
Cancer's invasion equation - lb72
https://www.newyorker.com/magazine/2017/09/11/cancers-invasion-equation
======
crusso
Honest question: Do many people read these entire New Yorker articles? This is
what happens to me as I'm looking at HN:

From the main page, I open a bunch of tabs that look interesting. On some
types of issues, I also open a tab on the HN discussion.

From there, I just wander through the tabs, reading stories and mostly just
glancing at some of the top comments. My goal when I browse is to learn
something new, and I try to remember that as I'm reading.

When I hit a New Yorker article's tab, I've often half-forgotten the subject
line from HN... maybe it matches the article's title, but I just start reading
regardless. Four or five paragraphs in, I start to think, "What the hell does
all this setup have to do with the article title I clicked on?" Sure, on some
level I know that it probably has something esoteric to do with the main
article. These people must be paid by the word.

A couple paragraphs further and I start turning the mouse wheel to skim ahead.
"Where do they start actually talking about the topic that looked
interesting?" At that point, the New Yorker column has maybe mentioned the
topic in an ancillary way, but oftentimes it's just warming up by bringing in
some personality that they're going to focus on later in relation to the
topic.

I get impatient.

I start scrolling faster, looking for some actual text to sink my mind into.
At this point, I'm very conscious that I have a bunch of other potentially
interesting tabs open in my browser and I've only allocated fifteen minutes or
so before I need to get back to work. I scroll way down, hoping that I'll hit
a paragraph that looks like it's full of information. Maybe I'll find one that
looks interesting, but at that point I also don't have a whole lot of context
to go on. It's like that endlessly long joke that you zone out on and then
when they get to the punchline, maybe it sounds kind of funny, but you weren't
paying attention to all the setup.

I close the tab and wonder how anyone has the time and patience to read these
things. Maybe I'm just a slow reader.

~~~
abpavel
In 1983 a girl in an esoteric dress stood in the rain outside the window of an
appartment of a man named Why Do All TNY Articles Start Like This.

~~~
dukoid
But this one starts with "Over the summer of 2011, the water in Lake Michigan
turned crystal clear. Shafts of angled light lit the lake bed, like
searchlights from a U.F.O.; later, old sunken ships came into view from
above."... oh, I see... nevermind... :)

~~~
randcraw
Yeah. That garden path caused me to elide a paragraph or two, but the rest of
the story was worth my persistence.

------
nonbel
>'“But, over all, would you say the temperature of the water was the key?” I
asked. “The water temperature’s a factor. The water chemistry would also have
contributed.” “So a combination of the temperature and the salinity?” “But
also the calcium content. That’s absolutely important.” I added that to my
list of drivers: “Temperature, salinity, calcium . . .”'

Of course... what is more important to determining the volume of a box? Is the
height a key variable? Sure, but you also need to know the width. Not only
that but also the height.

Surely irrelevant things like the color of the box, or material it is made of,
will also have non-zero correlations with the volume. This is one reason why
the NHST strategy of finding isolated "effects" will never lead to an
"equation for cancer", but is very good at generating large numbers of red
herrings.

You need a model of the process of carcinogenesis, and then to collect data
allowing you to estimate (at least get some decent upper/lower bounds on) the
parameters of the model (mutation rates, division rates, number of cells of
each type, % aberrant cells that get cleared by the immune system, % that
commit apoptosis, etc).

Armitage and Doll started this way back in the 1950s and had quite an effect
on the current cancer paradigm (slow accumulation of genetic errors in a
single cell lineage -> cancer), but since then it has been only a tiny
minority of cancer researchers working on the actual problem.

------
trhway
>Malignancy wasn’t simply about cells spreading; it was also about staying—and
flourishing—once they had done so.

>In the field of oncology, “holistic” has become a patchouli-scented catchall
for untested folk remedies: raspberry-leaf tea and juice cleanses.

why some "juices", or more specifically just plain baking soda in a glass of
drinking water, may actually help - at least for mice it doubled survival
chances here
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834485/figure/...](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834485/figure/F1/)

(it is pretty logical - metastatic invasion is based on acidic dissolution of
ECM (which is collagen mostly) and cancer tumor local environment is acidic as
a result of increased glycolysis and the resulting increased lactate
production, so increasing the pH of the tumor environment naturally impedes
metastatic invasion)

------
epmaybe
This article reminds me of all the things people talk about when they try and
approach cell signaling from a systems approach. Modeling biological systems
as an actual system probably does make sense in the long run. The problem is
that it's far, far harder to study and generate that model.

~~~
randcraw
And it's _extremely_ hard to sell biologists on the idea that your model just
happens to capture sufficient signal to be useful or to accomplish more than a
simple regression line on one or two known-to-be-causal factors. But I do
think the importance of context has become inescapable and any therapeutic
approach that overlooks it will fail to deliver needed efficacy.

Personally, I believe the day of telling the patient, "Sorry, but since none
of the existing drugs will work for you, we can't help further" \-- that era
of medicine is past. Using deep drills through the maze of each patient's
relevant / causal / contextual data, it's nigh time for us to dig deeper and
do better.

