Cancer history and where we are today

The last several blog entries have been largely about the historical journey of cancer.  Here I want to suggest how the historical state of affairs in medicine and cancer treatments have influenced where we are today, but also might encourage us to think that we are not as bad off as many (including me) tend to suggest at times in terms of cancer  treatment.

Historically, it is quite clear that medical improvements moved slowly.  We were in the dark ages for a long long period if time due to our over reliance on established dogma, our own belief systems, and fear.  Medicine and the seeking of truth behind medicine was held back for so long that we really did not have much to look forward to when we came across a major illness like cancer.  Now, major illnesses are still scary and fraught with difficulty, but we do look forward and are rightfully hopeful that we may be cured or at least stall the major illness in question.  Many, but not all cancers are treatable.  Many, but not all patients with cancer do get well again.  Many, but not all patients with cancer are ‘cured’ and live happy (we hope) and healthy (again we hope) lives. 

Now, we are at a new stage of our medical development.  No longer are good survival rates or even average survival rates acceptable.  In the past poor survival rates we accepted as normal.  We have now decided that NO patient should ever die of cancer.  This has led us allowed the alternative medical profession to see an upswing or a surge interest these days.  Patients are begging for additional avenues for potential treatments.  Now, when faced with a difficult cancer or when faced with advanced stage cancer, etc., patients are very heightened to learn more about what we can do in addition to or in replacement of the western medical treatments.  They DO NOT want to learn that their advanced cancer stage only poses a 10-20% survival rate. Many now wish to seek nuticeuticals and alternative medicines that may increase their survival rates.

Alternative medicines, nutritional, naturopathies, and other non-traditional medicines seem to fill the void.  They seem to be ideal in meeting the needs of patients.  In fact, natural remedies have always played roles in treatment.  But, as medical developments raced ahead and provided TRUE increases in survival benefits to patients with cancer and other chronic diseases, less emphasis was placed on them.  Scientific and national governance institutes shut out most forms of natural treatment and even made sure that traditional medical learning programs did not receive accreditation or were not medically approved.  This was fine when Western medicine was increasing in value…more and more people were living after surgery and other medical treatments.  No need for alternative medicine it was thought.  Why bother?

Things have changed…we have reached a bottleneck.  Now, it seems for many cancers and other chronic diseases….we are no longer increasing the survival rates of many of the more severe patients.  Medicines and treatment at our disposal work for many but are still not effective for others.  Newer additional medications and advancements in surgical techniques such as robotics, etc. are not proving to do much for these more severe chronic diseases.  We are still losing many late stage patients to cancer year after year.  So, will natural medicines, will alternative medical professionals, will supplements and others fill in the gap?  Can they achieve what traditional western based medicine has not?  Can they cure cancer, diabetes, cardiovascular disease, etc?  I just don’t know the answer to that. 

There is a mix of data out there.  There is TONS of anecdotal evidence but very few hard facts on how well these alternative forms of therapy work.  The issue I have always felt is that if they don’t do any harm…then why not allow them and encourage them in patients who have little other treatment options.  Giving people hope (realistic hope) and managing their expectations while providing them with alternative therapies, may not be a bad idea.  However, asking patients to take supplement blindly from folks who are selling them with little to no medical/scientific qualifications is quite scary.  Allowing the commercial aspects of marketing and sales of these alternative products with little to no medical or ethical oversight might prove to be a huge risk. 

What do we need to do.  1) Some scientific real hard data needs to be presented and accepted before many of these supplements and treatments are allowed.  The people who are selling them must separate themselves from the people who are testing them as to create a fair and open process.  2) The people who are selling and/or marketing these natural drugs and treatments MUST have some qualifications before doing so.  They must have some training.  They should not be sales folks with no scientific/medical instructions selling these products to people and telling them the benefits to their health.  3) Their must be some kind of oversight to these drugs and treatments.  Someone must look into the products to make sure that they contain what they say they do, to make sure that they are safe, and to oversee that they indeed do what they are intended to do.  Alternative medical practitioners should also have an accreditation body…someone out there must assess them to make sure they have the right training and will provide no harm to patients. 

