Bang for our buck
Last month, Nature published a damning article on the state of cancer research. In it, a former Amgen researcher C. Glenn Begley details how experiments from 47 out of 53 “landmark” cancer-related publications were irreproducible, prompting headlines such as In cancer science, many “discoveries” don’t hold up. Many of these highly-cited publications identify potential genetic targets for cancer treatment and drug research–“druggable” targets that now fall under a looming shadow of doubt. While Begley concedes that some of the failure in replicating experiments may be due to “technical differences or difficulties,” he also raises a more concerning factor: “What reasons underlie the publication of erroneous, selective or irreproducible data? The academic system and peer-review process tolerates and perhaps even inadvertently encourages such conduct.” Similarly, this system offers no incentives to confirm the scientific discoveries of others. Under pressure to win grant funding (publish or perish), researchers might be tempted to make biased and inaccurate conclusions. This not only jeopardizes the integrity of science but also wastes taxpayer funding, playing right into the narrative of the recent spate of science denialism and skepticism.
Given the inherent flaws with this system in combination with the astronomical costs of developing drugs and a less than stellar 4.7% success rate of bringing cancer drugs to market, are we just throwing money down the drain? An article published in Science Translational Medicine would suggest that a paradigm shift is long overdue:
More than half of the cancer occurring today is preventable by applying knowledge that we already have. Tobacco, obesity, and physical inactivity are the modifiable causes of cancer that generate the most disease. Cancer burden can be reduced by alterations in individual and population behaviors and by public health efforts as long as these changes are driven by sound scientific knowledge and social commitment to change. The obstacles to these efforts are societal and arise from the organization of institutions, including academia, and in the habits of daily life. To achieve maximal possible cancer prevention, we will need better ways to implement what we know and improved infrastructure that will better incentivize and support transdisciplinary, multilevel research and successful intervention.
(also quoted at the The Finch and Pea)
Prevention, of course, comes with its own obstacles. As the authors note, only 1.5% of current biomedical research is dedicated to “health services and implementation of effective prevention programs.” Furthermore, legislation and policy that encourage changes to individual and population behaviors are often met with charges of social engineering. And frustratingly, when research does yield effective vaccines to prevent cancers you can always rely on the ol’ culture wars to derail science, as was the case with Gardisil. It should be noted that the rate of new cancer cases in the US have dropped at an annual clip of 0.5% since 1998 thanks in part to better preventative measures (although this comes with a rise in obesity- and skin-related cancers). I think we can do much better than 0.5%.
New cancer test and treatment recommendations
Our reevaluation should also not be limited to cancer research. A two-year effort by the American Society of Clinical Oncology has culminated in new recommendations for cancer tests and treatments, mirroring recent, controversial recommendations for prostate and breast cancer screenings. Whereas part of these guidelines are driven by studies indicating that certain tests and treatments will not improve the prognosis of some cancer patients, they are also driven by financial considerations as many of these procedures are costly. While, understandably, it is often the case that patients and doctors will exhaust every avenue to find effective treatment, we cannot ignore the rising cost of cancer care. (And predictably, the specter of death panels rises…)
So Crazy It Just Might Work
Last November, I caught a captivating episode of This American Life that relates to the idea of rethinking how we approach “curing” cancer:
One day a successful cancer researcher named Jonathan Brody gave a talk at his alma mater, about how people in his field need to think outside the box if they’re going to find a cure. Afterward Jonathan’s old music teacher Anthony Holland shared an idea that was way out of the box: Killing cancer cells with electromagnetic waves.
The idea was simple, if you could break glass with a certain frequency of sound, maybe you could target cancer cells with a certain frequency that would leave normal cells unharmed. This story works on many levels: an interesting hypothesis, an unlikely collaboration between a scientist and music professor, how outside-the-box thinking can reinvigorate science, it even touches on the ethics of disseminating unvetted scientific data (open science anyone?). But what I found very compelling about the piece was that it illustrated the apparent gulf of understanding that the public has regarding the scientific method and why science often proceeds at a maddeningly slow pace. For, although, Anthony Holland initially observed cancer cells getting obliterated by EM waves, his experimental design turned out to be improperly controlled for and the experiments could not be successfully repeated. The segment does an excellent job of chronicling Professor Holland’s toiling and frustrating attempts to replicate his experiments, proving that it takes a certain kind of masochism to be a scientist. In the end, the story for me really highlights a cultural clash that underscores the public’s perception that “seeing is believing” while in science “convincing needs repeating.” It’s worth a listen.
You can also find out more about Anthony Holland’s documentary film in the making here.