Respectful Insolence

ResearchBlogging.orgWhy haven’t we cured cancer yet?

If we can put a man on the moon, why can’t we cure cancer?

If we can harness the atom, why can’t we cure cancer?

How many times have you heard these questions, or variants thereof? How many times have you asked this question yourself? Sometimes, I even ask this question myself. Saturday was the two year anniversary of the death of my mother-in-law from a particularly nasty form of breast cancer, and, even though I am a breast cancer surgeon, I still wonder why there was nothing in the armamentarium of science-based medicine that could save her from a several month decline followed by an unpleasant death. That’s why, to me at least, the timing of the publication of a study examining the genome of prostate cancer that was published in Nature a week and a half ago and summarized in this Science Daily news story was particularly apt. Performed as part of the National Cancer Institute’s Cancer Genome Project, the study undertook complete genome sequencing of seven advanced and aggressive prostate cancers. The results, as ERV put it, revealed what can be describe as a “train wreck.”

Personally, I’d describe it as looking as though someone threw a miniature grenade into the nucleus of a prostate epithelial cell. You’ll see what I mean shortly.

Of course, although that image does give you an idea of the chromosomal chaos in the heart of prostate cancer cells, it is inaccurate in that it implies a sudden explosion, after which the damage is done, and if there’s one thing we know about cancer it’s that in most cases it takes many years for a normal cell to progress to a cancer cell fully capable of metastasizing and killing its host. Cancer is really, really, really complex, of course, and have even pointed out before that when President Nixon launched the “war on cancer” 40 years ago scientists had no idea how complex or difficult cancer would turn out to be. Indeed, before I discuss the current study, it’s probably useful to reiterate a bit why, in order to put the study in context.

Cancer is not a single disease, and cancers are different

I’m sure that it probably becomes tiresome for readers to read this time and time again, and, believe me, sometimes I find it tiresome to keep repeating it, but it must be said: Cancer is not a single disease. It’s hundreds of diseases. Although there are many common themes in cancer, such as loss of responsiveness to growth signals with a resultant ability to grow unchecked. Other common capabilities of cancer cells include evasion of programmed cell death (apoptosis), inducing the surrounding tissue to provide a blood supply (angiogenesis), evading the immune system, and invading the blood or lymphatic systems to travel elsewhere in the body and take up shop in other organs, such as liver, lung, or bone. Although there are, again, common molecular themes by which cancers do this, individual cancers acquire these necessary (to the cancer) abilities by many different ways.

Even cancers arising from the same cell type can be quite different. For instance, the breast cancer that killed my mother-in-law was a rare spindle cell variant, which is quite different from the much more common invasive ductal carcinoma that is estrogen and progesterone receptor positive. Indeed, even within individual cancers, different populations of cells can be quite different. In many solid tumors, there are cells now referred to as “stem cells.” Personally, I consider this term a bit of a misnomer that I really don’t like because these cells are not really pluripotent, and the cell types into which they can differentiate are rather limited. Moreover, this nomenclature has also made the concept of the cancer stem cell more controversial scientifically than it really needs to be. What we are really talking about are a relatively small population of cells in many tumors that are endlessly self-renewing and, in general, resistant to chemotherapy. In mice, these are the only cells that can actually form a new tumor when transplanted into a new mouse, and these are the cells that appear to be responsible for relapse after chemotherapy and radiation therapy. Indeed, cancer progression can be viewed as being due to a case of evolution in which the tumor cells that survive selection to continue to grow are the ones that become best at doing all the things that tumor cells need to do to evade the body’s defenses and overcome its growth control signals.

One of my favorite examples of how cancer progression can be understood using evolutionary principles was a study of esophageal cancer by Carlo Maley, PhD, a researcher at The Wistar Institute, that was published nearly five years ago. In essence, Maley applied population biology principles, specifically the Shannon Diversity Index, to predict which cases of Barrett’s esophagus (a precancerous condition in which the cells lining the lower esophagus are changed by chronic inflammation such that they look more like the cells that line the inside of the stomach) are most likely to progress to invasive esophageal cancer.

Not only is cancer not a single disease, but individual cancers are made up of multiple different clones of cancer cells under selective pressure to become ever more invasive and deadly. Looking at it this way, it’s a wonder we don’t all die of cancer. We do, however, virtually all have small foci of cancer within us, as I’ve pointed out before. Yet most of us do not develop cancer, and fewer of us end up dying of cancer, even though cancer is currently duking it out with heart disease as the number one cause of death in industrialized societies. Fortunately, the steps required for cancer to become deadly are difficult and numerous, and the body’s defenses against cancer are formidable.

Mechanisms of carcinogenesis are not simple

Let’s take a trip in a time machine back to 40 years ago, around the time that Nixon signed the National Cancer Act of 1971. I was a child, and molecular biology was in its infancy. Few of the fancy tools that scientists take for granted these days when it comes to studying genes, proteins, and how they interact even existed. Heck, polymerase chain reaction (PCR)–at least, as we know it now–wasn’t even invented for another 12 years and didn’t become widespread until the late 1980s and early 1990s. (Nearly 20 years later, I still chuckle at the memory of the monster of a PCR machine, the only one in our department, that I occasionally tried to use in graduate school. The thing took up the better part of a benchtop.) In 1971, the very first oncogene discovered, src, had only been reported the previous year, and it hadn’t even been demonstrated that oncogenes were defective protooncogenes; i.e., genes involved in cell growth that were mutated in cancers. That discovery would not come until 1976. Tumor suppressor genes were not discovered until nearly 10 years later, when the retinoblastoma (Rb) gene was characterized in 1986. An even more famous tumor suppressor gene, p53 (or TP53), had been discovered in 1979 by Lionel Crawford, David P. Lane, Arnold Levine, and Lloyd Old, but had initially been thought to be an oncogene. Burt Vogelstein demonstrated its function as a tumor suppressor gene in 1989, and ultimately it was demonstrated to be a critical gene for responding to DNA damage. How that ten-year voyage from oncogene to tumor suppressor played out is described in detail here. It makes interesting reading how a scientific concept can change as new evidence comes in.

Thus, over the first 25 years or so after the National Cancer Act of 1971, it was all about the genes and mutations. The picture that began to emerge was that oncogenes drove tumor growth along with loss of tumor suppressor gene activity. This seemed to fit in nicely with Alfred G. Knudson’s “two-hit” hypothesis, which stated that not only were “hits” required in oncogenes to cause cancer but in tumor suppressors as well. Later, Burt Vogelstein developed a model of multi-stage carcinogenesis that required at least six mutations:

i-3546daeb5561e8d9f1227830cecd2119-Vogelstein-thumb-400x641-61599.gif

As you can see, things were getting pretty complicated. Even so, based on what we know now, even Vogelstein’s increasingly sophisticated models in retrospect turn out to have been fairly simplistic. We discovered this over the last decade or so, because, with the advent of expression array profiling (a.k.a. “gene chips” or “cDNA microarrays”) in the late 1990s, it became possible to measure the level of expression of thousands of genes at the same time. Before then, we did not have the computational power or the technology necessary to do this, but over the last decade or so, it’s become more apparent than ever before that it is not primarily individual genes that determine cancer, or even a handful of genes, but hundreds or even thousands of genes that form complex networks of interactions. Also, around 1998 it was discovered that there is a whole new class of RNA, known as microRNAs (miRNAs), which regulate gene expression. More recent evidence suggests that miRNA expression patterns might actually tell us more about how cancer develops than whole genome expression array profiling because individual miRNAs often regulate the expression of hundreds of genes.

And I’m not even getting into deep sequencing of whole genomes in cancer yet, or the metabolic derangements that characterize cancers and allow them to grow where normal cells cannot, derangements that are probably just as critical to the process of carcinogenesis as genetic alterations.

So, putting it all together as we understand it in 2011, cancer cells not only have mutations that result in dysregulated expression of oncogenes and tumor suppressors, but these changes result in the alteration of expression of hundreds of genes, and in different types of cancer it will be different batteries of genes and miRNAs that are messed up in different ways. In fact, in individual tumors, there will be different populations of cells with different sets of genes and miRNAs messed up in different ways. Even worse, as a tumor progresses, it tends to become more heterogeneous, meaning that the number of different populations of cells tends to increase. Looking at it this way, it’s amazing that we have been able to do as well as we have with various forms of “targeted” therapy directed at specific single molecular targets or a class of molecular targets in cancer cells. Gleevec®, for instance, has been amazingly successful as a targeted agent directed against several members of a class of enzyme known as a tyrosine kinases, and by that mechanism it has been phenomenally successful as a treatment for gastrointestinal stromal tumors and certain types of leukemia. Even hoary old Tamoxifen is a targeted therapy directed at the estrogen receptor, and it still remains a mainstay of treatment for estrogen receptor-positive cancers to this day, along with a newer class of drugs known as aromatase inhibitors.

