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Art of the Soluble | WE THE CURIOUS vol.2 no.2

Art of the Soluble | WE THE CURIOUS vol.2 no.2

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Published by Mackenzie Hawkins
It is a "groupthink." It is a tragedy. But there is another word for it as well. It is science -- this is how science works.
It is a "groupthink." It is a tragedy. But there is another word for it as well. It is science -- this is how science works.

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Published by: Mackenzie Hawkins on Sep 12, 2010
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05/19/2012

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 Art of the Soluble
 
Art of the SolubleWE THE CURIOUS vol.2 no.2
"Most of all, of course, I was lucky to survive," writes Clifton Leaf, the executiveeditor at Fortune. In 1978, at the age of fifteen, Leaf was admitted to a clinical trialat the National Cancer Institute and cured of Hodgkin's disease. "So it makes thequestion I am about to ask sound particularly ungrateful: Why have we made solittle progress in the War on Cancer?"The science of cancer -- our understanding of the disease -- has clearly progressed.We are now, in the words of Harold Varmus, head of Memorial Sloan-Kettering,"pretty damn knowledgeable" about how cancer arises. Altogether the cancerresearch community has published 1.56 million papers, largely on the genes and"signaling pathways" that go haywire in a cancer cell. "You get a paper where youchange one gene ever so slightly and you have a drastic effect of cancer in themouse," explains Jean-Pierre Issa, a leukemia researcher, "and that paper getspublished in Science or Nature, and in your best journals. That makes yourreputation. Then you start getting grants based on that. Open any major journal and80% of it is mice or drosophila [fruit flies] or nematodes [worms]."But, according to the head of cancer research and clinical investigation at Eli Lilly,mouse models are "woefully inadequate" for determining whether a cancer drugwill work in humans. "If you look at the millions and millions and millions of micethat have been cured and you compare that to the relative success, or lack thereof,that we've achieved in the treatment of metastatic disease clinically, you realizethat there just has to be something wrong with those models." Somehow, ourunderstanding of how cells can become cancerous -- and might be cured -- in thelab has not brought us the cure we need.
 
 In his article Why We are Losing the War on Cancer (and How to Win It), CliftonLeaf gives this stark summary: "In 1971, when the war on cancer began, 50% of people diagnosed with the disease went on to live at least five years. Today, 33years and some $200 billion later, the five-year survival rate is 63%, a modest 13-point gain. But a look behind the numbers for the four biggest killers -- lung, colonand rectal, breast, and prostrate cancer -- reveals that progress isn't being madewhere you might think it is. With the help of early detection and treatment, morepatients are living longer. Once a cancer has spread, however, chances of survivalare scarcely better now than they were three decades ago."If only we could assess our progress in terms of scientific knowledge gainedinstead of the metric that really counts: lives saved. But we can't. Nor is it clearthat the knowledge we have gained is the knowledge we need most to win this"war." Take, for instance the problem of metastasis. We talk about breast or coloncancer as the "big killers," but the original tumors in these areas are not, ultimately,what kill people with cancer. It is cancer's ability to spread -- to reach like "thearms of crab" -- into vital organs that causes death. "In the end," writes Leaf, "it isnot localized tumors that kill people with cancer; it is the process of metastasis --an incredible 90% of the time." Since the founding of The National CancerInstitute (NCI) in 1972, less than 0.5% of NCI grants focus on understanding theprocess of metastasis. In 2003, only 8% of the NCI grant proposals awarded evenmentioned the word metastasis.As one Dana-Farber researcher has pointed out, "It is as if one World Trade Centertower were collapsing on our society every single day." And yet, even as this goeson day after day, a proposal by an accomplished researcher to study the genefunction of metastases vs. primary tumors is now in its third resubmission to the

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