achievable goals than finding the magic “cure” that doesn’t exist. They also require broader scientific approaches than just giving lots of money to people — intelligent, qualified people — who are working specifically and narrowly on treating human diseases (although I also think we need to continue working on that kind of translational research, since that will give us progress in small steps).
But that’s why a “moonshot” to a “cure” bothers me: it’s the proposal of people with tunnel vision, who even so can’t see the target they’re aiming at, let alone find even the general direction they should point at.
I’m not the only one! Ars Technica objects for a different reason: sudden influxes of money into a field are indigestible. Slow steady growth is what you need to nurture scientific progress.
It’s how politicians cure cancer. Hard to get a good political sound bite (byte?) out of the reality of searching for a cure.
Jonathan Gitlin at Ars Technica agrees.
http://arstechnica.com/science/2016/01/dear-mr-president-please-stop-with-these-science-moonshots/
I agree with PZ, but I wouldn’t worry too much – the one thing government rarely does is carry though with what it says. Look at Gitmo. Look at Kennedy’s replacing mental prisons with real treatment. Look at the War on Drugs and No Child Left Behind.
I think this is a mixture of Obama not understanding the phenomenon himself and him trying to put it in terms that will have a sensationalistic impact on people. The result is, as you put it, though more elaborately, complete nonsense.
Finally I hear someone say it publicly.
@3
In fairness, JFK had a lot less time to work on that than Obama did on Gitmo.
Maybe diabetes would have been a better target.
Still, I think back to the massive list of improvements we ended up with from the Apollo program, and I have to wonder what we could do next. It wouldn’t be the worst thing in the world for that kind of effort to be supported in American labs and companies.
The last thing I’d want is a cure for cancer, or old age… one that costs a million or ten million, and no insurance would ever cover that cost. The world would descend into chaos or totalitarianism. Or both.
Oh, is that where the term “moonshot” originated? Here’s a website that tries to facilitate all sorts of moonshots:
https://www.solveforx.com/
Maybe some of those would be more practical to fully achieve. Still, hopefully Obama’s thing here will at least lead to improvements in the treatments and other practical results…
Stopping entropy is not enough, we must reverse it.
It could just take a lot of time and a Multivac.
More seriously, finding a way to put the CEO of Phillip Morris in jail could be a good start. He’s responsible for more American death than Ben Laden by multiple orders of magnitude. And there is still no drone strike of his office or home.
lucky 8, i guess:
to defend our POTUS, while it was a silly metaphor to call it a “moonshot”, and poor use of words to call for a “cure”; it does propose a long term project, to address the scourge of cancer that seems to be attacking us. It’s frequency only appears to be increasing due to medical competency addressing all the other diseases that would have killed us before cancer develops.
acually, to defend his use of the “moonshot” metaphor, the only way to get support for most goals is to present it as a single goal, not as a general reduction of the threat, or reducing the consequences of the threat. Noah joked, in response, that “there is only 11 months left, does Obama think Biden can solve cancer in 111 months? *smirk*” The whole point (of the moonshot metaphor) was to start thinking of addressing problems that require long term commitment. That progress against cancer is a long term incremental process, that to judge it be short term specific goals is misdirected. That, can be presented after the project is started rather than cause hesitation when presented initially..
PZ
I partly agree with what you say above but we do not have to prevent cancerous cells to provide people with a much greater chance of survival once the inevitable happens. “Cure” was probably an easy word to use when making a speech for mass consumption but really the next stage of cancer technology will be the ability to better control cancers and their spread once they occur.
Deja vu here. I seem to remember an official “War on Cancer” a few decades back.
Guess we lost that one, then.
re 11:
yet we made a lot of progress against lung cancer by advocating smoking cessation. Don’t remember if that was part of the War, but still worth mentioning.
People who have already gotten cancer may be out of luck. There never was a “cure” for polio. Once you had it you were stuck with the consequences.
One of the big things we should be looking into regarding cancer: look for treatment regiments that are less likely to result in residual cancer cells that are therapy-resistant. Also treatments less likely to leave residual cells that metastasize.
We have been making great strides in ‘curing cancer’. Just compare the current long term survival rates of many of the major defined kinds of cancer from 20 years ago to now gives impressive results for many of them. But I agree it is not practical to declare that we will now try to cure the damn thing. Such statements will just as likely vanish with the next tide, like a sandcastle.
