It is entirely possible that we can completely cure cancer. Not just a treatment, but actually prevent anyone from ever getting cancer in the first place. It would be super duper difficult, but we know it is possible because of the naked mole rat. Naked mole rats are essentially immune to cancer (I say essentially because this February scientists dicovered two individuals that had cancer, the only two documented cases). It is thus possible that genetic therapy could create a population of humans with no (or almost no) incidence of cancer.
No, they are protected from cancer because naked mole rats never get cancer, to our knowledge.
HMW-HA is a correlation that has not been proven to be effective for preventing cancer elsewhere. Remember, such claims used to be made about shark cartilage, too.
Read a little deeper. This is a part of the investigations into the way in which p16 works in naked mole rats. If it isn't HWM-HA then it is something in its chain of relationships.
"When HMW-HA was removed, the cells became susceptible to tumors, confirming that the chemical did play a role in making naked mole rats cancer-proof. [The] team also identified the gene, named HAS2, responsible for making HMW-HA in the naked mole rat. Surprisingly, the naked mole rat gene was different from HAS2 in all other animals. In addition naked mole rats were very slow at recycling HMW-HA, which contributed to the accumulation of the chemical in the animals' tissues. [Previously researchers] showed that the p16 gene in naked mole rats stopped the proliferation of cells when too many of them crowd together. In their latest work, the two biologists identified HMW-HA as the chemical that activates the anti-cancer response of the p16 gene."
I read the study, not just the article. (Perhaps you missed "elsewhere" in my statement above.)
Again, there are many steps before such a claim could be made, let alone before having a safe and effective "cure" using it. You can't just genetically engineer humans to manufacture and maintain large amounts of HWM-HA in their bloodstreams.
If we can reliably cure it (let’s say immunotherapy advances or whatever), it might not be worth the risk of side effects from preventive manipulation.
Of course, but if it's possible in one mammal, there's no real reason why it shouldn't be possible in another. I highly doubt that our vulnerability to cancer is somehow intrinsic to what makes us human.
This is obviously far off, but genetic modification opens up a whole new world of possibilities.
Naked mole rats aren't even rats, per se - they are the only species in its genus and the only known eusocial mammal. (I wonder if E. O. Wilson studied them?)
I am going to go against the grain of the usual sympathetic responses to this type of articles, and I am going to say that this is a case of pernicious and pointless casuistry. Apparently, this now passes for some kind of deep thought on the human condition.
Well of course any medical treatment for anything just leads to more medical treatment in the future; that's not a profound statement, not as long as people are mortal. And it's not limited to cancer. It used to be, in the bad old days, that some people became almost completely bedridden as their joints gave out, and then either died early or wished they did; now we have arthritis medications and joint replacement surgeries that let many of them (not all, but very many) enjoy decades of their retirements. Does this lessen the need for future orthopedic treatment? Obviously not, since it extends their lives and keeps them on their feet long enough to develop other joint problems. Does that make orthopedics and rheumatology pointless? As someone who needed the intervention of rheumatologists, I assure you that it doesn't.
In the case of cancer, nobody believes that one can make people live forever by curing their cancers; of course, they will live long enough to die of something, maybe even another cancer. Still, I personally know people in their 70s and 80s who would have been dead and buried 20 years ago if it wasn't for cancer treatment; and the idea of the "cancer moonshot" is to give the same chance to a lot more people. I came home today after visiting a very dear friend whose cancer is, with the current level of medicine, close to untreatable. Will she live forever if some treatment is developed for it? Well of course not. Would it be worthwhile to change the several months that she has left to live into several years? Of course, and yes, it would mean that she would require more cancer treatment, not less.
We can debate if the "moonshot" model is right for cancer (personally, I think it has merits), but these pseudo-profound dismissals of medicine are simply vulgar and annoying.
I was about to post the same- the article has such a "nothing is worth doing" level of pessimism about medicine that halfway through I was wondering if the author was suffering from depression.
He's right that an ever-older population will bring about more cancers- so we'd better have ways to treat them. And he's right that the "cancer moonshot" likely won't provide the singular, all-out cure, but no one outside of politicians claims it would; instead it will help provide partial cures that can reclaim thousands of healthy human-life-years, a worthy use of the money. That a professor of medicine draws such a poor picture of these issues sounds downright pathological.
The author acknowledged significant advances in cancer treatment, including one he called a moon landing in its own right (immunotherapy). No need to cast aspersions on his mental state---I think he's clear-eyed yet not despairing, facing the difficulties of cancer treatment (it's like stopping evolution from happening, if you think about it) but still recognizing the progress.
