There is No Holding Back Time
INTERESTING STUFF – 9 January 2016

Why There is No Cure or Prevention for Cancer

More than half a century ago, when I was somewhere around age 20, I worried a lot about cancer. I was terrified of it in the way of people who are not old enough yet to have become sanguine about what they cannot control.

In those days, hardly anyone survived cancer but I was astute enough to notice that most of them were old, past 50 or 60 or 70.

So I tamped down my fear and consoled myself with the thought that by the time I was that old, there would be a cure or a vaccine.

That was not a pie-in-the-sky idea then. It had not been long since everyone in the United States had lined up for their polio-preventing sugar cube.

In addition, during my childhood and in the few years following, science conquered whooping cough, diphtheria, smallpox, mumps and chickenpox, among others.

We were on such a roll in eliminating disease that had previously killed hundreds of thousands of people a year, it seemed inevitable that cancer wouldn't be far behind, and certainly before I reached the average (old) age for it.

Yet here we are 50-odd years later without much advance in cancer research beyond a few poisonous drugs that ravage the bodies of victims before they die anyway.

Cancer is still the second leading cause of death in the U.S. (584,881 in 2013) according to the Centers for Disease Control and Prevention. Why should that still be?

In between my youthful fear and now, we have invented the pacemaker, had continued success with heart and other organ transplants, made laser surgery for cataracts commonplace, mapped the human genome, invented a variety of high-tech diagnostic tools along with robots that do precise, miniature surgeries and made interesting advances for the blind and physically disabled.

There is more but maybe you, as I, are suitably impressed by that small list. Except – what happened to cancer?

About 18 months ago, the New York Times launched a fascinating and informative new column, “The New Health Care” that they describe as follows:

“Informed by research, Austin Frakt and Aaron Carroll explore and explain the changing landscape of health care.”

I've already learned a lot from these guys and a week or so ago, Mr. Frakt provided some daylight on cancer research in a story titled, Why Preventing Cancer Is Not the Priority in Drug Development.

If, before reading this article, I had ever put more than a second's worth of thought to why cancer is still such a scourge, I would have twigged to the answer immediately. It is what it always is in this country: profit. What else is new.

”There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months," writes Frakt, "than in drugs that would prevent cancer in the first place."

Frakt's story is reporting on a newly published study from Heidi Williams (and two others), an M.I.T. economics professor and recent MacArthur Foundation “genius” grant winner.

He provides a lot of wonky detail about the Food and Drug Administration drug trial requirements, patent extension, early and late stage drug effectiveness and this shocker:

”Use of surrogate endpoints with no known or strong relationship to survival is controversial. For example, the prostate-specific antigen [P.S.A.] test level — assessed with a blood test — is correlated with the amount of cancer in the prostate but has limited value in predicting prostate cancer survival.

“So, though they may be lucrative to drug companies, one would have little confidence that drugs approved based on P.S.A. test results would confer survival benefits.

“A recent systematic review found that most surrogate endpoints examined in cancer drug trials are weakly related to survival. Though most cancer drugs in recent years have been approved on the basis of surrogate endpoints, a majority of them have unknown or no beneficial survival effects.”

“No beneficial survival effects.” But drugs are nevertheless created, approved and sold at high prices based on them anyway. Instead of investing the time and effort to prevent cancer, big pharma repeatedly goes for the quickest bang for their buck. No wonder, as Frakt reports:

“Ms. Williams's study estimated that the commercialization lag's incentive to invest in drugs of shorter duration benefit led to 890,000 lost life-years among American patients found to have cancer in 2003 alone.”

Among Ms. Williams's suggestions for change, reports Frakt, are to pass legislation that will speed up drugs' path to market and/or to extend the period of “market exclusivity” before drugs go off-patent.

Yeah, right. Like big pharma will trip all over themselves to develop a cancer vaccine in exchange for another six months or year of patent protection.

What puny, useless solutions.

But the bigger question - the most awful-to-contemplate question - is why a society leaves the health and wellbeing - the fact of actual suffering and life or death - of its citizens to the whims of corporate profit?

What kind of government, corporate, philosophical monsters build such a society?

Let them charge anything at all for a television set - whatever they can get away with. No one will die. Who cares if a pair of shoes costs $5,000 (as some do). Fifty thousand for dinner at a restaurant? Why not? It isn't my - or society's - concern how billionaires spent their cash.

But it is unspeakable to withhold cancer research for no reason but to enhance profit. Read this grotesque sentence again:

”There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place."

Frakt is writing about cancer. I suspect the same could be said about Alzheimer's, diabetes, Parkinson's, stroke, heart disease, etc. And because elders contend with these diseases and conditions in far greater numbers than younger people, we should at least understand how we are being killed.

