Hacker News Reader

Comment by roenxi | Hacker News Reader

> Virologists aren't sitting around waiting to develop cancer before they decide to roll out the miracle cancer cures.

You say that, but the article suggests otherwise. This virologist did believe that her colleagues were sitting around not rolling out something that would cure her. It is pretty easy to see how a lot of cures would be stuck in the research world, unable to get to patients; there is no reason to believe they are moving quickly to bring cures to market. You can see people arguing up and down the thread how they have higher priorities than testing stuff to see if it might work.

View on HN

> This virologist did believe that her colleagues were sitting around not rolling out something that would cure her.

And because her outcome was so unexpected and unusual it got published as a case study. What you don't see are all the cases where the experimental miracle cure treatment did not work. What you also won't see in headlines are all the trials where putative miracle cures and other promising treatments failed to demonstrate survival benefits in larger cohorts than 1.

One of the counterintuitive things about cancer is how badly individual cases and responses to treatment generalize to the broader patient population. If you didn't know any better, you could easily read a story like this and think "wow, this breast cancer cure was just stuck in a lab somewhere!" But to put a story like this into context, you need to understand just how many individual miracle remission stories there are, and how varied individual cancers and responses to treatment are.

There are potential miracle cures almost everywhere, and a large number of them are being aggressively researched, tested on cancer patients at any given time - often as part of combination therapies. Some of these promising technologies do become breakthrough cancer treatments that create durable remissions, such as checkpoint inhibitors. The rest fizzle out.

I'd suggest this virologist actually does understand her field quite well. You're in the awkward position of arguing that an expert in a field doesn't understand what she is doing while citing evidence to support yourself that you (by construction) don't have. It is equally likely - actually quite a bit more likely - that we do have a huge number of improvements over current best-practice stuck in labs because people are insisting on damaging levels of certainty rather than letting people try things. This woman seemed fairly confident that she could achieve an improvement on clinical best practice.

There are risks, but having cancer is a risky business right from the get go.

I notice you've watered down your terminology from "cure" to "improvement on clinical best practice" which are pretty different things in the context of cancer treatment. However, I can respect the switch and I'll treat it as a sign you're starting to treat the subject a bit more seriously. It's more accurate to the outcome in the case study, too, since treatment was locoregional and neoadjuvant only. Full remission was only achieved with the traditional interventions of surgery and adjuvant targeted therapy.

> You're in the awkward position of arguing that an expert in a field doesn't understand what she is doing while citing evidence to support yourself that you (by construction) don't have.

No. I'm in the non-awkward position of arguing that non-experts should be careful about interpreting a single case study without context. Especially in a way that implies miracle cancer cures are sitting around in labs with no one paying any attention to them.

I don't think the average HN reader understands just how many wildly different treatments, drugs and therapies are being thrown at different cancers and how quickly medical oncology moves as a field. Cancers are an extremely complex family of diseases. Early results and case studies are correspondingly extremely difficult to interpret due to the variation in individual responses and disease course.

The existence of a "miracle" cancer treatment is almost ruled out from first principles. But if such a miracle treatment is sitting around in a lab, it would be non-trivial to tell it apart from the thousands of other promising candidate therapies that go on to pan out to nothing.

> I don't think the average HN reader understands just how many wildly different treatments, drugs and therapies are being thrown at different cancers

You say that as though it supports your thesis, but you obviously haven't thought thorough the implications if you don't believe there are a bunch of cures sitting around in labs.

You still can't deal with the main weakness in your argument here - this woman, who is very close to the pointy end of the stick and qualified enough, is evidence that the virology world is in fact sitting around on some fairly important techniques that could help cure her. Which is pretty much what we would expect given that taking something from the lab to the other side of the regulators involves enormous costs and demands of rigour.

And you seem a bit too focused on miracle cures. I suggest discarding that focus, miracles generally imply that something is impossible or unlikely. It is better to focus on realities and probable outcomes.

Reply on news.ycombinator.com