Cure for cancer?

[poochyena]

http://www.youtube.com/watch?v=z1ifXxbxhZc
what do you think?

Leaving it open because it's started a good discussion, but in future try to expand a bit and find a source slightly more reliable than a 3min YT link from a conspiracy theorist. -hawk

[Izawwlgood]

You need to do more than 30 seconds of internet research before getting swept up by cancer cures that big pharma crushed.

Or, you know, think for more than 5 seconds about the idiocy of such a claim.

[Sizik]

2 year old video about 5 year old findings.

[lutzj]

Apparently the drug works by renewing the energy sources of cells, causing them to work normally again.

riiight

[Sizik]

Which then allows them to begin apoptosis.

[Angua]

Is it the mitochondria thing again? Cancer cells are pretty good at not going down apoptotic pathways.

Anyway, one of the problems with the public taking an interest in this field is that some lab publishes promising findings, which then get reported, and then they have a hard time repeating them in different cell lines or something, which conspiracy theorists decide is due to big pharma keeping it quiet. There was a nature opinion article on this problem just the other week.

[Izawwlgood]

I don't understand this whole 'big pharma doesn't want to cure cancer!' is a thing. If you think for more than 30s about profit motives, you can surely see how coming up with the cure for cancer means your drug is going to net you quadrillions. Whereas the first competitor that releases a cure for cancer is going to invalidate your entire like of chemo or otherwise cancer treating drugs. And people are going to keep developing cancer. It's not only not how big pharma operates, but it's actually the opposite of what big pharma is after; you better believe they're all dashing, full sprint, towards realistic cures.

But, again, 'cure for cancer' is like saying 'cure for bad'. It's not going to be a single silver bullet compound.

[TheKrikkitWars]

Surely part of the issue here is that people think of cancer in the same way that they do any other disease... If we educated people about the natural history of disease of cancer, they'd begin to understand that we can't "cure cancer" in a conventional sense, not least because the cells we want to destroy are very simmilar to all the other cells of the body...

Directed drug delivery has the potential to improve our ability to treat localised malignancy, but that still relies on early identification... To treat metastatic cancers and cancers of the lymphatic and blood systems we're going to need a therapy which can discriminate between malignant and non-malignant cells, and which is highly toxic only to the malignant ones... That's complex enough before you consider the pharmakinetic angle of molecules with high toxicity and high selectivity (or even specificity, seen as this is theroetical); if the body metabolises it such that the portions responsible for selectivity and toxicity are separated then it's not going to work... Approaching it from a "normal" drug angle is an extremely daunting task and not all that realistic*.

*IMO, I'm not neccearily the best informed on the whole drug design process, as my field only really starts when the design process ends.

[poochyena]

i'm really glad to see educated comments and no "theres a cure for cancer and the government withholds it from the public to level out population and stimulate the health system"

what is it with people and conspiracy theories?

[TheKrikkitWars]

i'm really glad to see educated comments and no "theres a cure for cancer and the government withholds it from the public to level out population and stimulate the health system"

FWIW, My government does actually restrict access to cancer treatment based on a cost vs. benefit analysis; treratments which cause significant reduction in quality of life, are exorbitantly expensive, or will only prolong life for a small amount of time are less likely to be funded (and some may be funded for one cancer and not another if there is evidence to show that some cancers respond better to the treatment in question than others)... I feel that this is actually the right approach.

I can't help feeling that if anything big pharma is quite exploitative in offering new treatments which offer only the most meagre improvements in prognosis at exorbitant prices. It would be more ethical to use these incremental improvements as baby steps in R&D rather than selling them when there is little real benefit over another treatment; Make of that what you will

Having lost a sizeable number of family and friends to cancer and seeing the different effects on both them and the people around them of different approaches, I've come to sympathise with this viewpoint.

[Izawwlgood]

Most doctors and patients I've interacted with who were dealing with terminal cancer made it quite clear that they were either approaching, at, or past, the point of 'we've done all we can'. I don't think it's remotely predatory of a drug company to sell a drug that marginally lengthens a patients life; having options is always a good thing.

[qetzal]

I can't help feeling that if anything big pharma is quite exploitative in offering new treatments which offer only the most meagre improvements in prognosis at exorbitant prices. It would be more ethical to use these incremental improvements as baby steps in R&D rather than selling them when there is little real benefit over another treatment.