All of these do not mean that the alternative medical community and the natural products that go along with them need the same degree of oversight that synthetic drugs and surgery etc. demand. No, we do not need a FDA to oversee these.  But, we need some kind of safely and ethics board to oversee these.  We CAN NOT be hurting patients who area already sick by giving them products that have never been tested etc.  We CAN NOT give patients false hope and tell them they this natural agent will cure them of their cancer if there is NO evidence of that. 

So, in conclusion…medical history has helped guide the current state of affairs.  Patients want more….they want to live longer and healthier.  They now want more than traditional western based medication in many cases.  There are a lot fo potentially wonderful natural products out there.  These may fill the gaps.  However, they need to be regulated and they need to be studied.

Thank you…please see the Cancer Made Simple website for more information.

Dr. C

Even more cancer history

Paul Ehrlich

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Ok were were we….oh yes, we had just finished talking about how for thousands of years the common thought was that cancer was caused by too much of this hidden fluid in the body known at the ‘black bile‘, despite the fact that it had never been seen.  We also talked about how due to the ubiquitous production and flow of this black bile, physicians believed for many a thousand years that one should not remove the tumors/cancer if discovered…as the black bile would flow back in and the patient would be worse off.  Finally, since the Egyptians (if not earlier) all illness and especially cancer was caused by the gods of some sort of external influence that we had no control of and was not related to our own bodies per say. 

It took some daring rule breakers to actually question the Greeks dominance in medicine. As I also mentioned even when it became clear that Cancer was not due to black bile, as none could be found ever in any cadavers and cancer might be removable through surgery, some HUGE hurdles remained.  Two of them included post surgical death and the other included unbearable pain during the necessary operations. 

Both of these were solved in time and actually rather quickly in succession.  Two Germans Paul Ehrlich in 1828 and then Paul Ehrlich in 1878 linked chemicals that could be made in the lab with potential treatment that could be made in humans…never before thought possible.  All of this possible due to the chemical dye revolution that was going on in Germany at the time.  Modern chemistry was taking off and these two started linking chemistry and biology in ways never dreamed of.  Ehrlich eventually won the Nobel prize for using a chemical to kill the bacteria that was killing people with tuberculosis (in 1908). 

With this, although no anti cancer agent had been discovered, the road to the use of chemical to treat any disease including cancer was finally opened!  Other would now have to fill the coffers with appropriate medicines.

 Please stay tuned for more.

Please also visit cancer made simple to find out more about cancer!!!

Thanks Dr. C

more on cancer history

Mural painting showing Galen and Hippocrates. ...

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I had assumed that the history of cancer would be pretty boring and not of much interest.  But, after having read a book by Dr. Siddhartha Mukherjee called “The Emperor of all Maladies”, I think my perception has changed.  The history of cancer is full of many interesting twist and turns. Here, I will highlight only a few and talk about how they affected the outcome of cancer treatment for many years.

Historical facts are highly dependent on beliefs of the time and cancer history is no different.  What is surprising is how long old habits can last, even when it comes to life and death.  In the area of cancer…this is quite striking.  As I mentioned in my previous blog, the teachings from Hippocrates and from an avid follower of his, a physician named Galen, the theory of the four humors of cancer was very much in vogue.  In Roman times at around 460 AD when Galen wrote his theories, cancer was thought to be due to an excess of black bile.  The other three humors of liquids in the body incluced yellow bile (a cause of jaundice), Red or blood (too much caused blood related diseases) and phlegm (linked to many other ailments at that time).  At that time levers and pulleys (remember, the Romans had an advanced system of carrying water into their cities) were used to explain how these fluids moved from one part of the body to another and how if disrupted or collected in excess led to diseases such as cancer.  Galen’s teachings were so respected and so believable that they remained commonplace for over several thousands years.  The other issue that was so galvanized into physicians minds for years to come also came from Hippocrates and Galen.  That is that since cancer is a result of too much bile and that this black bile was everywhere, it made no sense to remove it.  The black bile would only flow right back into the place that the tumor was found before it was removed.  Galen had suggested that patients live longer if you just left the cancer in place.  This dogma remained in place well into the early 1900’s when surgeons did attempt to try and remove cancers by cutting them out.  Over and over again physicians would state how impractical it was to remove a tumor and how patients never recovered afterwards, so that this impossibility so it seemed remained entrenched for so long.

