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Chemotherapy is basically cave man medicine. That a therapeutic drug is explosive only adds to that sentiment. The idea that we'll basically poison you just up

Chemotherapy is basically cave man medicine. That a therapeutic drug is explosive only adds to that sentiment. The idea that we'll basically poison you just up to a point that's nearly fatal in order to kill the cancer is such a terrible way to treat someone. Now I'm not saying don't ever do it -- unfortunately that's where we're at in 2021. It's just kind of unbelievable that cancer remains so elusive that we're still using medical treatments that started from mustard gas usage during world wars, when we're so advanced technologically in so many other ways. Interestingly, cancers for children are largely successfully treated. I was at a fancy conference a few years ago where some cancer researchers were socializing over wine, and I asked them why that was versus adults. They said the difference was that parents are willing to do almost anything (aka enroll their kids in experimental treatments) to cure their kids, but adults aren't quite so willing for themselves. Thus the rate of experimentation was just so much higher for children to the point where it's often curable. Perhaps one day we'll be able to simulate the body well enough to the point where we can brute force treatments computationally to fix this gap.

fabian2k 5y ago
Many of the modern treatments are much more targeted, any antibody-based treatment is by nature extremely specific. But then you also have the problem that cancer isn't a single, unified disease, so a very targeted approach doesn't work for every cancer.
vibrio 5y ago
I agree with your wine-drinking physicians on clinical trial participation, and your question on how to improve broader participation. I also believe that there are fundamental difference in cancers that arrive in a young person versus cancers that have slowly evolved in the patients bodies, perhaps over a decade or more-the latter are likely much more stubborn.
robbiep 5y ago
The cancers that are treated successfully in children are the blood borne ones (mostly leukemias) and generally because they’re easier to wipe out and replace the marrow with. Some Childhood brain tumours are also very successfully treated, and most other adult cancers children don’t get. Sarcomas still kill people left right and centre though. The truth is that we’re already peeking out of the dark ages of chemotherapy. Immunothérapies have revolutionised the field and new stuff coming online is incredible. When I started medical school 11 years ago the 5 year survival of metastatic melanoma was close to 0%. It’s now close to the population average (well, not really, but it’s greater than 50%). Records are being smashed
- et2o 5y ago
  Metastatic melanoma? I haven’t seen any data showing close to 50% survival rate, where are you looking? Just managed a young patient with metastatic melanoma and very poor prognosis.
  - Herodotus38 5y ago
    I think they were referring to pd-1 inhibitors. I’m not an oncologist but that generally fits with what I’ve seen as a hospitalist. FWIW I personally know someone who has survived > 5 years who received it right when it cane out. Here’s a paper supporting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019511/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019511/
    - jcims 5y ago
      PD-1 inhibitors seem like magic when they work. Unfortunately they don’t work in every case, but it’s abundantly clear when they do that the immune system is good at killing unwanted cells roaming around the body. *smacks forehead*
  - robbiep 5y ago
    Yes sorry I should have specified, PD-1s. Was 4am in australia on mobile and wasn’t in the mood to reference. Sorry
dredmorbius 5y ago
A rather surprising number of chemo compounds trace directly to chemical warfare and compounds used during WWI, including several mustard-gas-related compounds. Some years ago, a close friend died of a relatively rare and aggressive form of cancer. Among my roles was running interference against those who were pitching various miracle cures, with that tired old scam laetril playing a significant role. In the decades since, I've watched developments in the science and development, as well as traced the history. It turns out that the treatment received a few decades ago was little changed from that of the 1960s, and has progressed little since. Genetic sequencing identified the affected chromosome of the triggering mutation in the 1980s, and we now know the specific codons involved. There remains no cure. Five year survival remains about 20%. Laetril is still a fraud. And several of the other patients we came to know during the course of my friend's treatment have died since of conditions related to the treatment itself, though yes, they did buy another 10--20 years. Cancer is brutal. I will note: "cancer" is a symptom cluster manifested by malignant growth, and virtually always due to genetic mutation within the affected cells (I'd say "always" though I'm not completely sure of that). The specific triggers, and the possibilities for cure, vary tremendously. Some bladder cancers are virtually entirely treatable by, of all things, tuberculosis baccili. Skin cancers if caught early pose little risk. Others are tremendously aggressive, and an online friend's posts progressed from announcing their partner's diagnosis with liver cancer to the partner's death over the course of less than two months. Broad-brush statements are virtually always false.
- agumonkey 5y ago
  There's a weird wedding here, toxic/warfare compounds dropped into your blood stream and nowadays it's used with administrative processes (for repeatability and liability purposes). Back in the days the people who came with the chemotherapies were also aggressive in the way the approach treatment (and according to De Vita it gave better results [but maybe cost more])