How would these be used as "baby steps in R&D?" They may be baby steps in terms of degree of benefit, but they typically represent one or more decades and hundreds of millions of dollars of R&D. If they do offer even a modest benefit, why should they be withheld from the public? That doesn't benefit anyone. What's wrong with offering at least that modest benefit while continuing to search for better treatments at the same time?

I suspect the phrase "exorbitant prices" is a clue to what really bothers you. Yes?

[TheKrikkitWars]

Most doctors and patients I've interacted with who were dealing with terminal cancer made it quite clear that they were either approaching, at, or past, the point of 'we've done all we can'. I don't think it's remotely predatory of a drug company to sell a drug that marginally lengthens a patients life; having options is always a good thing.

When you're talking about cost differences that can hit 5 figure sums for an improvement in prognosis (not outcome, but the statistically most likely outcome) that can be measured in weeks; I can't help but think that's senseless.

The thing is that whilst the exorbitant cost can be justified when you consider that they have to make a massive material investment and fund at least two more rounds of research (epidemiological & process chem) to bring them to market; but if those costs were ploughed into further development with that specific approach it would ultimately generate more benificial treatments sooner in the long term.

It doesn't neccessarily make commercial sense to concentrate more on R&D and maintain a smaller portfolio of more valuable active products; but in terms of advancment of treatment, I feel a case can be made...



@ qetzal: A significant proportion of the R&D costs are actually for the commercialisation of products, going from the initial synthetic method, to one which is suitable for making enough compound for a trial, to one which is workable on a commerical scale (i.e. from 50mg, to 100g-10kg, to +100kg) is actually very difficult; rarely are these complex syntheses infinitely scalable. Add in the added complication of going from something being done by hand, to designing and building a plant to produce it and you get the picture...
Of course having invested heavily in the original pure science research, the company is willing to invest here to bring it to market to hedge their risk; the sooner each bit of original research is making money, the less exposed they are in the market... Because being pipped to the post by a competitor could result in a massive loss.

I suppose this is now starting to digress towards the question of whether a profit making business is the best vehicle for the advancement of medical technology and by extention whether medicine is a commodity or a right; both rather thorny issues.

[addams]

i'm really glad to see educated comments and no "theres a cure for cancer and the government withholds it from the public to level out population and stimulate the health system"

FWIW, My government does actually restrict access to cancer treatment based on a cost vs. benefit analysis; treratments which cause significant reduction in quality of life, are exorbitantly expensive, or will only prolong life for a small amount of time are less likely to be funded (and some may be funded for one cancer and not another if there is evidence to show that some cancers respond better to the treatment in question than others)... I feel that this is actually the right approach.

I can't help feeling that if anything big pharma is quite exploitative in offering new treatments which offer only the most meagre improvements in prognosis at exorbitant prices. It would be more ethical to use these incremental improvements as baby steps in R&D rather than selling them when there is little real benefit over another treatment; Make of that what you will

Having lost a sizeable number of family and friends to cancer and seeing the different effects on both them and the people around them of different approaches, I've come to sympathise with this viewpoint.

Nice view point. I share it.
It seems that we are stuck thinking and fearing Cancer. There are many other ways to die.

I have been studying Social Death. Social Death leads to Physical Death. It is terrible and is easy to treat.
The Western Cultures seem to have a secular Religion that looks like a Karmic Connection.
The poor and alone must have done something to deserve it.

I think that Medical Care and all other forms of the group caring for the individual should be our honor to provide.

A nation that can afford to invade other countries and intimidate their own people could care for her own people. The US is a mess!

What does that have to do with Cancer? To have cancer is one thing. To have cancer and no food and no place to sleep that is clean and safe and to have no one to turn to is such a sorrow. The people of the US do not want a Nanny State?

Easy for the rich and healthy. When the tough guys get sick, they want a Nanny. The Assholes don't want anyone else to have a Nanny.

To be clear; I agree with the article you posted. Over treatment is a bad thing. No compassionate treatment at all is a bad thing, too

Some easy listening.

Spoiler:

http://www.youtube.com/watch?v=sWAFzVae9zc&feature=relmfu

[Angua]

@Krikkit

There is the argument that the way the law is currently written out, the drug companies are incentivised to get things on the market. This is because 1) you can't trial two new drugs in combination with each other - only one new drug at a time, however you can test combinations of that new one with existing drugs, and 2) you can't start trialling a new drug in patients who haven't explored all their options (or at least, it's very difficult) - the patients who get these drugs being trialled on them are often at the end stages when it would be unlikely that even if the drug was that effective that they would be cured (ie not die within the next year). So now you have the companies in a bind - in order to get the drug used at stages where they might be more useful, you first have to show that they are marginally effective in the endstage, and then hope that you can move the treatment earlier from there. If you think your new drug might be best with other new drug, you need to get one out first before you can try the next one.