Actually, this may have been a mixed blessing.  In fact, we now know that removing the cancer from the body was a risk and did cause death in patients nearly 100% of the time.  However, this was rarely due to cancer but due to other factors.  Actually, in reality surgery of any kind even minor skin surgery often resulted in death….it was not really an issue of cancer or not.  There was no understanding at all of pathogens like bacteria that were all over, including the air.  There was also no useful anesthetic for the longest time and alcohol and other spirits were often used, but they certainly did not dull the pain very much.

There were several turning points that finally lifted the veil off the idea that diseases were caused by humors alone (or even the thought that was common for thousands of years that the gods or somehow bad behavior gave you illnesses) caused diseases like cancer came from the detailed study of anatomy.  First in 1533 and then again in 1793 two different notable physician/anatomists (the subject still very new in the mid 1500’s) made detailed observations of the human anatomy…describing/recording their meticulous finding in pages and pages of drawings.  Neither ever found evidence for the three humors being compartmentalized in a way that they could cause things like cancer.  In fact, black bile was never found at all.  In the late 1700 and into the 1800 as more and more anatomists starting dissecting cancer after cancer from dead cadavers, it was quite clear that the issue of black bile simply could not be resolved and perhaps not trusted.  This was a HUGE leap and not trusted by the clinical community for many years.

Ok..well that’s it for now…next I will talk about how anesthesthetics and antibiotics helped change things even more drastically!

Thanks and I hope you have enjoyed reading this.  Please do visit Cancer Made Simple to find out more educational material on cancer!

Dr. C

Cancer: a brief history!

Hippocrates: a conventionalized image in a Rom...

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Hippocrates is very famous for what many Western Physicians very well know almost by heart…the Hippocratic oath that basically states that a clinician must treat every patient to his or her fullest without any prejudice.  However, Hippocrates a greek Philosopher/physician was also documented as being the first one to come up with the modern word for cancer.  He thought that the tumors in people who had died of cancer had spread around and crawled from one place to another and thus named it “karkinos” which means crab.  Although he is credited with naming the disease, he is certainly not the first ones to describe the disease.  That distinction belongs to the Egyptians which as far back as 1500 BC well before the Greek Hippocrates at 460 BC. 

There in Egypt at the time, tumors were discovered and removed in a somewhat similar fashion as today using simple surgery and the idea of using high heat to burn or ‘Cuaterize’ the flesh around the areas of the excised tissue was even used.  One of the best described then were tumors of the breast.  However, not surprisingly cancer was thought to be exclusively caused by the gods.  The Greeks also believed in spiritual reasons behind sickness and disease and Hippocrates and the “Coprus” movement at that time tried to teach people that illness was caused by external factors like the foods we eat, etc.  Hippocrates believed that humans were made up for four types of humors of fluids including, blood, phlegm, yellow and black bile.  He and other believed that cancer was a result of excess build up of black bile.  His teaching were so profound that they basically lay untested for thousands of years and only about 1400 years later did we get a more clear understanding of cancer.

More modern concepts of cancer came about in the early 1990’s.  For example, in 1847 a German clinical researcher named Virchow named a strange disease that was seen in the blood as leukemia and in doing so lay down the thinking that diseases like cancer have cellular causes and are not spontaneous or due to liquid humors and compositions.  Toward the end of his life Virchow discovered the reasons behind cancerous growths, mainly uncontrolled growth and actually coined the word ‘hyperplasia’ and ‘neoplasia’ terms that accurately reflect today’s understanding of cellular cancer.  Even in the early 1900’s it was understood that these blood cancers and even solid cancers could be what is known as indolent (quite) or chronic (full bloom) and that one could look under a microscope to get a better picture of the disease and that the basis was cellular.  This is again the start of modern-day cancer thought. 

Cancer is complex and like many other things in history the entire filed can not be boiled down to a few people like I just did.  But, to make things easy and straightforward, only the biggest issues were brought up.  Of course, there are hundreds of scientist and clinicians who have all together helped us define what we know about cancer.

