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Why haven't we cured cancer yet?

sciencebasedmedicine.org

151–160 of 167 posts

Re: Why haven't we cured cancer yet?

#151

Earlier quoted context omitted.

I understand where your ideas come from, I wish they were true. But sadly they are misinformed on many levels, and the root of the problem is you are playing a statistical game where reality will win. - There are not enough Billionaires to meet your needs, statistically you'll need quite a few to find any decent cures. Especially with 30 teams in play on each case; figuring out "what worked" is a bad numbers game in…

Statistically you'll need quite a few This is exactly the problem: statistics. In a problem where every case is unique, any use of statistics is an abuse of statistics. The roots of Western medicine are arguably pre-scientific, and certainly pre-statistical. We knew and could do a lot of things before we knew what a p-value was. If what "advancing knowledge" means to you is "accumulating p-values so I can publish pap…

>Modern scientific medicine is supposed - no, required (with the increasingly narrow exception of surgery) - to learn only in the first way. Guess what? It doesn't seem to be learning much. Or at least, much of any use. Maybe medicine isn't as much like physics as we'd thought.

Hmmm: http://www.ined.fr/fichier/t_paragraphe/27734/paragraphe_img...

It seems we've doubled our life expectancy in the last 50 years. Medicine isn't working you say?

Look, I'm bitter as much as anyone else about the state of academics. I'm ex-academic-biology and have made no bones about it, here in this thread or elsewhere. But you are seriously characterizing the entire field.

Do you know why people are dieing from cancer? Because we've cured all the other diseases that killed them off at age 40.

Think about that for a minute.

Cancer is simply your body falling apart, going off the rails and destroying itself. It's doing that because, frankly, we were never intended to live 100 years. Thanks to modern medicine, we live well past the age that normal diseases killed our ancestors.

Our reward: battling cancer, instead of tuberculosis, pnemonia, cholera, gangrene or simply fever.

Re: Why haven't we cured cancer yet?

#152
post #148
post #95

Earlier quoted context omitted.

Big drug companies are CONSTANTLY exploring new areas, trust me, they looked into DCA and found it wanting. I can't personally attest to the amount of R&D dollars spent by pharma on R&D, but it has been EXTENSIVELY studied, just checked out pubmed (gov't funded research). http://www.ncbi.nlm.nih.gov/pubmed?term=dichloroacetate If DCA were an effective agent, they would have handed the U of A a handsome check for that…

I have a question. There are loads of cancer charities, such as Cancer Research UK, . Does donating to these make any difference in progressing the research for a cure/treatement or does it not make any serious dent compared to the big pharmas?

Yeah, it does. But mostly because big pharma's actual "research" is pretty slim. Most basic research is done by university professors and their labs, which are then sold, licensed or simply picked up by big pharma.

Basically, big pharma doesn't have much time or money to spend on basic research since it has to run clinical trials and make money.

Re: Why haven't we cured cancer yet?

#153

Earlier quoted context omitted.

Statistically you'll need quite a few This is exactly the problem: statistics. In a problem where every case is unique, any use of statistics is an abuse of statistics. The roots of Western medicine are arguably pre-scientific, and certainly pre-statistical. We knew and could do a lot of things before we knew what a p-value was. If what "advancing knowledge" means to you is "accumulating p-values so I can publish pap…

> Modern scientific medicine is supposed - no, required (with the increasingly narrow exception of surgery) - to learn only in the first way. Guess what? It doesn't seem to be learning much. Or at least, much of any use. Maybe medicine isn't as much like physics as we'd thought. Hmmm: http://www.ined.fr/fichier/t_paragraphe/27734/paragraphe_img... It seems we've doubled our life expectancy in the last 50 years. Medic…

This point is so insightful and important, and I'm pointing it out in the hopes that more people will see it.

Re: Why haven't we cured cancer yet?

#154

Earlier quoted context omitted.

