Matching Cancers With the Best Chemical Treatments

Roland Piquepaille writes "When oncologists meet a new patient affected by a cancer, they have to take decisions about the best possible treatment. Now, U.S. researchers have devised an algorithm which matches tumor profiles to best treatments. They've used a panel of 60 diverse human cancer cell lines from the National Cancer Institute — called NCI-60 — to develop their "coexpression extrapolation (COXEN) system." As said one researcher, "we believe we have found an effective way to personalize cancer therapy." Preliminary results have been encouraging and clinical trials are now planned."

Comments

Whats next?

[ZachMG]

now that they are personalizing the treatment can you get any other flavors of kemo?

Insurance

[ChromeAeonium]

Lets just hope that doctors who use this algorithm still throughly examine every patient before beginning treatment, because, while probably useful, I doubt its as effective as a full examination by a professional. I kinda wonder if this would be used in lesser insurance policies to substitute extensive examinations. Premium insurance plan gets a full examination prior to treatment, the plans that cost less have the cancer run through an equation, and a treatment is printed out.

Re:Insurance

[Daniel Dvorkin]

The application of the algorithm will come well after the "full examination by a professional" stage -- they'll be using it once the cancer has been diagnosed, and they're deciding on which of several specific treatments to use.

Re:Insurance

[piojo]

Lets just hope that doctors who use this algorithm still throughly examine every patient before beginning treatment, because, while probably useful, I doubt its as effective as a full examination by a professional. Actually, if I remember correctly, an algorithm is better than doctors at diagnosing heart attacks... something about doctors being too human, and being unable to ignore statistically unimportant factors such as age (that is, being younger makes you less likely to experience a heart attack in just the same way that being younger makes you less likely to experience the symptoms of a heart attack--a given set of symptoms is equally to indicate a heart attack, regardless of age). My source? Blink, by Malcolm Gladwell. I'm probably misremembering a some of the details, but the point is there.

You may be right about its effectiveness in some cases, but its correctness, once it's perfected, will most likely be statistically better than the judgement of doctors.

Re:Insurance

[_14k4]

My wife is a breast cancer survivor (people are survivors from day one) and we are in the process of finding out that, hopefully, it has not spread to her bones. I can tell you, with 100% certainty, that cancer patients and caregivers do not care what the insurance companies say. The doctor can bill me personally and take the money right out of my paycheck if you need to. I will also say that, in my own experience, the oncology centers we have used have cared less about insurance than my PCP! One of the first things they ask is, "Do you need money to help pay bills during all of this?"

I would hope that this is used in conjunction with other treatment options - not as a "failsafe to lower level insurances"...

Re:Insurance

[protein folder]

In addition, since this program requires microarray gene expression profiling analysis, which is somewhat more complicated than a lot of lab work (AFAIK), you wouldn't do this test in the first office visit, but more likely much later, and for cancers that don't have or aren't responding to standard treatments.

Does it taste like chicken?

[r00t]

Imagine this. You go to the supermarket. Right there, next to the pork chops and sirloin steaks, is a cancer. A real human cancer. No creature was ever killed for it, so it's even vegan and PETA would love it.

You take it home, grill it up, and... well how does it taste? Do different types of cancer have different flavors? Which ones are good?

The stuff is damn easy, too easy even, to grow. We might as well make use of it.

Re:Does it taste like chicken?

[Torodung]

Oh man, Joe Jackson would have a field day with that...

--
Toro

Re:Does it taste like chicken?

[B3ryllium]

Some tumors contain teeth, hair, and other wacky fun items.

I'd rather not taste it, thank you very much.

Re:Does it taste like chicken?

[dubbreak]

Some tumors contain teeth, hair, and other wacky fun items.

Had I read that a month ago I wouldn't have believe it, but my fiance is a perioperative nurse (she works in the OR) and recently described tumors with hair and/or teeth inside.

I'd rather not taste it, thank you very much.

Me neither. I almost gagged when I had it visually described to me. I'd be full on projectile if someone put a steaming hair and tooth pile on my plate.

Re:Does it taste like chicken?

[fbjon]

This'll teach me not to read medical articles just before lunch. Argh.

Re:Does it taste like chicken?

[bersl2]

Aren't there supposed to be a few dogs that have been trained to smell the difference between healthy tissue and cancerous tissue? Or was that a bust? Or am I making it up?

Not that a dog can communicate the olfactory properties of tumors to us.

Re:Does it taste like chicken?

[Anonymous Coward]

No, it tastes like crab. Think about it.

Re:Does it taste like chicken?

[raddan]

Wow. Easily the most fucked up thing I've read on Slashdot. Just... wow.

Ooo dirty

[Null Nihils]

I bet you they're running the COXEN in some boxen.

I bet you the COXEN is a big... application, and the boxen are tight...ly... integrated... if they run Linux. Otherwise the boxen are hosen. Or something.

*ducks*

Re:Ooo dirty

[JonathanR]

A. A. Milne is turning in his grave.

Doctors generally won't like this

[syousef]

Most doctors won't even use computers to help them make diagnoses because they feel they should always be able to do better. What tends to happen is that if a rare condition presents they can miss it quite easily. I'm no doctor but I believe it has to do with the medical profession's heritage, culture and the politics of their licensing institutions. Doctors are taught that every diagnosis can be life or death. Using an aid like a computer to make the decision therefore is seen as a sign of weakness.