Unfortunately, in the grand scheme of things relatively few tumors are responsive to the targeting of single agents.

The prostate cancer genome

So what does this study tell us? Basically, scientists working at the Broad Institute, Weill Cornell Medical College, the Weizmann Institute of Science, Yale University, and Harvard University completely sequenced the entire genome of seven different prostate cancers and catalogued the abnormalities found by comparing the genome in prostate cancer with that found in the white blood cells of each patient, which were used as the normal control. Of course, this is what’s known as a “hypothesis-generating” study (a.k.a. a “fishing expedition” to those more inclined to disparagement). Personally, I have no problems with “fishing expeditions,” because without them we would have a serious lack of hypotheses to test. Moreover, this sort of fishing expedition is one where, almost no matter what scientists found, they would learn something useful about prostate cancer. True, it may not be the sort of knowledge that can be translated into therapy quickly. In fact, going in I would have predicted that it almost certainly would not be the sort of understanding that would lead to rapid improvement in prostate cancer treatment, and the results of this study show that it is not. What it does show is just how messed up the genome of cancer cells tends to be.

So what did the investigators find? Rearrangements and translocations. Lots and lots of intrachromosomal rearrangements and interchromosomal translocations. In fact, they found a median of 90 rearrangements and translocations per cancer genome (range: 43-213). They even included a pretty picture to represent the rearrangements. Known as a Circos plot, this graph shows the genomic location in the outer ring and chromosomal copy number in the inner ring (red, copy gain; blue, copy loss). Interchromosomal translocations and intrachromosomal rearrangements are shown in purple and green, respectively. (click on the picture to go to the Nature website and see the full size version):

i-88b1b9848d745e24b7579cd1723b1785-fig1-thumb-450x225-61601.jpg

These rearrangements were, as noted above, both within chromosomes (intrachromosomal) and between chromosomes (interchromosomal). These are represented in the following figure (again, click on the figure to see the full-size version):

i-a309df5afbd55b8266ab4e83a28337a8-fig2-thumb-450x446-61603.jpg

Panel A shows an idealized picture of how these translocations work, with chromosomal breaks and rejoining with pieces of other chromosomes. It’s not necessary for me to go into the details other than to point out that in panels B and C we see that the break points have a disturbing propensity to be located right in the middle of important genes, like tumor suppressors. For instance, in PR-2832, break points appear in the middle of TP53 and ABL1. In other tumors, investigators found recurrent rearrangements that involved CADM2 and PTEN. PTEN is a known tumor suppressor gene, but CADM2 (cell adhesion molecule 2). This result appears to be confirmatory of recent results implicating CADM2 as a tumor suppressor gene in prostate cancer. Overall, scientists observed some new rearrangements, and ones that had been detected before.

Or, to put it even more simply, as William Phelps, program director for Translational and Preclinical Cancer Research at the American Cancer Society, put it:

Here’s one way to conceptualize the alteration, Phelps said: “If the genome was a book, instead of just looking for out-of-place letters or misspelled words, whole genome sequencing looks for whole paragraphs that are in the wrong place.

“Because [the researchers] sequenced everything, they were able to map not only individual base changes but also how whole genes or segments of the chromosomes had moved around,” Phelps said. “By sequencing everything and comparing the normal DNA (in white blood cells), they could see that not only were there individual base changes in the genes, but the genes themselves had been reshuffled in the tumor as part of the process of becoming cancer,” he explained.

“If we could use those changes as a diagnostic tool that would be tremendously valuable,” he added.

Whole genome sequencing also enables scientists to look not only at “coding” genes, but also “noncoding” DNA around the genes that was once thought to be “junk” but is now known to play an important regulatory role within cells, Phelps said.

I’ll admit that when it was announced, I was skeptical of the utility of the Cancer Genome Anatomy Project. I still am, actually. Basically, it’s one massive fishing expedition. Not that fishing expeditions are bad in science; in fact we don’t fund enough of them. The problem comes when it’s a fishing expedition that costs $12 billion; then weighing the benefits of the potential discoveries versus the costs becomes key. However, as the years have gone by, I’ve become less skeptical, although I can’t say that I’ve exactly embraced it. This study leads me to consider that perhaps I was wrong in my original assessment. Also, having seen some of the truly idiotic criticisms of the CGAP doesn’t help to keep me hostile.

More interesting than whether I screwed up five years ago when I first heard of this project, these sorts of rearrangements have long been appreciated as being important in leukemias and lymphomas, but in solid tumors they had not–until relatively recently. One thing that is important to keep in mind is that these scientists focused on aggressive, advanced pancreatic cancer. Consequently, they were selecting for most “messed up” genomes. As more and more cancer genomes are sequenced, scientists will be able to make comparisons between aggressive and indolent tumors. It is possible that one day doctors will be able to sequence a patient’s tumor and use what is learned from this to tell whether the tumor is aggressive or not–or potentially whether it even needs treatment or not. I’ve written extensively about the problem of overtreatment and even about spontaneous regression. Wouldn’t it be great if we could identify patterns of rearrangements and mutations (or lack thereof) that are associated with slow growing, indolent tumors compared to patterns associated with fast-growing, deadly tumors like the one that killed my mother-in-law, and then be able to use that information to target therapy or to decide that a cancer patient can be safely treated with watchful waiting? Until the last few years, we really didn’t have the technology and computing power to make such a dream a possibility, but now we do.

So why haven’t we cured cancer, anyway?

I close with the same question with which I opened. Why haven’t we cured cancer yet, anyway? Yes, I know it’s a bit of a misleading question, given that we can actually cure quite a few cancers, including several leukemias and lymphomas, which are curable with chemotherapy and radiation, and solid tumors like breast and colorectal cancer which are curable with a combination of surgery, chemotherapy, and radiation. Unfortunately, although we do fairly well (and in some cases very well) against early stage cancer, we don’t do so well against stage IV metastatic disease, particularly solid tumors. The vast majority of these are not curable, and, very likely, the vast majority are much like the prostate cancer specimens studied by these researchers, full of chromosomal rearrangements and mutations leading to abnormalities in many different signaling pathways.

Last year, the tenth anniversary of the announcement of the results of the Human Genome Project provoked a veritable flood of “Why haven’t we cured cancer yet?” or “Why haven’t we cured this disease yet?” For example, Nicholas Wade wrote a painfully simplistic article last June entitled A Decade Later, Genetic Map Yields Few New Cures. It’s an article I lambasted for its simple-mindedness. Meanwhile, Dr. David Katz tried to appropriate the disappointment some felt that the HGP hadn’t yielded an unending stream of cures and diagnostic tests to argue for his favored “complementary and alternative” medicine belief that there is no such thing as genetic determinism in disease.

Let’s put it this way: The technology, techniques, and knowledge developed during the Human Genome Project laid the groundwork that has made it possible to sequence the entire genome of prostate cancer tumors and compare them this way. Come to think of it, I’m really dreading December 23, 2011. That will mark the 40th anniversary of Richard Nixon’s signing of the National Cancer Act of 1971. I just know that the month of December will be filled with stories lamenting, “Why haven’t we cured cancer yet?” or proclaiming the “war on cancer” to have been a failure. Some will be from the mainstream media, and even more will come from places like NaturalNews.com and Dr. Mercola’s website. That’s one prediction you don’t have to be a psychic to make. I also predict a whole bunch of articles and blog posts trying to claim that we’d be able to cure cancer “if only,” as in “if only” we’d be less “conservative” in our research approach (whatever that means and never mind that there are lots of high-risk approaches, and the ones that work only appear obvious in hindsight); “if only” we’d educate our kids in science better; “if only” we’d get rid of the FDA (yes, this guy was serious, as neuron-apoptosingly stupid as his argument was), or “if only” doctors didn’t make so much money treating cancer with drugs and wouldn’t make any money treating it with “natural” therapies.

In preparation for this landmark event, I’ll begin with a pre-emptive answer (which I’ll no doubt have to repeat in December). Why haven’t scientists cured cancer yet? Leaving aside the trite answer of “Which cancer?” I can say this: Because it’s hard. It’s very, very hard. It’s harder than going to the moon; it’s harder than building the nuclear bomb; it’s harder than wiping out smallpox. All of those were, of course, also very, very hard too, but cancer is a harder nut to crack still. It’s hundreds, perhaps thousands, of diseases. Each type of cancer can be many, even dozens, of different diseases in itself. Each tumor can be many diseases that are constantly evolving, both in response to the environment in which the cancer cells grow and to treatments that are thrown at them.

