21 February 2010

The real revolution: cancer

The October 2009 OHSU lecture "The end of cancer is within our reach" (which I hoped to attend but did not due to having broken my hand) is now available on video on the web. It gives a lively overview of the revolutionary potential of modern technology. The actual lecture starts around the 11:00 mark.

Dr. Druker starts with an analogy: the dramatic progress against infectious diseases in the early twentieth century. During all of previous history, epidemics of these diseases had repeatedly devastated human populations, mowing down millions of people at a time; we were almost defenseless against them. The key to change was a new scientific understanding of their causes -- the germ theory. It was this that made possible the new weapons -- antibiotics, vaccines, and public-health measures -- which almost eliminated infectious diseases as a cause of death in advanced nations and have greatly reduced them in the Third World as well.

Starting in the late twentieth century, a similar understanding of the causes of cancer was achieved; its roots lie in certain genetic abnormalities, which can arise by natural mutation or by being exposed to carcinogenic influences in the environment. The key to the defeat of cancer, researchers realized, was to develop drugs which targeted only cells manifesting these abnormalities, in contrast to the brute-force approach of earlier treatments such as chemotherapy. The first drug designed to work this way, Gleevec (targeting leukemia), produced dramatic results: clinical-trial patients deemed beyond saving showed clear improvement within weeks. Druker mentions one patient, told she had weeks to live, who is still alive and healthy almost eleven years later. Since its approval by the FDA in 2001, Gleevec has saved over 100,000 lives. Hundreds of other drugs based on the same principle, targeting other kinds of cancer, are in clinical trials right now.

Progress will be much faster than in the earlier fight against infectious disease, because of the rapidly-growing power and decreasing price of computer data processing. Identifying the genetic abnormalities involved in leukemia took twenty-five years; such a project would now take only three or four months, and will soon take only a matter of days. Sequencing the genes associated with a particular kind of cancer now costs $20,000, but this is expected to fall to $5,000 or even $1,000 within three to five years. Only in the twenty-first century has such rapid progress in such complex work become possible.

Druker mentions ways we could speed things up even more: better funding, a faster process for approving treatments for general use, and universal health coverage (as other advanced nations already have) so that everybody will have access to the new drugs and also to early diagnosis, a critical factor in successful treatment of many cancers. All these things would allow us to achieve the final victory sooner.

And time is of the essence; a matter of life and death, in fact. Half a million people die of cancer in the US every year, and many more in the rest of the world, so the amount of death and suffering that could be stopped by its eradication is vast. How else could our tax dollars be better spent? But Druker is clearly right -- the end of cancer is within our reach. The time is not far off when cancer will join the ranks of smallpox, polio, plague, and the other scourges that once terrorized our ancestors -- beaten and half-forgotten.


Blogger TomCat said...

Thanks for this, Infidel. It is indeed encouraging. I only hope that as these new treatments come online, people will not be excluced from recieving them by Insurance Company death panels or inability to obtain health care.

21 February, 2010 14:02  
Blogger godlizard (aka dotlizard) said...

I love the hopeful tone of this, but I was stopped in my tracks by the observations about funding and universal health coverage in the US. The knowledge that this is actually the biggest barrier between us and the cure(s), and the thought that people are dying while we struggle to find the funding ... well, it's depressing and frustrating. My dad is suffering from a rather bizarre and slow-moving form of lung cancer, which was diagnosed in the mid-to-late 90's, operated on in 1999 (with very limited success), attacked with radiation that destroyed a great deal of healthy tissue as well, and has left him dependent on oxygen. His health is fading fast, and even if the economic roadblocks were to vanish today, it would be too late.

I'm sure everyone has a similar story, someone they love who has died or is dying right now, while science teeters on the brink of a great breakthrough.

I'm sorry, I know this is very good news, I'm trying to be more cheerful, but I seem to be failing at that. I know that we've come so far with eliminating the very horrific sort of death sentence cancer has represented throughout history. I'm heartened by this news, for myself and my children and their children, but ... I guess I should just stop typing this and call my dad while I still can.

21 February, 2010 15:08  
Blogger tnlib said...

I actually watched that entire video, something I rarely do unless it's under two minutes. I've heard a little about Gleevec. In fact I have a friend who was diagnosed with leukemia and given a year to live. Two years later he is "alive and driving."

Great news and absolutely fascinating talk. I did notice the doctor in the film clip smoking a cigar. Thanks for posting this.

21 February, 2010 17:02  
Blogger Infidel753 said...

TomCat: Dr. Druker did mention that point in the question period at the end of the video. Even without health-care reform, these treatments will help the 85% of Americans who do have insurance (and hundreds of millions of people beyond the US) -- but we do need to close the gap for the other 15%.

21 February, 2010 18:12  
Blogger Infidel753 said...

GodLizard: I am very sorry to hear about your father. Obviously I hope that improved treatments will come into use soon enough for him. This is why I have always stressed the importance of speed in bringing such innovations forward -- every year's delay in implementing a full program of the new cancer drugs will cost half a million American lives (and more in other countries).

The funding picture has actually improved recently -- a good chunk of that $787-billion federal stimulus program was allocated to medical research grants, and is being spent, at OHSU among other places. Even rich individuals like Phil Knight (who donated $100 million to Druker's institute) are contributing something. But, yes, more is needed.

As I've said before, I believe Bush's worst crime was his ban on federal funding for embryonic stem-cell research. There are many serious medical conditions which we know could be cured by stem-cell therapy (because they have been cured that way in animals in the lab), and had it not been for the obstruction of research under Bush, we would have had cures for several of them already which will, instead, not be available for several more years. The unnecessary added suffering and death caused by that delay probably exceeds the suffering and death caused by the Iraq war.

21 February, 2010 18:22  
Blogger Infidel753 said...

TNLib: Glad you found the video interesting. This kind of work actually fascinates me much more than politics does. It's a struggle of human brainpower against an adversary we really need to defeat completely -- a struggle generally untainted by ideology.

Based on what's been accomplished so far, your friend probably has a good chance of living out a normal life-span.

It's amazing how much people used to smoke in old movies -- even doctors. I always notice that.

21 February, 2010 18:27  
Anonymous tnlib said...

Sue, I remember seeing something about this guy on 60 Minutes. However, I don't remember him turning blue - just mixing his own concoctions. They did a follow-up and I'm sad to report, he didn't survive.

godlizard: My heart goes out to you in a big way. You have no need to be sorry. I've been there, so I know how painful this must be for you. For the sake of your family, take care of you.

21 February, 2010 19:01  
Blogger godlizard (aka dotlizard) said...

Of all the criminal actions committed by the Bush admin, the attack on science and medicine stands to be the one with the most casualties, at least in terms of American lives.

I am encouraged by the amount of ass-kicking President Obama is doing these days, though. It's nice to see a President who has an actual spine, as opposed to one with Cheney's hand up his ass pulling all the levers.

21 February, 2010 19:20  

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