Our treatments (surgery, radiation, chemo) seem crude and/or to have horrible side effects; some even people amputate body parts in order to survive
Some cancers are still not detected until very late
It seems like there are lots of open questions about how cancer works (general impression)
I added that up and thought “well I guess we just don’t understand it well enough yet.”
I think you’ve convinced me that “pre-theory” is wrong. But I don’t think you can explain slow progress just by saying “this is a hard problem.” Infectious disease was also a hard problem! Nuclear physics was a hard problem. Etc. And we have way more resources to devote to the problem now (fact-check/citation needed, but without yet researching it I’m ~80% certain of this).
Based on the data in your chart, 21st-century cancer progress looks to be roughly half the speed of 20th-century infectious disease progress. So now I’m wondering, what would it take to double the speed of cancer progress? Do we need a breakthrough in science, in our understanding of how cancer works—filling in a gap in the theory? Or do we just need a breakthrough in technology? Or did the breakthrough already happen and it just needs to be made cheaper, or something like that?
At this point, we’re leaving the land of empirical fact behind and entering the conjectural realm.
With that caveat, I’m going to give two answers: cancer really is harder than infectious disease, and we are still mainly in a paradigm of treating diseases rather than fighting aging.
With infectious disease, we have two powerful strategies that are lacking in cancer. One is targeting the radically different physiology of infectious agents. Here, the targeting problem that impairs cancer therapies is much reduced. We had antibiotics and vaccines long before we had effective chemotherapies in large part for that reason.
Second is targeting the radically different life cycle of infectious agents. Besides STIs, infectious agents have to pass through an external environment to transmit between hosts, and that gives us an opportunity to intervene. We can purify water, cook food, socially distance from the sick, and exterminate vectors like mosquitos. Cancer originates within you, so we just can’t use this strategy.
I’m no physicist, so I can only gesture to a couple structural factors there. One is that with physics, you can directly test your hypothesis on a machine you build from the ground up, whereas in biology, you have to do all your research in an organism that wasn’t designed to accord with theory, and where there are enormous ethical barriers to just testing your ideas directly. You can’t just give somebody cancer and see if your chemo drug helps.
So point A is that a range of specific factors make cancer especially tough to solve relative to infectious disease or nuclear physics. It’s a little like your post from a while back about “why wasn’t this invented earlier,” but in reverse. We can point to specific factors, the ones I’ve just made, that are strong reasons to explain why it has taken longer to bring cancer deaths way down than infectious disease deaths.
Point B is that even now, we focus a lot on specific diseases like cancer that are actively causing patients suffering and are the most legible immediate causes of death. The whole anti-aging field starts by saying “by the time you’ve got old age diseases like cancer, your body’s systems for maintaining itself have gotten seriously impaired. Maybe we can slow or reverse that aging process so that instead of treating dangerous cancers in a body that is prone to getting another cancer soon after due to its advanced age, we just have bodies far less prone to cancer.”
Personally I think that sounds very promising and also has plenty of theory and data, and it’s where I plan to steer my research toward, but it’s also a field with no proven successes yet at least from self-described “anti aging” research. There are pre clinical trials underway, such as a trial of low dose rapamycin in dogs to establish safety and efficacy for as an anti aging drug in a species with similar physiology that shares our environment.
But again, echoes of ancient light: the anti aging field was barely a thing 20 years ago, so we’re seeing those early finds from Lab Centauri just arriving on Planet Clinic now. Last year tons of money poured into the field and it’s way more visible now, so if it’s not just a hype train we might see some truly revolutionary stuff around 2040.
The closest thing I can think of to, if not pre theory then “paradigm shift” in cancer is a refocusing of effort on slowing and reversing aging rather than treating cancer after the body is already in bad shape from a lifetime of biochemical warping.
If you want to double the speed of cancer progress, you’d need to shorten the time it takes to go from lab to trial to clinic without compromising patient safety and willingness to participate in trials. Also just keep dumping money in the space, although cancer probably isn’t your best bang for buck option as far as saving lives with biomedicine.
This isn’t cancer, but the Kidney Project has made a lot of progress on bioartificial kidneys and they tell me they need $10 mil to get through human trials. But it’s hard to come by the funding. So dump $10 mil on them and maybe you’ll cure kidney disease while reducing or eliminating a horrific organ black market.
This is great, thanks. I added a link to this comment in the body of the post.
