Malcolm Gladwell on cancer research
I was reading an article from the New Yorker this morning by Malcolm Gladwell on the Annals of Innovation. You can read the abstract here.
The article centres around the story of Synta/GSK's elesclomol in melanoma in 2007. The drug, like many others, started off promisingly but the final results showed that the patients did more poorly in the treatment arm. What the researchers didn't know at the time was that the target in melanoma was actually different from the one they were aiming at. The understanding of the biology had yet to evolve beyond chemotherapies at that time and our understanding of biomarkers in melanoma was sketchy at best.
Essentially, the author concluded:
“When will we find a cure for cancer?” Gladwell writes, “implies that there is some kind of master code behind the disease waiting to be cracked. But, so far as we can see, there isn’t a master code. There is only what can be uncovered, one step at a time, through trial and error.”
In some sense Gladwell's right, the process of finding new cancer drugs based on the biology of the disease goes one step at a time, science and research is necessarily iterative, after all. But he missed the reason why.
It's because cancers are heterogeneous.
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5 Responses to “Malcolm Gladwell on cancer research”
Gladwell does an excellent job of describing the tactical hurdles to developing cancer treatments, but he does not explore the much deeper “strategic” difficulties.
A remarkable, fact-based discussion of these can be found in “World Without Cancer” by G. Edward Griffin. Highly recommended, eye opening to say the least…
Enjoy.
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Malcom Gladwell represents the deep urge many people have on offering a lateral view on seemingly complex medical situations. The problem is
with the generalization of cancers. As MaverickNY has beautifully phrased that Cancers are heterogenous. The cracking of a magical code is never
gonna happen. It is one helluva tedious journey where different cancers are in different stages as far as decoding them is concerned.
‘The Treatment’, for me, was an interesting case study in one of two possible drug discovery methods. I’m am under no impression that one method of discovery was preferred over another in the article.
Cancer are heterogenous among patients and within the same patient. The most striking discovery in cancer research over the past 5 years, may be that a tumor contains cancer cells that are not genetically identical. Probably once you disengage the checks and balances of genetic repair as part of carcinogenisis, you enter a phase of rapid evolution, where new mutations are acquired by individual cancer cells and propogated. Thus not only do cancers behave differently from individual to individual, but even within an individual, cancer cells behave heterogenously.
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