10 ms·

Why Preventing Cancer Is Not the Priority in Drug Development

83 points by kungfudoi 11y ago

reasonattlm 11y ago
The same, often perverse, incentives operate on the potential treatment of aging. Lots of work on tinkering with end states, meaning age-related disease in advanced stages, and next to nothing on prevention, meaning periodic repair of the molecular damage that causes aging.
- netheril96 11y ago
  Really? I would think the rich are very much incentivized to fund any research that may slow down their aging (as are the poor, but they don't have enough money). When you have achieved most of the goals in your life, the remaining goal you have is perhaps to elongate that success for however longer you can. For example, several Chinese emperors, starting from the first one, were obsessed with living forever, giving tons of resources and power to "alchemists" who claimed to be able to produce medicine to keep the emperor young.
themartorana 11y ago
"There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place. That’s one of the findings from the work of Heidi Williams, an M.I.T. economics professor and recent MacArthur Foundation “genius” grant winner, who studied the problem along with Eric Budish, a University of Chicago economics professor, and Ben Roin, assistant professor of technological innovation, entrepreneurship and strategic management at M.I.T." I'm damn near 40, and the phrase "there's no money in a cure" has been around as long as I can remember. Heck, Chris Rock did a whole bit about it. [0] Is this just putting good science behind that phrase? Is there anything new here? [0] http://anonhq.com/chris-rock-on-big-pharma-no-money-in-the-cure-the-moneys-in-the-medicine/ http://anonhq.com/chris-rock-on-big-pharma-no-money-in-the-c...
- laotzu 11y ago
  It is the broken window fallacy: http://www.investopedia.com/ask/answers/08/broken-window-fallacy.asp http://www.investopedia.com/ask/answers/08/broken-window-fal...
- habitue 11y ago
  I was thinking this originally, but as I read it, it seems the referenced paper is much more narrowly focused. The idea is that the studies involved are easier to do on late-stage patients because mortality is the benchmark and people who are in an advanced stage die sooner. You find out whether it decreases mortality much quicker when the patients are closer to the end. Decreased testing time increases the time when the patent is both active and FDA approved (i.e. years they can make money on it). The usual reasoning behind "there's no money in a cure" is that you can squeeze a lot more money out by treating patients for years than by selling them a cure once. That's still a reasonable cynicism, but it's not what this paper was looking into. Edit: another way of thinking about it is that if a company is maximally evil (economically rational), they would want to research early-stage cancer treatments because that would allow them to milk the patient much longer. Even with this incentive, they still don't do it, they research treatments that are faster to verify efficacy for.
- jandrewrogers 11y ago
  There is an enormous amount of money in a cure, mitigation is mere tactical profit that you take when there is no obvious cure. The thing to remember is that, at least in the US biotech market, there are a large number of companies competing for those profits. Patients benefit immensely from mitigation research -- look at HIV. A lot of mitigation therapies were originally "cures" that did not work as well as hoped. At any point in time, patients have the choice across the spectrum of mitigations or cures. Cures are more difficult to produce but if they are available patients will choose them every time. Companies that produce mitigating medicine are counting on their ability to recoup investment before a cure materializes at some point in the future. If a cure becomes available, the value of their mitigation research goes to zero. Biomedical companies make bets that, if a disease looks particularly difficult to cure, mitigation will retain its value long enough to return a profit as a product. Most biomedical research companies are looking for cures because it allows them to do an end run around their competitors and grab most of the profits. Every biomedical company wants a cure because it completely displaces competitive mitigation strategies and therefore allows them to collect virtually all of the profits. Mitigation is the fallback position when cures fail. But biomedical research is looking for the cure that will give the a naturally monopoly position by default.
blhack 11y ago
This logic is just dumbfounding. How do the people saying stuff like this explain the existence of things like vaccines?
- coldtea 11y ago
  What about vaccines? Those are quite easy to make, and are made using existing disease-causing viruses. We know the mechanism, it applies to the whole population, and it's relatively simple and cheap to produce. The logistics are not the same with cancer preventing drugs at all.
  - dogma1138 11y ago
    Considering that there are no wide spread generic cancer prevention drugs how would you know?
    - coldtea 11y ago
      We already know that cancer is not caused by a virus (at least in the general case), so it can't be fixed in the same way as vaccines. And we've already been looking for cancer drugs for more than half a century to know that the logistics compared to vaccines are different. Let's put it this way: if they knew of a method to make cancer prevention drugs as easy and effective as vaccines, they'd have made them.
      - dogma1138 11y ago
