Is This How We'll Cure Cancer?
forbes.com
forbes.com
I am also in a country where you don't have to choose between pay or die, and I'm thankful for that. Seeing this kind of thing in print certainly makes you look twice and appreciate what you have.
Note that grandfathered plans are not subject to the out-of-pocket maximum until 2015.
P.S. Remember to vote in the 2014 and 2016 general elections if you live in a swing state.
This is toxic to democracy. People should vote no matter the state where they live otherwise it is only a tiny sliver of the swings that decided who rules the country and this allows for the money influx because you only have to buy/brainwash that sliver.
If a modern democracy manages to have 80% voter turnout you will be surprise how many safe seats will be not so safe.
So just vote - no matter where you live. It is your civil duty.
Are you suggesting that "people who decide to vote" is not a representative sample of the whole population? I am not sure of that, and a quick Google search shows mixed results.
> So just vote - no matter where you live. It is your civil duty.
I feel no loyalty to my country. I don't give a crap about civil duty. Most people I interact with feel the same way.
I really want to believe that's true, but I'm skeptical. Do you have any sort of research backing that up?
Shockingly they wanted to keep the price tag of ~3000$ you quoted which is > 95% of the population's gross annual income.
We also don't live in the US but he is lucky the drug company and his insurance pay 90% otherwise he'd be dead by now.
However, Obamacare is guaranteed to remain in effect only so long as the Democrats retain control of the Senate and the Presidency. If the Democrats lose one of them, then it will depend on whether certain vacancies open up on the Supreme Court. If they lose both, then that's the end of Obamacare.
I understand you're having a visceral reaction to the out-of-pocket maximum. But for the patient who has to take Gleevec for the rest of his life, it does not matter if he pays $1 for the premium and $10,000 for the medication, or $10,000 for the premium and $1 for the medication. It's the same $10,001 either way. It's just a matter of what you call it.
I think it's great that Poland reduced the premium to $0 for your father. But patients in many other countries still have to pay the premium even after they get sick. And nobody would say that their insurance refused to "pay for the treatment" just because it did not waive the premium. It becomes a matter of degree, not of principles.
The US still has the most expensive healthcare even after Obamacare. But at least it is now on the extreme end of the spectrum of universal health insurance. It is no longer off the charts.
For someone like the OP's dad, US is still not included. The $6k would cover, what, a month or two?
So this really isn't an cancer cure at all; it is B-cell cure. I'm surprised this isn't a more significant detail in the article. It's really the cell-equivalent of cutting off a cancerous limb.
I detest articles that use the word "cure" and "cancer" in the title. They are without fail so breathless about the clichéd achievement that they are exploiting in the headline that they either fail to acknowledge the real magnitude of the problem or gloss over it with practiced sleaze (not sure which happened to the writers here).
We've had a "cure" for cancer since the times when barbers also performed surgery on the side (Egyptian civilization, at least), and that is surgical excision. It's still the best treatment we have for many cancers, e.g. melanoma and lung cancer, both of which are much more common than the cancer in the article. It doesn't work for every cancer, but for some cancers it works good enough, and even better when combined with chemotherapy (which ham-handedly slows replication in every cell in your body). The point of any cure is to remove the cancer cells from your body and for some cancers they fortunately stay within one excisable area.
Like the GP comment pointed out, this is essentially a much more targeted version of the same thing. Obviously it would be better for the patient to retain B cells, without which they will have no adaptive immunity--just like a patient with melanoma would prefer to keep the hunk of their nose that the surgeon had to remove. This is an incremental, very fancy and very expensive improvement on the same old strategy of killing the organ to save the body. It will never work on non-blood cancers (which are the vast majority of cancers, BTW).
People do not understand that cancer is a disease that combines the trickiest parts of fighting aging with the trickiest parts of fighting infectious disease. Cell replication is one of the hardest things your body has to do, and it does it several trillions of times per day in your body, essentially copying about 1 billion TB worth of data while automatically detecting and fixing every dangerous error that could possibly result. It is natural that this process will screw up catastrophically at some point--on an infinite timescale, assuming we fix all other health issues, everybody will still get cancer just as surely as they age every year. And once they do, you have a cell that your immune system has carefully trained for decades not to engage, invading and hogging every resource it can, with mutations that allow it to adapt to selective pressures, including any drugs you might throw at it. Essentially, it's an infectious parasite, except it looks 99% like your own cells to your immune system, and is already perfectly suited to your body's style of metabolism.
