ADVERTISEMENT

Are we fighting cancer the right way?

lucas80

HB King
Gold Member
Jan 30, 2008
124,828
189,357
113
I happened to be up at 5 am Sunday listening to the BBC on my local NPR station WSUI, and there was an extremely interesting segment on about cancer research allocation. One of the segments featured Dr. Heidi Williams, an economist from MIT who has studied clinical trials for cancer drugs. One of the immediate things she found was that late stage drug research is double what is studied for prevention or early stages of cancer. There are many conclusions to draw, but one cannot help to wonder about the incentives of research. Williams believes she shows that short term successes can be more quickly proven because for late stage cancer the trial periods are shorter. That means drugs can be developed and marketed much more quickly than a study for a preventative plan, or a drug that attacks a cancer early on and then the patient lives for 20 years or so. That is not a bad thing against the researcher, it merely suggests companies and researchers are incentivized to go after the short term. Going after the long term does not draw an immediate return on investment.
This should be the original BBC program clip.
http://www.bbc.co.uk/programmes/p03hhfgl
 
I happened to be up at 5 am Sunday listening to the BBC on my local NPR station WSUI, and there was an extremely interesting segment on about cancer research allocation. One of the segments featured Dr. Heidi Williams, an economist from MIT who has studied clinical trials for cancer drugs. One of the immediate things she found was that late stage drug research is double what is studied for prevention or early stages of cancer. There are many conclusions to draw, but one cannot help to wonder about the incentives of research. Williams believes she shows that short term successes can be more quickly proven because for late stage cancer the trial periods are shorter. That means drugs can be developed and marketed much more quickly than a study for a preventative plan, or a drug that attacks a cancer early on and then the patient lives for 20 years or so. That is not a bad thing against the researcher, it merely suggests companies and researchers are incentivized to go after the short term. Going after the long term does not draw an immediate return on investment.
This should be the original BBC program clip.
http://www.bbc.co.uk/programmes/p03hhfgl
Have to balance helping those that have it with helping those that don't have it yet
 
I happened to be up at 5 am Sunday listening to the BBC on my local NPR station WSUI, and there was an extremely interesting segment on about cancer research allocation. One of the segments featured Dr. Heidi Williams, an economist from MIT who has studied clinical trials for cancer drugs. One of the immediate things she found was that late stage drug research is double what is studied for prevention or early stages of cancer. There are many conclusions to draw, but one cannot help to wonder about the incentives of research. Williams believes she shows that short term successes can be more quickly proven because for late stage cancer the trial periods are shorter. That means drugs can be developed and marketed much more quickly than a study for a preventative plan, or a drug that attacks a cancer early on and then the patient lives for 20 years or so. That is not a bad thing against the researcher, it merely suggests companies and researchers are incentivized to go after the short term. Going after the long term does not draw an immediate return on investment.
This should be the original BBC program clip.
http://www.bbc.co.uk/programmes/p03hhfgl

This is a perfect example of where the 'free market' fails, at least in the way our capitalist system runs (on quarterly earnings and annual returns). To develop preventive drugs and perform 5 year to 15 year followup and prove efficacy is well beyond the financial capabilities of most drug companies, and this kills the ROI for those types of therapies/drugs. Especially if a company can run 10 years worth of followup only to find the method doesn't work and scrap the 10 years of study along with many tens of billions of dollars.

This is why it makes much more sense for the companies to take on the types of therapy which yield returns in 5 years or less (e.g. the drug development can take several years, but with short-term patient followup studies, they can prove efficacy often in a year or less). Even then, it can still take nearly a decade to get a drug through the approvals processes and to market.

The types of studies on preventive care or preventive/early stage drugs is something that governments have the ability to fund over many decades, where different researchers and groups can hand off the successes/failures and slowly build upon groundbreaking solutions.