        Nonsense there are multiple types of vaccines toxiod vaccines for example vaccinate you against toxic compounds such as snake bites. There is quite a bit of research into regressive therapeutic and preventative vaccines against cancer currently. A vaccine is a process which teaches your immune system to combat a certain condition whether it's caused by a bacteria, parasite, a virus or a toxin it doesn't matter. If you can teach your own immune system to combat cancer by either teaching it to attack certain markers, or by disabling the "stealth" mechanisms which many types of cancer use to fly under it's radar you've effectively created a vaccine. Also vaccination is one of the most logistically complicated processes in medicine they are extremely short lived require very precise refrigeration and proper administration is considerably more critical than most cancer treatments, 80-90% of the cost of vaccination programs in developed and developing countries alike go into logistics. For cancer treatments even the experimental highly specialized ones it's completely the opposite, and run of the mill treatments like chemotherapy are easily administered by medical technicians under almost any circumstances.
apsec112 11y ago
A drug to treat cancer only has to be taken by people diagnosed with that cancer, for as long as they're diagnosed with it. A drug to prevent cancer has to be taken by everyone at risk for the cancer (which might be the entire population), for as long as they're at risk (likely decades). Hence, a treatment drug can be expensive and can have some nasty side-effects, while a prevention drug would have to be cheap with minimal side-effects. That's a much tougher constraint to work under.
- danieltillett 11y ago
  Yep. This is basically the same problem we have with Alzheimer's - the people you need to treat are healthy people. The FDA just won’t let you test anything with any danger in healthy people. Since all new treatments inherently have risk it is basically impossible to give a new drug or treatment to healthy people. Even giving something like metafomin [1] where we have decades of knowledge is in practice impossible to give to healthy people. No new treatment stands a chance. 1. https://en.wikipedia.org/wiki/Metformin https://en.wikipedia.org/wiki/Metformin
Gatsky 11y ago
This isn't a great representation of the issue. Everyone loves to hate the drug companies. First of all, the basic science is lacking. The vast majority of animal models in no way resemble the normal process by which humans develop cancer. The models are designed to grow aggressive cancers extremely fast so you can test drugs rapidly, publish your paper and get the next grant. Even more than that, what actually takes place in the years before a cancer becomes clinically relevant is quite speculative. So a long term commitment to funding prevention research is needed from governments and funding bodies, because pharma can't fund this kind of basic science. The other problem is that to do a good prevention trial, you need to identify people at risk. We aren't really that good at doing this (eg we screen ALL women above the age of 50 for breast cancer, we screen EVERYONE above the age of 50 for bowel cancer). There is some debate about whether screening in this manner is actually as worth wile as it has been made out to be, because it leads to over diagnosis without a survival benefit. So you have to be careful not to design an intervention that only prevents cancer in those who weren't going to be affected by it anyway. This is why you can't use surrogate end points - at the end of the day, for prevention, mortality is what matters. Are we going to give hundreds of millions of women drug X and make them suffer niggling side effects for 20 years because it reduces the rate of diagnosis of breast cancer? Definitely not - overall mortality is what matters (and quality of life). It's not even a given that you can actually identify people at risk - some researchers think cancer is just bad luck (ie it is not predictable at all, or the predicting factors are unknowable). Even if this is wrong however, cancer risk probably involves weak effects from hundreds or even thousands of factors. We are very far from working all of this out. A drug is probably not what we want. Actually a drug is really not what we want. They are too expensive and too much effort to distribute and monitor. Drugs also always produce health inequalities within and between nations. A holistic approach to improving our health and well being would be preferable, at least incorporating nutrition, exercise and psychology. Unfortunately the nutritional, exercise and psychological sciences are not hitting home runs in that regard, which is not surprising because they miss out on the billions we spend fighting an incredibly wasteful war on cancer.
- isomorphic 11y ago
  I could run eight miles a day with full pack, eat only protein and vegetables, have the mental outlook of the Buddha--and yet still get cancer because BP poured nearly two million gallons of Corexit into the Gulf of Mexico, creating unexpected toxins in the fish I ate. If the drug companies were to provide a pill to mitigate my hypothetical cancer, I would take it. As you wrote, cancer risk probably involves effects from many factors. However, I'm not sure how redirecting "billions" to, e.g., "psychological 'sciences'" serves to reduce the incidence of cancers that are essentially environmental in origin. Healthy lifestyle only goes so far; I suspect the vast bulk of cancers are due to environmental factors or are intrinsic to the human aging process.
pinaceae 11y ago
explain HPV vaccination then. and the banning of abestos. and all anti-smoking legislation. and all other EPA regulation banning carcinogens. etc etc etc.
pessimizer 11y ago
Dean Baker's comment: If Patent Monopolies Bias Cancer Research, Why Not Have Publicly Funded Trials? http://cepr.net/blogs/beat-the-press/if-patent-monopolies-bias-cancer-research-why-not-have-publicly-funded-trials http://cepr.net/blogs/beat-the-press/if-patent-monopolies-bi...
paul_milovanov 11y ago
If there is in fact such a problem with incentives, what entity do you think might have the power to create proper incentives, and what are the odds of it happening? Or perhaps let's shelf this discussion at least until we figure out how to incentivize sustainable development of new antibiotics. In fact, one extremely effective way to reduce cancer-related mortality would be to keep ignoring the problem with antibiotics. We may not exactly like the way that plays out though.
- netcan 11y ago
