11 ms·

When Cancer Was Conquerable

102 points by apsec112 8y ago

babkayaga 8y ago
To summarize: two proposals: 1. Once drugs have passed Phase I trials ... prescribe them 2. repeal ... a provision that requires drug developers to prove a medication's efficacy How is this different from Right to Try act? https://edition.cnn.com/2018/05/30/politics/right-to-try-donald-trump/index.html https://edition.cnn.com/2018/05/30/politics/right-to-try-don...
dlojudice 8y ago
Maybe at the time, from 40's to 70's, (1) there were low hanging fruits. It's reasonable to think the discovery process has become harder and (2) we didn't know much about how a fast clinical trial could go wrong [1] [1] https://en.wikipedia.org/wiki/Thalidomide https://en.wikipedia.org/wiki/Thalidomide
- tyu100 8y ago
  Yes, this was a ridiculous article. In addition, the FDA actually has fast-track approval for drugs in areas with no good treatment and any drug showing exceptional efficacy will make it through the approval process very quickly.
  - TheBeardKing 8y ago
    Keep in mind Reason is a libertarian site and approaches every topic with the goal of portraying the modern government always as a roadblock with never any benefit. Every article will be totally one-sided to not mention positive aspects of any government program or agency. edit: They actually did quickly mention FDA fast-track: >There have been some moves in the right direction. Between 1992 and 2002, the FDA launched three special programs to allow for faster approval of drugs for certain serious diseases, including cancer. And current FDA Commissioner Scott Gottlieb shows at least some appetite for further reform.
    - r_smart 8y ago
      I hear Reason used to be good. My experience with it over the last three years or so is that it's mostly garbage. It's become a lot of narrative confirmation but with little quality reasoning (drink!) or evidence. I don't go there anymore if I can help it. This law could be terrible, but if that's true, it should be provable without pretending to have data (the safety ratings are the same after non-safety legislation was passed!). Then there was that one time they published an anti-first amendment screed on the website. Reason annoys the bejesus out of me.
  - sithadmin 8y ago
    >the FDA actually has fast-track approval Which probably isn't as valuable as it seems. Case in point: look at how AKAO's fast-tracked antibiotic got slammed by the FDA.
sofon 8y ago
> One proposal, developed by American economist Bartley Madden, is "free-to-choose medicine." Once drugs have passed Phase I trials demonstrating safety, doctors would be able to prescribe them... > > More radically, it might be possible to repeal the 1962 Kefauver-Harris amendment to the Federal Food, Drug, and Cosmetic Act, a provision that requires drug developers to prove a medication's efficacy (rather than just its safety) before it can receive FDA approval. Personally I'd be in favour of letting seriously ill people try whatever they want. However I would not be in favour of allowing companies to charge for drugs which had not yet been proved effective. Providing drugs for free might give companies more data to help develop (or potentially prove safety, efficacy) but generating revenue here is too open to abuse.
- dithering 8y ago
  That's.... extremely sensible. A lot like not allowing a market for human organs.
  - nybble41 8y ago
    There is nothing sensible about not allowing a market for human organs, unless your goal is to ensure a shortage of organs.
    - dithering 8y ago
      You should look up where most of our medical teaching skeletons come from.
- HarryHirsch 8y ago
  One proposal, developed by American economist Bartley Madden, is "free-to-choose medicine." Physicians are extremely serious about medical ethics, and lawyers are very conscientious about conflicts of interest. What is wrong with the economic profession, that they talk and talk without any real-world considerations. We saw why Theranos tried to sidestep FDA authority, and with that experience fresh in mind that fellow wants to abolish efficicacy testing. Here, have some homeopathic globuli!
HarryHirsch 8y ago
What is the author even talking about, saying there is no progress in cancer therapy? Hanahan doesn't even mention immunology in the "Hallmarks of Cancer" (that's an influential review article from 2000), and less than ten years later it's a huge field of research, with several very powerful drugs in the clinic.
- tmikaeld 8y ago
  There's quite a lot of quite shocking results with Immunotherapy Research when it comes to Cancer. Which a lot of holistic doctors have picked up on and some clinics even treat cancer patients in. Like this clinic in Japan: https://www.saisei-mirai.or.jp https://www.saisei-mirai.or.jp who have published several studies and papers on their treatments. But yeah, why is it being ignored?
  - HarryHirsch 8y ago
    Immunotherapy isn't ignored at all. There are two small-molecule IDO inhibitors in clinical use, I think, some biologics as well, and the efficiency of CAR T-cell therapy is just staggering.
    - tmikaeld 8y ago
      I mean of course, ignored in the article, not in general.
      - HarryHirsch 8y ago
        Well, the article is not deliberative, it's polemics. Polemics has a point, it raises awareness, just compare Stallman's attitude to Linus' practicality (it helps if you turn out to be right), but there's sufficient awareness of the libertarian viewpoint already. So I wish they'd just stop, they are tiresome.
        CryptoPunk 8y ago
        First of all, the article mentioned immunotherapy. It'd help if people actually read articles before criticizing them. Second, the stakes are extremely high when we choose a particular economic path, so extensive discussion about every facet of economics, including the economic effect of regulatory intervention, is warranted. The population is not widely aware of the consequences of regulatory intervention, or even the fact that the economy is becoming more regulated over time (how often do you hear about the "since Reagan, we've tried neoliberalism" trope). The reason the number of healthcare administrators has increased 3,200 percent since 1970 (compared to an increase of 150 percent in physicians) is the growing number of regulations in healthcare: https://www.athenahealth.com/insight/expert-forum-rise-and-rise-healthcare-administrator https://www.athenahealth.com/insight/expert-forum-rise-and-r... Or take the example given from the article, of the cost of clinical trials increasing 12.2 percent per year (inflation-adjusted) in the 1980s, up from 7.3 percent in the 1970s. These are important enough issues to warrant extensive critical discussion. Libertarians may be wrong (though I don't think they are), but the discussion that has been had around these subjects is not commensurate with the stakes involved, so it's good thing if libertarian polemics attract more attention and discussion to them.
