Hope is not a good strategy, in life or in disease research.

November 29, 2012 8:22 AM

An influential US advocacy group has set a deadline to beat breast cancer by 2020. But it puts public trust at risk by promising an objective that science cannot yet deliver.

"Hope is not a good strategy, in life or in disease research. So the setting of goals, and the drive to reach them, is to be commended, and cancer is no exception. But a 2020 deadline for ‘ending’ breast cancer that former US President Bill Clinton endorsed earlier this month is misguided. Like other ‘beat cancer’ deadlines that are regularly floated, it is potentially harmful to the public trust that underpins the whole research enterprise, not to mention to the patients who understandably cling to hope, whatever its validity.

Clinton, who lost his mother to breast cancer, has become honorary chairman of a two-year-old campaign by the National Breast Cancer Coalition, which declares on its website that it has “One Mission: To End Breast Cancer by January 1, 2020”. The advocacy and research-funding organization, based in Washington DC, adds that it has a “strategic plan” to achieve that mission, by focusing on prevention and on eliminating the metastatic form of the disease, which is what kills.

The coalition provides a 4.5-page “blueprint”^[PDF] that is long on aspiration and short on scientific detail. For instance, it declares that by 2020 “we must understand how to prevent people from getting breast cancer in the first place”. This goal leans heavily on the development of a preventive breast-cancer vaccine. A research plan for this is said to be “in place” and will serve as a model for other, “catalytic projects”. These could include exploiting the role of viruses and inflammation in breast cancer, and targeting the immune system to prevent metastasis"

A clear introduction to how cancer develops and works, helpfully illustrated by Jorge Chan in comic form.

Our emerging understanding of the diversity and complexity of Breast Cancer previously.

posted by Blasdelb (64 comments total)

Does research work this way or is this only how we want research to work?
posted by TwelveTwo at 8:47 AM on November 29, 2012

Why 2020? Breast Cancer is bad, so we should end it even earlier. They should pledge to eliminate Breast Cancer by 2011, instead of this slacker shit.

It kind of makes you wonder... who profits by waiting so long? I mean, I'm not saying there's a conspiracy, here, but like... connect the dots, people.
posted by Greg Nog at 8:49 AM on November 29, 2012 [19 favorites]

OK, so, then, in 2020, when we still have breast cancer and have made only incremental progress in prevention and treatment... what? Blame the scientists for not being sufficiently like science fiction scientists?
posted by gurple at 8:53 AM on November 29, 2012 [3 favorites]

I work in cancer drug development -- have been doing it for the past 5 years - and I can't tell you how infuriating these publicity stunts are. Hasn't anybody learned the lesson from the 1971 "War on Cancer" or the innumerable papers coming out during the past few years of the post-genome era that have demonstrated the remarkable heterogeneity between tumors of the same type (that is, no two breast cancers are exactly alike)?

And what's worse is that we're learning that there's a remarkable amount of heterogeneity within an individual's tumor (that is, within the same tumor in the same person, there are substantial genetic differences between tumor cells). Our current paradigm for drug development for cancer is dominated by single-node attacks on very complex signaling networks within cancer cells, and we're barely doing well at that and are only now just starting to be able to understand and attack rapidly-developing resistance mechanisms by developing combinations of targeted therapies.

Given that it currently takes at least 4-5 years for a single screamingly active drug to get through clinical trials and to approval (conditional/accelerated approval at that), you'd have to focus the vast majority of drug development efforts on breast cancer to make even a substantial dent in 7 years. And the idea of "beating cancer"? Hell ... we'll be lucky if we can cure any metastatic cancer in the next 10 years.

I'm not entirely pessimistic -- we're making remarkable strides -- but this is a stunt, and one that does a disservice to science and the pharmaceutical industry. Advocacy groups shouldn't set timelines for scientists. It doesn't work that way.
posted by scblackman at 8:53 AM on November 29, 2012 [39 favorites]

So where's the prostate cancer deadline, eh?
posted by Segundus at 8:57 AM on November 29, 2012 [1 favorite]

By 2020, we pledge to create unpowered human flight, solely through flapping our pinioned wings. Here's how we'll meet this goal:

2013: Invest 2.5 billion dollars in our future
2014: Develop early models of artificial wings
2015: Slowly transition from artificial to biological wings, either by implant or by natural growth
2016: Wing flapping lessons that build on the strength of community
2017: Look at birds, and discover how nature has ALREADY been teaching us valuable lessons about how to stay strong in the presence of adversity
2018: Pay it forward; give the children a chance to hope
2019: Wings and flapping, with science
2020: Unpowered Flight Is Now a Reality
posted by Greg Nog at 8:57 AM on November 29, 2012 [34 favorites]

Prostate cancer: Mustaches over deadlines.
posted by scblackman at 8:57 AM on November 29, 2012 [1 favorite]

Why not? This approach also works for controlling rising sea levels.
posted by usonian at 8:58 AM on November 29, 2012

in 2020, when we still have breast cancer and have made only incremental progress in prevention and treatment... what?

It's a deadline, dude. If science doesn't completely cure it by then, we abandon science and start curing breast cancer by having Rafiki shake gourds on a staff over sick patients.
posted by Greg Nog at 9:07 AM on November 29, 2012 [5 favorites]

We need to put together a bipartisan committee that will put together a package of wide-ranging cuts in research funding that will go into effect automatically if we don't beat breast cancer by 2020.
posted by Nomyte at 9:12 AM on November 29, 2012

I blame breasts.
posted by It's Raining Florence Henderson at 9:14 AM on November 29, 2012

I propose a deadline for cancer in general -- 2015 maybe? We could totally pull the carpet out from under those people.
posted by dlg at 9:16 AM on November 29, 2012

So where's the prostate cancer deadline, eh?

Yea, I'm about as far from the whole "man's rights" thing as anyone you're likely to meet today but I've never grokked the whole big ticket, bumper sticker breast cancer stuff and this quote brought it to mind. The prostate aspect is a bit of a red herring and potential derailer but here I go anyway.

I'm not one that has internalized all the medical numbers surrounding cancer as it stand on the planet today but it seems like the money and effort, along with the public attention needed to provide those two things, should be allocated in proportion to how deadly or "bad" a cancer is with a dash of how easy it is to detect and treat thrown in there as well. Really, I'm not trying to belittle anything, let alone breast cancer*, but why not, according to that list I linked, try to cure rectal cancer by 2020?

I understand that the lung cancer battle is better fought elsewhere, a la prevention of smoking and/or exposure to irritants, so that one makes sense.

Is it really as simple as the fact that the colon cancer ribbon would have to be brown or something? Or because it's easier to detect breast cancer than colon cancer in time to save someone's life or deliver a higher quality of life after treatment? Or are women just that much better than men about being concerned about their health so they can mobilize better? Or is there an equalivent amount of money actually going towards colon cancer research but we never hear about it in the news because it's not sexy, pun only slightly intended, research?