  I think that's a question we would benefit greatly from answering, if we could.could markets are a powerful and useful thing. But, the longer we play this game the more gaps emerge where human and economic incentives do not meet eye to eye. If it were just a question of funding it would be solvable.
  - paul_milovanov 11y ago
    Sorry, I was kidding about "what entity". The same entity that traditionally steps in to solve the needs that otherwise are not met due to tragedy of the commons -- government. Patents, copyright protections (yes, they're screwed up now, but better than without), infrastructure like roads or postal mail historically. Just that US legislative process is spinning its wheels at the moment and for the foreseeable future.
bayesianhorse 11y ago
Well, preventing Cancer has been a priority for evolution since the first multicellular organisms arose. It's just not that easy. Developing a drug is an economically difficult thing: Spend billions for the chance to win billions. The only alternatives to big pharma in developing these drugs are big government and big charity (Gates' Foundation et al).
- sokoloff 11y ago
  Preventing cancer that prevents reproduction or hampers offspring survival is a priority for evolution. Cancer affecting the old is not strongly de-selected for by evolution.
  - bayesianhorse 11y ago
    There is no cancer which affects "the old" predominantly. The chances stay pretty much the same (with some exceptions). Also, at some age beyond 60, cancer stops being the main medical cause of death, being replaced by infections. I also don't subscribe to the theory that individuals have to procreate to boost the survival of their genes. In reality it's a bit more complex than that, and even very old people can and do contribute to the survival of their children or their close relatives.
    - kartan 11y ago
      > In reality it's a bit more complex than that, and even very old people can and do contribute to the survival of their children or their close relatives. That's true for human beings. But for most species that is not true. Maybe that's why we are better at longevity than other species (http://www.medcan.com/articles/a_finite_number_of_heart_beats/ http://www.medcan.com/articles/a_finite_number_of_heart_beat...). But we still have millions of years of evolution that say that it is better to be able to live short and intense than to be able to live long and die before achieving that of disease, predators, etc. Why nature will invest in an extreme long lifespan that is not going to happen? So for most species what happens to you as you grow old is not very important and other traits will be selected before lifespan by evolution.
memracom 11y ago
Just remember, Cancer isn't a disease. It is hundreds of different disease related to mutations in the function of cell division. Cells that don't need to divide, start dividing but the daughter cells are not the same as the parent. In order to treat Cancer with a drug, you need to identify which of the hundreds of subtypes it is and give the right drug. Either that, or give people cocktails of lots of drugs and hope that you can identify the right one before the other ones kill the patient. At this point there do not appear to be any magic bullets that will cure cancer, just lots of work and research to chip away at the problem, one subtype or one patient at a time. And cancer appears to be inherent in what we are, animals. It seems unlikely that we will be able to change what we are sufficiently to avoid cancer. No vaccines are likely. On the other hand, all the investment in Cancer research is paying off and is chipping away at this family of diseases. There are lots of reasons, not just new drugs, but some new drugs are part of the solution. Maybe the human race is at a point where we have solved all the easy problems and now have a hard slog to chip away at the rest of them, bit by bit.
randompost 11y ago
tldr; money
randompost 11y ago
tldr; money
JauntTrooper 11y ago
Preventative tools exist today that would significantly reduce the incidence rate of cancer. Much of them require lifestyle modifications and regulation, unfortunately, which is admittedly very difficult to do. Still, I suspect investment in these areas would likely have a higher return on investment than R&D into broad preventative drugs. (1) Smoking Cessation: Reducing tobacco use has a =huge= positive effect on cancer reduction - an order of magnitude higher than anything else we can do. 1 in ever 5 deaths of males over the age of 30 is due to to tobacco-induced illnesses, and a third of those are cancer [0]. Globally, 31% of men and 6% of women smoke daily. 17% of Americans are daily smokers. Over 1 billion people are projected to die due to tobacco-related illnesses in the 21st century. (2) Obesity: A recent epidemiological study found that 4% of cancer in men and 7% in women was due to obesity. It was as high as 40% for some cancers such as endometrial and esophageal adenocarcinoma [1]. (3) Alcohol/Red & Processed Meat: Consumption of alcoholic beverages is a known human carcinogen. A recent study estimated that 3.5% of all cancer deaths can be attributed to alcohol [2]. A separate study found that 3% of all cancers, including 21% of bowel cancers, was attributed to red & processed meats [3]. (4) Environmental & Occupational Hazards: The WHO estimates 19% of all cancers globally are attributable to environmental factors [4]. This includes air pollution, which likely causes 3% to 14% of all lung cancers, as well as exposure to chemicals in the workplace such as asbestos. [0] http://www.ncbi.nlm.nih.gov/books/NBK54023/ http://www.ncbi.nlm.nih.gov/books/NBK54023/ [1] http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3 http://www.cancer.gov/about-cancer/causes-prevention/risk/ob... [2] http://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet#q2 http://www.cancer.gov/about-cancer/causes-prevention/risk/al... [3] http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2015-10-27-processed-meat-causes-cancer-warns-who-report/ http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/... [4] http://www.who.int/mediacentre/factsheets/fs350/en/ http://www.who.int/mediacentre/factsheets/fs350/en/