Let's keep in mind that this can arise from any cell in your body that replicates, and just about every organ system has a good number of those to replenish malfunctioning or old cells and fix injuries. The possibilities are staggering and so are the number of known cancers.
There is no "magic bullet" that cures every single cancer, just like there is no "magic antibiotic" that kills every infectious bacterium. Even the smartest, most generalizable ideas right now, like cancer vaccines, depend on your immune system to make the final push, and the immune system is just as fallible as any other organ system. At the point where somebody can make the claim that all cancer is cured, we will as a matter of course have gained control over every replication event that occurs in our body (trillions upon trillions of nanoscale events per day). That will be a truly remarkable feat, but is in no way within reach of any foreseeable technology.
When we cure cancer, we will have by necessity cured aging and all infectious disease will have become a relatively trivial problem. That should put the claim of "curing cancer" into perspective.
I'm still waiting for the nanobots that we were promised two decades ago.
Imagine a billion nanobots swarming inside your body, networked [1] and analyzing every cell they come across. Over time, they build a gigantic database of your cells. Then they'll be able to use some heuristics to determine whether any given cell is a menace to your health. If it is, they either tag it for apoptosis or terminate it with a micro laser, depending on how reliable they think each method would be.
Movie material today, reality tomorrow. When this happens, I'll finally welcome the combination of "cure" and "cancer" in the same sentence.
You've basically described the immune system!
The immune system is imperfect, but it's a lot more complicated than any man-made system so far. Trillions of cells, thousands of genes controlling each one, hypermutations creating billions of different antibodies, slipping into and out of each corner of the body. Basically, organized chaos; by some measures, more complicated than the brain.
I would welcome potential designs for an auxiliary system, but what we have already is hard to understand, much less supplant. Certainly the concept of retraining the immune system is appealing, and looking beyond the OP's microbead/reinfusion rigamarole, we've already been doing that for decades via vaccines.
And considering that there are no laws of nature that prohibit redundant replication of data with virtually no errors there should be no limit to improvement in that area.
There most certainly are, at the information density of DNA. DNA is about a thousand times more information dense than our best hard drives. At that level, a passing photon can change or break enough chemical bonds to alter the bits. A nearby high-energy molecule can do the same. This actually happens gazillions of times per day in our body and we have a few hundred enzymes to automatically correct errors and a few hundred more to detect when those can't fix the problem and shut down the cell. The fact that it works at all is jaw-droppingly amazing. We take copying bits on and off hard drives for granted, and they only work for a few years max--cells operate on an entirely different scale of information transfer and yet some multicellular organisms live for centuries.
Unfortunately, I don't think you could improve the error checking mechanisms in our cells without fundamentally redesigning a lot of how we work. It would be interesting to try to add more "parity" mechanisms besides the complementary base pairing, which is used by most of the repair enzymes. From an evolutionary standpoint, no species would ever naturally develop perfect DNA replication because it would halt diversification, which is needed to survive continually changing environmental threats.
I should also add that it's a misconception that every cell in our body has the exact same DNA. That's only a half-decent approximation. In reality, a lot of our cells accumulate trivial mutations and it's OK. Some cells even rely on editing their own DNA to perform their primary function: that includes the B and T cells [1] which the cancer in the OP arise from.
My gut feeling is that the final cure for cancer (and by extension aging and other diseases) will come about through a much simpler mechanism (more basic I mean, not easier), more in line with engineering than medicine. They’ll need to be able to systematically map any type of cell in the body and trigger its death, then insert a replacement cell at that site or coerce the body into doing it. It may not be possible with just our immune systems because it’s an area that evolution overlooked and we just don’t have the genes and cellular machinery for it.
