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30 July 2012

Where's My Cure for Cancer?

Where's My Jetpack is an occasional segment on Life, the Universe & Everything Else, a podcast produced by the Winnipeg Skeptics and the Humanists, Atheists, and Agnostics of Manitoba. This segment aired on 29 July 2012, as part of Episode 27: The Benefits of Religion.

For decades now, scientists have been promising us untold marvels, from jetpacks to hovercars to computers that can think! But where are these wonders of technology? In Where's My Jetpack?, Old Man Newman demands answers, and our crack research team discusses the unforeseen pitfalls and setbacks facing new technology, and tells us exactly how long it will be before science fiction becomes science fact!

In this episode of Where's My Jetpack?, Old Man Newman demands to know "Where's My Cure for Cancer?"

Cancer isn't really one disease. Instead, it's the collective name given to many diseases with the same underlying issue: uncontrolled cell growth. These growths have the potential to "metastasize" or spread to other parts of the body.

Cancer is scary. While there are a host of factors that can increase your risk of developing cancer, it seems that if you live long enough, you'll end up with cancer of one sort or another. It's pretty much an inevitability.

According to the World Health Organization, cancer is the leading cause of death worldwide. This wasn't always the case, of course. A few thousand years ago, rates of cancer were much lower. So what happened? Is it due to the nefarious intervention of pharmaceutical companies or our modern industrial way of life? Although being sedentary can increase the rates in some types of cancer, this uptick in cancer rates seems to be largely because, on average, we live longer than at any time in the past (thanks in large part to science-based medicine and nutrition). Age is an independent risk factor for many cancers. This is most likely due to the fact that the DNA mutations that lead to cancer accumulate over time, and aging compromises the cellular repair mechanisms that prevent cancer.

Modern medicine has made steady progress over the last hundred years, developing preventions, treatments, and cures for one disease after another. These successes led to rampant speculation that a cure for cancer was right around the corner. But while many incremental advances in the state of cancer treatment have been made over the last several decades, and multiple types of cancer (including breast and prostate cancer) are all but curable when caught early, no one breakthrough has resulted in anything that can be reasonably called a universal "cure for cancer".

While many medical experts have pointed out that the early successes of modern medicine may have led us to be overly optimistic and that cancer is a tough nut to crack, conspiracy theorists have interpreted this perceived lack of progress as a sign that the large pharmaceutical companies are either uninterested in curing cancer or are actively suppressing one or more known cures.

There's actually a sizable difference between these two options. Let's tackle the more extreme claim first.

As with just about any expansive conspiracy theory, the idea that Big Pharma is trying to hide cancer cures from the public just doesn't add up. Perhaps the most obvious problem is that cancer researchers and those who work for pharmaceutical companies are people too! They're not robots, blind to the plight of their fellow human beings. They have family members who die of cancer, and, believe it or not, they die of cancer themselves. Even if you think that these people are only in it for the money, what good is a tidy profit if you're not around to spend it?

But even if Big Pharma were almost entirely peopled by human beings who cared nothing for themselves, their families, or the public at large, remember that it only takes one whistleblower, one person to leak the information to the public, and the whole house of cards comes tumbling to the ground. The larger the conspiracy, the more quickly it is likely to collapse. As Benjamin Franklin said, "Three may keep a secret, if two of them are dead."

But now lets turn to the more plausible hypothesis: that Big Pharma isn't terribly interested in curing cancer, because there would be no profit in it.

First of all, I'd like to point out that cancer isn't an infectious disease: it's not something that you can "catch" (although there are some pathogens that significantly increase the risk of contracting certain cancers). While it's possible to completely eliminate an infectious disease from a population (as we have done with polio, for example, or smallpox), an effective cure for cancer wouldn't prevent new cases from cropping up. For this reason, pharmaceutical companies wouldn't have to worry that a successful treatment of the disease would elimate it, hurting their bottom line. They could keep selling the treatment forever!

"But," I hear you say, "what if the drug weren't patentable?" Right, because nobody ever makes money on drugs that are off-patent. Tell that to every company that sells, oh, I don't know, acetylsalicylic acid: Aspirin has been off-patent for 95 years.

I'll grant, for the sake of argument, that many pharmaceutical companies may deem R&D on cancer cures unprofitable, and may decide to spend their research dollars elsewhere. So what? Is it wrong, somehow, for a for-profit corporation to spend its research dollars on those things that seem the most profitable? Perhaps. I actually think that it very well might be. But then I would ask you to recognise that this is not a critique of Big Pharma: it is a critique of capitalism.

In any event, we should expect corporations to spend their money in such a way as to maximize their profits, often with basic science research falling by the wayside. That's one of the reasons that publicly funded science is so important!

Pharmaceutical companies are generally not well liked. This is one of the reasons that these sorts of conspiracy theories exist. But can you imagine what a public relations coup it would be to be, to be known as the company that cured cancer?

Look, there's plenty that's wrong with the pharmaceutical industry. We don't need to waste our time leveling such petty criticism at them when so many real problems are at hand.

Stories of Big Pharma suppressing "the cure" are very common, and tend to gain a lot of traction on social media. An article titled "Scientists cure cancer, but no one takes notice" is the most recent example of this phenomenon. The journalistic irresponsibility doesn't end with the hyperbolic title. When one examines the details of the story, one quickly finds that while dichloroacetate (the chemical discussed in article) may prove a useful addition to the oncologist's toolbox, it is far from a "cure for cancer". At the time the article was published, there was limited evidence that it was effective against some forms of cancer in rodents, but no human trials had been conducted. But—contrary to the claims of the article's author—research continues to be done on DCA. A Big Pharma conspiracy this is not.

And there is light on the horizon. New developments in cancer treatment, big and small, happen all the time. May 2012 saw at least two promising new treatments announced. The first involves genetically modifying a patient's own immune cells. Trials have been conducted in human patients, and the treatment shows great promise in terms of both safety and efficacy. This gene therapy was initially designed to combat both cancer and HIV, but researchers believe that it can even successfully combat arthritis and other non-life threatening diseases.

The second new treatment involves a drug called thioridazine that shows promise in combating cancer stem cells, which seem to be the source of several cancers, including breast cancer and leukemia. According to the study's principal investigator, thioridazine is capable of actually changing cancer stem cells into non-cancerous cells. This research was conducted in-vitro (meaning in cultured cells outside a body), with in-vivo human trials to follow.

The truth is that it is unlikely that we will find any one cure for all cancers any time soon, but science-based medicine has been doing a very respectable job of extending the survival of patients diagnosed with all types of cancer. While the major breakthroughs have been few, incremental progress has been great. While incidences of cancer have increased slightly since 1975 (going from roughly 400 US cases per 100,000 in 1975 to 465 US cases per 100,000 in 2009), cancer mortality has dropped significantly, going from 199 per 100,000 to 173 per 100,000. While statistics vary by type of cancer, mortality was roughly 50% in 1975 and has fallen to about 37% in the United States.

When will we seen an end to cancer? I predict, perhaps optimistically, that within the next forty years most cancers will have ceased to be life-threatening. This is just one of the many reasons that we need to fund scientific research.

Cancer Fact Sheets: World Health Organization | National Cancer Institute (NIH)
Cancer Statistics: National Cancer Institute (NIH)
Discussion of Dichloroacetate: Dr. Steven Novella | Orac
Genetically Modified T Cell Therapy: ScienceDaily
Thioridazine Cancer Treatment: MedicalXpress

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