83 points by kungfudoi 11y ago

The same, often perverse, incentives operate on the potential treatment of aging. Lots of work on tinkering with end states, meaning age-related disease in advanced stages, and next to nothing on prevention, meaning periodic repair of the molecular damage that causes aging.

netheril96 11y ago
Really? I would think the rich are very much incentivized to fund any research that may slow down their aging (as are the poor, but they don't have enough money). When you have achieved most of the goals in your life, the remaining goal you have is perhaps to elongate that success for however longer you can. For example, several Chinese emperors, starting from the first one, were obsessed with living forever, giving tons of resources and power to "alchemists" who claimed to be able to produce medicine to keep the emperor young.

themartorana 11y ago

"There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place. That’s one of the findings from the work of Heidi Williams, an M.I.T. economics professor and recent MacArthur Foundation “genius” grant winner, who studied the problem along with Eric Budish, a University of Chicago economics professor, and Ben Roin, assistant professor of technological innovation, entrepreneurship and strategic management at M.I.T." I'm damn near 40, and the phrase "there's no money in a cure" has been around as long as I can remember. Heck, Chris Rock did a whole bit about it. [0] Is this just putting good science behind that phrase? Is there anything new here? [0] http://anonhq.com/chris-rock-on-big-pharma-no-money-in-the-cure-the-moneys-in-the-medicine/ http://anonhq.com/chris-rock-on-big-pharma-no-money-in-the-c...

