Too fast to label others as "conspiracy-mongers"?

So... from my maybe-nonrepresentative little perspective:

"Objectively pro-cancer" is something that if certain bloggers said it it would immediately mean that the blogger at least is being a bit flippant and probably outright sarcastic. When I first saw you quote that title the other day I kind of thought that the title itself-- though I didn't immediately guess the article itself was-- was probably a joke.

However, this is kind of a code word, sort of. The only reason that one would expect "objectively pro-cancer" is sarcastic is that "objectively pro-terror" was a buzzword that showed up in several deep-overboard right-wing blogs awhile back, and left-wing blogs promptly took to making fun of it. There's no particular reason you or anyone else in particular would have known or been able to guess that "objectively pro-cancer" was a joke-- in order to know it was a joke, you'd have to follow blogs or the outskirts of Blogonia enough to know that (1) "objectively pro-terror" was used seriously at one time and (2) there's a running joke of making fun of that now.

So I guess I'd say it was entirely reasonable of Ezra Klein to think that his/her(?) regulars would realize the title was sardonic, and entirely reasonable of you to think it was serious.

I read Ezra fairly regularly. I can't speak for the others you link, but Ezra has reguarly engaged the discussion about the flaws in developement of promising drugs such as this one. He is not touting conspiracies about big pharma. He is bemoaning the reality - why would any company invest the money it takes to do the trials, for something that won't make them a dime? I have never heard him complain that big pharma is holding cheap drugs back, in favor of more expensive ones. Only a system with holes in the funding of research into non profitable drugs.

At the same time, he is going off on a tare without really considering whether there might be very good reasons the funding hasn't provided, other than profitability. While there is limited funding, outside of big pharma, it does exist, especialy for cancer drugs. If this were as promising as is claimed, it seems to me that the funding would not be impossible to achieve.

I don't think this is so much conspiracy mogering as it is flying off half cocked. I have issues with that as well, but to me, it is far more forgivable than conspiracy mongering.

I knew "objectively pro-terror" was a running joke but I didn't know it had once been used seriously; I thought it originated with this Tom Tomorrow parody of conservative views of the media.

At any rate, I immediately recognized the title as a joke, but Orac's not as political as some bloggers, so I wouldn't be surprised if he missed the reference.

I think his view of the issue may be oversimplified, and his rhetoric overheated, but if you think he's seriously accusing someone of wanting more people to die of cancer, well, he's not.

Isn't it a little early to bring out the sackcloth and ashes over the supposed non-funding of trials of this drug anyway? It hardly seems reasonable to expect a clinical trial to materialize overnight; the paperwork alone would probably take weeks, if not months. If we come back in six months and nothing has been done to move this toward clinical trials, then it might be time to start writing letters to the NIH, or trying to get major charitable organizations to underwrite it, or whatever.

Oops - "his" in the third paragraph above refers to Ezra. On rereading I realized that this is not necessarily clear.

I think his view of the issue may be oversimplified, and his rhetoric overheated, but if you think he's seriously accusing someone of wanting more people to die of cancer, well, he's not.

That's not what I was saying. I got the impression from the title that Ezra was accusing the pharmaceutical companies of being "objectively pro-cancer."

But you are right. when you point out that it is early to be getting out the sackcloth and ashes. That's part of what annoyed me about the reaction of the blogosphere to this story. Many bloggers were acting as though the Phase II trial needed to see if this new compound has any efficacy against human cancers would never be funded if pharmaceutical companies didn't fund it. That's simply not true.

I do think you were more than a bit unfair to Ezra and Digby. The point that Big Pharma doesn't want to get involved unless it's not only profitable, but obscenely profitable, is perfectly justified and clearly is what is behind their posts. I would be tempted to say your response was tinged with a bit of hysteria, but I don't want to be insolent on your blog. I have no opinion about whether DCA is a good anticancer drug, although it is a metabolite of a chemical whose health effects I have been studying for decades. But I don't have the data and I don't think Pfizer of GSK is going to develop the data for me. Do you? That's clearly what they were saying in blog talk. You chose to understand it differently and went off on a rant.

From the remark above you seem to have a special sensitivity about criticism of drug companies. I am one of many who think they deserve the criticism. The Avastin/Lucentis example (about which you disagreed with me) is emblematic of a fundamental disagreement we have about the value and integrity of this industry. Is it hysterical of me to say so?

Just earning my "pharma shill" label, you know. ;-) And although I may have gone off on a bit of a rant, I could equally well point out that you chose to view the comments I lambasted a bit more charitably than, in my opinion, they deserved.

Of course, it's not hysterical to criticize big pharma in those terms. I never said it was and I don't go off like that on reasonable criticisms of big pharma. But then, come on, you know those were not the terms that Digby et al chose to use to frame the debate. In any case, it's more of a systemic problem than anything, as commenters pointed out. Any CEO of a pharmaceutical company has a fiduciary obligation not to pursue the development of drugs that are not likely to result in a profit. In retrospect, I may have been a bit harder on Ezra than he deserved, but I maintain that Digby and the others deserved it everything the got.

Believe it or not (being the "pharma shill" that I am), what irritates me is not criticism of big pharma but criticism that demonstrates ignorance, lack of critical thinking, and/or hysteria, which, I continue to contend, Digby et al demonstrated in spades (and certainly the last example from above did, exceeding even my original examples). The way their criticism was framed was that this was a "cure" that pharma wasn't interested in because it wouldn't be profitable. Heck, Digby even seemed to imply that pharma was "suppressing" DCA. How is this different from Kevin Trudeau's "Natural Cures 'They' Don't Want You To Know About"? Leave out the word "natural," and it sounds uncomfortably similar.