However… CRISPR. Just sayin’.
This is one of those things where it’s hard to make predictions. We may have some breakthroughs immunotherapy style that make it much easier to target cancer cell populations, or it may just come from gradually improving various kinds of treatments – better chemotherapy, better matching of drug mixes to tumors, more precise surgery, and so forth. I don’t think we’ll ever have a singular “cure” for cancer in the foreseeable future, but I could see the day when it’s a set of chronic illnesses where they can at least keep it controlled and mitigate the side-effects (like with HIV).
I wouldn’t totally rule out some type of deeper “cure” at some point, though. There are mammalian species that are extremely resistant to cancer (naked mole rats), and it’s possible we’ll find something in common amidst various cancer diseases that can be targeted. Admittedly, gene sequencing of metastatic tumors has made me less optimistic about that latter one – metastatic cancer is a crazy quilt of mutations across different tumors.
If we’re going to cure something, how about Alzheimer’s? That’s a long and degrading way to die, and with the baby boomers reaching retirement, that would prevent a lot of misery as well as strain on the medical infrastructure.
I would love a cure for Alzheimer’s. It runs in my family, and I took care of dad when he was dealing with it. I’m really not looking forward to that age myself if they haven’t found a reliable treatment.
My latest health news is that my cancer is very unlikely to return, which is excellent. I still have to deal with the results of the current treatment for my variety of cancer, so, less invasive and gentler treatments that are still reliably effective would be great for the next bunch of folk diagnosed with what I had.
An actual reliable treatment of any sort would be good for the more aggressive and persistent kinds of cancer, too. Melanoma is still pretty chemo resistant, unless they have had a breakthrough since 2010 when my husband passed from that. Pancreatic cancer still has a pretty fast and aggressive rep.
Really, though, reliable treatment is about as close as I think we can get on most kinds of cancer and on Alzheimer’s. I’d really love to be wrong, though, and have something better. If you aim for a cure or prevention, and fall short but still enhance our knowledge of the problem, and come up with better treatments, I think that’s still a good outcome.
“There is no such thing as a cure for cancer.” PZ, you sound like an anti-vaxxer. There is a cure for many types of cancer. We cure more than 50% of all invasive cancers in the USA. That’s fact. The cancer death rate has been falling 1-2% per year for more than a decade. This data is tracked by the SEER database. It’s not arcane or inaccessible. http://www.cancer.gov/about-cancer/what-is-cancer/statistics. The current basic and clinical research is already driving a revolution in cancer care. It uses powerful genetic tools to describe and then attack different cancer types and sub-types. Please don’t say such foolish things like there’s no such thing as a cure for cancer. I already have enough quackery to deal with from the usual mushy headed sources. I don’t need you, a scientist and skeptic, adding to the disinformation.
That was my immediate thought when I heard Obama talk about curing cancer. Cancer is increasingly a disease that affects the elderly. Curing cancer would be great, but without a cure for dementia, it will only increase the suffering of the elderly, and especially for the caregivers upon whom most of the burden will fall.
Of course, dementia too is caused by a wide range of diseases, so it’s likely there is no one easy prevention/cure, but a large majority of cases are caused by a handful of disease, most notably Alzheimer’s, so it might only take a small number of breakthroughs to make a big difference. Worth a moonshot, I’d say.
Actually I’m gonna assert that Obama is already having a positive effect on survival rates from cancer, because, my insurance plan could not legally drop me when my cancer was diagnosed, I can still purchase insurance even with the mother-of-all pre-existing conditions, and with Covered California (my state’s Obamacare market) I found a plan that I could afford where I could stay with my doctors and continue getting care from the same cancer center.
Now, I know that not everyone was helped to my degree, but, I give thanks loudly every time I see a doctor or have some medical test because I don’t have to choose between medical care and shelter or food. I’m in no danger of going medically bankrupt, and I am aware of how common medical bankruptcy has been. People who want to ditch the ACA and won’t put their own plan on the table for comparison are asking me to take a blind leap, and I don’t have the stomach for that. Just, no.
So, is a cure a pie in the sky goal? Yes, probably.
Do I think that reaching for that goal will still concretely help actual people? Yes, I think it will.