laotzu 11y ago
It is the broken window fallacy: http://www.investopedia.com/ask/answers/08/broken-window-fallacy.asp http://www.investopedia.com/ask/answers/08/broken-window-fal...
habitue 11y ago
I was thinking this originally, but as I read it, it seems the referenced paper is much more narrowly focused. The idea is that the studies involved are easier to do on late-stage patients because mortality is the benchmark and people who are in an advanced stage die sooner. You find out whether it decreases mortality much quicker when the patients are closer to the end. Decreased testing time increases the time when the patent is both active and FDA approved (i.e. years they can make money on it). The usual reasoning behind "there's no money in a cure" is that you can squeeze a lot more money out by treating patients for years than by selling them a cure once. That's still a reasonable cynicism, but it's not what this paper was looking into. Edit: another way of thinking about it is that if a company is maximally evil (economically rational), they would want to research early-stage cancer treatments because that would allow them to milk the patient much longer. Even with this incentive, they still don't do it, they research treatments that are faster to verify efficacy for.
jandrewrogers 11y ago
There is an enormous amount of money in a cure, mitigation is mere tactical profit that you take when there is no obvious cure. The thing to remember is that, at least in the US biotech market, there are a large number of companies competing for those profits. Patients benefit immensely from mitigation research -- look at HIV. A lot of mitigation therapies were originally "cures" that did not work as well as hoped. At any point in time, patients have the choice across the spectrum of mitigations or cures. Cures are more difficult to produce but if they are available patients will choose them every time. Companies that produce mitigating medicine are counting on their ability to recoup investment before a cure materializes at some point in the future. If a cure becomes available, the value of their mitigation research goes to zero. Biomedical companies make bets that, if a disease looks particularly difficult to cure, mitigation will retain its value long enough to return a profit as a product. Most biomedical research companies are looking for cures because it allows them to do an end run around their competitors and grab most of the profits. Every biomedical company wants a cure because it completely displaces competitive mitigation strategies and therefore allows them to collect virtually all of the profits. Mitigation is the fallback position when cures fail. But biomedical research is looking for the cure that will give the a naturally monopoly position by default.

blhack 11y ago

This logic is just dumbfounding. How do the people saying stuff like this explain the existence of things like vaccines?

coldtea 11y ago
What about vaccines? Those are quite easy to make, and are made using existing disease-causing viruses. We know the mechanism, it applies to the whole population, and it's relatively simple and cheap to produce. The logistics are not the same with cancer preventing drugs at all.
- dogma1138 11y ago
  Considering that there are no wide spread generic cancer prevention drugs how would you know?
  - coldtea 11y ago
    We already know that cancer is not caused by a virus (at least in the general case), so it can't be fixed in the same way as vaccines. And we've already been looking for cancer drugs for more than half a century to know that the logistics compared to vaccines are different. Let's put it this way: if they knew of a method to make cancer prevention drugs as easy and effective as vaccines, they'd have made them.
    - dogma1138 11y ago
      Nonsense there are multiple types of vaccines toxiod vaccines for example vaccinate you against toxic compounds such as snake bites. There is quite a bit of research into regressive therapeutic and preventative vaccines against cancer currently. A vaccine is a process which teaches your immune system to combat a certain condition whether it's caused by a bacteria, parasite, a virus or a toxin it doesn't matter. If you can teach your own immune system to combat cancer by either teaching it to attack certain markers, or by disabling the "stealth" mechanisms which many types of cancer use to fly under it's radar you've effectively created a vaccine. Also vaccination is one of the most logistically complicated processes in medicine they are extremely short lived require very precise refrigeration and proper administration is considerably more critical than most cancer treatments, 80-90% of the cost of vaccination programs in developed and developing countries alike go into logistics. For cancer treatments even the experimental highly specialized ones it's completely the opposite, and run of the mill treatments like chemotherapy are easily administered by medical technicians under almost any circumstances.

apsec112 11y ago

A drug to treat cancer only has to be taken by people diagnosed with that cancer, for as long as they're diagnosed with it. A drug to prevent cancer has to be taken by everyone at risk for the cancer (which might be the entire population), for as long as they're at risk (likely decades). Hence, a treatment drug can be expensive and can have some nasty side-effects, while a prevention drug would have to be cheap with minimal side-effects. That's a much tougher constraint to work under.

danieltillett 11y ago
Yep. This is basically the same problem we have with Alzheimer's - the people you need to treat are healthy people. The FDA just won’t let you test anything with any danger in healthy people. Since all new treatments inherently have risk it is basically impossible to give a new drug or treatment to healthy people. Even giving something like metafomin [1] where we have decades of knowledge is in practice impossible to give to healthy people. No new treatment stands a chance. 1. https://en.wikipedia.org/wiki/Metformin https://en.wikipedia.org/wiki/Metformin