This isn't intended to 'bag on' companies for not taking this type of research on - they simply do not have the financial resources and the long-term timeframe to wait for their ROI. Let the government work lay that foundation; then farm the manufacturing etc out to the companies. This is pretty much the way vaccines work - government needs to provide incentives to companies to make them because the ROI is not that good, and if a vaccine ends up not working after all the clinical trials (with a fairly low payout for each dose), no drug company is interested.
 
Isn't the structure for long term studies and drug development already there in the form of our public research universities and the many non-profit corporations that exist to find cures? What about institutions like Mayo, Sanford, etc, etc?
 
We need to remember that cancer and heart disease
can be passed on through the family genes. If a father
had serious heart trouble, then he can pass it on to his
children. The same is true with some types of cancer.
 
Isn't the structure for long term studies and drug development already there in the form of our public research universities and the many non-profit corporations that exist to find cures? What about institutions like Mayo, Sanford, etc, etc?

This was my thought as well. ^^ I am interested in this subject, but not terribly well informed about all of the ins and outs of cancer research. So hopefully there can be a "conversation" here without it immediately being wrecked by a political hack(s).
 
Isn't the structure for long term studies and drug development already there in the form of our public research universities and the many non-profit corporations that exist to find cures? What about institutions like Mayo, Sanford, etc, etc?

The public research institute still needs grant funding to run the study, be it from private groups (American cancer society, etc) or through NIH grants from the government, which are exceedingly difficult to obtain. I think only about 10-20% of NIH grant proposals are approved. And studies that are closer to a drug/treatment are more likely to get funding than one that still has a lot of background data and long term follow up data to collect. Much of this is due to the overall underfunding of NIH and the incentive to fund shorter studies.
 
The public research institute still needs grant funding to run the study, be it from private groups (American cancer society, etc) or through NIH grants from the government, which are exceedingly difficult to obtain. I think only about 10-20% of NIH grant proposals are approved. And studies that are closer to a drug/treatment are more likely to get funding than one that still has a lot of background data and long term follow up data to collect. Much of this is due to the overall underfunding of NIH and the incentive to fund shorter studies.

Exactly.
If we continue to play the 'we pay too many taxes' card, then there's no justification to complain that no one is searching for the preventive/early stage solutions for cancer, where there is far more 'bang for the buck'. Should we fight to eliminate government waste and redundancy? Yep. But let's not dump everything into one bucket regarding our taxes and what we are spending that tax money on.
 
The public research institute still needs grant funding to run the study, be it from private groups (American cancer society, etc) or through NIH grants from the government, which are exceedingly difficult to obtain. I think only about 10-20% of NIH grant proposals are approved. And studies that are closer to a drug/treatment are more likely to get funding than one that still has a lot of background data and long term follow up data to collect. Much of this is due to the overall underfunding of NIH and the incentive to fund shorter studies.
Junior faculty at research universities are also under enormous pressure to produce publishable results early in their careers ("publish or perish"). The tenure/career advancement system tends to incentivize short term over long term results.
 
I happened to be up at 5 am Sunday listening to the BBC on my local NPR station WSUI, and there was an extremely interesting segment on about cancer research allocation. One of the segments featured Dr. Heidi Williams, an economist from MIT who has studied clinical trials for cancer drugs. One of the immediate things she found was that late stage drug research is double what is studied for prevention or early stages of cancer. There are many conclusions to draw, but one cannot help to wonder about the incentives of research. Williams believes she shows that short term successes can be more quickly proven because for late stage cancer the trial periods are shorter. That means drugs can be developed and marketed much more quickly than a study for a preventative plan, or a drug that attacks a cancer early on and then the patient lives for 20 years or so. That is not a bad thing against the researcher, it merely suggests companies and researchers are incentivized to go after the short term. Going after the long term does not draw an immediate return on investment.
This should be the original BBC program clip.
http://www.bbc.co.uk/programmes/p03hhfgl

Sad, but I'm not surprised. Most medical research in the U.S. is done by/for pharmaceutical companies. The economic system often gets in the way of the most fruitful avenues for research and technology development. Adding to the horror is that insurance companies often don't cover the best treatment options because we've centered our values on money rather than health. Try to be born in another universe next time around.
 