When you think about it that's insane. There's no way any doctor can know every medical condition that presents, even the rarer ones. What's needed is a system whereby the doctor can check his diagnosis against what comes up with a computer search against the same symptoms. There needs to be no stigma in doing this. If something comes up that's rare but could fit the doctor then needs to have a think about whether it's worth addressing. Systems like this have been rejected by the medical profession time and again which is unfortunate because to get good at diagnosis they'd need to be honed with a lot of feedback, particularly where multiple conditions present. However they have the potential to help pick up serious conditions earlier than what even the best doctor might without them.

Same goes for this system except we're talking treatment choice not diagnosis. One hurdle is getting other doctors to accept it. Another is making sure the control and final say remains with the doctor and patient not some machine. There'd be great temptation for the medical insurers to use such a system to avoid providing treatment that a doctor believes is necessary.

Re:Doctors generally won't like this

[Ihlosi]

Using an aid like a computer to make the decision therefore is seen as a sign of weakness.

It also opens a floodgate for all kinds of interesting liability issues. No medical device manufacturer wants to be hit with an avalanche of lawsuits - which is what's going to happen when they make a device that does anything more advanced than making trivial diagnostic or therapeutic decisions (i.e. "patient has ventricular fibrillation -> administer defibrillation shock").

Re:Doctors generally won't like this

[macklin01]

Don't forget that the gap needs to be bridged from both sides: while it will indeed take some cultural changes in the medical community to use computational / predictive tools in choosing therapy, it will also require cultural changes in the modeling community to facilitate this. Furthermore, doctors' trust in computational tools must be earned by a well-validated track record of results by the mathematical / engineering community. Interestingly, these cultural changes are underway and can already be observed.

My primary field of research is developing computational tools for modeling cancer progression and angiogenesis, primarily using a PDE point of view where I model nutrient transport within the body and uptake by tumor cells, some simple biomechanics, the degradation and remodeling of the extracellular matrix by the tumor, and the resulting motion of the tumor boundary within the tumor. In fact, this was my dissertation topic just a little over a month ago; the interested reader can see my publications here and some animations of cancer simulations here.

In the several years I've been doing this work, I've seen interesting changes on both sides of the aisle. The mathematical models of cancer have grown in sophistication and realism at an incredible speed. Five or six years ago, models would only examine a single, isolated aspect of cancer growing in homogeneous tissues that were more idealized than even simulated in vitro petri dishes; today, they model many aspects of cancer and the interaction between those aspects. Several years ago, the models were little more than interesting mathematical objects with simplified, spherical solutions that weren't very interesting outside the mathematical community; today, we're simulating complex tumor shapes in fairly realistic tissues, and the results are shedding light on current problems in cancer biology that are otherwise difficult to understand.

Several years ago, it was difficult to even get doctors, oncologists, and others to even look at our research (in our field in general). Today, we're building a track record of results that makes the work easier to trust. Mathematicians and engineers are also realizing the need to acquire the "vocabulary" and biological background necessary to communicate with doctors and biologists, and they're making moves to bridge the gap and collaborate. In the meantime, more cancer biologists are realizing that it takes more than studying isolated cells to understand cancer systems, and they're reaching out to mathematicians to model these complex systems.

The result: very rich and exciting collaborations between doctors and mathematicians to develop helpful predictive tools. My group (at the UT Health Science Center in Houston, with the M.D. Anderson Cancer Center) is doing exciting joint work with oncologists, biologists, mathematicians, and engineers to combine experiments with well-calibrated models of glioblastoma, an aggressive form of brain cancer. Sandy Anderson and Vito Quarnata are doing similar joint mathematical/biological work on breast cancer at Vanderbilt and the University of Dundee, and their work has been featured on slashdot before.

So, it really requires growth toward collaboration from both sides, but fortunately, the need for this has been recognized by both communities and is occurring as we speak. It's a very exciting time in cancer systems biology and computational / predictive oncology! -- Paul

Re:Doctors generally won't like this

[bwen]

As a physician, I resent your inaccurate and uninformed response. "Doctors are taught that every diagnosis can be life or death" - where did you hear that? You are making sweeping generalizations and accusations. The ASSUMPTION that physicians resist using a computer to research a medical problem is ridiculous (at least in the US.) I do not know a MD that is not comfortable with a computer nor with researching a medical problem online. We often have resources that the general public does not use, and due to lack of an additional 7-11 years of post-grad training, would not understand. You seem to typify the person that turns to herbs from China that mostly consist of grass/dirt and expound how modern science is ignoring it. We very much appreciated you in the dark ages, thanks for your insight!

Re:Doctors generally won't like this

[UbuntuDupe]

Oh really? So doctors have hastened the end of the hand-scrawl prescription so they can replace it with a computerized database that automatically checks for possible excessive dosage or condition interaction? So doctors quickly change to empirically validated methodologies that sidestep their "expertise" for a rote checklist? So doctors are interested in lifting the artificial limits on MDs granted? So doctors never wait until a patient "asks his doctor about NewMeda" to research it, and never change their treatment recommendation based on that? (You might want to have a word with pharma ad departments ...)

