THCB

Stop Cancer Research?

Now here is a novel idea to save lives and stop the cancer plague; stop trying!  Sounds as crazy to me, as it does to you, but this idea actually may have merit.  Some smart people are saying that we have spent too much money for little gain, thus it is time to give up and by retreating win more battles in the war on cancer, than by charging ahead.

The Cancer Prevention and Research Institute of Texas (CPRIT) is the second largest cancer research agency in the United States, after the National Cancer Institute, controlling a pot of $3 billion dollars, most of which funds basic science and clinical research.  At recent hearings, university scientists and leaders in biotech proposed that CPRIT cut back on the money it is pouring into laboratories.  As Professor John Hagan of the University of Texas proclaimed, “If people didn’t get cancer in the first place, CPRIT would accomplish much of its mission.”

This radical idea was echoed in a scary article in the September issue of Lancet Oncology, entitled “First do no harm: counting the cost of chasing drug efficacy.” This editorial reviewed data, which shows that between 2000 and 2010 many new cancer drugs produced marginal extensions in survival and simultaneously increased risk of treatment associated death and side effects. The Lancet authors emphasized the vital need as we develop new therapies to carefully measure both benefit and harm before FDA approval and for careful post-marketing follow up after drugs are released to the general population.

Now in reality no one is saying that we should shut down cancer research labs and simply hope for the best.  Eventually we will completely cure this disease and basic science, as well as the development of new therapies, is key to that future. Perhaps what we should hear from these words is an idea about a different balance in health and healthcare.

One hundred years ago, the medical model was one of acute disease and trauma.  The major events that threatened life were infection, such as syphilis and TB, childbirth and accidents.  Chronic illness was rare because we did not live long enough, as the average lifespan in the United States in 1900 was 47 years.  Medical science therefore focused on measures to prevent and treat infections, make birth safer and treat injury.  This resulted in the rapid rise in life span to 70 years by 1950.

Then the model of illness changed to that of extended diseases such as heart disease, dementia, diabetes and cancer, and research focused not on preventing these illnesses but on treating the affect of these maladies.  It is a chronic illness approach where large numbers of patients spend the last years of their lives debilitated while receiving increasingly toxic and expensive therapy to draw out functionally limited lives. This has increased survival only six or seven more years.

The alternative model proposed is a modification of the present life – disease cycle, which instead of focusing on deterioration in the last years of life, targets the prevention of disease during healthy youth.  The concept is to achieve high functioning illness free life for the longest possible time and then have the cycle complete with a short end-of-life acute phase focusing on quality.  In other words live a healthy life, to say 90, and then die quickly. Theoretically, this would produce a net longer lifespan and a higher functioning level with less suffering.

The scientists testifying in Texas emphasized the need to spend dollars on true health maintenance, studying at a basic science level as well as in the general population, methods to prevent and delay chronic disease.  We think of good health practices, such as diet, exercise, reduced alcohol and avoiding smoking as core to such an approach, and as such we each have a responsibility for our own bodies, but while critical this approach is too basic.  Sophisticated health practices must be developed, examples of which are the HPV vaccine which by preventing Papillomavirus infection in young people will shortly wipe out cervical cancer, understanding cancer causing genetics or identifying man made chemicals which infest our environment and cause disease.

We must not stop cancer research; the suffering from these diseases requires compassion and a cure.  However, as we assign health priorities it may be wise to realize that man at his base is not a chronically ill creature cursed to live a wretched life of suffering and pain, but rather he possesses a marvelous body which is naturally strong and robust by design, and perhaps our goal should be to keep him that way.

James C. Salwitz, MD is a Medical Oncologist in private practice for 25 years, and a Clinical Professor at Robert Wood Johnson Medical School. He frequently lectures at the Medical School and in the community on topics related to cancer care, Hospice and Palliative Medicine. Dr. Salwitz blogs at Sunrise Rounds in order to help provide an understanding of cancer.

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Ron HammerleAnnePSteveHPeter1Richard Weiberger Recent comment authors
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Ron Hammerle
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Ron Hammerle

Thank you, Jim, for having the courage to write what many have thought but feared to write publicly..

DeterminedMD
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DeterminedMD

I don’t want to “hijack” the thread, but offer this I feel somewhat related to the pending election and what PPACA will do to health care regarding Oncology options if left as is: Neither candidate has the intestinal fortitude to call it as it is, natural selection is partially a player to cancer occuring in our species, so just trying to save all these lives is not helping the course of our species, and I really do not understand this failed argument that medicine has to save every live, irregardless of cost, time, energy, and philosophical point of view. I… Read more »

AnneP
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AnneP

I’m with the people who say they have no use for a “doctor” like you. I do think there are many cases where people are overtreated and harmed, but you’re the reason people clamor for treatment, they think those who are opposed to overtreatment have attitudes like yours (but most of us don’t).

DeterminedMD
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DeterminedMD

yeah, I’m sure people who are so virulently outraged by what I wrote above are so realistic with setting boundaries with health care expenses. Again, pathetic and predictable that noting we cannot deal with death and realistic outcomes brings replies of “no use for a doctor like you” and even question my training backround. You PPACA folks really do deserve the ilk that created PPACA, and I will have no real feelings WHEN the legislation burns such advocates who have buried their heads after the legislation was rammed through a partisan process. Hey, to read this AM the folks who… Read more »

DeterminedMD
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DeterminedMD

Just ask British folks how wonderful and quickly implemented their treatments have been the past 20 years.

