Charlie Rose: Cancer
Great all-science show on Charlie Rose tonight, if it was rather frustrating for a would-be physician scientist to watch at times. Did anyone catch it? Frustrating partly because it showed the highly educated layman's basic lack of understanding of how science works (and what an astoundingly complex problem human biology is). But mostly because the guests brought up two very salient points: One, in the U.S. we do a terrible job of making basic preventative procedures accessible to the general public; and Two, despite great advances in understanding the biology of cancer, the drugs in the clinic just aren't keeping pace.
Great points, which deserve only complex answers. But it boggled me that no guest (or Charlie himself) could bring themselves to even suggest that: One, some form of universal health coverage just might be an extremely cost effective way to prevent cancers and improve our overall health; and Two, giant for-profit pharmaceutical firms may not be the most efficient midwives for drug discovery and development.
You could argue against both those suggestions, and effectively, too. But no one dared even bring them up. The closest anyone got was when the very eloquent Dr. Harold Varmus cautiously suggested that our low rate of colonoscopies might have something to do with "the way we deliver health care in this country". But no closer.
And as an aside, this was the first time I've seen Andy Grove speak. I hope he isn't actually in charge of any decision-making at Intel. I couldn't diagnose him from the TV, but there's definitely some sort of frontal lobe dementia going on there.
Great points, which deserve only complex answers. But it boggled me that no guest (or Charlie himself) could bring themselves to even suggest that: One, some form of universal health coverage just might be an extremely cost effective way to prevent cancers and improve our overall health; and Two, giant for-profit pharmaceutical firms may not be the most efficient midwives for drug discovery and development.
You could argue against both those suggestions, and effectively, too. But no one dared even bring them up. The closest anyone got was when the very eloquent Dr. Harold Varmus cautiously suggested that our low rate of colonoscopies might have something to do with "the way we deliver health care in this country". But no closer.
And as an aside, this was the first time I've seen Andy Grove speak. I hope he isn't actually in charge of any decision-making at Intel. I couldn't diagnose him from the TV, but there's definitely some sort of frontal lobe dementia going on there.
Comments
An article in the NYTimes today tells of a breakthrough by scientists trying to discover why some lung cancer patients respond fanatasically to a new drug, while others aren't helped at all. Turns out that about 10% of cancers have a specific mutation in the gene targeted by the drug that makes those tumors exceptionally susceptible. This is exactly the sort of incremental finding, repeated thousands of times, which will help us win the war on cancer. Soon a test will identify which patients have tumors with the mutation, they can be treated with this wonderfully effective drug, and for them, the war on cancer has been won.
But it's rather different from the viewpoint of the pharmaceutical compnay that developed this drug:
But the findings may also hurt AstraZeneca by limiting use of Iressa to those with the mutation. Worldwide, 125,000 patients have taken Iressa; in the United States, 64,000 prescriptions for the drug have been written since it was approved.
Dr. Roman Perez-Soler, chairman of oncology at Montefiore Medical Center in the Bronx, said he was besieged this week by calls from Wall Street analysts as rumors of the upcoming papers began to spread.
"They are all very scared of this," Dr. Perez-Soler said. "They think this will shrink the market by 90 percent." He said he did not think that would happen yet.
Those analysts are right - it will shrink the market for the drug, and so reduce its profitability. It reveals an interesting clash of motivations: for the drug company, it's better to not know how a drug works, because if you don't, you'll give it to everyone in the hope it will help some of them. If you know exactly how it works, you'll give it only to that subset of people you know it will help.
There's nothing wrong or evil about that - a company exists to make a profit. That's what it's supposed to do. But having that completely understandable profit motivation hinders the progress of science; results in a huge waste of health care money on drugs that don't work on a particular patient; and is clearly against the best interest of a patient who would rather be treated with one drug that does work than twenty drugs, nineteen of which don't. So maybe, just maybe, we should be talking about ways to do drug development without the profit motive.
Within the context of drugs, most don't work the way they are supposed to; most don't inhibit the things they are targeted for, and almost all of the drugs on the market were discovered by accident and have unknown and unexplored targets. The human body and the drugs we supply it are black boxes for the most part regardless of how much 'progress' science has made in the last half century. We are better able to determine what we don't know than to say for sure what we do know.
Drugs, truly effective drugs, will possibly have to be tailored to the individual to account for all of the isoforms, presence/lack thereof of the targets and any possible binding partners the drug interacts with on its way to the "ultimate" target.
Bah. To hell with pharms in its current state...
I do agree, the title of this thread is unintentionally misleading. Maybe it should be "Charlie Rose Show, Topic: Cancer". Anyway, glad that Charlie hasn't made any sad revelations about his health.
The Frontline episode about the DNA Race seemed to frame a similar argument about private industry versus public research. In everything that I've read and watched on that topic it seems that the private research is what kicked the public research right in the crotch, daring it to keep up. That kind of competition arguably sped up the documentation of the human genome by years. Will the potential cost to consumers be worth it? Absolutely.
The same with pharms. If the big drug co's don't "want" to know exactly who's to benefit from their products that won't stop outside researchers from making those types of discoveries. The truth will out.
I don't know what steps we can take to remove the fear of early screening from our society other than beginning with our children and teaching them a "non-fear" of doctors at the same time they're learning their ABC's. How exactly you accomplish this 'good doctor propoganda" is beyond me. Kids hate anybody that sticks a needle in them!
Originally posted by CosmoNut
Your subject line makes it sound like Charlie Rose HIMSELF has cancer.
Exactly.
-Neø
Originally posted by Neø
Exactly.
-Neø
Didn't even occur to me. Charlie Rose: Iraq, Charlie Rose: Terrorism, Charlie Rose: Politics, Charlie Rose: Cancer. If any any of the mods would like to add "Show" in there, or change it to "Charlie Rose: War on Cancer", or "Charlie Rose on Cancer", feel free. I guess the last makes it sound like a new recreational drug, though.