Re:Doctors generally won't like this

[SetupWeasel]

If I had a dollar for every time a doctor almost killed me because they were to certain of themselves to do the proper testing (an X-ray) and research (PDR), I would have 3 dollars.

That, my friend, is 3 dollars too many.

I fear the day I get a serious disease, because I can't trust doctors with a sinus infection.

Re:Doctors generally won't like this

[bwen]

I'll try to address your points (some of which are valid) First, the vast majority of doctors do not possess programming skills to create the database/program for computerized prescriptions. Most are happy to use it as it is usually quicker, more legible, goes on file automatically and checks against allergies to the medication. I have not met a doctor who thinks he is completely infallible- although some have a "God complex" Second - doctors do rely on their "expertise," which does not mean ignoring "empirically validated methodologies" - do you think there is a conspiracy to actively participate in bad medicine when there is typically no benefit to it. Where's the tin foil hat? Third, I don't think doctors are interested in competing against more physicians for the same job; who wants their job taken by someone for less? That said, the artificial limits (largely circumvented by foreign medical schools but still limited by residency slots) do keep the quality of MDs up as it is fairly competitive to get into med school Fourth, if you want us to watch commercials to find out the latest meds you will be disappointed. The advertisement of prescription meds has gotten ridiculous - the commercials are laughable. Doctors are not trying to ignore the literature out there- there is a large amount out there and computers and programmers are helping us access it more every day.

Re:Doctors generally won't like this

[QunaLop]

I think that you make some valid points, however, i wanted to expand on the fact that "no one knows everything" - People seem to have limited memory, this system may be a key component in a general "diagnosis AI." I imagine someday a system where a physician enters your symptoms and test results, the system would then provide the user with possible diagnoses and medical tests to perform to further reduce possible diagnoses/confirm a diagnosis.

I was originally diagnosed with an "infectious tumour" (not cancer) due to complications in retrieving tumour cells. For 6 months i was given heavy antibiotics, and those 6 months were both very damaging to my long-term health and did not produce any positive results. Finally it was decided to perform another biopsy, and a proper diagnoses was established, and the original biopsy result subsequently made sense, hindsight... Anyways, I imagine, someday an AI system that would circumvent this "blanking of possibilities" and would prevent potentially avoidable situations like mine, where lives are risked and permanent damage results. This will not "obsolete" physicians - they are more than vending machines that dole out diagnoses.

Re:Doctors generally won't like this

[UbuntuDupe]

First, the vast majority of doctors do not possess programming skills to create the database/program for computerized prescriptions My complaint was NOT that "every doctor has not written a database program to replace prescriptions"; it was that that doctors resist such a change to one.

I have not met a doctor who thinks he is completely infallible- although some have a "God complex" I haven't seen an unsecure operating system -- although I have seen Windows.

Second - doctors do rely on their "expertise," which does not mean ignoring "empirically validated methodologies" - do you think there is a conspiracy to actively participate in bad medicine when there is typically no benefit to it. I think that doctors do resist transparency in their occupation for fear of bringing failures to light and having to conform to methodologies that imply the irrelevance of (a large part) of their "expertise", absolutely. This is a human failing, in which doctors are far from alone -- but it is a failing. If you want an example, there's a case where following a rote algorithm in checking for a heart attack was right 98 percent of the time, while a doctor's expertise yielded 75-89% accuracy, yet was resisted. It was detailed in a Malcom Gladwell's Blink. (Google cache of summary)

, I don't think doctors are interested in competing against more physicians for the same job; who wants their job taken by someone for less? And who does? But I haven't seen computer programmers set up limits on how many people can become one each year on the (flimsy, self-serving) grounds that it's necessary to keep quality up.

Fourth, if you want us to watch commercials to find out the latest meds you will be disappointed No, I want you find out about new medicines through the proper channels. But any time you change your recommendation because the *patient* initiated a talk about the new drug, you are admitting failure to keep your knowledge current. And pharmas basically rely on that happening -- successfully. Think about it.

Re:Doctors generally won't like this

[edsyc]

I wouldn't be so quick to get on your "I'm a physician" high horse. Of course physicians use computers in their work. But when it comes to making diagnoses, there is plenty of evidence that physicians resist using computer aids:

Kaplan B. Evaluating informatics applications: Clinical decision support systems literature review. Int J Med Inform. 2001;64:15-37.

Overhage JM, Tierney WM, McDonald CJ. Computer reminders to implement preventive care guidelines for hospitalized patients. Arch Intern Med. 1996;156:1551-6.

Rocha BHSC, Christenson JC, Evans RS, Gardner RM. Clinicians' response to computerized detection of infections. J Am Med Inform Assoc. 2001;8:117-25.

Re:Doctors generally won't like this

[bwen]

I haven't found a resistance to using computerized prescriptions where they are effectively implemented- there are good programs and bad ones. Power failures and system freezes are 2 of the problems with the present ones. If a program is more efficient, reliable, easy to use and codes/bills effectively, you can be sure that doctors will not resist it. There are a few subpar programs out there that i have used that are not effective. The lack of transparency is, I believe, less a matter of pride and more one of fear of litigation. Threats of lawsuits are extremely common and real ones are common enough. We do have internal reviews that do evaluate cases/poor outcomes. Advertising companies push meds to the public; i read up on meds and prescribe what I think is appropriate. I personally don't rely on drug companies/reps to be completely forthright with their meds and I am not alone.