For more information on cancer please do come visit me at Cancer Made Simple!

Dr. C

Cancer history

I bet very few of you know how cancer got its name and why it is called cancer in the first place?  Stay tuned and I will let you know where the term came from and more information about how cancer was ‘founded’ historically.

Please feel free to ask me any questions and suggest some topics that you might be interested in seeing a blog article about.

Thanks Dr C.

Drug companies and the war on cancer III

Logo of the United States National Cancer Inst...

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So the last two blog entries have painted a bleak picture on the anti cancer drug development process. 

I do not think that the picture need to stay dark and there is some reason to hope that things will change in the future.  Furthermore, there are certainly some gains and headway being made in the US, Europe and some parts of Asia in terms of new ideas coming into the pipeline and so on.  So, things are not all doom and gloom.  In fact, the best gains have been made with early detection of breast and prostate cancer, vaccines against HPV in preventing cervical cancer and finally with non smoking campaigns which are finally seeming to sink in.

However, where do we go from there with drug companies and researchers.  Here are some suggestions.  Reward risk takers.  Fund researchers who are not following the herd…give money to those who think outside of the current dogma.  Fund project that reward groups of researchers working together in unique ways to uncover overlapping and interrelated pathways so that more patients may benefit instead of just a few.  Program project grants are awarded by the NIH, but at much lower levels that the PI initiated grants (a PI is a principal investigator usually working on his or her own lab).  Fund projects that combine drugs and or that look at multiple pathways, not just one as is very typical.  Stop funding in such large amounts ‘me too’ research that uses the same mouse models that are injected with human tumors and that look at tumor shrinkage as an end point. 

We need to pressure the FDA to remain vigilant for safety but to start taking some risks as well.  1)  Why not allow clinical researchers to start with patients who starting treatment for the first time to be placed in clinical trials instead of those who have failed all forms of treatment?  2)  Why not allow multiple forms of therapy to be used at the same time (yes I realize that it makes for a highly complex statistical task and does add risk, but may prove to be much more affective at helping to ‘cure’ a patient’s cancer?  3) Why not allow new classes of drugs to be tested even if we don’t have tons and tons of data on it?

For the legal community and tort law, well this is a tough one….how to minimize this.  We have got to put some sort of halt on the legal community in conjunction with the drug companies for allowing companies to ‘patent’ or hold legal rights to the combinations on drugs.  this push by the legal community to allow this drives up the cost of the drug and almost always prevents it from getting marketed due to arguing by companies and such.  The cost of all the litigation is in part driven by the FDA and the patient care issues.  We should think about revising the entire legal tort law process for cancer drugs.  This again is not easy and will cause much pain but will also lower costs and speed up the process of getting promising drugs to the patient. 

As we age as a population, we are going to see cancer becoming more and more prominent.  As I have mentioned over and over again, complete cures for cancer is not an achievable goal for the forseeable future.  HIV patients now live for a long-long time with AIDS but are not cured.  That is one disease.  Cancer is many.  But, for sure we can make headway in preventing cancer and keeping it at bay once it is detected.  Early treatment can be something that is promoted at the clinical schools and in public health initiatives. People will continue to die of cancer, but perhaps they will die of it in old age and not young.  Perhaps their quality of life can be enhanced and perhaps we can find drugs that are less toxic but very effective. 

Thanks for reading this blog and this series of ‘War on cancer’.  Please look out for more entries and do visit my cancer made simple page.

Dr. C

Drug companies and the war on cancer part II

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This topic has been popular so far and I have decided to expand on this area here and discuss some other problems with the system while I have an audience.  The problem I would like to discuss is that of the ‘Clinical Trial‘ process of anti-cancer drugs.  This is a very VERY expensive component of the drug companies expense when trying to get a drug to the market.  The FDA and other agencies like it do require that the drugs are tested in clinical settings with humans.  This is actually a good idea and should be done before a drug is released to the market as Humans will be using it in the clinical settings (not mice in cages…as early studies are performed with).  However, this process has perhaps gotten out of hand these days and drug companies are struggling with unimpressive drugs that cost WAY too much to develop.