  - dredmorbius 5y ago
    There's also a direct connection to vivisection and human-subjects research during wartime which would fail to meet most ethical review board standards today. References are pretty easy to find: After promising animal research, physician researchers connected with Yale University and the University of Chicago tried injecting sulfur mustard and its somewhat milder relatives, the nitrogen mustards, into the veins of cancer patients in the early 1940s. This was the first time a systemic treatment was given for cancer. “It would upset the whole body,” says Smith. “That proved to be valuable when you deal with certain kinds of leukemia or lymphoma.” https://www.the-scientist.com/foundations/from-chemical-weapon-to-chemotherapy--19171946-65655 https://www.the-scientist.com/foundations/from-chemical-weap... Not long after the discovery of nitrogen mustard, Sidney Farber of Boston demonstrated that aminopterin, a compound related to the vitamin folic acid, produced remissions in children with acute leukemia. https://www.cancer.org/cancer/cancer-basics/history-of-cancer/cancer-treatment-chemo.html https://www.cancer.org/cancer/cancer-basics/history-of-cance... I'm not certain Japan's Unit 731 was engaged in research with chemotherapy precursors, though the range of testing was extensive, and the US provided a grant of immunity after the war. Please note that pretty much anything horrific you can imagine, and then some, is discussed in the links which follow. https://nationalinterest.org/blog/reboot/unit-731-japans-secret-horrifying-human-experiments-175476 https://nationalinterest.org/blog/reboot/unit-731-japans-sec... https://en.wikipedia.org/wiki/Unit_731 https://en.wikipedia.org/wiki/Unit_731
devy 5y ago
I am not surprised the a Class 1 HAZMAT is used as the chemo agent for glioblastoma, the most malignant form of brain tumor. My father in law just recently passed with glioblastoma stage 3, from admitted to hospital to passing in a couple of month.
2OEH8eoCRo0 5y ago
>Perhaps one day we'll be able to simulate the body well enough to the point where we can brute force treatments computationally to fix this gap. This is why as a total outsider/non-expert I believe we will cure everything in the next 50 years if we do not regress or destroy ourselves.
- josefx 5y ago
  Remember how Steve Jobs suicided on fruitarianism instead of getting his cancer treated when it was found in its early stages? The biggest tech company on the planet was basically led by an anti science lunatic with millions of followers. We will probably end up almost destroying our selves twice over before we get anywhere near curing every disease. On the plus side wiping out almost all of humanity should also take care of dozens of illnesses.
- short_sells_poo 5y ago
  We still don't understand much of the inner workings of our own body. It's a bit like the divide between quantum physics and the macroscopic world. We have successfully observed and modeled individual processes as they happen at a cellular level, and we can draw some statistical conclusions at the whole body level, but much of the area in-between is basically unknown. One just needs to look at nutrition or the farce that is "nutrition science". We only barely understand what we are supposed to eat to maximize our health, and that's such a basic and fundamental concept that I feel anything like "brute force treatments computationally to fix this gap." would require multiple generational leaps in our understanding. In other words, I feel like you are extrapolating to space flight when we have just recently invented the catapult. Hell, we are only starting to suspect that the gut biome affects our consciousness. How crazy is that? And yet it is a very sobering indicator of how little we know. The human body is an incredibly complicated system with so many feedback loops that I'd put it in the same class as solving the halting problem or establishing a grand unified theory of physics. We have modern robotics and tools like laser knives, but we still have to poke needles into a patient's brain to determine where to cut out tumors. I don't mean to disparage the doubtlessly talented surgeons of today, but to me this seems barely above medieval techniques. Our tools have improved 100 fold, our understanding just barely. I think at best the prediction we can make is that "we believe eventually all diseases should be treatable". But to say that in the next 50 years we can become functionally immortal (treat all diseases), is a very long stretch IMO.
open-source-ux 5y ago
My understanding is that chemotherapy is indiscrimate when it attacks cells - it affects cancerous and healthy cells alike. However, doctors assume the healthy cells will recover from the weakening effects of chemotherapy. Meanwhile the cancer cells are stressed to a greater degree by the chemotherapy and thus suspectible to death. All this is presented as the "best outcome" scenario for chemotherapy treament. However, for some patients (and depending on their type of cancer) chemotheraphy can leave lingering side-effects and can even cause cancerous cells to recur or turn even more aggressive. For some cancer patients, chemotherapy is not about curing the cancer but slowing the cancer spread ("treatable but not curable" is the phrase used by doctors for some cancer conditions). Although chemotheraphy can be succesful for some (many?) patients, as you say it still feels like a crude, blunt approach to treating cancer. Doctors might baulk at that description. But consider: if someone has a non-metasized cancer (i.e. cancer in one part of the body that has not spread to other parts of the body), chemotherapy is applied with blunt force to the entire body including to the majority of healthy cells in the body. I can't see how anyone can say this isn't a coarse and crude treatment method even when the outcome is deemed successful.