As long as the United States applies the profit motive even to matters of life and death, nothing will change. Read the story in full at The New York Times.

Comments

Exactly.

I spent the last two years living with and caring for my sister who had adenocarcinoma. We had the high point of hearing that there was no evidence of disease and then eight months later the lowest point of our lives hearing the disease was back and she was terminal. These are two points that I think any person can understand, but it is the time between these two points that people don't get. People who are not directly involved with daily radiation and it's devastating effects on the body, the weekly chemotherapy and the nausea, vomiting, and diarrhea that keep you up all night, or in the end when your loved one doesn't eat or drink water and you know you are seeing the end of a loved one's life can cheer drugs that extend life. These advances in extending life make us all feel like pharma is working on that cure and any day now cancer will be cured. Maybe if we all saw what cancer really does instead of the beautiful actress fading gently away with a beautiful scarf to signify her suffering wrapped around her head we might say no more, but then cancer is always someone else's problem until it's not.

Mr. Frakts assessment of why drug companies priorities lie elsewhere other than in finding a cure are probably correct given some of the stories as of late attesting to their out and out greed.
On the other hand comes Google, who this past year, has dedicated itself to finding a cure for death. Hopefully, some of that nice Google money will actually go to funding Cancer (curing) research.

To be clear, Bruce Cooper, Mr. Frakts is reporting on the assessment of the results of research done by Professor Williams and her colleagues. It is not his assessment.

Nobody has mentioned that other very important factor about cancer, which is that we live in an increasingly toxic world. The only remedy is to clean up our polluted air and our chemical-laden water, replace our mass-produced and de-natured food with healthful alternatives and take a good look at everything else that loads extra stress on to our bodies (including the ridiculously frenetic pace at which so many people are now living their lives).

Until we, as a worldwide human community, join forces to do that, our immune systems are going to be increasingly compromised and unable to do their job of dealing with rogue cells.

(Yes, I know some of us lead healthy lives and still get cancer. But we all breathe the same air. Environmental pollution is a biggie and there's only so much an individual can do about that.)

The true answers will not come out of a pill bottle or a syringe.

Finding a cure/vaccine for cancer is a bit like trying to find a vaccine for old age. If you live long enough, it's one of several diseases/conditions that will probably end your life (cells and immunities weaken and deteriorate, and the body inevitably succumbs). Nor is it a simple matter of finding a single cure for a single disease. There are many, many kinds of cancer requiring many different kinds and combinations of treatments. I've long condemned the profit motive that drives Big Pharma, but I think it's oversimplifying to believe there will be a single vaccine to prevent all cancers. Admittedly I may not be the most objective observer; I've have been undergoing breast cancer treatment since last April. It's a tough way to learn about a tough disease, but boy do you learn.

This morning on CBS news, it was reported that there has been a significant drop in deaths from cancer........I can't recall the exact figures or time frame, but the decrease was surprising to me. The reporter stated that the drop resulted primarily from the decrease in smoking which seems to add further credence to what Marian has posted.

We are after all a capitalist society & the bottom line is master especially with big pharma & the gun manufacturers. How sad. Dee

Over the past few days, I've watched two programs that have left me thinking a lot about of things. The first was a program describing the debates and investigations into the origin and status of the universe, (i.e. the Steady State theory versus the Big Bang Theory). For millennia, the greatest obstacles to a definitive answer to this has been a lack of adequate research tools (primarily telescopes and satellites) and our limited human knowledge, and the tension between science and religion. It occurs to me that the same can be said of all the big questions and challenges in life, cancer and dementia being just two of these. We are such a tiny way along the continuum of understanding. With further advances on the technology developed over the past two decades especially, and if the world and humankind survives long enough, we may come to understand and deal with these big things. The bigger challenge, I think, is connected to the other program, a six hour series done by PBS (WGBH) in 1998 on slavery and the history of Africans in America from 1590 to 1865. This program leaves me more concerned about whether we have what it would take to make the relief of suffering a priority, regardless of the cost or who was doing the suffering. I hope we are advancing not only in technology and science, but in compassion and empathy, but there seems to be a lot of evidence that says we are not.

Twenty-first century capitalism has been aptly characterized as "vulture capitalism" in many (but not all) situations. As long as profit is the motivating factor, vulture capitalists will do whatever they have to do to ensure the most obscene level of profit they can squeeze out of the rest of us. Offshore tax havens? Sure. Cheating emissions control devices so we all breathe dirtier air? Absolutely. Another me-too ED drug? Of course. A cancer preventive or early-stage treatment drug? Well, not so fast. Where's the money in that?