tlear 8y ago
It is quite incredible just how clueless we are about human biology, cancer and related things on the fundamental level. Like a bunch of cavemen staring sky and imagining a bear and wondering why some light move around unlike others.
- xamuel 8y ago
  Don't know why people are downvoting you. I did my postdoc at a biomedical research institute at a prestigious university, and you're 100% right. The work I was doing was related to using ontologies to label anatomical parts. Forget "staring at the sky and imagining a bear", that would be tremendous progress if the cavemen actually agreed on one common word, "bear"!
michaelbuckbee 8y ago
The HPV Vaccine (and consequent drop in cervical cancer rates - [1]) certainly seems like an improvement. Similarly, the near fanatical application of sunscreen, reduction in cancer causing chemicals, etc. I would have thought would have brought the cancer rate down as well. 1 - https://www.sciencealert.com/the-hpv-vaccine-has-halved-cervical-cancer-rates-in-the-past-10-years https://www.sciencealert.com/the-hpv-vaccine-has-halved-cerv...
- beat 8y ago
  HPV vaccine isn't just preventing cancer. I have a rare and potentially fatal condition - HPV warts growing on my vocal cords. I need laser surgery on my vocal cords a few times a year to keep talking, and ultimately to keep breathing. It's really rare, though... 1.6 adult cases per 100k, and about twice that many child cases (doctors generally believe it's passed during childbirth). Children die from it because it goes undiagnosed, with doctors treating it as bronchitis, when the only actual treatment is specialist surgery. At any rate, I totally applaud the rise of HPV vaccine. No one should have to deal with this crap.
agumonkey 8y ago
Told that to oncologist, got vaporized. It's a tough moral issue, lack of regulation = deaths, too much regulation = deaths.
- nybble41 8y ago
  > lack of regulation = deaths, too much regulation = deaths lack of regulation = people make their own choices, take risks, and sometimes suffer the consequences too much regulation = people die because you killed them Freedom comes with risk, even at times the risk of death. It is not your place to decide how much risk other people are allowed to take.
  - agumonkey 8y ago
    Exactly how I feel about this, with the added bonus of white-coat syndrom. If some doctor says 'you are dead' then why fight.
EamonnMR 8y ago
My understanding is that they won't approve a cancer drug unless it's strictly as or more effective than existing drugs, even if it's efficacy to side effect ratio is more favorable.
axus 8y ago
The article could have done a post-mortem of the 20-year taxol approval. It sounds obviously wrong, but I'd like to know how it could be done right. Cancer can be very complex, and treatment based on assumptions can shorten lives and kill fertility when another treatment would have been appropriate. A webcomic author updated their blog about their experience: https://www.erfworld.com/blog/view/60504/rob-lindas-1st-anniversary https://www.erfworld.com/blog/view/60504/rob-lindas-1st-anni...
anovikov 8y ago
I think the whole reason why cancer deaths aren't receding as fast as we'd like them to is exactly that heart disease deaths, and violent deaths (anything from murder to suicide to a car accident) are receding quickly. Therefore, people live longer, and get cancer with higher probability.
- TheBeardKing 8y ago
  Right, it would make much more sense to talk about cancer diagnosis or survivability by a certain age, like 50 or 60. By 70-90 most people have been exposed to so many carcinogens the likelihood of some sort of cancer is near guaranteed.
  - beat 8y ago
    It's not even carcinogens. Cellular decay is a thing. As we age, our genetics start breaking down due to imperfect copying. Cancer is basically just bugs in DNA's software.
scott_s 8y ago
> More radically, it might be possible to repeal the 1962 Kefauver-Harris amendment to the Federal Food, Drug, and Cosmetic Act, a provision that requires drug developers to prove a medication's efficacy (rather than just its safety) before it can receive FDA approval. Since this more stringent authorization process was enacted, the average number of new drugs greenlighted per year has dropped by more than half, while the death rate from drug toxicity stayed constant. The additional regulation has produced stagnation, in other words, with no upside in terms of improved safety. If that were to happen, we can expect that the drug market would become like the supplement market: full of pseudo-science and products that do nothing. Right now, supplement makers are prohibited from making specific medical claims; they can say something like "gives you energy," but they can't say "cures cancer." The only reason they don't is because they legally can't. (And even then they sometimes do, and sometimes get away with it.) If they were suddenly allowed to, we would not get a flood of new drugs from the current pharmaceutical companies. We would get a flood of sugar pills from the current supplement companies. The "since" part of the paragraph is also a bit of non-sequitur. Before and after the 1962 provision, drug companies had to prove safety, so it's not a surprise the death rate from drug toxicity stayed constant. Proving efficacy is about preventing companies from exploiting the public by selling stuff that has no hope of ever working as advertised. The blind spot of proposals like this is that they assume good-faith actors acting rationally. They completely ignore bad-faith actors willing to sociopathically exploit people.
- bryanrasmussen 8y ago
  are you sure it's really a blind spot and not a bad faith proposal itself?
- raverbashing 8y ago
  I think there are deeper questions to be asked: - What is the false negative rate for currently mandated FDA mandated efficacy studies? - How can studies be improved so it identifies good/bad drug candidates better and quicker?
  - nonbel 8y ago
