13 ms·

Cancer medicine generates enormous revenues but marginal benefits for patients?

186 points by jwblackwell 7y ago

stewbrew 7y ago
Well, this is one side of the discussion. While I agree to some extent, the author should also answer the question whether he honestly thinks he would have been better off 90 years ago if some cancer got detected with him in, say, 2 weeks from now (such things usually happen really fast). You can of course take the stance that 90 years ago that cancer would have been misdiagnosed and left untreated and that 90 years ago he would have probably died of something else before that cancer would have got lethal. I personally rather prefer having the cancer cut out as soon as possible. Also some arguments are not honest. It's right that e.g. most dead men have some form of undiagnosed prostate cancer, which they didn't notice. But screening programs usually are not designed for e.g. 90 years old people for who it probably doesn't make that much of a difference whether an early stage cancer gets diagnosed. Screening programs usually are for younger people who will most likely get old enough to benefit from an early diagnosis.
- hannob 7y ago
  > Screening programs usually are for younger people who will most likely get old enough to benefit from an early diagnosis. You say "likely". But the problem is you don't have evidence. Noone has shown that these screening programs do have these benefits [1]. If they have I don't think anyone would argue with that. The tricky issue is: Actually showing the benefits of these screening programs is hard. It requires large-scale studies with longterm followup. It's expensive. But it nevertheless should be done. [1] https://www.bmj.com/content/352/bmj.h6080 https://www.bmj.com/content/352/bmj.h6080
  - Retric 7y ago
    People have done studies like you propose, but long term studies always lag improvements in treatment. You can’t see 20 year mortality statistics for 2020’s cancer treatment options until 2040. CDC supports screening for breast, cervical, colorectal (colon), and lung cancers Screening for ovarian, pancreatic, prostate, testicular, and thyroid cancers has not been shown to reduce deaths from those cancers. The USPSTF found insufficient evidence to assess the balance of benefits and harms of screening for bladder cancer and oral cancer in adults without symptoms, and of visual skin examination by a doctor to screen for skin cancerexternal icon in adults. https://www.cdc.gov/cancer/dcpc/prevention/screening.htm https://www.cdc.gov/cancer/dcpc/prevention/screening.htm PS: Showing differences in overall mortality based on differences in treatment for an uncommon disease requires truly massive study’s. Failing to show a correlation is expected with noisy data and insufficient sample sizes.
    - stewbrew 7y ago
      The problem also is that diagnosis doesn't stop progressing. Today's opponents to cancer screening often argue with data from the 1990s. On the other hand proponents often refer to data of underpowered, badly designed trials. Also, there exists no real guideline as to what would be "sufficient evidence". How much better would the survival of screening participants would have to be? In exchange, how much pain may be inflicted on people who get false-positive results. This discussion is extremely difficult. And once you are in the situation that you or somebody close to you get's diagnosed with cancer, it becomes really difficult to deal with arguments like: "On average the whole population does not benefit from you having diagnosed your cancer early so that after some small surgery, you'll continue living as if nothing had happened."
- throwawaylolx 7y ago
  >the author should also answer the question whether he honestly thinks he would have been better off 90 years ago if some cancer got detected with him in, say, 2 weeks from now (such things usually happen really fast). No, the hypothetical situation in your question misses the gist of the article: the hypothetical situation should still be in present day but with much less funds having been spent on cancer research.
  - stewbrew 7y ago
    You don't get good cancer diagnosis without funding. You don't get neoadjuvant therapies without funding.
mft_ 7y ago
I was really hoping for a strong conclusion to this article - a powerful answer to the obvious question of 'so what now?'. After all, the author has just spent a lot of words tearing down the (generally well-meaning) attempts of scientists (and others) to prolong the lives of people who are diagnosed with cancer. But all we get at the end is "Conservative cancer medicine, as I envision it, would engage in less testing, treatment, fear-mongering, military-style rhetoric and hype. It would recognize the limits of medicine, and it would honor the Hippocratic oath: First, do no harm.". Fuckin' really? No details, no data, no actual suggestion (or idea?) of how to actually implement this? No analysis of how (or even whether) this will help people? And of course, let's ignore the fundamental hypocrisy here: having just spent an article discussing how shit doctors (apparently) are at doing the best thing for their patients, he apparently wants doctors to be the ones in control of this new, 'do less' approach? Fucking clueless clickbait blog nonsense - the Scientific American should be ashamed that this made it through their editorial process as is. - Also, let's examine these two sections: "But one study found that 72 new anticancer drugs approved by the FDA between 2004 and 2014 prolonged survival for an average of 2.1 months. A 2017 report concluded that “most cancer drug approvals have not been shown to, or do not, improve clinically relevant end points,” including survival and quality of life. Medical conservatives happily adopt new therapies “when the benefit is clear and the evidence strong and unbiased,” the authors emphasize, but many alleged advances “offer, at best, marginal benefits.”" Who, exactly, is going to serve as the judge and jury for what constitutes a sufficient improvement in clinically relevant endpoints? Should that role be given to "medical conservatives" - i.e. people who the author thinks are more trustworthy than people who disagree with him? (PS I fully understand the application of cost:benefit analyses to new drugs - and maybe this is a direction that the US needs to go. But note that the author's conclusion section didn't even touch on this as an option.)