* Mrs.Eld has had surgery 2x to remove lumps, one of which before she was even out of high school. So, yea, I understand and fear breast cancer as much as the next fella. Please don't construe any of what I'm saying as dismissive, it's just me trying to get a better grasp of if my cynicism meter is malfunctioning or needs to be re-calibrated.
posted by RolandOfEld at 9:18 AM on November 29, 2012 [2 favorites]

The breast cancer money-raising machine senses that we're beginning to suffer from pink overload, and tries another tack: "Send us even more of your cash now, and we'll stop asking in 2020."

You're much more likely to die of heart disease - it's the number one killer across the board, with a big lead of 24%, versus less than 2% for breast cancer - but I suppose you just can't make as much profit by telling people to get their asses off the sofa and go for a walk now and then.
posted by Mary Ellen Carter at 9:19 AM on November 29, 2012

"A wish list disguised as a strategic plan? You're stealing my bit!"

-- Mitt Romney.
posted by Capt. Renault at 9:22 AM on November 29, 2012 [2 favorites]

This is a pattern with a lot of advocacy groups, it seems to me---I see fundraising promises and earnest papers declaring the intention of "Ending Rape", "Eliminating Breast Cancer", and "Not One More Traffic Death". Such claims make me a lot less likely to support an organization, because I don't like having my intelligence insulted. But I suspect that from a fundraising perspective, "No More Bad Things Ever" is a lot more effective than "Fewer Bad Things In The Medium Term".
posted by ThatFuzzyBastard at 9:23 AM on November 29, 2012 [2 favorites]

When even Sorkin-era West Wing thinks your stunt is unrealistically hopeful, reconsider.
posted by Navelgazer at 9:29 AM on November 29, 2012 [1 favorite]

I understand that the lung cancer battle is better fought elsewhere, a la prevention of smoking and/or exposure to irritants, so that one makes sense.

Actually, that one's kind of interesting, 'cause there's this public perception that Lung Cancer, so frequently caused by smoking, is therefore unworthy of funding because the patients deserve whatever they get.

The Lung Cancer Alliance has recently started trying to call attention to this by starting their Deserves To Die ad campaign. I myself hadn't really thought about this until a few years back, when a friend's mom died of lung cancer, and she mentioned how little funding lung cancer gets compared to breast cancer.

I suppose if one wanted to get really into the patriarchy issues at play, one might examine the way that a disease which attacks the visual signifier of femininity is playing into our notions of women as passive-victims-to-be-protected-by-agentic-actors. Which I am not particularly inclined to argue, given that at the end of the day, breast cancer is still bad, and no matter what gender dynamics are at play, it would still be cool as hell to rid ourselves of any kind of cancer, and more funding is indeed a good way to start that process.
posted by Greg Nog at 9:37 AM on November 29, 2012 [2 favorites]

So last year there was an event across the street from my lab for the administrators that run the local MASSIVE university hospital's cancer research and treatment to pat themselves on the back on an anniversary or something and, being a starving grad student, I put on a button up shirt to crash the party for free food. I fixed myself a big plate of the university's especially fancy catering option and sat in on a few of the talks, and one of them blew me away. It was by one of the very top administrators about his view on where the focus in cancer research should be and he used as a central anecdote an experience he had conducting interviews for a new head of the MASSIVE big money cancer research center. He told the story of how he had this one amazing candidate in mind who conspicuously knew his shit, had nature papers, came from years of extraordinarily productive experience in administrating exactly this kind of thing and was, at least according to the anecdote, totally blowing the interview out of the water. However the kick was that, when the amazing applicant was asked what their goal would be, they came out with what sounded like a very good answer about increasing efficiency, providing effective support to PIs, and other appropriate things - but it wasn't the right answer, which was apparently CURE CANCER. He was summarily dismissed.

The administrator then went on a 15 minute rant about how most of the people who have dedicated their lives to cancer research are insufficiently focused on curing cancer, all cancer not cancers, and need people like him to drive them back towards this - in his words - single minded focus. I don't know who they ended up going with, but its pretty shitty that they probably either felt the need to lie to this deluded and powerful guy or were so ignorant themselves that they honestly believed that this problem that is inherent to our multicellular nature and unfixed by billions of years of evolution would ever be totally solved or could be thought of in such simplistic terms.
posted by Blasdelb at 9:41 AM on November 29, 2012 [12 favorites]

LOOMING RESEARCH CLIFF!
posted by srboisvert at 9:46 AM on November 29, 2012

I suppose if one wanted to get really into the patriarchy issues at play, one might examine the way that a disease which attacks the visual signifier of femininity is playing into our notions of women as passive-victims-to-be-protected-by-agentic-actors. Which I am not particularly inclined to argue, given that at the end of the day, breast cancer is still bad, and no matter what gender dynamics are at play, it would still be cool as hell to rid ourselves of any kind of cancer, and more funding is indeed a good way to start that process.

Right, very well said and I agree. I just personally know people who, as their main function of employment, do nothing but run statistical models to determine the best ways to allocate funds/strength to battle certain infectious diseases. I'm also the type to want to maximize efficiency, often to a fault. That makes the issues surrounding funding and goal direction pretty interesting to me.

Best of luck to people in the front line of the fight against ____ cancer.
posted by RolandOfEld at 9:46 AM on November 29, 2012 [1 favorite]

We'll just have to find some way to militarize breast cancer so we can keep funding research after the deadline, just like NIF.
posted by ook at 9:54 AM on November 29, 2012

"I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the Moon and returning him safely to Earth."

"I believe that this world should commit it self to achieving the goal, before this decade is out, of reducing then eliminating breast cancer from this Earth."

It's good to have goals. It's often good to have benchmarks.
posted by inturnaround at 9:57 AM on November 29, 2012

Hope is not a good strategy... So the setting of goals, and the drive to reach them, is to be commended

Hope is not a good strategy, but commitment to a concrete, time-specific goal often is. cf Putting a man on the moon within a decade.

Or, closing Guantanamo within a year.

If there's a problem here it's that the goal is not so much challenging as far-fetched. (Or so it seems to me, I'm no expert.)

But the what-will-people-think-when-it's-missed is a bit of a red herring. What I think about Obama not closing Guantanamo is it mattered a heck of a lot to him to do it, he tried his damn best, and made some progress, but the entirety of the thing was beyond him for various complex reasons. Which is for the most part a lot better than would have occurred without some highly visible time-specific commitment.

This stuff is not that different from what we were hearing from assorted Nobel Laureates about the likely medical benefits to come out of mapping the human genome. Do we now think they were full of it for not realizing the complexity of what they were predicting, and being way too optimistic about how soon applications could be expected? Mostly we don't.

The interesting thing to me would be to know why people who presumably do know something about the subject think this isn't a completely far-fetched goal.