Statistically you'll need quite a few This is exactly the problem: statistics. In a problem where every case is unique, any use of statistics is an abuse of statistics. The roots of Western medicine are arguably pre-scientific, and certainly pre-statistical. We knew and could do a lot of things before we knew what a p-value was. If what "advancing knowledge" means to you is "accumulating p-values so I can publish pap…

> Modern scientific medicine is supposed - no, required (with the increasingly narrow exception of surgery) - to learn only in the first way. Guess what? It doesn't seem to be learning much. Or at least, much of any use. Maybe medicine isn't as much like physics as we'd thought. Hmmm: http://www.ined.fr/fichier/t_paragraphe/27734/paragraphe_img... It seems we've doubled our life expectancy in the last 50 years. Medic…

It seems we've doubled our life expectancy in the last 50 years. Medicine isn't working you say?

Mostly gains in infant mortality, plus antibiotics. We're coasting on the mid-20C golden age of medicine. Modern medicine is great - postmodern medicine sucks.

Replace "50" with 20 or even 30 and ask the same question.

Re: Why haven't we cured cancer yet?

#155

Earlier quoted context omitted.

You're absolutely right that this is the mentality that future treatments need to take. Yeah, and I'm sure our regulatory infrastructure will catch up sometime in the Obama administration. That is, the Malia Obama administration... If this time frame were possible this would be ideal, however, unfortunately each of these steps (if they are possible) takes significantly longer than an evening, and typically far longer…

> You're not going to tell me the actual chemical reactions are slow. It's all human labor. I'm going to tell you that you are, in fact, wrong. Chemical reactions (pharmacodynamics) may be fast, but pharmacokinetics may very well be slow. There is a reason you have to take antibiotics for at least two weeks, or wait three months to see an effect from SSRIs. These things literally take time. Not all processes are inst…

Identifying the protein targets could be a lifetime's work. Identifying drug interactors is another big project, verifying efficacy takes time, synthesis takes time, verifying purity, determining best method of delivery to the patient, half life, dosage, interactions with other drugs, on and on and on. It all takes time.

Look, I'm not an idiot. I know it takes 10-20 years to develop a drug. But I also know that many of the drugs we use now were developed before any of these processes existed. Aspirin anyone? Penicillin?

All of the processes and techniques used by the present-day pharmaceutical industry are predicated on the cultural assumption that, as I said earlier, it's better to let a thousand patients die of neglect than kill one with a drug. In fact, three orders of magnitude may be understanding the asymmetry - it might as well be six.

Once you learn how to do things incredibly slowly, incredibly expensively and incredibly carefully, you're going to be completely ignorant of any way in which they might be done "fast, cheap and out of control."

Very much a parallel situation is the nuclear industry. Does it really take 20 years to design and build a nuclear reactor? Done the modern American way it does. And indeed, there's a much better argument for nuclear overregulation than cancer drug overregulation - still not a good one IMHO.

There's plenty of experience from military programs, even from the other side of the Iron Curtain, that tells us it's not that difficult, slow or expensive to build a nuclear reactor. But if you ask any nuclear professional, you'll be asking someone who knows in great detail how to build reactors the ultra-paranoid way. As far as he's concerned, that's the only way to do it.

Nobody in the pharmaceutical industry knows how to execute effectively with a short OODA loop. The knowledge and experience would have to be created, certainly at the cost of errors and lives. That's a far cry from saying that it cannot possibly exist.

Think about the way weapons are tested and deployed, not in the play wars we fight now but in a real war like WWII. Many, many soldiers in WWII died from unanticipated weapons failure. But if weapons hadn't been developed with the tightest possible OODA loop, we'd have been fighting Tiger tanks with cavalry lances.

We're not fighting a "war on cancer." The military psychology is entirely absent. We're playing a game. As an earlier poster said, "it's an exciting time to be a cancer biologist." Is it an exciting time to be a cancer patient?