- keanzu 7y ago
  The authors worried that “the FDA may be approving many costly, toxic drugs that do not improve overall survival.” I don't think they purport to serve as or appoint anyone to serve as judge and jury for "sufficient" improvement. The concern is the approval of drugs which provide no improvement.
Damorian 7y ago
As someone who works in healthcare, I don't disagree with the entire sentiment here, with the exception of screening. In my opinion, it would be simpler and more cost effective to monitor cancerous and precancerous indicators rather than immediately go for surgery/treatment. Most people probably freak out if you tell them they have a golf ball sized growth on their kidney though.
- fredgrott 7y ago
  Yeah, but we are still missing those inputs form the previous life years that lead to cancer, ie exposure to chemicals through work, diet, etc as its the environmental load that matters here combined with the genetics profile of course
- loceng 7y ago
  And then to take it one step further: focusing on prevention and being proactive, which may require more research funding, however that no one can or is widespread promoting a solid set of known practices to reduce cancer is a problem.
  - smt88 7y ago
    > however that no one can or is widespread promoting a solid set of known practices to reduce cancer is a problem My friend at American Cancer Society would take issue with that statement. He flies all over the world educating public health officials about how to fight tobacco use. Tobacco by itself is a huge cause of preventable cancers. The next big one is sun exposure, so ACS also promotes proper sunscreen use (and avoidance of tanning beds). The ones caused by genes and random mutations are also a large percentage, but you can't teach people how to avoid those. People should get radon tests in their home as well. Most lung cancer is either due to tobacco or radon. After that, there isn't much advice specific to cancer: eat moderately and exercise.
    - nonbel 7y ago
      There is a skin cancer pandemic since health authorities started warning people to avoid the sun. It is found mostly in people who avoid/block the sun and not eg people who work outside everyday. https://www.ncbi.nlm.nih.gov/pubmed/20231499 https://www.ncbi.nlm.nih.gov/pubmed/20231499 https://www.ncbi.nlm.nih.gov/pubmed/20541680 https://www.ncbi.nlm.nih.gov/pubmed/20541680 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694089/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694089/ Also, tobacco smoke seems to be an exceptionally weak carcinogen. It is near impossible to get it to cause cancer in animals (while eg, radioactive dust easily does so). Think about it, people expose themselves almost 24 hrs per day for decades and still less than 25% get lung cancer. https://www.ncbi.nlm.nih.gov/pubmed/15765916 https://www.ncbi.nlm.nih.gov/pubmed/15765916 https://www.ncbi.nlm.nih.gov/pubmed/29370344 https://www.ncbi.nlm.nih.gov/pubmed/29370344
inviromentalist 7y ago
Ive seen medical attempt to sell me extra services within their hospital network with my kid. 2000$ to fix Tongue Tie with surgery. Laser procedure is 600$ and done at a dentist. The ($200-300k/yr) physician said there was data surgery is better. So I looked it up, no data, and surgeons started using laser because it heals better. Upon confronting she said- if you ask a physician they will recommend a physician. (So factionalism?) Why is this nonscience acceptable in medical? On a different note, hospitals somehow get patients for non hospital needs.(disclaimer my wife owns her own practice and competes) For instance if you go to a hospital for physical therapy, you will likely have 1 Dr for at least 2 patients. You get 37 minutes of treatment because they can legally bill for 1 hour. At my wife's clinic, she treats 1 on 1, and sometimes sessions go over 1 hour. There are no advantages of a hospital for this care. I'm not sure if overregulation or lack of patient information is to blame. I'm horrified at the thought of being sick and dealing with our medical cartels.
- SuoDuanDao 7y ago
  This would be in the US I presume? Proponents of single payer focus a lot on the issues with insurance taking profits, but I think the real problem with capitalist medicine is that the skills needed for selling medical procedures and helping patients heal are not really compatible. Doctors being forced to sell their own services creates a perverse incentive towards the most expensive procedures, which unfortunately are often also the most risky.
  - Hnrobert42 7y ago
    That person is likely not in the US. We put the $ before the digits.
    - stillherebitch 7y ago
      What do you mean, "not likely in the U.S."? Didn't you hear their perfectly accurate description of the typical selfish, greedy doctor, whose only real concern is making money and not the patient's health? Sounds exactly like a thousand another similar anecdotes I've heard from a thousand different people.
jaked89 7y ago
Cancer is not a disease, but a state of overall body deterioration. You can't fix it; only the body can fix itself. Stop attacking it with carbs and plant oils, and give it the fuel it needs: unprocessed animal protein and fat.
- tsherr 7y ago
  Is this based on fact it opinion?
  - jaked89 7y ago
    The entire medical field is based on opinion and wizardry. We're sicker and weaker than ever. I've healed myself from various conditions by going carnivore. Take it or leave it.
    - gus_massa 7y ago
      There is a lot of snake oil, from crackpot websites to overhyped university press release. Anyway, two clear points where medicine work: https://en.wikipedia.org/wiki/Penicillin https://en.wikipedia.org/wiki/Penicillin https://en.wikipedia.org/wiki/Smallpox#Eradication https://en.wikipedia.org/wiki/Smallpox#Eradication
