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livSeems to be yet another variation of this synthetic outrage being forwarded all over the internet. Sometimes it's zombie stories from years ago being recirculated, because people have seen the story but not the debunking. Sometimes it's a very slight variation on the theme: the amazing discovery that's being suppressed seems to have mutated from a cheap wonder drug to a cancer-killing virus recently. But otherwise the elements of the OMG this is so terrible!!!! screed are suspiciously similar. And it's just as much bullshit as every other iteration of this.
I'm sticking my neck out and saying this, even though I only seen the rumours and outraged Twitter and FB posts, I haven't traced the detail of the story back to its source and verified how little is factual. There's a pattern to these stories, and it's based on several misconceptions about how the world actually works.
They've discovered the cure for cancer
No, they've discovered something that gives statistically significant results in a lab test. In most cases this means something that kills cancer cell lines, if you're really lucky it means that it shrinks artificially created pseudo-tumours in inbred rats and mice. There are literally hundreds of such treatments discovered every year – I've discovered a couple in my time – and most of them are never developed into actual drugs that can be taken by real people with cancer.
Sometimes they kill the particular cultured cell line that some researchers happened to work with, but not really anything else. Sometimes they're reasonably effective at killing lab-grown cells, but not actual tumours. Sometimes they work reasonably ok in the kind of artificial tumours we use experimentally to test potential new drugs with relatively less suffering caused to the experimental animals than if we actually gave them cancer, but not in more realistic, but more ethically problematic animal models. Sometimes they work pretty well in lab rats but not in any other organism. Very often they kill cancer cells, but also have devastating or even lethal side-effects on healthy tissue. Sometimes they are reasonably effective and reasonably safe, but not enough better than existing treatments to justify the effort of developing them to a point where they would actually be usable.
So a very tiny proportion of potential treatments that look promising in initial tests actually go forward into clinical trials. This isn't because of an evil conspiracy, this is because scientists are doing their job properly and making a concerted effort to falsify an initially promising hypothesis. And doctors are doing their job properly and not giving sick, dying, highly vulnerable patients new drugs just because they're new, if they haven't yet been properly tested and there isn't a reasonable chance the new discovery will help.
And of the drugs that go into clinical trials, the overwhelming majority are also rejected. Most typically because they're just not safe enough to use. And note that the bar for "safe enough" is pretty low, given that most traditional cancer treatments are extremely toxic, such as deliberately inducing severe radiation burns or applying repeated high doses of really nasty poisons and carcinogens directly into a patient's bloodstream. Plus if someone is dying of so far incurable cancer, a pretty high level of risk may well be better than the alternative. But that doesn't make it ethical to give terminally ill people a treatment which causes more harm than the disease.
Some drugs are rejected because in spite of the extensive pre-clinical work, they turn out not to work after all in real patients. Some are just too unpredictable, they may miraculously cure a small number of patients but cause terrible suffering to others and despite intensive searching nobody can find what determines which will happen. This is particularly hard to accept, because if you happen to be aware of one of the lucky miraculously cured people, it can seem gratuitously evil on the part of doctors to withhold the new drug from you or your loved one. Again, some are rejected because they sort of work, but not any better than current drugs, and something people have been working with for decades is a better bet than a new option which may turn out to have rare problems.
But it can't be patented
This is pretty unlikely if you know anything about how the patent system actually works, rather than the caricature of it that floats around on the internet. It's a bit of a geek article of faith that all of intellectual property law is really only there to interfere with our freedom to acquire free entertainment, and a bit of a leftie article of faith that all of intellectual property law is really only there to help big corporations oppress poor people. I don't deny that sometimes IP law gets used for evil purposes, but it's also the case that many otherwise sensible people are far too ready to believe that patent = evil and are very uncritical about any claim that supports that view.
Thing is, if there's a cheap, easy to make chemical which is out of patent or not patentable, it's still possible to obtain a patent for a novel use of it, such as treating cancer. If some academic research gets published and later turns out that the approach proposed in the published research is worth developing as a real drug or medical tech, that doesn't mean that it's "too late" to patent anything. The process of going from a lab experiment to a generally available drug is extremely complicated and difficult and almost certainly involves multiple innovations. Formulating the drug in a way that is convenient or at least plausible to administer, that reliably gets the right dose into the circulation, and ensures that the half-life of the drug is long enough to have the desired effect but that it doesn't hang around in the body forever, and avoiding weird interactions between the active ingredient and the "carrier" components of the formulation, all of these are problems which have to be solved. Then you get scaling up to be able to make enough of the drug to distribute it to all the patients who need it, which is a manufacturing problem. Solving these problems is likely to involve innovations which are potentially patentable. Hey, sometimes it's even possible to patent a particular detailed treatment protocol or a method of training doctors to be able to successfully apply your new treatment.