Peter1
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Peter1

“The scientists testifying in Texas emphasized the need to spend dollars on true health maintenance, studying at a basic science level as well as in the general population, methods to prevent and delay chronic disease. We think of good health practices, such as diet, exercise, reduced alcohol and avoiding smoking as core to such an approach, and as such we each have a responsibility for our own bodies, but while critical this approach is too basic. Sophisticated health practices must be developed, examples of which are the HPV vaccine which by preventing Papillomavirus infection in young people will shortly wipe… Read more »

DeterminedMD
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DeterminedMD

Preventative care is not profit making. Hey, all of you who demand the business model stay entrenched in health care settings, can’t have it both ways. I don’t know if Peter1 embraces that viewpoint, but a lot here do. And, another point of view to enrage the insightless masses, if you are old enough to have adult children and should one of them be told he/she can’t be hired because the 70 year old guy still there who is less functional with the job responsibilities will sue the company if he is forced out to let a new face into… Read more »

DeterminedMD
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DeterminedMD

And it is actively happening in health care, and anyone who wants to accuse me yet again of insensitivity and violating the hippocratic oath, think about it, doctors are making less money, so putting off retirement, not staying up with CMEs because, hey, they have a lifetime license to practice in their specialty so the rules don’t apply to them regarding license renewals, so they stay at the practice that can’t hire new young up to date docs, so, who gets this wonderful effective care you all clamor for per PPACA?

The proponents really don’t think it through, do they!?

DeterminedMD
Guest
DeterminedMD

Just to show where this culture is headed, I heard on my local news radio this AM a story of how a 70 year old man successfully sued to get over $200K payment for being terminated for his age, when the company hired 2 younger workers, per the story, to replace him. I mean, really, are people going to work to 75, 80 years old and, wait for it folks, I know the word horrifies some, the FINITE population of job opportunity will be diminished just so people can now expect to work for 50plus years. I know, here come… Read more »

SteveH
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SteveH

Then why are you an MD? Assuming that you are of course.

BobbyG
Guest

Copy that.

DeterminedMD
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DeterminedMD

thanks for the validation. Save the whales, nah, don’t have the time or money. But, who does have the money? That doesn’t matter, right out of the Obama/Democrat handbook.

Gotta love people challenge i am a physician for not genuflecting to the “save everyone” dogma. Pathetic and predictable.

Richard Weiberger
Guest

Your remarks are not only insensitive but they seem to be utterly ignorant of our shared rights to life and liberty and the pursuit of happiness. ( Have you read the 14th amendment?) Why a 20 year old is any more (or less) entitled to a pursuit of happiness because of some limitation of the number of paths on that trail is utterly repugnant.

DeterminedMD
Guest
DeterminedMD

People who say the 16 trillion dollar debt is inconsequential, that is not only insensitive, it is dangerous. You people out there who claim resources are infinite, again, what freakin planet do you all congregate on!?

SteveH
Guest
SteveH

Do you advocate reducing green house gas emissions? Taxing carbon? If not, you must think resources are infinite.

DeterminedMD
Guest
DeterminedMD

Taxing carbon, is oxygen too far off the horizon? As ugly are Republicans are with starting wars, Democrats can’t ignore any element to tax. I’ll be the first to note that if the Democrats get control of the Legislative Branch while keeping the rock star at the White House, they will add even more taxes to PPACA. Hell, they’ll try to tax human contact between providers and patients. Are gloves an exception? Again, pathetic, predictable, and new lows for gall. Tax carbon, think ya cute? Do you look at your children every time you preach for more programs to add… Read more »

SteveH
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SteveH

Geez, you’re predictable. Do you ever think about anything or all your opinions simply downloaded pre-formed for your consumption?

DeterminedMD
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DeterminedMD

So many people here just write endless threads comments spouting data, studies, statistics, and other sheer volumes of numbers, well, let’s talk real numbers here, shall we? How many people over the age of 70 diagnosed with a new, first time clinical cancer of sizeable morbidity and mortality have a 5 year lifespan that would meet the average citizen’s definition of reasonable quality of life? Too vague and nondescript a question for those who want quantifiable terms? OK, let’s get to the heart of the inquiry, shall we? How many people with stage 2 or higher primary cancers with mets… Read more »

john
Editor

unspoken here is the lance armstrong scandal, which I think has a lot of people stopping and asking out loud if the cancer research community should be rethinking the way it does business. things have clearly reached a crisis point. a timeout might be a really good idea.

Richard Weisberger
Guest

Be careful about making forecasts while looking in the rear view mirror, that will make your premise obsolete.  What do i mean?  We may be entering a moores law of personalized medicine.  First, Pharamcological  agents going forward should be orders of magnatude more precise over the those that exist today. Second,  delivery systems will also be orders of magnatude more accururate. Third, research and the costs associated therewith will soon be include more open source and thus lower costs methods. In sum, expect the unexpected. 

atlibertytosay
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atlibertytosay

Yes, Yes. I have found myself wondering about this ( as a nurse, and charitable attender of fundraisers everywhere). What if all this money was spent on patient care and prevention? I have increasingly wondered about the incentive for many drug companies to “find a cure”. I am not one of those people saying that the cure is known and they drug companies are sitting on it. But those people actually exist. I do see, that incentives to cure need to increase, and cutting some of the money on researching new drugs for treatments that increase life expectancy by days,… Read more »