Btw, for as long as I've known, since the late 80s at least, cancer research charities have raised enormous amounts on money and spent it on pure research that had nothing directly to do with cancer even. Things like protein folding, and even things like artificial intelligence and computer vision research that might indirectly help with work on protein folding and scanning cell images.

If your theory is "Give me a few billion, then go away and let me do whatever I want for a few decades", they already tried that.
posted by philipy at 10:04 AM on November 29, 2012

Not a goal that is completely impossible to achieve. When you inevitably fail, it just makes you defeatist. It would be better to set a reasonable goal, like a % reducing in mortality or an increase in the average years of survival or something like that, and you need to set the deadline further ahead.

Even if a scientist magically invented the perfect breast cancer vaccine right this very moment, it would still be in clinical trials when 2020 hits. Medical research just does not move this fast, and even with enough funding or awareness, it never could - medical ethics would prevent it.
posted by Mitrovarr at 10:06 AM on November 29, 2012 [2 favorites]

But as an advocacy group isn't it their job to put people's feet to the fire with a harsh deadline? It'd be different if the White House or the NIH or especially somebody who was doing the actual job of curing cancer was setting the deadline but it isn't.

(I don't know if I actually agree with what I just said, so please tell me where I'm wrong.)
posted by MCMikeNamara at 10:18 AM on November 29, 2012

I agree that these grand stunts don't really seem to help with what matters - research, awareness and treatment. I get why they are doing it, but I also just roll my eyes. (Though a lot of the cancer advocacy groups make me roll my eyes.) It might make people some people feel sort of empowered, but what's it really going to achieve.

I'm a breast cancer survivor, and you know what? I am more concerned about education, detection, and better treatment options than any "cure". What would a cure actually entail? A vaccine that could only work with certain types of breast cancer? What about those of us with BRCA1 or BRCA2? I know my attitude of "let's treat this" was only really possible because I'd already seen my mom and grandmother go through treatment. It's not pleasant, but it's doable (if you catch it early).

I also agree that there are lots of cancers that need more attention and support. The stigma of lung cancer might be good for smoking prevention, but I've heard too many stories of people who never smoked dying from lung cancer.
posted by kendrak at 10:25 AM on November 29, 2012

Can't believe no one posted this yet (could have sworn I'd seen it on the blue before):
There will never be a cure for cancer
posted by Hactar at 10:30 AM on November 29, 2012 [1 favorite]

Can't believe no one posted this yet (could have sworn I'd seen it on the blue before):

It has been linked in comments many times, at least once by myself: in the last thread we had on this general subject.
posted by adamdschneider at 10:42 AM on November 29, 2012

That, and it's actually part of the posted links (the longer version you see once you click on the FPP).
posted by Mitrovarr at 10:47 AM on November 29, 2012

Its also linked in this very post
posted by Blasdelb at 10:47 AM on November 29, 2012

Yea, as much as I like PhD Comics*, and even that one in particular, I always feel, cynical as I am, that things that say 'never' are never true.

If you'd have told someone not-so-many years ago that we'd have eradicated this or that disease they would have thought you were crazy and would have likely told you it would never happen.

If you ever get a chance to meet Jorge Cham do so; he was awesome at the signing Mrs.Eld attended.
posted by RolandOfEld at 10:50 AM on November 29, 2012

"Btw, for as long as I've known, since the late 80s at least, cancer research charities have raised enormous amounts on money and spent it on pure research that had nothing directly to do with cancer even. Things like protein folding, and even things like artificial intelligence and computer vision research that might indirectly help with work on protein folding and scanning cell images."

Protein folding has a lot to do with cancer
posted by Blasdelb at 10:59 AM on November 29, 2012 [4 favorites]

I like the idea of throwing a lot of money at curing diabetes.
posted by asperity at 11:19 AM on November 29, 2012

Not a goal that is completely impossible to achieve.

My favorite line in the site is probably "A deadline changes everything and makes the impossible possible." which has me screaming "THEN IT'S NOT IMPOSSIBLE, BY DEFINITION" a la WINDMILLS DO NOT WORK THAT WAY
posted by Greg Nog at 11:47 AM on November 29, 2012 [1 favorite]

When I worked in public health, I'd occasionally see groups who were trying to do some kind of project and told they needed measurable goals and objectives but had no clue about how to do that.

More than once, I saw a group that said one of their goals was to reduce the incidence of lung cancer over the next ten years. Good luck inventing that time machine!
posted by straight at 12:05 PM on November 29, 2012

Why 2020? Breast Cancer is bad, so we should end it even earlier.

Maybe the scientists are being like Scotty in Star Trek. They'll probably have it licked by 2014, but they're just inflating the time required, just in case. Or so they look like amazing rockstars by coming in under schedule.
posted by Sara C. at 12:56 PM on November 29, 2012

Blasdelb, was that the same dude who gave an interview berating all of these lazy researchers for taking Saturdays off when CANCER? (I have to see if I can find that one.)
posted by en forme de poire at 12:59 PM on November 29, 2012

Wait, there are researchers who take off Saturdays?

More seriously though I wish I would be surprised if it were, these guys are everywhere.
posted by Blasdelb at 1:30 PM on November 29, 2012 [1 favorite]

I'm not one that has internalized all the medical numbers surrounding cancer as it stand on the planet today but it seems like the money and effort, along with the public attention needed to provide those two things, should be allocated in proportion to how deadly or "bad" a cancer is with a dash of how easy it is to detect and treat thrown in there as well. Really, I'm not trying to belittle anything, let alone breast cancer*, but why not, according to that list I linked, try to cure rectal cancer by 2020?
posted by RolandOfEld at 11:18 AM on November 29

Actually, a lot of money goes towards "education" and "raising awareness" and while that's important, it's kind of annoying. Most women use the pill at some point in their lives, and I've never been able to get a prescription for the pill without first having to sit through an annual exam and an educational talk from my doctor or their nurse about breast self-exams and what to look for. Afaik, their bills aren't paid by the breast cancer groups, so when I give money to somebody to run a 5k to raise awareness, as far as I can tell, I'm just paying for the breast cancer organization to advertise and administer a 5k run, with some information about breast cancer sort of incidentally tacked on. It's a super inefficient way of lowering cancer rates. From a raising awareness point of view, it seems like we could move on and start raising awareness of, say, how having HPV affects your chances of getting head and neck cancer, or how you should always get any sores in your mouth that won't heal checked out, or how you can still get cancer if you chew tobacco instead of smoking it, or other things that relate pretty directly to cancer risk that aren't as widely known.
posted by joannemerriam at 1:56 PM on November 29, 2012 [2 favorites]

y favorite line in the site is probably "A deadline changes everything and makes the impossible possible."