My mother died of metastatic breast cancer at age 69 in the '70s. Although the survival rate has improved, probably for a variety of reasons, I don't think there's been a lot of progress in making the very pricey drugs used to treat it less toxic. I decided back then that, if I got cancer, I would not spend the last 2 years of my life sicker from the treatment than from the disease. I still feel that way nearly 50 years later. Fortunately, I now live in a right-to-die state.

That doesn't change the fact that I think our "health care" system is based on profit and is therefore not going to protect my health unless there's money in it.

Well, the techno-generation (Google, Musk, Gates, etc) are pinning their hopes on developing A.I. (artificial intelligence) to the point IT can solve all human problems, including either preventing and/or curing cancer. I've recently been doing a lot of reading/research into "machine learning" and kind of amazed at this whiz-kid universe. They are making far greater strides than one would know from the nightly news. However, as usual, there are some who are warning an intelligent machine far greater than human intelligence just might decide to destroy us for being defective.

At any rate, it doesn't surprise me there is more profit on extending life a few months to suffer unbearably instead of preventing cancer. I've long thought that Big Pharma actually thrives on our ills, and many of our present-day ills are caused in turn by big corporations that are ruining the air we breathe, the mass-manufactured food we eat, etc. It's a vicious circle, but profitable for them, deadly for us.

Fourteen years ago, when my husband was diagnosed with Stage IV colon cancer, we both began to learn about the "business" of cancer. It is huge, practically a self-sustaining system, that employs many many people, and of course creates huge profits for big pharma. It is next to impossible, as far as I can see, for a cure and/or the elimination of the disease to occur in a capitalist society like ours. And, not only is it the business and profit angle, but also, as another poster pointed out, the toxic environment we have created and must live in. I have long said you cannot spoil the habitat without harming the inhabitants, and whether or not enough studies exist to prove it to the powers that be, we all know it is true.
My husband lived for the predicted 2 years, with first one chemo and then another. We had periods of hope and joy, and then of course, the ultimate death sentence. The one positive thing I can say about cancer is it gives you time to sort out your life and do what needs to be done. This we did, and we did it well, but I will advocate for the prevention science any day.

I agree with Marion; we need to focus as much (or more) on cleaning/stopping pollution of our environment as much as we do seeking cures for cancer.

Ronnie, you have demonstrated an incorporation of the best cancer-prevention strategies: adopting a mostly plant-based diet and daily exercise. Applause to you!

Another wrong-minded monster related to Big Pharma is cousin Big Ag (agriculture). I am a little encouraged by the slow-but-sure growing trend of awareness for adopting more healthy lifestyles - consuming organic foods and staying active.

Excellent post, excellent responses!

Another side of all this is the - especially in the US - our denial of death. As if we all have the right and should be able to live forever. Wouldn't it be wonderful if we educated, from an early age, that death is the natural end point of life. That we supported our dying instead of pushing yet another toxic drug leading to a very short, painful and miserable approach to death.

My father died a horrible death from a cancer in his mouth. My mother had five massive cancers before she died of renal failure. My best friend, Jo, died of breast cancer. Another friend died of lung cancer....oh, the list for each of us is endless. Jo said shortly before she died that she hoped breast cancer could be held off more than 2 years. That's all she had. Now one can live after a diagnosis for up to 15 years.

I am small and can do little about this scourge. I volunteer at the American Cancer Society's Discovery Shop/Point Loma. The money we earn goes to research. I wish I could do more than sort and shelve and post on Facebook, but I can do that.

Excellent blog post, Ronni, followed by some thoughtful and sadly true comments on the state of our health care system as seen by those of us who have been, for many years, the recipients of this system.

The state of drug company profit gouging and lack of research dollars spent on a cure for the cancers that strike so many of us is a terrible reality. I have seen several of my best friends die from breast cancer while medicine touts the mammogram-which does not begin to correctly diagnose many stages of cancer. How many doctors have invested in MRI and X-ray facilities so that they benefit from sending their patients. I know my doctors group has a close relationship with the local MRI facility because of that.

The sad truth is that, as other have noted, our lifestyle and the toxins in our lives cause many forms of cancer. Including the X-rays we go to...last time I was in the hospital I questioned the necessity of an X-ray for the issue I was in for..I knew it was kidney stones, had been having issues with them for several months and had also been x-Rayed 3 times for the same problem. I refused the X-ray and surprisingly the RM on duty agreed with me. She said it was a CYA for emergency department..not really medically necessary.

Like others I do what I can to take care of myself. Volunteer at a local Heart association office and do 'papering' (distribute flyers) at kcal events to encourage self breast exams-which is still the most efficient way to find a tumor in the earliest stages.

