2. Meager results in 50 years


The $93.2 billion direct medical expenditures  for cancer in the U.S. in 2008 were almost 100 times greater than those of 50 years earlier ( 1963, for example, had only $1.2 billion in medical expenditures for cancer ).  Compare this to the increased cost of primary food for the same time period of only from 3 to 4 times (in comparison: bacon went from $0.79/lb to $2.99/lb; eggs from $0.55 dozen to $1.29/dozen, bananas from $0.10/lb to $0.39/lb, hamburger from $0.20 to $0.99, chicken from $0.29/lb to $0.99/lb; onions from $0.15/lb to $0.59/lb, etc.).

During the past 50 years reduction in cancer deaths has been recorded as a
mere 5%, while for heart disease the reduction was 64%.

That the direction in cancer research needs to be changed to make it more efficacious is evident when one becomes aware that the reduction of the cancer death rate in the world’s most industrialized countries who have a cancer cost of $741 billion/year is approximately the same as in less developed countries .

If the most industrialized countries, with their annual cancer cost of $750 per capita, were getting their money's worth from this cost, their cancer death rate should be lower than the less industrialized countries with a much lower cost per capita. Data reported  in the figure below that were gathered by the World Health Organization, adapted by the American Cancer Society and published by the National Institutes of Health-National Cancer institut e, show this not to be true. 

In fact, the most industrialized countries should be located at the bottom of the graph where the death rate is lower and the less industrialized countries that invest less money to fight cancer should show a higher death rate and be located at the top of the graph. Because they are not, this proof that the money currently spent by the most industrialized countries to fight cancer is not translated into lives saved.


youralt (Click on picture to increse size)

The New York Times, April 23, 2009  writes:

"
death rate for cancer, adjusted for the size and age of the population, dropped only 5 percent from 1950 to 2005. In contrast, the death rate for heart disease dropped 64 percent in that time, and forflu andpneumonia, it fell 58 percent."

youralt  (Click on picture to increase size) A Stubborn Disease  Interactive Graphic


"Advances elusive in the Drive to Cure Cancer" is the title of the article mentioned above that further states: "Richard M. Nixon announced a new goal.Cancer would be cured by 1976, the bicentennial. When 1976 came and went, the date for a cure, or at least substantial progress, kept being put off. It was going to happen by 2000, then by 2015..."


Now the International Union Against Cancer ( UICC that unites 353 member organizations in 112 countries in the global fight against cancer) is calling to action to sign a Declaration to reach 11 targets to substantially reduce the global cancer burden by 2020.

However, no tools, avenues, strategies, or plans  to achieve that goal by 2020 are reported in the Declaration, nor any tools or strategies that would help anyone understand how the reduction of cancer deaths would be implemented is described on their web site. This “Cancer Research Project Comparison” table reporting all cancer research is a tool that would allow to achieve the targets listed by UICC that cannot find cancer patients and their friends against it.


The article in The New York Times continues: "Cancer has always been an expensive priority. Since the war on cancer began, theNational Cancer Institute , the federal government’s main cancer research entity, with 4,000 employees, has alone spent $105 billion. And other government agencies, universities, drug companies and philanthropies have chipped in uncounted billions more." 


The article continues: "Still, the perception, fed by the medical profession and its marketers , and by popular sentiment, is that cancer can almost always be prevented. If that fails, it can usually be treated, even beaten.


...the grim facts about cancer can be lost among the positive messages from the news media, advocacy groups and medical centers, and even labels on foods and supplements, hinting that they can fight or prevent cancer.


The words tend to be carefully couched, but their impression is unmistakable and welcomed: cancer is preventable if you just eat right and exercise. If you are screened regularly, cancers can be caught early and almost certainly will be cured. If by some awful luck, your cancer is potentially deadly, miraculous new treatments and more in the pipeline could cure you or turn your cancer into a manageable disease...


Unfortunately, as many with cancer have learned, the picture is not always so glowing.


