Just got through reading “The Emperor of All Maladies” on my Kindle today. Both my mom and dad died from Cancer, so it seemed like a good idea to read up on the subject.
This was an excellent book which provided a great historical overview of Cancer and how science has come to grapple with it. At one point the author makes the joke that Cancer has the Kevin Bacon thing going on: take any subject, and within 7 logical jumps you’ll be at Cancer research. It touches on almost all areas of modern life and science.
If you’ve suffered from Cancer or know somebody who has, this is a good book to read. A bit long and detailed, but it’s a big subject.
Now that I’m done, it got me to thinking: the structure of how we study Cancer might be entirely inappropriate to the disease itself.
Not to spoil the book (we don’t cure Cancer in the end), but as it turns out current belief is that each Cancer is a highly individualized thing — it’s your body’s programming breaking down, and each person’s programming breaks down in it’s own way. Yes, there are broad generalities — leukemia looks like leukemia — but even then, there are lots of different subtypes, dozens or hundreds of mutations can lead to the disease, and only a few of those might be critical. Indeed, it looks like part of the discussion nowadays is whether there’s some way of simplifying Cancer in order to create and provide treatment.
In response to this terrible uniqueness of the disease, I think, several new sciences around bioinformatics have sprung up. There’s a school of thought that says that what we need is not a cure: what we need is a computerized system that “debugs” what’s wrong with each person’s cancer and provides unique therapy appropriate to that. Lots of five-dollar words here, including proteomics, cytogenic chemotherpathy, etc.. The water’s too deep for me, but I get the part about complex systems of programming breaking down. Been there, done that.
This analogy makes a lot of sense to me as a layman, but I wonder about the way governments and scientists discover and approve new drugs. Does the solution fit the system we’ve created to find the solution?
The entire idea of empirical science is that we gather data, note patterns, make hypotheses, then prove them. Mathematical induction is key part of it: if it works a few times and can be reproduced, it will work always. But Cancer is exactly the opposite of that. In fact, one of the reasons it’s been so tough to handle is our idea that it’s just one disease we’re facing. It’s not.
So let’s suppose that there are a million different proteins which either are under or over expressed due to a Cancer. _If_ you had ways of correcting each one, and _if_ a computer could do the analysis, theoretically you could create an intervention that would be tailored to that particular cancer, changing and evolving as the “bugs in the programming” for that particular person mutated.
But how could you test this in a double-blind study? Would you test each one of the two million interventions? Impossible. Test the computer program? Non-conclusive (and perhaps not able of being reproduced, as the program should be evolving along with technology).
I don’t see any way the government could approve of such a therapy, and more importantly, I don’t see any way private companies could make money from helping folks, unless you let them start patenting each one of the two million interventions, which would effectively bring research to a standstill.
I think the way we do science, the way we do medicine, the way we regulate markets where companies can help each other — all of these things don’t match up to the solution we’re working towards in Cancer research. And a lot of people are going to die because of it.
Here’s hoping I’m wrong.If you've read this far and you're interested in Agile, you should take my No-frills Agile Tune-up Email Course, and follow me on Twitter.