Re: Why haven't we cured cancer yet?

#156

Earlier quoted context omitted.

Omeprazole has been about for nearly quarter of a century; and is fairly well understood - hell I can walk down to my local drug store and pick up a load from the shelves. You say this like it follows. I can too. I can read the label as well, which says to take it for no more than 28 days "without the advice of a doctor." Presumably this is the period for which it's been studied. The idea of doing a double-blind stud…

Presumably this is the period for which it's been studied. So, without perfect information - I decide. The thing about the modern world is that you can make informed choices - information is only a Google away. For example; my specific knowledge of that particular drug is not high. But this morning I found out: - The drug is well researched as being tolerated in the short to medium term - There is concern that long t…

- There is concern that long term use may increase the risk of intestinal or stomach cancers (based on mouse studies) - So far the longest term test has been 6 years (somewhat longer than your 28 days theory).

In fact, 28 days is a standard recommended limit for drugs available over the counter. It is fairly hard to do damage to yourself, with those sorts of drugs, in that time - but after that you really need the advice of a doctor who understands all of the risks involved.

I can't believe you just said "understands all the risks involved." On the basis of mouse studies and some completely uncontrolled, non-blind 6-year longitudinal study. Or meta-analysis. Or whatever.

Is this the best information we have or can get? Sure. Are the words understands all appropriate? No, they are not.

Aiming for this kind of certainty, and constantly, unconsciously boasting of it, is how postmodern medicine works itself into a box where it's completely unable to think. The information available in this case is shite. But the decision still needs to be made.

Re: Why haven't we cured cancer yet?

#157

Earlier quoted context omitted.

Basically - any single chaotic factor outside the narrowly defined boundaries you have mentioned, will bork your entire system. Sure. If you're stupid. Science isn't for the stupid. There is a common if implicit belief that systematic methods will allow the dull, or worse the dishonest, to advance the frontiers of knowledge. No - the rules of science need to be made for those both brilliant and honest. Everyone else…

? > There is a common if implicit belief that systematic methods will allow the dull, or worse the dishonest, to advance the frontiers of knowledge. Ok, I'm taken aback by that - people actually think that people who are dull and dishonest become scientists? I mean I can understand that they become - frauds -. But scientists? Well maybe not in my country, but perhaps where you live. Anyway thats just plain daft - the…

Ok, I'm taken aback by that - people actually think that people who are dull and dishonest become scientists? I mean I can understand that they become - frauds -. But scientists? Well maybe not in my country, but perhaps where you live.

I'm afraid the problem is that my standards of both intelligence and honesty are much higher than yours.

Our society has far too many scientists churning out what Kuhn called "normal science." Look at all the scientists in the '70s and '80s who performed fantastic feats of normal science to sequence some gene or other. Science and society in 2012 are precisely as advanced as they'd be if all these researchers had been driving cabs.

Well, aren't the rules of science the scientific method? Which anyone can use?

Anyone can use a paintbrush, too. Not everyone can paint a Picasso.

Re: Why haven't we cured cancer yet?

#158
post #147
post #98

Earlier quoted context omitted.

I'm going to be a heretic and argue that the problem with cancer research is institutional, not biological. The biological problem is clearly very hard, but the institutional problem is impossible. You might or might not be familiar with the term "OODA loop," originally developed by fighter pilots: http://en.wikipedia.org/wiki/OODA_loop If the war on cancer was a dogfight, you'd need an order from the President every…

You are ranting about your own confabulated view of cancer research. Crizotinib is a case in point. It is a small molecule that works very well for lung cancer, but only if a patient's cancer has a particular chromosomal fusion. This drug went from being a 'candidate' molecule to having gold standard data and FDA approval in 5 years. No fantasies about billionaires required. The way you conceptualise a cancer patient…

This drug went from being a 'candidate' molecule to having gold standard data and FDA approval in 5 years.

