Saturday, October 31, 2015

Killing Cancer

Human Diseases

An article, by Vincent DeVita and Elizabeth DeVita-Raeburn, in Aeon gives an excellent overview on why the “war on cancer” has not achieved the level of success it could. There have been many successes, as I have written about here, but there can be more according to this article. As is the case with all battles, it is not so much about money (although it is necessary), but about the allocation of resources and how to effectively harness collected human knowledge.

It is also about putting aside the need for personal aggrandizement, always a difficult if not impossible task for smart people. In short, some human desires, such as protecting turf. employing outdated ideas, and fearing change defeat the over-all intentions of winning the war.  While this article reflects on the system in the United States, it likely has resonance elsewhere.

When someone writes an article like this, it is important to know who they are and why they are doing so. For one, Vicent DeVita is a former director of the National Cancer Institute and the Amy and Joseph Perella Professor of Medicine at Yale Cancer Center and Yale School of Medicine; Elizabeth DeVita-Raeburn is is a journalist and author who writes about science, medicine and psychology. They have co-authored a book, The Death of Cancer (2015). One of them had a personal encounter with cancer, as many of us have recently had. When this happens, your perspective changes.

In “Death of Cancer,” (October 23, 2015), the article starts with a confession:
Six years ago, I (Vincent) was diagnosed with life-threatening prostate cancer that would have killed most men. I survived because I was able to call on colleagues to deliver aggressive surgery outside the standard of care (hormone therapy) for my type of disease. Without a doubt, the operation saved my life.
What happened in my case should be how things happen as a matter of course, but it’s not. That more people than necessary continue to die from cancer has nothing to do with ‘the failed war on cancer’ – a familiar refrain in the press – or a lack of scientific tools, which have begun to accumulate at a breathtaking pace. Rather, obstacles take the form of not using the tools we already have to cure more; a reluctance to drop outdated beliefs; bureaucratic battles among physicians and medical groups; and outdated regulation by the US Food and Drug Administration (FDA) whose policies hinder the innovations wrought by cancer drug‑development in recent years.
These issues are well‑known to doctors and researchers, but many are reluctant to talk about them overtly for fear that they could damage their colleagues or their chances of getting a grant or drug application approved.
This can be boiled down to the ideas of conformity, notably to a system that is no longer relevant today; this includes the protocol to testing new or experimental drugs and therapies, which in the U.S. falls under the control and protection of the F.D.A. Such protocols are rigid, lengthy and costly, all the enemies of eradicating cancer. The article says:
Recently, at a dinner for the FDA Commissioner, I sat next to an outstanding clinical investigator who works with the exciting new drugs recently available for advanced melanoma. For the first time in my long career, we are seeing remissions that are likely cures of this ferocious disease. I asked my dinner companion how he was affected by all the regulations that have been piled on the FDA and the NCI. He said: “Vince, if they would leave me alone, I could cure so many more patients.”
This is the end game; truly, nothing else matters. The human desires, so to speak, have to catch up to the technology. Individual achievement, no matter it being the trope of movies and fiction books, will not bring about breakthroughs. Neither will regulation. I have never heard of regulation winning the Nobel Prize in medicine.

For more, go to [Aeon]

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