- zaroth 5y ago
  Not entirely indiscriminate. For example as I understand it, a lot of chemo drugs attack cells that divide quickly. Which is why a lot of times hair loss is a side effect because they are some of the faster dividing cells in the body.
  - da_chicken 5y ago
    My understanding was that chemotherapy drugs often affect cells literally as they divide. The exact mechanisms vary, but it's that timing of affecting a cell during division that makes a given substance possible to be used as chemotherapy drug.
joe_the_user 5y ago
Chemotherapy combined with surgery and radiation is still a standard and still does cure a significant portion of people - my father's cancer was cured by this "ordinary method". The problem is that more selective methods of killing cancers run up against the tendency of cancer cells to mutate and find a defense against them. And this is definitely stuff that's killing you and the cancer and hoping the cancer dies first. To keep going, you need a strong reason to live.
gus_massa 5y ago
> That a therapeutic drug is explosive only adds to that sentiment. Explosivity and toxicity are unrelated. Cyanide can kill you, but it's not explosive IIRC. You can make explosives with aluminum, but it's safe to use as a food container, ... > Chemotherapy is basically cave man medicine. The main problem is that cancer cells and normal cells are very similar. Anything that kills cancer cells will probably kill normal cells. Anything that is safe for normal cells is probably safe for cancer cells. Killing one but not the other is like a poll trickshot. (Killing bacteria or fungus is easier, because some of the molecules they use are different, and sometimes they produce the molecules using a different method, so you can make a drug that attack the difference and hope the best.) Also, not all the treatment for cancer use chemotherapy methods. Some cancers are affected by hormones, so you can modify the hormone levels. (This also cause problems in the part of you body that use the hormone, so it's a tradeoff.)
- EE84M3i 5y ago
  >Explosivity and toxicity are unrelated. Really? Doesn't something being explosive mean it's highly unstable and reactive? Presumably ingesting highly reactive reagents is toxic.
  - dogorman 5y ago
    > Really? Doesn't something being explosive mean it's highly unstable and reactive? Not particularly, no. Some certainly are, but others require a great deal of activation energy to detonate. Nitroglycerine (another explosive medication) is notoriously touchy. But C4 is only mildly flammable; you can heat up your meal by lighting a piece of C4 on fire then put the fire out by smashing it with a hammer; it won't detonate like that. https://en.wikipedia.org/wiki/C-4_(explosive)#Detonation https://en.wikipedia.org/wiki/C-4_(explosive)#Detonation
    - EE84M3i 5y ago
      Sure, but in this context, the drug we're talking about exploded with a drop hammer test, right? That seems more like nitroglycerin than C4.
cubicmeter 5y ago
this could be true that as a different example along the lines of the same conclusion: Women-only medical conditions are less known by medical fields, and there are fewer treatments. Its because the society treats women's lives less seriously. For example pregnancy is still pretty mysterious in general medicine. Birth control pills are to prevent women fertility etc. It could be true that children lives are deemed more important by parents and more researched.
caymanjim 5y ago
Chemotherapy, like cancer, is not one thing. Some of it is a matter of poisoning the body in ways that disrupt rapidly-dividing cells. This is why chemo patients frequently lose their hair (and other things you don't hear as much about, like gametes, fingernails, mucous membranes/digestive lining). You can call this "cave man medicine". Although that's more dismissive than is warranted, there's no denying that it's a blunt instrument. Other chemotherapy treatments are "holy shit, we live in the future." They're targeted and have almost no side effects. You specifically reference mustard gas. I had lymphoma, and one of my treatments was bendamustine, which is directly related to that class of chemicals, and the subsequent research. It's broadly toxic. The other treatment was rituximab, which is a monoclonal antibody that targets the CD20 protein that manifests on B cells, which are just one of many cells involved in the lymphatic system. I have to say the whole thing was a walk in the park. Bendamustine isn't fun, but I never vomited once, never lost my hair, and outwardly didn't look any different at all. I felt pretty shitty for about three days once a month after treatment. Kinda like a mild flu, but honestly I'd take the bendamustine over the flu any day. I usually took three days off work for it, primarily because I had to be at the chemo infusion center for a few hours to get the drugs. I could have worked through it (not that I should ever have had to, but I could have). The rituximab was a walk in the park. I took that once a month for a year, then every two months for two more years. Aside from an allergic reaction the first time (solved with Benadryl subsequently), I barely noticed it at all. It was, at its worst, nowhere near as bad as a hangover. I know I'm fortunate in that these treatments existed for my cancer, and that my cancer has a high survival rate (I've been clear for over a decade). Many people are far worse off, even if they survive. I like to take these opportunities to dispel some of the misconceptions that are out there.
- azinman2 5y ago
  I'm glad that worked out well for you. I have friends who haven't been as lucky. Again, I'm not suggesting don't do chemo, I just wish we were much further ahead in targeted and less toxic treatment options such that chemo wasn't in the picture.