What is the problem?  1)  The cost of clinical trials in the US and Europe is absolutely huge and is driving away drug development by smaller companies who actually have innovative and potentially effective ideas. 2) Most anti cancer drugs are required to be tested on the most sick cancer patients and not on newly diagnosed cancer patients (the latter only happens when the drug has been around for many years and lots of data is available, but not for new drugs being tested).  Now, this sounds like a great idea, but as you might see in a minute it’s not.  The sickest of patients who have tried other therapies and are still unresponsive and their cancer is progressing are usually eligible for clinical trials with new agents (as long as they can tolerate the drugs, eg. they can not be too old or have other underlying conditions like heart problems, etc.).  So you might think that is a drug works in the sickest of patients it is likely to work on patients who are less sick and whose cancers are less advanced.  But, this is not the case.  You see, late stage cancer patients look nothing like early stage cancer patients….especially late stage cancer patients who have failed previous therapies.  As cancers progress and get more and more lethal, they get larger of course and they also move to other locations…and the cancers have added extra mutations etc.  So, although the cancer may shrink due to the new cancer drug and things look good in the more advanced cancer patients, the drugs don’t always work and produce different results in patients who are newly diagnosed or not as advanced.  3) Another problem is that since these patients are so sick even if their lives are extended for an additional month and even if only 10-15% of patients respond well, this may be enough for the trial to be considered a success.  In fact, those increases are not very big for the average patient and rarely translate to patients who are not in the earlier stages of their cancer.  The 12-14 years is takes for the company to develop a drug that frequently leads to 10-15% survival benefits of a few extra months is not very good indeed and is often too typical.  Some drugs do shrink tumors but end up having no or little survival benefits. 

These new drugs usually cost thousands of dollars a month, typically provide only limited survival benefits, in usually patients with the most advanced cancers, and have taken well over ten years to develop.  I am not sure about you, but this does not sound like a resounding success to me.  It seems like a bit of a failure.  But, wait…let’s not go that far.  Le’s examine why this system works this say and leads to these kinds of problems. 

First the science.  The drugs are usually targeted at very specific molecular pathways in the cancer cell. To be fair to the scientists (as I have been for many years) it’s only natural to take this reductionist approach of developing something that is very specific and maybe even sensitive.  So, if you make something so specific you might not be surprised to know that it may only work on a small subset of cancers with that particular issue.  The granting agencies are only giving money usually to those who focus on very manageable problems that can be tightly controlled (unfortunately cancer is not like this at all in the real world), so the scientist need to follow the money.  Testing the scientific principle like we are taught requires very controlled and specific pathways etc. Drug companies base their work on what thousands of scientist have done and thus are strongly influenced by this as well. 

Now the FDA.  The FDA is going to allow drugs that are safe.  Unfortunately, to be safe sometimes means that the amount used has to be reduced so that the toxic effects of the drugs are reduced.  This also reduced the beneficial effects of the drug on the cancer.  Furthermore, the FDA likes to award marketing status to drugs that have a lot of previous data on them and are hesitant to do so with completely new classes of drugs or drugs which come from undefined sources (such as plants, etc.).  So, companies must constantly look for drugs that fit these parameters and frequently are stuck with less than blockbuster drugs

Legal/Regulatory; The regulatory/legal framework is set up such that safety is first and that the unknown is unacceptable.  This is why new drugs can only be tested on patients with advanced forms of the cancer, ethical guidelines say that only very sick patients can be experimented on, when in fact there are a lot more patients who are recently getting the disease.    That is why advanced cancer patients can be tested but not newly diagnosed patients.  This may sound like a good thing, but in the end its keeping a lot of those who might benefit from new drugs from not getting them.  The idea is that people in the early stages of cancer are healthy and do not need to be treated…this is a very silly idea and I don’t really know where it came from.  But, that is what clinicians are taught.  So, again don’t do anything until the cancer is more advanced. 

Anyhow, I hope that you now have a better understanding of why anti cancer drugs cost so much, are frequently not very effective, and the limitations that exist for their development.  I will talk more about this issue from time to time.  Do send me some comment if you have further questions and do visit my Cancer made simple website for more information. 

Dr C