Five years! I know that's fast by industry standards. Why, it's only one more year than it took us to win World War II. Also, for a full measure of the OODA loop, you should start counting from when the target was discovered.

The way you conceptualise a cancer patient's plight is also insulting and grotesque. They are not nihilists willing to try anything, who we can gladly sacrifice in our pursuit of cure. They have family and friends, and they really want to go their granddaughter's wedding next month and if you harm them with loosely justified bullshit science, you haven't helped anyone.

"Insulting and grotesque" is apparently in the eye of the beholder. I actually find this attitude pretty insulting and grotesque.

Some patients, it's true, are very comfortable being paternalized. Both my grandfathers were killed by the present standard of care in prostate cancer, "watchful waiting." They were both men who would have died rather than challenge an authority figure. And die they did.

Re: Why haven't we cured cancer yet?

#159

Earlier quoted context omitted.

> You're not going to tell me the actual chemical reactions are slow. It's all human labor. I'm going to tell you that you are, in fact, wrong. Chemical reactions (pharmacodynamics) may be fast, but pharmacokinetics may very well be slow. There is a reason you have to take antibiotics for at least two weeks, or wait three months to see an effect from SSRIs. These things literally take time. Not all processes are inst…

Identifying the protein targets could be a lifetime's work. Identifying drug interactors is another big project, verifying efficacy takes time, synthesis takes time, verifying purity, determining best method of delivery to the patient, half life, dosage, interactions with other drugs, on and on and on. It all takes time. Look, I'm not an idiot. I know it takes 10-20 years to develop a drug. But I also know that many…

Well first, I don't think you're an idiot. I haven't downvoted a single one of your comments because I think they are all constructive and thought-provoking...even if I don't agree with many of your points. =)

Regarding Aspirin, Penicillin, et al, many of those drugs are the low hanging fruit in pharmacology. We've already plundered many of the easy molecules. I would contest that many of the present-day pharmaceutical assumptions are predicated on the fact that the easy molecules have already been found.

The reason many drugs fail is not because clinical trials are too long - its because the drugs themselves prove ineffective, unsafe or both. Is a 2% increase in survival rate worth a 20% increase in mortality due to complications and side effects?

We are past the days that you can find compounds that mold poops out, and use it to cure 90% of humanity's ailments.

I certainly agree that clinical trial regulations are too long, with too much bureaucracy. They could stand to be shortened considerably. BUT, they also exist for a reason - safety is important.

Also consider the safety of the patient. Cancer patients are usually willing to try anything to avoid dieing of cancer. There needs to be some protection such that these people are not unduly taken advantage of.

There is a fine moral line between allowing people to take risky drugs to cure their disease and allowing companies to treat cancer patients as expendable hamsters.

*Side note: I am no fan of big pharma either. They are effectively marketing firms that sell pills, not research companies (anymore). But that is not really what we are discussing at present =)

Re: Why haven't we cured cancer yet?

#160
post #147

Earlier quoted context omitted.

You are ranting about your own confabulated view of cancer research. Crizotinib is a case in point. It is a small molecule that works very well for lung cancer, but only if a patient's cancer has a particular chromosomal fusion. This drug went from being a 'candidate' molecule to having gold standard data and FDA approval in 5 years. No fantasies about billionaires required. The way you conceptualise a cancer patient…

This drug went from being a 'candidate' molecule to having gold standard data and FDA approval in 5 years. Five years! I know that's fast by industry standards. Why, it's only one more year than it took us to win World War II. Also, for a full measure of the OODA loop, you should start counting from when the target was discovered. The way you conceptualise a cancer patient's plight is also insulting and grotesque. Th…

Honest question: would you be less bitter about your grandfathers' death if they had been given some unproven, entirely experimental risky drug...and then died immediately after because of said drug?

How would you feel about your grandparents being used as a few more numbers to confirm that a drug is not, in fact, effective or safe in treating prostate cancer?

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