3 ms·

Reading articles like this reminds me how little we know. Before we had a theory of germs (viruses and bacteria), we believed that sickness came from phlogiston

Reading articles like this reminds me how little we know. Before we had a theory of germs (viruses and bacteria), we believed that sickness came from phlogiston. This did a decent job of explaining how disease spread, but didn't do a very good job of how explaining how it originated. If you were sick, you were enveloped in a cloud of invisible nastiness, and staying away was a good way to remain healthy. Certain things, like carcasses and stinky puddles, were thought to be carriers of phlogiston. The thing that I find most interesting about the theory of phlogiston is how close it is. It's almost right, but humanity needed a fundamental shift in the way we thought about disease to actually start to solve the problems of disease. I feel like cancer is the modern form of phlogiston. It's close, but cancer is slippery enough that it's got to be wrong; I want to be clear, though, that the theory may still be useful. Now, perhaps breaking down cancer into it's distinct forms (breast cancer, skin cancer, etc.) will get us there - this approach may have led us to the discovery af germs as different types of phlogiston. But I can't help but think that our mental model for cancer is wrong.

bonoboTP 9y ago
Phlogiston theory was about fire and how it works. It was disproved with the discovery of oxygen and its role in fire. I don't know of any connection between this and theories of disease. I heard the old suspected cause of diseases like plague was so called "bad air" among other things.
- ollin 9y ago
  Yeah, I think OP confused phlogiston theory [https://en.wikipedia.org/wiki/Phlogiston_theory https://en.wikipedia.org/wiki/Phlogiston_theory] with miasma theory [https://en.wikipedia.org/wiki/Miasma_theory https://en.wikipedia.org/wiki/Miasma_theory]. The description of miasma theory by OP is more or less correct, it's just that the name is wrong.
digi_owl 9y ago
Its not so much that we know little, but that we keep making assumptions based on limited data. Assumptions that end up hampering our efforts in the long run.
mythrwy 9y ago
"All models are wrong; some models are useful. "
agumonkey 9y ago
I often wonder if there will be a massive shift in views of the world that will belittle the last 200 years.
Joeboy 9y ago
The theory of demonic possession was also not too far off the current germ theory of disease, it just turns out the demons are really little and there are lots of them.
fossuser 9y ago
I'd recommend this book: https://www.goodreads.com/book/show/7170627-the-emperor-of-all-maladies https://www.goodreads.com/book/show/7170627-the-emperor-of-a... His other book (The Gene) is also great. The current model allows drugs like Herceptin to be found that target the actual mechanism of action of a specific cancer (rather than just targeting the growth more generally)(https://www.amazon.com/Her-2-Making-Herceptin-Revolutionary-Treatment/dp/0812991842 https://www.amazon.com/Her-2-Making-Herceptin-Revolutionary-...). Models can always be improved, but there's a lot of evidence that the current model is on the right path. I suspect two likely futures for general cancer 'cures'. Both require sequencing the cancer of the patient and then determining which set of growth related mutations it has (thankfully there aren't an infinite amount). Then you either give them a tailored drug cocktail that either inhibits or activates those specific areas (that you need to take forever like herceptin) or you use something like CRISPR to edit the code directly. Both of these methods require sequencing to be inexpensive and 'precision' medicine. Both methods are also vulnerable to future mutations. (Also Phlogiston was attempting to explain fire, not sickness: https://en.wikipedia.org/wiki/Phlogiston_theory https://en.wikipedia.org/wiki/Phlogiston_theory)
toufka 9y ago
I don't think it's our model of 'cancer' that is wrong - we can recreate it in lab, we know quite a bit about it, even though it's extraordinarily disingenuous to call it a single thing. Our model for developing drugs is stuck. Small molecules were unbelievably (literally) useful against invaders of our bodies. They can discriminate and interupt vital processes of one biology without effecting another's biology. This made the development of small molecule drugs in the 20th century against bacteria, fungi, and even some viruses verry effective. Cancer is you. There is no biologically 'other' one can use as a discriminant that doesn't apply equally somewhere else in you. Socially we've built an entire pharmaceutical industry whose talents are focused entirely on a methodology for finding 'interruptors' of foreign disease. And again, that is not cancer. Look the the new CAR-T therapies for cures to cancer. They disrupt the pharmaceutical industry's methodologies in thier development. There can't be a tox test or a primate study. They are fundamentally customizable, cheap, and curative, but they are the injection of genetically modified immune cells containing invented and designed protein tools - not small molecules. There is literally not yet a vocabulary to distinguish these new therapies from the drugs of the 20th century. They are as distinct from drugs as vaccines - but have literally only been tested on a few hundred people, being approved by the FDA only in the past two months.
- L_Rahman 9y ago
  Hi /u/toufka, do you have any papers or summaries of CAR-T you'd recommend? The first-level Google results are all PR-heavy so I'm hoping you can share something more granular and explanatory.
  - pas 9y ago
    https://www.cancer.gov/about-cancer/treatment/research/car-t-cells https://www.cancer.gov/about-cancer/treatment/research/car-t... https://www.reddit.com/r/medicine/comments/6x6q6v/fda_approves_novartis_car_tcell_therapy_for/ https://www.reddit.com/r/medicine/comments/6x6q6v/fda_approv... https://www.reddit.com/r/Futurology/comments/6wqtc8/mass_general_team_reports_first_complete/ https://www.reddit.com/r/Futurology/comments/6wqtc8/mass_gen...
  - toufka 9y ago

