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Comment by robbies | Hacker News Reader

> pump already sick people full of poison

I don't think it's unreasonable to ask for explanation/references/proof of what you mean when you say 'poison'. I don't know your particular experiences with chemotherapy, but I hear this soundbite parroted too often without any effort to actually research what chemotherapy is actually trying to accomplish. I'm not saying people shouldn't investigate their recommended treatment plans, but this often unwarranted suspicion of modern cancer treatment techniques is mystifying to me.

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My mother has had cancer twice. My father: twice. My sister: four or five times. My brother: once. My mother's mother died during treatment for cancer. At least three of my mother's sisters have had cancer. I took care of my sister after her first mastectomy.

They do pump cancer patients full of poison. The patients know it. The doctors know it. Maybe I am a little too deep in the weeds here, but I am astonished this assertion is being questioned at all.

I think the gp just doesn't like this liberal usage of the word "poison".

Most medication is "poison" to people who are otherwise healthy. NSAIDs are bad for the stomach, pills for insomnia will make you fat, narcotics will make you fall asleep, epinephrine can stop your heart. We take them because their ill effects aren't as bad as the good they produce.

Cancer chemotherapy is mostly unique because it produces a lot of suffering to someone who appears to be quite healthy. There are other medicines with horrible side effects, but you'll usually have to be obviously sick with something like malaria in order to be treated with one of those.

it goes deeper than that because of the way our bodies metabolize chemicals we often have to pump poisons in to kill something at far greater toxic levels than to kill that thing if it was outside our bodies

Chemotherapy, for most cancers, achieves tumor shrinkage and a temporary extension of life, at the cost of severe life quality degradation. It's a tradeoff that most cancer patients think is worth it. I think that this therapeutic benefit puts us in a grey zone with regard to the definition of poison. The substances would undoubtably be considered poison in other contexts (e.g. mustard gas) but the doses are carefully calibrated to just-barely not kill a patient. Maybe "poison" is a function of usage intent?

"Chemotherapy, for most cancers, achieves tumor shrinkage and a temporary extension of life, at the cost of severe life quality degradataion."

This is just not true.

I provide you with this list of cases where chemotherapy can cure people (established in phase III double blind randomised controlled trials):

Early stage breast cancer

Early stage colon cancer

Acute myeloid leukaemia

Acute lymphoblastic leukaemia

Diffuse large B-cell Lymphoma

Paediatric neuroblastoma, retinoblastoma, nephroblastoma etc etc

Testicular seminoma and non-seminoma

Testicular germ cell tumours

Note that breast and colon cancer are among the top 3 most common cancers.

Let me revise that: for solid tumors, chemotherapy can cure people, but typically doesn't.

At one extreme, early stage (solid) cancers are primarily cured by surgery. At the other extreme (metastasis), chemotherapy is a terminal rollercoaster.

In between those extremes (e.g. some limited local progression), adjuvant chemotherapy seems to be useful for breast cancer, but has only a very small effect for colon cancer (http://www.sciencedirect.com/science/article/pii/S0140673607...) and none for lung cancer (http://jnci.oxfordjournals.org/content/95/19/1453.short).

When you say adjuvant chemotherapy 'seems' to be useful in breast cancer, what exactly do you mean? How does a meta-analysis of 20,000 patients in randomized controlled trials showing a persistent reduction in risk of recurrence and death equate to 'seeming'?

http://www.ncbi.nlm.nih.gov/pubmed/25917869

It seems like a lot of the "chemo = poison" arguments are part of an ill-informed appeal to nature. Which is an especially stupid argument considering cancer is a natural process run amok.

The dose makes the poison. Even water can become toxic with a high enough dosage. Calling chemo drugs poisonous isn't really helpful. At best, it's like saying water is wet. At worst, you wind up misinforming people and contributing to decisions that are based on bad information. The side effects of cytotoxics make chemotherapy difficult on the patient, but the alternative is a good deal worse and permanent to boot.

Which is an especially stupid argument considering cancer is a natural process run amok.

We don't actually know this. We don't really understand what cancer is. We know that in some cases viral infection is the cause of a specific cancer, but we don't really know the exact mechanism behind what makes cancer, cancer.

I am not a fan of the idea of "auto-immune disease." I think that's bullshit. I think it basically is an admission we have no fucking clue what we are talking about.

The body does things for a reason. Just because we don't understand it does not mean the body has simply lost its mind.

We fundamentally need a better mental model of these things.

You are talking about chemo provided via infusions. We are seeing increasing number of chemo in pills that are noted for being far more bearable for patients while still being effective.

I saw 'local delivery' through surgically added path ways (basically planting metal tubes through your skin into the tumor or organ). A bit violent for tissue but I bet a whole lot better for the overall system. I'm still surprised medicine didn't find a way to craft this kind of thing in a more organic way so they can interact with the tumor as locally as possible without requiring such barbary.

> I'm still surprised medicine didn't find a way to craft this kind of thing in a more organic way so they can interact with the tumor as locally as possible without requiring such barbary.

But this is the holy grail of oncology, is it not? To reach cancer cells non-invasively with spot-on accuracy so healthy cells are spared?

Sure, ability to target a bad cell and only a bad one is. There are many way, membrane markers etc. But they all involve using the main vascular system with potential harmful leaks. Now if you can create your own 'chemo vessel' to reach into a tumor. Erf sounds naive even to me now.

That's how chemotherapy works. Primarily it just kills cells. Typically it has a more potent effect on faster reproducing cells. Because cancer cells often lack the repair mechanisms and support systems of healthy cells they are sometimes more susceptible to being damaged than healthy cells. That plus the focus on fast dividing cells means that sometimes the cancer cells will die off while your non-cancerous tissues persevere and are able to recover after the end of the treatment. It's also why chemotherapy has its notable side effects though (weakness, paleness, nausea, and hair loss) because hair follicles, the digestive tract lining, and new blood cells are also targeted.

That's a neat, simple explanation. Thanks :)

It's a sound bite because it's true. That's not a reason to avoid chemotherapy--it's probably the best method we have right now of fighting cancer--but the biggest concern with prescribing chemotherapy is how much and how long can the patient sustain it, and does the benefit outweigh the costs.

Classic chemo drugs are cytotoxic which is safe to refer to as a poison. Modern targeted therapies can take different approaches

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