9 ms·

Every disease is a different beast, and biology is very hard to tame. We've thrown probably trillions of dollars at cancer over the past few decades, and only

Every disease is a different beast, and biology is very hard to tame. We've thrown probably trillions of dollars at cancer over the past few decades, and only in the past few years, with immuno-oncology, has there been any real hope of progress toward broad cures (there was a heady moment after Gleevec, too, but that turned out to be the exception rather than the rule). There was just a huge wave of Alzheimer's treatments that people were so hopeful might make any dent in the disease. They all failed, apparently because the breakthrough we thought we had made in understanding the disease turned out to be specious. Had the drugs made ANY improvement they'd be on the market and we'd all be bitching about how pharma "likes to make bandaids rather than cures," and that would have been a disservice to the years of toil people put into these drugs. Not every pharma actor is a good actor. But overall the space is mostly filled with scientists and doctors trying to make people healthier, and mostly failing.

DoreenMichele 9y ago
My father had Alzheimer's. He lived another 3 years after doctors announced he had six months left because my mom was a devoted wife who quit her job to take care of him. He also survived colon cancer in his late 60s for the same reason and I flew out and took care of my sister after her first mastectomy with her first round of cancer. The doctors attributed my father's survival after they wrote him off for dead to my mother's care. They interviewed her on tape and changed the practices at their clinic based on what she had to say. From what I gather, two different cancer clinics began offering patients German Penaten cream to help their surgical scars heal because that was why my father's 16 inch surgical scar did so well. I have zero reason to believe you are correct. There are some differences between different diseases. But my life's experience suggests that a) getting fed right b) getting proper care from someone who actually cares about you and c) adequate control over your environment are pretty universal beneficial, regardless of your exact diagnosis. (But I'm just a woman, so not likely to be listened to. Yes, I'm feeling pretty bitter about that at the moment.)
- TeMPOraL 9y ago
  > But my life's experience suggests that a) getting fed right b) getting proper care from someone who actually cares about you and c) adequate control over your environment are pretty universal beneficial, regardless of your exact diagnosis. Not sure what your point is. Those things are helpful, can extend healthspan a bit, but they're also completely orthogonal to medicine, and are not solutions.
  - DoreenMichele 9y ago
    Wow, completely orthogonal. So, curing Rickets and Scurvy by identifying the nutritional deficiencies behind them us totally not an advance in medicine. This explains a lot of what is wrong with medicine today. It was different when I was growing up. Doctors would treat all the kids in the family at one time so some infection didn't simply get passed around endlessly. We seem to have stopped doing that, and we wonder why drug resistance is such a problem.
    - morgante 9y ago
      It seems like you're more interested in promoting a particular worldview (see your advocacy of a "primary breadwinner") than seeking out medical solutions based on science.
    - TeMPOraL 9y ago
      I meant that in context of your entire comment tree; e.g. things like: > Things that are actually health promoting, like having a full-time parent to care for the kids and primary breadwinner, eating right, exercise etc are boring and don't make VCs rich. Correct me if I'm wrong, but I see you implying something like "why do medicine, if we could eat less 'junk food', work less and smile more instead". > curing Rickets and Scurvy by identifying the nutritional deficiencies behind then us totally not an advance in medicine That's indeed the domain of medicine. Which will tell you, "you need more nutrient $X in your diet" as a solution to the problem, instead of "eat healthier" (for values of 'healthier' determined by current fitness fashion).
      - DoreenMichele 9y ago
- jforman 9y ago
  Home care is important, but technology can make major impacts, too. Here is a Kaplan-Meier curve for statins: http://www.bmj.com/content/bmj/337/bmj.a2423/F2.large.jpg?width=800&height=600 http://www.bmj.com/content/bmj/337/bmj.a2423/F2.large.jpg?wi... That is a lot of life that these drugs have given a whole lot of people. AIDS is largely a managed disease now, thanks to therapeutics, starting with AZT. Steve Jobs thought that he needed better nutrition to manage his disease, and he was wrong. He had a chance of living a much longer life had he let medicine intervene earlier. (And I had no idea what your gender was until you mentioned it. I'm sorry that you don't feel heard.)
- new299 9y ago
