Twenty years from now, you’ll be more disappointed by the things you didn’t do than the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover.
Mark Twain
There is not too much of “explore, dream, discover” in Obama’s initiative about cancer, the Cancer Moonshot initiative. I have already written about it. Since my last commentary, a Blue Ribbon Panel was assembled, and this distinguished panel came up with ten recommendations.
Remember my prediction, the one that the $1 billion would go directly where the other billions of dollars have gone in the past 45 years? The money will go for CANCER TREATMENT, not PREVENTION. Yes, I was right, nine out of ten recommendations designate the money for treatment.
If the listed below recommendations were anonymously reviewed by any NIH NCI peer review panel, they would have been dismissed as not well justified, low impact, and catering to profit-driven interests.
Feast your mind on the following recommendations:
A. Establish a network for direct patient involvement: …this recommendation calls for cancer patients to join a new national network that … will provide them with a genetic profile of their cancer and let them “preregister” for clinical trials.
My response: Please, re-think the clinical trials first, then ask for more patient participation. There was an excellent idea on re-structuring the current "randomized controlled" clinical trials in the documentary “Surviving terminal cancer”.
B. Create a clinical trials network devoted exclusively to immunotherapy … for pediatric and adult cancers …to advance research in this area and could lead to new vaccines to prevent cancers of all types in children and adults.
My response: Where is the high impact in this maneuver? Also, I have not seen any rationale in this approach: how exactly would a clinical trials network result in new vaccines that prevent all cancers? Was this recommendation even written by a scientist or a sci-fi writer?
C. Develop ways to overcome resistance to therapy… this calls for establishment of multidisciplinary research teams to understand how drug resistance develops and find ways to prevent tumors from resisting the drugs meant to kill them.
My response: Really, the molecular mechanisms of drug resistance are extremely well studied. It is a matter of implementing the accumulated knowledge.
D. Build a national cancer data ecosystem… this would link many of the nation’s largest data repositories to enable one-stop, free access for researchers, doctors, and patients to share data on cancer and fuel faster progress.
My response: I am always suspicious when someone uses unusual combinations of words such as “national cancer data ecosystem”. Try to put it simply, for example: “implement obligatory sharing of data”. This is good, but how are we going to achieve it?
E. Intensify research on the major drivers of childhood cancers … intensifying research in cell biology, genomics, proteomics, and drug development would accelerate development of new therapies that target these cancer-causing proteins.
My response: Of course, we need to continue researching childhood cancers. I am not sure how this constitutes a novel and breakthrough recommendation? I assume we have been doing it all along.
F. Minimize cancer treatment’s debilitating side effects …this should support development of guidelines for managing patient-reported symptoms and side effects of cancer treatment in adults and children, with the goal of helping patients stay on their drug regimens and improve their quality of life.
My response: How about managing the health awareness and lifestyle factors that predispose to cancer instead? “Helping patients stay on their drug regimen”? Does this sound like trying to increase the profit for big pharma?
G. Expand use of proven prevention and early detection strategies…several cancer prevention and risk-reduction strategies have proven to be effective, including tobacco control, colorectal cancer screening, and HPV vaccination. The recommendation also calls for increasing testing for hereditary cancer syndromes in people with certain types of cancer and their family members, so those identified as high risk can begin early prevention or screening efforts.
My response: Out of the ten recommendations, this is THE ONLY one that deals with prevention, and YET, it does not mention the major lifestyle factors that contribute to cancer today: our sugar-laced diet, the physical inactivity, and the obesity. Tobacco use has been decreasing in the U.S. and we should continue doing whatever we have been doing about it.
Of course, the profit had to be factored even in a "prevention" recommendation: why not start excessively sequencing and screening, if someone could profit from it? Remember, the hereditary cancer syndromes account for maximum 20% of all cancers. The other 80% are mostly due to lifestyle, environment, age. Behavioral changes and educational efforts are implemental; however, they are not even mentioned here.
H. Mine past patient data to predict future patient outcomes: … we need to understand why patients with the same type and stage of cancer, and same treatment end up with different outcomes. The idea is that analyzing the tumor tissue from patients may discover genetic and other factors that impact response.
My response: We already know that amazingly diverse factors modulate the treatment response of individual patients. Instead, we should focus on the main factors/approaches that we know impact almost ALL cancer patients. How about examining the effect of ketogenic dietary regimens that could benefit more than 90% of all cancer patients? Or how about researching Coley's vaccine and why 40-50% of the advanced cancers were cured with this approach?
I. Develop a 3D cancer atlas: a web-based catalog of the genetic lesions and cellular interactions in tumor, immune, and other cells in the tumor microenvironment. The hope is that we will learn about the “evolution of tumors” and this will allow for developing predictive models of tumor progression and response to treatment.
My response: This is equivalent to going fishing into a land without any water body, not even a puddle. We already know that there is not only inter-individual heterogeneity of primary cancers, but also heterogeneity between the cells in the primary cancer in a patient, heterogeneity within the cells of a single metastasis, and between the cells of different metastases of the same individual. Why do we think that we can make sense of the cancer cell "insanity"? This expedition is hopeless. Instead, focus on the initial stages of neoplastic development, when we can really have an impact.
J. Develop new cancer technologies: increase the public–private sector collaboration to develop new tools or refine technologies (e.g., implantable microdosing devices that deliver drugs directly into a tumor to test their effectiveness, and advanced imaging technologies to study cancers at extremely high resolution).
My response: These new high-tech toys may not have any impact since the drugs used for the treatment would be the same. The only result will be the escalation of the cancer care cost.
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