A Pointless Cancer ‘Moonshot’
nytimes.com
nytimes.com
"These rodents are protected from cancer because their tissues are very rich with high molecular weight hyaluronan (HMW-HA)."
HMW-HA is a correlation that has not been proven to be effective for preventing cancer elsewhere. Remember, such claims used to be made about shark cartilage, too.
"When HMW-HA was removed, the cells became susceptible to tumors, confirming that the chemical did play a role in making naked mole rats cancer-proof. [The] team also identified the gene, named HAS2, responsible for making HMW-HA in the naked mole rat. Surprisingly, the naked mole rat gene was different from HAS2 in all other animals. In addition naked mole rats were very slow at recycling HMW-HA, which contributed to the accumulation of the chemical in the animals' tissues. [Previously researchers] showed that the p16 gene in naked mole rats stopped the proliferation of cells when too many of them crowd together. In their latest work, the two biologists identified HMW-HA as the chemical that activates the anti-cancer response of the p16 gene."
Again, there are many steps before such a claim could be made, let alone before having a safe and effective "cure" using it. You can't just genetically engineer humans to manufacture and maintain large amounts of HWM-HA in their bloodstreams.
This is obviously far off, but genetic modification opens up a whole new world of possibilities.
Well of course any medical treatment for anything just leads to more medical treatment in the future; that's not a profound statement, not as long as people are mortal. And it's not limited to cancer. It used to be, in the bad old days, that some people became almost completely bedridden as their joints gave out, and then either died early or wished they did; now we have arthritis medications and joint replacement surgeries that let many of them (not all, but very many) enjoy decades of their retirements. Does this lessen the need for future orthopedic treatment? Obviously not, since it extends their lives and keeps them on their feet long enough to develop other joint problems. Does that make orthopedics and rheumatology pointless? As someone who needed the intervention of rheumatologists, I assure you that it doesn't.
In the case of cancer, nobody believes that one can make people live forever by curing their cancers; of course, they will live long enough to die of something, maybe even another cancer. Still, I personally know people in their 70s and 80s who would have been dead and buried 20 years ago if it wasn't for cancer treatment; and the idea of the "cancer moonshot" is to give the same chance to a lot more people. I came home today after visiting a very dear friend whose cancer is, with the current level of medicine, close to untreatable. Will she live forever if some treatment is developed for it? Well of course not. Would it be worthwhile to change the several months that she has left to live into several years? Of course, and yes, it would mean that she would require more cancer treatment, not less.
We can debate if the "moonshot" model is right for cancer (personally, I think it has merits), but these pseudo-profound dismissals of medicine are simply vulgar and annoying.
He's right that an ever-older population will bring about more cancers- so we'd better have ways to treat them. And he's right that the "cancer moonshot" likely won't provide the singular, all-out cure, but no one outside of politicians claims it would; instead it will help provide partial cures that can reclaim thousands of healthy human-life-years, a worthy use of the money. That a professor of medicine draws such a poor picture of these issues sounds downright pathological.
We've definitely moved on since then. Moonshot or no, anything that helps make that experience less likely has to be a good thing.
Actually coming to grips with the idea that a seemingly mundane engineering issue is what gets him was surprising.
Give that problem 10 years and I suspect I'll read the news one day and hear about how we've now solved it.
That sentence made that great article awesome.
"as long as we are human" could also be read as "as long as we are built on legacy hardware" ;-)
Does he just want a more dourer PR campaign? I suppose "We probably won't cure cancer, but, I guess this is better than nothing" would be more realistic.
BUT.
There are range of new approaches to cancer that are not particular and specialized to a very small number of cancers, or that can in principle be adapted with comparatively little work to target different cancer types from a common core platform.
This is what will produce meaningful control of cancer: attacking the commonalities present in many or all cancer types.
The best and most promising approach here is interdiction of telomere lengthening. All cancers must lengthen telomeres. They have to. If they can't, they wither. So block telomerase, block ALT, and cancer goes away. You can either block these mechanisms globally for a while, long enough to kill the cancer, but not long enough to kill the patient due to stem cell depletion, or combine this with any of the targeted delivery mechanisms under development to turn it off only in cancer tissue.