And most cancer cell genomes probably look like the prostate cancer genomes analyzed in this paper. There’s a less thorough study that suggests that the breast cancer genome does.

Does that mean I have no hope? Of course not! Otherwise, I wouldn’t keep doing what I’m doing. I am simply expressing humility in the face of a protean foe that has thus far withstood our best efforts to eradicate it. That does not mean that it will continue to do so. After all, never before have we had the tools that we have now to probe deeply into the biology of cancer at the whole genome level as we do today.

Still, it will be hard.

REFERENCE:

Berger, M., Lawrence, M., Demichelis, F., Drier, Y., Cibulskis, K., Sivachenko, A., Sboner, A., Esgueva, R., Pflueger, D., Sougnez, C., Onofrio, R., Carter, S., Park, K., Habegger, L., Ambrogio, L., Fennell, T., Parkin, M., Saksena, G., Voet, D., Ramos, A., Pugh, T., Wilkinson, J., Fisher, S., Winckler, W., Mahan, S., Ardlie, K., Baldwin, J., Simons, J., Kitabayashi, N., MacDonald, T., Kantoff, P., Chin, L., Gabriel, S., Gerstein, M., Golub, T., Meyerson, M., Tewari, A., Lander, E., Getz, G., Rubin, M., & Garraway, L. (2011). The genomic complexity of primary human prostate cancer Nature, 470 (7333), 214-220 DOI: 10.1038/nature09744

Comments

  1. #1 Aaron
    February 21, 2011

    Good article.

  2. #2 DonZilla
    February 21, 2011

    We survivors deeply appreciate everything you docs do. Thanks so much Orac!

  3. #3 Mojo
    February 21, 2011

    If we can put a man on the moon, why can’t we cure cancer?

    Because rocket science isn’t exactly rocket science?

  4. #4 David
    February 21, 2011

    Good article.

    One of the reasons people ask “why haven’t we cured cancer yet” is that every so often, some scientist or other pops up, proclaiming that his/her research is so great that the cure is just around the corner.

    Here’s Francis Collins in 2003, to congress: “Completion of the human genome sequence offers a unique opportunity to understand the role of genetic factors in health and disease, and to apply that understanding rapidly to prevention, diagnosis, and treatment. This opportunity will be realized through such genomics-based approaches as identification of genes and pathways and determining how they interact with environmental factors in health and disease, more precise prediction of disease susceptibility and drug response, early detection of illness, and development of entirely new therapeutic approaches.”
    source: http://www.genome.gov/11007447

    Genomics has been hyped far beyond any reasonable expectations.

    We need more public statements like yours, to temper the promotional statements of people like Francis Collins (who believes in genetics almost as if it were a religion). Thanks.

  5. #5 Brett
    February 21, 2011

    Excellent essay, Orac.

    I remember being slightly shocked at how incredibly complex and difficult Cancer is after reading The Emperor of All Maladies. It makes me pretty grateful that at the very least, I can avoid a lot of the risk simply by not smoking as a man.

  6. #6 Ryan
    February 21, 2011

    This is a little off topic, and I understand not really important, but since this is the most recent post I thought I would ask here if anyone else noticed the shot of Respectful Insolence last night during the Dateline report on Suzanne Somers?

  7. #7 Karen
    February 21, 2011

    Why? The simple answer is because there’s just flat out too much money to be made in this country treating it.

  8. #8 BB
    February 21, 2011

    @#7
    Oh for Pete’s sake– As if cancer patients aren’t CLAMORING for cures!

    Troll, go away.

  9. #9 Lawrence
    February 21, 2011

    #7 – so, how do you reconcile vaccines in this thought-process? If more money is to be made on treatments, the pharma industry would have no interest in vaccines.

    Seriously, we’ve made substantial strides in Cancer treatments & prevention (just see the HPV vaccine) – being as complex as a problem as it is, there isn’t a silver bullet that will be a cure-all.

  10. #10 dusonfnp
    February 21, 2011

    Dang, Lawrence beat me to it! I was going to say that it would be so great if we had, say, a vaccine to prevent cancer, but that if we did, the anti-vaccine crowd would find something wrong with it. Oh wait…..

  11. #11 Dangerous Bacon
    February 21, 2011

    “Why? The simple answer is because there’s just flat out too much money to be made in this country treating (cancer).”

    Of course! None of the oncologists, other physicians, researchers, supporting staff and employees/executives of the pharmaceutical industry will ever come down with cancer, or have relatives/friends with cancer, so naturally they have no interest in curing it!

    It’s so obvious, I can’t believe I didn’t think of it first.

    I hear Suzanne Somers is going to have a series on CNN featuring alternative cancer cures. That should solve the problem once and for all.

  12. #12 palindrom
    February 21, 2011

    #7 — That’s a common argument, but it’s also wildly dumb. A cure would be hugely profitable for whatever company developed it (I believe they charge a pretty penny for Gleevec). So the economic motive to come up with a cure is gigantic — not to mention the fact that so many of us will get cancer at some point.

  13. #13 T. Bruce McNeely
    February 21, 2011

    Why? The simple answer is because there’s just flat out too much money to be made in this country treating it.

    Right. Just like there’s too much money to be made in the iron lung and orthopedic rehab industry to allow polio vaccine to be available. Just like there’s too much money to be made from tuberculosis sanitoria and chest surgery to allow antibiotics for threatment of Tb.

    Idiot.

  14. #14 rob
    February 21, 2011

    i am sure teh Big Pharma is working on a vaccine for cancer that is filled with “toxins” and ground up baby harp seals that they can use to make billions and billions of dollars, take over the United Nations and force everyone to re-adopt Betamax.

    p.s. good article Orac. i learned a lot!

  15. #15 lilady
    February 21, 2011

    Excellent article Orac. You are right that the forty year anniversary of Nixon’s misstatement about curing cancer will be used by CAM hucksters to advance their cancer “cures” with gullible consumers.

    @Karen. Tell us all about the international cabal of money-hungry scientists, researchers and physicians who are even willing to sacrifice their kids to keep the international conspiracy going.

    I presume you personally or your loved ones have never been affected by a diagnosis of cancer. Or, if you have some personal experience with a CAM cure, please provide details. If at some future time you receive a diagnoses of cancer, you should seek out a CAM “”cure” BEFORE you follow an oncologist’s advice..so that you don’t skew the bothersome details about the effectiveness of alternative medicine cures.

  16. #16 SarniaSkeptic
    February 21, 2011

    #7/Karen: In case you didn’t notice, there was a full essay written just below the “Why can’t we cure cancer?” heading and above the spot where it asked you if you had anything stupid to add contribute.

  17. #17 prn
    February 21, 2011

    Nice article. “less conservative” might be that our researchers put more effort into more high quality, long term phase II tests, looking for home runs. And then giving preference to lower cost, high therapeutic index results, over high priced, proprietary, low index stuff.

    CRC (no, not the Rubber Bible)
    My favorite phase II test is Matsumoto (2002) etc, 5 Md-PhDs and others, running retrospective biomarkers on 10 year survival with no loss to followup. Run until they get a near quantitative result for a large fraction of stage III CRC patients, with a $2-4 per month adjunctive treatment, cimetidine. See also Sato 2010 using CA19-9 with E-selectin (by the CSLEX1 test).

    The thing that bothers me most is that the crucial biomarker, CSLEX1 is not made available in the US, nor is CA19-9 much less CSLEX1 tissue staining readily available. WTF. Other papers suggest cimetidine beneficial for many stage IV CRC, even without biomarkers sharpening the results.

    If “we” were running a legitimate “war of on cancer” we would beg, borrow or steal promising technologies. Here, we can’t even take a persistently proferred gift (CSLEX1 for CD15s, sialyl Lewis X). Anyone should compare positive CSLEX1 + CA19-9 tissue tests (or even blood tests) paired with adjunctive cimetidine treatments against the survival changes in KRAS etc tests + Avastin or tyrosine inhibitors results.

    With commonly biomarked CRC patients, the Japanese appear to beat the daylights out of us with their treatments, metronomic oral treatments with glycans (PSK, etc) + oral pro-5FU + cimetidine (+ LV and/or other cheap cocktail mixers for stage IV) for almost no money (ca $200 per month vs $5K-$15K-$25k per month) and much fewer side effect profiles for stage III-IV CRC. Yet the most one might hear in the US market areas is a bored burp on a sponsored annual cruise or the med oncolgists’ dinner meeting, while the sponsor presents an expensive failing drug + more incentives.

