5 ms·
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 ani
by 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 agoI 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.
- Ntrails 11y ago>I suspect the vast bulk of cancers are due to environmental factors or are intrinsic to the human aging process Sure. Those generalisations are super easy but don't help a pharma company to design research. Which are which? What factors are meaningful? How do I isolate them and test against them? Is there even a vague chance this research leads to a drug that I can sell for $$$? (also is there any evidence that a protein and vegetable only diet reduces the risk of cancer in a meaningful fashion?)
- tomhoward 11y agoI 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... Maybe, or maybe not. When you actually have cause to investigate this stuff deeply, as I have, it's surprising to discover how little is known about these kinds of things. If you could take 100 people of similar age and health and had them all "run eight miles a day with full pack, eat only protein and vegetables, have the mental outlook of the Buddha", and 50 developed cancer and 50 didn't, little is known about why any given person would stay healthy and another would get sick. 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. Having researched this topic in great depth, I'm now persuaded by the medical researchers like Bruce Lipton and Rudi Tanzi who assert, with solid scientific evidence, that psychology - particularly subconscious emotions - are a major factor in determining whether a person will develop or recover from serious illnesses like cancer, diabetes, Alzheimer's, MS, ALS, etc. Of course these ideas don't get much acceptance or affirmation from the majority of mainstream medical researchers, because, hey, everyone already knows that psychology and physiological health are totally independent, right? It turns out we don't actually need to be redirecting "billions" to, e.g., "psychological 'sciences'". It would suffice to let go of some of the unexamined assumptions and prejudices that prevail in the current research landscape, and pay some attention to the more open-minded researchers who are already investigating these things and coming up with promising findings.