
A Pointless Cancer ‘Moonshot’ - BGyss
http://www.nytimes.com/2016/05/27/opinion/obamas-pointless-cancer-moonshot.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region&region=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region
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openasocket
It is entirely possible that we can completely cure cancer. Not just a
treatment, but actually prevent anyone from ever getting cancer in the first
place. It would be super duper difficult, but we know it is possible because
of the naked mole rat. Naked mole rats are essentially immune to cancer (I say
essentially because this February scientists dicovered two individuals that
had cancer, the only two documented cases). It is thus possible that genetic
therapy could create a population of humans with no (or almost no) incidence
of cancer.

~~~
ams6110
Ok I'll state the obvious: people are not rats.

~~~
openasocket
Of course, but if it's possible in one mammal, there's no real reason why it
shouldn't be possible in another. I highly doubt that our vulnerability to
cancer is somehow intrinsic to what makes us human.

This is obviously far off, but genetic modification opens up a whole new world
of possibilities.

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yaakov34
I am going to go against the grain of the usual sympathetic responses to this
type of articles, and I am going to say that this is a case of pernicious and
pointless casuistry. Apparently, this now passes for some kind of deep thought
on the human condition.

Well of course any medical treatment for anything just leads to more medical
treatment in the future; that's not a profound statement, not as long as
people are mortal. And it's not limited to cancer. It used to be, in the bad
old days, that some people became almost completely bedridden as their joints
gave out, and then either died early or wished they did; now we have arthritis
medications and joint replacement surgeries that let many of them (not all,
but very many) enjoy decades of their retirements. Does this lessen the need
for future orthopedic treatment? Obviously not, since it extends their lives
and keeps them on their feet long enough to develop other joint problems. Does
that make orthopedics and rheumatology pointless? As someone who needed the
intervention of rheumatologists, I assure you that it doesn't.

In the case of cancer, nobody believes that one can make people live forever
by curing their cancers; of course, they will live long enough to die of
something, maybe even another cancer. Still, I personally know people in their
70s and 80s who would have been dead and buried 20 years ago if it wasn't for
cancer treatment; and the idea of the "cancer moonshot" is to give the same
chance to a lot more people. I came home today after visiting a very dear
friend whose cancer is, with the current level of medicine, close to
untreatable. Will she live forever if some treatment is developed for it? Well
of course not. Would it be worthwhile to change the several months that she
has left to live into several years? Of course, and yes, it would mean that
she would require more cancer treatment, not less.

We can debate if the "moonshot" model is right for cancer (personally, I think
it has merits), but these pseudo-profound dismissals of medicine are simply
vulgar and annoying.

~~~
TheOtherHobbes
A while ago I was reading a harrowing description of life in the 1930s. One of
the author's memories was the sound of a neighbour in a nearby house screaming
- and screaming, _and screaming_ \- in unbearable pain while dying of cancer.

We've definitely moved on since then. Moonshot or no, anything that helps make
that experience less likely _has_ to be a good thing.

~~~
DrScump
That neighbor's tumor type could still well be incurable, but palliative care
and pain management have improved significantly since then.

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joss82
_We are essentially temporary cell colonies evolved to relay life to the next
generation, and as long as we are human, there will always be another cancer._

That sentence made that great article awesome.

~~~
duncan_bayne
... and also, perhaps inadvertently, explains some of the appeal of
transhumanism.

"as long as we are human" could also be read as "as long as we are built on
legacy hardware" ;-)

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funkysquid
I'm not sure how you get from, "this is a difficult problem that won't be
solved soon", to, "throwing money at this problem is pointless". It seems like
the best way to solve problems is not to give up, but to keep the people who
are trying to fix it well funded.

Does he just want a more dourer PR campaign? I suppose "We probably won't cure
cancer, but, I guess this is better than nothing" would be more realistic.

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reasonattlm
There is a verge that is going to be crossed for cancer soon. The reason that
cancer research and development is a slow, expensive, ugly morass is that 99%
of the people involved are targeting biochemistry peculiar to a very small
number of the thousands of relevant varieties and subtypes of cancer. A year
of lab time is much the same ballpark of cost whatever you happen to be doing,
give or take. So if it takes a thousand distinct cures to defeat cancer, it'll
never get done.

BUT.

There are range of new approaches to cancer that are not particular and
specialized to a very small number of cancers, or that can in principle be
adapted with comparatively little work to target different cancer types from a
common core platform.

This is what will produce meaningful control of cancer: attacking the
commonalities present in many or all cancer types.

The best and most promising approach here is interdiction of telomere
lengthening. All cancers must lengthen telomeres. They have to. If they can't,
they wither. So block telomerase, block ALT, and cancer goes away. You can
either block these mechanisms globally for a while, long enough to kill the
cancer, but not long enough to kill the patient due to stem cell depletion, or
combine this with any of the targeted delivery mechanisms under development to
turn it off only in cancer tissue.

There are a few labs working on aspects of this, more on the telomerase side (
e.g. [http://www.eurekalert.org/pub_releases/2015-05/cndi-
csa05111...](http://www.eurekalert.org/pub_releases/2015-05/cndi-
csa051115.php) ) than the ALT side, because ALT cancers are only about 10% of
the total, and ALT is still not completely cataloged. ( See: [http://www.the-
scientist.com/?articles.view/articleNo/42444/...](http://www.the-
scientist.com/?articles.view/articleNo/42444/title/Control-ALT--Delete-
Cancer/) )

SO.

It is foolish to talk about cancer as a thing that medical science cannot get
to the bottom of. There are very clear approaches to get to the bottom of
cancer and fix it.