Oh, god, don't let any boss I will ever have see this, please.
posted by adamdschneider at 2:13 PM on November 29, 2012 [1 favorite]

Is it really as simple as the fact that the colon cancer ribbon would have to be brown or something?

There's already a ribbon for colon cancer. It's blue.
posted by scody at 2:45 PM on November 29, 2012 [1 favorite]

Whoops, hit post too fast. Meant to comment on this:

Or is there an equalivent amount of money actually going towards colon cancer research but we never hear about it in the news because it's not sexy, pun only slightly intended, research?

My understanding, while I was going through treatment for colon cancer, is that there is pretty significant ongoing research in the field (it's the second-leading cause of cancer deaths, after all), but that the mega money/research really does go to breast cancer.
posted by scody at 2:56 PM on November 29, 2012

How very disappointing, metafilter. There's an interesting documentary Pink Ribbons, Inc. that's even streamable on Netflix. I urge you to watch it.

Yes, you can't set deadlines for science. That's obvious. But it's that very obviousness that ought to have been your tipoff, that there is more to this than a silly headline. Instead, folks plunge in for the easy laugh, while the point glides right over their heads.

It's the oldest trick in the PR book - the provocation. Everybody understands very well, that discoveries don't come on a schedule, otherwise, they would not be discoveries, but planned unveilings. Please give the people behind this campaign the credit you'd give someone with a grade school education. But we're so eager to point and laugh at the "rubes", that we miss the most obvious.

Quite obviously this is meant to shake up the status quo. Because while you were pointing and laughing, you missed the utter and complete failure that breast cancer research has been for the past 30 years, despite countless billions raised and spent.

And watch that documentary: the dirty truth is not simply that "cancer is hard", or worse "cancer can never be cured", the truth is that time and money has been wasted on a monumental scale.

Yes cancer is hard. But the approach to finding a cure has been nothing short of shameful in its disorganization and lack of focus and coordination. You have teams of scientists duplicating work, working at the margins of the issues, and corporations pouring most funds into trying to find a marketable product which frequently does little but extend life by a few weeks in terminal cases. What every woman is hoping for is not to get the disease in the first place, yet only about 5% of the research money goes to finding best prevention methodology. Not much is going to fundamental research to illuminate what causes cancer in the first place. Most goes to finding cures - preferably ones which can be sold by big pharma - once the disease has been established. It would be like focusing 95% of your money on finding a drug to cure lung cancer while ignoring smoking as a cause altogether.

Here's what is missing: a central coordinating agency that can harness the enormous resources into focused search for prevention, cure and understanding of breast cancer. A Manhattan Project if you will. How far are we away from a Manhattan Project approach? As far away as the Manhattan Project itself was as a weapon development strategy compared to medieval knights each working on his own petty weapons isolated in his own village.

We have a medieval set up for medical research. We need a modern 21 century approach.

The 2020 goal is A PROTEST - in dispair over the failed approach of the past three decades. It's a rally and a cry to arms. We need a Manhattan Project approach to breast cancer, and perhaps it's easiest to do when you set goals - yes even unrealistic ones. Because it focuses attention on how we can do things better. Because what we are doing so far has been an utter failure.

Instead, we're told "you can't cure cancer" by assorted morons. If you believe that, you're an idiot. There are animals out there that are remarkable for virtually never getting cancer - the naked mole rat is one such example. These are rodents - and rodents are notoriously given to cancer, in fact for many strains of mice that's their #1 reason for death. Yet these RODENTS - the naked mole rats - almost never get it. Obviously, something about their genetic makeup solves the cancer problem. They are also amazingly long-lived for rodents (30 years). In an age where we are on the cusp of being able to affect genetic cures and able to modify our entire genome you are a moron luddite to believe we can never cure cancer - you merely lack imagination, you chump. There is no biological law that says cancer is an inevitability in mammals - and btw. we share the vast majority of our genes with rodents - and what's good enough for the naked mole rat should be good enough for us.

What we lack is knowledge and technology. Both are solvable problems for science and engineering. We can do this with intelligent focus and a modern - not medieval as it is today - science research infrastructure. But I guess that would mean a major political and economic reorientation, and how can we do that when there's all that money that needs to grow an ever bigger Pentagon with ever bigger killing machines.

No. Push for reforms as hard as you can. Buying a pink ribbon product is a scam and a way to make you think you're doing something while in reality it turns you away from political involvement. Because you're a chump if you think that politics doesn't enter science. We've seen how it does, when millions died in the AIDS epidemic because politics drove science involvement or noninvolvement and priorities. It's always been political. There is no pure science ivory tower. Get involved and DEMAND reform and a modern research infrastructure.

And what if you can't reform due to entrenched interests? SMASH the system. That's what the "Cure by 2020" is to me. A cry of PROTEST and desperation. Just as ACT UP was. We're not going to sit here and die. Yes, tying up traffic in ACT UP is not going to cure AIDS, nor is setting deadlines like "cure cancer by 2020", but that's not the point. The point is to focus attention on the obvious FAILURE of the current approach - frankly to all medical science - and a desperate need to stop business as usual and try for something better.

Because we can do better than this. And it starts with a challenge - whether to put a man on the moon, come up with a super weapon or cure a complex disease through understanding our genetic makeup. It may not be realistic to set a date - in fact we know it isn't. But it starts the conversation.

The easiest thing is to point and laugh at the desperate people who have been dying by the tens of thousands every year. I hope you got you jollies, ho, ho, ho, "cure cancer by 2020", ho, ho, ho, how stupid! Now get out of the way, so people can talk about how to meet challenges and not resign ourselves to our sad lot of "cancer is incurable".
posted by VikingSword at 3:41 PM on November 29, 2012 [2 favorites]

Btw, for as long as I've known, since the late 80s at least, cancer research charities have raised enormous amounts on money and spent it on pure research that had nothing directly to do with cancer even. Things like protein folding, and even things like artificial intelligence and computer vision research that might indirectly help with work on protein folding and scanning cell images.

If your theory is "Give me a few billion, then go away and let me do whatever I want for a few decades", they already tried that.

I can't get over how incredibly wrong this is.

The connection between protein folding and cancer is mind-numbingly obvious: mutations and cancer drugs. Mutations change how proteins fold, change their action, and cause cancer. You have to know how proteins fold in order to design new drugs that target a specific protein. This is a fundamental and essential avenue of research for cancer.

Imaging: every tumor is actually a mixture of normal tissue, tumor cells, immune cells, and vasculature, and etc. Being able to see cancer turns out to be incredibly useful! A lot of in vitro work involves looking at cancer cells in a petri dish. If this is automated, rather than being able to test, say, 1,000 drugs a day on cell lines, perhaps we can try all combinations and test 1,000,000 drug combos a day, a qualitative in addition to quantitative improvement. These are absolutely essential tools, and directly needed by cancer research.