I’m really skeptical that we’ll have nanobots to do that anytime in the foreseeable future, but, there are tons of other options like engineered viruses or chromosomes that don’t seem nearly as far-fetched. If we forget about medicine for a moment and just think about the fact that the compressed human genome fits on a CD, then the mutations in a cancer cell are going to be much smaller than that, potentially small enough that they can be encoded as something akin to lisp programs. They could find markers from a cancer cell in the lab, and then evolve genes to recognize them and tag or kill the cells with genetic algorithms in a computer. When we hear about engineered viruses killing the people they were meant to treat, I think that happens because humans just can’t program something like that manually. It has to be evolved over generations to take into account countless factors that might not occur to us.
To me, that kind of simulation is straightforward. It’s just another big data problem, and we need better sequencing so that patients can get loaded into a computer cheaply. Once a solution has been evolved with a high degree of certainty (like thousands of times the confidence level of anything today), and has a reliable cutoff switch, then synthesizing that becomes “just an engineering problem”.
TL;DR: We need github for medicine so that all of the tools in the arsenal can be recruited as external libraries and simulations can be run in a distributed fashion by hackers who handily find solutions to any problem that’s thrown at them but can’t be bothered to obtain medical degrees.
Once cure exists - the real cure, meaning no single cell is left from original cancer that survived the latest 'cure' to then pass its genes to its progeny (which is maybe impossible, who can say) - there is no risk to adaptation to the cure.
Now, I can imagine scenarios when this would not hold - for instance vertical genetic transfer to different hosts via some infectious vector but that is probably highly improbable.
First of all, this hypothesis is still highly contested in the literature. There are no doubt certain pathways (usually part of cell cycle regulation) that happen to be used by most cancers, but there are hundreds of genes involved in the cell cycle and we aren't even close to enumerating all the ways that it can malfunction. The fact that most cancers use similar pathways is no doubt reflective of the fact that they are the easiest pathways toward malignancy, not the only pathways.
Secondly, say we do take the top N common mechanisms and create a bulletproof inhibitor. Now your statement about convergent evolution is no longer true. Anything that kills cancer cells (excision, radiation, chemotherapy, something targeted) exerts selective pressure, and you will instead start seeing cancers that utilize the (N+1)th easiest pathway, (N+2)th, and so on. It's like trying to stop all the ways that a car could break down: possible up to a certain point, impossible in the long run.
I also contest the statement that "you are basically reverting its evolution to day 0". Germline predispositions for cancer are an important part of the disease and not selected against in a society where people have natural-born kids between 20 and 40. If there were a cure for cancer, it would probably involve genetically engineering humans that are extremely unlikely to get it (and also age very slowly, etc.). But then you are looking at a totally different kind of society.
> genetic transfer to different hosts via some infectious vector but that is probably highly improbable
This is not only probable, it is known (so far, 12% of human cancers). Viruses linked directly to cancer include HPV, EBV, HTLV, and polyomavirus [1]. A virus that causes cancer can be a very successful virus, depending on how long the infectious/replicative phase is compared to the symptomatic phase. Replicating infected host cells = more viral production = greater likelihood of survival and transmission.
There are some researchers that think that all cancer is caused by viruses that have yet to be identified. I don't think that's literally true, but we can find all kinds of remnants of ancient viruses in our genome, so in a way, they might be on to something.
You have no idea what those words mean.
This.
People need to stop thinking cancer as a single disease, but as a constellation of disease. Just like you cannot "cure" the Internet from computer viruses with a magic program, you cannot cure cancer in with an unique solution.
So, not scalable?
So...if we had considerably larger plasma donations, maybe?
This is akin to how, for example, insulin and human growth hormone are now produced; previously they also lacked scalability due to having to be sourced from cadavers.
So yes right now it's not scalable, but in the future this limitation will hopefully be corrected.
http://www.telegraph.co.uk/health/healthnews/10765132/Artifi...
Even with hybridomas?
Since you asked though, I don't think hybridomas really solve the difficulty of reconstituting a persons antibodies ex vivo. A healthy human has somewhere around a trillion different antibodies circulating. I would conservatively estimate that the research community has produced a few thousand different hybridomas since they were first described in 1975. The problem of scaling that or any other in vitro technique to the trillions seems unlikely to be solved.