    >"How can studies be improved so it identifies good/bad drug candidates better and quicker?" These are not at all hard to identify, but too many people have "bought in" to the bad methods and incorrect results they generated. The main obstacle to progress in medical research is political rather than scientific. Are you willing to give up cherished beliefs like "tobacco smoke is a strong carcinogen", or "amyloid-beta causes alzheimers", to get cures for diseases?
baldfat 8y ago
Lost my son at 12 years old in 2013 (Bone Cancer) and lost my sister when she was 15 in 1996 (Brain Cancer). The fight for pediatric cancer research funding is worse. If you have a chemo for kids (All of kids cells are growing which makes it much more difficult to fight cancer) it has less side-effects and is effective for adults. If you have a new adult chemo it doesn't mean nothing for Pediatric. We went over 20+ years without one new Chemo till St. Baldrick's funded chemo for Neroblastoma came out a few years ago. Bone Cancer does have funding, from dog owners. Bone Cancer my son has hasn't had a change in survival rates in 35 years. Fortuitously people have greater hope for a cure for dogs then sick kids and are putting millions into bone cancer research and we hope that once they finally have something we can start the 10 year process of testing for kids. We wouldn't have done the trial for bone cancer. Reason is that when your in a trial you have to leave the tumor in the body so they can see the effectiveness. Bone cancer is extremely painful and is only curable through surgery. Why would anyone agree to leaving the painful hard tumor in your kids body??? My son had a 15% chance of surviving 5 years when he was diagnosed with bone cancer (It was in his whole left femur and both lungs, bone cancer for some reason grows in your lungs so you have crazy bone cells growing in your lungs). He made it past 4.5 years, but it grew into both legs, his neck, and hip and had countless surgeries, radiation and chemo and it all sucked. That the funding isn't there is a constant thought in your brain at all times. Heck American Cancer Society (Largest on the planet) gave a penny per dollar raised to pediatric cancer research and then cut funding to kids camps and family resources about 7 years ago so they could focus on adult research. They finally agreed to stop using pictures of kids sick on their fund raising efforts. So yeah it is frustrating.
- jaequery 8y ago
  stories like this makes me almost hate life. no kid and parents should suffer this way. I'm really sorry to hear about your loss, I hope you find peace and strength to get through the experience. I could only imagine what you might have went through, I'm sure it must have been real tough.
  - baldfat 8y ago
    Surprisingly, if you hang out with kids with cancer you will find them incredibly upbeat and engaged in life (Most of the time. Even people without cancer have our days). Personally these events have increased my enjoyment of life and I try to not ever take a day for granted. My faith also was increased in the midst of these difficult times. Now there is still a dent in the door frame where I punched it when I almost dropped him when he was in hospice and needed to go to the bathroom. I leave it there to remind me how mad I got and how much it sucked (We usually remember our past by remembering happy times and forgetting negative times), but for the most part it has made me a and my family better.
csours 8y ago
Bottom line up front: If you have good points, make them. Don't lie to me. Ways this article misuses statistics and history (lies): 0. Title: When Cancer was Conquerable. Response: Cancer has never been conquerable. Chemotherapy increased survival rates. Also, cancer is not a single disease. 1. "The first attempt to treat cancer in humans with chemotherapy happened within days of doctors realizing that it reduced the size of tumors in mice." Response: True, but misleading. Critical question: What treatment is being replaced? When nothing else worked, you might as well try something. Going from 0% effective treatment to 20% effective treatment is huge enough to warrant extreme risks. Going from 50% to 55% may not warrant the same risks. 2. "Cancer deaths have fallen by a total of just 5 percent since 1950." Response: Everyone will die eventually, some people die of cancer; many more people die with cancer (but not necessarily because of cancer). A better metric would be a combination of things like added years of life due to treatment and quality of life factors. 3. "It is now nearly impossible to conceive of going from a eureka moment to human testing in a few years, much less a few days." Response: Thank goodness. First, all the easy solutions have been tried. Second, if there is a reasonably, or even partially effective solution in place, the new proposal MUST at least shown to be safe - something that cannot be done in a few days. 4. "To find cures for cancer, we need novel approaches that produce dramatic results. The only way to get them is by lowering barriers to entry." Response: The only way to reproduce the dramatic results of the past is to stop treating cancer, and then replace the lack of treatment with a new treatment. Also, there is no such thing "the only way". There is "the only thing I thought of" or "this is the way I think will work" 5. "Running a clinical trial now requires getting "protocols" approved." Response: Among other things, if you just run a study and then try to find some benefit, you will ALWAYS find some benefit. 6. "The problem is clear: Despite tens of billions of dollars every year spent on research, progress in combating cancer has slowed to a snail's pace." Response: https://en.wikipedia.org/wiki/Potato_paradox https://en.wikipedia.org/wiki/Potato_paradox 7. "Years ago, a Cato Institute study estimated the loss of life resulting from FDA-related drug delays from 1962 to 1985 in the hundreds of thousands." Response: Did Cato also do a study to show lives saved by FDA (and IRB, and safety testing) drug cancellations? New drugs are not risk free. 8. "We used to think cancer was conquerable. Today, that idea is often laughed off as utopian. But there are countless reasons to believe that progress has slowed because of organizational and governmental problems, not because the disease is inherently incurable." Response: We also used to thing we'd have anti-gravity and moon bases by this point. There is also a much deeper understanding of the class of diseases known as cancer.
paulpauper 8y ago