Is it worth it? I’m not objective here. I have a horse in this race.
Yeah, my first question was “which cancer?”.
There are clearly cancers we can treat well already and there are cancers that we can hardly do anything about. Clearly if there were a cure for a unified thing called cancer we wouldn’t see such different results.
Prevention is usually much cheaper and more effective than a “cure”. Look at smallpox, polio, cholera, malaria, a whole list of others.
We do not have a cure for any cancer. We have relatively effective treatments, and they’re getting better. There’s a difference.
Raucous@19: I’m reading this as analogous to saying that we don’t and can’t have a cure for disease. We can and do have cures for many different individual strains of various diseases. If your goal is nebulous, it’s doomed.
Oh, here’s your third: René Angélil.
@19, You’re saying that a Biologist taking a negative position on the potential for a universal Cancer cure is somehow not a skeptical position because you really, really want it to be true?
Evidently you haven’t read the threads PZ has posted, often when he was teaching a course on cancer, about the different genetic mutations required of cells before they become malignant.
A cure would require either the mutations to be reversed, or a “magic bullet” that would take out only mutated cells, and keep the non-mutated (at least toward cancer) cells alive.
My money is on “no cure”.
@PZ Myers #24:
Indeed there is, but how would you classify Gardasil? A literal cure isn’t the same as a preventative, but when it comes to smallpox or polio we’re happy to accept vaccination as a potential global solution to those diseases. We’re all used to politicians claiming more than they can deliver by making sweeping public statements which don’t hold up in the specific terms of the discipline they refer to, so isn’t that the real contention rather than that significant advances may be made against many cancers if attention and resources could sensibly be focused upon them?
In other words, politicians of all stripes sometimes speak in absolutes. Yeah, we know, that’s why we sometimes despise them. But it’s also possible to ignore the spin and recognise it as something which we realise is worth doing on the whole, and is therefore worth supporting.
The best part: The Republicans refusing to applaud the idea of getting rid of cancer.
Yeah, the “moonshot for a cure” language is problematic (the gun part notwithstanding), but I’m not sure it directly translates to a poor way to distribute the new monies for the cancer problem. A better analogy would be firing a shotgun of research dollars into the mosquito swarm of cancer. I hope Obama’s science advisers choose the finest grain shot, and avoid the double-aught approach, to distribute the research money.
Isn’t “cure for cancer” kind of along the same lines as “cure for virus”?
Hmm. To be fair, I would like it if we could find the cure for virus.
@31 Addendum: Making the new money “just for cancer” is also problematic if the basic research isn’t also being funded. Maybe extend the shotgun analogy to make sure the shot that isn’t aimed at a mosquito hits basic research backstop instead.
As someone who periodically tries to explain thermodynamics to creationists, I have to say: Aaaack, no! It’s not a thermodynamic problem, and if it was, the solution would be simple: just couple your repair mechanism to a larger entropy increase (/free energy decrease) and you’d be good to go.
One can describe the problem in information-theoretic terms, as the accumulation of conditional entropy of the individual cells’ genomes (conditioned on the organism’s “original” genome). But this is Shannon entropy, not thermodynamic entropy; they’re different things, and they play by different rules.
I heard about Alan Rickman at the end of an already rubbish day. I was not happy about that news. He was one of my favourites. I could even forgive his being Snape. I was spending some time with my mum last night and we were talking about him for some reason – I think we were watching Pointless, and there was something about actors in the adaptation of the one that isn’t Pride & Prejudice; [thing & other thing]. We did our little ritual of desperately grasping for the few phonemes that stick in our minds and let us finally spit his name out of the void where it always hides between retrievals and everything. I really wasn’t expecting him to be dead the next day.
I’m of the opinion that Obama came out as openly anti-cancer so that conservatives would be faced with that most disgusting of choices: openly coming out for cancer.
Didn’t Nixon try to have a “moonshot” on cancer already? I don’t recall that that worked out too well, or maybe it just took longer than a politician’s term of office to produce anything useful. Certainly didn’t produce a universal cure.
@34
Was that an attempt at a postmodern essay?