Phyllis Kutt, 61, a retired teacher in Cambridge, Mass., believed the advertisements and public service announcements. She thought she would never get cancer -- she is avegetarian, she exercises, she is not overweight, she does not smoke. And only two people in her extended family ever had cancer.


Then, in May 2006, Ms. Kutt'smammogram showed a foggy spot. The radiologist decided it was insignificant, but six months later, her internist found a walnut-sized lump in her right breast close to her armpit. It was the area that had been foggy on the mammogram.


"I was in real shock," Ms. Kutt said. "How could this be happening to me?"...


Dr. Leonard Saltz, acolon cancer specialist atMemorial Sloan-Kettering Cancer Center, deals with misperceptions all the time. “People too often come to us expecting that the newest drugs can cure widespread metastatic cancer ,” Dr. Saltz said. “They are often shocked to find that the latest technology is not a cure.. .”


One reason for the misunderstanding, he said, is the words that cancer researchers and drug companies often use. “Sometimes by accident, sometimes deliberately, sometimes with the best intentions, sometimes not, we may paint a picture that is overly rosy
, ” he said.


As a doctor who tries to be honest with patients, Dr. Saltz says he sees the allure of illusions .


“It would be very hard and insensitive to say, ‘All I’ve got is a drug that will cost $10,000 a month and give you an average survival benefit of a month or two,’
 ” he said. “The details are very, very tough to deal with.”


The New York Times next day, April 24, 2009
  published another article stating:


"Data from the National Center for Health Statistics show that death rates over the past years … plummeted for heart disease, stroke, and influenza and pneumonia. But for cancer, they barely budged.


Are the statistics lying, hiding major advances because of the way the data are analyzed?  


No, researchers say .


DEATH RATES
are not perfect — no measure is. But they are considered the PUREST MEASURE . That is one reason groups like theAmerican Cancer Society and theNational Cancer Institute use death rates rather than something else, like the number of people living with cancer, to assess progress in fighting the disease..."


On August 28, 2009, The New York Times comments  
the death of Senator Edward M. Kennedy with the following:


"Like almost no one else, Senator Edward M. Kennedy embodied the frustrations of the nation's 40-year war on cancer .

Mr. Kennedy strongly supported the idea of a war on cancer, promoting it for months before President Richard M. Nixon announced the battle was to begin in 1971, and advocating for more money than Nixon initially wanted to spend.


And when Mr. Kennedy learned he had brain cancer last year, he became one of the millions whose fate was not much changed by the cancer war. Despite billions that have been spent, the death rate from most cancers barely budged ...


Mr. Kennedy lived just 15 months after his diagnosis -- just about the median survival for patients with his type of tumor who got the radiation and chemotherapy regimen that has become the standard of care...


The story of Mr. Kennedy's battle with glioblastoma is one that raises questions of hope and reality and of how much the health care system should pay for hope.

As has happened with most cancers in the nation's 40-year war on cancer, progress on glioblastomas has been incremental. With these deadly brain cancers in particular, the disease remains poorly understood. And even though many patients, like Mr. Kennedy, who sought care at Duke University Medical Center, travel looking for cutting-edge care, there are limited options for treatment that have been shown to help.


Yet the cost is high. Estimates of the total cost from experts at various medical centers range from $100,000 to $500,000 ."


The proof that Dr. Saltz's statement in The New York Times dated April 23, 2009: "allure of illusion " in the matter of cancer is true, is that if research had found a solution with the $300 billion spending from when Nixon declared war on cancer in 1971, the prominent people (rich industrial figures, powerful politicians, actors, etc., some of which are listed on this link), would have had access to the cure no matter how much the cost.


The problem is that even them, like everyone else, could not defeat the disease because efficacious early detection tools were not available. In fact, as proven by experimental data, early detection at this time is the only factor showing efficacy in save the life in 90% to 98% of the cases.


Therefore it should be a priority to support, fund and promote technological solutions targeted to early cancer detection.

However, data reported in this “Cancer Research Projects Comparison” table show that a solution targeted to early cancer detection exist for more than a decade, but not only it was not pursued by research, but on many occasions it was opposed by several decision makers in the field who should have been promoting it.  