Where I was coming from was:
We have put a lot of resources into fighting cancer:
We declared a “War on Cancer” ~50 years ago
There are over $7B for it in this year’s appropriations act, about 15% of NIH’s total budget
There are also lots of private foundations working on it
It is the canonical example of a big, important thing to be working on
We seem to be making only slow progress
It is still the number one cause of death
Scott Alexander’s summary was “gradual improvement”
Our treatments (surgery, radiation, chemo) seem crude and/or to have horrible side effects; some even people amputate body parts in order to survive
Some cancers are still not detected until very late
It seems like there are lots of open questions about how cancer works (general impression)
I added that up and thought “well I guess we just don’t understand it well enough yet.”
I think you’ve convinced me that “pre-theory” is wrong. But I don’t think you can explain slow progress just by saying “this is a hard problem.” Infectious disease was also a hard problem! Nuclear physics was a hard problem. Etc. And we have way more resources to devote to the problem now (fact-check/citation needed, but without yet researching it I’m ~80% certain of this).
Based on the data in your chart, 21st-century cancer progress looks to be roughly half the speed of 20th-century infectious disease progress. So now I’m wondering, what would it take to double the speed of cancer progress? Do we need a breakthrough in science, in our understanding of how cancer works—filling in a gap in the theory? Or do we just need a breakthrough in technology? Or did the breakthrough already happen and it just needs to be made cheaper, or something like that?
At this point, we’re leaving the land of empirical fact behind and entering the conjectural realm.
With that caveat, I’m going to give two answers: cancer really is harder than infectious disease, and we are still mainly in a paradigm of treating diseases rather than fighting aging.
With infectious disease, we have two powerful strategies that are lacking in cancer. One is targeting the radically different physiology of infectious agents. Here, the targeting problem that impairs cancer therapies is much reduced. We had antibiotics and vaccines long before we had effective chemotherapies in large part for that reason.
Second is targeting the radically different life cycle of infectious agents. Besides STIs, infectious agents have to pass through an external environment to transmit between hosts, and that gives us an opportunity to intervene. We can purify water, cook food, socially distance from the sick, and exterminate vectors like mosquitos. Cancer originates within you, so we just can’t use this strategy.
I’m no physicist, so I can only gesture to a couple structural factors there. One is that with physics, you can directly test your hypothesis on a machine you build from the ground up, whereas in biology, you have to do all your research in an organism that wasn’t designed to accord with theory, and where there are enormous ethical barriers to just testing your ideas directly. You can’t just give somebody cancer and see if your chemo drug helps.
So point A is that a range of specific factors make cancer especially tough to solve relative to infectious disease or nuclear physics. It’s a little like your post from a while back about “why wasn’t this invented earlier,” but in reverse. We can point to specific factors, the ones I’ve just made, that are strong reasons to explain why it has taken longer to bring cancer deaths way down than infectious disease deaths.
Point B is that even now, we focus a lot on specific diseases like cancer that are actively causing patients suffering and are the most legible immediate causes of death. The whole anti-aging field starts by saying “by the time you’ve got old age diseases like cancer, your body’s systems for maintaining itself have gotten seriously impaired. Maybe we can slow or reverse that aging process so that instead of treating dangerous cancers in a body that is prone to getting another cancer soon after due to its advanced age, we just have bodies far less prone to cancer.”
Personally I think that sounds very promising and also has plenty of theory and data, and it’s where I plan to steer my research toward, but it’s also a field with no proven successes yet at least from self-described “anti aging” research. There are pre clinical trials underway, such as a trial of low dose rapamycin in dogs to establish safety and efficacy for as an anti aging drug in a species with similar physiology that shares our environment.
But again, echoes of ancient light: the anti aging field was barely a thing 20 years ago, so we’re seeing those early finds from Lab Centauri just arriving on Planet Clinic now. Last year tons of money poured into the field and it’s way more visible now, so if it’s not just a hype train we might see some truly revolutionary stuff around 2040.
The closest thing I can think of to, if not pre theory then “paradigm shift” in cancer is a refocusing of effort on slowing and reversing aging rather than treating cancer after the body is already in bad shape from a lifetime of biochemical warping.
If you want to double the speed of cancer progress, you’d need to shorten the time it takes to go from lab to trial to clinic without compromising patient safety and willingness to participate in trials. Also just keep dumping money in the space, although cancer probably isn’t your best bang for buck option as far as saving lives with biomedicine.
This isn’t cancer, but the Kidney Project has made a lot of progress on bioartificial kidneys and they tell me they need $10 mil to get through human trials. But it’s hard to come by the funding. So dump $10 mil on them and maybe you’ll cure kidney disease while reducing or eliminating a horrific organ black market.