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Comment by msie | Hacker News Reader

Dear Downvoter, Am I wrong?

Your comment was just unnecessary cynicism.

http://blog.ycombinator.com/new-hacker-news-guideline

"Critical thinking is good; shallow cynicism, on the other hand, adds nothing of value to the community. It is unpleasant to read and detracts from actual work. If you have something important but negative to say, that's fine, but say it in a respectful way."

https://news.ycombinator.com/newsguidelines.html

"Avoid gratuitous negativity." "Resist commenting about being downvoted. It never does any good, and it makes boring reading."

> "...and it makes boring reading."

I've always felt that this was wishful thinking on the part of the mods. Discussions about downvotes (or completely legitimate questions as to why something was downvoted) are no more boring than hundreds of other topics discussed here every day.

Your tone is misplaced. I'm an oncologist, and with no conflicts of interest I can assure you these drugs are a bona fide breakthrough.

As a lay person, its hard not to see the word "breakthrough" as essentially meaningless as its so overused. Insulin, and the polio vaccine I can see in that category... But there have been so many drugs like Avastin (which sadly I had personal experience with through my wife's cancer, which were supposed to be breakthroughs.. miracles etc... Yet, when the dust settled and more data beyond the initial company reported data came to light, it extended life expectancy by very little time.... Our oncologist was pretty good about holding expectations in check. But if we went by the company's claims, we would have been sadly disappointed through false hope, as well as the VAST majority of people who took Avastin. Or Erbitux was another. It was offered to my wife as an option... The pharma gloss used all sorts of superlatives, yet for her cancer, it would have given her an extra few weeks based on some of the studies we were able to dig up. For the kind of money spent for (in some cases) really shitty quality of life, $100k might be better spent on improved hospice care and pain control for the person.

I agree with you that the word is overused. Avastin is most certainly not a breakthrough, I don't know any oncologist that considers it as such.

I think the word is justified in this context however because the rationale behind immunotherapy is very sound, and it seems able to cure a non-negligible proportion of patients with otherwise incurable disease.

If you google "Avastin breakthrough" (remember, we lay people have far more time with Dr. google), its still touted as this miracle drug, and is even being pushed as a treatment for non colon cancers of which there is little evidence it does anything... And remember, there are oncologists / doctors who lend their name to the company PRs... Its so sad to think someone would spend $20k on a useless drug, when $20k towards supportive treatments would go such a long, long way for quality of life :( I know there are genuine big steps forward. The cancer that killed Terry Fox for example is so treatable now. And there are good and effective drugs out there, and some that are bullshit. But from the perspective out here, its difficult, sometimes very difficult to tell the real breakthroughs from marketing hype.

You're presumably referring to the 1000 mountains PhD comic (was XKCD). The difference with the immune drugs is that the immune system can recognize ~500 of the 1000 mountains (the most mutated cancers). So by getting around the immune-evasion system, the immune system can clean up most highly-mutated cancers.

URL to this? XKCD is always relevant.

Oops, it was PhD comics, not XKCD:

http://www.phdcomics.com/comics/archive.php?comicid=1162

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