Clifton Leaf, in his March 22, 2004 article published in FORTUNE Magazine
calls CANCER the Public Enemy No. 1
(see in the Figure below that cancer death rate is hardly reduced, while heart disease has been cut to one third during the last 50 years ) 


youralt (Click on picture to increase size)


The same (FORTUNE) article reports: "...a look behind the numbers for the four biggest killers—lung, colon and rectal, breast, and prostate cancer—reveals that progress isn’t being made where you might think it is. With the help of early detection and treatment, more patients are living longer. Once a cancer has spread, however, chances of survival are scarcely better now than they were three decades ago....


Americans have spent, through taxes, donations, and private R&D, close to $200 billion, in inflation-adjusted dollars since 1971. What has that national investment netted so far? Without question, the money has bought us an enormous amount of knowledge, just as Varmus says [ $200 billion was spent until 2003,  that amount would now be close to $300 billion, because the article is reporting $14.4 billion annual cancer funding for 2003 split as: $4.7 billion spending by National Cancer Institute, $1.9 billion total other federal funding, $1 billion by major charities, $0.8 billion by cancer centers and $6 billion by Pharmaceutical company R&D]...


According to PubMed, the NCI’s online database, the cancer research community has published 1.56 million papers—that’s right: 1.56 million!—largely on this circuitry and its related genes in hundreds of journals over the years. Many of the findings are shared at the 100-plus international congresses, symposiums, and conventions held each year.

Yet somehow, along the way, something important has gotten lost.
The search for knowledge has become an end unto itself rather than the means to an end.

And the research has become increasingly narrow, so much so that physician-scientists who want to think systemically about cancer or the organism as a whole—or who might have completely new approaches—often can’t get funding. Take, for instance, the NCI’s chief funding mechanism, something called an RO1 grant. The grants are generous, averaging $338,000 apiece in 2003 ...


The incentives are not aligned with the goals,” says Leonard Zwelling, vice president for research administration at M.D. Anderson,..

Jean-Pierre Issa, a colleague of Zwelling’s who studies leukemias, is equally frustrated by the community’s mindset. Still, he admits, the system’s lure is powerful. “You get a paper where you change one gene ever so slightly and you have a drastic effect of cancer in the mouse, and that paper gets published in Science or Nature, and in your best journals. That makes your reputation. Then you start getting grants based on that,” he says. “Open any major journal and 80% of it is mice or drosophila [fruit flies] or nematodes [worms].
When do you get human studies in there?

Indeed, the cancer community has published an extraordinary 150,855 experimental studies on mice , according to a search of the PubMed database. Guess how many of them have led to treatments for cancer? Very, very few...


Vishva Dixit, a vice president for research in molecular oncology at Genentech in South San Francisco, is even more horrified that “99% of investigators in industry and in academia use xenografts.” Why is the mouse model so heavily used? Simple. “It is very convenient, easily manipulated,” Dixit explains. “You can assess tumor size just by looking at it.” Although drug companies clearly recognize the problem, they haven’t fixed it. And they’d better, says Weinberg, “if for no other reason than [that] hundreds of millions of dollars are being wasted  every year by drug companies using these models.”...


It is exciting to see a tumor shrink in mouse or man and know that a drug is doing that. A shrinking tumor is intuitively a good thing. So it is no surprise that it’s one of the key endpoints, or goals, in most clinical trials . That’s in no small part because it is a measurable goal: We can see it happening. (When you read the word “response” in a newspaper story about some exciting new cancer drug, tumor shrinkage is what it’s talking about.)


But like the mouse, tumor regression by itself is actually a lousy predictor for the progression of disease.

Oncologists can often shrink a tumor with chemo and radiotherapy. That sometimes makes the cancer easier to remove surgically. If not, it still may buy a little time. However, if the doctors don’t get every rotten cell, the sad truth is that the regression is not likely to improve the person’s chances of survival . That’s because when most malignant solid tumors are diagnosed, they are typically quite large already—the size of a grape, perhaps, with more than a billion cells in the tumor mass.