Besides which, in recent years I've repeatedly heard from high-up people working for drug companies that these days their business model is to reduce their reliance on big patents. The patent system gives essentially aseven-year time-limited monopoly, but given the complexity of modern medicine, and cancer treatment is for various reasons an extreme case, it can often take most of that protected time (10 to 15 years is not atypical, from what I've heard) to actually develop a drug to the point where it's clinically useful and change the working practices of medical teams so that the new treatment is routinely preferred over the old one. So what I'm picking up is that ruthless, cold-hearted capitalist companies that care more about the shareholders' bottom line than about curing sick people are starting to seek other ways to make profits. (Sure, the people who are saying this could be lying to us naive academic researchers; if you automatically believe that anyone employed by "Big Pharma" is part of the conspiracy, then you are not going to find this line of argument convincing.)
If a treatment truly is unpatentable, well then, companies are going to try making money by making a better or at least more popular generic version than their rivals. They're going to do the absolutely standard capitalist thing of shifting more by selling it at a cheaper price. Or use their advantages in already having the infrastructure in place to be able to make more of it faster than their rivals. Or they're going to sell to the developing world / global south where the sheer size of the potential market can sometimes outweigh the relatively lower amount of money available for medicine (and the relative difficulties of enforcing patents). If the treatment is difficult to manufacture and distribute, it can still demand a high market price even without the legal monopoly provided by the patent system. There's an effective technical monopoly for companies that have the resources to produce the drug in big enough quantities and with good enough quality control to be used. And if it genuinely is easy and cheap to make, you can bet that small entrepreneurs would be all over it if for some inexplicable reason the big companies decided not to take the opportunity to make easy money.
Note I'm not claiming that pharmaceutical companies are actually benevolent and altruistic! Just that even with the assumption that they care vastly more about profit than ethics, it makes no sense at all to "suppress" a genuinely effective new treatment for cancer because it can't be patented.
So it's being suppressed!
Well, it's possible. I am constitutionally disinclined to believe conspiracy theories, but maybe one day I'm going to get egg on my face when I learn that some shadowy cabal of evil capitalists really is cackling and rubbing their hands together over how much more profitable it is to let people die of cancer than cure them. But ask yourself this: if there really is a worldwide conspiracy, do you honestly think some guy on Facebook or semi-literate blogger has Uncovered The Truth?
The thing is, there isn't any central deciding board out there choosing which initially promising experiments should be taken forward through the entire long, expensive and highly complex process of actually developing a new treatment which gets used for real patients. There are lots of different people making lots of individual decisions at all kinds of levels, the scientists themselves, the businesses or non-profit research institutions that employ them, the people who decide how to allocate the funding (government bodies, charities, venture capitalists, boards of directors etc), and so on. Even among the drugs that do get commercialized, there are still decisions as to which ones are offered to patients: doctors have to evaluate the evidence and decide whether to switch to a new treatment, hospitals have to decide whether buying a new drug is cost-effective, and national-level politics plays a role as well.
Some of those decisions are going to lead to the wrong outcome, whether by bad luck or malice / putting profit ahead of human suffering. So I'm sure it does happen that sometimes more effort goes into developing an objectively less good treatment than one that would have turned out to be better if only it had been developed. But that's rarely because of any one direct comparison between two potential treatments, and even when it is, the question of which of these options will make more money through patents is very unlikely to be the sole consideration. Not that that itself is a particularly straightforward thing to assess anyway; crudely there's a reasonable correlation between successful, effective treatments and how much money can be made from them. In fact, a more likely reason why why a potentially wonderful cancer treatment is likely to be abandoned (not suppressed) is because it is only good for a very rare kind of cancer. So grandiose claims about how this amazing wonder drug or magical virus is effective against every known kind of cancer should give even more reason to be suspicious of the story that They are suppressing its production.
The other big reason to be extremely skeptical about these kinds of scare stories is that very often they originate from quacks who are peddling some kind of miracle cure. They want desperate cancer patients to believe that the whole medical, scientific, political and commercial establishment is conspiring against them, so that they'll be good little marks for whatever someone's selling. That could be magic, it could be something that is completely untested and unvalidated, it could be a genuine drug (perhaps even the very one that's supposedly being suppressed by evil corporations) being manufactured without the appropriate quality control and safety checks.
This is pretty much a potted version of a rant I subjectedjack to when he innocently asked me about the cancer-killing virus story. So I thought I should put it on the internet for posterity! I should note that I know quite a lot about cancer research, as it's been my profession for ten years, but my knowledge of IP law comes from the fact that my childhood was pretty much as portrayed in this Calvin and Hobbes strip.
For a more detailed takedown of the story, with actual citations rather than just ranting, see this excellent piece by David Gorski on DCA. As far as I can tell the DCA story from 2007 is the memetic ancestor to all the related scandals that keep doing the rounds, though even DCA itself hasn't died out, it shows up on social networks every so often.
