6 ms·

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

by 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.
- mft_ 7y ago
  That's not how I read it, although to be fair, it's not written clearly. This is the full quote from the article: 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. The authors worried that “the FDA may be approving many costly, toxic drugs that do not improve overall survival.” Therefore, the implication is that drugs which prolonged survival by an average of 2.1 months (which was the FDA's track record for approvals between '04 and '14) are not sufficiently "clinically relevant" to justify approval (presumably the 2017 report quoted from includes these drugs). Therefore the question remains: if small but incremental improvements (av 2.1m) aren't sufficient to warrant approval, what level of improvement would be sufficient? And who are the right people to draw this rather important line in the sand?
  - DanBC 7y ago
    Living 2.1m longer may not be seen as an advantage if those two months are spent in severe pain trapped in a hospital bed suffering from a wide range of serious side effects. We need to talk about death and we need to talk about what people want when they die. A few people do want to struggle and gain every extra day they can no matter how painful that's going to be for them, but that's not what most people want.
    - mft_ 7y ago
      I agree with your sentiment, but that's a bit of a straw man you're building there. The FDA would require that those two extra months usually aren't spent suffering unbearable additional side effects from the treatment, and it would also be fairly uncommon for such patents to be "in severe pain trapped in a hospital bed". In contrast, if you've got (say) three months to live, the prospect of an extra few months with a reasonable quality of life, if probably something many people would take.
      - 7y ago
zzzcpan 7y ago
> 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. You are showing massive bias here. It's ok to criticize science, it's normal and necessary even, but to "believe" in science and "well-meaning" of scientists and trust their opinions and conclusions is not, it's harmful, like in this case causing literal unnecessary suffering of real people and robbing them and their families while they are.
- mft_ 7y ago
  To answer your point directly: for sure, I have a bias that the majority of scientists who work in cancer research generally mean well. But holding a positive view of (bias towards?) such people and their motives doesn't constitute not being willing to criticise science? -- In this case, my frustration is that the author isn't intelligently criticising the science; I totally agree with you that science (and related issues, such as FDA approvals, or cost:benefit analyses of drugs) should of course always be open to exploration and criticism. Instead, he's written an opinion piece masquerading as science, by using a variety of supportive quotes and excerpts to build a general case that cancer is big business, that there's a kind-of dark nefarious industry behind it all, and that people who work in this area are complicit in hurting patients with cancer. (It feels one step away from a conspiracy theory.) By confusing totally different topics (e.g. marketing of cancer drugs, vs. value of screening, vs. cost:benefit of cancer treatments, vs. side-effects of cancer drugs, etc.), by paying insufficient attention to any of them, and by employing such a broad brush, he turns a set of highly complex topics into a pointless oozing vat of negativity, possibly aligned with his workd-view.
  - stillherebitch 7y ago
    > 'Instead, he's written an opinion piece masquerading as science, by using a variety of supportive quotes and excerpts to build a general case that cancer is big business, that there's a kind-of dark nefarious industry behind it all, and that people who work in this area are complicit in hurting patients with cancer. (It feels one step away from a conspiracy theory.)' Conspiracies aren't theories. They're crimes. Where did Adolf Hitler learn eugenics from? The USA. You think all of the eugenicist just died off, or somehow lost interest in exterminating people? Your incredulity says nothing about the likelyhood of this being true, and everything about your own profound, typically American naivete.

by mft_ 7y ago

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.

mft_ 7y ago
That's not how I read it, although to be fair, it's not written clearly. This is the full quote from the article: 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. The authors worried that “the FDA may be approving many costly, toxic drugs that do not improve overall survival.” Therefore, the implication is that drugs which prolonged survival by an average of 2.1 months (which was the FDA's track record for approvals between '04 and '14) are not sufficiently "clinically relevant" to justify approval (presumably the 2017 report quoted from includes these drugs). Therefore the question remains: if small but incremental improvements (av 2.1m) aren't sufficient to warrant approval, what level of improvement would be sufficient? And who are the right people to draw this rather important line in the sand?
- DanBC 7y ago
  Living 2.1m longer may not be seen as an advantage if those two months are spent in severe pain trapped in a hospital bed suffering from a wide range of serious side effects. We need to talk about death and we need to talk about what people want when they die. A few people do want to struggle and gain every extra day they can no matter how painful that's going to be for them, but that's not what most people want.
  - mft_ 7y ago
    I agree with your sentiment, but that's a bit of a straw man you're building there. The FDA would require that those two extra months usually aren't spent suffering unbearable additional side effects from the treatment, and it would also be fairly uncommon for such patents to be "in severe pain trapped in a hospital bed". In contrast, if you've got (say) three months to live, the prospect of an extra few months with a reasonable quality of life, if probably something many people would take.
    - 7y ago

zzzcpan 7y ago

> 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. You are showing massive bias here. It's ok to criticize science, it's normal and necessary even, but to "believe" in science and "well-meaning" of scientists and trust their opinions and conclusions is not, it's harmful, like in this case causing literal unnecessary suffering of real people and robbing them and their families while they are.

mft_ 7y ago
To answer your point directly: for sure, I have a bias that the majority of scientists who work in cancer research generally mean well. But holding a positive view of (bias towards?) such people and their motives doesn't constitute not being willing to criticise science? -- In this case, my frustration is that the author isn't intelligently criticising the science; I totally agree with you that science (and related issues, such as FDA approvals, or cost:benefit analyses of drugs) should of course always be open to exploration and criticism. Instead, he's written an opinion piece masquerading as science, by using a variety of supportive quotes and excerpts to build a general case that cancer is big business, that there's a kind-of dark nefarious industry behind it all, and that people who work in this area are complicit in hurting patients with cancer. (It feels one step away from a conspiracy theory.) By confusing totally different topics (e.g. marketing of cancer drugs, vs. value of screening, vs. cost:benefit of cancer treatments, vs. side-effects of cancer drugs, etc.), by paying insufficient attention to any of them, and by employing such a broad brush, he turns a set of highly complex topics into a pointless oozing vat of negativity, possibly aligned with his workd-view.
- stillherebitch 7y ago
  > 'Instead, he's written an opinion piece masquerading as science, by using a variety of supportive quotes and excerpts to build a general case that cancer is big business, that there's a kind-of dark nefarious industry behind it all, and that people who work in this area are complicit in hurting patients with cancer. (It feels one step away from a conspiracy theory.)' Conspiracies aren't theories. They're crimes. Where did Adolf Hitler learn eugenics from? The USA. You think all of the eugenicist just died off, or somehow lost interest in exterminating people? Your incredulity says nothing about the likelyhood of this being true, and everything about your own profound, typically American naivete.