    Somewhere, between the gatekeepers at NCI, NIH and FDA, we have a failure to assimilate.

  18. #18 nybgrus
    February 21, 2011

    @7:

    gee guys, didn’t leave me much….

  19. #19 Not House
    February 21, 2011

    Reminds me of this PhD Comic entry

  20. #20 LW
    February 21, 2011

    Karen @7: “Why? The simple answer is because there’s just flat out too much money to be made in this country treating it.”

    Difficult as this may be for you to imagine, there is more than one country in the world; different countries have different health care systems and medical communities; and — I know this one is really hard — some of those countries do not like America very much, and would be absolutely gleeful if they could announce that their scientists had found a cure for cancer where American scientists have failed.

  21. #21 Dianne
    February 21, 2011

    My usual answer to the question, “Why can’t we cure cancer?” is “Why can’t we cure infectious disease?” Cancer is a class of diseases, not a single disease.

    Ironically, we CAN cure many forms of cancer. The cure rate for testicular cancer is about 95%. Many lymphomas and some leukemias can be cured as well. So can early to mid-stage breast cancer, colorectal cancer, and others. In contrast, when’s the last time you ever heard of someone being cured of hypertension, diabetes, or heart disease? These can all be treated, but only very, very rarely cured. We also can’t cure polio, measles, herpes, or chicken pox: we can prevent them but not treat them. Cancer’s one of the more curable diseases. So why do oncologists get so little credit?

  22. #22 Doctor Smart
    February 21, 2011

    As long as secular oppressives and the FDA stand in the way, cancer will NEVER be cured. Big pharma sees no money in a cure when they can continue expensive treatments forever. If a cure were to be found, big pharma might go bust. We can’t have that now, can we?

    I am all in favor or a cure for cancer no matter who finds it whether it be a science lab, or an individual working from his own home. Who cares how the cure is found and who finds it? That is irrelevat to the problem. We need to restrict the FDA and big pharma so that we can find the cure.

    Who is to say a cure for cancer has not already been found and the man who discovered it had an “accident”? It happens more than you know. Oil companies, drug companies, government agencies all are responsible for the deaths of individuals who are smarter than they are. Just look what happened to Tesla. He was a slave to the government. There is no telling what technology that man gave to us that is restricted by government for political reasons.

    In any rate if you have cancer you can go about curing it three different ways. Any of these ways will probably end up in death anyway:

    1) dangerous chemo and radiation
    2) all natural methods
    3) hope you get abducted by aliens and they cure you

    Here is my two cents worth

    Indole-3-carbinol

    Supports detoxification, particularly of cancerous hormone metabolites.

    Coriolus versicolor (Trametes versicolor)

    Coriolus contains polysaccharides that have been shown to enhance immune function. It is manly used for esophageal, lung, stomach, and colon cancer. Note: It can be safely used in conjunction with conventional treatment (surgery, chemotherapy, and radiation)

    Maitake (Grifola frondosal)

    Maitake enhances immune cells that fight cancer. It is most effective for breast, prostate, liver and lung cancers. Note: It can be safely used in conjunction with conventional treatment (surgery, chemotherapy, and radiation)

    Proteolytic enzymes

    Proteolytic enzymes have been shown to have numerous anticancer effects. Note: It can be safely used in conjunction with conventional treatment (surgery—except not three days before or after surgery–chemotherapy, and radiation)

    Astragales (Astragalus membranaceus)

    Astragalus enhances natural killer and other immune cells that fight cancer. Note: It can be safely used in conjunction with conventional treatment (surgery, chemotherapy, and radiation).

    Curcumin

    This extract from turmeric has many different anticancer effects. Note: It can be safely used in conjunction with conventional treatment (surgery, chemotherapy, and radiation). Curcumin helps the body to destroy mutated cancer cells, so they cannot spread through the body and cause more harm. A primary way in which curcumin does so is by enhancing liver function. Additionally, other suggested mechanisms by which it may protect against cancer development include inhibiting the synthesis of a protein thought to be instrumental in tumor formation and preventing the development of additional blood supply necessary for cancer cell growth.

    Essiac

    Essiac is a combination of detoxifying herbs derived from an ancient Indian healing formula, and it has attained a reputation for great success in treating cancers of all kinds. When buying Essiac—many brands use the name—look for the following set of herbs: sheep sorrel, burdock root (Articum lappa). Slippery elm (Ulmus fulva), rhubarb root, watercress, blessed thistle (Cnicus benedictus), red clover (Trifolium pretense), and kelp (Ascophyllum nodosm).

    Selenium
    Selenium is essential for the heart and immune system and helps other antioxidants work better in the body. Selenium may reduce the risk of certain cancers. A study done 20 years a group concluded that cancers (excluding skin cancers) was reduced by 37%; the incidence of lung cancer was reduced by 46%, colorectal cancer by 58%, and prostate cancer by 63%.
    Milk Thistle

    Silymarin and other chemicals from milk thistle have also been tested in laboratory studies involving various types of human cancer cells. In general, they seem to interrupt cancer cell division as well as shortening the time that cancer cells live. They may also stop or limit the formation of new blood vessels that supply tumors. Not recommended for breast cancer!

    Graviola

    It is widely used as an alternative treatment to some forms of cancer and is considered to have very powerful antioxidant properties. Graviola selectively kills colon cancer cells at “10,000 times the potency of Adriamycin.” That is a very effective chemotherapy drug. Graviola is extremely effective in isolating and killing lung cancer cells.
    http://www.rain-tree.com/graviola.htm

    Conjugated Linoleic Acid (CLA)

    This fatty acid found in red meat and cheese showed strong anti-cancer properties, was particularly effective in inhibiting breast and prostate tumors, as well as colorectal, stomach, and skin cancer, including melanoma. Scientists found CLA to be more strongly anti-carcinogenic than other fatty acids. What made CLA especially unique is that even low concentrations significantly inhibited cancer cell growth.

    Cat’s Claw

    It enhances immune functions and has anti-tumor properties. It stimulates the immune system, reduces inflammation, protects cells, fights free radicals, cleanses bowels, kills cancer cells, and kills leukemia cells.

    Green Tea

    Green tea is known for its cancer fighting properties. It contains EGCG which has been found to cut off blood vessels that feed cancerous tumors.

    Noni

    Noni is a fruit that resembles the pineapple. Research shows that it may be effective in not only blocking tumor growth, but also inducing cancer cells to return to normal. Noni stimulates the immune system.

    Olive Leaf Extract

    It enhances the immune system and has shown good results in fighting cancer.

    7-Keto

    7-Keto is a metabolite of DHEA that possesses anti-cancer properties without converting into testosterone or estrogen.

    Flaxseed Oil

    Flaxseed oil has anti-oxidant properties and may protect against, and prevent the spread of cancer.

  23. #23 Doctor Smart
    February 21, 2011

    As long as secular oppressives and the FDA stand in the way, cancer will NEVER be cured. Big pharma sees no money in a cure when they can continue expensive treatments forever. If a cure were to be found, big pharma might go bust. We can’t have that now, can we?

    I am all in favor or a cure for cancer no matter who finds it whether it be a science lab, or an individual working from his own home. Who cares how the cure is found and who finds it? That is irrelevat to the problem. We need to restrict the FDA and big pharma so that we can find the cure.

    Who is to say a cure for cancer has not already been found and the man who discovered it had an “accident”? It happens more than you know. Oil companies, drug companies, government agencies all are responsible for the deaths of individuals who are smarter than they are. Just look what happened to Tesla. He was a slave to the government. There is no telling what technology that man gave to us that is restricted by government for political reasons.

    In any rate if you have cancer you can go about curing it three different ways. Any of these ways will probably end up in death anyway:

    1) dangerous chemo and radiation
    2) all natural methods
    3) hope you get abducted by aliens and they cure you

    If you do have cancer, here are a few tips

    1) stay away from sugar and processed foods. cancer feeds on sugar
    2) get your PH levels checked to make sure you body is not too acidic
    3) see if your doctor will inject liquid Vitamin C directly into your tumor. This has been highly efective in some patients. if you cannot find a doctor who will do this, Mexico and South American have doctors that will give you any treatment you request as long as they see cash money coming their way.
    4)Outside of chemo and radiation, do research for yourself oline and in the bookstores. You can learn from patients with the same thing you had.