  • Like
Reactions: cigaretteman
Is there anybody else in the world trying to fight cancer or is it just us?

I'm sure there are, but we are the wealthiest nation in the world and often have the best facilities in the world.

If we arn't researching up to what we could be and not doing it in a matter that is going to lead to the best results then it's going to hamper results around the world.
 
  • Like
Reactions: cigaretteman
This is a perfect example of where the 'free market' fails, at least in the way our capitalist system runs (on quarterly earnings and annual returns). To develop preventive drugs and perform 5 year to 15 year followup and prove efficacy is well beyond the financial capabilities of most drug companies, and this kills the ROI for those types of therapies/drugs. Especially if a company can run 10 years worth of followup only to find the method doesn't work and scrap the 10 years of study along with many tens of billions of dollars.

This is why it makes much more sense for the companies to take on the types of therapy which yield returns in 5 years or less (e.g. the drug development can take several years, but with short-term patient followup studies, they can prove efficacy often in a year or less). Even then, it can still take nearly a decade to get a drug through the approvals processes and to market.

The types of studies on preventive care or preventive/early stage drugs is something that governments have the ability to fund over many decades, where different researchers and groups can hand off the successes/failures and slowly build upon groundbreaking solutions.

This isn't intended to 'bag on' companies for not taking this type of research on - they simply do not have the financial resources and the long-term timeframe to wait for their ROI. Let the government work lay that foundation; then farm the manufacturing etc out to the companies. This is pretty much the way vaccines work - government needs to provide incentives to companies to make them because the ROI is not that good, and if a vaccine ends up not working after all the clinical trials (with a fairly low payout for each dose), no drug company is interested.
That's interesting as I have an aquaintance who runs the University of Colorado's cancer research dept. His comment was that it's easier to get funded for aggressive cancers because of the quicker results (as you implied). He has 2 immuno-therapy patents for melanoma and osteosarcoma.

The interesting thing to me was that he said where it gets "dirty" is competing w/ other companies for facilities to do the research. Very competitive.

He's a pretty funny guy as he's particularly interested in gut bacteria right now and all the potential of fecal transplants. Anyway, the funny part is that he says you won't see much done about it in the near future because that will be a tough pill for patients to swallow (poop joke).
 
  • Like
Reactions: Joes Place
That's interesting as I have an aquaintance who runs the University of Colorado's cancer research dept. His comment was that it's easier to get funded for aggressive cancers because of the quicker results (as you implied). He has 2 immuno-therapy patents for melanoma and osteosarcoma.

The interesting thing to me was that he said where it gets "dirty" is competing w/ other companies for facilities to do the research. Very competitive.

He's a pretty funny guy as he's particularly interested in gut bacteria right now and all the potential of fecal transplants. Anyway, the funny part is that he says you won't see much done about it in the near future because that will be a tough pill for patients to swallow (poop joke).

Yep. You can see results on aggressive stuff rather quickly, because a 2 or 3 month benefit to lifespan shows up easily when there is a benefit (although it's arguable whether that type of benefit is truly beneficial to a patient already past retirement age).

To run the studies and demonstrate benefits for something like prostate cancer, where it can remain latent and non-threatening for many many years before it becomes aggressive, can require 10 or 15 years of followup before you can show any benefit. This is why the 'handoff' to Biden to 'take on cancer' is mostly a dog and pony show - it will still require many years of research to prove anything out, no matter how much we spend this particular year. We should fund these types of studies and work, but be as efficient as possible in the approach.

Kudos on the poop joke!
 
Yep. You can see results on aggressive stuff rather quickly, because a 2 or 3 month benefit to lifespan shows up easily when there is a benefit (although it's arguable whether that type of benefit is truly beneficial to a patient already past retirement age).

To run the studies and demonstrate benefits for something like prostate cancer, where it can remain latent and non-threatening for many many years before it becomes aggressive, can require 10 or 15 years of followup before you can show any benefit. This is why the 'handoff' to Biden to 'take on cancer' is mostly a dog and pony show - it will still require many years of research to prove anything out, no matter how much we spend this particular year. We should fund these types of studies and work, but be as efficient as possible in the approach.