PZ – Here is the story behind the “cancer moonshot”. It’s already in place with private funding by a group of top biotech companies in California. It is lead by billionaire Doctor Soon-Shiong. He stated today that the group is searching for a treatment (not a cure) by enabling the human immune system to attack and suppress cancers identified in individuals.
http://www.latimes.com/topic/business/patrick-soon-shiong-PEBSL000560-topic.html
The notion of a “cancer moonshot” makes me wince too. It just proves that Democrats can be (almost) as clueless about science as Republicans are.
re 35:
By Grabthar’s Hammer, he shall be avenged. Never back down never surrender.
coincidentally, he was also at 69, too similar to Ziggy that the supernatural is starting to stir against suppression.
words fail, too dusty here…
If I may put in a plug for the book “The Emperor of All Maladies” by Siddhartha Mukherjee, it’s really very good (and the audiobook is good, too) He doesn’t quite go straight into why cancer isn’t exactly something that can be cured as a single phenomenon, but he does a great job of putting the whole thing into perspective.
I have one family member who’s been living for the last 5 years with a stage IV lung cancer. It’s a battle but they are coming up with new chemos and new tricks that have extended her life at least 4 years past what she’d have expected to get in the 80s. At the same time, I had another acquiantance diagnosed with pancreatic cancer last May, and he was dead by September. “Cancer” is no single thing; it’s a category of disorders that share common causes and have wildly different prognosis. Mukerjee’s book had me reeling in horror a few times as I remembered when I was a kid during the days of the ‘radical’ surgeries, where a breast cancer diagnosis might result in you coming home sans latissimi dorsi and pectoralis major, never mind a breast. I remember friends of the family who died quickly from lung cancers and my cousin died in 1985 of a leukemia that nowadays you can sometimes be cured of. Again, Mukerjee does a great job of showing how cancer treatments are all over the place because cancer is a variety of things. There are moments in the book that will make you weep; I won’t spoiler any of it. Read it.
Money spent on cancer will doubtless yield other knowledge in other areas as well as useful treatments for cancer. For fuck’s sake – spend the money. Cancel the F-35 or the littoral fighting vessel and research on cancer could be funded at epic levels for a very long time. Like the moon race, cancer research would have all kinds of knock-on benefits resulting from it. The US Taxpayers are getting ready to spend $300b (probably $1t by the time overruns are taken into account) to ‘upgrade’ (read: make entirely new shit) ‘our’ nuclear arsenal. Yeah, spend the money on cancer research instead.
You’ll notice nobody’s asking the taxpayers, “hey how do ya feel about the nuke upgrade, huh?” it’s just assumed that’s going to happen. “Democracy” (snort)
PZ, you are 100% wrong. And I think you are being disingenuous. There is no Cure for Cancer because there in no capital C in cancer. It is not one disease as you correctly pointed out. Millions of people have been cured. Not every type of cancer and not every individual with cancer, but millions nonetheless. Cured means the person lives the rest of their life without a recurrence of the cancer and no detectable evidence of the disease. Cancer free until they die of something else. That’s what cured of cancer means. It’s individual; each cancer has individual genetic marker of disease. Saying, “We do not have a cure for any cancer,” is just wrong.
@Marcus, please put in as many plugs for “The Emperor of All Maladies” by Siddhartha Mukherjee as you can.
Well, the “rule of three” has just been verified. Celine Dion’s husband has died of throat cancer.
Alan Rickman was a favorite in our house. My grandson adores the Harry Potter films.
My husband and I love Galaxy Quest.
We also love an obscure little film in which he starred call Bottle Shock, which tells the story of how the wines of Napa valley competed with French wines and won, gaining a worldwide reputation. Rickman played a very believable wine snob.
Athywren @ 35,
Sadly I don’t know much about Rickman outside of the Harry Potter movies, but for me Snape was JK Rowlings’ masterpiece–he was unlike any other fictional character I can think of, with the possible exception of some treatments of Judas. And Rickman played him perfectly.
Based on comments from Daniel Radcliffe, it sounds like he was a good person, as well as a good actor. I guess I’ll have to learn more about him.
Raucous Indignation @#45 —
Marcus, please put in as many plugs for “The Emperor of All Maladies” by Siddhartha Mukherjee as you can.
Seriously. It’s a beautiful book. Horrifying at times, of course… But the part about Jimmy and the baseball uniforms and all that – oh, wow. Just… wow.