Progress is slow because much of the long hanging fruit has been picked Cancer is much more difficult and complicated than other types of diseases Clinical trials bypass the FDA but very seldom result in cures or improved survival. It's not like people with advanced cancer are being denied experimental treatments, but the problem is for every success that gets media attention, the vast majority of these treatments do nothing or are even harmful
- nonbel 8y ago
  >"Progress is slow because much of the long hanging fruit has been picked Cancer is much more difficult and complicated than other types of diseases" Or maybe the people researching it haven't been doing a very good job and have generated a bunch of irreproducible (even in principle) results: https://news.ycombinator.com/item?id=17702380 https://news.ycombinator.com/item?id=17702380 Trying to make sense of a topic when the literature is filled with incorrect facts would be quite difficult and complicated.
bproven 8y ago
What are the options in regular (preventive maintenance ) cancer screening? Cancer is horrible and I feel like by the time we discover the cancer - when it presents itself as a symptom - it can be too late. I realize in general preventive medicine seems to be rarely practiced and medical costs are insane (especially in the US), but is it scientifically feasible to detect most cancers early if proper screening were done on a regular basis?
iooi 8y ago
> Cancer deaths have fallen by a total of just 5 percent since 1950. This is suuuuper misleading, to the point where I'm thinking that the author has an agenda. Cancer deaths is the wrong metric to use, since population is always increasing and the proportion of people getting cancer is also changing over time. You want to look at the cancer death rate instead, from 1991 to 2015 the cancer death rate decreased by 26%. It's also really important to take into account that mortality rates are _vastly_ different across different types of cancers and across genders -- in that same time period, the death rate for males with lung cancer decreased by 45%! [2] Again, this article is misleading and probably has an agenda behind it. If you want to learn more about the history of cancer treatment, The Emperor of All Maladies is a great book. [1] https://www.cancer.org/latest-news/understanding-cancer-death-rates.html https://www.cancer.org/latest-news/understanding-cancer-deat... [2] https://www.cancer.org/latest-news/facts-and-figures-2018-rate-of-deaths-from-cancer-continues-decline.html https://www.cancer.org/latest-news/facts-and-figures-2018-ra...
- simulate 8y ago
  Scott Alexander (Slatestarcodex) had a post about this earlier this month: http://slatestarcodex.com/2018/08/01/cancer-progress-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2018/08/01/cancer-progress-much-mo... The gist of the post was that cancer rates since 1990 have gone down primarily because smoking has declined, not because cancer treatment has improved.
  - iooi 8y ago
    Which isn't related to cancer death rates, which is the proportion of people who die from cancer out of the population of people that have cancer.
    - deleted 8y ago
      [deleted]
    - tyingq 8y ago
      If you assume really old people don't have higher death rates, I suppose.
psychometry 8y ago
>In 1971, three decades after Gilman's discovery, the U.S. government declared a "war on cancer." Since then, we have spent nearly $200 billion in federal money on research to defeat the disease. But we haven't gotten much bang for our buck: Cancer deaths have fallen by a total of just 5 percent since 1950. (In comparison, heart disease deaths are a third of what they were then, thanks to innovations like statins, stents, and bypass surgery.) People live a lot longer than in 1950, which gives them more years to get cancer. This is why you have to report age-diagnosis-specific outcomes and not merely incidence or prevalence.
alexandercrohde 8y ago
I'd be curious to hear why these highly experimental approaches (e.g reprogramming immune cells) can't be done in animals with cancer to vet them. However, I appreciate the spirit of constant vigilance against the lethargy of bureaucracy, even if I know nothing myself firsthand on this topic.
- mjewkes 8y ago
  >why these highly experimental approaches (e.g reprogramming immune cells) can't be done in animals with cancer They absolutely are, all the time. Animal testing is relatively cheap (esp. for mice) and widespread in biotech. It's generally hard to get an IND approval (step 1 of human testing) without successful animal tests. Animal models, unfortunately, aren't super effective at predicting human outcomes.
MisterBastahrd 8y ago
Reason is an unserious publication with an ironic name. The author of this particular article has a financial interest in pushing untested medicine on the suffering. Cancer is a catch-all for a number of different diseases (having a few similarities) that require different treatments. The author chooses to ignore the average age of the population, the size of the population, the diet of the population, and obesity within the population when pulling out statistics. The regulatory framework surrounding medical treatment and drug testing exists BECAUSE people were being harmed by untested medicine. Thalidomide is just one example.
tenYearsGone 8y ago
It’s actually really easy force research to move faster, but to do so people basically must throw caution to the wind, and gamble with the possibility of extremely unpleasant outcomes, on top of also not surviving. Being less safe is as simple as operating outside the conventional protections that regulatory bodies use, in order to safeguard ethics. If that’s not your priority, and you want to press your luck, feel free to take your chances, so long as you acknowlege your adoption of the risks that ride along with that decision. Break the law, in favor of searching places others dare not go. It’s uncharted territory, out where there’s no lifeguard. Maybe it seems timid to shy away from risk in a dire situation, but honestly, push hard enough, and I’m sure enterprising people will ignore their own safety in pursuit of impatience.
valuearb 8y ago
“In 1971, Congress passed the National Cancer Act, which established 69 geographically dispersed, NCI-designated cancer research and treatment centers. James Watson—one of the discoverers of the structure of DNA and at the time a member of the National Cancer Advisory Board—objected strenuously to the move. In fact, DeVita in his memoir remembers the Nobel winner calling the cancer centers program "a pile of shit." Watson was fired that day.” Watson didn’t understand congress rarely approves anything that durant supply pork to a majority of districts.