  I guess there are a few issues with this: The first is, anecdotes are interesting, but is there data that supports this? It seems like there are too many variables, and that at home care may not help in all circumstances anyway. Secondly, "getting proper care from someone who actually cares about you" by which I guess you mean a family member or close friend. Is not viable is many circumstances... Finally, I guess it comes down to "what do you actually do". If it proves helpful, what can you do to promote this? Fund family member to quit their jobs to care for relations? It seems like that would be open to abuse and difficult to administer.
  - DoreenMichele 9y ago
    The US is on a very short list of countries that do not provide maternity leave and iirc it is the only country on that list that does not have the excuse that we are too poor and underdeveloped to afford it. We could start with just providing maternity leave as a small step forward here. It is a well proven model with lots of examples out there and not terribly open to abuse because you have to have a baby to get it. I would be fine if we provided parental leave for both parents when a child is born. But I would be happy with just bringing the US into the 21st century and getting on the same page as basically the rest of the planet and just starting with maternity leave. I only mention parental leave because if I don't, you can guarantee someone will accuse me of something nefarious for not explicitly stating that.
    - new299 9y ago
      I agree that parental leave is valuable (though I'd love to see data supporting this if you have it). But it seems like a very different issues that increasing health care outcomes in general.
      - DoreenMichele 9y ago
        Well, color me speechless. I don't think we have anything further to discuss.
        9y ago
- belorn 9y ago
  Getting familiar food regularly, having someone who genuinely cares about you, and having control of your environment are all medically recognized (with peer reviewed research to support it) methods to reduce stress and stress hormones. And stress is a significant factor in mortality rates. Its a major predictor for long life and health. It impacts metabolism, pain reception and recovery rates, and reduced stress in surgical patients is a universal good regardless of diagnosis. Its not a cure. It won't stop an infection or cure cancer, but the benefits are very real and has a good bit of research behind it.
xyhopguy 9y ago
To be fair though, we are really close with cancer. Like really really close. cfDNA is revolutionary for our measurements. Crispr is revolutionary for understanding. So close.
- Fomite 9y ago
  Note that it appears CRISPR will not be easy to implement in humans, thanks to some pre-existing immunities from frequently colonizing bacteria.
  - xyhopguy 9y ago
    Personally I see crispr more as a tool for functional genomics. It took like two decades to knockout all pairs of genes in yeast. With crispr I've seen people do it in a single experiment.
- jdale27 9y ago
  To be fair though, we are really close with cancer. Like really really close. cfDNA is revolutionary for our measurements. Crispr is revolutionary for understanding. So close. Just curious, on what do you base this opinion? Do you work in cancer research, or another biomedical field? These tools will definitely advance our understanding, but my feeling (as someone who worked in genomics for several years, though not in cancer) is that if you think "we are really close" to curing cancer (pardon me if I misinterpreted your statement) with these technologies, you are buying into a lot of hype around them. It's natural that that hype exists, though, given how much VC money is being poured into this area right now.
  - xyhopguy 9y ago
    can't say too much but I work on the stats side of liquid biopsy. Been in genomics (on the cs side) for the last 6 years. the encouring part to me is 1) we can predict the effect of a treatment given the tumors clonal composition, 2) we can test the effects of drugs much more quickly thx to crispr 3) easily profile a tumors composition with cfDNA. 1 and 3 imply we may be able to drive clonal evolution to a place where we can indefinitely treat patients. 2 gives us a lot more options.
tinokid 9y ago
>overall the space is mostly filled with scientists and doctors trying to make people healthier, and mostly failing. Failing flat, i.e., not making people healthier but not making them sicker either, is not a problem. Failing down, i.e. trying to make people healthier but making them sicker instead, is and has been a huge problem with modern medicine, even when done with the best of intentions. Yes, the past century has seen great progress in neutralizing infectious disease (though it is likely that the HIV epidemic itself was an "own goal" of basically iatrogenic origin [1]), but nearly everything else, including cancer, is a wash. Unfortunately, a sober analysis of the benefits and harms of actors in the medical space cannot afford to give much credit for effort or good intentions. [1] http://science.sciencemag.org/content/346/6205/21 http://science.sciencemag.org/content/346/6205/21