      - deleted 7y ago
        [deleted]
      - lebuffon 7y ago
        Full disclosure: I have not read the article yet but gathered a sense of it from the comments here. I like your citations. They make me think about a recent radio interview in Canada where an MD was discussing cervical Cancer. He would not say that vaccination for HPV prevented Cervical Cancer. He would only say that it prevented pre-cancerous lesions and Cervical cancer "is never seen without pre-cancerous lesions". I can understand using scientific rigour to avoid jumping to conclusions. However it makes me wonder about Louis Pasteur and the discovery of micro-bacterial disease origins. Would he have said: "I can't say that these bacteria causes disease X but we have never seen disease X without the presence of these bacteria." ? All that to say perhaps medical research has been going down the wrong path with Cancer. We have one clear case of viral "involvement". :-) How big a stretch is it to extend research in that direction and look for more cases?
mrosett 7y ago
This article is a case study in “if you say something controversial enough, people will pay attention regardless of the quality of your argument.” There’s a lot of hype in the cancer industry and there are still many diseases that can’t be treated effectively. But the bizarre claim that we aren’t any better at treating it than we were 50 years ago is just wrong. The timing is particularly ironic, coming after a decade of particularly rapid progress. The survival advantage conferred by immunotherapy is very meaningful, and it’s being used in diseases that were previously intractable. The author waves away the benefits of immunotherapy while focusing on the cost and side effects. Undoubtedly, it is expensive, and speaking from experience, the side effects aren’t fun. But the cost will come down, and the side effects are generally more manageable than chemotherapy. If I really steelman the article, I can see a couple decent points and maybe even agree with them. I might believe that aggressive screening is counterproductive, for instance. But for an article complaining about “hype”, this piece is a remarkable sequence of exaggerations, fallacies, cherry-picked data, and hand-waving.
- throwawaylolx 7y ago
  >The timing is particularly ironic, coming after a decade of particularly rapid progress. The survival advantage conferred by immunotherapy is very meaningful Can you post some resources that support this with numbers? >this piece is a remarkable sequence of exaggerations, fallacies, cherry-picked data, and hand-waving. Could you point me to the fallacies and exaggerations in the article?
  - mrosett 7y ago
    There are a lot of statistical fallacies like this: > The current age-adjusted mortality rate for all cancers in the U.S., 152.4 deaths per 100,000 people, is just under what it was in 1930, according to a recent analysis. The US is a very different population than it was in 1930 in ways that go beyond age. If you want to make a statement like this to point out that changes to lifestyle (e.g smoking/obesity) can totally offset medical progress, then go ahead and make that argument explicitly. But simply citing the headline mortality number to argue "LITTLE NET PROGRESS AFTER 90 YEARS" is unjustifiable. Edit: As far as evidence of efficacy, here's a more-or-less random clinical trial showing a meaningful survival benefit for melanoma patients given ipilimumab (the first cancer immuotherapy): https://clinicaltrials.gov/ct2/show/results/NCT00636168?view=results https://clinicaltrials.gov/ct2/show/results/NCT00636168?view... Note that ipilimumab is no longer the standard of care for melanoma as pembro has even higher efficacy. There are a lot more trials out there if you're inclined to spend time looking through results.
alexfromapex 7y ago
It’s the narcissistic executives that lead a decent amount of the cancer medicine companies focusing on their next round of golf or nice car. I thought medicine would be different but it’s almost the exact same.
johnpowell 7y ago
I get a 20 minute drip of Pembrolizumab every three weeks. I had it done two days ago. 28K per infusion. The cancer has spread since I have been taking it. But I don't know if the cancer is spreading slower with taking it or not. I'm 1.5 million deep in medical bills from the last year. I no longer open my mail or answer my phone. I am just waiting for the day I go in for treatment and they turn me away.
- agumonkey 7y ago
  Good luck. Just throwing this in case it can give you some hints: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410650/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410650/ (McAllister/Desprez team) endocannabinoids can affect regulation of cell proliferation which seems to slow the growth of tumors and spread of metastases In some talk, Pr Desprez showed scanned of a stage 4 woman (lung+mets) where the spread had stopped (no knowledge of her fate since, I'm not claiming miracles) If I was to fight cancer and was able to get my hands on cbd concentrates I'd try it. It's not very expensive and may help (it also improves appetite and nausea IIRC)
- stevespang 7y ago
  Hope that you put your home and all your assets in a trust for your kids before you got treatments. You can declare bankruptcy in Texas or Florida and still keep your house, but I guess that only works if you are still alive . . . after you die the medical community just files suit to steal all your assets.
- lambdaba 7y ago
  I've heard about great successes with animal based ketogenic diets, and fasting. There's a clinic in Hungary that treats and (tries to, despite apparent censorship), publish research: https://www.researchgate.net/publication/331812176_PALEOLITHIC_KETOGENIC_DIET_PKD_AS_A_STAND-ALONE_THERAPY_IN_CANCER_CASE_STUDIES https://www.researchgate.net/publication/331812176_PALEOLITH... Hope you'll find something that works, even if only augmenting your current treatment
  - swiley 7y ago
Hnrobert42 7y ago
I am disappointed in Scientific American for publishing such shoddy work. Anyone can cherry-pick one piece of evidence per point to make themselves seem well supported. That doesn’t mean they are.