Kudos on the poop joke!
Have you seen the Burzynski (sp) documentary on medullablastoma? Any take on it?
 
I'm sure there are, but we are the wealthiest nation in the world and often have the best facilities in the world.

If we arn't researching up to what we could be and not doing it in a matter that is going to lead to the best results then it's going to hamper results around the world.

Yeah, but everybody keeps saying that the socialists have all the answers for healthcare. So, why isn't Denmark kicking our asses in the race to cure cancer?
 

Consider me skeptical.

From the title, I agree that the Cancer treatment business IS a business, but that doesn't mean there's a giant conspiracy for mainstream therapies (e.g. radiation, chemo, etc).

But just visiting his website and FAQs, some things do not pass the smell test.

They allegedly have been performing clinical trials on their antineoplastons since 1993; they ONLY list 'Phase II' trials as completed, and I see no fully randomized Phase III results.

His FAQ lists a SINGLE Phase II study with ONLY 10 patients. That's really really hard to take seriously.

Phase I studies are safety only studies (first, do no harm), and are on small groups of patients.
Phase II studies are small efficacy/dosage related studies and are NOT randomized.
Phase III studies are fully randomize, and are far more challenging to 'pass'. (e.g. Medtronic just had a device in development for drug-resistant high blood pressure therapy which had gone thru several Phase II successful studies; they just failed the Phase III a couple years ago, which means going back to square one).

So, at first glance, he sounds like a snake oil salesman, using this documentary as a propaganda piece to justify his therapy options.

And...just looking at a Google link now, it appears my skepticism may be well-founded...

http://www.csicop.org/si/show/stanislaw_burzynski_four_decades_of_an_unproven_cancer_cure/

After nearly forty years, it is still not entirely clear exactly what Burzynski originally isolated, but it is clear that antineoplastons almost certainly do not have significant anticancer activity. Excellent detailed summaries of the state of the evidence have been provided by Saul Green (2001; 1992) and, more recently, on the American Cancer Society (2012) and National Cancer Institute (2013a; 2013b) websites. In brief, based on his hypothesis that a naturally occurring biochemical system in the body, distinct from the immune system, could “correct” cancer cells by means of “special chemicals that reprogram misdirected cells,” Burzynski used gel filtration to separate blood and urine fractions and test them in cell culture for anticancer activity. Of his original thirty-nine fractions, today Burzynski treats patients mainly with AS-2.1 (also known as Astugenal or Fengenal) and A-10 (also known as Atengenal or Cengenal). As Saul Green (2001; 1992) and others (Antineoplaston Anomaly 1998) have reported, AS-2.1 is the sodium salt of phenylacetic acid (PA), a potentially toxic chemical produced by normal metabolism and detoxified in the liver to phenylacetylglutamine (PAG). To boil ANP chemistry down to its essence, AS-2.1 is primarily a mixture of PA and PAG, and AS-10 is primarily PA. Of note, PA had been studied as a potential anticancer agent years before Burzynski discovered it (Sandler and Close 1959) and, although it has been studied intermittently for fifty years, it has shown little promise against brain tumors (Chang et al. 1999).

Consistent with what is known, the National Cancer Institute (NCI) characterized the concentrations of ANPs required to show antitumor effects in cell culture or animal studies as “excessively high” and reflecting a “lack of activity” (NCI 2013a), concluding very generously that the evidence that ANPs have significant anticancer activity is “inconclusive.” In 1999 the Mayo Clinic published a phase 2 clinical trial of ANPs versus recurrent glioma (Buckner et al. 1999). Other investigators have had difficulty replicating Burzynski’s results, including the NCI, Sigma-Tau Pharmaceuticals, and the Japanese National Cancer Institute (Green 2001; 1992). The one exception is Hideaki Tsuda, a Japanese anesthesiologist at Kurume University, who claims to have observed remarkable results in a randomized clinical trial adding ANPs to chemotherapy infused directly into the hepatic artery to treat liver metastases from colorectal cancer. Indeed, Dr. Tsuda appeared in the most recent Burzynski documentary touting impressive results from this clinical trial. Unfortunately, at this writing, these results remain unpublished, and Tsuda’s previously published ANP work is not impressive. Amusingly, Eric Merola sent out a complaint on social media lamenting that the Lancet Oncologyrejected Dr. Tsuda’s manuscript, ascribing the rejection to a Big Pharma conspiracy to suppress ANPs (Gorski 2013c).
 