Now, I get into the domain of wild speculation. What you'd really need is a single system capable of producing a nearly unlimited variety of different antibodies. The most viable option to my mind would be a transgenic mammal (let's say a goat since it's easy to get antibodies from milk) which would produce humanized antibodies. However, given the relatively small demand for such treatments, I think any such efforts are unlikely.
[1]: http://www.reuters.com/article/2014/05/15/us-health-cancer-m...
My understanding is that one of the main benefits of vaccines will be to make relapse much less likely as the stimulated immune system will eradicate any leftover cancer cells in the body.
The research might be moving fast, but access to these new treatments still moves at a glacial pace. At least for the people who need them... patients have to wait years until drug trials run their full course, even when preliminary results consistently show these treatments are effective.
One can understand why these rules and regulations are in place, but surely there's a better way of assessing the risk/benefit of prematurely approving certain treatments for diseases that will almost certainly kill (or gravely, permanently debilitate) those who suffer from them long before the drug is approved.
Speaking from personal experience dealing with this right now, it's extremely frustrating that these treatments are just out of reach because access to them is surrounded by so much red tape -- If you don't have $120k sitting in your wallet, that is.
But from what I understand the process is pretty universal so can be applied to more than one cancer type.
Medical statistics ( http://www.cancerresearchuk.org/cancer-info/cancerstats/surv... )show that overall cancer survival rates have been improving according to a linear trend - by an absolute amount of ~0.65% per year.
This would put the date at which cancer is "cured" at somewhere in the 2090s. So, are we talking about continuing this trend or surpassing it? How much of a step forward is this and is it likely to be applied trivially to other forms of cancer?
Does anybody have numbers on 10-20 year survival?
We should be saying "Is this how we will cure a cancer?"
There have been several miracle "cures" for cancer, none of them has turned out to be a miracle cure. Even the idea that cancer is not "one cause, one cure" has not been held for a long time, and was never universally held. Lymphoma was always treated differently than breast cancer, for instance.
But the more interesting point in the book, re a cure for cancer: "the only intervention ever known to reduce the aggregate mortality for a disease--any disease--at a population level was prevention. Even if other measures were chosen to evaluate our progress against cancer...it was indubitably true that prevention, as a strategy, had been neglected by the NCI in its ever-manic pursuit of cures."
In other words: cures make good headlines; we get excited by cures. But the only way to reduce the mortality rate of cancer is through prevention. Long-term we'll make more progress finding ways to prevent cancer, not cure it.
It is a fundamental principle of evolution that things that replicate faster and survive better will prevail. We are made of coordinated, replicating cells. They happen to be in a mutual "truce" to act as one organism at the expense of individual cell survival. Most cells that break the truce do badly on their own and die out. However, given enough tries at the prize, some cells will find a way to beat the system and replicate at the expense of the other cells still serving the whole body.
Some people have genetic deficiencies that give potentially malignant cells a jump start on the process. Certain environmental exposures will increase the rate of errors and therefore the frequency of tries that cells will get to become cancerous. But the outcome will always be the same; as we prolong human life through better medical care the incidence of cancer can only rise.
It would be most accurate to say that cancer is an evolutionary phenomenon that occurs between cells of a multicellular organism and causes a heterogenous group of diseases.
I understand supply and demand...but come on! We're talking about people's lives here. This just sounds like exploitation. The fact that the insurance company has to pay doesn't make it any better. Just easier to get the money.
The corporations who have billions and billions to spend on it, they need a profit motive to give someone a research budget. It's why they have the billions and billions.
It's not the only system imaginable, but it's the one we got.
Why can an Internet store convince its investors to operate at a loss, while a pharmaceutical company cannot tell its investors: "Hey guys, we're working on a freaking cancer cure for humanity, this is way bigger than space travel, so we're not going to be profitable in the near future, a'ight?".
However, the corporation (and its investors) focusing on long term profits and long term good is not incompatible with charging quadruple the price for its existing drugs. Bringing in more money faster means having more money to reinvest on R&D to research more new cures faster. In which case, double the price again if insurance companies will keep paying it.
At the end of the day those obscene profits are coming from insurance premiums spread over nearly the entire population, making it effectively a private sector tax. If that tax is, in fact, largely going to cancer research, I'm OK with it.