Re:Doctors generally won't like this

[vegiVamp]

IANAA (I am not an American), but if the way the American lawsuit-culture is perceived here is anywhere near accurate, then I can imagine MDs are quite reluctant to use this kind of tech.

Imagine someone going for an examination, and the MD deciding to dismiss the software's suggestion that the patient may have some rare disease. If the patient later does turns out to be suffering from that disease, or even dies from it, the malpractice lawsuits will soon be flying, even though the doc's decision may have been perfectly reasonable.

In the end, instead of adding to the likelyhood of uncommon conditions being caught early, it will serve to add a ton of stress to the job, and probably even more 'preventative' subscription of various drugs.

Re:Doctors generally won't like this

[protein folder]

Well, COXEN will generally be used (at least at first) to suggest treatments for cancers that have either failed or don't have first-line treatments. So presumably the doctor has already tried or doesn't know which drug to use. In addition, since chemotherapeutic agents are generally administered in combinations, and because there are quite a few cancer drugs out there, the number of different combinations can be quite high, so hopefully this can be used to predict a few drugs that a) haven't been used, b) don't have adverse reactions or high toxicity (when administered together) and c) will work. Anyway, the doctor can decide to take the suggestions presented by the program or not. They're the ones administering the drugs, so it's really their call.

Feedback, of course, is critical.

Re:Doctors generally won't like this

[abushga]

What five idiots moderated this post "insightful?"

I'm still around to write this because my oncologist kept such a clear focus on my disease stage and response to treatment. His knowledge, experience, intuition, and talent in asking the right questions achieved a miraculous outcome. Like a true /.er, I burned a lot of bandwidth researching the etiology of my phenotype; my long-suffering oncologist patiently fielded my unanswered questions, even though they were often beyond the scope of his practice. It was impressive watching him access data not avilable to me on a broadband connection, correctly interpreting my concern, and resolving the question in straightforward terms.

TFA simply describes one more tool among the vast array physicians keep in mind and utilize as needed. I've read thousands of abstracts and hundreds of journal articles and have a good grasp of the subject matter. I would trade all of that learning for a ten minute conversation with my oncologist.

Re:Doctors generally won't like this

[syousef]

Well truly I don't care that you resent the response. Your profession is full of some very shonky people.

As a patient I've received some extremely bad treatment from doctors, and so have my loved ones. Some examples:

- A loved one repeatedly got seizure causing medication increased despite seizures clearly being listed as a contra-indication. This is by a neurologist as well as GPs. In the end she was having a seizure every day or 2. I looked it up and brought this to their attention at which point he said yeah okay stop taking it. Luckily I had looked up the fact that stopping this med cold turkey causes suicidal depression so when I suggested she be weaned off he said "uh okay". I honestly think she would be dead now if I didn't intervene.

- Repeated misdiagnosed posterior dislocated shoulder. I've had to personally troll through pubmed to get them to believe a loved one's dislocates and that she's not a mallingerer because the idiots in the ER don't know the difference between posterior and anterior dislocations and that a posterior dislocation requires an auxillary view to diganose on an X-ray. Oh you can SEE the damn shoulderblade protruding but since the (wrong) x-rays show nothing they insist she must be making it up. Her shoulder is very bad because the diagnosis was originally missed and the shoulder stayed dislocated literally for months.

- I once had to get a medical for a job (one of the first professional jobs I'd applied for. I was in my early 20s) I used the opportunity of being in the city to meet up with my mother for lunch. She waited outside as I was examined. The doctor, who had a larger stomach than me, proceeded to tell me that I looked pregnant and should not be eating mummy's cooking. Almost exact words. He said he'd pass me this time but he'd have to write me up as a heart disease risk.

- I'm currently dealing with an arthritic ankle that's going to require a mid-fusion. One specialist suggested an arthroscopy and when I agreed quickly palmed me off to his secretary to arrange it and as a primary contact. When I'd ask medical questions she started fielding them (knowing nothing about the specifics of the case) instead of passing them on to the specialist. I got a second opinion from a better known specialist. He says the arthroscopy is a waste of time and that I should come back for the mid-fusion later this year. However he's very focused on a flatfoot deformity I've always had and that can't be fixed and he then started giving me some very unscientific dieting advice (don't eat carbs after 4pm) - knowing i have an arthritic ankle he still wants me to somehow magically lose weight because "it'll work wonders". Oh these diagnoses - a cat scan, an MRI and 3 consultations lasting less than an hour cost me about $1000 and that's with government assistance.

Realistically any formal complaints made about these doctors will leave me or those I care about with a black mark against our names and leave us unable to get medical care. Anything informal that identifies the doctors is an invitation to a defamation suit.

So I've resorted to double checking every diagnosis and every prescription. I have a B.Sc. in Computer Science and a Masters in Astronomy so I have some idea how to do research and take my time learning new terms etc, but I shouldn't need to double check everything like this. Medicine isn't my speciality. This is bullshit.