Gatsky 11y ago

This isn't a great representation of the issue. Everyone loves to hate the drug companies. First of all, the basic science is lacking. The vast majority of animal models in no way resemble the normal process by which humans develop cancer. The models are designed to grow aggressive cancers extremely fast so you can test drugs rapidly, publish your paper and get the next grant. Even more than that, what actually takes place in the years before a cancer becomes clinically relevant is quite speculative. So a long term commitment to funding prevention research is needed from governments and funding bodies, because pharma can't fund this kind of basic science. The other problem is that to do a good prevention trial, you need to identify people at risk. We aren't really that good at doing this (eg we screen ALL women above the age of 50 for breast cancer, we screen EVERYONE above the age of 50 for bowel cancer). There is some debate about whether screening in this manner is actually as worth wile as it has been made out to be, because it leads to over diagnosis without a survival benefit. So you have to be careful not to design an intervention that only prevents cancer in those who weren't going to be affected by it anyway. This is why you can't use surrogate end points - at the end of the day, for prevention, mortality is what matters. Are we going to give hundreds of millions of women drug X and make them suffer niggling side effects for 20 years because it reduces the rate of diagnosis of breast cancer? Definitely not - overall mortality is what matters (and quality of life). It's not even a given that you can actually identify people at risk - some researchers think cancer is just bad luck (ie it is not predictable at all, or the predicting factors are unknowable). Even if this is wrong however, cancer risk probably involves weak effects from hundreds or even thousands of factors. We are very far from working all of this out. A drug is probably not what we want. Actually a drug is really not what we want. They are too expensive and too much effort to distribute and monitor. Drugs also always produce health inequalities within and between nations. A holistic approach to improving our health and well being would be preferable, at least incorporating nutrition, exercise and psychology. Unfortunately the nutritional, exercise and psychological sciences are not hitting home runs in that regard, which is not surprising because they miss out on the billions we spend fighting an incredibly wasteful war on cancer.

isomorphic 11y ago
I could run eight miles a day with full pack, eat only protein and vegetables, have the mental outlook of the Buddha--and yet still get cancer because BP poured nearly two million gallons of Corexit into the Gulf of Mexico, creating unexpected toxins in the fish I ate. If the drug companies were to provide a pill to mitigate my hypothetical cancer, I would take it. As you wrote, cancer risk probably involves effects from many factors. However, I'm not sure how redirecting "billions" to, e.g., "psychological 'sciences'" serves to reduce the incidence of cancers that are essentially environmental in origin. Healthy lifestyle only goes so far; I suspect the vast bulk of cancers are due to environmental factors or are intrinsic to the human aging process.

pinaceae 11y ago

explain HPV vaccination then. and the banning of abestos. and all anti-smoking legislation. and all other EPA regulation banning carcinogens. etc etc etc.

pessimizer 11y ago

Dean Baker's comment: If Patent Monopolies Bias Cancer Research, Why Not Have Publicly Funded Trials? http://cepr.net/blogs/beat-the-press/if-patent-monopolies-bias-cancer-research-why-not-have-publicly-funded-trials http://cepr.net/blogs/beat-the-press/if-patent-monopolies-bi...

paul_milovanov 11y ago

If there is in fact such a problem with incentives, what entity do you think might have the power to create proper incentives, and what are the odds of it happening? Or perhaps let's shelf this discussion at least until we figure out how to incentivize sustainable development of new antibiotics. In fact, one extremely effective way to reduce cancer-related mortality would be to keep ignoring the problem with antibiotics. We may not exactly like the way that plays out though.

netcan 11y ago
I think that's a question we would benefit greatly from answering, if we could.could markets are a powerful and useful thing. But, the longer we play this game the more gaps emerge where human and economic incentives do not meet eye to eye. If it were just a question of funding it would be solvable.
- paul_milovanov 11y ago
  Sorry, I was kidding about "what entity". The same entity that traditionally steps in to solve the needs that otherwise are not met due to tragedy of the commons -- government. Patents, copyright protections (yes, they're screwed up now, but better than without), infrastructure like roads or postal mail historically. Just that US legislative process is spinning its wheels at the moment and for the foreseeable future.

bayesianhorse 11y ago

Well, preventing Cancer has been a priority for evolution since the first multicellular organisms arose. It's just not that easy. Developing a drug is an economically difficult thing: Spend billions for the chance to win billions. The only alternatives to big pharma in developing these drugs are big government and big charity (Gates' Foundation et al).