Mild spoiler alert:
At the beginning he talks about the experience an ancient Egyptian queen had (extrapolating, of course) with a breast cancer that killed her. And compares it with today’s experience. He describes the interim stages – such as the ‘radical’ period. When he was going through that all I could think of was my high school girlfriend, who is alive and doing well, 12 years after a gamma knife/chemo treatment for her breast cancer – which would have almost certainly consumed her life into pain and probably killed her if it had been in the 1970s or even 1980s.
We won’t “cure cancer” – that’s stupid. But many many people with cancer are cured, and that’s what matters.
I also recommend Orac’s article de blog “if we can send a man to the moon why can’t we cure cancer?”
http://scienceblogs.com/insolence/2011/02/21/why-cant-we-cure-cancer/
it’s excellent. TL;DR: evolution affects cancers – a tumor is not a blob of all the same cancerous tissue, it’s often an entire branching tree of mutated cells. If you’re lucky, they haven’t mutated into something that resists all the chemo options. If you’re not…
BTW – one other thing I think I may as well mention here. Progress gets made. When I turned 50, I started getting regular nags about colonoscopy. (Yeah, yeah…) and that’s how my sister discovered she had her stage IV lung cancer (“uh, those cells in your colon… they’re lung tissue.”) But I’ve been putting it off.
Anyway, I was talking with my GP about it and he thought I was putting it off because of pain/discomfort/embarrassment, etc (no, it’s fear) and he mentioned that now they have a fecal sample screening thing that they can do. It’s a little pack you take home, and you send in a poo sample and they tell you either that you’re OK or maybe it’s time to come in and have a camera up your ass.
^ That’s progress.
Cure? No. Progress, yes.
It’s depressing because we’ve lost a couple amazing humans lately, but there are also a lot of forms of cancer that are maybe not manageable but you can live a decent life for 4, 5, maybe more years under a death sentence. Beats the hell out of what would happen to you in the 70s. Progress is good. And spending a lot of effort on research to “cure cancer” will inevitably result in progress even though a cure is not even something we can sensibly talk about. Progress is good.
It sure would be nice if cancer researchers had Pentagon Money and The Pentagon had to have a bake sale to raise money for the bombs it’s gonna drop on MSF hospitals. There’s progress and there’s progress, eh.
magistramarla:
Yes, Alan Rickman was very good in that film, as always, but as little films go, my fave would be Blow Dry. Rickman is fabulous in that film, and sports one of the best character tattoos ever.
Too late, Rickman was #3. Fifty posts, and nobody mentioned Lemmy yet….
I’ll third Emperor of All Maladies, although it admittedly made my disease-related anxiety worse. It’s a beautiful, brilliant book.
This seems like a problem of equivocation. Medically speaking, we don’t really have a cure for anything. Even infections, which are probably about as close to a cure as we might have for anything in the form of antibiotics, still only have highly effective treatments.
“We should invest our money and infrastructure into developing a series of highly effective treatments for different forms of cancer” is not particularly punchy. “Cure for Cancer” while not medically accurate in the stated goal, seems rhetorically fine to me.
Exercising a bit of fantastical SF elements: if we had microtech capable of excising tumors anywhere in the body without damaging the attached tissue, it wouldn’t medically be a cure for cancer, but it would be a highly effective treatment regimen against any kind of tumor. At worst, metastasized cancer would become a chronic condition rather than a death sentence. I don’t think anyone would complain about such a discovery being an insufficient medical breakthrough to justify a “war on cancer” nomenclature.
Duh. Cancer is not one disease and it is very unlikely that there will ever be A cure for “cancer” much like A cure for “infectious disease” is unlikely. On the other hand, cures for particular cancers in individuals? Trivially easy. Some simply need to be whacked out and that’s that. Hodgkin’s lymphoma? 98% cure rate* for young people. Testicular cancer? Only kills those that don’t follow up and complete their treatment. Cures. As in, go on to die of something else.
Granted, that “something else” is often another cancer. This is no surprise since you’re taking a person who is prone to cancer already and giving them medications that shred their DNA. But that no more means that they weren’t cured of their first cancer than the UTI I had last year means I wasn’t really cured of the strep throat I had as a kid.
Oh, and of course we’re not going to reverse entropy. We’re going to add more energy to the system. Just like we always do.