102 points by apsec112 8y ago

To summarize: two proposals: 1. Once drugs have passed Phase I trials ... prescribe them 2. repeal ... a provision that requires drug developers to prove a medication's efficacy How is this different from Right to Try act? https://edition.cnn.com/2018/05/30/politics/right-to-try-donald-trump/index.html https://edition.cnn.com/2018/05/30/politics/right-to-try-don...

dlojudice 8y ago

Maybe at the time, from 40's to 70's, (1) there were low hanging fruits. It's reasonable to think the discovery process has become harder and (2) we didn't know much about how a fast clinical trial could go wrong [1] [1] https://en.wikipedia.org/wiki/Thalidomide https://en.wikipedia.org/wiki/Thalidomide

tyu100 8y ago
Yes, this was a ridiculous article. In addition, the FDA actually has fast-track approval for drugs in areas with no good treatment and any drug showing exceptional efficacy will make it through the approval process very quickly.
- TheBeardKing 8y ago
  Keep in mind Reason is a libertarian site and approaches every topic with the goal of portraying the modern government always as a roadblock with never any benefit. Every article will be totally one-sided to not mention positive aspects of any government program or agency. edit: They actually did quickly mention FDA fast-track: >There have been some moves in the right direction. Between 1992 and 2002, the FDA launched three special programs to allow for faster approval of drugs for certain serious diseases, including cancer. And current FDA Commissioner Scott Gottlieb shows at least some appetite for further reform.
  - r_smart 8y ago
    I hear Reason used to be good. My experience with it over the last three years or so is that it's mostly garbage. It's become a lot of narrative confirmation but with little quality reasoning (drink!) or evidence. I don't go there anymore if I can help it. This law could be terrible, but if that's true, it should be provable without pretending to have data (the safety ratings are the same after non-safety legislation was passed!). Then there was that one time they published an anti-first amendment screed on the website. Reason annoys the bejesus out of me.
- sithadmin 8y ago
  >the FDA actually has fast-track approval Which probably isn't as valuable as it seems. Case in point: look at how AKAO's fast-tracked antibiotic got slammed by the FDA.

sofon 8y ago

> One proposal, developed by American economist Bartley Madden, is "free-to-choose medicine." Once drugs have passed Phase I trials demonstrating safety, doctors would be able to prescribe them... > > More radically, it might be possible to repeal the 1962 Kefauver-Harris amendment to the Federal Food, Drug, and Cosmetic Act, a provision that requires drug developers to prove a medication's efficacy (rather than just its safety) before it can receive FDA approval. Personally I'd be in favour of letting seriously ill people try whatever they want. However I would not be in favour of allowing companies to charge for drugs which had not yet been proved effective. Providing drugs for free might give companies more data to help develop (or potentially prove safety, efficacy) but generating revenue here is too open to abuse.

dithering 8y ago
That's.... extremely sensible. A lot like not allowing a market for human organs.
- nybble41 8y ago
  There is nothing sensible about not allowing a market for human organs, unless your goal is to ensure a shortage of organs.
  - dithering 8y ago
    You should look up where most of our medical teaching skeletons come from.
HarryHirsch 8y ago
One proposal, developed by American economist Bartley Madden, is "free-to-choose medicine." Physicians are extremely serious about medical ethics, and lawyers are very conscientious about conflicts of interest. What is wrong with the economic profession, that they talk and talk without any real-world considerations. We saw why Theranos tried to sidestep FDA authority, and with that experience fresh in mind that fellow wants to abolish efficicacy testing. Here, have some homeopathic globuli!

HarryHirsch 8y ago

What is the author even talking about, saying there is no progress in cancer therapy? Hanahan doesn't even mention immunology in the "Hallmarks of Cancer" (that's an influential review article from 2000), and less than ten years later it's a huge field of research, with several very powerful drugs in the clinic.

tmikaeld 8y ago
There's quite a lot of quite shocking results with Immunotherapy Research when it comes to Cancer. Which a lot of holistic doctors have picked up on and some clinics even treat cancer patients in. Like this clinic in Japan: https://www.saisei-mirai.or.jp https://www.saisei-mirai.or.jp who have published several studies and papers on their treatments. But yeah, why is it being ignored?
- HarryHirsch 8y ago
  Immunotherapy isn't ignored at all. There are two small-molecule IDO inhibitors in clinical use, I think, some biologics as well, and the efficiency of CAR T-cell therapy is just staggering.
  - tmikaeld 8y ago
    I mean of course, ignored in the article, not in general.
    - HarryHirsch 8y ago
      Well, the article is not deliberative, it's polemics. Polemics has a point, it raises awareness, just compare Stallman's attitude to Linus' practicality (it helps if you turn out to be right), but there's sufficient awareness of the libertarian viewpoint already. So I wish they'd just stop, they are tiresome.
      - CryptoPunk 8y ago
        First of all, the article mentioned immunotherapy. It'd help if people actually read articles before criticizing them. Second, the stakes are extremely high when we choose a particular economic path, so extensive discussion about every facet of economics, including the economic effect of regulatory intervention, is warranted. The population is not widely aware of the consequences of regulatory intervention, or even the fact that the economy is becoming more regulated over time (how often do you hear about the "since Reagan, we've tried neoliberalism" trope). The reason the number of healthcare administrators has increased 3,200 percent since 1970 (compared to an increase of 150 percent in physicians) is the growing number of regulations in healthcare: https://www.athenahealth.com/insight/expert-forum-rise-and-rise-healthcare-administrator https://www.athenahealth.com/insight/expert-forum-rise-and-r... Or take the example given from the article, of the cost of clinical trials increasing 12.2 percent per year (inflation-adjusted) in the 1980s, up from 7.3 percent in the 1970s. These are important enough issues to warrant extensive critical discussion. Libertarians may be wrong (though I don't think they are), but the discussion that has been had around these subjects is not commensurate with the stakes involved, so it's good thing if libertarian polemics attract more attention and discussion to them.