True enough that I shouldn't bandy about accusations of depression. But the author derides a billion-dollar cancer research effort as "pointless" in the title. He may recognize the progress, but he's bizarrely adamant that people won't cure cancer.
I totally agree. I was diagnosed with Leukemia(AML) at age 24. I am 31 now. I had cancer 2 times, both times 20 years before it would have killed me, but because of all the research I get to be alive, I have a son and a wife and a family who I impact every day. Sure I understand I am more prone to getting more cancers down the road, but having the road to go down is way better than a dead end at age 24. Keep the moonshot going baby.
A while ago I was reading a harrowing description of life in the 1930s. One of the author's memories was the sound of a neighbour in a nearby house screaming - and screaming, and screaming - in unbearable pain while dying of cancer.
We've definitely moved on since then. Moonshot or no, anything that helps make that experience less likely has to be a good thing.
Totally agree. I'll also add that we don't even need to definitively eradicate the possibility of cancer to consider it effectively "cured". If we can reduce the rate of cancers such that they only start to appear in populations that are approaching, say, 80+ years of age, it will probably become more effective to focus on other leading causes of death rather than dwelling on cancers that end up killing people in their 100s (if general life expectancy rises to the point where cancer becomes endemic among the bustling 100+ age demographic, we can cross that bridge when we come to it)
Yeah, we'll definitely want a "dementia moonshot", or a few, before we attempt to create a generation of centenarians. However, cancer incidence climbs terrifyingly rapidly when people reach their 60s - long before we are ready to give up on them. A successful cancer moonshot (and the Nixon one, by the way, was quite successful) will let millions of people enjoy many good years with their loved ones; not to mention that it would also save many young people from dying of cancer, although that's a much smaller share of cancer patients.
My otherwise healthy grandfather is going to be killed by cancer in the next few months. And for what seems like an utterly stupid reason: if they cut it all out of his neck, there's no way currently to replace the lymph nodes he'd lose or create enough replacement tissue to cover it over.
Actually coming to grips with the idea that a seemingly mundane engineering issue is what gets him was surprising.
Give that problem 10 years and I suspect I'll read the news one day and hear about how we've now solved it.
We are essentially temporary cell colonies evolved to relay life to the next generation, and as long as we are human, there will always be another cancer.
I'm not sure how you get from, "this is a difficult problem that won't be solved soon", to, "throwing money at this problem is pointless". It seems like the best way to solve problems is not to give up, but to keep the people who are trying to fix it well funded.
Does he just want a more dourer PR campaign? I suppose "We probably won't cure cancer, but, I guess this is better than nothing" would be more realistic.
There is a verge that is going to be crossed for cancer soon. The reason that cancer research and development is a slow, expensive, ugly morass is that 99% of the people involved are targeting biochemistry peculiar to a very small number of the thousands of relevant varieties and subtypes of cancer. A year of lab time is much the same ballpark of cost whatever you happen to be doing, give or take. So if it takes a thousand distinct cures to defeat cancer, it'll never get done.
BUT.
There are range of new approaches to cancer that are not particular and specialized to a very small number of cancers, or that can in principle be adapted with comparatively little work to target different cancer types from a common core platform.
This is what will produce meaningful control of cancer: attacking the commonalities present in many or all cancer types.
The best and most promising approach here is interdiction of telomere lengthening. All cancers must lengthen telomeres. They have to. If they can't, they wither. So block telomerase, block ALT, and cancer goes away. You can either block these mechanisms globally for a while, long enough to kill the cancer, but not long enough to kill the patient due to stem cell depletion, or combine this with any of the targeted delivery mechanisms under development to turn it off only in cancer tissue.
It is foolish to talk about cancer as a thing that medical science cannot get to the bottom of. There are very clear approaches to get to the bottom of cancer and fix it.
Therapies that could reliably cure any cancer are often worthy of research, but I'd put the expected value of these approaches lower than that of "ugly morass" standard research.
Reason 1; cancer therapies have to effectively kill cancer cells and not important non-cancer cells. Cancer therapies that exist today achieve this by mucking about in mechanisms that are important to cancers and not (or not so much) to other cells. But cancers are diverse- there may just not be anything that's common to all cancer and not shared by healthy cells. Telomere regeneration is a nice candidate, but as you noted, its also important to stem cells- can humans withstand enough damage to their stem cell populations to make a meaningful difference to difficult cancers? (For that matter, telomere regeneration is also important to gametes, so telomere-based therapies may also render the patient infertile.)
