The Cure Who Cried Wolf: Cancer and the Quest for Honesty in Reporting
The Cure for Cancer is really around the corner
The problem with the Cure for Cancer is that it gets seriously announced every 5–10 years. The more often a grand prophecy doesn’t come true, the more we ignore it. The problem with previous pronouncements, such as after Halstead’s radical mastectomy in the early 1880s or with the discovery of chemotherapy in the 1940s, is that they occurred in a black box: We didn’t know anything about how cancers worked. We thought they were like typical infections, such as tuberculosis, and all they needed was the right key to unlock them. Because we now know how cancers work, and because our theories for how to cure it are getting validated with an increasing frequency, the road map to the cure is at hand.
“I’m cured” will be gradually be replaced with, “I’m taking something for my cancer”
One problem at the outset is the words “cure” and “cancer”. Cancer is not quite a disease. Diseases are loosely defined as disorders or abnormal conditions, but cancers occur when your cells’ normal functions, such as reproduction, work too well, or as they say in medicine, in an unregulated manner. Cures to other diseases simply attack the disorder, similar to how an army would attack an invader. With cancer, though, it’s more like the TV show Battlestar Galactica where you can’t tell the invaders from the humans.
Mastectomies aren’t “The Cure” because it’s like destroying a wing of the spaceship that was infected, without realizing that cylons (the human-looking cyborgs in Battlestar) are still in other parts of the spaceship. Years after the mastectomy, the cancers can return — or metastasize — in other organs.
And chemotherapies aren’t “The Cure” because that’s like releasing a poison throughout the whole spaceship, killing all sorts of unregulated behavior in the hope that it kills all the cylons in the process. But this doesn’t account for the cylons adapting, or in many cases, simply surviving the poison.
So the problem with the word “cure” is that you don’t ever get rid of the underlying conditions for cancer. All your cells contain the genes to become cancerous, it’s just a matter of time before they accumulate enough mutations to get there. Technically, every healthy person’s symptoms are equivalent to someone whose cancer is in remission.
Compared to the torture of treatment, cancer remission is the cure. Survivors continue to say “I’m cured” or “I beat it” simply because to say something else, such as “My cancer is being treated” is too worrisome. It sounds too much like you still have an albatross around your neck. Once less and less people die of cancer, though, survivors will say, “I’m taking something for my cancer” similar to how people today say, “I’m taking something for my diabetes”.
Oncogenetic testing will follow in the footsteps of retail genetic testing like 23andMe
The cure for cancer isn’t a silver bullet, at least not for the foreseeable future. Rather it’s a collection of knowledge about how cells misbehave, and a collection of techniques on how to stop them from misbehaving. That’s it. Or more technically: The cure for cancer is genetics and targeted therapies. Through the field of “oncogenetics” we are profiling every cancer gene and how it makes cells behave badly. Cancer screening will eventually be similar to the $99 personal genetic sequencing service from 23andMe. We will take biopsies of our tumors, send them to a lab to be sequenced, and everybody will have their own personal onconome emailed back.
Targeted therapies detect signatures of specific oncogenes and disable cells that express them. For example, some oncogenes help cells move around with little arms, which have a peculiar protein structure. If you can design a therapy to just target those arms and disable the attached cell, that person is cured.
There are on the level of 30–60 other features, like these arms, that when abused, make a cell cancerous. For example, PD-L1 is a protein receptor that normally allows cells to avoid being attacked by the immune system. When used improperly, those cells become cancerous. Keytruda, which is the drug that cured Jimmy Carter’s cancer, binds to this receptor.
The success of targeted therapies has been mounting. The first one, Herceptin, was introduced in the late 1990s. By 2015 it was on The World Health Organization’s List of Essential Medicines. Patients can get tested for the oncogene HER2, get a prescription for Herceptin along with chemotherapy, and have a 50–50 chance to “beat” their cancer. Such success rates were unheard of ten years ago.
Groundbreaking cancer drugs like Herceptin and Keytruda used to come in like a trickle, once every 5–10 years. Now, it’s starting to pour. The number of drugs for targeted therapies in 2015 that were in FDA approval were on the order of 10–20, whereas the year before it was under 10, and before that just a few every year. But even without looking at FDA approvals, just one visit to clinicaltrials.gov shows a mountain of Phase II clinical trials available for cancer patients. Phase I is when a new drug is tested for dosage safety. Phase II is when the drug is ready for testing on a larger group of patients. This flood of Phase II trials will soon lead to a flood of FDA-approved drugs.
Oncologists have taken notice, and clinical trials are now one of the four standard pillars for cancer treatment, the other three being chemotherapy, radiation, and surgery. Back in the 1990s, access to clinical trials was nearly impossible. Cancer patients had to lobby in courts, on the grounds of compassion, for access to Phase I trials of Herceptin. Only a few prevailed. Today, oncologists are so optimistic that no such lobbying is needed. You just ask.
In 2015, we had cancer show up in our family. The news was crushing, and in order to make sense of it all, I read Siddhartha Mukherjee’s 592-page tome, The Emperor of All Maladies: A Biography of Cancer. Based on that book, and based on my talks with cancer researchers over six months, I’m a lot more optimistic. The more I share my thoughts with those closer to the labs, the more targeted therapies seem like the answer. Everybody is signing up for clinical trials.
I originally wrote this piece before Jimmy Carter’s miraculous cure with Keytruda in December of 2015. The critical media, including NPR, slammed the mainstream media who touted Carter’s so-called “cure”. The problem, they argued, is headlines such as “Carter’s Cancer Gone” provide false hope. However, upon examining the supposed mainstream articles that tout Carter’s success, I found that they do in fact include qualifying notes about the nature of remission. In other words, the critical media is engaging in a bit of straw man. The more accurate headline for Carter’s success would say his cancer has been treated. But given the extent of Carter’s turnaround, from Stage 4, and the historical context that just a few years ago, such a turnaround was next to impossible, a headline that says “cancer gone” accompanied with medical qualifications in the article is just fine.
The critical media has been burned too much by false promises, that they may never come out and fully endorse cure theory. The result is that stories like Carter’s are buried quickly. A cancer diagnosis still arrives like a death sentence, and the clinical trial option is still a bit obscure unless you have the right doctors who volunteer that information, or you seek it out yourself. Is there a danger, then, in keeping the “cure” in the closet?