Of course, I'd personally prefer a public sector tax that I knew was going to research and not gold-plated fountains.
In a healthy society--at least, a healthy society that is also as wealthy as ours--the solution would be to recognize medical research as a clear public good, and reallocate some of our society's wealth to fully fund both research and production of medicines.
What we have instead is...well, we have a lot of different factors interacting. But just to name a few: we have a government that has convinced us that propping up the military-industrial complex is the most important possible use for billions of dollars, and we have private wealth concentrated in a small number of people who will fight like mother tigers against any attempt to appropriate the smallest amount of their money for the public good.
But that's all complicated and unpleasant to think about. So...hey, cancer research is expensive.
There's something wrong with a system where the primary purpose of institutions who fight disease is to make money. Super-valuable research is treated in the same way as making widgets or developing Facebook games -- all that matters is how many dollars it generates for each $100 invested. I find it simultaneously outrageous and ludicrous that the yardstick against which the CEO of Novartis will be judged is how much money the company made, not whether it cured freaking cancer.
The only diseases governments have helped us with are those addressable by public health programs (and there are quite a few of those, to be fair.) For the rest, no one has ever found a more effective funding mechanism than private industry.
On finding replacements / alternatives for our fast reducing arsenal of effective antibiotics - not so much. We are on the brink of a very scary phase in modern medicine - where antibiotics may soon become almost useless and very little is being done about it because it is not profitable.
It does seem more promising than http://en.wikipedia.org/wiki/Spontaneous_remission.
Did the other 3 die?
Most people here don't know about it, because it's in use since ~1920 in the sowjet union/russia/eastern europe and not in the west. (for example to fight bacteria, that is resistant to all antibiotics)
So yeah, hope we don't cure the common cold with a mutated virus any time soon LOL.
Damn...that must have been some industrial strength RA meds to work that fast. Plus that is quite a leap of faith even in isolation...those meds don't always drop the white cell count as expected.
If its not Remicade it is probably something in that family of therapies and would have similar quick effects against a cytokine storm.
"Any headline which ends in a question mark can be answered by the word no."
http://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines
"On paper Jimenez seems an unlikely backer for one of the most revolutionary medical breakthroughs any company has ever tried to develop. He’s a marketer by trade"
At that point I stopped reading. The answer is indeed "no."
http://en.wikipedia.org/wiki/Cancer#Causes
We need to fix our environment instead of hacking ourselves to deal with a broken one.
Cancer exists because you don't need to live to 150 years old to successfully reproduce. It costs too much from a biological perspective to prevent cancer, calories and nutrients better spent on raising children and to some extent grandchildren.
People got cancer back when the environment was pristine, they were just more likely to get eaten by the crocohippo first.
The observation is always the same: Cancer is one of the "western diseases" that starts appearing in native populations when they are exposed to colonists. And it's not just because of longer lives: people start getting cancer at higher rates at earlier ages.
Taubes blames the problem on insulin-like growth hormone that is secreted in response to high-carbohydrate foods, and creates an environment perfect for rapid cell growth. Pollan doesn't speculate on the cause, other than to say that there is something wrong with the western diet. Jaminet speculates that we will find more types of cancer are cause by infectious agents, since cell immortality and rapid reproduction is a perfect strategy for a virus and since we have found several so far: http://en.wikipedia.org/wiki/Infectious_causes_of_cancer
Galen in 2nd century AD observed cancer, and used the term "oncos" to describe it. Celsus in 1st century AD did the same, and used the term "cancer" for the first time. Hippocrates in 4th century BC described several different types of cancer and called them, generically, "carcinos" ("crab" in Greek).
Egyptian texts from at least 1600 BC, with some going back to 3000 BC, describe different cases of cancer, noting with regret: "there is no treatment".
Dinosaurs, 65 million years ago and more, suffered from various types of cancer such as hemangioma, desmoplastic fibroma, and osteoblastoma.
Cancer is, has been, and always will be the evil shadow of all multicellular life.