Which means we're likely to be stuck dealing with a dozen or hundred-odd different treatments, each of which targets some eccentricity of a specific cancer subtype, but-
Reason 2: There are lots of smart people plugging away at this problem, backed by lots of research money. In addition to being an objectively important problem for humanity, cancer is also an interesting biological conundrum and also the most likely cause of death for a bunch of old people with stratospheric net worths. Even hacking at the problem in bits and pieces, its not unlikely that cancer will become a completely tractable disease (even if a golden-bullet "cure" doesn't arrive) within our lifetimes.
I am not cynical about humans living longer etc as this article seems to claim. However I am cynical about the approach of calling everything a moonshot. For Moonshot, there were clearly measure-able goals before you were able to land on moon in say 10 yrs. Now in Cancer research or any research is not executed in the same paradigm as planning a voyage to moon.
Yeah my point maybe a minor one, but I dislike the dumbing down of things or appealing to past glory.
the better we get at keeping people alive, the older they will get
I'm generally not a fan of people either but there are kids with cancer that I feel should get some time to enjoy their lives outside of dying in a hospital if at all possible, someday.
Besides, there are still many, many millions of people in the USA who can't get insurance so even if there was a "cure" or life extension, they couldn't afford it. Don't worry, they will die for you because emergency rooms don't treat cancer. For example if I got cancer, I'd be screwed.
Not the OP, but I don't have insurance because I can't afford it. Furthermore, attempts to use Healthcare.gov to try and even start an application process did and continue to fail because I don't have a credit history and therefore do not exist in their system and hit a roadblock. I cannot sign up for Medicaid in my state either for the same reason.
And while it may be technically mandatory, I have so far fallen below the income level that requires it and so haven't yet been fined for being unable to afford it. I almost did this year, but managed to request an exemption because there were no plans in my area below the necessary price threshold. And even if I were fined, paying the fine is easier and cheaper than dealing with actually getting a (very shitty) plan.
In Arizona, a credit history is part of their verification process, same as Healthcare.gov. Because I don't have a credit history, I don't exist in the system and therefore any application attempt fails at the "cannot verify your identity" stage and offers no path for recourse.
Edit: Not directly related to the main topic, but Amazon Payments also uses Experian—same as Arizona medicaid and Healthcare.gov—for identity verification, and if you don't have a credit history you get permabanned without explanation from continuing to use Amazon Payments. After asking them why several times, they block you from contacting their support again. Worst customer experience I've ever had with a major company, especially Amazon which is usually quite fantastic to deal with as a customer.
26 states refused to expand medicaid which was a critical part of Obamacare's plan to get everyone insurance.
So it is very possible to make too little to get insurance outright and too much to get medicaid. In fact there are many millions of people in that boat in 2016. Apparently we are illegal human beings, walking around without insurance.
It's not mandatory in the US; you just pay a penalty the next time you file your taxes if you went too long without insurance.
Spoiler: the penalty is far less than the cost of having insurance, which means it's still cheaper to just be uninsured (so long as you stay relatively healthy) and pay up on your tax return.
Seconded. I paid a ~$450 penalty for not having health insurance for calendar year 2015. The very cheapest health plan in my ZIP is $1,932 a year. It has a $5,000 deductible, $300 emergency room copay, $25 primary care co-pay... basically it's just as bad as no health insurance at all. Why spend the $1,500 extra?
It effectively is a fine, but it's not a criminal penalty, so it's kind of like an opt-out fee that's significantly cheaper than most of the supposedly affordable plans. (Which are extremely expensive even at the low-end where they're completely useless with $10,000 deductibles.)
I think you are dramatically underestimating the cost of getting "actually sick" if you think a $10,000 annual out-of-pocket maximum is "completely useless". Not to put too fine a point on it, but $10k could be a mere couple hours of care in the ER.
Also, there are cost-sharing reductions which would reduce that $10k significantly depending on your income.
If you do find yourself in need of actual medical care but without any insurance, the workaround is simply you will have to move to a new state, which will allow you to sign up outside of open enrollment periods.
The maximum out of pocket costs under the law is $6850 for an individual and $13700 for a family.
Regardless, the law is the law and it's undoubted that the folks who choosing not to do their legally required part and maintain health insurance will immediately jump on a plan if they happen to need care. Bunch of selfish jerks.
It is technically impossible for millions of Americans to get insurance. I mean unless you can print your own money.
26 states refused to expand coverage so there is a huge hole and they went to the supreme court who said it was perfectly okay for them to do that. Google it.
Hillary will be unlikely able to fix this and Trump definitely won't fix this, so if I get cancer in the next eight years (plausible, both parents died from it) I am screwed, though technically I could undo my entire life, move to another state and wait a year to apply and hope I don't die in the meanwhile. Yay America.