jcims 7y ago
Patient schnoz blasting right on undressed port catheter? Tsk tsk.
- edwhitesell 7y ago
  I'm not in the medical field, but I never wore a mask when my port was accessed (the nurses did). Sure, less exposure is better, but could you explain further?
  - jcims 7y ago
    I'm not in the medical field either, but based on my experience patients are either asked to wear a mask or turn their head away while the port is being accessed until it's removed or there is a dressing in place. Step 7 : https://www.specialove.org/wp-content/uploads/joomla/58f-PRO_CVAD_Accessing_and_Deaccessing_Ports.pdf https://www.specialove.org/wp-content/uploads/joomla/58f-PRO...
loceng 7y ago
Watching Eric Weinstein's The Portal episode #18 yesterday - https://www.youtube.com/watch?v=QxnkGymKuuI https://www.youtube.com/watch?v=QxnkGymKuuI - where he presents the DISC (Distributed Idea Suppression Complex), made me frame this in a different way: what questions does the cancer treatment industry avoid? Why aren't all cancer companies, organizations, also researching or putting funding towards prevention? The answer is obvious to me, however why as society don't we require a sort of tax to counter (and fund) what the industry isn't aligned to do profits wise?
- stillherebitch 7y ago
  > 'Why aren't all cancer companies, organizations, also researching or putting funding towards prevention? The answer is obvious to me,' The truth is much more sinister than you imagine. Profit actually has little to do with it. The reality is, all of this cancer is caused by all of the carcinogenic chemicals that this "civilization" is exposed to daily. There is no cure, other than a complete reworking of the entire civilization from the ground up, which won't be allowed to happen. Which is exactly why they like to pretend so strongly that everything is just fine and they are "racing for the cure." It's all bullshit. THERE IS NO CURE. What they are actually "racing" to do is get their bomb shelters built and stocked with food and supplies, so they can set all of the nations of the world at war with one another while they hide away and let you apes kill each other off. What is this "we as a society" business you're talking about? Especially in regards to taxation. You think it's "society" that taxes people? No, it's the government. The same people who own the medical cartel own the government also, and the news media, and everything else. They own HN also--which is why this account isn't long for this world, just as the previous ones were quickly downvoted, flagged, and shadowbanned.
deleted 7y ago
[deleted]
dannykwells 7y ago
This article is absolute 100% bullshit. -Metastatic melanoma: used to be lethal, now 50% cure rate.[1] -Non small cell lung cancer: same, now around 25% [2, 4] -Breast cancer used to have a terrible prognisis, now 75% survive. [3] -Not to mention the myriad of blood cancers with new, strong, cell therapy treatment options with 40-50% durable cure rate. I don't know this person, but seriously, whoever he is, fuck you dude. Millions of us work day and night trying to improve care, and 99% of us arent getting rich. [1] https://www.nejm.org/doi/full/10.1056/NEJMoa1709684 https://www.nejm.org/doi/full/10.1056/NEJMoa1709684 [2] https://www.nejm.org/doi/full/10.1056/NEJMoa1801946 https://www.nejm.org/doi/full/10.1056/NEJMoa1801946 [3] https://www.breastcancer.org/research-news/20100930 https://www.breastcancer.org/research-news/20100930 4. https://investors.merck.com/news/press-release-details/2019/Five-Year-Survival-Data-for-Mercks-KEYTRUDA-pembrolizumab-in-Advanced-Non-Small-Cell-Lung-Cancer-NSCLC-from-First-KEYNOTE-Trial-at-2019-ASCO-Annual-Meeting/default.aspx https://investors.merck.com/news/press-release-details/2019/...
- mrosett 7y ago
  Thank you for writing a more concise version of what I tried to write below.
  - ianai 7y ago
    You made some very good arguments with solid information here. So much so that I flagged this article. Doesn’t seem what HN should spend its time refuting.
    - xiphias2 7y ago
      I flagged it as well an hour ago, I don't know why it's still up, probably the mods are not looking at HN right now.
    - mrosett 7y ago
      Thanks!
- nonbel 7y ago
ag56 7y ago
> if 2,000 women have mammograms over a period of 10 years, one woman’s life will be saved by a positive diagnosis. Meanwhile 10 healthy women will be treated unnecessarily, and more than 200 “will experience important psychological distress ... I have never understood this argument. I’d rather be incorrectly told I had terminal cancer 100 times over, than not be told and... die. You know what’s worse than psychological distress? Dying. You knowing what’s worse than an unnecessary surgery? Dying. This is so obvious, I struggle to understand how this “overdiagnosis” argument even got started.
- zzzcpan 7y ago
  The problem is nobody is telling you the truth or providing a way to make an informed decision. And not just because they want to take your money, but also because they themselves simply don't know how to make such decisions. They pretty much just try various things on real people to see if they work or that can confirm the hunches they have for further interventions, ignoring consequences of doing any of it. Like in your particular example, every unnecessary surgery actually increases your chances of dying during surgery or sometimes after it, not to mention the chances of crippling you forever, but you don't know what those chances exactly are and worse, you are assuming there isn't such risk, while it's crazy high. So high, that 100 times false positive rate absolutely makes it a no brainer to never undergo such diagnosis, it pretty much guarantees to make things worse for or kill a lot of people. And yet nobody will give you the numbers to make a rational decision.
  - nonbel 7y ago
    I met someone who went for a checkup and they convinced him to get a screening colonoscopy. It was clear but a few months later he started having problems and went back. Then they told him he had colon cancer caused by damage to the tissue during the colonoscopy.