  24. #24 Jarred C
    February 21, 2011

    Living in California, I’m used to seeing alternative medicine quacks in league with hippies and other anti-establishment folks. So it came as a surprise when I visited Doctor Smart’s name-link, and the first article I saw on the page was about how those damned protesters in WI are anti-capitalism.

    I mean, I know idiots like him exist (see post 21 for a beautiful example of idiocy), but I’m still a little bit surprised to see them when I do. They’re just not as common in my neck of the woods.

    It’s also odd to see someone complain about people being against capitalism, and at the same time, he himself complain about “big pharma” doing exactly what would be allowed in a pure capitalist economy.

  25. #25 Doctor Smart
    February 21, 2011

    The protestors in Wisconsin is all about socialism and throwing down America. It has little to do with ‘rights”.

    Did you read any of the signs there? I liked the one protestor who said he would like to gang rape a Fox News analyst. What a violent uncivilized thug he was. Maybe he should be gang raped by monkeys.

    Big pharma is in bed with the FDA and politicians. Yes their methods work well in the capitalist system, but censorship is not the capitalist way. It sounds more like something a socialist would do.

    You probably didn’t even read the entire post anyway. Did you even read about the violent attacks some of these protestors are committing? One protestor was arrested after ripping the wires out of a tea Party counter protestor’s speaker system and then punching the tea party member.

    I swaer if I attend this event in wisconsin I will bring multiple 32 oz canisters of grizzly bear strength pepper spray and a few tazers. These left wing thugs are violent and dangerous. Self defense is not an option in an uncivilized violent anti-american rally such as they are holding.

  26. #26 Gray Falcon
    February 21, 2011

    One who calls himself Doctor Smart, here’s some advice on pretense and humility from someone I’m sure you respect:

    7 When he noticed how the guests picked the places of honor at the table, he told them this parable: 8 “When someone invites you to a wedding feast, do not take the place of honor, for a person more distinguished than you may have been invited. 9 If so, the host who invited both of you will come and say to you, ‘Give this person your seat.’ Then, humiliated, you will have to take the least important place. 10 But when you are invited, take the lowest place, so that when your host comes, he will say to you, ‘Friend, move up to a better place.’ Then you will be honored in the presence of all the other guests. 11 For all those who exalt themselves will be humbled, and those who humble themselves will be exalted.”

    http://www.biblegateway.com/passage/?search=Luke+14%3A7-11&version=NIV

  27. #27 LW
    February 21, 2011

    Why would Big Pharma go bust if there were a cure for cancer? If there were, more people would grow old, and old people need more medication, on average, than young people. And they need it for longer than the average cancer patient who will probably either die or go into remission instead of requiring daily treatment for decades. As I understand it, Viagra and treatments for baldness are highly profitable.

  28. #28 Lawrence
    February 21, 2011

    The hypocricy is strong with this one –

    1) Go to South America – they’ll do whatever you want, as long as you bring cash (yeah, good advice).

    2) Not even FauxNews is running stories on violent protestors in WI – you’re a moron.

    Oh yeah, again, you’re a moron. Don’t you think “Big Pharma” would like nothing more than to get rid of the FDA? Kinda puts you on the same side, doesn’t it?

    Google University is the last place someone should look for medical advice.

    Again, you’re a moron.

    Oh, and you can’t have it both ways – Pharma is all about treatment, but then Pharma is all about the vaccines – so which is it?

    Moron. Moron, and can I say it again, MORON!

  29. #29 T. Bruce McNeely
    February 21, 2011

    So, (non) Doctor Smart has the cure for cancer, does he?

    If he has the cure for paranoid schizophrenia, he’s obviously not choosing to use it.

    Also, here are a few more examples of Alties not fitting the Granola stereotype:

    Lorraine Day

    A few Canadian loonies (and I’m not talking about currency)

  30. #30 chris
    February 21, 2011

    good article. doctor smart is insufferably glib about a complicated and heterogeneous problem that has been nicely capsulized in the post. curing cancer is really, really hard, and all the easy cancers are now treatable, leaving the 2/3 ‘hard ones’. in canada today, heart attack, stroke, diabetes, hip fracture deaths, ie, all the ‘easy ones’, are down 40% in 10 years, partly due to cheap drugs, that big pharma made a lot of money from for very little investment in r+d. all this means is that people will live longer/healthier so they are more likely to die, in older age, from….cancer.

  31. #31 RMD
    February 21, 2011

    One more thing, Dr.Smart @23, protestors is spelled protesters. It is a plural word and takes a plural verb. Thus “protestors in Wisconsin is all about socialism…” makes you sound like Dr.Stupid.

  32. #32 Anthro
    February 21, 2011

    Well, Dr. Smarty, I have been in Madison for a few days and have seen tens of thousands of protestErs, every single one of whom has been nothing but polite, engaging and totally ignoring any stray teabaggers wandering about (and there are a few). These people are your neighbors (well, maybe not, because you probably live in a trailer in the woods or out in the desert somewhere). They are teachers, teaching assistants, medical professionals and paraprofessionals, and firefighters. They are interacting with each other and the police who are ambling about with them or on their bicycles, laughing and sharing stories.

    You know NOTHING–NOTHING. I am a West Coaster transplanted to Wisconsin some years ago who has often felt out-of-place with the midwestern reserve, but I am enormously proud of the very fine people who are at our state Capitol fighting for the right to maintain their collective bargaining rights so that they may continue to have health care coverage in case they get any form of the myriad diseases we call cancer.

    I am a proud Badgerwoman today. And thanks for this very illuminating post Orac. I am so sorry about your mother-in-law and hope that this type of research will eventually shed some light on ways to help those similarly stricken.

  33. #33 Doctor Smart
    February 21, 2011

    @ gray falcon

    Thanks. great Bible verse, but “science” blogs atheists/socialists/jesus haters might not like you posting this on their sight. Better yet, the White House Science adviser called global warming skeptics “heretics” today. I guess that finally proves that the environmental movement is a religious movement and the earth is their God. That being said, since Al Gore is the founding father of the global warming religion, he would definitaly appreciate you not putting your verses on his internet that he invented. It makes his religion look bad.

    I do not know what “faux news” is. Must be related to MSLSD news.

    Moonbattery has the latest photos and news from the protestors in wisconsin. Look it up yourself and stop depending on the corrupt Obamamania media to do it for you. You know they never show things like this unless a tea partier were to do it. Then it would be top news for six months straight.

  34. #34 Doctor Smart
    February 21, 2011

    If you google “wisconsin protest signs” you will see much hypocrisy. The left wing who screams at conservatives for calling Obama a nazi are doing the eaxact same thing to the governor there. You will see signs like “walker is a turd” and “walker = hitler”, etc. There are even organizations (community organizers?) there who are pushing global socialism. he one sign that caught my attention more than any was the fascist nutjob phsychopath that who said he would like to gang rape a Fox News analyst. i am sending that photo and link to Fox News in hopes they will track down that pervert and nail his ass to the wall in jail.

    There were many signs protesting Fox news. I am not sure what Fox news has to do with wisconsin budget cuts, but there is more to this protest than meets the eye. From all the moonbats and communists there, I am going on the assumption that this thing was planned in advance. We know the Egypt protest was planned in 2008. These protests are highly organized and well planned out. There is nothing spontaneous about this crap. This is an intentional movement. I pray a blizzard will come and freeze the outcasts back to their dungeons.

    Then, there were “violent rhetoric” signs everywhere. The same people who wanted to prosecute sarah palin over her “violent rhetoric” is using violent rhetoric themselves. What dummies they are. The governor should just ignore them. Eventually they will get hungry and bored and go back home. They can only protest for so long before bill need to be paid, food gets scarce, and the comforts of home start to be missed. Ignore them and they will go away.

    As a matter of fact just google “wisconsin violent protest signs” and you will see all kind of communist freaks wanting to kill Bush, kill walker, etc. If someone gets shot at this outrageous event, it will be becuase of the labor union’s “violent rhetoric”.

    Oh, and just to let you know one of your own liberals held up a sign that read “fags doom unions”. Go figure. I though all liberals were “tolerant”.

    These thugs are dangerous.

    Do some reading foryourselves and turn off that idiot box (television).

  35. #35 prn
    February 21, 2011

    Lost a detailed answer with several links to RI’s “filter”. Please post it.

    Overall I liked the article. However I think we’ve made a lot more published progress, that we aren’t utilizing well, or all, in the US. Cheap effective answers that when well coordinated earlier in treatment (nontoxic neoadjuvants, early adjuvant treatment, nontoxics starting day 0-2, more coventional parts at 2 weeks) and together in less toxic cocktails, make more sense science based medicine wise.