Now, I realise that only trialling end-stage cancer patients is a sensible thing to do from an ethical view point - just pointing out that this is why you end up with lots of new drugs at the moment that are only licensed for it.

[folkhero]

When you're talking about cost differences that can hit 5 figure sums for an improvement in prognosis (not outcome, but the statistically most likely outcome) that can be measured in weeks; I can't help but think that's senseless.

I would presume that the people who value a few extra weeks at a point greater than figures are glad that the decision is not yours to make.

[qetzal]

@TheKrikkitWars

Two points.

First, what folkhero said. You may not think it's worth paying $200K for an extra 3 months of life. Frankly, neither do I. But other people should be free to decide those things for themselves. If they think an extra week of life is worth $10 million, who are we to say they're wrong?

The issue, of course, is when their expensive drug is paid for with public funds. Then someone else has to make a decision on what drugs provide adequate benefit for an acceptable cost.

Second point. The main cost of developing a drug is not the cost to scale up manufacturing. The main cost is trying to figure out whether the drug actually works in people, and the fact that most of the time, it won't. You have to scale up the drug at least enough to test it in thousands of patients, and you still have a very substantial chance of learning that it doesn't work.

The sad truth is that our test tube assays and cell culture methods and even animal testing are extremely crappy at identifying good human drugs. Even when drugs seem to show positive effects in Phase II clinical trials, they still fail all to often in Phase III.

So in a very real sense, we can't know if a new drug idea really works until we've taken it all the way through Phase III. In essence, the system we have now is already taking the baby steps in R&D that you asked for. Unfortunately, we're so bad at it that each step forward requires full clinical development.

What we really need is a) to get much better at separating good drugs from bad at a much earlier point in development (preferably before human testing), and b) to come up with new approaches that will have much larger therapeutic benefits. Everyone agrees that the cancer drugs we have now are crappy, and that the ones we keep developing are only slightly less crappy. We just haven't (yet?) figured out how to do better.

[Shadow5]

I'm wondering whether anyone has heard of cancer treatment with respect to immune cycling.

Some doctors in Australia have been having some fairly impressive results by timing the administration of chemotherapies to cycles in the immune system, enabling the chemotherapy to take effect without severely damaging the immune system.

I'm looking for the paper now, I'll let people know where to access it when I do

[Shadow5]

A more recent development is the area of antibody research. I know of a company which is having amazing success with such a therapy in treating Multiple Myeloma, producing significant reductions in the cancer with no known side effects.

It may be worth noting that most of the advances in disease treatment (that I am aware of) are being developed by small start-ups working with the scientists who made the discovery and are later licensed to a big pharma to produce, market and distribute.

In regards to the Treatment Vs Cure conspiracy, I personally do think there is far too much emphasis on 'treatment' over seeking a 'cure', and I do believe this is in part fuelled by the pharma companies focusing on treatments which are far more profitable.

[qetzal]

In regards to the Treatment Vs Cure conspiracy, I personally do think there is far too much emphasis on 'treatment' over seeking a 'cure', and I do believe this is in part fuelled by the pharma companies focusing on treatments which are far more profitable.

Meaning what? That pharma companies deliberately avoid developing potential cures? Do you seriously think it's more profitable to sell a crappy chemo drug where the patient still DIES after 6 months, than it would be to sell a drug that CURES them? That's just ludicrous.

[Shadow5]

In regards to the Treatment Vs Cure conspiracy, I personally do think there is far too much emphasis on 'treatment' over seeking a 'cure', and I do believe this is in part fuelled by the pharma companies focusing on treatments which are far more profitable.

Meaning what? That pharma companies deliberately avoid developing potential cures? Do you seriously think it's more profitable to sell a crappy chemo drug where the patient still DIES after 6 months, than it would be to sell a drug that CURES them? That's just ludicrous.

Specifically with cancer, but also with other lethal and or debilitating hard to treat diseases there is no real real reason to avoid a cure, the 20 years of patent and market exclusivity you'd get out of something like that would be far more profitable. I was more referring to things like Lipitor, Ritalin and various cardiac medication, where for many cases drugs are prescribed when changes in lifestyle or proper dental work would solve the problem.

In short, there is no real financial incentive to not cure cancer.