bonoboTP 9y ago

Phlogiston theory was about fire and how it works. It was disproved with the discovery of oxygen and its role in fire. I don't know of any connection between this and theories of disease. I heard the old suspected cause of diseases like plague was so called "bad air" among other things.

ollin 9y ago
Yeah, I think OP confused phlogiston theory [https://en.wikipedia.org/wiki/Phlogiston_theory https://en.wikipedia.org/wiki/Phlogiston_theory] with miasma theory [https://en.wikipedia.org/wiki/Miasma_theory https://en.wikipedia.org/wiki/Miasma_theory]. The description of miasma theory by OP is more or less correct, it's just that the name is wrong.

digi_owl 9y ago

Its not so much that we know little, but that we keep making assumptions based on limited data. Assumptions that end up hampering our efforts in the long run.

mythrwy 9y ago

"All models are wrong; some models are useful. "

agumonkey 9y ago

I often wonder if there will be a massive shift in views of the world that will belittle the last 200 years.

Joeboy 9y ago

The theory of demonic possession was also not too far off the current germ theory of disease, it just turns out the demons are really little and there are lots of them.

fossuser 9y ago

I'd recommend this book: https://www.goodreads.com/book/show/7170627-the-emperor-of-all-maladies https://www.goodreads.com/book/show/7170627-the-emperor-of-a... His other book (The Gene) is also great. The current model allows drugs like Herceptin to be found that target the actual mechanism of action of a specific cancer (rather than just targeting the growth more generally)(https://www.amazon.com/Her-2-Making-Herceptin-Revolutionary-Treatment/dp/0812991842 https://www.amazon.com/Her-2-Making-Herceptin-Revolutionary-...). Models can always be improved, but there's a lot of evidence that the current model is on the right path. I suspect two likely futures for general cancer 'cures'. Both require sequencing the cancer of the patient and then determining which set of growth related mutations it has (thankfully there aren't an infinite amount). Then you either give them a tailored drug cocktail that either inhibits or activates those specific areas (that you need to take forever like herceptin) or you use something like CRISPR to edit the code directly. Both of these methods require sequencing to be inexpensive and 'precision' medicine. Both methods are also vulnerable to future mutations. (Also Phlogiston was attempting to explain fire, not sickness: https://en.wikipedia.org/wiki/Phlogiston_theory https://en.wikipedia.org/wiki/Phlogiston_theory)

toufka 9y ago

I don't think it's our model of 'cancer' that is wrong - we can recreate it in lab, we know quite a bit about it, even though it's extraordinarily disingenuous to call it a single thing. Our model for developing drugs is stuck. Small molecules were unbelievably (literally) useful against invaders of our bodies. They can discriminate and interupt vital processes of one biology without effecting another's biology. This made the development of small molecule drugs in the 20th century against bacteria, fungi, and even some viruses verry effective. Cancer is you. There is no biologically 'other' one can use as a discriminant that doesn't apply equally somewhere else in you. Socially we've built an entire pharmaceutical industry whose talents are focused entirely on a methodology for finding 'interruptors' of foreign disease. And again, that is not cancer. Look the the new CAR-T therapies for cures to cancer. They disrupt the pharmaceutical industry's methodologies in thier development. There can't be a tox test or a primate study. They are fundamentally customizable, cheap, and curative, but they are the injection of genetically modified immune cells containing invented and designed protein tools - not small molecules. There is literally not yet a vocabulary to distinguish these new therapies from the drugs of the 20th century. They are as distinct from drugs as vaccines - but have literally only been tested on a few hundred people, being approved by the FDA only in the past two months.

L_Rahman 9y ago
Hi /u/toufka, do you have any papers or summaries of CAR-T you'd recommend? The first-level Google results are all PR-heavy so I'm hoping you can share something more granular and explanatory.
- pas 9y ago
  https://www.cancer.gov/about-cancer/treatment/research/car-t-cells https://www.cancer.gov/about-cancer/treatment/research/car-t... https://www.reddit.com/r/medicine/comments/6x6q6v/fda_approves_novartis_car_tcell_therapy_for/ https://www.reddit.com/r/medicine/comments/6x6q6v/fda_approv... https://www.reddit.com/r/Futurology/comments/6wqtc8/mass_general_team_reports_first_complete/ https://www.reddit.com/r/Futurology/comments/6wqtc8/mass_gen...
- toufka 9y ago