sokoloff 11y ago
Preventing cancer that prevents reproduction or hampers offspring survival is a priority for evolution. Cancer affecting the old is not strongly de-selected for by evolution.
- bayesianhorse 11y ago
  There is no cancer which affects "the old" predominantly. The chances stay pretty much the same (with some exceptions). Also, at some age beyond 60, cancer stops being the main medical cause of death, being replaced by infections. I also don't subscribe to the theory that individuals have to procreate to boost the survival of their genes. In reality it's a bit more complex than that, and even very old people can and do contribute to the survival of their children or their close relatives.
  - kartan 11y ago
    > In reality it's a bit more complex than that, and even very old people can and do contribute to the survival of their children or their close relatives. That's true for human beings. But for most species that is not true. Maybe that's why we are better at longevity than other species (http://www.medcan.com/articles/a_finite_number_of_heart_beats/ http://www.medcan.com/articles/a_finite_number_of_heart_beat...). But we still have millions of years of evolution that say that it is better to be able to live short and intense than to be able to live long and die before achieving that of disease, predators, etc. Why nature will invest in an extreme long lifespan that is not going to happen? So for most species what happens to you as you grow old is not very important and other traits will be selected before lifespan by evolution.

memracom 11y ago

Just remember, Cancer isn't a disease. It is hundreds of different disease related to mutations in the function of cell division. Cells that don't need to divide, start dividing but the daughter cells are not the same as the parent. In order to treat Cancer with a drug, you need to identify which of the hundreds of subtypes it is and give the right drug. Either that, or give people cocktails of lots of drugs and hope that you can identify the right one before the other ones kill the patient. At this point there do not appear to be any magic bullets that will cure cancer, just lots of work and research to chip away at the problem, one subtype or one patient at a time. And cancer appears to be inherent in what we are, animals. It seems unlikely that we will be able to change what we are sufficiently to avoid cancer. No vaccines are likely. On the other hand, all the investment in Cancer research is paying off and is chipping away at this family of diseases. There are lots of reasons, not just new drugs, but some new drugs are part of the solution. Maybe the human race is at a point where we have solved all the easy problems and now have a hard slog to chip away at the rest of them, bit by bit.

randompost 11y ago

tldr; money

randompost 11y ago

tldr; money

JauntTrooper 11y ago

Preventative tools exist today that would significantly reduce the incidence rate of cancer. Much of them require lifestyle modifications and regulation, unfortunately, which is admittedly very difficult to do. Still, I suspect investment in these areas would likely have a higher return on investment than R&D into broad preventative drugs. (1) Smoking Cessation: Reducing tobacco use has a =huge= positive effect on cancer reduction - an order of magnitude higher than anything else we can do. 1 in ever 5 deaths of males over the age of 30 is due to to tobacco-induced illnesses, and a third of those are cancer [0]. Globally, 31% of men and 6% of women smoke daily. 17% of Americans are daily smokers. Over 1 billion people are projected to die due to tobacco-related illnesses in the 21st century. (2) Obesity: A recent epidemiological study found that 4% of cancer in men and 7% in women was due to obesity. It was as high as 40% for some cancers such as endometrial and esophageal adenocarcinoma [1]. (3) Alcohol/Red & Processed Meat: Consumption of alcoholic beverages is a known human carcinogen. A recent study estimated that 3.5% of all cancer deaths can be attributed to alcohol [2]. A separate study found that 3% of all cancers, including 21% of bowel cancers, was attributed to red & processed meats [3]. (4) Environmental & Occupational Hazards: The WHO estimates 19% of all cancers globally are attributable to environmental factors [4]. This includes air pollution, which likely causes 3% to 14% of all lung cancers, as well as exposure to chemicals in the workplace such as asbestos. [0] http://www.ncbi.nlm.nih.gov/books/NBK54023/ http://www.ncbi.nlm.nih.gov/books/NBK54023/ [1] http://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#q3 http://www.cancer.gov/about-cancer/causes-prevention/risk/ob... [2] http://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet#q2 http://www.cancer.gov/about-cancer/causes-prevention/risk/al... [3] http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2015-10-27-processed-meat-causes-cancer-warns-who-report/ http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/... [4] http://www.who.int/mediacentre/factsheets/fs350/en/ http://www.who.int/mediacentre/factsheets/fs350/en/