forgotpwagain

Microfluidics is a sexy field. About ten years ago, it was nearing the peak of its first hype peak. This brought a lot of attention to the field and corresponded to the first time people started talking about precision medicine and "lifestyle" diagnostic tools.

Theranos was at the right time with a very intriguing idea, but one that was ultimately not a model for reality. They were able to get lots of capital at this time in preparation to develop a product that ultimately never materialized (and more fundamentally, may not be physically possible).

Computing will help. But we also need new fundamental technologies that get us information that old methods from molecular biology miss. DNA sequencing isn't everything--we need to be able to look at ALL of the biomolecules within an organism and their dynamics.

A lot of this is front-loaded in the 4 years of undergraduate training, 4 years of medical school, and 4-6 years of residency training that physicians do.

Physicians are trained to preload all possible diagnoses based on a certain set of initial symptoms--they have ideas about what the potential answer might be when you inform them of their symptoms, but in order to narrow that space down, additional workup needs to be performed (tests, imaging, etc) and until those results come back, anything else they say is speculation.

(edited, fixed a typo)

I'm curious what the effects of my seeing lots of TV ads during my childhood are. I honestly can't remember specific ads very well, but I'm sure that seeing thousands of soundbites glorifying instant gratification must have had some sort of an effect on me.

I will note that Siddhartha Mukherjee is also the author the _The Emperor of All Maladies_, perhaps the greatest popular science book on cancer that is scientifically and historically accurate and very engaging. I highly recommend it (and will be picking up this book on the basis of Dr. Mukherjee's previous work).

I'm not an expert, but I think there's been a variety of attempts for vascular renormalization--to restore the normal flow of vessels to allow for drug delivery, etc. Rakesh Jain's lab (at MGH) is a big player in this field and is worth looking up if you're interested.

I'm not personally familiar with work in developing capillary devices, but it wouldn't surprise me at all if this was an approach under development--it certainly makes a lot of sense.

Sure--you won't be able to get every tumor. But there are certain markers that are more common than others, so if you can get the top ~10 done within reasonable measures of safety, you could prevent a nontrivial number of cancers.

There are a handful of embryonic proteins that are normally expressed during development but are absent in the adult that are particularly promising. One of the hallmarks of cancer is dedifferentiation--losing specific markers and function and looking more and more like a stem cell that can continue to replicate, and these embryonic proteins are known to be reexpressed in many tumors.

The method by which vaccinations work is immunological. I think the most exciting frontier in cancer biology is prophylactic (preventative) vaccination. If we are able to develop effective vaccines against cancers, that will very much change the game.

This is currently a research frontiers area--but in 10-20 years, I believe that we will have made significant inroads on it.

In general, blood cancers are more accessible than solid tumors. With blood cancers, the majority of the cancer cells are in the blood or in very well perfused tissues (bone marrow, spleen, thymus, etc), meaning that drugs/treatments can get to the targets very easily.

With solid tumors, you have to deal with the complexities of the tumor microenvironment. The tumor microenvironment is the complex environment of the cancer tumor tissue. Of particular note, decreased lymphatic drainage, increased connective tissue, and aberrant angiogenesis (growth of new blood vessels) create very high interstitial fluid pressures within the tumor, limiting the ability of drugs or cells to penetrate within the tumor and "work their magic" by reaching the cells/target molecules of interest, etc.

Blood cancers are a good proof-of-principle for many cancer therapies; translation to solid tumors is difficult (see challenges with CAR-T cell immunotherapy).

As for gene manipulation in blood--yes, it is relatively easy to manipulate genes in blood. Hematopoetic Stem Cells (which differentiate into all different kinds of blood cells) can be withdrawn without too much difficulty, manipulated in the lab, and then reinjected into the patient.

I seem to recall it being that one's risk of lung cancer due to smoking drops to being very close to a non-smoker's risk after refraining from smoking for 10 years.

Other damage is certainly done to the lungs that can cause other issues--emphysema, cardiovascular problems, etc--but the risk from the "scariest" threat out there is greatly diminished.

I would argue that the best engineers focus on themselves quite a bit--they just focus on improving themselves and their strengths and weaknesses instead of their relative ranking among others.