186 points by jwblackwell 7y ago

Well, this is one side of the discussion. While I agree to some extent, the author should also answer the question whether he honestly thinks he would have been better off 90 years ago if some cancer got detected with him in, say, 2 weeks from now (such things usually happen really fast). You can of course take the stance that 90 years ago that cancer would have been misdiagnosed and left untreated and that 90 years ago he would have probably died of something else before that cancer would have got lethal. I personally rather prefer having the cancer cut out as soon as possible. Also some arguments are not honest. It's right that e.g. most dead men have some form of undiagnosed prostate cancer, which they didn't notice. But screening programs usually are not designed for e.g. 90 years old people for who it probably doesn't make that much of a difference whether an early stage cancer gets diagnosed. Screening programs usually are for younger people who will most likely get old enough to benefit from an early diagnosis.

hannob 7y ago
> Screening programs usually are for younger people who will most likely get old enough to benefit from an early diagnosis. You say "likely". But the problem is you don't have evidence. Noone has shown that these screening programs do have these benefits [1]. If they have I don't think anyone would argue with that. The tricky issue is: Actually showing the benefits of these screening programs is hard. It requires large-scale studies with longterm followup. It's expensive. But it nevertheless should be done. [1] https://www.bmj.com/content/352/bmj.h6080 https://www.bmj.com/content/352/bmj.h6080
- Retric 7y ago
  People have done studies like you propose, but long term studies always lag improvements in treatment. You can’t see 20 year mortality statistics for 2020’s cancer treatment options until 2040. CDC supports screening for breast, cervical, colorectal (colon), and lung cancers Screening for ovarian, pancreatic, prostate, testicular, and thyroid cancers has not been shown to reduce deaths from those cancers. The USPSTF found insufficient evidence to assess the balance of benefits and harms of screening for bladder cancer and oral cancer in adults without symptoms, and of visual skin examination by a doctor to screen for skin cancerexternal icon in adults. https://www.cdc.gov/cancer/dcpc/prevention/screening.htm https://www.cdc.gov/cancer/dcpc/prevention/screening.htm PS: Showing differences in overall mortality based on differences in treatment for an uncommon disease requires truly massive study’s. Failing to show a correlation is expected with noisy data and insufficient sample sizes.
  - stewbrew 7y ago
    The problem also is that diagnosis doesn't stop progressing. Today's opponents to cancer screening often argue with data from the 1990s. On the other hand proponents often refer to data of underpowered, badly designed trials. Also, there exists no real guideline as to what would be "sufficient evidence". How much better would the survival of screening participants would have to be? In exchange, how much pain may be inflicted on people who get false-positive results. This discussion is extremely difficult. And once you are in the situation that you or somebody close to you get's diagnosed with cancer, it becomes really difficult to deal with arguments like: "On average the whole population does not benefit from you having diagnosed your cancer early so that after some small surgery, you'll continue living as if nothing had happened."
throwawaylolx 7y ago
>the author should also answer the question whether he honestly thinks he would have been better off 90 years ago if some cancer got detected with him in, say, 2 weeks from now (such things usually happen really fast). No, the hypothetical situation in your question misses the gist of the article: the hypothetical situation should still be in present day but with much less funds having been spent on cancer research.
- stewbrew 7y ago
  You don't get good cancer diagnosis without funding. You don't get neoadjuvant therapies without funding.

mft_ 7y ago

I was really hoping for a strong conclusion to this article - a powerful answer to the obvious question of 'so what now?'. After all, the author has just spent a lot of words tearing down the (generally well-meaning) attempts of scientists (and others) to prolong the lives of people who are diagnosed with cancer. But all we get at the end is "Conservative cancer medicine, as I envision it, would engage in less testing, treatment, fear-mongering, military-style rhetoric and hype. It would recognize the limits of medicine, and it would honor the Hippocratic oath: First, do no harm.". Fuckin' really? No details, no data, no actual suggestion (or idea?) of how to actually implement this? No analysis of how (or even whether) this will help people? And of course, let's ignore the fundamental hypocrisy here: having just spent an article discussing how shit doctors (apparently) are at doing the best thing for their patients, he apparently wants doctors to be the ones in control of this new, 'do less' approach? Fucking clueless clickbait blog nonsense - the Scientific American should be ashamed that this made it through their editorial process as is. - Also, let's examine these two sections: "But one study found that 72 new anticancer drugs approved by the FDA between 2004 and 2014 prolonged survival for an average of 2.1 months. A 2017 report concluded that “most cancer drug approvals have not been shown to, or do not, improve clinically relevant end points,” including survival and quality of life. Medical conservatives happily adopt new therapies “when the benefit is clear and the evidence strong and unbiased,” the authors emphasize, but many alleged advances “offer, at best, marginal benefits.”" Who, exactly, is going to serve as the judge and jury for what constitutes a sufficient improvement in clinically relevant endpoints? Should that role be given to "medical conservatives" - i.e. people who the author thinks are more trustworthy than people who disagree with him? (PS I fully understand the application of cost:benefit analyses to new drugs - and maybe this is a direction that the US needs to go. But note that the author's conclusion section didn't even touch on this as an option.)

keanzu 7y ago
The authors worried that “the FDA may be approving many costly, toxic drugs that do not improve overall survival.” I don't think they purport to serve as or appoint anyone to serve as judge and jury for "sufficient" improvement. The concern is the approval of drugs which provide no improvement.