pcarolan 5y ago
You’re right that we haven’t made much progress but this drug is the only advancement in brain cancer in decades and has very few side effects for most people. Compared to traditional chemotherapy, it is a game changer for many patients’ quality of life.
fossuser 5y ago
There are some drugs that target the underlying mechanism, herceptin is a particularly famous one. For those interested in this kind of thing I’d highly recommend the book The Emperor of All Maladies. For Herceptin specifically, there was a book called her-2.
flying_kiwi 5y ago
> It's just kind of unbelievable that cancer remains so elusive One of the problems with cancer is that it's really an umbrella term that covers a huge variety of problems to solve. There are many, many ways for the normal cell lifecycle to get disrupted, and they will all respond differently to different treatments. I'm not sure if a single technology will ever appear to allow all cancers to be treated.
al2o3cr 5y ago
The idea that we'll basically poison you just up to a point that's nearly fatal in order to kill the cancer is such a terrible way to treat someone. TBH that's how a _lot_ of drugs work - for instance, sabotaging certain parts of cell division can be an effective treatment because the disease needs that mechanism more than the patient. It's also a hazard in drug discovery - the linked blog has plenty of examples of compounds that did a GREAT job of disrupting biological activity of a pathogen in a Petri dish because they're GREAT at wrecking biology in general. One other note, re: "started from mustard gas" - many antibiotics are really just chemical weapons we're borrowing from fungi.
refurb 5y ago
I’d say this is a pretty unfair assessment. Sure chemotherapy such as nitrogen mustards are still used (because they are effective) but plenty of newer drugs are very targeted. And it’s not like our approach is all that different for other life threatening diseases. Multi-drug resistant infection? Let me use antibiotics on you that will make you deaf and maybe damage your heart.
- azinman2 5y ago
  I said started with, not continued to be exactly that. Of course new drugs and treatments have come out since. Many other drugs/treatments can also be really bad! I'm on some pretty bad drugs myself right now (not cancer related), and wish other options existed here too. Cancer isn't the only area of medicine where I wish I was born hundreds of years in the future!
marzell 5y ago
"That a therapeutic drug is explosive..." seems sensationalistic. Reminds me of when people say things like "x contains chemicals used in x!". What's the practical problem with this?
- lazide 5y ago
  For one, it’s probably pretty lucky the plant that makes it hasn’t exploded yet. The workers and neighbors probably benefit from knowing?
Gatsky 5y ago
This is a very ignorant and low effort comment. Let me illustrate: > Chemotherapy is basically cave man medicine A meaningless statement. Actually, there is a sophisticated system of diagnosis and staging to work out who needs chemotherapy at all. This includes CT scans, ultrasound, MRI, positron emission tomorography. Chemotherapy agents are modern pharmaceuticals with a variety of supportive care measures to help patients who can benefit from them. How is nanoparticle bound paclitaxel a cave man medicine? > The idea that we'll basically poison you just up to a point that's nearly fatal in order to kill the cancer is such a terrible way to treat someone. Again, ignorant. Highly toxic multi-agent chemotherapy is used in acute leukaemias, because the patient will literally die next week or sometimes in a day unless you start treating. In that case you are trying to help someone who is already very sick, so of course there is a high mortality rate, but it is less than the 100% without treatment. How do you suggest we work out the best dose of chemotherapy, apart from giving it at increasing doses and monitoring what happens in a phase I trial? Anyway, many chemotherapy agents are given at a dose that controls disease and maintains quality of life in incurable disease, in direct opposition to your off-hand comment. > Now I'm not saying don't ever do it -- unfortunately that's where we're at in 2021. Do you realise that there are malignancies which are 100% fatal without chemotherapy, but curable with chemotherapy? Germ cell tumours in men for example. Acute leukaemias. Lymphomas. Gestational trophoblastic tumours. So what on earth are you talking about? > It's just kind of unbelievable that cancer remains so elusive that we're still using medical treatments that started from mustard gas usage during world wars, when we're so advanced technologically in so many other ways. Most chemotherapy agents in use today are not based on mustard gas, for a start. Many of them come from plants. One of the most useful and well tolerated chemotherapy agents comes from the bark the pacific yew tree. Anyway, the argument is stupid - your car engine is based on explosions, so car engines cannot be sophisticated or useful? > Interestingly, cancers for children are largely successfully treated. I was at a fancy conference a few years ago where some cancer researchers were socializing over wine, and I asked them why that was versus adults. They said the difference was that parents are willing to do almost anything (aka enroll their kids in experimental treatments) to cure their kids, but adults aren't quite so willing for themselves. This is bullshit. Walk into a clinical trials unit in an adult cancer centre and you'll see. The reason cancers in children are different are because the biology is different, to state the bleeding obvious. Also children are much more physiologically resilient and don't have other medical problems, so their response to treatment is fundamentally different.

