Hacker News new | ask | show | jobs
by signed0 4856 days ago
Being fairly young, I can not remember a time in my life when a disease was cured or a vaccine created that significantly reduced transmission. I keep expecting a grand announcement like "AIDS cured" or "Cancer defeated" but there are always so many caveats that it feels like progress isn't being made. I wonder if it was the same way with other diseases in the past, and I am just being important, or if modern day ones are somehow different.
9 comments

Since 1980, we've developed vaccines for:

   - Hepatitis B,
   - Chicken Pox,
   - HPV,
   - Rotavirus,
   - Hepatitis A,
   - and Pneumococcal.
There's also been a lot of improvements in existing vaccines, regular new Influenza strain vaccines, etc...

A lot of those simply got quietly introduced into the routine vaccination schedule for children and the diseases quietly vanished without much fanfare in those countries.

Polio is almost eliminated world-wide now, but that's taken decades.

http://www.cdc.gov/vaccines/pubs/vacc-timeline.htm

http://www.chop.edu/service/vaccine-education-center/vaccine...

That's uplifting to know! I've had several of those vaccines, but I didn't realize that they were developed so recently.
They just don't make the news. HIV is a very hard virus to fight by its nature, and it's only been around for a few decades, but even so progress has been amazingly fast.

Also, HIV is one of the few highly lethal epidemic diseases that continue to exist in the developed world so it receives a lot of attention, however a lot of progress is being made on other fronts.

For example, the HPV vaccine is a big deal, and should lead to a massive decrease of cervical cancers (largely caused by HPV infection). Also, the Varicella vaccine has been added to the standard "MMR" lineup (now MMRV). It's hard to get excited about wiping out "chickenpox" but the vaccine should reduce the incidence of deaths due to complications related to infection in children and especially in adults, as well as shingles and other illnesses related to infection. Rinderpest, a disease of cattle and some other ungulates, has been officially wiped out as of 2011. Additionally, several malaria vaccines are now in clinical trials. If they prove effective it could easily save millions of lives per year.

HIV and cancer are particularly tricky.

HIV mutates incredibly quickly, which makes it incredibly hard to find a "vaccine", because something that works against one strain probably won't work against the others. The same goes for treatments - most HIV patients have to take a various combinations of drugs (the slang term is their "cocktail") which vary in effectiveness both per-patient and over time.

Cancer is difficult for a different reason altogether: it's the body's own cells. To oversimplify, it's (relatively) easy to find a medicine that can target foreign cells, but it's hard to find a medicine that will target cancerous cells and not be equally deadly (or more deadly) to healthy cells, because cancerous cells so closely resemble healthy ones.

Progress is being made - just look at Bill Gates and his campaign for eradicating polio.

Another problem with cancer is that is not a single illness, but a family of diseases covered with a single name. Bone cancer is very different of pancreatic cancer that is very different from lung cancer that is very different from colon cancer that is very different from ... Some cure approaches work with all of them, but other approaches are more specific. Trying to eradicate all forms of cancers is like trying to eradicate all bacterial diseases at once.
Yes and No. You/We should not classify the cancers by "locations". It makes as much sense as classifying a leak in the house as "bathroom leak", "ceiling leak", "stairs leak". There are different cancers happening in different locations of the body and some share the same roots no matter where they start. The fact that they affect a specific organ is not necessarily related to the cancer type itself. There are often several mutations even for a single "cancer location" identified.
You are right, I was oversimplifying. For example, Wikipedia lists 4 more frequent types of brain tumors, and each of them has subclassifications. The origin of the cancer is important, because the cancer cell retain some properties of the original cells, for example if they are affected by hormones. So location is important to distinguish if it started as a breast or skin cancer, but it's not important to distinguish if it started as a hand or foot cancer.

(After metastasis, the location is not important to understand the properties of the tumor, but it can affect the symptoms.)

We need to get deeper. Cancer is a direct result from genetic mutations, the very mechanism that enables evolution. It's a (or rather many) mutation that causes uncontrolled cell division while suppressing apoptosis and other mechanisms of the body to regulate cell growth.

(See also: http://en.wikipedia.org/wiki/P53)

In your lifetime (probably) we've developed and widely deployed the first human cancer vaccine among other things.

I was born in 1985, the year that AZT (the first effective anti-HIV drug) was patented, since then we've developed a whole spectrum of anti-retroviral drugs and turned HIV from a death sentence to an unpleasant chronic illness. The advances in anti hepatitis drugs are similarly enormous.

If you're over 20, then basically any non-generic drug sold in the US was developed in your life-time.

There is a lot of progress being made on HIV/AIDS.

How to tell? Speak to any gay man who lived through the 80s and early 90s. In every reasonable sized gay ghetto, there were funerals every week for people dying of AIDS-related diseases.

Now there are far more treatment options: if one knows they've been exposed, a month-long PEP regimen can stop one from becoming HIV+.

Truvada has been approved by the FDA, which can reduce the risk of transmission by between 44% and 73% - this can be used to reduce the transmission rate for highly sexually-active MSM populations, and can also be a second line of defence for (both heterosexual and gay) HIV negative partners of HIV+ people (because condoms can break).

That there is new development on a possible route to reduce mother-infant transmission is exciting.

And the other day I saw this story - http://www.theatlantic.com/technology/archive/2013/02/could-... - redesigning needles could dramatically reduce transmission among IV drug users.

There won't be a grand announcement of "AIDS cured". What there will be is lots and lots of little things: improved public health messaging, improved drugs, more prophylaxis/vaccine research, lower prices for drugs and so on. We've come an enormous way already on HIV/AIDS. That there are people who were diagnosed in their 30s who are now living into their 60s or 70s is a huge improvement from people being diagnosed and dying within a year or two.

>There won't be a grand announcement of "AIDS cured".

There might be if DRACO succeeds, and I would be surprised if some future medical advance doesn't cure it eventually.

HIV is also fundamentally different and difficult in that it is a retrovirus. This matters tremendously when it comes to eradicating the virus from an infected individual - it's not just a foreign body abusing the cell's replication mechanisms any more.
Malaria hasn't been cured but we have much better anti-malarial drugs now.

Same for HIV.

Who told you that malaria has no cures? I've had malaria three times, and was cured each time.
Vaccine I should have said
The chicken pox vaccine is what comes to mind as a recent one.
Sadly, there isn't any money in curing diseases. Pharmaceutical companies make money on recurring treatments.