Yeah, but everybody keeps saying that the socialists have all the answers for healthcare. So, why isn't Denmark kicking our asses in the race to cure cancer?

No one has all the answers. However socialized medicine is producing better results.

As for why Denmark isn't kicking our asses in the race to cure cancer, because they are a small country and we have more then 55 times as many people and nearly 60 times as much money.
 
This is a perfect example of where the 'free market' fails, at least in the way our capitalist system runs (on quarterly earnings and annual returns). To develop preventive drugs and perform 5 year to 15 year followup and prove efficacy is well beyond the financial capabilities of most drug companies, and this kills the ROI for those types of therapies/drugs. Especially if a company can run 10 years worth of followup only to find the method doesn't work and scrap the 10 years of study along with many tens of billions of dollars.

This is why it makes much more sense for the companies to take on the types of therapy which yield returns in 5 years or less (e.g. the drug development can take several years, but with short-term patient followup studies, they can prove efficacy often in a year or less). Even then, it can still take nearly a decade to get a drug through the approvals processes and to market.

The types of studies on preventive care or preventive/early stage drugs is something that governments have the ability to fund over many decades, where different researchers and groups can hand off the successes/failures and slowly build upon groundbreaking solutions.

This isn't intended to 'bag on' companies for not taking this type of research on - they simply do not have the financial resources and the long-term timeframe to wait for their ROI. Let the government work lay that foundation; then farm the manufacturing etc out to the companies. This is pretty much the way vaccines work - government needs to provide incentives to companies to make them because the ROI is not that good, and if a vaccine ends up not working after all the clinical trials (with a fairly low payout for each dose), no drug company is interested.
This was well stated. With a 20 year patent life for the chemical compounds, filed prior to any real research effort, the companies would see little to zero ROI on something that would take this much time to pass the scrutiny of the FDA. My understanding of cancer research is pretty limited, but I recall hearing that efficacy is not the big challenge with cancer drugs. They can find treatments that are efficacious, but those treatments have the unfortunate side effect of killing the patient. In general, not easy targets to pursue.
 
Consider me skeptical.

From the title, I agree that the Cancer treatment business IS a business, but that doesn't mean there's a giant conspiracy for mainstream therapies (e.g. radiation, chemo, etc).

But just visiting his website and FAQs, some things do not pass the smell test.

They allegedly have been performing clinical trials on their antineoplastons since 1993; they ONLY list 'Phase II' trials as completed, and I see no fully randomized Phase III results.

His FAQ lists a SINGLE Phase II study with ONLY 10 patients. That's really really hard to take seriously.

Phase I studies are safety only studies (first, do no harm), and are on small groups of patients.
Phase II studies are small efficacy/dosage related studies and are NOT randomized.
Phase III studies are fully randomize, and are far more challenging to 'pass'. (e.g. Medtronic just had a device in development for drug-resistant high blood pressure therapy which had gone thru several Phase II successful studies; they just failed the Phase III a couple years ago, which means going back to square one).

So, at first glance, he sounds like a snake oil salesman, using this documentary as a propaganda piece to justify his therapy options.