tlear 8y ago

It is quite incredible just how clueless we are about human biology, cancer and related things on the fundamental level. Like a bunch of cavemen staring sky and imagining a bear and wondering why some light move around unlike others.

xamuel 8y ago
Don't know why people are downvoting you. I did my postdoc at a biomedical research institute at a prestigious university, and you're 100% right. The work I was doing was related to using ontologies to label anatomical parts. Forget "staring at the sky and imagining a bear", that would be tremendous progress if the cavemen actually agreed on one common word, "bear"!

michaelbuckbee 8y ago

The HPV Vaccine (and consequent drop in cervical cancer rates - [1]) certainly seems like an improvement. Similarly, the near fanatical application of sunscreen, reduction in cancer causing chemicals, etc. I would have thought would have brought the cancer rate down as well. 1 - https://www.sciencealert.com/the-hpv-vaccine-has-halved-cervical-cancer-rates-in-the-past-10-years https://www.sciencealert.com/the-hpv-vaccine-has-halved-cerv...

beat 8y ago
HPV vaccine isn't just preventing cancer. I have a rare and potentially fatal condition - HPV warts growing on my vocal cords. I need laser surgery on my vocal cords a few times a year to keep talking, and ultimately to keep breathing. It's really rare, though... 1.6 adult cases per 100k, and about twice that many child cases (doctors generally believe it's passed during childbirth). Children die from it because it goes undiagnosed, with doctors treating it as bronchitis, when the only actual treatment is specialist surgery. At any rate, I totally applaud the rise of HPV vaccine. No one should have to deal with this crap.

agumonkey 8y ago

Told that to oncologist, got vaporized. It's a tough moral issue, lack of regulation = deaths, too much regulation = deaths.

nybble41 8y ago
> lack of regulation = deaths, too much regulation = deaths lack of regulation = people make their own choices, take risks, and sometimes suffer the consequences too much regulation = people die because you killed them Freedom comes with risk, even at times the risk of death. It is not your place to decide how much risk other people are allowed to take.
- agumonkey 8y ago
  Exactly how I feel about this, with the added bonus of white-coat syndrom. If some doctor says 'you are dead' then why fight.

EamonnMR 8y ago

My understanding is that they won't approve a cancer drug unless it's strictly as or more effective than existing drugs, even if it's efficacy to side effect ratio is more favorable.

axus 8y ago

The article could have done a post-mortem of the 20-year taxol approval. It sounds obviously wrong, but I'd like to know how it could be done right. Cancer can be very complex, and treatment based on assumptions can shorten lives and kill fertility when another treatment would have been appropriate. A webcomic author updated their blog about their experience: https://www.erfworld.com/blog/view/60504/rob-lindas-1st-anniversary https://www.erfworld.com/blog/view/60504/rob-lindas-1st-anni...

anovikov 8y ago

I think the whole reason why cancer deaths aren't receding as fast as we'd like them to is exactly that heart disease deaths, and violent deaths (anything from murder to suicide to a car accident) are receding quickly. Therefore, people live longer, and get cancer with higher probability.

TheBeardKing 8y ago
Right, it would make much more sense to talk about cancer diagnosis or survivability by a certain age, like 50 or 60. By 70-90 most people have been exposed to so many carcinogens the likelihood of some sort of cancer is near guaranteed.
- beat 8y ago
  It's not even carcinogens. Cellular decay is a thing. As we age, our genetics start breaking down due to imperfect copying. Cancer is basically just bugs in DNA's software.

scott_s 8y ago

> More radically, it might be possible to repeal the 1962 Kefauver-Harris amendment to the Federal Food, Drug, and Cosmetic Act, a provision that requires drug developers to prove a medication's efficacy (rather than just its safety) before it can receive FDA approval. Since this more stringent authorization process was enacted, the average number of new drugs greenlighted per year has dropped by more than half, while the death rate from drug toxicity stayed constant. The additional regulation has produced stagnation, in other words, with no upside in terms of improved safety. If that were to happen, we can expect that the drug market would become like the supplement market: full of pseudo-science and products that do nothing. Right now, supplement makers are prohibited from making specific medical claims; they can say something like "gives you energy," but they can't say "cures cancer." The only reason they don't is because they legally can't. (And even then they sometimes do, and sometimes get away with it.) If they were suddenly allowed to, we would not get a flood of new drugs from the current pharmaceutical companies. We would get a flood of sugar pills from the current supplement companies. The "since" part of the paragraph is also a bit of non-sequitur. Before and after the 1962 provision, drug companies had to prove safety, so it's not a surprise the death rate from drug toxicity stayed constant. Proving efficacy is about preventing companies from exploiting the public by selling stuff that has no hope of ever working as advertised. The blind spot of proposals like this is that they assume good-faith actors acting rationally. They completely ignore bad-faith actors willing to sociopathically exploit people.