So you know what you can do with your resentful self don't you?

This will save my time and give me confidence BUT

[prolene]

Variations exists, so its not that straight forward, however Algorithms like these act as a wonderful reference.

Not a new idea

[Crashbull]

There is a lab in Germany that's been doing that for years now. This isn't a new idea. I'm just really surprised and a bit disappointed that no one in the US has bothered to do something like this before.

Re:Not a new idea

[Solra Bizna]

America, behind another country in $(SCIENCE)? SHOCKING! :P

-:sigma.SB

Re:Not a new idea

[AngryDad]

All I can say - good luck with that. I did this in 1995 for CHD (coronary heart disease) patients. We analyzed 5-years of data for ~2500 patients in order to identify the best suitable treatment. It did not go very well - factor analysis revealed too many variables and although we identified several trends and patterns, they were inconsistent and unlikely suitable to be used clinically.

Re:Not a new idea

[protein folder]

Well, COXEN works by examining patterns of genetic deregulation for each individual cancer tissue sample, and so this should be a more direct measurement of the causative factors than the situation you've described.

Algorithm kindly sponsored by Pfizer

[Anonymous Coward]

int drug_choice_algorithm(){
   int our_most_expensive_drug = 1;
   int other_cheaper_option = 0;

   if(patient_has_insurance()){
       return our_most_expensive_drug;
   }
   else {
       if (patient_is_rich()){
           return our_most_expensive_drug;
       }
   }
   return our_most_expensive_drug;
}

 

Obligatory Simpsons...

[Anonymous Coward]

Some tumors contain teeth, hair, and other wacky fun items.

Marge: But the grocery store sells meat for 35 cents a pound.
Lisa: And it doesn't have teeth and hair in it.
Homer: Those are prizes.

NCI-60

[DrZZ]

To see all the underlying data, go to DTP Human Tumor Cell Line Screen data page on the National Cancer Institute's Developmental Therapeutics Program web site. There's a lot more data listed here.

Teratoma.

[Ihlosi]

Had I read that a month ago I wouldn't have believe it, but my fiance is a perioperative nurse (she works in the OR) and recently described tumors with hair and/or teeth inside.

This is most likely a tumor type that is called teratoma (literally: "monstrous tumor").

http://en.wikipedia.org/wiki/Teratoma

Re:Teratoma.

[dubbreak]

Or a dermoid cyst.

Good news

[wamerocity]

I work at the Huntsman Cancer Hospital, a division of the University of Utah hospital. I draw blood on dozens of patients every day and see the same pattern of treatment as we see similar cancer patients come in. I can only see this as a good thing to help diversify and specialize treatments.

As someone who won the lottery and was treated in a cancer hospital myself, I found my doctor seemed to put me on a fast track to treatment, straight out of the books, which involved removing an important part of my anatomy (not THAT part). With much resistance on my part, I got him to investigate other options and I actually got to keep my spleen.

From a doctors POV, I know it can be difficult as well as uneconomical to see every patient as a super-special-individual-with-their-own-needs-and- feelings, but with the type of stigma surrounding the C-word (not THAT C-word) it is pretty much a necessity, at least from my experience. If this new system requires doctors to spend a little more time with a patient and yield a higher success rate, then it is an all-around win.

Re:Good news

[bcolflesh]

I ruptured my spleen when I was a kid (fell out of building) - I can tell you that it's not important at all and has had no effect on my health in my 25+ years since the accident.

Re:Good news

[wamerocity]

Well, that's good to hear. However, given that 25 years plus the age of a kid (6-8?) you're in your mid thirties, so you are still pretty young (as am I). The spleen is responsible for b-cell differentiation: i.e. it's what forms a custom response to new foreign invaders. Our body protects itself by 2 approaches: The "Let's devise a strategic way to take out the enemy" (B-Cell) way, or the "Let's kick everyone's ass unless they can show us ID that they are on our side" (T-cell) way. Because you are young, you probably have a good immune system so it probably hasn't been noticeable, but when you get in your 50's and 60's, infections and colds will hit you much harder than they hit others, and will take longer to recover from.

I know this isn't as serious as a threat as say losing a lung or having damaged heart tissue, but as someone with an already weakened immune system, it can escalate to a serious problem rather quickly.

Anyone?

[scottmckaygibson]

Did anyone else read this as, "Matching Cancers With the Breast..." when they first skimmed over the title?

Re:Anyone?

[utopianfiat]

Paging Dr. Freud

Re:Data type correction...