You'll note that most of my smackdown was over specific misinformation and misuse of terminology, such as using the word "cure, assuming that promising in vitro and animal results guarantee that DCA will work in humans and the implication that the $600-800 billion would be needed to see if this drug works in humans. My beef is with such idiocy (and, yes, I'm insolent enough to call those posts "idiocy"), not with criticisms of big pharma. In fact, as I said in my original post, the main reason such hysteria bugs me is because it obscures the real problems with our system of drug development. In other words, it's all heat and no light.

As for the example of Avastin/Lucentis, well, I was just showing off my knowledge of angiogenesis inhibitors. ;-)

" But then, come on, you know those were not the terms that Digby et al chose to use to frame the debate. It's also a systemic problem, as commenters pointed out. Any CEO of a pharmaceutical company has a fiduciary obligation not to pursue the development of drugs that are not likely to result in a profit. In retrospect, I may have been a bit hard on Ezra, but I maintain that Digby and the others deserved it."

On the contrary, that's exactly how I thought he framed it. The word "cure" was used loosely, but in the context it clearly meant "potential cure" (which I am skeptical of, knowing something about DCA, but we'll have to see, assuming someone is able to test it, which is not an assumption I make automatically). Regarding the inaccuracies about how much it costs to do a trial, this is a confusion the drug companies should take the blame for. They are continually bullshitting us about how much they spend on R&D (I don't believe the $800 million figure and neither do other objective observers) so it isn't surprising that laypeople get it confused. The confusion was deliberately sown. Better than seeing that the money goes into marketing.

By the way, the idea that cancer is not one disease but many diseases is much trickier than you give it credit for. Fractures are not one injury but many different injuries from one point of view, but all are discontinuities in the structure of the bone from another point of view. Many cancers that look very different clinically and are managed differently and have different prognoses stilll have common mechanisms. As Brian MacMahon pointed out forty years ago, there are two different ways to classify diseases, causally and manisfestationally, and clinicians have chosen, for good and practical reasons, to use a manifestational classification for cancer. If you were to do it causally it would look different.

I chose this example specifically because while these are nitpicks in this context they are extremely important in other contexts. You chose to apply your context to their discourse, just as I just applied some critical thinking from another context to what you wrote in this one. When I deliberately provoked you on the quackery issue it was specifically to try to get some critical thinking on the question of what it means to know things and what science is. I understood that is not the kind of critical thinking you engage in when you criticize alternative medicine and I took note of that in my original post and my response to it. The idea that there is only one kind of critical thinking needs to be looked at more critically, IMHO.

What passes for critical thinking in one place may be hypercritical thinking in another. I think that's the case with your attack on Ezra and Digby. It was unfair, in my view.

Ezra's comments are relatively measured if you got the joke of the title. Digby, however, is insinuating some pharmaceutical conspiracy not to pick up the drug because they don't want their products to compete with a cheap cure for cancer, which is both groundless based on the story and ignorant of the science and history of cancer treatments; Randular is flat out in tinfoil hat country.

The causality vs manifestation distinction revere brings up is important because drug development is going to be rooted in causality. This sows a lot of confusion in discussions of drugs meant to treat diseases defined by manifestation and can lead to unfounded hyping or criticism of drugs when the drug only works against a subset of the causal mechanisms. Informed comment requires awareness of the distinction.

By the way, the idea that cancer is not one disease but many diseases is much trickier than you give it credit for. Fractures are not one injury but many different injuries from one point of view, but all are discontinuities in the structure of the bone from another point of view. Many cancers that look very different clinically and are managed differently and have different prognoses stilll have common mechanisms.

True enough, but even so, I'm sure you would have to agree with me that it's still incorrect to refer to cancer as "one disease" (which is what several of the bloggers I came across were doing). It's not one disease, even using your example; indeed, I could turn it around and say that many cancers that look very similar clinically turn out to have different mechanisms by which they developed. At best, when you get down to mechanisms of cancer formation, you'll decrease the number of types of cancers (probably)-- but not necessarily. As the emerging fields of genomics and proteomics show us, there is still amazing heterogeneity in cancer cells phenotype at the molecular level. Even cancers from the same organ and of the same histological subtype may not, in fact, be the same type of "cancer" when examined at a molecular level with cDNA microarray technology, for instance. Douglas Hanahan and Robert Weinberg wrote a great review article on the hallmarks of cancer, in which they identified six characteristics that cancer cells must attain to become malignant. There are many ways to achieve these phenotypic characteristics, and even cancers in the same organs might utilize different pathways to achieve them.

So, yes, cancer as "many diseases" is a tricky concept, but, I suspect, probably not tricky in quite in the way that you meant when chastising me.

Along the lines of Weinberg, when I teach about cancer for my purposes (chemical carcinogenesis) I say cancer is a phenotype of a cell that divides when it wants and where it wants without any regard or consideration of the tissue or the organism. This is a crude depiction of the relevant biological features I need for my purpose, of course, but it gets the job done. A clinician, on the other hand, needs to know how differentiated the cell is, whether the tumor was invasive, etc., because those features are important for prognosis, treatment and management. In fact many of the "distinctions" between types of cancer are distinctions specifically aimed at management and prognosis for clinical purposes, and may have nothing to do with etiologic classifications important in public health. That is the kind of issue I was pointing to. But I think you over reacted to Digby and Ezra. It was pretty clear what their point was in context, which I've already discussed. It isn't hard to go into another context and find some technical points that are wrong but miss the point, which is what I think you did.