bryanrasmussen 8y ago
are you sure it's really a blind spot and not a bad faith proposal itself?
raverbashing 8y ago
I think there are deeper questions to be asked: - What is the false negative rate for currently mandated FDA mandated efficacy studies? - How can studies be improved so it identifies good/bad drug candidates better and quicker?
- nonbel 8y ago
  >"How can studies be improved so it identifies good/bad drug candidates better and quicker?" These are not at all hard to identify, but too many people have "bought in" to the bad methods and incorrect results they generated. The main obstacle to progress in medical research is political rather than scientific. Are you willing to give up cherished beliefs like "tobacco smoke is a strong carcinogen", or "amyloid-beta causes alzheimers", to get cures for diseases?

baldfat 8y ago

Lost my son at 12 years old in 2013 (Bone Cancer) and lost my sister when she was 15 in 1996 (Brain Cancer). The fight for pediatric cancer research funding is worse. If you have a chemo for kids (All of kids cells are growing which makes it much more difficult to fight cancer) it has less side-effects and is effective for adults. If you have a new adult chemo it doesn't mean nothing for Pediatric. We went over 20+ years without one new Chemo till St. Baldrick's funded chemo for Neroblastoma came out a few years ago. Bone Cancer does have funding, from dog owners. Bone Cancer my son has hasn't had a change in survival rates in 35 years. Fortuitously people have greater hope for a cure for dogs then sick kids and are putting millions into bone cancer research and we hope that once they finally have something we can start the 10 year process of testing for kids. We wouldn't have done the trial for bone cancer. Reason is that when your in a trial you have to leave the tumor in the body so they can see the effectiveness. Bone cancer is extremely painful and is only curable through surgery. Why would anyone agree to leaving the painful hard tumor in your kids body??? My son had a 15% chance of surviving 5 years when he was diagnosed with bone cancer (It was in his whole left femur and both lungs, bone cancer for some reason grows in your lungs so you have crazy bone cells growing in your lungs). He made it past 4.5 years, but it grew into both legs, his neck, and hip and had countless surgeries, radiation and chemo and it all sucked. That the funding isn't there is a constant thought in your brain at all times. Heck American Cancer Society (Largest on the planet) gave a penny per dollar raised to pediatric cancer research and then cut funding to kids camps and family resources about 7 years ago so they could focus on adult research. They finally agreed to stop using pictures of kids sick on their fund raising efforts. So yeah it is frustrating.

jaequery 8y ago
stories like this makes me almost hate life. no kid and parents should suffer this way. I'm really sorry to hear about your loss, I hope you find peace and strength to get through the experience. I could only imagine what you might have went through, I'm sure it must have been real tough.
- baldfat 8y ago
  Surprisingly, if you hang out with kids with cancer you will find them incredibly upbeat and engaged in life (Most of the time. Even people without cancer have our days). Personally these events have increased my enjoyment of life and I try to not ever take a day for granted. My faith also was increased in the midst of these difficult times. Now there is still a dent in the door frame where I punched it when I almost dropped him when he was in hospice and needed to go to the bathroom. I leave it there to remind me how mad I got and how much it sucked (We usually remember our past by remembering happy times and forgetting negative times), but for the most part it has made me a and my family better.

csours 8y ago

Bottom line up front: If you have good points, make them. Don't lie to me. Ways this article misuses statistics and history (lies): 0. Title: When Cancer was Conquerable. Response: Cancer has never been conquerable. Chemotherapy increased survival rates. Also, cancer is not a single disease. 1. "The first attempt to treat cancer in humans with chemotherapy happened within days of doctors realizing that it reduced the size of tumors in mice." Response: True, but misleading. Critical question: What treatment is being replaced? When nothing else worked, you might as well try something. Going from 0% effective treatment to 20% effective treatment is huge enough to warrant extreme risks. Going from 50% to 55% may not warrant the same risks. 2. "Cancer deaths have fallen by a total of just 5 percent since 1950." Response: Everyone will die eventually, some people die of cancer; many more people die with cancer (but not necessarily because of cancer). A better metric would be a combination of things like added years of life due to treatment and quality of life factors. 3. "It is now nearly impossible to conceive of going from a eureka moment to human testing in a few years, much less a few days." Response: Thank goodness. First, all the easy solutions have been tried. Second, if there is a reasonably, or even partially effective solution in place, the new proposal MUST at least shown to be safe - something that cannot be done in a few days. 4. "To find cures for cancer, we need novel approaches that produce dramatic results. The only way to get them is by lowering barriers to entry." Response: The only way to reproduce the dramatic results of the past is to stop treating cancer, and then replace the lack of treatment with a new treatment. Also, there is no such thing "the only way". There is "the only thing I thought of" or "this is the way I think will work" 5. "Running a clinical trial now requires getting "protocols" approved." Response: Among other things, if you just run a study and then try to find some benefit, you will ALWAYS find some benefit. 6. "The problem is clear: Despite tens of billions of dollars every year spent on research, progress in combating cancer has slowed to a snail's pace." Response: https://en.wikipedia.org/wiki/Potato_paradox https://en.wikipedia.org/wiki/Potato_paradox 7. "Years ago, a Cato Institute study estimated the loss of life resulting from FDA-related drug delays from 1962 to 1985 in the hundreds of thousands." Response: Did Cato also do a study to show lives saved by FDA (and IRB, and safety testing) drug cancellations? New drugs are not risk free. 8. "We used to think cancer was conquerable. Today, that idea is often laughed off as utopian. But there are countless reasons to believe that progress has slowed because of organizational and governmental problems, not because the disease is inherently incurable." Response: We also used to thing we'd have anti-gravity and moon bases by this point. There is also a much deeper understanding of the class of diseases known as cancer.