This weeks "Rolling Stone" had a fine article about what it cost to house prisoners at "Gitmo"..almost $2 million PER YEAR PER PRISONER. Think how this money might be better spent if given to cancer research. Instead it is used to house just over 100 prisoners, many of whom have been slated for release since 2006 and are still there. Besides being a terrible statement on "American Justics" it is a terrible waste of money..money that could be spent in research!

What the hell can we do about either issue? I guess take the best care of ourselves that we can and try to vote for a government that can follow thru on its promises. President Obama made closing Gitmo one of his first priorities in 2008..still it sits there in Cuba, costing the tax paying public, you and I, millions of dollars that could and should be directed to medical care.

Best to you all, and Ronni thanks for posting such an honest blog.

Elle, your neighbor in Beaverton

The book "The Empire of All Maladies: A biography of cancer" by Siddhartha Mukherjee is a big fat book that is nearly impossible to put down, both fascinating, beautifully written, and profound. The Pulitzer was well deserved for that one.

I agree with most of the posters observations, Especially PiedType. I am now newly called a cancer survivor. Still enduring the side effects of chemo treatments. (I'm typing with tingling and numb fingers, which I'm told will pass)
My Fallopian Tube cancer is quite rare. according to my doctors. And I know many stories of cancer treatments and deaths.
However I also know as most of you do also that cancer is not one disease and there is no treatment for cancer as such. Some scientists have found a way to extract the DNA from a cancer cell and the means to create a cure for that cancer. But it is that cancer only.I spoke with my oncologists about that work and he told me they had done a few treatment with those methods.
So there can be no cure for cancer, per se.
But I am in full agreement with the diagnosis of where and why funds are allocated and of the FDA's too cosy relation ship with the pharmaceutical industry. After all, didn't one of our"great" presidents say"The business of America is business"!

I had friends who are now dead who thought that cancer researchers intentionally did not want to find a cure to cancer because then they wouldn't have all that money that cancer sufferers cough up. I have heard the same thing about cardiologists and heart disease. What doctor or researcher would rather have a nice annual income treating sick people versus maybe a nobel prize for curing cancer or make major inroads on heart disease and be in history books for many years, fame and fortune, and maybe marry a supermodel? (disclosure: I am a cardiac nurse). I think the answer is obvious. I do agree that big pharma would rather churn out expensive drugs than develop vaccines. Remember, cancer and heart disease are tough problems. There are many researchers working for NIH and universities that are not in the pocket of big pharma (some are, of course). Lots of people are living longer now and better because of the research done in the last few years. Cynicism is easy and a type of laziness.

Very interesting posts and comments. As an American living now in Canada for about 5 years, I can not tell you how impressed and thankful that things worked out for me to live here. Unlike many negative rumours I had heard, I find this healthcare system here, so superior than anything I had experienced while living in the U.S. for most of my life. I have a family doctor I see regularly, have had quite a number of visits to various specialists, and hospital visits. Never once did I have to pay a dime. My impressions are that the doctors here, do what is needed including ordering whatever tests are needed without concern that there is an insurance company behind every decision they make, trying to dictate what they have to do(or what they will or will not pay for). U.S. Healthcare is driven by the Insurance companies and pharmaceutical companies, not doctors! Yes, taxes here are higher to pay for it, but I gladly pay them, knowing I do not worry now about growing deductibles or higher premiums, loss of insurance, or being bankrupt by a medical emergency. It is hard for me to describe the difference in feeling, when going to a hospital and only being concerned about my health without having the stigma or fear of how much is this going to cost me, attached to it. And don't get me started on the differences in drug costs here, over what is happening in the U.S. Just before moving here, I had an unfortunate incident, being rushed to the hospital for a suspected heart attack. I was met by a woman with a clipboard first, wanting to know all my insurance information. I was struggling having to breathe, while trying to get out my wallet to validate insurance(so they would get paid before letting me see a doctor). If I did not have insurance, god know what would have happened. Sorry for the long post, but the system here is just so much more humane. And I do feel for my fellow Americans, as I know it would be nearly impossible to dismantle and/or change over to a system like this, when the "for profit" insurance and pharmaceutical companies have such a strong stranglehold, on the entire healthcare system there. There is a basic cultural difference in the people(and government) here, toward healthcare, childcare for working parents, and costs of college, which i can only describe as a system created from the heart, rather than from the pocketbook.

Though the article is very well written, as usual, I got a little bit confused about pharmaceutical companies making drugs to prolong the suffering of cancer patients to actually treating them and then to preventing them.

What are we talking about here, curing or preventing? I believe I have come across several articles already about cancer treatments and there definitely are thousands of articles about cancer prevention.

Or am I missing something?

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