I'm sticking my neck out and saying this, even though I only seen the rumours and outraged Twitter and FB posts, I haven't traced the detail of the story back to its source and verified how little is factual. There's a pattern to these stories, and it's based on several misconceptions about how the world actually works.
They've discovered the cure for cancer
No, they've discovered something that gives statistically significant results in a lab test. In most cases this means something that kills cancer cell lines, if you're really lucky it means that it shrinks artificially created pseudo-tumours in inbred rats and mice. There are literally hundreds of such treatments discovered every year – I've discovered a couple in my time – and most of them are never developed into actual drugs that can be taken by real people with cancer.
Sometimes they kill the particular cultured cell line that some researchers happened to work with, but not really anything else. Sometimes they're reasonably effective at killing lab-grown cells, but not actual tumours. Sometimes they work reasonably ok in the kind of artificial tumours we use experimentally to test potential new drugs with relatively less suffering caused to the experimental animals than if we actually gave them cancer, but not in more realistic, but more ethically problematic animal models. Sometimes they work pretty well in lab rats but not in any other organism. Very often they kill cancer cells, but also have devastating or even lethal side-effects on healthy tissue. Sometimes they are reasonably effective and reasonably safe, but not enough better than existing treatments to justify the effort of developing them to a point where they would actually be usable.
So a very tiny proportion of potential treatments that look promising in initial tests actually go forward into clinical trials. This isn't because of an evil conspiracy, this is because scientists are doing their job properly and making a concerted effort to falsify an initially promising hypothesis. And doctors are doing their job properly and not giving sick, dying, highly vulnerable patients new drugs just because they're new, if they haven't yet been properly tested and there isn't a reasonable chance the new discovery will help.
And of the drugs that go into clinical trials, the overwhelming majority are also rejected. Most typically because they're just not safe enough to use. And note that the bar for "safe enough" is pretty low, given that most traditional cancer treatments are extremely toxic, such as deliberately inducing severe radiation burns or applying repeated high doses of really nasty poisons and carcinogens directly into a patient's bloodstream. Plus if someone is dying of so far incurable cancer, a pretty high level of risk may well be better than the alternative. But that doesn't make it ethical to give terminally ill people a treatment which causes more harm than the disease.
Some drugs are rejected because in spite of the extensive pre-clinical work, they turn out not to work after all in real patients. Some are just too unpredictable, they may miraculously cure a small number of patients but cause terrible suffering to others and despite intensive searching nobody can find what determines which will happen. This is particularly hard to accept, because if you happen to be aware of one of the lucky miraculously cured people, it can seem gratuitously evil on the part of doctors to withhold the new drug from you or your loved one. Again, some are rejected because they sort of work, but not any better than current drugs, and something people have been working with for decades is a better bet than a new option which may turn out to have rare problems.
But it can't be patented
This is pretty unlikely if you know anything about how the patent system actually works, rather than the caricature of it that floats around on the internet. It's a bit of a geek article of faith that all of intellectual property law is really only there to interfere with our freedom to acquire free entertainment, and a bit of a leftie article of faith that all of intellectual property law is really only there to help big corporations oppress poor people. I don't deny that sometimes IP law gets used for evil purposes, but it's also the case that many otherwise sensible people are far too ready to believe that patent = evil and are very uncritical about any claim that supports that view.
Thing is, if there's a cheap, easy to make chemical which is out of patent or not patentable, it's still possible to obtain a patent for a novel use of it, such as treating cancer. If some academic research gets published and later turns out that the approach proposed in the published research is worth developing as a real drug or medical tech, that doesn't mean that it's "too late" to patent anything. The process of going from a lab experiment to a generally available drug is extremely complicated and difficult and almost certainly involves multiple innovations. Formulating the drug in a way that is convenient or at least plausible to administer, that reliably gets the right dose into the circulation, and ensures that the half-life of the drug is long enough to have the desired effect but that it doesn't hang around in the body forever, and avoiding weird interactions between the active ingredient and the "carrier" components of the formulation, all of these are problems which have to be solved. Then you get scaling up to be able to make enough of the drug to distribute it to all the patients who need it, which is a manufacturing problem. Solving these problems is likely to involve innovations which are potentially patentable. Hey, sometimes it's even possible to patent a particular detailed treatment protocol or a method of training doctors to be able to successfully apply your new treatment.