Cancer charities do not constitute a huge amount of money for research. For example, in 2011 Susan G. Komen gave out $63 million for research, a mere 15% of their revenues. Compare this to the NIH's $715 million, or even the Department of Defense's $150 million. The idea that anybody is getting a few billion dollars and working in isolation for a decade is so far from the truth that it can't even be considered a humorous exaggeration, it's just a direct misrepresentation of how anybody, anywhere, works. Furthermore, the bottleneck in cancer research isn't so much the quantity of funds for research, or their particular allocation, the problem is more the structural pipeline from cancer research to clinical trial to patient treatment. This pipeline problem is bemoaned at every cancer conference I go to, and is even the subject of entire cancer conferences. Any complaints about lack of funds are entirely different in nature; the issue is that people don't want to spend such a large fraction of their time writing grant applications instead of doing actual research (The success rate is 10% these days, by the way! And each grant application represents about a month's dedicated work! And the new two strike policy means that you have to spend an even greater fraction of your time writing grants instead of revising that grant that was considered highly promising and nearly flawless by the last review panel! And cancer researchers also have to read these proposals and debate them, and )

When we decided to go to the moon in a decade, it's not like Kennedy went to NASA and said "Why are you wasting all this time working with hydrogen? Hydrogen has nothing to do with the moon!" when in fact it turns out that you may need some sort of fuel for getting astronauts out of the Earth's gravitational well. At least with the moon, we already knew how to build rockets, and such a project was firmly in the realm of engineering, and not basic science. Because it was engineering, there were estimates on what needed to be done, and in 1961, setting a goal of getting to the moon in a decade was at least feasible. But in cancer, it's not like it's 1961, it's like it's 1920, when the New York Times published an editorial so ignorant of physics that it said rockets don't work in a vacuum. Actually' it's more like the pre-Newton era: we know some basic relationships between quantities, but we don't know enough to build a rocket. Biology is so much more complicated than physics, and experiments take so much more wall time to perform, that a "good chunk," of cellular biology is a black box. I can't even say "most" because we don't know how much we don't know, that "good chunk" could be any amount of knowledge.

Advocacy groups have an essential place in the fight against cancer: that role is forcing changes in the way that all the other parties, such as the governmental regulatory bodies, pharmaceuticals, health care providers, patients, and cancer researchers, interact with each other. Breast cancer advocacy groups in particular have done amazing things for cancer research and treatment in the past, and in really pushing such structural changes forward. For example breast cancer advocacy groups forced compassionate use of Herceptin. And the FDA is only going to change the way that they look at approving treatments if advocacy groups get in their faces and make the FDA listen to scientists on new ways to prove efficacy.

We really need advocacy groups to push forward new ways that doctors and patients interact with researchers so that research is translated from the lab to the hospital (or preferably, the home!) more quickly. This is the path forward if you want to accelerate research, but it is fraught with ethical and legal boundaries that the advocacy groups would be really really good at dealing with. Conversely, doctors, researchers, regulators, and pharmaceuticals can not deal with these issues alone. Raising money for research should not be advocacy groups' primary goal, and perhaps even raising "awareness" should not be their goal, other than to educate patients and oncologists. Knowledgeable cancer survivors and interested non-doctors and non-researchers should be setting the boundaries of how we incorporate new research into everyday practice, deliberating on what is ethical, deciding on how we inform patients of the risks involved with new treatments, and establishing best practices for all areas of cancer. Basically, they need to tell us how to balance the goal of giving every person the best possible treatment for their disease with the goal of learning the most from each cancer case to improve future treatments. Only advocacy groups can walk this fine line.

Dealing with such nitty-gritty details, and talking to lots of people about these issues is far more difficult than feel-good goal setting. If any of these people have a practical plan on how to end breast cancer by 2020, have them write up a grant proposal, and if it's plausible it will get funded. But it's not plausible. It takes 10 years of outcome data to establish that you're treatment program can cure breast cancer, so unless two yeas ago they were secretly giving thousands or millions of breast cancer patients experimental treatments, 2020 is a hopeless goal.

People really want to fight against cancer, and unfortunately we're seeing more and more people abuse this good will. The proliferation of pink products purporting to fight cancer is somewhat astounding, and I have to wonder how many of them are scams, and how long until people tire of them. This proposal is a similar abuse of the good will, as it does nothing but serve the publicity interests of this particular advocacy group. If by some miracle breast cancer is gone in 2020 (an impossible though wonderful dream), the group takes credit, if it doesn't, no skin off their back, as their donors won't hold them accountable. Their blueprint is common sense pablum that makes no headway towards their goal. A call to impossible actions is a call to no action at all.
posted by Llama-Lime at 3:45 PM on November 29, 2012 [9 favorites]

Btw, for as long as I've known, since the late 80s at least, cancer research charities have raised enormous amounts on money and spent it on pure research that had nothing directly to do with cancer even. Things like protein folding, and even things like artificial intelligence and computer vision research that might indirectly help with work on protein folding and scanning cell images.

What were they supposed to do? How would you have allocated the money?

If you think that we basically understand how to cure cancer, and all that's left to do is some engineering work and filling in of blanks, then, sure, maybe spending money on a broad range of research initiatives isn't the right path. On the other hand, if this really is a big problem, where our understanding is limited and a solution is decades away (if one ever comes), then it makes sense to spread the investments around a little, because it's hard to predict which will eventually prove to be most important.

My understanding is that cancer fits the latter description much better than the former.

If your theory is "Give me a few billion, then go away and let me do whatever I want for a few decades", they already tried that.

You could use this argument to dismiss almost any area of ongoing research.
posted by Serf at 3:51 PM on November 29, 2012 [2 favorites]

Yes cancer is hard. But the approach to finding a cure has been nothing short of shameful in its disorganization and lack of focus and coordination. You have teams of scientists duplicating work, working at the margins of the issues, and corporations pouring most funds into trying to find a marketable product which frequently does little but extend life by a few weeks in terminal cases. What every woman is hoping for is not to get the disease in the first place, yet only about 5% of the research money goes to finding best prevention methodology. Not much is going to fundamental research to illuminate what causes cancer in the first place. Most goes to finding cures - preferably ones which can be sold by big pharma - once the disease has been established. It would be like focusing 95% of your money on finding a drug to cure lung cancer while ignoring smoking as a cause altogether.

I find little to agree with here, either. Typically, duplicating work is a feature of science, not a bug. If this happens in a very promising avenue of research, it means that nothing is missed, and that the work is replicated in parallel rather than in serial.

What you call "working at the marigns of the issue" could as easily be called doing basic research. What you call "working for a marketable product" could as easily be called working towards the very best that can be done today rather than tomorrow. We shouldn't be doing one or the other, we should be doing some combination of both.