By the time it’s discovered, there is a strong chance that some of those cells have already broken off from the initial tumor and are on their way to another part of the body. This is called metastasis. Most of those cells will not take root in another tissue or organ: A metastasizing cell has a very uphill battle to survive once it enters the violent churn of the bloodstream. But the process has begun— and with a billion cells dividing like there’s no tomorrow, an ever-growing number of metastases will try to make the journey. Inevitably, some will succeed.


In the end, it is not localized tumors that kill people with cancer; it is the process of metastasis—an incredible 90% of the time.

Aggressive cells spread to the bones, liver, lungs, brain, or other vital areas, wreaking havoc. So you’d think that cancer researchers would have been bearing down on this insidious phenomenon for years, intently studying the intricate mechanisms of invasion. Hardly. According to a FORTUNE examination of NCI grants going back to 1972, less than 0.5% of study proposals focused primarily on metastasis—trying to understand, for instance, its role in a specific cancer (e.g., breast, prostate) or just the process itself. Of nearly 8,900 NCI grant proposals awarded last year, 92% didn’t even mention the word metastasis…


So pharma companies, quite naturally, don’t concentrate on solving the problem of metastasis (the thing that kills people); they focus on devising drugs that shrink tumors (the things that don’t)…


“We have a shortage of good ideas that are likely to work,” agrees Bruce Johnson, a Dana-Farber oncologist who runs lung-cancer research for institutions affiliated with the Harvard Medical School, a huge partnership that includes Massachusetts General Hospital, Brigham and Women’s Cancer Center, and others.


That is also the devastating conclusion of a major study published last August in theBritish Medical Journal. Two Italian pharmacologists [Garattini and Bertele'] pored over the results of trials of 12 new anticancer drugs that had been approved for the European market from 1995 to 2000, and compared them with standard treatments for their respective diseases. The researchers could find no substantial advantages— no improved survival, no better quality of life, no added safety—with any of the new agents. All of them, though, were several times more expensive than the old drugs. In one case, the price was 350 times higher


Avastin was added to the standard chemotherapy regimen, the combination managed to extend the lives of some 400 patients with terminal colorectal cancer by a median 4.7 months. (A previous trial of the drug on breast cancer patients failed.) Oncologists consider the gain substantial, considering that those in advanced stages of the disease typically live less than 16 months. And

Erbitux? Although it did indeed shrink tumors, it has not been shown to prolong patients’ lives at all. Some certainly have fared well on the drug, but survival on average for the groups studied didn’t change.


Still, Erbitux was approved for use primarily in “third line” therapy, after every other accepted treatment has failed. A weekly dose costs $2,400. Remember, it took several years and the participation of thousands of patients in three stages of testing, tons of data, and huge expense to find out what the clinicians and researchers already knew in the earliest stage of human testing: Neither drug will save more than a handful of the 57,000 people who will die of colorectal cancer this year


Michael Sporn, a professor of pharmacology and medicine at Dartmouth Medical School, has two words for this: “Absolute nonsense!” He goes on: “We’ve been stuck with this definition of what cancer is from 1890. It’s what I was taught in medical school: ‘It’s not cancer until there’s invasion.’ That’s like saying the barn isn’t on fire until there are bright red flames coming out of the roof ”…


Adds Sporn: “All these people who are obsessed with cures, cures, cures, and the miraculous cure which is still eluding us, they’re being—I hate to use this word, but if you want to look at it pragmatically—they’re being selfish by ignoring what could be done in terms of prevention .” The amazing thing about this theory—other than how obvious it is—is that we can start applying it right now.


Precancerous cell changes mark the progression to many types of solid-tumor cancers; many such changes are relatively easy to find and remove, and others are potentially reversible with current drugs and other treatments.

A perfect example is the Pap smear, which detects premalignant changes in the cells of the cervix. That simple procedure, followed by the surgical removal of any lesions, has dropped the incidence and death rates from cervical cancer by 78% and 79%, respectively, since the practice began in the 1950s. In countries where Pap smears aren’t done, cervical cancer is a leading killer of women…


With current drugs, early-stage ovarian cancer is more than 90% curable; late stage is 75% deadly . Early results on a protein test for pancreatic cancer are promising as well, says Liotta (chief of pathology at the NCI).


