> (...) medical orthodoxy hasn't made any progress on cancer in ~60 years
Are you crazy or am I reading you wrong? You are saying you are as likely to survive cancer in 2017 as you were in the fifties? (from a medical perspective)
Are you crazy or am I reading you wrong? You are saying you are as likely to survive cancer in 2017 as you were in the fifties? (from a medical perspective)
Of course you are more likely to survive cancer now than in the 50's. There is not a credible person that would claim otherwise... "credible" being the proper claim. Look at any cancer survival rate and you'll see improvement. That whole statement makes me question every word he/she wrote because it is just so false. At this point his/her words need serious references for proof.
[Edited for spelling mistakes]
For more, as I suggested, see Prof. Seyfried's book and Travis Christoffersen's book, Tripping Over the Truth.
https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid...
https://www.cancer.gov/about-cancer/understanding/statistics
And one more piece of reading about Dr. Seyfried... https://sciencebasedmedicine.org/ketogenic-diets-for-cancer-...
* In 1975, the incidence rate for all cancers combined in the United States was 400 new cases for every 100,000 people in the population; the mortality rate was 199 deaths for every 100,000 persons.
* In 2007, the latest year for which we have updated statistics, the U.S. incidence rate for all cancers combined was 461 new cases diagnosed for every 100,000 people in the population; the mortality rate was 178 deaths for every 100,000 persons.
...
The improvements in survival seen since the mid-1970s reflect progress in diagnosing certain cancers, such as prostate cancer, at earlier stages and improvements in treatment.
/end quote
They're saying almost exactly what I was: Incidence hasn't changed much, and the survival rate improvement is just from early detection. Actual ability survive, treat or cure cancer _itself_ hasn't changed.
† The HPV vaccine has somewhat "cured" cervical cancer, but that was effectively an accident!
http://i.dailymail.co.uk/i/pix/2011/11/22/article-2064659-0E...
(You can find these graphs with some simple google images searches)
Notice that most cancers, the longevity doesn't change much at all in that ~40 year period. Personally I was expecting some dramatic improvements like the one you allude to (going from 3 to 30 years). It doesn't happen.
I think generally we somehow assume that because there's lots of money being spent on cancer and fancy machines and so on that everything must be better, when in the graphs we only see these various marginal improvements in some specific cancers. I think probably the number one reason for this mismatch is nobody likes to talk about cancer.
My understanding is that most cancer research has focused on how to take advantage of earlier diagnosis by putting early-stage cancers into remission, or slowing their progression.
The "thing about cancer" is that it's somewhat exponential in growth: if you have cancer in one place, it's easy to treat; if you have cancer in four places, it might be in 16 places by the time you're treated those four.
It's like a manhunt for a criminal group that knows they've been made: they started out meeting in one building, but they're on the run, parting from one-another's company and spreading out across the world. If you catch the group when it's still in one building, you can just raid that building; but it's very hard to do raid a thousand individuals once they're living scattered across the whole world.
So early-stage cancer is "easy", and late-stage cancer is "hard"; and, insofar as we haven't come up with a brilliant way to solve the hard problem (a whole-body chemotherapy that doesn't hurt non-cancer cells) we've set ourselves to the task of combining screening with early-stage therapies to try to eliminate cancers before they can become late-stage.
I know you are smarter than this... Why are you ignoring the fact that all cancer rates of survival are skyrocketing by those measurements while the hardest cancers still remain hard.
I'm not ignoring it, it's there, it shows the median life expectancy going from roughly 1 up to 6 years. Great.
The problem I have is two things: First that most of that gain is from prevention and detection, not treatment. I really want the treatment to get vastly better like it has in the entire rest of medicine (give or take). Believe it or not, a 6-fold increase in 40 years isn't really that great of an outcome.
Second is the interpretation of the split. Your interpretation is that there are "easy" and "hard" cancers to fight. I think it's actually that some are easy to detect or prevent. At base, they're all as horrible as each other left unchecked. But, we can see a melanoma much more easily than a blastoma. Therefore the graph will fool us in to thinking there is progress at attacking cancer.
To tie it back to the books I mentioned earlier, to me, they have a much better theory for why all this is happening than the prevailing theory of "cancer is broken DNA" and "cancer is really complicated". The idea that a) it's mitochondria and b) it's actually quite simple, to me, seems to fit the evidence much better.
This is from a UK charity operating in England. England has poor cancer outcomes. The report was written before the "be clear on cancer" stuff currently happening.
It's worth reading in the context of this discussion you're both having because it gives a pretty balanced account.
> when in the graphs we only see these various marginal improvements in some specific cancers.