A ton of research goes into finding the mechanisms that cause cancer, the mutations (or cellular contexts) that drive carcinogenisis. If you instead mean that we're not spending much on looking for environmental causes of cancer, the burden on you is to show that outside of tobacco, sun damage, and radiation, we're missing big environmental causes, because the new data we're getting from sequencing is so far showing that those are the primary environmental causes, and any money that would have been spent in that direction without good reason to look there would have been wasted.

I can not get behind a big organization coordinating others' research directions; you'd need to demonstrate what particular gains could be had from that, because it's not clear that there are any. And there's definitely a good chance for stifling a lot of thought and innovative directions.

I could get behind an organization that catalogued discovery, and brought together all the data that was being generated. One of the biggest challenges of cancer research is sifting through the mountain of knowledge and results.
posted by Llama-Lime at 4:08 PM on November 29, 2012 [6 favorites]

Both my mother and my eldest sister have breast cancer. In (hopefully only) my mom's case, it's terminal. For the sake of my other sister (and myself; don't forget that men get breast cancer too, and it's more likely to kill us) I certainly hope it will be cured soon.

Any extra attention paid to any form of cancer is a win in my book. No one should have to die that way.
posted by Thoughtcrime at 4:09 PM on November 29, 2012

I have so much to say about this but it's a topic I'm exhausted by. I don't even know where to start.

First of all, there is no conspiracy to not "cure" cancer. Drug companies can only benefit from advances in cancer treatment. We're on the forefront of personalized, targeted therapies. I can say this because I actually am someone who is receiving targeted therapy based on the genetic mutations present in my tumors.

The thing is, it's hard to figure out how to target individuals. The number of cancer patients who take part in clinical research is tiny. In two or three years, it will be more common to genetically profile an individual's tumor, but right now that pretty much only happens for those of us with specific cancers or metastatic disease who have failed first-line or second-line therapy. So the data set researchers are working with right now is small.

I have low-grade ovarian cancer. My cancer isn't as aggressive as some, but that makes it harder to treat. There is no standard of therapy for treating this kind of cancer. The genetic profiling of my tumor -- my original tumor from 2003 -- shows a KRAS and an NRAS mutation. It doesn't matter what that means because it isn't the mutations I want to talk about, but the incidence of those mutations. KRAS mutations are present in 15% of ovarian cancers. NRAS mutations are present in 4%. The chances of having both is infinitesimal. There are probably only a few dozen (if that) women in the world with these concurrent mutations who are enrolled in clinical trials to try and figure out what combination of drugs will work to stop our cells from proliferating without control.

I'm still waiting on tumor samples from 2010 and 2012 to be genetically profiled. It may be that in the seven years between my original diagnosis and my recurrence I developed other mutations. I may have mutations that haven't even been identified yet. It's really hard to look for something you don't know exists.

Will breast cancer be cured by 2020? Probably not, because there really isn't such a thing as breast cancer. There are thousands of cancers that originate in the breast, but each one operates a little bit different from the next. At best, there will ways of managing metastatic disease but even that will present problems because we won't know the long-term effects of the drugs we will be using to control the cancer. Solve one problem and you might just create another.
posted by Felicity Rilke at 4:29 PM on November 29, 2012 [7 favorites]

VikingSword, your whole comment is filled with so much wrongness and badness! It's kind of remarkable!
posted by Greg Nog at 8:26 PM on November 29, 2012

Instead, we're told "you can't cure cancer" by assorted morons. If you believe that, you're an idiot. There are animals out there that are remarkable for virtually never getting cancer - the naked mole rat is one such example. These are rodents - and rodents are notoriously given to cancer, in fact for many strains of mice that's their #1 reason for death. Yet these RODENTS - the naked mole rats - almost never get it. Obviously, something about their genetic makeup solves the cancer problem.

Cool, so all we need to do is map all the potentially relevant genomic differences between a naked mole rat and a person at the exon, intron, intergenic, and genome organization levels and test these exhaustively until we find a few leads (though cancer signaling pathways are complicated, so we may also need to screen pairwise and 3-way interactions), make gene therapy work a lot better real quick, and then engineer those foreign genes (or gene combos, or intergenic elements) into mice/rats/people until we get one that cures cancer completely without serious side effects.

I mean I think it's a fine idea to study, say, tumor suppressor pathways in animals that don't tend to die from cancer (or more accurately, that die of something else before they die of cancer - mole rats don't live to 120 or anything, and I'm not aware of any evidence that if you prolonged their lifespan to match ours that they would not start getting tumors as well). And I think taking an "engineering" mindset is a potentially cool approach. People work on things like this already. But this research is (at most) no more promising or, certainly, to yield a universal cure for cancer than any number of lines of inquiry funded by the NIH right now. I think even the people who work on this kind of thing would agree that to bet the farm on naked mole rat engineering alone would be an insane move.
posted by en forme de poire at 9:01 PM on November 29, 2012 [6 favorites]

Cool, so all we need to do is map all the potentially relevant genomic differences between a naked mole rat and a person

No. That is not what I wrote at all. You completely missed the point, instead reading things into the comment that weren't there.

The reason I brought up naked mole rats was as a counterargument to the pernicious idea that "cancer will never be cured / can never be cured", an idea that was expressed in the cartoon that's linked to endlessly in these kinds of FPPs including this one. The idea is that there is some kind of biological law that says that cancer is an inevitability. That's clearly bullshit, because examples of animals exist that don't get cancer (and I don't mean animals like sharks, which also almost never get cancer) that are evolutionarily not so far removed from us - mammals that share a huge amount of genetic code with us.

Because naked mole rats are rodents, just as mice are, and many strains of mice die overwhelmingly of cancer, it's clear that their genetic makeup is what makes them cancer-resistant. Note that naked mole rats are extremely close genetically to mice - which tells you that it might not be that many genes involved that result in dramatic differences in cancer susceptibility. It's not like the difference between a shark and a mouse.

Indeed, we know that sometimes a single gene or a relative handful of genes can be responsible for dramatic differences in physiological function - f.ex. a single gene alteration in roundworms can extend their lifespans by 40%. There are countless examples of small variations in SNPs being responsible for huge functional differences. For all that, I am not supposing, indeed I doubt, that only a handful of genes are involved in cancer - it's a very complex process and odds are this is reflected in the genes. But that is no reason to exaggerate the complexity either (mice and naked mole rats are extremely close genetically).

While we may learn a lot from naked mole rats, nowhere do I claim that we can simply duplicate the pathways and cure/prevent human cancer. What I do claim is that naked mole rats tell us that cancer is not a biological inevitability.

It also tells us the direction in which an ultimate cure will be found - genetic engineering. Not duplicating the naked mole rat genetic pathways. Naked mole rats merely show us a proof of concept. Just as if someone claimed that flight is impossible for objects heavier than air, you could point to the example of birds - clearly such flight IS possible, though obviously we don't need to duplicate how birds do it... an airplane can do nicely. Same here. Naked mole rats prove that mammals don't always have to get cancer. It points to the avenue we'll beat cancer - genetic engineering - not necessarily duplicating mole rat genetic pathways.