fabian2k 5y ago

Many of the modern treatments are much more targeted, any antibody-based treatment is by nature extremely specific. But then you also have the problem that cancer isn't a single, unified disease, so a very targeted approach doesn't work for every cancer.

vibrio 5y ago

I agree with your wine-drinking physicians on clinical trial participation, and your question on how to improve broader participation. I also believe that there are fundamental difference in cancers that arrive in a young person versus cancers that have slowly evolved in the patients bodies, perhaps over a decade or more-the latter are likely much more stubborn.

robbiep 5y ago

The cancers that are treated successfully in children are the blood borne ones (mostly leukemias) and generally because they’re easier to wipe out and replace the marrow with. Some Childhood brain tumours are also very successfully treated, and most other adult cancers children don’t get. Sarcomas still kill people left right and centre though. The truth is that we’re already peeking out of the dark ages of chemotherapy. Immunothérapies have revolutionised the field and new stuff coming online is incredible. When I started medical school 11 years ago the 5 year survival of metastatic melanoma was close to 0%. It’s now close to the population average (well, not really, but it’s greater than 50%). Records are being smashed

et2o 5y ago
Metastatic melanoma? I haven’t seen any data showing close to 50% survival rate, where are you looking? Just managed a young patient with metastatic melanoma and very poor prognosis.
- Herodotus38 5y ago
  I think they were referring to pd-1 inhibitors. I’m not an oncologist but that generally fits with what I’ve seen as a hospitalist. FWIW I personally know someone who has survived > 5 years who received it right when it cane out. Here’s a paper supporting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019511/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019511/
  - jcims 5y ago
    PD-1 inhibitors seem like magic when they work. Unfortunately they don’t work in every case, but it’s abundantly clear when they do that the immune system is good at killing unwanted cells roaming around the body. *smacks forehead*
- robbiep 5y ago
  Yes sorry I should have specified, PD-1s. Was 4am in australia on mobile and wasn’t in the mood to reference. Sorry

dredmorbius 5y ago

A rather surprising number of chemo compounds trace directly to chemical warfare and compounds used during WWI, including several mustard-gas-related compounds. Some years ago, a close friend died of a relatively rare and aggressive form of cancer. Among my roles was running interference against those who were pitching various miracle cures, with that tired old scam laetril playing a significant role. In the decades since, I've watched developments in the science and development, as well as traced the history. It turns out that the treatment received a few decades ago was little changed from that of the 1960s, and has progressed little since. Genetic sequencing identified the affected chromosome of the triggering mutation in the 1980s, and we now know the specific codons involved. There remains no cure. Five year survival remains about 20%. Laetril is still a fraud. And several of the other patients we came to know during the course of my friend's treatment have died since of conditions related to the treatment itself, though yes, they did buy another 10--20 years. Cancer is brutal. I will note: "cancer" is a symptom cluster manifested by malignant growth, and virtually always due to genetic mutation within the affected cells (I'd say "always" though I'm not completely sure of that). The specific triggers, and the possibilities for cure, vary tremendously. Some bladder cancers are virtually entirely treatable by, of all things, tuberculosis baccili. Skin cancers if caught early pose little risk. Others are tremendously aggressive, and an online friend's posts progressed from announcing their partner's diagnosis with liver cancer to the partner's death over the course of less than two months. Broad-brush statements are virtually always false.

