Thursday, April 20, 2017

The Emperor of All Maladies

Cancer is the modern killer that seems to fit our society perfectly. It is not a single disease, but a related group of many different conditions, all of which involve cells growing out of control. Reports of cancer have occurred back in ancient times. However, it has become much more prevalent today. Most cancers require multiple mutations to occur before cells start growing "out of control". People born with a mutation will often have a head start, however, getting cancer is not a given. It occurs more often in older people because they have had a greater chance to have a mutation occur. Carcinogens help aid the mutation process, but are no guarantee of contracting cancer. Some cancers (such as prostate cancer) occur frequently in old age, yet are often not the cause of death. Others may be extremely genetically related and occur at younger ages.
The medical profession has gone through many phases in the attempt to cure cancer. The many different types of cancer have differing biologies and treatments. The understanding of cancer has changed over time. Researchers had thought they had found strong indicators and causes, but the "easy" ones were often isolated to a few small types of cancers. Initial treatment used the "all out war" approach. A cancer and any nearby tissue were removed. Toxins and radiation were used to eradicate any cells. (Alas, this would often cause harm to the person and other parts of their body.) Modern research has helped uncover gene pathways and enable more targeted approaches that only impact unique aspects of the cancer cells. Cancer, however, grows and mutates rapidly, requiring targeted approaches to adapt to the changes. Some cancers have high rates of cure success, while others are still a death sentence.
Politics often becomes involved in treatments. If a potential cure is available, why limit it to a few people in chemical trials? Why not let everyone benefit? The quest to find a great cure has lead to some not-so-great experiences. For breast cancer, a South African doctor was showing extremely high remission rates for his procedure. People demanded it and forced insurance companies to cover it. Alas, it turns out the results were fraudulent, and not independently confirmed. It did not lead to long-term success and the insurance companies were actually right to be hesitant. Even good cures more only prolong life a few months or years. Is it worth it? For some people individually, the extra time may be a great benefit. For society, however, we are still looking for the long term cure.

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