...this is not a million-dollar commitment. It’s a billion-dollar one. But the nation is already investing billions in research, and that doesn’t even include the $64 billion a year we spend on treatment [This was in 2003, which became $93.2 billion in 2008  and keeps increasing exponentially with very little results in premature cancer death reduction]


"The Truth about CANCER: Don't try to cure it Just find it" writes on the cover page WIRED Magazine on December 22, 2008  

WIRED’s article provides data and valid arguments in support of early cancer detection. It provides a figure which reports the 5-year survival rates at different stages for the four most prevalent cancers: Lung, Prostate, Ovary and Pancreas with the following title. "The Riddle of Early Detection: More than 140 million Americans will get cancer at some point in their lives. Find it early and survival rates are high. Catch it late and it's much more likely to be fatal. "


youralt (Click on picture to increase size)


The issue is further addressed in more detail starting from an example of ovarian cancer as stated: "Ovarian cancer, like most cancers, is measured in four stages. Stage I is early, when the disease is contained in the ovaries. In stage II, it may be present in the fallopian tubes or elsewhere in the pelvis. By stage III, it has migrated into the abdomen or lymph nodes. And by stage IV, the malignancy has spread, or metastasized, into major organs like the liver or uterus. (The first three stages are further subdivided into A, B, and C levels.)

For ovarian tumors discovered in stage I or II, the survival rate 10 years after diagnosis is reassuringly high—almost 90 percent—because treatment is straightforward: surgery, perhaps followed by low doses of radiation. But survival rates drop precipitously as the diagnosis shifts to stage III or IV, when the cancer is well established and spreading. Here, the survival rate falls to 20 percent and then to 10 percent.

Unfortunately, more than two-thirds of ovarian cancers aren't found until these later stages.


The survival rate for many cancers is similar to the cliff-like curve that defines ovarian malignancies . Find the disease early, thanks to a stray blob on an x-ray or an early symptom, and the odds of survival approach 90 percent. Treatment —surgery—is typically low risk. But find it late, after the tumor has metastasized, and treatment requires infusions of toxic chemicals and blasts of brutal radiation. And here the prognosis is as miserable as the experience.

This reality would seem to make a plain case for shifting research and resources toward patients with a 90 percent, rather than a 10 or 20 percent, chance of survival. But these are largely hypothetical patients. Cancer may be present, but since it hasn't been detected, as a practical matter these cases don't yet exist.

People with full-blown cancer, however, are very real. They are our fathers and mothers, our children and friends. They're right in front of us. These are the 566,000 Americans who will die of cancer this year.


The US spends billions of dollars to save these late-stage patients, trying to devise better drugs and chemotherapies that might kill a cancer at its strongest. This cure-driven approach has dominated the research since Richard Nixon declared war on the disease in 1971. But it has yielded meager results: The overall cancer mortality rate in the US has fallen by a scant 8 percent since 1975 [5% according to official data and The new York Times’ article in April 24, 2009]. (Heart disease deaths, by comparison, have dropped by nearly 60 percent in that period. [64% according to official data and The New York Times’ article in April 24, 2009]).

We are so consumed by the quest to save the 566,000 that we overlook the far more staggering statistic at the other side of the survival curve: More than a third of all Americans—some 120 million people—will be diagnosed with cancer sometime in their lives. Their illness may be invisible now, but it's out there. And that presents a great, and largely unexamined, opportunity: Find and treat their cancers early and that 566,000 figure will shrink.


Conventional medical technologies—blood tests, x-rays, MRIs—can serve as proxies for proximity, but the picture they offer is often incomplete and obscured. Without a way to positively identify illness early, to detect that first spark, medicine will continue to be a last resort.


When we see cancer early, we have a chance to fight it. In fact, much of the meager increase in cancer survival rates over the past 30 years can be attributed not to new chemotherapies or treatments but to early detection.