Damorian 7y ago

As someone who works in healthcare, I don't disagree with the entire sentiment here, with the exception of screening. In my opinion, it would be simpler and more cost effective to monitor cancerous and precancerous indicators rather than immediately go for surgery/treatment. Most people probably freak out if you tell them they have a golf ball sized growth on their kidney though.

fredgrott 7y ago
Yeah, but we are still missing those inputs form the previous life years that lead to cancer, ie exposure to chemicals through work, diet, etc as its the environmental load that matters here combined with the genetics profile of course
loceng 7y ago
And then to take it one step further: focusing on prevention and being proactive, which may require more research funding, however that no one can or is widespread promoting a solid set of known practices to reduce cancer is a problem.
- smt88 7y ago
  > however that no one can or is widespread promoting a solid set of known practices to reduce cancer is a problem My friend at American Cancer Society would take issue with that statement. He flies all over the world educating public health officials about how to fight tobacco use. Tobacco by itself is a huge cause of preventable cancers. The next big one is sun exposure, so ACS also promotes proper sunscreen use (and avoidance of tanning beds). The ones caused by genes and random mutations are also a large percentage, but you can't teach people how to avoid those. People should get radon tests in their home as well. Most lung cancer is either due to tobacco or radon. After that, there isn't much advice specific to cancer: eat moderately and exercise.
  - nonbel 7y ago
    There is a skin cancer pandemic since health authorities started warning people to avoid the sun. It is found mostly in people who avoid/block the sun and not eg people who work outside everyday. https://www.ncbi.nlm.nih.gov/pubmed/20231499 https://www.ncbi.nlm.nih.gov/pubmed/20231499 https://www.ncbi.nlm.nih.gov/pubmed/20541680 https://www.ncbi.nlm.nih.gov/pubmed/20541680 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694089/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694089/ Also, tobacco smoke seems to be an exceptionally weak carcinogen. It is near impossible to get it to cause cancer in animals (while eg, radioactive dust easily does so). Think about it, people expose themselves almost 24 hrs per day for decades and still less than 25% get lung cancer. https://www.ncbi.nlm.nih.gov/pubmed/15765916 https://www.ncbi.nlm.nih.gov/pubmed/15765916 https://www.ncbi.nlm.nih.gov/pubmed/29370344 https://www.ncbi.nlm.nih.gov/pubmed/29370344

inviromentalist 7y ago

Ive seen medical attempt to sell me extra services within their hospital network with my kid. 2000$ to fix Tongue Tie with surgery. Laser procedure is 600$ and done at a dentist. The ($200-300k/yr) physician said there was data surgery is better. So I looked it up, no data, and surgeons started using laser because it heals better. Upon confronting she said- if you ask a physician they will recommend a physician. (So factionalism?) Why is this nonscience acceptable in medical? On a different note, hospitals somehow get patients for non hospital needs.(disclaimer my wife owns her own practice and competes) For instance if you go to a hospital for physical therapy, you will likely have 1 Dr for at least 2 patients. You get 37 minutes of treatment because they can legally bill for 1 hour. At my wife's clinic, she treats 1 on 1, and sometimes sessions go over 1 hour. There are no advantages of a hospital for this care. I'm not sure if overregulation or lack of patient information is to blame. I'm horrified at the thought of being sick and dealing with our medical cartels.

SuoDuanDao 7y ago
This would be in the US I presume? Proponents of single payer focus a lot on the issues with insurance taking profits, but I think the real problem with capitalist medicine is that the skills needed for selling medical procedures and helping patients heal are not really compatible. Doctors being forced to sell their own services creates a perverse incentive towards the most expensive procedures, which unfortunately are often also the most risky.
- Hnrobert42 7y ago
  That person is likely not in the US. We put the $ before the digits.
  - stillherebitch 7y ago
    What do you mean, "not likely in the U.S."? Didn't you hear their perfectly accurate description of the typical selfish, greedy doctor, whose only real concern is making money and not the patient's health? Sounds exactly like a thousand another similar anecdotes I've heard from a thousand different people.

jaked89 7y ago

Cancer is not a disease, but a state of overall body deterioration. You can't fix it; only the body can fix itself. Stop attacking it with carbs and plant oils, and give it the fuel it needs: unprocessed animal protein and fat.

tsherr 7y ago
Is this based on fact it opinion?
- jaked89 7y ago
  The entire medical field is based on opinion and wizardry. We're sicker and weaker than ever. I've healed myself from various conditions by going carnivore. Take it or leave it.
  - gus_massa 7y ago
    There is a lot of snake oil, from crackpot websites to overhyped university press release. Anyway, two clear points where medicine work: https://en.wikipedia.org/wiki/Penicillin https://en.wikipedia.org/wiki/Penicillin https://en.wikipedia.org/wiki/Smallpox#Eradication https://en.wikipedia.org/wiki/Smallpox#Eradication
    - deleted 7y ago
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    - lebuffon 7y ago
      Full disclosure: I have not read the article yet but gathered a sense of it from the comments here. I like your citations. They make me think about a recent radio interview in Canada where an MD was discussing cervical Cancer. He would not say that vaccination for HPV prevented Cervical Cancer. He would only say that it prevented pre-cancerous lesions and Cervical cancer "is never seen without pre-cancerous lesions". I can understand using scientific rigour to avoid jumping to conclusions. However it makes me wonder about Louis Pasteur and the discovery of micro-bacterial disease origins. Would he have said: "I can't say that these bacteria causes disease X but we have never seen disease X without the presence of these bacteria." ? All that to say perhaps medical research has been going down the wrong path with Cancer. We have one clear case of viral "involvement". :-) How big a stretch is it to extend research in that direction and look for more cases?