agumonkey 5y ago
There's a weird wedding here, toxic/warfare compounds dropped into your blood stream and nowadays it's used with administrative processes (for repeatability and liability purposes). Back in the days the people who came with the chemotherapies were also aggressive in the way the approach treatment (and according to De Vita it gave better results [but maybe cost more])
- dredmorbius 5y ago
  There's also a direct connection to vivisection and human-subjects research during wartime which would fail to meet most ethical review board standards today. References are pretty easy to find: After promising animal research, physician researchers connected with Yale University and the University of Chicago tried injecting sulfur mustard and its somewhat milder relatives, the nitrogen mustards, into the veins of cancer patients in the early 1940s. This was the first time a systemic treatment was given for cancer. “It would upset the whole body,” says Smith. “That proved to be valuable when you deal with certain kinds of leukemia or lymphoma.” https://www.the-scientist.com/foundations/from-chemical-weapon-to-chemotherapy--19171946-65655 https://www.the-scientist.com/foundations/from-chemical-weap... Not long after the discovery of nitrogen mustard, Sidney Farber of Boston demonstrated that aminopterin, a compound related to the vitamin folic acid, produced remissions in children with acute leukemia. https://www.cancer.org/cancer/cancer-basics/history-of-cancer/cancer-treatment-chemo.html https://www.cancer.org/cancer/cancer-basics/history-of-cance... I'm not certain Japan's Unit 731 was engaged in research with chemotherapy precursors, though the range of testing was extensive, and the US provided a grant of immunity after the war. Please note that pretty much anything horrific you can imagine, and then some, is discussed in the links which follow. https://nationalinterest.org/blog/reboot/unit-731-japans-secret-horrifying-human-experiments-175476 https://nationalinterest.org/blog/reboot/unit-731-japans-sec... https://en.wikipedia.org/wiki/Unit_731 https://en.wikipedia.org/wiki/Unit_731

devy 5y ago

I am not surprised the a Class 1 HAZMAT is used as the chemo agent for glioblastoma, the most malignant form of brain tumor. My father in law just recently passed with glioblastoma stage 3, from admitted to hospital to passing in a couple of month.

2OEH8eoCRo0 5y ago

>Perhaps one day we'll be able to simulate the body well enough to the point where we can brute force treatments computationally to fix this gap. This is why as a total outsider/non-expert I believe we will cure everything in the next 50 years if we do not regress or destroy ourselves.

josefx 5y ago
Remember how Steve Jobs suicided on fruitarianism instead of getting his cancer treated when it was found in its early stages? The biggest tech company on the planet was basically led by an anti science lunatic with millions of followers. We will probably end up almost destroying our selves twice over before we get anywhere near curing every disease. On the plus side wiping out almost all of humanity should also take care of dozens of illnesses.
short_sells_poo 5y ago
We still don't understand much of the inner workings of our own body. It's a bit like the divide between quantum physics and the macroscopic world. We have successfully observed and modeled individual processes as they happen at a cellular level, and we can draw some statistical conclusions at the whole body level, but much of the area in-between is basically unknown. One just needs to look at nutrition or the farce that is "nutrition science". We only barely understand what we are supposed to eat to maximize our health, and that's such a basic and fundamental concept that I feel anything like "brute force treatments computationally to fix this gap." would require multiple generational leaps in our understanding. In other words, I feel like you are extrapolating to space flight when we have just recently invented the catapult. Hell, we are only starting to suspect that the gut biome affects our consciousness. How crazy is that? And yet it is a very sobering indicator of how little we know. The human body is an incredibly complicated system with so many feedback loops that I'd put it in the same class as solving the halting problem or establishing a grand unified theory of physics. We have modern robotics and tools like laser knives, but we still have to poke needles into a patient's brain to determine where to cut out tumors. I don't mean to disparage the doubtlessly talented surgeons of today, but to me this seems barely above medieval techniques. Our tools have improved 100 fold, our understanding just barely. I think at best the prediction we can make is that "we believe eventually all diseases should be treatable". But to say that in the next 50 years we can become functionally immortal (treat all diseases), is a very long stretch IMO.

open-source-ux 5y ago

My understanding is that chemotherapy is indiscrimate when it attacks cells - it affects cancerous and healthy cells alike. However, doctors assume the healthy cells will recover from the weakening effects of chemotherapy. Meanwhile the cancer cells are stressed to a greater degree by the chemotherapy and thus suspectible to death. All this is presented as the "best outcome" scenario for chemotherapy treament. However, for some patients (and depending on their type of cancer) chemotheraphy can leave lingering side-effects and can even cause cancerous cells to recur or turn even more aggressive. For some cancer patients, chemotherapy is not about curing the cancer but slowing the cancer spread ("treatable but not curable" is the phrase used by doctors for some cancer conditions). Although chemotheraphy can be succesful for some (many?) patients, as you say it still feels like a crude, blunt approach to treating cancer. Doctors might baulk at that description. But consider: if someone has a non-metasized cancer (i.e. cancer in one part of the body that has not spread to other parts of the body), chemotherapy is applied with blunt force to the entire body including to the majority of healthy cells in the body. I can't see how anyone can say this isn't a coarse and crude treatment method even when the outcome is deemed successful.

zaroth 5y ago
Not entirely indiscriminate. For example as I understand it, a lot of chemo drugs attack cells that divide quickly. Which is why a lot of times hair loss is a side effect because they are some of the faster dividing cells in the body.
- da_chicken 5y ago
  My understanding was that chemotherapy drugs often affect cells literally as they divide. The exact mechanisms vary, but it's that timing of affecting a cell during division that makes a given substance possible to be used as chemotherapy drug.