There are a few labs working on aspects of this, more on the telomerase side ( e.g. http://www.eurekalert.org/pub_releases/2015-05/cndi-csa05111... ) than the ALT side, because ALT cancers are only about 10% of the total, and ALT is still not completely cataloged. ( See: http://www.the-scientist.com/?articles.view/articleNo/42444/... )
SO.
It is foolish to talk about cancer as a thing that medical science cannot get to the bottom of. There are very clear approaches to get to the bottom of cancer and fix it.
Reason 1; cancer therapies have to effectively kill cancer cells and not important non-cancer cells. Cancer therapies that exist today achieve this by mucking about in mechanisms that are important to cancers and not (or not so much) to other cells. But cancers are diverse- there may just not be anything that's common to all cancer and not shared by healthy cells. Telomere regeneration is a nice candidate, but as you noted, its also important to stem cells- can humans withstand enough damage to their stem cell populations to make a meaningful difference to difficult cancers? (For that matter, telomere regeneration is also important to gametes, so telomere-based therapies may also render the patient infertile.)
Which means we're likely to be stuck dealing with a dozen or hundred-odd different treatments, each of which targets some eccentricity of a specific cancer subtype, but-
Reason 2: There are lots of smart people plugging away at this problem, backed by lots of research money. In addition to being an objectively important problem for humanity, cancer is also an interesting biological conundrum and also the most likely cause of death for a bunch of old people with stratospheric net worths. Even hacking at the problem in bits and pieces, its not unlikely that cancer will become a completely tractable disease (even if a golden-bullet "cure" doesn't arrive) within our lifetimes.
Yeah my point maybe a minor one, but I dislike the dumbing down of things or appealing to past glory.
I'm generally not a fan of people either but there are kids with cancer that I feel should get some time to enjoy their lives outside of dying in a hospital if at all possible, someday.
Besides, there are still many, many millions of people in the USA who can't get insurance so even if there was a "cure" or life extension, they couldn't afford it. Don't worry, they will die for you because emergency rooms don't treat cancer. For example if I got cancer, I'd be screwed.
And while it may be technically mandatory, I have so far fallen below the income level that requires it and so haven't yet been fined for being unable to afford it. I almost did this year, but managed to request an exemption because there were no plans in my area below the necessary price threshold. And even if I were fined, paying the fine is easier and cheaper than dealing with actually getting a (very shitty) plan.
You don't need to have a credit history to get Medicaid. Heck, a complete lack of one may work in your favor.
In CA, you don't even have to be here legally to get Medicaid (MediCal) now.
Edit: Not directly related to the main topic, but Amazon Payments also uses Experian—same as Arizona medicaid and Healthcare.gov—for identity verification, and if you don't have a credit history you get permabanned without explanation from continuing to use Amazon Payments. After asking them why several times, they block you from contacting their support again. Worst customer experience I've ever had with a major company, especially Amazon which is usually quite fantastic to deal with as a customer.
So it is very possible to make too little to get insurance outright and too much to get medicaid. In fact there are many millions of people in that boat in 2016. Apparently we are illegal human beings, walking around without insurance.
Spoiler: the penalty is far less than the cost of having insurance, which means it's still cheaper to just be uninsured (so long as you stay relatively healthy) and pay up on your tax return.
Also, there are cost-sharing reductions which would reduce that $10k significantly depending on your income.
If you do find yourself in need of actual medical care but without any insurance, the workaround is simply you will have to move to a new state, which will allow you to sign up outside of open enrollment periods.
Regardless, the law is the law and it's undoubted that the folks who choosing not to do their legally required part and maintain health insurance will immediately jump on a plan if they happen to need care. Bunch of selfish jerks.
26 states refused to expand coverage so there is a huge hole and they went to the supreme court who said it was perfectly okay for them to do that. Google it.
Hillary will be unlikely able to fix this and Trump definitely won't fix this, so if I get cancer in the next eight years (plausible, both parents died from it) I am screwed, though technically I could undo my entire life, move to another state and wait a year to apply and hope I don't die in the meanwhile. Yay America.
I'd say cancer is worse!