Deaths from skin cancer, which is the most obvious to diagnose and treat, have fallen 10 percent. Since the Pap smear—a simple swab of the cervix for precancerous and cancerous cells— became part of routine care in the US in the 1950s, cancer incidence and mortality rates due to cervical cancer have fallen by 67 percent.


Despite this proven model, early detection is an afterthought in cancer research. The pharmaceutical industry spends nearly $8 billion annually on cancer research, according to the International Union Against Cancer, most of it steered toward drug development and late-stage treatments. The major cancer foundations spend lavishly on cure-based research: The Susan G. Komen Breast Cancer Foundation spent $180 million on cures in 2007; the Michael Millken Prostate Cancer Foundation spends about $14 million annually pursuing a cure for prostate cancer; the National Cancer Institute spent just 8 percent of its 2007 budget, less than $400 million, on detection and diagnosis research...


The challenges that linger around early detection reflect a larger disconnect between how we want medicine to work and how it actually does. When we go to the doctor, we expect a definitive diagnosis—a true verdict of what's wrong. Having that, we expect a clear prognosis—an expert prediction of what's going to happen. But the thing is, no matter how brilliant your physician may be, these things always boil down to a guess—informed by lab tests and experience, perhaps, but still a guess.

We want medicine to be deterministic, to follow clear laws and mechanisms. But in reality, it's almost always probabilistic, more calculation than divination. There is no certainty in medicine. Early detection, which is steeped in probability predictions and statistics, just makes these calculations more transparent than we're used to encountering...

For a disease like cancer, so often seen as a death sentence, early detection promises a trade-off. At first, it makes things more complicated. It introduces more doubt and complexity into an already complicated equation.

But in return, early detection promises that this doubt can be quantified, that these new variables can be broken down into metrics, analyzed, and factored into our health decisions. Early detection proposes that the result of this calculation—complicated and ambiguous as it is—will yield better results for individuals and for their families.


This year from 2 to 4 February, 2010 was held at CERN (European Center for Paricle Physics) the First International Workshop at CERN on Physics for Health by the title: "PHYSICS FOR HEALTH: Towards a European roadmap for using physics tools in the development of diagnostics techniques and new cancer therapies
"


The key to finding the answers to all questions, inconsistencies and contradictions raised by the above cited articles in FORTUNE Magazine, The New York Times and WIRE, was given by the Director General of the most prestigious research laboratory in the world, that has just turned on a particle accelerator LHC costing over 13 billion dollars.


CERN Director General Rolf Heuer who, during the opening speech at the workshop attended by scientists, physicists, physicians and decision makers in the field of health care, requested the implementation of the “DIALOGUE”.


Heuer stated: .”..
for me the main thing is THE DIALOGUE between Physics and Health. We need to know the needs on one hand and we need to know which technology can deliver what. We need to understand the problem on one hand and we need to understand the constraints in the other hand. So the DIALOGUE is what I expect from this workshop.

You have to understand each other’s language, that is already the first barrier which has to be overcome. So, what I expect from this workshop is that you [over 500 physicists, physicians and health- care workers and providers who were attending the workshop] 
take the opportunity to intensify the DIALOGUE between Physics and Health, between the needs, technology, etc. and you should look forward.

What I would like from this workshop is easy to say, but I would like to have some brainstorming here... What I would like to say in my concluding remarks, if I make it back with the plane on Thursday is that you have come up with a roadmap, what to do in the next year, what to tackle in the next project, what technology..,
how to continue this dialogue.

This would be, I think, a big success if you will come up with a roadmap on how to move from Physics technology to Medicine, that is what I would like to charge this workshop with, so I am looking forward to seeing what I can conclude in two days," said CERN Director General (see the video recording of Heuer’s opening speech)


If all parties would implement the “DIALOGUE” requested by CERN Director, this might not only clarify each inconsistency, contradiction listed above, but such DIALOGUE referred to this Table which allow to compare cancer research projects that have more potentials to reduce cancer death and cost, it could also be the tool which leads to finding a solution to the cancer problem.
 

 

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