Monday, May 16, 2011

Cure for Cancer: from the perspective of someone actually in the field

There has been a resurfacing of an article that was published in 2007 in regards to there being a cure for cancer and that "big pharam" is keeping us from this cure.

Here is a summary and the actual publication of the findings published in Cancer Cell journal. And another summary and publication of further findings published a year later in 2008

My brother is a Geneticist who is currently running a lab at  The University of Oxford in England where his specialty is finding a cure for Leukemia. He has a finger on the pulse of what is accurate and what isn't when it comes to the scientific world and cancer. When I came across this article again I was curious what he thought. If it was just a resurrection of old information or something that might actually be of some truth. If my brother was being paid out by "big pharam" to keep this under wraps, he would be a very rich man- which he isn't.  

You have to agree though that it has a certain psychological appeal (to that little conspiracy theorist inside each of us). There is something compelling about the notion that the powers that be are not acting in our interest. It gives us a (usually false) sense of empowerment to think we are peeking behind the curtain and seeing what’s really going on.

But on close inspection the story makes no sense. The core flaw in this notion is the unstated premise that the medical establishment is a monolithic entity capable of acting with one intent. Rather, like many aspects of our civilization, modern medicine is a complex organism with many independent parts, and no one piece has dominion over all the others. The pharmaceutical industry does not control all of medical research. It does fund a great deal of research, because it has billions of dollars to invest in R&D and it does direct its research funds to developing drugs that will make them money. But there is also billions of dollars in research funding from the government, and from private organizations, patient groups, and other sources. And of course, there are many other countries each with their own medical research infrastructure.

And research is not the only piece of the puzzle either. There are professional organizations, academic institutions, and disease advocacy groups.The notion of “a cure for cancer” is also highly improbable. Cancer is not a single disease, but a category of disease with a great deal of variation. That is why there are numerous treatments for cancer, and treatments need to be specifically tailored to the cancer type, stage, and location, as well as the individual patient.

But what about this specific treatment – dichloroacetate, or DCA? Promoters of science-based medicine deal with many types of health claims. Some are purely magical, others are physical but are clear quackery. DCA is neither. It is a legitimate drug with an interesting mechanism of action and some potential as a treatment for some cancers and other conditions as well (but to be clear up front, it is not a proven and accepted treatment for cancer in humans).

DCA falls under the category of prematurely promoting an experimental drug before it has been adequately studied. It can sound very compelling to hear the story of how DCA works to kill cancer cells. It certainly sounds like it is a cure for cancer. But medical researchers have been here before. Many potential treatments look good in the test tube, but do not eventually work as treatments in humans. Cancer is complex, and biology is complex, and in a living person the net effects may not be what we expect.

There is also safety to consider. Medical decision-making is about risk vs benefit. There is a tendency for naive and sensational reports to hype a treatment by focusing entirely on the potential benefits. But before we can reasonably recommend or give a treatment, we need to know something about the risks as well. We want to make sure we are not doing more harm than good.

Right now the preliminary evidence for DCA is weak but there is still a glimmer of promise. It looks like the ability to kill cancer cells is low, and therefore any clinical effect may be limited. Further, serious side effects are also coming to light. The drug has been linked to serious brain dysfunction and nerve damage. What all of this research also shows is that DCA is being researched. Contrary to the core claim in the article making the rounds, DCA is getting just the research attention it deserves.

DCA is just one of many potential future cancer treatments in the pipeline. It is an interesting approach, focusing on cancer cell metabolism, specifically mitochondrial function, and that may be the most interesting thing about DCA. But in its current form it’s activity seems to be low and its toxicity high. It may still find a role in cancer treatment. There may be specific cancers for which it has high activity, especially when combined with other treatments. There is a lot of research to be done. And we may find derivatives that are even better. Or, it may ultimately fail as a treatment.

A common story in the cancer-treatment world is that a new potential treatment, based upon a novel approach, is sensationalized as a cure for cancer. But then 5-10 years later we still haven’t cured cancer. But what has often happened is that the new treatment works, it just has a limited role in a subset of cancers. It prolongs survival and is being used- it’s just not the “cure” that it was originally hyped to be.

The history of cancer treatment has taught researchers to be humble and realistic. New treatments are great, and they are each contributing to the slowly increasing survival of many cancers. We are making progress with a lot of singles – just not the grand-slam home-runs that the media wants for good headlines.

As wonderful as it would be we can't believe the conspiracy-mongering and the hype. The research is happening. It is being targeted largely to therapies in proportion to their promise. But unfortunately research progresses much more slowly than rumors spread through Facebook and Twitter.

[Hat Tip to T. A. Milne- my brother]

1 comment:

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