    I gave an example of Japanese using high quality phase II tests Matsumoto (2002) with cheap biomarkers. Sato (2010). The Japanese based answer? Actual oral cocktails at ca $200 per month instead of $5k-$15k-$25k per month with much less toxicity and suffering. Perhaps better results too for a large fraction of advanced CRC cases.

    I am left asking why the (seemingly) most important CRC biomarker techniques aren’t readily available outside Japan. The cheapest chemo parts, UFT, a 5FU prodrug available worldwide including UK, outside NoAm, aren’t available in the US, despite some clear advantages, when used or tested properly.

  36. #36 superdave
    February 21, 2011

    Do not feed the trolls has become a common internet refrain, but there are few websites on the internet where trolls literally can make the difference between life or death for it’s readership. Therefore I commend the people here for taking trolls to task. Good job.

  37. #37 Gray Falcon
    February 21, 2011

    Sir who calls himself “Smart”, you completely ignored the point of my biblical quote, which was to point out the absurdity of calling yourself “Smart”. Also, it is the height of arrogance to make accusations without providing evidence, but humility requires one be able to abandon foolishness.

  38. #38 Chemmomo
    February 21, 2011

    Hey Karen @7:
    Many treatments do cure. What’s your point?

  39. #39 Doctor Smart
    February 21, 2011

    “humility requires one be able to abandon foolishness.”

    If that were true, socialists would not exist. This website would not exist.

    @ superdave

    trolls like liberal sandwiches.

  40. #40 Chris
    February 21, 2011

    Oh, wow, the morphing troll is an idiot.

    prn, please learn how to cite better.

  41. #41 Gray Falcon
    February 21, 2011

    Three things. One, this thread is about cancer, do not bring up the Wisconsin protests. Two, whenever you make an accusation, provide evidence for it. So far, you’ve just made assertions. Three, here’s what the bible says about socialism:

    http://www.biblegateway.com/passage/?search=Acts+4%3A32-35&version=NIV

    The Believers Share Their Possessions
    32 All the believers were one in heart and mind. No one claimed that any of their possessions was their own, but they shared everything they had. 33 With great power the apostles continued to testify to the resurrection of the Lord Jesus. And God’s grace was so powerfully at work in them all 34 that there were no needy persons among them. For from time to time those who owned land or houses sold them, brought the money from the sales 35 and put it at the apostles’ feet, and it was distributed to anyone who had need.

  42. #42 prn
    February 21, 2011

    Found it, thanks. Original post, now #17 on CSLEX1 biomarkers with adenocarcinomas and PSK-UFT-CIM-LV+others for CRC stage III-IV, had finally posted later. Cimetidine, my 2 cents, per treatment, prn.

  43. #43 Chris
    February 21, 2011

    Yeah, much better, prn. Eventually Orac approves the ones in the spam trap.

  44. #44 Doctor Smart
    February 21, 2011

    @gray falcon

    You point would be?

    If it is socialism, it is a poor point. They as INDIVIDUALS brought the money out of their won free will becuase they wanted to and it was distributed to anyone who had need. Churches still do this. it’s called an offering.

    Under socialism, their money and belongings would have to mandatory to be given to whomever the government saw fit to give it to. There would be no choice in giving it and individuality would be dead. Under Jesus’ teaching individuals were still individuals, not collective slaves to government entities.

    Socialism is the opposite of individual lierty and fredom. it makes slaves out of people becuase it bans them from making money for themselves to spend and give as they individually see fit. Socialism is a satanic ideal becuase it takes away the human factor. it takes away character and makes everyone the same.

    Your karl marx line of thinking is dangerous, anti-american, and anti-Christian. Karl marx was the spawn of satan. His ideals killed millions. Everywhere communism/socialism has been tried it has failed. it does not and will not work. Give it a rest.

    Jesus taught us as individuals and part of His people to give to the poor, but it was not a mandate of a government dictator who would put us to death if we did not do so. He instructed His followers to do these things and they did so, not out of mandatory force, but out of dedication and respect for the Son of God and His teachings. It was not socialism. It was a voluntary action of His disciples and followers to do these things and take care of each other. it it had been socialism jesus would have said “By decree of law you must hand over your belongings to ceasar and he will redistribute it as he sees necessary. If you failt to do so you will be jailed or fined”. That is socialism.

    If you want socialism, move to Cuba. It works well down there.

  45. #45 Gray Falcon
    February 21, 2011

    You seem to have few qualms imposing other religious laws on people, so why should “Sell what you have and give to the poor” be any different? Also, see what happened to Ananias and Sapphira.

    On topic, however, let me explain the difference between pride and humility. Humility is coming up with an idea, asking “Does this work?”, testing to see if it works, asking others to test it so that the results are not colored by your perceptions, and, once the evidence comes in, deciding it probably works. This is how science works.

    Pride, however, is having an idea (such as thinking reducing sugar intake cures cancer), assuming it to be true, declaring oneself a genius for having thought of it, and refusing to believe any evidence to the contrary.

  46. #46 prn
    February 21, 2011

    prn, please learn how to cite better.
    Chris, I assume you are looking at my #35, instead of the original Matsumoto and Sato linked cites in #17. In #35, I avoided the annoying link-cite filter.

  47. #47 Gray Falcon
    February 21, 2011

    Oh, and here’s an example of legally-mandated “socialism” in the Bible:

    http://www.biblegateway.com/passage/?search=Leviticus%2019:9-10&version=NIV

    9 “‘When you reap the harvest of your land, do not reap to the very edges of your field or gather the gleanings of your harvest. 10 Do not go over your vineyard a second time or pick up the grapes that have fallen. Leave them for the poor and the foreigner. I am the LORD your God.

  48. #48 Lycanthrope
    February 22, 2011

    I saw a commercial not too long ago for a news segment about the cold and flu season wherein the reporter asked “If we can put a man on the moon, why can’t we cure the common cold?”

    The segment was called Good Questions. Sigh…

  49. #49 Gil
    February 22, 2011

    Maybe the Moon landing isn’t a good example. Forty years on, there have been many advancements in the treatment of cancers. What may have been untreatable in 1970 may be treatable nowadays. On the other hand, the rocket technology to put a man on the Moon in 2011 would be much the same as the technology of 1970.

  50. #50 David N. Andrews M. Ed., C. P. S. E.
    February 22, 2011

    Mojo: “Because rocket science isn’t exactly rocket science?”

    Exactly. A good understanding of Newtonian mechanics will get your rocket on the moon. And, if there’s enough fuel on the thing you launch up there, then the same sort of mechanics will get it back for you. No rocket science involved: just basic engineering mechanics.

    ‘Dr.’ ‘Smart’: “As long as secular oppressives and the FDA stand in the way, cancer will NEVER be cured. Big pharma sees no money in a cure when they can continue expensive treatments forever. If a cure were to be found, big pharma might go bust. We can’t have that now, can we?”

    How’s about you go and play marbles on the busiest runway at some busy international airport, eh? That would be the most constructive contribution you could ever make to this blog.

    LW: “Why would Big Pharma go bust if there were a cure for cancer? If there were, more people would grow old, and old people need more medication, on average, than young people. And they need it for longer than the average cancer patient who will probably either die or go into remission instead of requiring daily treatment for decades. As I understand it, Viagra and treatments for baldness are highly profitable.”

    Thanks for that, LW… on the basis that ‘Dr.’ ‘Smart’ wasn’t smart enough to figure that one out, can we all agree on the above proposal as being the best thing that ‘Dr.’ ‘Smart’ could possibly do for the blog?

    Lawrence: “Google University is the last place someone should look for medical advice.”

    That’s where ‘Dr.’ ‘Smart’ must have graduated BFA*, MFN**, DBM***!

    * Bachelor of Fuck All
    ** Master of Fucking Nothing
    *** Doctor of Bullshit Marketing

    Guess who: “Your karl marx line of thinking is dangerous, anti-american, and anti-Christian. Karl marx was the spawn of satan. His ideals killed millions. Everywhere communism/socialism has been tried it has failed.”

    Politics: FAIL
    History: FAIL
    Economics: FAIL
    Theology: FAIL
    Psychology: FAIL

    ‘Dr.’ ‘Smart’ is most likely a doctor of nothing!

  51. #51 Donna B.
    February 22, 2011

    oh my. Dr. Smart… go away, please. You are nuts and not representative of any group except nuts.

    Here is where I say that nuts are fringe groups of any political ideology. Nuttiness is their identifying factor, not ideology.