*Some restrictions apply: This is the cure rate for Germany. The cure rate in the US is lower. Guess why? Yes, you’re absolutely right! No insurance, no or at least less than ideal treatment.
OTOH, I think you’re exactly right about a “moonshot” being the wrong analogy. We don’t need a moonshot. We need a 100 years war. That is, we need to admit that the greatest threat to the US (and Europe and Japan, Australia, India, etc) is not war or terrorism or even right wing nuts, but rather disease. We need to spend money on basic, translational, and clinical research like we would if cancer (heart disease, alzheimer’s, various infectious pathogens, AGING) had just bombed Pearl Harbor and were heading for Seattle. Because, you know, they are. In the past we couldn’t do anything about that because we simply didn’t have the resources and knowledge. Now we have them. Do we want to live or die*? It’s really that simple a choice.
*And don’t bring up the “but if we lived forever it would be AWFUL” crap either. We MIGHT have the ability to double life expectancy right now. We’re nowhere near creating eternal ennui. It’s not a problem to worry about right now.
PD-1 inhibitors. Send the immune system in to kill the crap out of those cells. Modern immunologic based therapy appears to work best on…highly mutated cells that are typically extremely resistant to classic chemotherapy. Is it a cure? Who knows? Given that we’re still in the “what does THAT button do?” period of figuring out how to use the drugs, I’d say that the results will probably get better over time. Might lead to cures in some people. Almost certainly won’t be THE cure for CANCER any time soon.
Neither BMS nor Merck paid me squat for this positive discussion of their products.
Praise for the original moonshot is far from universal as well — it was a publicity-focused (instead of sustainable or useful) project as well.
This always reminds me of PHD Comics about this subject:
Tales from the Road – MD Anderson Cancer Center
Small pox is pretty much “cured” on a population level. OTOH, we can’t actually cure it if someone does manage to contract it somehow. Guinea worm infection is well on its way to being cured too. Less than 100 cases in 2015. No vaccine, but it’s possible to prevent transmission with simple measures such as straining water before drinking it. Not sure how well anti-parasitics work on it.
Really? If you got cancer–any cancer–would you rather be treated with any treatment available in 2016 or only those available in 1969?
@Maroon, 47
Don’t get me wrong, I don’t disagree with you at all. Snape is probably the best character in the Potterverse, and there’s nothing really wrong with the Harry Potter books or films as far as I’m aware. It’s just that I’m a massive and slightly irrational snob about some things, and there are a lot of things about that world that irritate me on a cellular level. That I even felt the need to forgive him for taking the role says far more about me and my flaws than it does about him or his career decisions.
You definitely do have to learn more about him. You won’t regret it, he was brilliant.
Another pharaoh announcing another pyramid-building project you say? Imagine my utter shock. Oh well: let’s debate which model of pyramid is most appealing, or whether we’d rather see a cluster of little pyramids, and ignore questions like whether pyramid building is a good idea, or why we let God-Kings divert our energies for the sole purpose of immortalizing them.
(OK, I lie. The original moonshot had three other purposes. Mostly, to develop aerospace technology to the point that we could deliver nuclear missiles to any target on the planet. Secondarily, to ensure that if space were ever militarized, we would control it. And tertiarily to humiliate the Soviets.)
Kind of a pity that with all of the things President Obama is kinda geeky about, The West Wing apparently isn’t one of them.
Oh course, it’s possible he pulled the (IMHO) wrong lesson from that episode.
I learned that Dan Haggerty just died of cancer. So, that makes three… or five. As a kid I loved the TV show The Life and Times of Grizzly Adams. Dan seemed so kind. RIP Dan you will be missed.
@55 dianne
I disagree. Waging war is a technical problem. We knew what we needed to do to win. Cancer is a biological problem and quite frankly not only do we not know how to cure cancer we don’t even know what we would need to know to address the problem. Much of the progress that has been made in the last few decades is more apparent than real. Earlier diagnosis doesn’t necessarily mean people with cancer are living longer but people are living longer with the knowledge they have cancer. At least some of the rest of the progress is due to better surgical and post-surgical procedures. Also of course you have cancers like prostate or to a lesser extent breast where because of improved diagnostic techniques people are being ‘cured’ of tumors that likely never would have been a problem had they been left alone. They are needlessly suffering from side effects of their treatment.
