Are we really losing the war on cancer? Clifton Leaf’s provocative new book, “The Truth in Small Doses,” claims we are. He’s a bit off-base there — but his prescription is dead on: The key to success is scrapping bureaucratic science and embracing tools that can attack cancer at the speed of life.
Since 1990, the death rate from cancer has declined. But Leaf, a cancer survivor and Fortune editor, says that’s not enough.He notes that part of the gain comes from finding more cancers earlier, making them easier to treat. Moreover, he points out that more people are dying from cancer today — 567,628 cancer deaths in 2009, 62,000 more than in 1990.
But this doesn’t add up to losing the war.
As Leaf himself notes, most of the growth in cancer incidence has come because we’re not dying from other diseases. In particular, more people are developing cancer because they’re surviving heart attacks and strokes.
It’s a familiar cycle: Deaths from heart attacks skyrocketed after 1930 because back then fewer people were dying from pneumonia, tuberculosis and diabetes. Then the heart-attack death rate started to drop in 1975 — which is when cancer death rates started to rise.
But they stopped rising in 1991. Since then, both the incidence of cancer and death rates have fallen by about 20 percent.
Leaf claims it should be even more, given what we know about cancer and what we can learn. He has a point.
Cancer isn’t a single disease. It is a conspiracy of renegade cells, genetic mutations and biological actions working together to create tumors. Not only does cancer grow differently in each person, each tumor in every individual grows and evolves in its own unique way.
Genetically controlled mechanisms cause tumors to start and spread; cancer drugs that target these mechanisms can deliver individual tumors a knockout blow. That’s where we’ve made the most progress.
Columbia University economist Frank Lichtenberg looked at the relationship between medical innovation and death rates for about 60 cancers. For the period 1990-2000, he found that newer treatments paired with tests that home in on specific tumors accounted for about 65 percent of the drop in cancer death rates. And from 2000 to 2010, such personalized cancer treatment account for all the decline.
Lichtenberg also estimates that the value of less cancer mortality since 1990 has added about $4.5 trillion to our economy.
Leaf says that we must build on that success. He points to something called systems biology, which can analyze billions of interconnected biological actions and sift through thousands of genes and individual tumor mutations. Systems biology, he argues, is the key not only to preventing new cancers from developing but also to stopping tumors before they evolve to outwit the latest generation of targeted treatments.
There’s more: Scientists are ignoring the opportunity to prevent cancers by mapping out what Leaf calls the “mind boggling variability of mutations in each tumor.”
Cancer researchers still conduct randomized, placebo-controlled trials, RCTs. Such studies ignore the variation among tumors, assuming contrary to fact that every cancer grows in the same way. They also require thousands of patients and years to conduct.
And RCTs still divide patients into one group that gets a drug with the other getting a placebo — even when a genetic link to treatment is known. So we force dying patients into studies that can’t cure them, knowing they might not get a new treatment.
Bottom line: Much of the money for cancer research is poured into an approach that is as deadly as the disease. And we stick to this approach because Food and Drug Administration rules for testing new drugs, and National Cancer Institute guidelines for getting grants to do the research, both insist on it.
Ultimately, Leaf calls for what amounts to a biological counter-insurgency against cancer — targeting tumors and individualizing care.
We’ve made much progress in the war on cancer — but today’s approach to researching, developing and using treatments can’t finish the job. We’re missing the targets by design. Sometimes, to win the war, you need new approaches and new leadership.
Robert Goldberg is vice president of the Center for Medicine in the Public Interest and publisher of valueofinnovation.org.