Besides which, in recent years I've repeatedly heard from high-up people working for drug companies that these days their business model is to reduce their reliance on big patents. The patent system gives essentially a
If a treatment truly is unpatentable, well then, companies are going to try making money by making a better or at least more popular generic version than their rivals. They're going to do the absolutely standard capitalist thing of shifting more by selling it at a cheaper price. Or use their advantages in already having the infrastructure in place to be able to make more of it faster than their rivals. Or they're going to sell to the developing world / global south where the sheer size of the potential market can sometimes outweigh the relatively lower amount of money available for medicine (and the relative difficulties of enforcing patents). If the treatment is difficult to manufacture and distribute, it can still demand a high market price even without the legal monopoly provided by the patent system. There's an effective technical monopoly for companies that have the resources to produce the drug in big enough quantities and with good enough quality control to be used. And if it genuinely is easy and cheap to make, you can bet that small entrepreneurs would be all over it if for some inexplicable reason the big companies decided not to take the opportunity to make easy money.
Note I'm not claiming that pharmaceutical companies are actually benevolent and altruistic! Just that even with the assumption that they care vastly more about profit than ethics, it makes no sense at all to "suppress" a genuinely effective new treatment for cancer because it can't be patented.
So it's being suppressed!
Well, it's possible. I am constitutionally disinclined to believe conspiracy theories, but maybe one day I'm going to get egg on my face when I learn that some shadowy cabal of evil capitalists really is cackling and rubbing their hands together over how much more profitable it is to let people die of cancer than cure them. But ask yourself this: if there really is a worldwide conspiracy, do you honestly think some guy on Facebook or semi-literate blogger has Uncovered The Truth?
The thing is, there isn't any central deciding board out there choosing which initially promising experiments should be taken forward through the entire long, expensive and highly complex process of actually developing a new treatment which gets used for real patients. There are lots of different people making lots of individual decisions at all kinds of levels, the scientists themselves, the businesses or non-profit research institutions that employ them, the people who decide how to allocate the funding (government bodies, charities, venture capitalists, boards of directors etc), and so on. Even among the drugs that do get commercialized, there are still decisions as to which ones are offered to patients: doctors have to evaluate the evidence and decide whether to switch to a new treatment, hospitals have to decide whether buying a new drug is cost-effective, and national-level politics plays a role as well.
Some of those decisions are going to lead to the wrong outcome, whether by bad luck or malice / putting profit ahead of human suffering. So I'm sure it does happen that sometimes more effort goes into developing an objectively less good treatment than one that would have turned out to be better if only it had been developed. But that's rarely because of any one direct comparison between two potential treatments, and even when it is, the question of which of these options will make more money through patents is very unlikely to be the sole consideration. Not that that itself is a particularly straightforward thing to assess anyway; crudely there's a reasonable correlation between successful, effective treatments and how much money can be made from them. In fact, a more likely reason why why a potentially wonderful cancer treatment is likely to be abandoned (not suppressed) is because it is only good for a very rare kind of cancer. So grandiose claims about how this amazing wonder drug or magical virus is effective against every known kind of cancer should give even more reason to be suspicious of the story that They are suppressing its production.
The other big reason to be extremely skeptical about these kinds of scare stories is that very often they originate from quacks who are peddling some kind of miracle cure. They want desperate cancer patients to believe that the whole medical, scientific, political and commercial establishment is conspiring against them, so that they'll be good little marks for whatever someone's selling. That could be magic, it could be something that is completely untested and unvalidated, it could be a genuine drug (perhaps even the very one that's supposedly being suppressed by evil corporations) being manufactured without the appropriate quality control and safety checks.
This is pretty much a potted version of a rant I subjected
jack to when he innocently asked me about the cancer-killing virus story. So I thought I should put it on the internet for posterity! I should note that I know quite a lot about cancer research, as it's been my profession for ten years, but my knowledge of IP law comes from the fact that my childhood was pretty much as portrayed in this Calvin and Hobbes strip. For a more detailed takedown of the story, with actual citations rather than just ranting, see this excellent piece by David Gorski on DCA. As far as I can tell the DCA story from 2007 is the memetic ancestor to all the related scandals that keep doing the rounds, though even DCA itself hasn't died out, it shows up on social networks every so often.
(no subject)
Date: 2012-09-13 04:00 pm (UTC)There can be minor manipulation of clinical trial results. As you say it's unlikely you'd be able to cover up negative results completely, and honestly it's not worth the risk even for an putative evil pharma company. Nobody wants to spend lots of money developing a drug that they already know doesn't work or is dangerous! However you can have things like massive publicity about one trial that gave promising results while a trial that gave mixed results is effectively buried in some minor journal where no-one will ever see it. And there are quite a lot of so-called "marketing studies" where the purpose is not so much to find out data about how the drug works, but to draw attention to the drug among doctors. So yes, there are problems, but not the kind of conspiracy theory that these scare articles go on about.
I am pretty sure there isn't a single "cure for cancer", no. There are some approaches that are reasonably general, such as blocking the blood supply to the tumour, but even that is somewhat limited in its effectiveness. And you're right, cancer isn't one disease with one aetiology.