~~~
maxander
Therapies that could reliably cure any cancer are often worthy of research,
but I'd put the expected value of these approaches lower than that of "ugly
morass" standard research.

Reason 1; cancer therapies have to effectively kill cancer cells and not
important non-cancer cells. Cancer therapies that exist today achieve this by
mucking about in mechanisms that are important to cancers and not (or not so
much) to other cells. But cancers are diverse- there may just not _be_
anything that's common to all cancer and not shared by healthy cells. Telomere
regeneration is a nice candidate, but as you noted, its also important to stem
cells- can humans withstand enough damage to their stem cell populations to
make a meaningful difference to difficult cancers? (For that matter, telomere
regeneration is also important to gametes, so telomere-based therapies may
also render the patient infertile.)

Which means we're likely to be stuck dealing with a dozen or hundred-odd
different treatments, each of which targets some eccentricity of a specific
cancer subtype, _but_ -

Reason 2: There are _lots_ of smart people plugging away at this problem,
backed by lots of research money. In addition to being an objectively
important problem for humanity, cancer is also an interesting biological
conundrum and _also_ the most likely cause of death for a bunch of old people
with stratospheric net worths. Even hacking at the problem in bits and pieces,
its not unlikely that cancer will become a completely tractable disease (even
if a golden-bullet "cure" doesn't arrive) within our lifetimes.

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thetruthseeker1
I am not cynical about humans living longer etc as this article seems to
claim. However I am cynical about the approach of calling everything a
moonshot. For Moonshot, there were clearly measure-able goals before you were
able to land on moon in say 10 yrs. Now in Cancer research or any research is
not executed in the same paradigm as planning a voyage to moon.

Yeah my point maybe a minor one, but I dislike the dumbing down of things or
appealing to past glory.

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ck2
_the better we get at keeping people alive, the older they will get_

I'm generally not a fan of people either but there are kids with cancer that I
feel should get some time to enjoy their lives outside of dying in a hospital
if at all possible, someday.

Besides, there are still many, many millions of people in the USA who can't
get insurance so even if there was a "cure" or life extension, they couldn't
afford it. Don't worry, they will die for you because emergency rooms don't
treat cancer. For example if I got cancer, I'd be screwed.

~~~
ams6110
Why don't you have insurance? It's mandatory now.

~~~
ubernostrum
It's not mandatory in the US; you just pay a penalty the next time you file
your taxes if you went too long without insurance.

Spoiler: the penalty is far less than the cost of having insurance, which
means it's still cheaper to just be uninsured (so long as you stay relatively
healthy) and pay up on your tax return.

~~~
ams6110
No it is mandatory, hence the penalty for not having it.

~~~
waterphone
It effectively is a fine, but it's not a criminal penalty, so it's kind of
like an opt-out fee that's significantly cheaper than most of the supposedly
affordable plans. (Which are extremely expensive even at the low-end where
they're completely useless with $10,000 deductibles.)

~~~
zaroth
I think you are dramatically underestimating the cost of getting "actually
sick" if you think a $10,000 annual out-of-pocket maximum is "completely
useless". Not to put too fine a point on it, but $10k could be a mere couple
hours of care in the ER.

Also, there are cost-sharing reductions which would reduce that $10k
significantly depending on your income.

If you do find yourself in need of actual medical care but without any
insurance, the workaround is simply you will have to move to a new state,
which will allow you to sign up outside of open enrollment periods.

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MistahKoala
Well that was a lot more pessimistically fatalist than I was anticipating.

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xupybd
With the rise of antibiotic resistance, cancer will become less relevant.

~~~
refurb
I think you're way overestimating the impact of antibitoic resistance.

~~~
rue
Antibiotic resistance is the biggest health threat we face.

~~~
refurb
Maybe, but we don't even know if it will happen (mass drug resistant
infections).

I'd say cancer is worse!