paulpauper 8y ago

Progress is slow because much of the long hanging fruit has been picked Cancer is much more difficult and complicated than other types of diseases Clinical trials bypass the FDA but very seldom result in cures or improved survival. It's not like people with advanced cancer are being denied experimental treatments, but the problem is for every success that gets media attention, the vast majority of these treatments do nothing or are even harmful

nonbel 8y ago
>"Progress is slow because much of the long hanging fruit has been picked Cancer is much more difficult and complicated than other types of diseases" Or maybe the people researching it haven't been doing a very good job and have generated a bunch of irreproducible (even in principle) results: https://news.ycombinator.com/item?id=17702380 https://news.ycombinator.com/item?id=17702380 Trying to make sense of a topic when the literature is filled with incorrect facts would be quite difficult and complicated.

bproven 8y ago

What are the options in regular (preventive maintenance ) cancer screening? Cancer is horrible and I feel like by the time we discover the cancer - when it presents itself as a symptom - it can be too late. I realize in general preventive medicine seems to be rarely practiced and medical costs are insane (especially in the US), but is it scientifically feasible to detect most cancers early if proper screening were done on a regular basis?

iooi 8y ago

> Cancer deaths have fallen by a total of just 5 percent since 1950. This is suuuuper misleading, to the point where I'm thinking that the author has an agenda. Cancer deaths is the wrong metric to use, since population is always increasing and the proportion of people getting cancer is also changing over time. You want to look at the cancer death rate instead, from 1991 to 2015 the cancer death rate decreased by 26%. It's also really important to take into account that mortality rates are _vastly_ different across different types of cancers and across genders -- in that same time period, the death rate for males with lung cancer decreased by 45%! [2] Again, this article is misleading and probably has an agenda behind it. If you want to learn more about the history of cancer treatment, The Emperor of All Maladies is a great book. [1] https://www.cancer.org/latest-news/understanding-cancer-death-rates.html https://www.cancer.org/latest-news/understanding-cancer-deat... [2] https://www.cancer.org/latest-news/facts-and-figures-2018-rate-of-deaths-from-cancer-continues-decline.html https://www.cancer.org/latest-news/facts-and-figures-2018-ra...

simulate 8y ago
Scott Alexander (Slatestarcodex) had a post about this earlier this month: http://slatestarcodex.com/2018/08/01/cancer-progress-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2018/08/01/cancer-progress-much-mo... The gist of the post was that cancer rates since 1990 have gone down primarily because smoking has declined, not because cancer treatment has improved.
- iooi 8y ago
  Which isn't related to cancer death rates, which is the proportion of people who die from cancer out of the population of people that have cancer.
  - deleted 8y ago
    [deleted]
  - tyingq 8y ago
    If you assume really old people don't have higher death rates, I suppose.

psychometry 8y ago

>In 1971, three decades after Gilman's discovery, the U.S. government declared a "war on cancer." Since then, we have spent nearly $200 billion in federal money on research to defeat the disease. But we haven't gotten much bang for our buck: Cancer deaths have fallen by a total of just 5 percent since 1950. (In comparison, heart disease deaths are a third of what they were then, thanks to innovations like statins, stents, and bypass surgery.) People live a lot longer than in 1950, which gives them more years to get cancer. This is why you have to report age-diagnosis-specific outcomes and not merely incidence or prevalence.

alexandercrohde 8y ago

I'd be curious to hear why these highly experimental approaches (e.g reprogramming immune cells) can't be done in animals with cancer to vet them. However, I appreciate the spirit of constant vigilance against the lethargy of bureaucracy, even if I know nothing myself firsthand on this topic.

mjewkes 8y ago
>why these highly experimental approaches (e.g reprogramming immune cells) can't be done in animals with cancer They absolutely are, all the time. Animal testing is relatively cheap (esp. for mice) and widespread in biotech. It's generally hard to get an IND approval (step 1 of human testing) without successful animal tests. Animal models, unfortunately, aren't super effective at predicting human outcomes.

MisterBastahrd 8y ago

Reason is an unserious publication with an ironic name. The author of this particular article has a financial interest in pushing untested medicine on the suffering. Cancer is a catch-all for a number of different diseases (having a few similarities) that require different treatments. The author chooses to ignore the average age of the population, the size of the population, the diet of the population, and obesity within the population when pulling out statistics. The regulatory framework surrounding medical treatment and drug testing exists BECAUSE people were being harmed by untested medicine. Thalidomide is just one example.

tenYearsGone 8y ago

It’s actually really easy force research to move faster, but to do so people basically must throw caution to the wind, and gamble with the possibility of extremely unpleasant outcomes, on top of also not surviving. Being less safe is as simple as operating outside the conventional protections that regulatory bodies use, in order to safeguard ethics. If that’s not your priority, and you want to press your luck, feel free to take your chances, so long as you acknowlege your adoption of the risks that ride along with that decision. Break the law, in favor of searching places others dare not go. It’s uncharted territory, out where there’s no lifeguard. Maybe it seems timid to shy away from risk in a dire situation, but honestly, push hard enough, and I’m sure enterprising people will ignore their own safety in pursuit of impatience.

valuearb 8y ago

“In 1971, Congress passed the National Cancer Act, which established 69 geographically dispersed, NCI-designated cancer research and treatment centers. James Watson—one of the discoverers of the structure of DNA and at the time a member of the National Cancer Advisory Board—objected strenuously to the move. In fact, DeVita in his memoir remembers the Nobel winner calling the cancer centers program "a pile of shit." Watson was fired that day.” Watson didn’t understand congress rarely approves anything that durant supply pork to a majority of districts.