The question isn’t whether we live or die because we’re all going to die. The question is how much we’re willing to spend in attempting to postpone the inevitable. I read a book written back in the ’80s that claimed that 90% of US health dollars are spent on people in their last six months of life. I doubt that has either changed much or is much different elsewhere in the world.
What blows my mind is: why the fuck does anyone still smoke cigarettes? Gezus fuck de fuck, what de fuck?!
One of the points Mukerjee makes in “The Emperor of All Maladies” is that if people just stopped smoking, it would have a better and more positive impact on all the cancer outcomes than anything else humans can or have done. Right there.
“Stop being stupid” is a lot easier than being super smart.
@66 Marcus Ranum
Because although the incidence of lung cancer is about 10-20 fold higher in smokers than non-smokers, most smokers don’t get lung cancer.
Nope. Some of them get bladder cancer, head and neck cancer, prostate cancer, myeloproliferative neoplasms…practically the only cancer that smokers DON’T get more than nonsmokers is CLL. CLL is a weird monster. But extremely responsive to ibrutumib.
Of course, not all smokers get cancer. Some get heart disease, COPD, osteoporosis, stroke…But apparently not Alzheimer’s. Another weird disease, but there it is.
But it’s an analogy US-Americans understand and practically the only one they’ll take seriously. The Pentagon’s budget is something like 50% of discretionary spending. Peacetime spending. Have to use it to get US-Americans interested
It’s called lead time bias and, yes, epidemiologists are aware of the issue. But if you’re claiming that it’s all or mostly due to lead time bias, how do you explain 20 year follow up on Hodgkin’s lymphoma patients? That just did not happen in, say, 1969. It’s not a condition that you have for 20 years with or without your knowledge. Or changes in 5-year survival in conditions that have no screening test? That covers basically all the hematologic malignancies. Yet hematologic malignancies are the area where the greatest progress in long term survivals with no sign of recurrence (in any other disease, we’d just say “cure”) has been made.
It’s been noted. Embarrassing as crap. That’s why the screening recommendations and, to some extent, the treatment recommendations have changed since the peak over treatment years of the late 1990s.
I can’t comment on the rest of the world, but it’s definitely changed in the US. Did you miss the whole hospice movement? Also, ICU care is expensive and sometimes it fails, so at least sometimes the great expense in the last 6 months of life is because a healthy person got mangled badly, but not killed, in a car crash and efforts to save them failed. I guess we could just stop treating people who were badly hurt to save money, but it seems like a bad idea to me.
Look at it another way: What else do we need the resources for? We can feed the country with about 4 farmers in Iowa. We can make all the crap we need with robots and a couple of people to repair them when they break*. What do we need to spend money and resources on? What’s the growth industry? Medicine. Might as well admit that we’re undergoing a paradigm shift much like the one that took most people from being farmers to being factory workers.
*Exaggerated for effect. Of course it’s not really that easy.
Except that the lung cancer rate appears to be increasing in non-smokers. Don’t freak out too badly yet. It’s not a huge effect. Yet. Probably.
@70 diane
Education for one. Improving access to healthy food in inner cities. Improving access to preventative care. Cancer already gets more funding than its disease burden warrants.
If most of the economy is based on the need to keep people alive by manipulating their biology (as opposed to the traditional economy that is based on keeping people alive by growing enough food to avoid starvation) then high levels of spending on education have to happen. Hard to teach someone how to analyze and interpret high throughput microRNA chips if they can’t read. Improving access to primary care is kind of a “duh” as well. Improving access to healthy food in inner cities is so trivially easy that it’s extremely socially embarrassing that it hasn’t happened already. Seriously, how can this even be a problem in the US and Europe?
The lifetime incidence of cancer (I think including minor skin cancers) is 1 in 2 for men, 1 in 3 for women. Call me crazy, but I think this would be a good disease to spend some money on.
You know the old story? A banker, an immigrant, and a (native born) worker are sitting at a table with 20 cookies. The banker eats 19 cookies and says to the worker, “Watch it! The immigrant’s after your cookie!” Well, I don’t want to fight over the last cookie. I want 18 of the cookies the Pentagon is eating.
Pfft, silly statist spendocrats. If we just won Elon Musk – real-life Ironman! – to the cause cancer would be cured within the quarter.
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I’m more wortied about that “etc” thing.
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