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Cancer

No Such Disease

Are we going to “eliminate the suffering and death due to cancer” by 2015, a goal set by the National Cancer Institute? Unfortunately, I greatly doubt it. Will we speed up the timetable, as Senator Arlen Specter has apparently asked, and do it by 2010? Absolutely not, and here’s why.
There’s a widespread myth at work here: that there’s a disease called cancer. Cancer is actually the end result of what are probably hundreds (thousands?) of different diseases. We have confused ourselves by giving them the same category name – it’s like the old-style classification of infections as various “fevers.” There are many, many ways that a cell can end up with (and maintain) the deranged growth profile that we think of as cancerous, and it’s going to take a lot of different treatments to do anything about them. (See this post and this one for some of the consequences of that for the drug industry.)
Look at the situation today. Every type of tumor has specific front-line treatment regimes, and they don’t overlap that much. The best agents for some types of cancer are totally useless against some of the others. It’s possible that some of those multikinase inhibitors that I was writing about the other day could have a broader spectrum of activity, but even if that pans out, it’s likely that different kinase “fingerprints” will be needed for different varieties of tumor.
Actually, there are two myths at work in Senator Specter’s question. The other one is that research can be sped up to any degree desired. Although more money is always nice, thanks, there comes a point where it’s not sufficient to buy you better results. In the case of the various cancers, it’s for sure that there are many, many important details that we don’t even know about yet. And, as usual, a good amount of the things that we do already know are going to turn out to be wrong. Time, money, intelligence, luck, and hard work are all going to have to be tossed into the pot in great quantities, and there are no other ingredients that can substitute for any of those.

10 comments on “No Such Disease”

  1. SRC says:

    A common problem in the business world, confusing science with engineering. In the street it takes the form of “If we/they can put a man on the moon…”

    Non-scientists fail to differentiate the processes of finding hitherto unknown solutions to poorly understood problems with implementing already known solutions to well-understood problems.

    Progress on the latter may be homogeneous to first-order in money spent, but the former is homogeneous to zeroth order. Having more guys stumbling around who don’t what to do either isn’t a big help when you’re trying to figure out what to do next.

  2. Peter Ellis says:

    The second myth they’re buying into is the one that says that if you start with 40 women, you can get a baby in a week.

  3. Groko says:

    Then, on the other hand, angiogenesis as a phenomenon is applicable to all solid cancer tumors…

  4. Derek Lowe says:

    Ah, but “angiogenesis as a phenomenon” is driven by a bewildering array of biochemical signals. Not all of them are applicable to a given tumor type, by any means. This is what we’re finding out in recent years with the first waves of anti-angiogenic drug candidates, that they don’t have nearly the spectrum of activity that we would have hoped for.

  5. ctl says:

    I wonder why he set his sights so low. Why not ask for the eradication of all cancers right now? I mean, if you guys in the pharma industry aren’t human beings constrained like the rest of us by outside limitations, but creatures who produce your results by sheer willpower, why wait so long for you heartless bastards to get around to wanting to end cancer?

  6. jeet says:

    to be kind-of fair, I don’t think we had the knowledge thirty years ago when Nixon’s “War on Cancer” was launched about the incredible varieties of cancers let alone the knowledge (still incomplete) of various cell control mechanisms that allow us to now look at this disease in a different light.

    On the angiogenesis front we have more than direct receptor inhibitors, we also have therapies that use angiogenesis as drug targeting for traditional chemo.

    A lot of progress, but not a cure.

  7. Dr_Toot says:

    Hey, what’s the big deal, it’s just a f*cking lawyer talking, since when do we take them seriously. Anyway, politics & its attendant hyperbole will be with us until we’re all genetically engineered to actually be nice to each other (shudders). I will say you do a good job explaining the fact that cancer is a variety of diseases; same thing goes for just about everything we stroke our chins & diagnose in medicine: M.S., hyperetension, depression, etc.

  8. Utenzi says:

    And don’t forget schizophrenia. That’s another cluster of ailments under one heading.

  9. Ed Reid says:

    If cures for all of the specific diseases typically referred to as cancers were to become available at cob today, the FDA would not approve their use in humans before Senator Spector’s target date.

  10. NoFreeLunchMD says:

    Thanks Derek. You’ve said it better than I could. I hate it when people claim that “A cure to cancer exists, but is being hidden by the drug companies.” On top of the fact that people will keep getting cancer, so the drug companies could easily make a fortune with such a cure, I also point out two other issues:
    1) THERE IS NO SUCH DISEASE AS “CANCER.” But your “fever” analogy is the best one I’ve heard.
    2) THERE IS ALREADY A CURE FOR CANCER. Breast cancer, when caught early, can be cured. I’ve done it myself (well, I was a medical student first-assisting on the lumpectomy). Thyroid cancer is almost universally curable with radio-iodine therapy. And Lance Armstrong, while not yet “cured,” may very well be if he crosses the mythical 5-year threshold.
    I get irritated at breat cancer advocates who advocate “fighting for a cure,” when the cure is early detection and excision. They want all cures to be as easy as a course of azithromycin. Not going to happen.

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