Cancer is not inevitable. Cancer can be cured and can be prevented altogether. And the way to do that is through genetic engineering.

or more accurately, that die of something else before they die of cancer - mole rats don't live to 120 or anything, and I'm not aware of any evidence that if you prolonged their lifespan to match ours that they would not start getting tumors as well

Wow, talk about self-goal - you've missed spectacularly. You could not have picked a worse example for longevity than the naked mole rat. There are broadly observed biological rules regarding lifespan across species. For mammals it seems loosely related to size, where smaller mammals such as mice live shorter lives than larger ones. A quick list:

"for common house mouse, 4
for Norway rat 7
for dogs, 29 (See List of oldest dogs)
for cats, 38
for polar bears, 42
for horses, 62
for Asian elephants, 86"

For a small rodent the naked mole rat is a FREAKIN PHENOMENON of longevity at 30 years! It's a bloody champion! I actually did an FPP on the naked mole rat, but here's a snippet from wikipedia:

"The naked mole rat is also of interest because it is extraordinarily long-lived for a rodent of its size (up to 28 years[17]) and holds the record for the longest living rodent.[18] Naked mole rats are highly resistant to cancer[19] and maintain healthy vascular function longer in their lifespan than shorter-living rats."

"Naked mole rats appear to have a high resistance to cancer; cancer has never been observed in them.[26] A potential mechanism that averts cancer is an "over-crowding" gene, p16, which prevents cell division once a group of cells reaches a certain size. Most mammals, including naked mole rats, have the gene p27 which does a similar task, but prevents cellular reproduction at a much later point than p16 does. The combination of p16 and p27 in naked mole rats cells is a double barrier to cell proliferation.[27] Hypersensitivity to contact inhibition may be the reason for the cancer resistance of the naked mole rat.[28]
Blind mole rats Spalax golani and Spalax judaei also appear to be immune to cancer but by a different mechanism.[29]"

You appear to be profoundly confused about what cancer is. Cancer rates generally rise with age, and it is thought that one reason for programmed aging and cell death is precisely to avoid uncontrolled proliferation and infinite lifespan of disregulated (cancerous) cells. But that has NOTHING to do with absolute lifespan across species. Short lived species get cancer as they age too - but that doesn't mean that elephants will have the same rate of cancer rates at age 2 as a mouse would - how absurd. Species either get cancer or not - most do - even though they have radically different lifespans.

Cancer has NEVER been observed in naked mole rats even as they outrageously outperform in longevity all other rodents, it is stupid to suppose that had we only managed to get them to live a year more, boy would THEN cancer get them! There are no 120 year old rodents, but there are rodents that NEVER get cancer no matter how old they are even up to the maximum lifespan FOR THEIR SPECIES.

I think even the people who work on this kind of thing would agree that to bet the farm on naked mole rat engineering alone would be an insane move.

Well, the "insane moves" are all in your imagination, since I never made such a proposal. What I did do, is propose that if we are to find a cure/prevention of cancer it will have to come from genetic engineering. I further proposed that we are limited at present by infrastructure, resources and political will to make it happen. These are all solvable problems.

1) Swap the budgets for the Pentagon and the National Cancer Institute. You want war on cancer? Then treat it like a war - with the appropriate budgets. Or were you only blowing sunshine up our asses when you spoke of a "War on Cancer"? Throw national defense size resources at this - millions of people and trillions of dollars. It took us decades to beat the Soviets. It'll take us decades to beat cancer. But it's doable... if we have the political will to reorganize our society and radically alter our priorities. Is it an outrageous use of resources? To me, it's more outrageous to put the exact same resources into bombs. I'd rather put it to fight cancer.

2) Giant challenges work. We mapped the human genome in a race between government and private sector scientists. This is the point of the "cure breast cancer by 2020" challenge. Everybody understands that it's unrealistic - but stating the challenge focuses energy. It will be immensely more complex, but you gotta start somewhere and at some point. Now is as good a time as any. Every day we delay the search for cure/prevention, another batch of people die from cancer. Start today.
posted by VikingSword at 12:31 AM on November 30, 2012

"And the way to do that is through genetic engineering."

You use these words like you understand what they mean, but neither genes nor engineering work this way. We have found really interesting things about where the cancer resistance of naked mole rats comes from, but they aren't even remotely adaptable to human genetics, even if human genetics were a thing we could meaningfully adapt.

Naked mole rats are incredibly interesting, and the study of them does hold a lot of promise for the detection, treatment, and prevention of cancers - but the ready cure of all cancer it is not. I think a lot of the problem in your understanding of cancer is that cancer is ultimately a really poor word to describe the phenomenon in a way that laymen can understand, it is ultimately a negative definition that describes all of the kinds of cells that for whatever reason fail in their core duty to not hog the spotlight from germline cells rather than a positive definition of specific failures. Thus from an educated perspective, curing breast cancer is itself a foolishly ignorant goal, though one that researchers can certainly work within as it is pretty close to a much better goal of understanding and addressing specific breast cancers.

This kind of thing is important, it is vital that we as a scientific community accurately represent what we are doing and what is possible. In this thread I've been particularly impressed by the many non-biologist cancer survivors who have come in plainly and knowledgeably speaking my language to reference the nature of their cancers, but this kind of thing is only possible when we communicate honestly about cancer.

There are many very good reasons to be suspicious of the effect, scientific understanding, and motives of the various pink-washing movements, but while they make a lot of noise they are indeed a remarkably small part of the fight against cancers.

"You appear to be profoundly confused about what cancer is. Cancer rates generally rise with age, and it is thought that one reason for programmed aging and cell death is precisely to avoid uncontrolled proliferation and infinite lifespan of disregulated (cancerous) cells."

This is just embarrassing, dude, you're quoting wikipedia - dead citations and all - and a high school level understanding to a working molecular biologist. You've run right up to the Dunning-Kruger effect and your banging your head against it won't make it go away.
posted by Blasdelb at 2:02 AM on November 30, 2012 [7 favorites]

"In an age where we are on the cusp of being able to affect genetic cures and able to modify our entire genome you are a moron luddite to believe we can never cure cancer - you merely lack imagination, you chump."

Also, while there seems to have developed a cottage industry with Kurzweil and the singularity fuckers around convincing rubes that this is the case, occasionally enabled by big names with big egos, it absolutely is not. Meaningfully altering the genetic information of somatic cells is doable but only on incredibly limited scales and in incredibly limited contexts. Meanwhile, manipulating the genetic information of germline cells is a MASSIVE can of worms we are not likely to open anytime soon, even if we could meaningfully do it for all kinds of good reasons. What we are currently on the cusp of is the real and achievable goal of medicines developed against specific cancers that are more meaningfully defined using genetic techniques and targeted towards those cancers using those same techniques adapted to diagnostics. This is both REALLY COOL and also actually real.
posted by Blasdelb at 9:22 AM on November 30, 2012 [1 favorite]

"The point is to focus attention on the obvious FAILURE of the current approach - frankly to all medical science - and a desperate need to stop business as usual and try for something better."