joe_the_user 5y ago

Chemotherapy combined with surgery and radiation is still a standard and still does cure a significant portion of people - my father's cancer was cured by this "ordinary method". The problem is that more selective methods of killing cancers run up against the tendency of cancer cells to mutate and find a defense against them. And this is definitely stuff that's killing you and the cancer and hoping the cancer dies first. To keep going, you need a strong reason to live.

gus_massa 5y ago

> That a therapeutic drug is explosive only adds to that sentiment. Explosivity and toxicity are unrelated. Cyanide can kill you, but it's not explosive IIRC. You can make explosives with aluminum, but it's safe to use as a food container, ... > Chemotherapy is basically cave man medicine. The main problem is that cancer cells and normal cells are very similar. Anything that kills cancer cells will probably kill normal cells. Anything that is safe for normal cells is probably safe for cancer cells. Killing one but not the other is like a poll trickshot. (Killing bacteria or fungus is easier, because some of the molecules they use are different, and sometimes they produce the molecules using a different method, so you can make a drug that attack the difference and hope the best.) Also, not all the treatment for cancer use chemotherapy methods. Some cancers are affected by hormones, so you can modify the hormone levels. (This also cause problems in the part of you body that use the hormone, so it's a tradeoff.)

EE84M3i 5y ago
>Explosivity and toxicity are unrelated. Really? Doesn't something being explosive mean it's highly unstable and reactive? Presumably ingesting highly reactive reagents is toxic.
- dogorman 5y ago
  > Really? Doesn't something being explosive mean it's highly unstable and reactive? Not particularly, no. Some certainly are, but others require a great deal of activation energy to detonate. Nitroglycerine (another explosive medication) is notoriously touchy. But C4 is only mildly flammable; you can heat up your meal by lighting a piece of C4 on fire then put the fire out by smashing it with a hammer; it won't detonate like that. https://en.wikipedia.org/wiki/C-4_(explosive)#Detonation https://en.wikipedia.org/wiki/C-4_(explosive)#Detonation
  - EE84M3i 5y ago
    Sure, but in this context, the drug we're talking about exploded with a drop hammer test, right? That seems more like nitroglycerin than C4.

cubicmeter 5y ago

this could be true that as a different example along the lines of the same conclusion: Women-only medical conditions are less known by medical fields, and there are fewer treatments. Its because the society treats women's lives less seriously. For example pregnancy is still pretty mysterious in general medicine. Birth control pills are to prevent women fertility etc. It could be true that children lives are deemed more important by parents and more researched.

caymanjim 5y ago

Chemotherapy, like cancer, is not one thing. Some of it is a matter of poisoning the body in ways that disrupt rapidly-dividing cells. This is why chemo patients frequently lose their hair (and other things you don't hear as much about, like gametes, fingernails, mucous membranes/digestive lining). You can call this "cave man medicine". Although that's more dismissive than is warranted, there's no denying that it's a blunt instrument. Other chemotherapy treatments are "holy shit, we live in the future." They're targeted and have almost no side effects. You specifically reference mustard gas. I had lymphoma, and one of my treatments was bendamustine, which is directly related to that class of chemicals, and the subsequent research. It's broadly toxic. The other treatment was rituximab, which is a monoclonal antibody that targets the CD20 protein that manifests on B cells, which are just one of many cells involved in the lymphatic system. I have to say the whole thing was a walk in the park. Bendamustine isn't fun, but I never vomited once, never lost my hair, and outwardly didn't look any different at all. I felt pretty shitty for about three days once a month after treatment. Kinda like a mild flu, but honestly I'd take the bendamustine over the flu any day. I usually took three days off work for it, primarily because I had to be at the chemo infusion center for a few hours to get the drugs. I could have worked through it (not that I should ever have had to, but I could have). The rituximab was a walk in the park. I took that once a month for a year, then every two months for two more years. Aside from an allergic reaction the first time (solved with Benadryl subsequently), I barely noticed it at all. It was, at its worst, nowhere near as bad as a hangover. I know I'm fortunate in that these treatments existed for my cancer, and that my cancer has a high survival rate (I've been clear for over a decade). Many people are far worse off, even if they survive. I like to take these opportunities to dispel some of the misconceptions that are out there.

azinman2 5y ago
I'm glad that worked out well for you. I have friends who haven't been as lucky. Again, I'm not suggesting don't do chemo, I just wish we were much further ahead in targeted and less toxic treatment options such that chemo wasn't in the picture.

pcarolan 5y ago

You’re right that we haven’t made much progress but this drug is the only advancement in brain cancer in decades and has very few side effects for most people. Compared to traditional chemotherapy, it is a game changer for many patients’ quality of life.