mrosett 7y ago

This article is a case study in “if you say something controversial enough, people will pay attention regardless of the quality of your argument.” There’s a lot of hype in the cancer industry and there are still many diseases that can’t be treated effectively. But the bizarre claim that we aren’t any better at treating it than we were 50 years ago is just wrong. The timing is particularly ironic, coming after a decade of particularly rapid progress. The survival advantage conferred by immunotherapy is very meaningful, and it’s being used in diseases that were previously intractable. The author waves away the benefits of immunotherapy while focusing on the cost and side effects. Undoubtedly, it is expensive, and speaking from experience, the side effects aren’t fun. But the cost will come down, and the side effects are generally more manageable than chemotherapy. If I really steelman the article, I can see a couple decent points and maybe even agree with them. I might believe that aggressive screening is counterproductive, for instance. But for an article complaining about “hype”, this piece is a remarkable sequence of exaggerations, fallacies, cherry-picked data, and hand-waving.

throwawaylolx 7y ago
>The timing is particularly ironic, coming after a decade of particularly rapid progress. The survival advantage conferred by immunotherapy is very meaningful Can you post some resources that support this with numbers? >this piece is a remarkable sequence of exaggerations, fallacies, cherry-picked data, and hand-waving. Could you point me to the fallacies and exaggerations in the article?
- mrosett 7y ago
  There are a lot of statistical fallacies like this: > The current age-adjusted mortality rate for all cancers in the U.S., 152.4 deaths per 100,000 people, is just under what it was in 1930, according to a recent analysis. The US is a very different population than it was in 1930 in ways that go beyond age. If you want to make a statement like this to point out that changes to lifestyle (e.g smoking/obesity) can totally offset medical progress, then go ahead and make that argument explicitly. But simply citing the headline mortality number to argue "LITTLE NET PROGRESS AFTER 90 YEARS" is unjustifiable. Edit: As far as evidence of efficacy, here's a more-or-less random clinical trial showing a meaningful survival benefit for melanoma patients given ipilimumab (the first cancer immuotherapy): https://clinicaltrials.gov/ct2/show/results/NCT00636168?view=results https://clinicaltrials.gov/ct2/show/results/NCT00636168?view... Note that ipilimumab is no longer the standard of care for melanoma as pembro has even higher efficacy. There are a lot more trials out there if you're inclined to spend time looking through results.

alexfromapex 7y ago

It’s the narcissistic executives that lead a decent amount of the cancer medicine companies focusing on their next round of golf or nice car. I thought medicine would be different but it’s almost the exact same.

johnpowell 7y ago

I get a 20 minute drip of Pembrolizumab every three weeks. I had it done two days ago. 28K per infusion. The cancer has spread since I have been taking it. But I don't know if the cancer is spreading slower with taking it or not. I'm 1.5 million deep in medical bills from the last year. I no longer open my mail or answer my phone. I am just waiting for the day I go in for treatment and they turn me away.

agumonkey 7y ago
Good luck. Just throwing this in case it can give you some hints: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410650/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410650/ (McAllister/Desprez team) endocannabinoids can affect regulation of cell proliferation which seems to slow the growth of tumors and spread of metastases In some talk, Pr Desprez showed scanned of a stage 4 woman (lung+mets) where the spread had stopped (no knowledge of her fate since, I'm not claiming miracles) If I was to fight cancer and was able to get my hands on cbd concentrates I'd try it. It's not very expensive and may help (it also improves appetite and nausea IIRC)
stevespang 7y ago
Hope that you put your home and all your assets in a trust for your kids before you got treatments. You can declare bankruptcy in Texas or Florida and still keep your house, but I guess that only works if you are still alive . . . after you die the medical community just files suit to steal all your assets.
lambdaba 7y ago
I've heard about great successes with animal based ketogenic diets, and fasting. There's a clinic in Hungary that treats and (tries to, despite apparent censorship), publish research: https://www.researchgate.net/publication/331812176_PALEOLITHIC_KETOGENIC_DIET_PKD_AS_A_STAND-ALONE_THERAPY_IN_CANCER_CASE_STUDIES https://www.researchgate.net/publication/331812176_PALEOLITH... Hope you'll find something that works, even if only augmenting your current treatment
- swiley 7y ago

Hnrobert42 7y ago

I am disappointed in Scientific American for publishing such shoddy work. Anyone can cherry-pick one piece of evidence per point to make themselves seem well supported. That doesn’t mean they are.

jcims 7y ago

Patient schnoz blasting right on undressed port catheter? Tsk tsk.