Please, don't take your medical and scientific information from a "liberal foodie intellectual" with a B.A. in English (not that there's anything wrong with any of these attributes in particular, they're just not qualifications to talk competently about cancer).
http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer...
http://web.archive.org/web/20110716111312/http://www.cancerd...
http://www.bordet.be/en/presentation/history/cancer_e/cancer...
http://www.academia.edu/227680/Epidemiologic_study_of_tumors...
"An interesting phenomenon has arisen during the course of multi-year studies related to the rarity of cancer in antiquity. This is of interest especially when considering that hundreds of Egyptian mummies and more than 10,000 dinosaur bones were evaluated. In contrast, the rate of cancer incidence has dramatically increased since the Industrial Revolution. The rarity of cancer in antiquity has been attributed to the lack of pollution and changes in diet and lifestyle, and most recent findings suggest that cancer may be a manmade disease (Nat Rev Cancer 10, 728–733). Thus, while a lack of adequate techniques for disease diagnosis and detection may partially explain the overall lack of cancer found during the millennia, the current cancer trends are now primarily associated with carcinogens in our modern industrialized society (Nat Rev Cancer 10, 728–733)."
I am not a fan of pseudo-scientific, moral-panicky speculations about the evils of "modern life" from the likes of Pollan et al. myself; but in this particular case, as your article explains, there is considerable evidence that cancer (standardized) prevalence was indeed much lower in pre-modern societies. Also, for some types such as colorectal cancers, some dietary habits (prevalent, as it happens, in modern societies) are very well-known and well-established risk factors, accounting for up to a 70% increase in relative risk in some studies [3].
As I said: I symphatize with your view, but be mindful of confirmation bias.
[1] Eg. controlling for age and other risk factors in the study population.
The actual causes are less well understood. One hypothesis is that we live longer, but given studies that have tracked aboriginal people who moved into cities and compared them against their native kin have shown an increase in the Western cancers, that hypothesis is weak at best. Beyond the unhealthy SAD ("standard American diet"), we also have pollutants, stressors, and who knows what else that can influence cancer.
So you're left with a slew of variables and a lot of sick people. Fifty years ago, cancer was seen as a metabolic disorder, and maybe some are. One of the largest pieces of evidence for this is cancer's inability to metabolize anything but glucose for energy. Cancers that are metabolic diseases would certainly be affected negatively by a growth-hormone-rich environment coupled with consistent access to as much blood sugar as the cancer wants.
Trying to oversimplify with "it's the bread" causes a near visceral reaction in many people, which is unfortunate, because, while it may not be the bread, the bread may be acting as Miracle Grow for the cancer. For me, I'm choosing a diet that, hopefully, won't be an energy smorgasbord for tumors.
Unhealthy eating (especially very salty/spicy/fermented foods), alcohol use, and so on also classify as environmental factors. But they are not caused by pollution or chemical-laden foods, merely bad life choices. Copious quantities of red meat isn't good, organic or no.
I don't meant to imply our bad handling of the planet causes no cancer, it certainly does. But it does not cause anywhere close to 90% of cancer cases. Not by a long shot.
The point stands. How many people consciously make an effort to prevent cancer in every aspect possible? On a personal level as much as a societal level, we're doing little to address the preventable causes of cancer. Why are so many people making so many "bad life choices"?
The wikipedia article on capsaicin links to this study as well as several others and indicates that capsaicin may have carcinogenic or anticarcinogenic properties based on several studies: http://en.wikipedia.org/wiki/Capsaicin#Effects_of_dietary_co...
You probably shouldn't be all that concerned about eating spicy food... on the other hand, if you don't smoke, you eat well, and you aren't obese, you're roughly 55-65% less likely to die of cancer: http://en.wikipedia.org/wiki/Cancer#Causes
[1]: http://www.amazon.com/Emperor-All-Maladies-Biography-Cancer/...
"Cancer is caused by both internal factors (such as inherited mutations, hormones, and immune conditions) and environmental/acquired factors (such as tobacco, diet, radiation, and infectious organisms). The link between diet and cancer is revealed by the large variation in rates of specific cancers in various countries and by the observed changes in the incidence of cancer in migrating. For example, Asians have been shown to have a 25 times lower incidence of prostate cancer and a ten times lower incidence of breast cancer than do residents of Western countries, and the rates for these cancers increase substantially after Asians migrate to the West."