DoreenMichele 9y ago

My father had Alzheimer's. He lived another 3 years after doctors announced he had six months left because my mom was a devoted wife who quit her job to take care of him. He also survived colon cancer in his late 60s for the same reason and I flew out and took care of my sister after her first mastectomy with her first round of cancer. The doctors attributed my father's survival after they wrote him off for dead to my mother's care. They interviewed her on tape and changed the practices at their clinic based on what she had to say. From what I gather, two different cancer clinics began offering patients German Penaten cream to help their surgical scars heal because that was why my father's 16 inch surgical scar did so well. I have zero reason to believe you are correct. There are some differences between different diseases. But my life's experience suggests that a) getting fed right b) getting proper care from someone who actually cares about you and c) adequate control over your environment are pretty universal beneficial, regardless of your exact diagnosis. (But I'm just a woman, so not likely to be listened to. Yes, I'm feeling pretty bitter about that at the moment.)

TeMPOraL 9y ago
> But my life's experience suggests that a) getting fed right b) getting proper care from someone who actually cares about you and c) adequate control over your environment are pretty universal beneficial, regardless of your exact diagnosis. Not sure what your point is. Those things are helpful, can extend healthspan a bit, but they're also completely orthogonal to medicine, and are not solutions.
- DoreenMichele 9y ago
  Wow, completely orthogonal. So, curing Rickets and Scurvy by identifying the nutritional deficiencies behind them us totally not an advance in medicine. This explains a lot of what is wrong with medicine today. It was different when I was growing up. Doctors would treat all the kids in the family at one time so some infection didn't simply get passed around endlessly. We seem to have stopped doing that, and we wonder why drug resistance is such a problem.
  - morgante 9y ago
    It seems like you're more interested in promoting a particular worldview (see your advocacy of a "primary breadwinner") than seeking out medical solutions based on science.
  - TeMPOraL 9y ago
    I meant that in context of your entire comment tree; e.g. things like: > Things that are actually health promoting, like having a full-time parent to care for the kids and primary breadwinner, eating right, exercise etc are boring and don't make VCs rich. Correct me if I'm wrong, but I see you implying something like "why do medicine, if we could eat less 'junk food', work less and smile more instead". > curing Rickets and Scurvy by identifying the nutritional deficiencies behind then us totally not an advance in medicine That's indeed the domain of medicine. Which will tell you, "you need more nutrient $X in your diet" as a solution to the problem, instead of "eat healthier" (for values of 'healthier' determined by current fitness fashion).
    - DoreenMichele 9y ago
jforman 9y ago
Home care is important, but technology can make major impacts, too. Here is a Kaplan-Meier curve for statins: http://www.bmj.com/content/bmj/337/bmj.a2423/F2.large.jpg?width=800&height=600 http://www.bmj.com/content/bmj/337/bmj.a2423/F2.large.jpg?wi... That is a lot of life that these drugs have given a whole lot of people. AIDS is largely a managed disease now, thanks to therapeutics, starting with AZT. Steve Jobs thought that he needed better nutrition to manage his disease, and he was wrong. He had a chance of living a much longer life had he let medicine intervene earlier. (And I had no idea what your gender was until you mentioned it. I'm sorry that you don't feel heard.)
new299 9y ago
I guess there are a few issues with this: The first is, anecdotes are interesting, but is there data that supports this? It seems like there are too many variables, and that at home care may not help in all circumstances anyway. Secondly, "getting proper care from someone who actually cares about you" by which I guess you mean a family member or close friend. Is not viable is many circumstances... Finally, I guess it comes down to "what do you actually do". If it proves helpful, what can you do to promote this? Fund family member to quit their jobs to care for relations? It seems like that would be open to abuse and difficult to administer.
- DoreenMichele 9y ago
  The US is on a very short list of countries that do not provide maternity leave and iirc it is the only country on that list that does not have the excuse that we are too poor and underdeveloped to afford it. We could start with just providing maternity leave as a small step forward here. It is a well proven model with lots of examples out there and not terribly open to abuse because you have to have a baby to get it. I would be fine if we provided parental leave for both parents when a child is born. But I would be happy with just bringing the US into the 21st century and getting on the same page as basically the rest of the planet and just starting with maternity leave. I only mention parental leave because if I don't, you can guarantee someone will accuse me of something nefarious for not explicitly stating that.
  - new299 9y ago
    I agree that parental leave is valuable (though I'd love to see data supporting this if you have it). But it seems like a very different issues that increasing health care outcomes in general.
    - DoreenMichele 9y ago
      Well, color me speechless. I don't think we have anything further to discuss.
      - 9y ago
belorn 9y ago
Getting familiar food regularly, having someone who genuinely cares about you, and having control of your environment are all medically recognized (with peer reviewed research to support it) methods to reduce stress and stress hormones. And stress is a significant factor in mortality rates. Its a major predictor for long life and health. It impacts metabolism, pain reception and recovery rates, and reduced stress in surgical patients is a universal good regardless of diagnosis. Its not a cure. It won't stop an infection or cure cancer, but the benefits are very real and has a good bit of research behind it.