[quarkie68]

Replace int with long int to be more accurate. :-)

Cancer Industry

[pitdingo]

A good article on the cancer industry--> http://www.newstarget.com/021892.html

Re:Cancer Industry

[Anonymous Coward]

Also read about the suppression of Laetrile (vitamin B17), a substance found in fruit seeds (usually taken from apricot kernels) that has cured cancer for many people. (that site also has lots of information about other antics of the 'medical mafia')

It's a horrible reality to wake up to, but the pharmaceutical industry generally has a vested interest in people being ill, in promoting a very limited medical paradigm that focuses on suppressing symptoms with drugs rather than understanding causes, and especially in not curing the dreaded 'uncurable' diseases like cancer. Quite simply, if everyone is healthy, who will they sell their drugs to? ;)

Of course, most people just don't want to hear this, because they want the comfort of 'knowing' that if they get ill they can go to the doctor and get something that will make them better. The pharmaceutical companies have been able to exploit fear of disease very effectively and present themselves as the saviours, to the point where many people assume that if a medicine has been made in a big factory and comes in a pill or a syringe then it's been proven to be safe and effective - yet anything based on naturally occuring substances or that is non-chemically-based is treated with suspicion or outright hostility. The brainwashing is so complete that mainstream 'debate' often starts with assuming that some new 'life-saving drug' is good and the only question asked - presented as a huge, difficult 'moral maze' - is who should cough up the money for it.

Woo-Hoo - Big Bucks for me!!!

[JSC]

Can you say 'Licensing Fees'?

John Coxen

My take on cancer treatments(been there done that)

[up2ng]

From TFA "Another issue is that the 60 cell lines did not include all important cancer types (for example, certain bladder cancers, lymphomas, and small cell lung cancers were not among the 60 lines studied)."

Soooo. My wife (Lymphoma when she was 32) and me (Small cell Lung Cancer at 37) aren't included. My treatment was with chemo drugs that have been in use for 30+ years (VP-16 & Cisplatin) with Chest Radiation. It really sucks that there aren't any new treatments for anything except Breast Cancer these days.
I would liked to know that advances in SCLC could give me more time than the (only 5% make it to 5 years) and I am 1 year into it.

I don't want to sound sour but everytime I see a cancer story on /. I hope it will eventually help someone to not go through the hell that is cancer treatment because it doesn't do anything for me

Re:My take on cancer treatments(been there done th

[Anonymous Coward]

Cancer is hell one way or another. My girlfriend and I are going through it right now as she was diagnosed with breast cancer earlier this year, and is in her 16th week of chemo. The really, REALLY hellish part for us though, is knowing that there may be better treatments out there, and the thing that is holding us back from it is the way the insurance system works in Japan where we live. There are two kinds of drugs, insured and uninsured. Simple enough. The problem is, the Japanese national health insurance system works in a way that if you chose to use an uninsured drug, you are uninsured for all related medical expenses. Everything from visiting the doctor for counseling, all the way to the radiation and hormonal therapy that is otherwise covered by insurance. The end result is that you have to be filthy rich to pay for it all (approx. $20,000 per month for the duration of treatment, which is a couple years) or you're SOL.

I'm sorry to hear that there haven't been many large advancements in the area of your particular kind of cancer. That said, it's sometimes even more painful to know that there are better treatments, but you're not eligible because you aren't rich enough. I'm all for this algorithm and better diagnosis, but I wonder if, in my girlfriend's particular case, the end result wouldn't simply be a confirmation that indeed we can't use the drug that is perfect for her cancer.

And of course there are myriads of other things we're (literally sometimes) pulling our hair out over. Things like medical marijuana. While puritans and the ignorant are arguing over morality and whether or not it should be legal, my girlfriend is given a medicine that barely helps her nausea and lack of appetite, and her family and I need to work hard with her to make sure she doesn't waste away.

I guess what I'm trying to get to is that these medical advancements are great, but simply removing a bunch of brureaucratic road blocks alone would do wonders.

And yeah, I think I went a bit OT there. I share you're pain though, and I guess I needed to vent a bit.

Wow

[up2ng]

I had no idea that there were countries that had a more fucked up system then what they keep telling us we have here in the U.S.(Micheal Moore & the movie "Sicko")
The most unbelievable part is that there is a tiered approach. Thank you for the eye opener and best wishes to your lady.
P.S. If you don't have Kytril or similar for nausea, this should be easy for you in Japan - Ginger lots of it.

Re:Whats next? Graviola?

[UKRevenant]

Graviola is shown to be upto 10000 times more effective than chemo on some cancers, but you are unlikely to find anyone recommending it as the drug companies are more interested in finding the active component and patenting it than helping cure people.

A friend of mine has cancer that was so bad she was warned that the treatment was more about managing the progress of the disease than curing it. After 6 months her doctor could not explain why her cancer was in remission. The reason she gives is the gaviola capsules she had been taking. Now whether it was not as bad as she believed in the first place or it was positive thinking or something else I do not know. But I do know I am prepared to be counted as a believer in herbal medicine.

If anyone wants to know where she got them from, I will find out and post here if requested. I think it was a small company in Bradford (UK).

kill the cancer by killing the patient

[nido]

I don't want to sound sour but everytime I see a cancer story on /. I hope it will eventually help someone to not go through the hell that is cancer treatment because it doesn't do anything for me The "normal" way of treating cancer (and heart disease, and diabetes, and arthritis, and ...) is way too profitable to make it anything but losing proposition for the patient. First they fleece the patient for all they're worth (even better if they've good insurance or Medicare), then the patient frequently dies anyways. The medical-industrial complex likes this state of affairs because it's good for their bottom line.

Effective cancer therapies are unprofitable because the patent has expired, or is by its very nature unpatentable. DCA's patent expired years ago, Vitamin D is just a regular vitamin especially concentrated in Cod liver oil, and Ozone and Hydrogen Peroxide are just ways of getting extra oxygen into an mass of anaerobic rogue cells.