    And where I say that any scientist who confuses his science with political ideology is a de facto ideological nutcase.

    One of the reasons I keep reading Orac is that he does not let his political ideology rule his science. I have no doubt that were he and I to go toe to toe politically, we’d disagree on many points.

    But… the man has got his stuff together when it comes to understanding cancer and to how much about cancer is not understood.

    My husband is “living proof” that cancer is not one disease. He is (so far) a survivor of three primary cancers. There’s no evidence that his colon cancer, prostate cancer, or bladder cancer are related. They are all “primary” cancers.

    My husband is also a union member and Democrat… and a Marine and military retiree. A bit of a political conundrum, no?

    His service in the 1960s in the Marines exposed him to Agent Orange and he witnessed up close and personal several above ground nuclear weapons tests.

    All his cancers (and his Type II diabetes) are “presumptively” considered by the VA to have been caused by either his exposure to Agent Orange or radiation. Yet… he has refused to even consider filing a claim with the VA even though several of his doctors have suggested he do so.

    And… I’m sort of proud of his refusal, while at the same time being appalled by it because none of these diseases “run” in his family.

    Because of his service, he and I (and our children while under our care) have the best medical care our country offers. (That was one of the things offered to him as an incentive to re-enlist every time. It was a promise.)

    BUT none of that matters when it comes to the actual diagnoses and treatment of the cancers, does it? The colon cancer was treated surgically 17 years ago. The prostate cancer was treated radiologically 4 years ago. The bladder cancer has been treated immunologically for almost two years… until the treatment became painfully intolerable a few months ago.

    It is not just my husband’s cancers I’ve had to deal with lately. My mother’s uterine cancer (not the cause of her death), my first stepmother’s ovarian cancer (a reaction to chemo the cause of her death), my second stepmother’s death from lung cancer, and my father’s recent diagnosis with lung cancer.

    My own diagnosis with a benign brain tumor has also been enlightening. Benign in this case means that it is not going to spread to other organs — it does not mean that it will not cause harm.

    I hate the fact that medicine is now political. How stupid can politics be?

  52. #52 prn
    February 22, 2011

    Donna, um, linking religion with the extra helping of politics seems to be Dr Smart’s original mistake, with others careening into the personal commentary first. Although I do not ignore surgery and chemo, neither would I ignore Smart’s list of low toxicity adjuncts.

    His list is perhaps 2/3rds incomplete, but one can find low or nontoxic generic adjuncts that have evidence to different degrees that involve differentiation, apoptosis, immune stimulation; inflammation, hormone, angiogenesis, enzyme or gene expression inhibitors.

    Money related biases in medicine ARE a continued, increasing problem.

  53. #53 Calli Arcale
    February 22, 2011

    Dr Smart:

    Big pharma sees no money in a cure when they can continue expensive treatments forever. If a cure were to be found, big pharma might go bust. We can’t have that now, can we?

    There’s a massive problem with that statement — if there is no cure for cancer, then the patient cannot continue expensive treatments forever, because the patient will be dead. Cancer is extremely common, and not just among humans. The longer you live, the greater your risk of developing it. Therefore, it is in Big Pharma’s interests to find cures for various cancers — partly so they can tap the massive market of people with those cancers (who would much rather take Company A’s cure and live than take Company B’s treatment and then die), but also to increase the chances of those people later needing other drugs sold by the same company. If your company sells hypertension drugs, acid reducers, pain relievers, and diabetes supplies, developing a drug that cures a common form of breast cancer would actually increase your profit considerably — both because people would flock to you for the drug but also because they’d then live long enough to buy your other drugs as well.

    It is very much in Big Pharma’s interests to keep people alive as long as possible. They make more money that way, not less.

  54. #54 Andrew Dodds
    February 22, 2011

    Ok, random treatment thought just occurred..

    So, Cancer cells in the body are constantly evolving. Could we use this to help treatment? For instance, you could try this -

    - Supply patient with a daily dose of a metabolite that is used in cell proliferation but not normally available in the bloodstream. Or critical signaling molecule.
    - Apply a targeted therapy against the gene or gene product that the cancer cells use to create the item you are supplying
    - This would hopefully push the cancer to evolve to stop producing this item, because it’s available in the bloodstream. Normally, a therapy of the kind described would push the cancer to evolve a work around, but in this case the easiest way is just to knock out the relevant gene.
    - Now you can withdraw the metabolite dosage from the first step and in theory watch the cancer die due to the evolved dependency.

  55. #55 Andrew Dodds
    February 22, 2011

    Ok, random treatment thought just occurred..

    So, Cancer cells in the body are constantly evolving. Could we use this to help treatment? For instance, you could try this -

    - Supply patient with a daily dose of a metabolite that is used in cell proliferation but not normally available in the bloodstream. Or critical signaling molecule.
    - Apply a targeted therapy against the gene or gene product that the cancer cells use to create the item you are supplying
    - This would hopefully push the cancer to evolve to stop producing this item, because it’s available in the bloodstream. Normally, a therapy of the kind described would push the cancer to evolve a work around, but in this case the easiest way is just to knock out the relevant gene.
    - Now you can withdraw the metabolite dosage from the first step and in theory watch the cancer die due to the evolved dependency.

  56. #56 Steven Clyde Coon
    February 22, 2011

    One of the reasons cancer can not be cured. After reading the article, as well as the comments. Nobody can agree, It seems the majority of the comment’s did there best to pick apart the article learn to cooperate! put your fine mind’s together! Come up with a salution!

  57. #57 T. Bruce McNeely
    February 22, 2011

    If we can put a man on the Moon, why can’t we put a man on the Sun?

  58. #58 Eleanor Carlson
    February 22, 2011

    Thank you for the clarifying article. It seems like it would be more efficient to emphasize research on preventing the external and internal environments leading to activation of cancer cells in our bodies.

    I suspect the results would lead to major political battles with giant corps. Look how research on the affects of smoking gave people a choice about whether they wished to increase their odds of developing cancer. But it didn’t outlaw making or selling cigarettes.

    Most of us are having way too much fun with our tech toys to be concerned with the toxic by-products of their manufacture. However, more research could force changes if it could show significant correlations between cancer activity and those byproducts entering our food and water.

  59. #59 Joe
    February 22, 2011

    “If we can put a man on the Moon, why can’t we put a man on the Sun?” Posted by: T. Bruce McNeely | February 22, 2011 12:34 PM

    There is a major, technical problem there. You see, during the day the Sun is too hot- so you would have to go at night. However, the Sun is 93 million miles from us and we can’t travel fast enough to make the round trip overnight.

  60. #60 Rob Jase
    February 22, 2011

    I would like to point out that the incidence rate for cancer on the moon has been zero since we first landed there.

    One celestial body at a time please.

  61. #61 herr doktor bimler
    February 22, 2011

    preventing the external and internal environments leading to activation of cancer cells in our bodies.

    The internal environment leading to cancer cells is called “being alive”.

  62. #62 David N. Andrews M. Ed., C. P. S. E.
    February 22, 2011

    TBMcN: “If we can put a man on the Moon, why can’t we put a man on the Sun?”

    Do we think that Orac would maybe give us a blog post for commenting as to which man (or woman) we’d most like to put on the sun?

  63. #63 Doctor Smart
    February 22, 2011

    @ gray falcon

    there is no socialism in the Bible no matter how much you wish it to be. Well actually there is a case of collectivism in the Bible. Since it is in Genesis you probably don;t believe it though. Remember the tower of Babel? How a socialist society was destroyed by God?

    Socialism is a satanic ideal, not a Godly one.

    @ “Dr.”David Andrews CSPXYZNIVIIXIX whatever

    Go do a colonoscopy with your face. Just becuase you cheated you way through school and got a bunch of fancy letters behind your name, give you no right to think of yourself any higher than anyone else. Snob. Now, how far do you have to stick your face up someone’ butt to see their uvula? Go try it and leave me alone. And watchout for aggressive turds while you are in there.

  64. #64 NJ
    February 22, 2011

    David Andrews @ 50:

    ‘Dr.’ ‘Smart’ is most likely a doctor of nothing!

    QFT.

    DS @ 63:

    {high pitched buzzing noise analogous to mosquito}

    The whole post drips of failed attempts to compensate for personal feelings of inferiority. The same poster loaded up on creationist nonsense over at Greg Laden’s place.

    But, I won’t discount the possibility of a pretty good Poe…

  65. #65 Everbleed
    February 22, 2011

    Kudos to Ryan @ post #6

    Oh my FN gawd. So Ryan and Everbleed are the only fuckin’ people who noticed the millisecond shot of RI on a major national network TV show.

