501derful.org
You can’t miss it; the Fortune Magazine appearing on newsstands splashes the assertion that we’re losing the “war on cancer” all over its cover. For anyone interested in the conquest of cancer it’s probably worth reading. (You need a subscription to access the article online, so buy it on newsstands or send me an e-mail for a copy.)
The author, Clifton Leaf, cites the statistics on cancer mortality, especially mortality for late-stage disease, and concludes that not a great deal of progress has been made in the medical conquest of the disease. He acknowledges that prevention and early detection have reduced the incidence and mortality for lung and breast ca, but he is less than congratulatory about progress in treatment overall. His basic position is that—for the $200 billion spent by government and non-government sources since 1971, the start of the War on Cancer—we haven’t gotten much.
Leaf identifies what he thinks, after months of interviewing authoritative sources, are several key reasons why not much progress is being made.
- Lack of adequate orchestration of the overall cancer research and development effort resulting in a highly fragmented jumble of efforts in academia, research hospitals, pharmaceutical companies, government funding and regulatory agencies, and advocacy groups (that’s us!).
- A “dysfunctional ‘cancer culture'” that results in highly focused but unspectacular research and products. There are too many incentives to do less risky, less imaginative work.
- Over-reliance on the inadequate mouse models to be the functional hurdle for what does and does not go forward for development.
- Neglect of research on metastasis and potential treatments like anti-angiogenesis.
- The torturous approval process that takes forever to reach conclusions and discourages research on more-difficult-to-measure things like prevention of tumors.
- Insufficient attention to biomarkers for earlier detection…
And on and on.
I think what Leaf points to are issues worthy of discussion, certainly. But I’d take exception to one overall subtext of the article: namely, that we’re wasting too much effort trying to find out small biological details when we should be looking for what works in treatment whether we understand it fully or not. He quotes Dana Farber as saying decades ago that we don’t need to understand it all to have more effective treatment, and cancer patients can’t wait.
I’d disagree. The more I see of the biology of cancer the more I think that we have from the outset way, way underestimated the complexity of cancer. Or, put another way, we’ve underestimated the subtlety and complexity of life and cancer is a kind of directory to all the many, many ways life’s basic processes can go wrong. Life processes are kind of like fractal patterns—not like fractals, they are fractal—where, each time you zoom in, there’s another level of complexity. I’m sure we can make progress, but it’s like that old bromide: you can pay me now or you can pay me later, but you’re gonna pay. We’ve got to know the details all the way down. The alternative etiologies, the sheer complexity of the mechanisms, and the resiliency of tumors when faced with destruction via basic biological evolutionary mechanisms say to me that better treatments will be like rest-stops on a long journey. It’s like a trip of 1,000 miles where the kids keep asking “are we there yet?” No.
Every few months an article appears like this one in which a serious author expresses disappointment that we’re not where we ought to be by now in conquering cancer. That’s why I think the ACS ought to proactively set public expectations and position itself as an enduring force in an epic struggle. We sure should avoid looking like a naive Pollyanna. We need to promulgate a new, realistic set of expectations for future progress based on scientific reality, or we’ll end up looking inadequate over and over.