Some of the things Edgar Cayce (early proponent of holistic medicine) recomended for lung cancer were Castor oil packs and brandy fumes inhaled from a charred oak barrel...

The main thing is to take charge of your own health. Dr. Zieve's book, Healthy Medicine has a good overview of a medical system that is patient-oriented, rather than organized for the benefit of teh profiteers.

COXEN old technology?

[trainor]

we did things like this over a decade ago at SUGEN. i did some stuff like this in the years after SUGEN too, just for fun, but took a completely different approach. the main caveat is that some of the NCI screening data is questionable, so extrapolating from those particular zones would likely be bogus. if anyone is really interested in this stuff, there is a nice 1997 article where NCI reviewed its efforts in _Science_, volume 275, number 5298, pages 343-349, (DOI: 10.1126/science.275.5298.343)

there is one little statistical typo that i found, and some of the assay conditions for certain cell lines may not have been optimal, but here's the abstract:

An Information-Intensive Approach to the Molecular Pharmacology of Cancer (Weinstein, et al.)

Since 1990, the National Cancer Institute (NCI) has screened more than 60,000 compounds against a panel of 60 human cancer cell lines. The 50-percent growth-inhibitory concentration (GI50) for any single cell line is simply an index of cytotoxicity or cytostasis, but the patterns of 60 such GI50 values encode unexpectedly rich, detailed information on mechanisms of drug action and drug resistance. Each compound's pattern is like a fingerprint, essentially unique among the many billions of distinguishable possibilities. These activity patterns are being used in conjunction with molecular structural features of the tested agents to explore the NCI's database of more than 460,000 compounds, and they are providing insight into potential target molecules and modulators of activity in the 60 cell lines. For example, the information is being used to search for candidate anticancer drugs that are not dependent on intact p53 suppressor gene function for their activity. It remains to be seen how effective this information-intensive strategy will be at generating new clinically active agents.

Re:COXEN old technology?

[protein folder]

I'd be interested in hearing about some of the work you did (and also what SUGEN is--I'm sorry but I'm not familiar with it).

The NCI-60 data can be spurious, but maybe some confidence assessment can be made based on the number of times any individual compound has been tested.

Re:Whats next? Graviola?

[dmpyron]

WHAT A CROCK! And I suppose this will also enlarge my penis. You make the claim that it's "shown to be up to 1000 times more effective". Cites, please. And don't go trotting out the supposed study from Johns Hopkins. That's an urban legend that they have been trying to kill for a while. http://www.snopes.com/medical/disease/cancerupdate .asp

Why this is important

[Mab_Mass]

OK, I don't see anybody else here posting to this point, so I thought that I would jump in here.

The thing that is really striking about this study is that this is the first example that I've heard of that uses genetic information about an individual patient to customize treatment. Most treatment decisions simply look at individual phenotypes (ie, apparent, external traits) to help make the decisions, but by starting to look directly at genotypic information, we are getting much closer to the point of actually treating the fundamental, underlying sources of the problems instead of just targeting behaviors.

Eventually, I would expect that this is where medicine will go, especially for things like cancer. For example, let's say that a particular form of cancer is triggered in part by a failure of a given molecular pathway. If you can run a genetic screen (like is being done with the micro-arrays here), you will be to able to specifically diagnose the original cause of the cancer, so by providing a drug that restores this individual pathway, you can block the growth of the cancer and allow the body's natural checks to help bring things under control.

To be clear, this study is a long way from that point. Right now, all they have done is find the correlations between genotypes and responses to treatment, which is a good first step, especially if it provides predictive power. A next step will be to use these correlations to help understand the exact mechanisms happening in those particular cancers and how the treatments have effected those mechanisms. From there, you can start to customize the treatment to be more specific, giving few side effects and more effective response.

In any case, it's pretty neat, and we can expect more and more of this sort of thing as new technologies in biology start hitting the market and older technologies keep improving throughput and efficiency.

Re:Why this is important

[protein folder]

If I had points, I'd mod you up.

M.D.s won't like this comment either. :)

[nido]

That said, the artificial limits (largely circumvented by foreign medical schools but still limited by residency slots) do keep the quality of MDs up as it is fairly competitive to get into med school The Osteopathic profession is also helping to meet the (artificial) doctor shortage. As you might be aware, Allopaths organized in the mid-1800's to exterminate their competition. The problem was that they were getting their clock cleaned by health care providers who used more effective modalities than bleeding, mercury and surgery. 100 Years of Medical Robbery covers how the AMA managed to shut down 1/2 the country's medical schools between 1910 and the 1960's (also read the followup, 'Real Medical Freedom'). How the Cost-Plus System Evolved also mentions the Flexner Report in a discussion of how the system is set up to fleece patients.

Osteopathy was able to survive the great purges of the late 19th and early 20th centuries not only because the philosophy is superior to Allopathy, but also because it was organized enough to resist the American Medical Association's onslaught. Andrew Taylor Still, founder of Osteopathy, didn't care much for the Materia Medica, but pharmacology was added to the Osteopathic curiculum early in the 20th century in order to keep the profession from being exterminated.

