Why haven't we cured cancer yet?

Statements like this prove the systemic abuse of statistics that is pharma regulation. You've - quite unconsciously, no doubt - reversed the definition of proof, asserting that failure to prove a positive is equivalent to proving a negative.

Of course you don't believe this. But your institutional jargon automatically generates the lie. Orwell had a point.

Today's viable drug is a survivor in a winnowing process in which any of a thousand screwups - often mere failures of trial design - can kill it. Moreover, while some of these are corporate errors (not the drug's fault), many of the design failures are institutional and uncorrectable.

For instance, testing cancer drugs of the "magic bullet" type against late-stage tumors is utterly ridiculous, as these genetic Cthulhus are the last place anything targeted is likely to work on. But this is the only place our testing paradigm is viable. The drunk looks under the lamppost for his keys, again and again.

Advanced genotyping might reveal that a certain tumor has five pathways for evading apoptosis. Five different molecules are needed to shut them all down. In an individual trial, each molecule fails. It thus - to use your language - "proves ineffective."

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

It's a commonplace assertion that most of these older compounds (certainly aspirin and penicillin) would fail an early toxicity screen and never get close to a mouse, let alone a patient.

I have no idea whether this is true. But if it is, Western medicine is objectively in the same position as NASA: it can no longer do the things it did 40 years ago. Welcome to Trantor.

Turns out, when your life expectancy is less than a year, you are willing to try a lot of things.

You know what's better than going to your granddaughter's wedding next month? Living long enough to see your granddaughters born.

My mother applied for every experimental drug treatment available. She got accepted into 1 out of 6. Her doctor told her it's standard practice for drug companies to deny access to experimental drugs if they believe the success rate is going to be low, because it makes their success rate look lower.

Think about that for a second.

The drug had already passed the safety trials, i.e. they knew it wouldn't kill her, but they weren't sure whether it would help her. The company thought there was a low, but not non-zero chance the treatment would work, and they denied it.

My mother knew she was going to die, she was grasping at straws for a cure. Trying new treatments isn't sacrifice.

The sacrifice is not doing and learning everything you can. The sacrifice is throwing away fully informed and willing test subjects, and having a bureaucracy that prevents people from trying to save their own lives.

It has never been shown that treating cancer patients up until the time of death makes any difference to either quality of life or survival (http://www.biomedcentral.com/1472-684X/10/14). Sometimes there is a tyranny about the biology of cancer that is difficult to overcome even with agents that are known to be effective, not even when you have run out of all drugs completely.

You might scoff at the notion of a good death. But then there is this trial (http://www.nejm.org/doi/full/10.1056/NEJMoa1000678). This was a trial which compared early palliative care with late palliative care involvement for patients with metastatic lung cancer. They were otherwise treated with standard therapy/clinical trials/whatever was available. Astonishingly, those patients that received early palliative care had less treatment overall and lived nearly 3 months longer - by getting less treatment, and focusing on quality of life. If there was a new drug that helped people with lung cancer live 3 months longer, it would be revolutionary.

On the basis of this evidence and my personal experience, I believe there is potential harm in taking the attitude of wanting to try everything by default. This attitude may be right for some people, but for others, it may shorten their lives for no benefit and leave them and their families unprepared for the inevitable end.

There is no escape from the notion that the latest drug might just turn everything around. It is certainly true that when a drug like this comes along, there will be some people who miss out and die because they or their doctors didn't try hard enough. But how much potential harm can you justify because of this tiny, tiny risk?