Now here is a novel idea to save lives and stop the cancer plague; stop trying! Sounds as crazy to me, as it does to you, but this idea actually may have merit. Some smart people are saying that we have spent too much money for little gain, thus it is time to give up and by retreating win more battles in the war on cancer, than by charging ahead.
The Cancer Prevention and Research Institute of Texas (CPRIT) is the second largest cancer research agency in the United States, after the National Cancer Institute, controlling a pot of $3 billion dollars, most of which funds basic science and clinical research. At recent hearings, university scientists and leaders in biotech proposed that CPRIT cut back on the money it is pouring into laboratories. As Professor John Hagan of the University of Texas proclaimed, “If people didn’t get cancer in the first place, CPRIT would accomplish much of its mission.”
This radical idea was echoed in a scary article in the September issue of Lancet Oncology, entitled “First do no harm: counting the cost of chasing drug efficacy.” This editorial reviewed data, which shows that between 2000 and 2010 many new cancer drugs produced marginal extensions in survival and simultaneously increased risk of treatment associated death and side effects. The Lancet authors emphasized the vital need as we develop new therapies to carefully measure both benefit and harm before FDA approval and for careful post-marketing follow up after drugs are released to the general population.
Now in reality no one is saying that we should shut down cancer research labs and simply hope for the best. Eventually we will completely cure this disease and basic science, as well as the development of new therapies, is key to that future. Perhaps what we should hear from these words is an idea about a different balance in health and healthcare.
100 years ago, the medical model was one of acute disease and trauma. The major events that threatened life were infection, such as syphilis and TB, childbirth and accidents. Chronic illness was rare because we did not live long enough, as the average lifespan in the United States in 1900 was 47 years. Medical science therefore focused on measures to prevent and treat infections, make birth safer and treat injury. This resulted in the rapid rise in life span to 70 years by 1950.
Then the model of illness changed to that of extended diseases such as heart disease, dementia, diabetes and cancer, and research focused not on preventing these illnesses but on treating the affect of these maladies. It is a chronic illness approach where large numbers of patients spend the last years of their lives debilitated while receiving increasingly toxic and expensive therapy to draw out functionally limited lives. This has increased survival only six or seven more years.
The alternative model proposed is a modification of the present life – disease cycle, which instead of focusing on deterioration in the last years of life, targets the prevention of disease during healthy youth. The concept is to achieve high functioning illness free life for the longest possible time and then have the cycle complete with a short end-of-life acute phase focusing on quality. In other words live a healthy life, to say 90, and then die quickly. Theoretically, this would produce a net longer lifespan and a higher functioning level with less suffering.
The scientists testifying in Texas emphasized the need to spend dollars on true health maintenance, studying at a basic science level as well as in the general population, methods to prevent and delay chronic disease. We think of good health practices, such as diet, exercise, reduced alcohol and avoiding smoking as core to such an approach, and as such we each have a responsibility for our own bodies, but while critical this approach is too basic. Sophisticated health practices must be developed, examples of which are the HPV vaccine which by preventing Papillomavirus infection in young people will shortly wipe out cervical cancer, understanding cancer causing genetics or identifying man made chemicals which infest our environment and cause disease.
We must not stop cancer research; the suffering from these diseases requires compassion and a cure. However, as we assign health priorities it may be wise to realize that man at his base is not a chronically ill creature cursed to live a wretched life of suffering and pain, but rather he possesses a marvelous body which is naturally strong and robust by design, and perhaps our goal should be to keep him that way.
James C. Salwitz is an oncologist who blogs at Sunrise Rounds.