    Seriously, why is this news not being noticed.

    God damn it Orac, stop saving people’s lives for a minute and notice what happened.

  66. #66 Gray Falcon
    February 22, 2011

    So, one who calls himself “Doctor Smart”, care to explain a few things? Such as why it isn’t arrogant to call yourself “Doctor Smart”, or why you think the Tower of Babel was built by a socialist society. Or why you can’t accept that charity to the poor and needy was, in fact, written into God’s law? Or why we should trust your advice on cancer, other than because you think you’re brilliant? Any reasons?

    You’ve exalted yourself above God, and have been humbled beneath the dirt. Give it up, man.

  67. #67 Jarred C
    February 22, 2011

    Everbleed, my fiance and I both noticed it, but we didn’t comment here about it. So did Salty Current on Orac’s Garry Trudeau post.

  68. #68 Snerd
    February 23, 2011

    ‘Dr Smart’, you are mentally ill. Seek help.

  69. #69 novalox
    February 23, 2011

    @63

    That whole post was so laughably bad, I’d almost think it was a Poe.

    @68

    Nah, he/she/it’s just having a temper tantrum since almost everyone has shot him and his ideas down.

  70. #70 Phila
    February 23, 2011

    That whole post was so laughably bad, I’d almost think it was a Poe.

    I’d bet the farm on it. It’s paint-by-numbers trolling by someone who’s just trying to get a rise out of people (and, unfortunately, succeeding).

  71. #71 NZ Sceptic
    February 23, 2011

    Why can’t we cure cancer? Well, we can’t predict earthquakes either! We do our best, and we try to remain rational but nature is always bigger than we are. New Zealand is a small country with 4 million population. http://www.nzherald.co.nz/

  72. #72 Everbleed
    February 23, 2011

    Jarred C…

    I posted on the same night on Orac’s latest post just after the airing here on the west coast. After work today I will see if a tape is available online and post a link. I believe the “flash” of RI was of just one (or even under a) second, but it gives some evidence to the fact that either Dr. Nancy or a Producer of the show is paying attention. In Orac’s career he is finally nearing 10 million hits. Dr. Nancy has 10 million viewers in a day.

    Apparently four people so far have noticed. One would think others here would be interested. Of course I don’t have a clue if Orac has made it on the news one hundred times before. Hell, I’ve never run into a single person who reads Orac. So I got excited.

    Maybe if we let PZ know, he’ll put it on Pharyngula. We know he likes Orac. Be pretty sad to have PZ get the credit for noticing.

  73. #73 sciencelizard
    February 23, 2011

    On the plus side, as my generation grows up, talk of a ‘failed war on cancer’ will dissipate. Why?
    1) maybe *just maybe* people will grow up with a better understanding of cancer as many diseases
    2) People ever listened to anything nixon said? ;-)
    3) We are totally primed for exceptionally low expectations for what ‘succeeding’ at a war means in a post Iraq/Afghanistan conflict era.

  74. #74 suji george
    February 23, 2011

    The fact that so many factors can contribute to cancer and there for it is difficult to have targeted approach to treat cancer.

  75. #75 suji george
    February 23, 2011

    The fact that so many factors contribute to cancer and there for it is difficult to have a targeted approach to treat cancer.

  76. #76 phisrow
    February 24, 2011

    This reminds me of a favorite(but not original to me, alas) retort to “If we can put a man on the moon…” related nonsense:

    “If we can put a man on the moon, why can’t we shoot people for Apollo-related non sequiturs?”

  77. #77 Calli Arcale
    February 24, 2011

    I’m watching NASA TV right now, as the crew of STS-133 boards Discovery for her final mission into the deepest deep. The thought that keeps going through my mind, knowing that Constellation has been canceled, is this:

    If we can put a man on the moon, why don’t we?

    It’s rhetorical; I know the answer. It’s because we don’t care enough, collectively. Fortunately, that is not true of cancer, and though we’re not putting more boots on the Moon, we are exploring the biology and treatment of cancer, and I am confident that some cancers which are incurable now will have treatments by the time I die. This is because unlike a Moon mission, cancer treatment is enormously profitable, and also something nearly everybody has a personal stake in. So we do care, and consequently the money is there to do the work.

  78. #78 prn
    February 25, 2011

    Multifactorial cancer battles with multicomponent cocktails, including use of biomarkers, genomics and various inhibitors or modifiers, have already begun with varying degrees of coverage of the possible mechanisms. Presently it takes so much attention to detail, it is a research project or a skilled shotgun approach sort of like championship skeet shooting.

    The groups trying to treat the most biomarkers or pathways with large amounts of “something” have to use mostly non-or low toxicity components because most human bodies are typically struggling to sustain (quality of) life with only 2-4 toxic components.

    Sort of like Neil landing the Eagle on the moon, flying by the seat of his pants with crude instrumentation, for a soft landing. Too many mistakes, and one crashes into eternal silence. Land softly, and all the nut jobs start saying you really didn’t do it.

  79. #79 David N. Andrews M. Ed., C. P. S. E.
    February 26, 2011

    “Go do a colonoscopy with your face.”

    How’s fuck off sound?

    “Just becuase you cheated you way through school and got a bunch of fancy letters behind your name, give you no right to think of yourself any higher than anyone else.”

    Um – I worked my way through university. A real one. Not Google U., like you obviously did!

    “Snob.”

    Loser.

    “Now, how far do you have to stick your face up someone’ butt to see their uvula?”

    DFKDFC…

    “Go try it and leave me alone.”

    When you leave us the fuck alone, we’ll respond in kind. Otherwise, deal with having set yourself up as a whippin’ post.

    “And watchout for aggressive turds while you are in there.”

    Which ones? The likes of you?

    ———————————————————

    Seems like I hit a nerve with ‘Dr.’ ‘Smart’ …

    Good.

    Not much sympathy for the twat.

  80. #80 hello
    June 5, 2011

    There is a cure for cancer, discovered a few years back actually. It’s called DCA, or Dichloroacetic acid. Google it.
    And why we don’t use it? It is more profitable to treat instead of cure. Also, the drug cannot be patented.

  81. #81 Chris
    June 5, 2011

    Dear Necromancer, DCA has been discussed multiple times on this blog. You should try actually using the little search box on the upper left hand side of this page, and also visiting the most recent page where it is the main topic:
    http://scienceblogs.com/insolence/2011/05/the_dca_zombie_arises_again.php

  82. #82 Viktor
    November 21, 2011

    If you dont want to get Cancer ….move to the Island of Okinawa !!!!! Thats it !! Lets be honest . People who have long lives are thick skined ,relax people who can take a joke and dont care mach for mony !! Just my opinion.

  83. #83 Chris
    November 21, 2011

    [citation needed]

    (oh, and putting the url of someone else’s blog in the “URL” box is really lame)

  84. #84 Debra
    February 17, 2012

    Still why can’t we even get better treatment…seams we still have the same old poison for treat. I’ve been told there is too much money in cancer treat to cure it???

  85. #85 Chris
    February 17, 2012

    Debra, perhaps you should actually read the article. And some of the more recent ones by Orac. Since he is a cancer surgeon he has written many articles on the subject, including some very moving bits about his family members’ suffering.

  86. #86 Antaeus Feldspar
    February 17, 2012

    Exactly, Debra! That’s why no one would ever try to cure smallpox – it’s way too profitable to treat smallpox to ever do anything like trying to prevent it, let alone eradicating it.

    OH WAIT.

  87. #87 Lawrence
    February 17, 2012

    @Debra – we are getting better treatments. Treatments today cover a wider variety of cancers, with better odds of success than even a few years ago.

    Since Cancer just isn’t one disease, there won’t be just one cure (or treatment for that matter).

    In today’s world, do you realize the amount of money an individual or corporation would make if they did find the cure for Cancer?

  88. #88 Chris
    February 17, 2012

    I still think Debra should read this blog before commenting. If she has an open mind she might actually learn something.

  89. #89 helpfindacure
    March 16, 2012

    CHECK OUT THIS RESEARCH GROUP OUT OF THE UNIVERSITY OF WASHINGTON … RESEARCH YOU COULD HELP WITH IF YOU HAVE A COMPUTER http://boinc.bakerlab.org/rosetta

    http://fold.it/portal/

    from Stanford University

    http://folding.stanford.edu/English/FAQ-PS3#ntoc3

    http://folding.stanford.edu/

    http://boinc.bakerlab.org/rosetta/team_display.php?teamid=6986

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