edwhitesell 7y ago
I'm not in the medical field, but I never wore a mask when my port was accessed (the nurses did). Sure, less exposure is better, but could you explain further?
- jcims 7y ago
  I'm not in the medical field either, but based on my experience patients are either asked to wear a mask or turn their head away while the port is being accessed until it's removed or there is a dressing in place. Step 7 : https://www.specialove.org/wp-content/uploads/joomla/58f-PRO_CVAD_Accessing_and_Deaccessing_Ports.pdf https://www.specialove.org/wp-content/uploads/joomla/58f-PRO...

loceng 7y ago

Watching Eric Weinstein's The Portal episode #18 yesterday - https://www.youtube.com/watch?v=QxnkGymKuuI https://www.youtube.com/watch?v=QxnkGymKuuI - where he presents the DISC (Distributed Idea Suppression Complex), made me frame this in a different way: what questions does the cancer treatment industry avoid? Why aren't all cancer companies, organizations, also researching or putting funding towards prevention? The answer is obvious to me, however why as society don't we require a sort of tax to counter (and fund) what the industry isn't aligned to do profits wise?

stillherebitch 7y ago
> 'Why aren't all cancer companies, organizations, also researching or putting funding towards prevention? The answer is obvious to me,' The truth is much more sinister than you imagine. Profit actually has little to do with it. The reality is, all of this cancer is caused by all of the carcinogenic chemicals that this "civilization" is exposed to daily. There is no cure, other than a complete reworking of the entire civilization from the ground up, which won't be allowed to happen. Which is exactly why they like to pretend so strongly that everything is just fine and they are "racing for the cure." It's all bullshit. THERE IS NO CURE. What they are actually "racing" to do is get their bomb shelters built and stocked with food and supplies, so they can set all of the nations of the world at war with one another while they hide away and let you apes kill each other off. What is this "we as a society" business you're talking about? Especially in regards to taxation. You think it's "society" that taxes people? No, it's the government. The same people who own the medical cartel own the government also, and the news media, and everything else. They own HN also--which is why this account isn't long for this world, just as the previous ones were quickly downvoted, flagged, and shadowbanned.

deleted 7y ago

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dannykwells 7y ago

This article is absolute 100% bullshit. -Metastatic melanoma: used to be lethal, now 50% cure rate.[1] -Non small cell lung cancer: same, now around 25% [2, 4] -Breast cancer used to have a terrible prognisis, now 75% survive. [3] -Not to mention the myriad of blood cancers with new, strong, cell therapy treatment options with 40-50% durable cure rate. I don't know this person, but seriously, whoever he is, fuck you dude. Millions of us work day and night trying to improve care, and 99% of us arent getting rich. [1] https://www.nejm.org/doi/full/10.1056/NEJMoa1709684 https://www.nejm.org/doi/full/10.1056/NEJMoa1709684 [2] https://www.nejm.org/doi/full/10.1056/NEJMoa1801946 https://www.nejm.org/doi/full/10.1056/NEJMoa1801946 [3] https://www.breastcancer.org/research-news/20100930 https://www.breastcancer.org/research-news/20100930 4. https://investors.merck.com/news/press-release-details/2019/Five-Year-Survival-Data-for-Mercks-KEYTRUDA-pembrolizumab-in-Advanced-Non-Small-Cell-Lung-Cancer-NSCLC-from-First-KEYNOTE-Trial-at-2019-ASCO-Annual-Meeting/default.aspx https://investors.merck.com/news/press-release-details/2019/...

mrosett 7y ago
Thank you for writing a more concise version of what I tried to write below.
- ianai 7y ago
  You made some very good arguments with solid information here. So much so that I flagged this article. Doesn’t seem what HN should spend its time refuting.
  - xiphias2 7y ago
    I flagged it as well an hour ago, I don't know why it's still up, probably the mods are not looking at HN right now.
  - mrosett 7y ago
    Thanks!
nonbel 7y ago

ag56 7y ago

> if 2,000 women have mammograms over a period of 10 years, one woman’s life will be saved by a positive diagnosis. Meanwhile 10 healthy women will be treated unnecessarily, and more than 200 “will experience important psychological distress ... I have never understood this argument. I’d rather be incorrectly told I had terminal cancer 100 times over, than not be told and... die. You know what’s worse than psychological distress? Dying. You knowing what’s worse than an unnecessary surgery? Dying. This is so obvious, I struggle to understand how this “overdiagnosis” argument even got started.

zzzcpan 7y ago
The problem is nobody is telling you the truth or providing a way to make an informed decision. And not just because they want to take your money, but also because they themselves simply don't know how to make such decisions. They pretty much just try various things on real people to see if they work or that can confirm the hunches they have for further interventions, ignoring consequences of doing any of it. Like in your particular example, every unnecessary surgery actually increases your chances of dying during surgery or sometimes after it, not to mention the chances of crippling you forever, but you don't know what those chances exactly are and worse, you are assuming there isn't such risk, while it's crazy high. So high, that 100 times false positive rate absolutely makes it a no brainer to never undergo such diagnosis, it pretty much guarantees to make things worse for or kill a lot of people. And yet nobody will give you the numbers to make a rational decision.
- nonbel 7y ago
  I met someone who went for a checkup and they convinced him to get a screening colonoscopy. It was clear but a few months later he started having problems and went back. Then they told him he had colon cancer caused by damage to the tissue during the colonoscopy.