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August 17, 2005
No Such Disease
Are we going to "eliminate the suffering and death due to cancer" by 2015, a goal set by the National Cancer Institute? Unfortunately, I greatly doubt it. Will we speed up the timetable, as Senator Arlen Specter has apparently asked, and do it by 2010? Absolutely not, and here's why.
There's a widespread myth at work here: that there's a disease called cancer. Cancer is actually the end result of what are probably hundreds (thousands?) of different diseases. We have confused ourselves by giving them the same category name - it's like the old-style classification of infections as various "fevers." There are many, many ways that a cell can end up with (and maintain) the deranged growth profile that we think of as cancerous, and it's going to take a lot of different treatments to do anything about them. (See this post and this one for some of the consequences of that for the drug industry.)
Look at the situation today. Every type of tumor has specific front-line treatment regimes, and they don't overlap that much. The best agents for some types of cancer are totally useless against some of the others. It's possible that some of those multikinase inhibitors that I was writing about the other day could have a broader spectrum of activity, but even if that pans out, it's likely that different kinase "fingerprints" will be needed for different varieties of tumor.
Actually, there are two myths at work in Senator Specter's question. The other one is that research can be sped up to any degree desired. Although more money is always nice, thanks, there comes a point where it's not sufficient to buy you better results. In the case of the various cancers, it's for sure that there are many, many important details that we don't even know about yet. And, as usual, a good amount of the things that we do already know are going to turn out to be wrong. Time, money, intelligence, luck, and hard work are all going to have to be tossed into the pot in great quantities, and there are no other ingredients that can substitute for any of those.
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