Today most Doctors of Osteopathy's practice is identical to a Medical Doctor's, but some do utilize their manipulation training, and a handful specialize in manipulation. My D.O.'s work would seem like magic to the uninitiated - some light touches here & there, and with some patients, *poof*, all better (other patients, including myself, take a bit longer to receive all the benefit they can from his techniques). There's quite a science to what he does, but he never tries to explain much of the detail about his findings/diagnosis to me (I get the layman's explanation when I ask).

I don't mean to be inflammatory - it's just that I wasn't helped by the 'regular' doctors I visited, went somewhere else, and am satisfied with the results I've obtained. Drugs and surgery do have their place, of course, but most health complaints are better treated with gentler methods that better address the cause.

Robert Zieve is also an M.D. - you might like his book, Healthy Medicine: A Guide to the Emergence of Sensible Comprehensive Care.

What a world...

[RealErmine]

where I can go to a hospital, have my life-threatening ailment reduced to a few numbers and receive "personalized" treatment by plugging them into a cold, unfeeling math equation.

While the story uses a poor choice of language, the ability to cut-down arbitrary treatment plans would be a step in the right direction. More surgical strikes instead of carpet-bombing.

Re:Whats next? Graviola?

[UKRevenant]

"WHAT A CROCK!" !! well its nice of you to dismiss it so quickly and easily. My friend was relieved to know that her delayed funeral was just a figment of her and my imagination.

I also said upto 10,000 times more effective, not just 1,000! This is the claim that outrages you so much. I can understand that as it does seam to good to be true, but then ketchup was reported in the national press (UK) earlier this year to be a very effective treatment for prostate cancer. Sadly I cannot remember the study they based that story on.

I let my friend know your comments and her response was to ask me to post the following information for you. Now upon reading it I notice that the reference is actually against one particular chemotherapy drug which I have no idea if it is the best one for the job or not.

The following quote is not from Johns Hopkins and in fact makes no mention of him/it.

Quote:
Much of the recent research on Graviola has been on a novel set of phytochemicals that are found in the leaves, seeds and stem of Graviola which are cytotoxic against various cancer cells. In an 1976 plant screening program by the National Cancer Institute, the leaves and stem of Graviola showed active cytotoxicity against cancer cells and researchers have been following up on this research ever since.(21) Two separate research groups have isolated novel compounds in the seeds and leaves of the plant which have demonstrated significant anti-tumorous, anticancerous and selective toxicity against various types of cancer cells, publishing 8 clinical studies on their findings.(22 - 29) One study demonstrated that an isolated compound in Graviola was selectively cytotoxic to colon adenocarcinoma cells in which it was 10,000 times the potency of adriamycin (a chemotherapy drug).(23) Cancer research is ongoing on Graviola, and four new studies have been published in 1998 which further narrow down the specific phytochemicals which are demonstrating the strongest anticancerous and antiviral properties.(30 - 33)
Footnotes:

1. de Feo, V. 1992. Medicinal and magical plants in the northern Peruvian Andes. Fitoterapia63: 417-440
2. Vasquez, M. R., 1990 Useful Plants of Amazonian Peru. Second Draft. Filed with USDA's National Agricultural Library. USA
3. Grenand, P., Moretti, C., Jacquemin, H., 1987. Pharmacopees taditionnels en Guyane: Créoles, Palikur, Wayãpi. Editorial l-ORSTROM, Coll. Mem No. 108. Paris, France
4. Branch, L.C. and da Silva, I.M.F. 1983. "Folk Medicine of Alter do Chao, Para, Brazil." Acta Amazonica 13(5/6):737-797.
5. de Almeida, E.R., 1993. Plantas Medicinais Brasileiras, Conhecimentos Populares E Cientificos. Hemus Editora Ltda.: Sau Paulo, Brazil.
6. Asprey, GF. & Thornton, P. 1955. Medicinal Plants of Jamaica. III West Indian Med J 4: 69-92
7. Ayensu, ES. 1978. Medicinal Plants of the West Indies. Unpublished manuscript: 110P-(1978) Office of Biological Conservation Smithsonian Institution, Washington, DC
8. Weniger, B. et.al., 1986. Popular Medicine of the Central Plateau of Haiti. 2. Ethnopharmacological Inventory J Ethnopharmacol 17 1: 13-30 (1986)
9. Feng, P.C. et.al., Pharmacological Screening of Some West Indian Medicinal Plants. J Pharm Pharmacol 14 : 556-561 (1962)
10. Meyer, TM. The Alkaloids of Annona Muricata. Ing Ned Indie 8 6: 64- (1941)
11. Carbajal, D., et.al., Pharmacological Screening of Plant Decoctions Commonly Used in Cuban Folk Medicine. J Ethnopharmacol 33 1/2: 21-24 (1991)
12. Misas, CAJ et.al., Contribution to the Biological Evaluation of Cuban Plants. IV. Rev Cub Med Trop 31 1: 29-35 (1979)
13. Sundarrao, K et.al., Preliminary Screening of Antibacterial and Antitumor Activities of Papua New Guinean Native Medicinal Plants. Int J Pharmacog 31 1: 3-6 (1993)