We see very good improvements in breast cancer, and this is partly because of the vigorous campaigning and fund raising. We've also seen big improvements in colon cancer, non-Hodgkins Lymphoma and Rectal cancer.
«
In the United States, the overall cancer death rate has declined since the early 1990s. The most recent Annual Report to the Nation on the Status of Cancer, published in March 2016, shows that from 2003 to 2012, cancer death rates decreased by:
1.8 percent per year among men
1.4 percent per year among women
2.0 percent per year among children ages 0-19
»
A sustained 1.5 percent decrease per-year is not something that can be wholly attributed to early detection or reclassification. It is huge; a 1.5 percent yearly decrease means halving mortality in ~50 years. If this metric is true (and there's no reason to discredit it), then:
- Some other mortality cause is increasing and dwarfing cancer; or
- Cancer survivability metrics are being negatively affected by early detection.
In any case, it's quite difficult to make a strong case that medical knowledge regarding cancer has not progressed in 60 years and that outcomes are stable. Such a large decrease in cancer death rates must be fueled by some major structural force.
If you look around your an find lots of graphs like this:
http://medicine-opera.com/wp-content/uploads/2012/07/cancer-...
which show that rates haven't really changed since 1930, give or take.
The variance you see in the graph is things like lots more people smoking then not smoking any more, the prevention methodology of either finding cancer early or preventing high-risk people (e.g. mastectomies). But the actual chance of death hasn't really changed.
Compare and contrast to things like surviving anything else (heart attack, stroke and so on) and it's night-and-day.
Um.. immune therapies, targeted genetic therapies, TIL therapies... all kind of a big deal.
Sorry, you don't know what you're talking about.
And rates say nothing about efficacy / quality of treatment. (And even when new treatments are not more effective, often the side effects are much milder (to non-existent): getting an extra three years sick and in pain, vs getting them as your normal self is a huge difference)
Edit: what I mean by that is that rates of incidence say nothing about how effective the treatments are. It can both be true that rates are going up (say, due to air pollution) and that treatments are more effective.
---
Reply to comment below: again, you are wrong. Jesus, stop. One example: Ipilimumab and PD-1 inhibitors have a ~20% effectiveness rate against melanoma, a cancer that was considered a sure death sentence just 15 years ago. Some patients have not had any recurrence in a decade, they seem cured, which was unheard of before.
And targeted drugs like dabrafenib buy most patients an extra 6-18 months, almost side effect free. With more of these coming out, it seems like soon it'll be possible to cycle patients even longer (some combos already are known to extend their effect).
This doesn't qualify as "major"? The ability to reprogram our immune system to kill cancer cells, or to reprogram pathways in faulty cells?
All the things you mention are innovations, they just haven't really changed average mortality numbers, which is what I care about.
Edit: the parent post changed their argument to being about 'efficacy' or quality of care. Personally, I prefer a cure to a high-quality and effective 3 months in hospital then death. Thus I focus on the mortality statistics.
Edit again: quote:
> This doesn't qualify as "major"? The ability to reprogram our immune system to kill cancer cells, or to reprogram pathways in faulty cells?
I'd define major as some large change to average mortality from cancer. The same way heart attacks are now vastly more survivable, or we don't get them in the first place. For example, in another comment, someone linked to the NIH's numbers
https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid...
They show from 1975 to 2007 incidence of cancer going from 400 per 100k to 461 (e.g. up). I'd define a major improvement as that going to 200 or 100 per 100k people (e.g. down). The 5-year survivability has gone up for the same reason incidence went up, early detection.
Yes, there are specific therapies that improve things 20% here or there for certain very targeted groups. I hope I am in one of those groups if I ever get cancer, but again the averages haven't changed much at all, especially when compared to other chronic disease.
Am I confused?
The central point I'm trying to make, which was a surprise to me as much as others, is that there hasn't been some dramatic decline in cancer like I expected. If you look at graphs for other things we see amazing gains in prevention and treatment that don't particularly occur in cancer. To pick one at random, the pancreatic cancer line on the graph above is basically flat.
And so, if it isn't changing a whole lot, why is that? The standard theory is that cancer is really complicated and it's DNA. The alternative theory is that it's the mitochondria(l DNA).
I'm not in some crusade against medicine, it just seems to make more sense to me and explains the lack of progress.
As Feynman said, the easiest person to fool is yourself, so who knows, maybe I'm wrong. But then I also worry about the story of the doctor who invented washing hands between procedures, and the story of the doctor who discovered the cause of stomach ulcers.
Pancreatic cancer mortality is heavily correlated with age. What happened is that people now live longer, and when older people get pancreatic cancer, they have a lot more probability to die.
http://www.cancerresearchuk.org/health-professional/cancer-s...