DIAGNOSED WITH BLADDER CANCER TWENTY YEARS AGO AND DRAMATIC SURVIVAL RATES IN CHILDHOOD LEUKEMIA YET THE CANCER MANHATTAN PROJECT STILL SEARCHES FOR THE ANSWERS
He was diagnosed with bladder cancer. The 80 something patient was telling me about his medical history. As I listened to this man with a history of coronary artery bypass and diabetes I expected him to tell me that this was the latest and probably final attack on his health. Only it turned out the diagnosis of bladder cancer was made twenty years ago! If there was ever something like a Manhattan Project in medicine it is probably the effort to find a "cure" or "cures" for cancer. If you look at the survival rates for bladder cancer, often if bladder cancer is detected and treated at an early stage the survival rate is high. On the other hand some other patients have succumbed to cancer within a few months of diagnosis. Cancer is probably the number one problem in medicine and probably in the public's mind. There have been some dramatic successes in treatment and survival of some cancers. Yet cancer still has a kind of scary mystique associated with it that the other big medical problem, heart disease seems to lack.
Newsweek recently had a fascinating article about how cancer research is done and what works in cancer treatment or at least produce more practical results. And also how some things in science and medicine are sometimes decided in decidely unscientific ways. According to the article, "there is no more common refrain among critics of how the war on cancer has been waged than that innovative ideas, ideas that might be grand slams but carry the risk of striking out, are rejected by the National Cancer Institute in favor of projects that promise singles...Part of the answer is that the infrastructure of cancer is to keep things moving along as they have been and to reward people doing safe research."
I have written in Purple Medical Blog about some of the recent new developments in early cancer diagnosis and treatment such as the drug abiraterone for prostate cancer, the new blood test for ovarian cancer and the vaccine treatment at Johns Hopkins for pancreatic cancer.
It's logical to expect that if you understand how your car engine works you have a better chance of fixing it. But sometimes if you don't know where the engine knocking is coming from but you know if you add synthetic motor oil it stops you do it anyway.
As Dr. David, a pediatric oncologist points out in his blog,"Funding for pediatric oncology clinical trials, which are so expensive that they can only be done with the support of NCI or a pharmaceutical company that hopes to uncover the next blockbuster drug, is at $26.4 million per year and has been dropping steadily since 2003. This decrease in funding has had a real impact. A number of trials being conducted by the Children’s Oncology Group have had to close, and others have been reduced in size or delayed. These clinical trials are responsible for one more astounding fact about childhood cancer: approximately 3 of every 4 children diagnosed with cancer will be cured.
The story in Newsweek suggests that theoretical research into the basic biological mechanisms of cancer have not yielded as much practical results as might be expected. And that some of the great successes have come from coordinated efforts to use existing medications and modalities and experiment with combinations to see which might work better. It goes on to point out as an example the singular success of pediatric oncologists in battling childhood leukemia who by tinkering with drug doses and combinations of drugs and timing were able to develop methods that are successful in the majority of cases.