And...just looking at a Google link now, it appears my skepticism may be well-founded...

http://www.csicop.org/si/show/stanislaw_burzynski_four_decades_of_an_unproven_cancer_cure/

After nearly forty years, it is still not entirely clear exactly what Burzynski originally isolated, but it is clear that antineoplastons almost certainly do not have significant anticancer activity. Excellent detailed summaries of the state of the evidence have been provided by Saul Green (2001; 1992) and, more recently, on the American Cancer Society (2012) and National Cancer Institute (2013a; 2013b) websites. In brief, based on his hypothesis that a naturally occurring biochemical system in the body, distinct from the immune system, could “correct” cancer cells by means of “special chemicals that reprogram misdirected cells,” Burzynski used gel filtration to separate blood and urine fractions and test them in cell culture for anticancer activity. Of his original thirty-nine fractions, today Burzynski treats patients mainly with AS-2.1 (also known as Astugenal or Fengenal) and A-10 (also known as Atengenal or Cengenal). As Saul Green (2001; 1992) and others (Antineoplaston Anomaly 1998) have reported, AS-2.1 is the sodium salt of phenylacetic acid (PA), a potentially toxic chemical produced by normal metabolism and detoxified in the liver to phenylacetylglutamine (PAG). To boil ANP chemistry down to its essence, AS-2.1 is primarily a mixture of PA and PAG, and AS-10 is primarily PA. Of note, PA had been studied as a potential anticancer agent years before Burzynski discovered it (Sandler and Close 1959) and, although it has been studied intermittently for fifty years, it has shown little promise against brain tumors (Chang et al. 1999).

Consistent with what is known, the National Cancer Institute (NCI) characterized the concentrations of ANPs required to show antitumor effects in cell culture or animal studies as “excessively high” and reflecting a “lack of activity” (NCI 2013a), concluding very generously that the evidence that ANPs have significant anticancer activity is “inconclusive.” In 1999 the Mayo Clinic published a phase 2 clinical trial of ANPs versus recurrent glioma (Buckner et al. 1999). Other investigators have had difficulty replicating Burzynski’s results, including the NCI, Sigma-Tau Pharmaceuticals, and the Japanese National Cancer Institute (Green 2001; 1992). The one exception is Hideaki Tsuda, a Japanese anesthesiologist at Kurume University, who claims to have observed remarkable results in a randomized clinical trial adding ANPs to chemotherapy infused directly into the hepatic artery to treat liver metastases from colorectal cancer. Indeed, Dr. Tsuda appeared in the most recent Burzynski documentary touting impressive results from this clinical trial. Unfortunately, at this writing, these results remain unpublished, and Tsuda’s previously published ANP work is not impressive. Amusingly, Eric Merola sent out a complaint on social media lamenting that the Lancet Oncologyrejected Dr. Tsuda’s manuscript, ascribing the rejection to a Big Pharma conspiracy to suppress ANPs (Gorski 2013c).
My reference has more to do w/ the politics of the issue than his clinical results. If you watch it, you will understand.
 
My reference has more to do w/ the politics of the issue than his clinical results. If you watch it, you will understand.


Based on the synopsis of his 'documentary' that I'd posted, it appears that he is the one doing the 'politicizing', instead of completing AND publishing Phase II and Phase III studies of his work. Failing to provide that information (combined with the multiple failures of other groups to replicate his results) implies he is mostly full of s**t.

There is no doubt that cancer treatment, like any other medical treatment, is met by some form of a business, be that a drug company, a hospital, a device company or whatever. But all of those companies comply with the FDA rules to validate their tools/methods and provide unarguable statistical data which shows patient benefit. I can find nothing from anything on his site which meets that basic criteria. That is not a 'political' issue, it is a lack of fundamental and provable science issue. The rules/requirements that FDA lays out are publicly available knowledge, and thousands of companies comply with them to legally market their products/services.

He has very limited (practically zero) credibility to be calling out businesses which actually provide viable cancer treatments for cancer patients, as though they are someone part of a large cabal to fleece patients and the general public. I really doubt his documentary is worth my time to personally view; the compounding nugget that Dr. Oz has 'endorsed' his documentary only further erodes any confidence I have that is it based on facts. Dr Oz is a complete 'zero' on cred when it comes to endorsing anything.
 
ADVERTISEMENT

Latest posts

ADVERTISEMENT