xyhopguy 9y ago

To be fair though, we are really close with cancer. Like really really close. cfDNA is revolutionary for our measurements. Crispr is revolutionary for understanding. So close.

Fomite 9y ago
Note that it appears CRISPR will not be easy to implement in humans, thanks to some pre-existing immunities from frequently colonizing bacteria.
- xyhopguy 9y ago
  Personally I see crispr more as a tool for functional genomics. It took like two decades to knockout all pairs of genes in yeast. With crispr I've seen people do it in a single experiment.
jdale27 9y ago
To be fair though, we are really close with cancer. Like really really close. cfDNA is revolutionary for our measurements. Crispr is revolutionary for understanding. So close. Just curious, on what do you base this opinion? Do you work in cancer research, or another biomedical field? These tools will definitely advance our understanding, but my feeling (as someone who worked in genomics for several years, though not in cancer) is that if you think "we are really close" to curing cancer (pardon me if I misinterpreted your statement) with these technologies, you are buying into a lot of hype around them. It's natural that that hype exists, though, given how much VC money is being poured into this area right now.
- xyhopguy 9y ago
  can't say too much but I work on the stats side of liquid biopsy. Been in genomics (on the cs side) for the last 6 years. the encouring part to me is 1) we can predict the effect of a treatment given the tumors clonal composition, 2) we can test the effects of drugs much more quickly thx to crispr 3) easily profile a tumors composition with cfDNA. 1 and 3 imply we may be able to drive clonal evolution to a place where we can indefinitely treat patients. 2 gives us a lot more options.

tinokid 9y ago

>overall the space is mostly filled with scientists and doctors trying to make people healthier, and mostly failing. Failing flat, i.e., not making people healthier but not making them sicker either, is not a problem. Failing down, i.e. trying to make people healthier but making them sicker instead, is and has been a huge problem with modern medicine, even when done with the best of intentions. Yes, the past century has seen great progress in neutralizing infectious disease (though it is likely that the HIV epidemic itself was an "own goal" of basically iatrogenic origin [1]), but nearly everything else, including cancer, is a wash. Unfortunately, a sober analysis of the benefits and harms of actors in the medical space cannot afford to give much credit for effort or good intentions. [1] http://science.sciencemag.org/content/346/6205/21 http://science.sciencemag.org/content/346/6205/21