fossuser 5y ago

There are some drugs that target the underlying mechanism, herceptin is a particularly famous one. For those interested in this kind of thing I’d highly recommend the book The Emperor of All Maladies. For Herceptin specifically, there was a book called her-2.

flying_kiwi 5y ago

> It's just kind of unbelievable that cancer remains so elusive One of the problems with cancer is that it's really an umbrella term that covers a huge variety of problems to solve. There are many, many ways for the normal cell lifecycle to get disrupted, and they will all respond differently to different treatments. I'm not sure if a single technology will ever appear to allow all cancers to be treated.

al2o3cr 5y ago

The idea that we'll basically poison you just up to a point that's nearly fatal in order to kill the cancer is such a terrible way to treat someone. TBH that's how a _lot_ of drugs work - for instance, sabotaging certain parts of cell division can be an effective treatment because the disease needs that mechanism more than the patient. It's also a hazard in drug discovery - the linked blog has plenty of examples of compounds that did a GREAT job of disrupting biological activity of a pathogen in a Petri dish because they're GREAT at wrecking biology in general. One other note, re: "started from mustard gas" - many antibiotics are really just chemical weapons we're borrowing from fungi.

refurb 5y ago

I’d say this is a pretty unfair assessment. Sure chemotherapy such as nitrogen mustards are still used (because they are effective) but plenty of newer drugs are very targeted. And it’s not like our approach is all that different for other life threatening diseases. Multi-drug resistant infection? Let me use antibiotics on you that will make you deaf and maybe damage your heart.

azinman2 5y ago
I said started with, not continued to be exactly that. Of course new drugs and treatments have come out since. Many other drugs/treatments can also be really bad! I'm on some pretty bad drugs myself right now (not cancer related), and wish other options existed here too. Cancer isn't the only area of medicine where I wish I was born hundreds of years in the future!

marzell 5y ago

"That a therapeutic drug is explosive..." seems sensationalistic. Reminds me of when people say things like "x contains chemicals used in x!". What's the practical problem with this?

lazide 5y ago
For one, it’s probably pretty lucky the plant that makes it hasn’t exploded yet. The workers and neighbors probably benefit from knowing?

Gatsky 5y ago

This is a very ignorant and low effort comment. Let me illustrate: > Chemotherapy is basically cave man medicine A meaningless statement. Actually, there is a sophisticated system of diagnosis and staging to work out who needs chemotherapy at all. This includes CT scans, ultrasound, MRI, positron emission tomorography. Chemotherapy agents are modern pharmaceuticals with a variety of supportive care measures to help patients who can benefit from them. How is nanoparticle bound paclitaxel a cave man medicine? > The idea that we'll basically poison you just up to a point that's nearly fatal in order to kill the cancer is such a terrible way to treat someone. Again, ignorant. Highly toxic multi-agent chemotherapy is used in acute leukaemias, because the patient will literally die next week or sometimes in a day unless you start treating. In that case you are trying to help someone who is already very sick, so of course there is a high mortality rate, but it is less than the 100% without treatment. How do you suggest we work out the best dose of chemotherapy, apart from giving it at increasing doses and monitoring what happens in a phase I trial? Anyway, many chemotherapy agents are given at a dose that controls disease and maintains quality of life in incurable disease, in direct opposition to your off-hand comment. > Now I'm not saying don't ever do it -- unfortunately that's where we're at in 2021. Do you realise that there are malignancies which are 100% fatal without chemotherapy, but curable with chemotherapy? Germ cell tumours in men for example. Acute leukaemias. Lymphomas. Gestational trophoblastic tumours. So what on earth are you talking about? > It's just kind of unbelievable that cancer remains so elusive that we're still using medical treatments that started from mustard gas usage during world wars, when we're so advanced technologically in so many other ways. Most chemotherapy agents in use today are not based on mustard gas, for a start. Many of them come from plants. One of the most useful and well tolerated chemotherapy agents comes from the bark the pacific yew tree. Anyway, the argument is stupid - your car engine is based on explosions, so car engines cannot be sophisticated or useful? > Interestingly, cancers for children are largely successfully treated. I was at a fancy conference a few years ago where some cancer researchers were socializing over wine, and I asked them why that was versus adults. They said the difference was that parents are willing to do almost anything (aka enroll their kids in experimental treatments) to cure their kids, but adults aren't quite so willing for themselves. This is bullshit. Walk into a clinical trials unit in an adult cancer centre and you'll see. The reason cancers in children are different are because the biology is different, to state the bleeding obvious. Also children are much more physiologically resilient and don't have other medical problems, so their response to treatment is fundamentally different.