Developing a cancer drug without Big Pharma: this hospital shows it can be done

Drug development faces a forecasting problem, not a measurement problem. In the same way that temperature, pressure, and humidity readings have been collected for centuries, it wasn’t until we developed models and computational power that accurate weather forecasting became possible.

Similarly, in drug development, we’ve long had access to extensive pre-clinical data and measurement tools. However, without predictive models to interpret this data, we will continue to struggle to forecast a drug’s safety and effectiveness in humans.

Interesting coincidence that for the last several decades, the rate of success of a drug advancing from a phase 1 clinical trial to approval is about 10%, which was just about how good we were at forecasting tomorrow’s weather between 1900-1950.

> - Doctors want the best outcomes for their patients. They’ll use whatever treatment is most effective.

They will often do what make them the most money. Also remember that is doctor is subject to rules and regulations. He risks loosing his license if he does not toe the line. Your average medical student is about half a million dollars in debt when he/she graduates.

> - Doctors want the best outcomes for themselves. If they’ve found an effective treatment that others are overlooking then they’ll seek to publish.

Doctors do want the best outcomes for themselves, but if you manged to become a doctor, it means that you have never learned to question authority. Many doctors believe that what they are taught is Gospel. A doctor or a medical student who questions authority, will either not make it through medical college, or will have a license revoked.

>- Patients want the best outcomes for themselves. If there is an overlooked treatment then they’ll communicate it to their doctor.

A patient is generally ridiculed, or ignored by the doctor if he suggests something that he thinks is better.

It goes without saying that there are exceptions both among doctors and patients.

No, not your personal experience, but the experiences of the others. For example look up Linus Pauling's writings on the subject, and the writings of his detractors. Spend atleast 50 hours on it.

Also see my post on the same thread: https://news.ycombinator.com/item?id=42266462

A utility-maximizing drug discovery system would, I think, devote some effort to biological experimentation on healthy humans, giving them chemical probes to see how that affected their biology. As is, ethics requires we get this information accidentally, for example from that famous recreational drug chemist who gave himself Parkinson's Disease with a botched synthesis that made a highly neurotoxic chemical. And some of the information comes from drug trials. A useful drug is not the only value obtained from a drug trial -- each trial is also a test of a hypothesis about the mechanisms of a disease.

One of the books of the "Colossus" trilogy (about a computer that takes over the world) had the computer doing this sort of medical experimentation on randomly selected drafted subjects, with the idea of maximizing overall utility. It shows the problem with utility maximization as a goal, similar to the requirement that people give up a healthy kidney if someone else needs a transplant.

Deeply disappointed by the comments replying to this. I would reply to each individually, but feel like I'd get throttled by hackernews, so I'll just reply to everyone here.

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shepherdjerred writes that this is unlikely because doctors want what is best for their patients and would notice a cure were it available.

This is kind of true. Some doctors do know about and prescribe vitamin c with typical therapy. Here is an umbrella review of hundreds of such cases documenting positive results from using vitamin C.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8812486/

The issue is not whether doctors will prescribe it - I expect anyone could ask their doctor for it. Vitamin C is safe, well tolerated, and shown to mitigate symptoms of chemotherapy. Doctors can and do prescribe it.

The issue is why an apparently promising therapy isn't getting better testing to establish whether or not it is effective despite it being known for decades.

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adamredwoods writes that while his wife was still alive people in her group tried it.

I'd love to know more - especially type of cancer and whether the vitamin c was administered orally (no effect expected) or by IV (depending on type of cancer possible effect expected) and at what dosage.

Here's a randomized controlled trial showing substantial benefits of high dose IV vitamin C for patients with advanced pancreatic cancer - they live longer, the cancer progresses slower, and their quality of life is generally better.

https://pubmed.ncbi.nlm.nih.gov/39369582/

Adam goes on to suggest I should do the funding myself if I think there is a miracle cure here.

There are a couple ideas here. If I or a loved one ever develop cancer - then of course (depending on type of cancer) I would take high dose IV vitamin C, along with similar therapies that are well established as safe and potentially useful.

As far as "Doing the research myself" - honestly, I might. My path would be to construct a website compiling the research, explaining why people with cancer should try this, explaining how you can get your doctor to prescribe it to you (or, since you don't need a prescription to take vitamin c, how you can DIY), and have functionality to support people registering that they are a cancer patient who has decided to take vitamin c (or not) and give updates.

The hope with the website would be that it could compile enough raw data to become compelling to medical professionals.

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Panzer04 asks "if the therapy works if it's as trivial and simple as you say" - why isn't it being done?

Vitamin C is sometimes used. That's why we have hundreds of case studies and, in some cases, randomized controlled trials and other experiments documenting its use and efficacy.

My comments here aren't based on what I say or think - my original source was an article explaining the research on cancer.gov. Vitamin C (again: high dose and IV administered) is known to have potential benefits for cancer patients.

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cyberax says "Sigh. Vitamin C quackery again" and then offers a partial explanation of the mechanism for how vitamin C causes cell death in cancer cells - which is better explained in the link I originally provided.

cyberax then claims, without evidence, that cancer cells quickly evolve resistance to it. I don't believe there is any such evidence, having read several papers on this and never seeing it mentioned - nor, by my understanding, is it plausible that cancer cells could fundamentally change how they work to get immunity to this. Perhaps I'm wrong though and cyberax could supply some evidence.

I notice in the replies to cyberax pfdietz says "There is evidence that high doses of antioxidants can make cancer worse" - and then links 2 papers exploring the use of vitamin E as a cancer treatment. Vitamin E, despite sharing quite a few letters with Vitamin C, is a different thing.

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dennis_jeeves2 writes that "Linus Pauling (of the Nobel Laureate fame) working along with some physicians did do 'rigorous' research on it".

This is not correct and explained in the first few paragraphs of my original link. Linus Pauling used orally administered vitamin C which results in weaker blood concentrations and therefore less impact on cancer. The modern method uses IV administered high dose Vitamin C (which I was careful to write in my comment).

While Pauling's method shows little effect in randomized controlled trials, high dose IV Vitamin C does show benefits.

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insane_dreamer writes that "Medical trials to prove its safety in human subjects -- pretty essential -- is a lengthy, multi-stage process that is extremely expensive to carry out."

Pretty meaningless comment. The safety of vitamin C is already well established.

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pjc50 also cites Linus Pauling - which, again, is explained in the first couple paragraphs of the link I originally posted. High dose orally administered vitamin C doesn't work - there are limits on how much you can increase blood concentration through oral administration, so most of the high dose is lost.

That's why, as explained in my original comment/link, the modern protocol uses IV administered vitamin C.

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alphan0n quotes an XKCD strip saying "Bullets can induce cell death in a wide variety of cancers as well."

A bad comment because the tests I've been linked to have been in vivo, and my original link explains why this kills cancer cells and not healthy cells.

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That's my review of the comments. I would characterize them as exceptionally uninformed - which is odd. Why would people feel the need to comment on a subject they don't know about and simultaneously refuse to read the outline I originally linked which answers all the questions and criticisms posted here?