If they can come up with something better than their frankly delusional 'blueprint' (PDF) I would certainly be open to listening to new ideas about how to make the basic research, applied research, pipeline development, and marketing processes work better - but if past performance is any predictor of future success I suspect that the good ideas we need won't be coming from them. It is pretty precisely equivalent to this proposal only the words are bigger and the concepts more out of reach from the average layman. Their deadline isn't presented as inspiration, it is fraudulently presented as possible if only they get enough money, and the ideas they have for accomplishing it are so transparently stupid that it was difficult for at least me to tell if it was parody or not.
posted by Blasdelb at 9:38 AM on November 30, 2012 [2 favorites]

VikingSword, I'm not so sure that the grand challenge model is a good one here. All the examples you've cited -- the Manhattan project, the moon landing, the Human Genome Project -- were started at a point where we had a basic understanding of how to accomplish the task at hand. The Manhattan project was created because physicists suggested that an atomic bomb would be possible, not because the military ran a crash program asking for a really huge bomb by any means possible. Kennedy gave his speech partially in response to Gagarin's spaceflight. And DNA sequencing was possible at the beginning of the Human Genome Project.

In all three of these cases, while there were major technical challenges remaining to be solved, the basic theory and route to the goal were reasonably clear. I'm not in medicine or biology, but I'd be surprised if you could convince a substantial number of knowledgeable doctors or biologists to agree that eliminating all types of cancers is a problem that currently meets that description.

Increased funding, on the other hand -- I'd believe that would be useful. But I'd be leery of a single medium-term big push. Cancers are likely to exist for a long, long time to come, so you want to create science careers and structural changes, not just a bunch of new postdoc positions.

(Also, man: "idiot", "stupid", "moron", "luddite", "chump"? That's unpleasant. I get that you're frustrated, but it sounds like others in this thread have some pretty valuable thoughts and experience that deserve more consideration than that.)
posted by Serf at 9:49 AM on November 30, 2012 [4 favorites]

Other people have made good points above, but I wanted to say really quickly that the last common ancestor of mole rats (family Bathyergidae) and mice (family Muridae) has been estimated at 50-75 million years ago. It is very difficult to map complex traits even among variants of the same species. Using mouse and mole rat to find specific genetic differences associated with cancer susceptibility would be yet more so.
posted by en forme de poire at 10:33 AM on November 30, 2012 [1 favorite]

While I appreciate all of the naked mole rat love that's going on, I vaguely recall a similar craze around sharks not getting cancer, including a book, and a whole cottage industry around shark cartilage that hurt the shark population and didn't do much for human cancer.

Now, granted, that this was an empiric approach and not a genomic approach, but the point remains: it is very hard to prove what causes a negative and then translate that into something therapeutically useful for humans. It'd be like doing genomic analysis of all of the people who smoke 3 packs a day and live to be 90 and not get lung cancer and emphysema as a way of identifying potential treatments for lung cancer and emphysema.
posted by scblackman at 11:00 AM on November 30, 2012 [2 favorites]

And, by the way, "Naked Mole Rat Love" will be the name of my punk rock band if I ever get around to forming one.
posted by scblackman at 11:01 AM on November 30, 2012 [1 favorite]

With the whole naked mole rat thing, you can't necessarily apply the reasons that they can avoid cancer to humans. Naked mole rats have very, very strange biology and an extremely low metabolism (they are the only cold-blooded mammals), and I'm certain that many of the unusual features about their biology contribute to their long lifespan and cancer avoidance. It is unlikely that you can simply take the elements that make their cancer avoidance work and paste them into humans, any more than you could engineer humans to have a bird's wings and expect flight.

Or, to put it another way "Grasshoppers aren't affected by falling damage! I bet if we study their genome, we can splice in the elements that protect them from falling, and create humans that can fall indefinite distances without harm!"
posted by Mitrovarr at 11:06 AM on November 30, 2012 [3 favorites]

Or, "Spiders can lift grasshoppers twice their size! I bet if we splice radioactive spider genes into my DNA, I could lift a car!"
posted by straight at 11:22 AM on November 30, 2012

"Or, to put it another way "Grasshoppers aren't affected by falling damage! I bet if we study their genome, we can splice in the elements that protect them from falling, and create humans that can fall indefinite distances without harm!""

You could use this program to do it! (On Metafilter Previously)
posted by Blasdelb at 11:50 AM on November 30, 2012

One other quick point:

Short lived species get cancer as they age too - but that doesn't mean that elephants will have the same rate of cancer rates at age 2 as a mouse would - how absurd. Species either get cancer or not - most do - even though they have radically different lifespans.

Indeed, I'm aware that yearly cancer rates differ between long- and short-lived animals, since both trends are influenced strongly by common factors like time to sexual maturity and mating frequency/lifestyle. The point that I was making is that if you could somehow prevent mole rats from dying from whatever it is they tend to die from currently (I have no idea what) and extend their lifespan to be comparable to ours, there is no reason to expect that they would continue to be cancer-free the whole time. After all, cancer is driven by mutation and so the risk of cancer rises with the number of cell divisions. And while it appears that tumor suppressor pathways have been particularly strongly selected in mole rats for whatever reason, years beyond the "natural" lifespan of the mole rat are outside the regime in which natural selection has previously been operating over the last few million years. So my problem with the claim that "naked mole rats tell us that cancer is not a biological inevitability" is that it is much stronger than what the evidence really says, which is that cancer is not a biological inevitability over the span of 20-30 years. That sounds a lot less ground-breaking, even if it's meant to be mostly inspirational and not a direct source of insights about our own physiology.

Meaningfully altering the genetic information of somatic cells is doable but only on incredibly limited scales and in incredibly limited contexts. Meanwhile, manipulating the genetic information of germline cells is a MASSIVE can of worms we are not likely to open anytime soon, even if we could meaningfully do it for all kinds of good reasons. What we are currently on the cusp of is the real and achievable goal of medicines developed against specific cancers that are more meaningfully defined using genetic techniques and targeted towards those cancers using those same techniques adapted to diagnostics. This is both REALLY COOL and also actually real.

Yes, this 100x.
posted by en forme de poire at 2:41 PM on November 30, 2012 [1 favorite]

And even more fundamentally:

The idea is that there is some kind of biological law that says that cancer is an inevitability. That's clearly bullshit...

On the contrary, in a very real sense, there is actually such a law: natural selection.
posted by en forme de poire at 2:52 PM on November 30, 2012 [1 favorite]