Tuesday, April 28, 2009

The Mirage of “The Cure”

We are wasting our lives waiting for miracle cures. That’s the sense I get from some recent health news.

Hoping for a cure is one thing. Working towards a cure, that’s understandable. Anyone who suffers from an illness, whether it's just the common cold or something much worse, surely wishes that it will go away and won’t ever happen again. But, recent news is not hope inspiring.

Geneomics: Show Limited Value in Predicting Disease

Recent advances in decoding the genome has led many to predict an age of “personalized medicine”. The notion is that we would soon learn which gene was responsible for which disease. Then, we could give an individual advance warning that he is likely to get a specific disease so he can take appropriate preventive action or plan life accordingly.

Things haven’t worked out that way.

The April 23, 2009 issue of the New England Journal of Medicine has several articles (see here, here and here) reviewing the progress made in understanding the relationships between genes and diseases.

A New York Times story summarized the results: “The era of personal genomic medicine may have to wait. The genetic analysis of common disease is turning out to be a lot more complex than expected.” The scientific method used in the genomic studies turned out to be more successful than expected, but what has been learned is different than what people had hoped. “Unlike the rare diseases caused by a change affecting only one gene, common diseases like cancer and diabetes are caused by a set of several genetic variations in each person.” One of the authors, Dr. David B. Goldstein of Duke University, writes that “In pointing at everything, genetics would point at nothing.”

Basically, except in rare cases, we’re unlikely to find a simple relationship between genes and disease. No magic cures here.

Cancer: Little Progress Towards Cure

Another recent NY Times articleIn Long Drive to Cure Cancer, Advances Have Been Elusive – began:

In 1971, flush with the nation’s success in putting a man on the Moon, President Richard M. Nixon announced a new goal. Cancer would be cured by 1976, the bicentennial.

When 1976 came and went, the date for a cure, or at least substantial progress, kept being put off. It was going to happen by 2000, then by 2015.

The article noted that the death rate for cancer has dropped only 5% in the past 45 years, very small compared to declines in death rates for other illnesses such as heart diesease, flu and pneumonia. Progress on prevention has also been “agonizingly slow”.

And yet the popular perception is that various prevention methods (e.g. high-fiber diets) are effective, that early detection will make a big difference in disease progression, and that “miraculous treatments and more in the pipeline could cure you or turn your cancer into a manageable disease.”

The misperceptions stem from the public’s desire to have a miracle to believe in, and the profession’s reluctance to be more frank.

As a doctor who tries to be honest with patients, Dr. [Leonard] Saltz [a colon cancer specialist at Memorial Sloan-Kettering Cancer Center] says he sees the allure of illusions.

“It would be very hard and insensitive to say, ‘All I’ve got is a drug that will cost $10,000 a month and give you an average survival benefit of a month or two,’ ” he said. “The details are very, very tough to deal with.”

The public demand for an immediate, easy cure has also gotten in the way of potential progress — we want the current way to work, and so are unwilling to look at alternatives:

And for all the money poured into cancer research, there has never been enough for innovative studies, the kind that can fundamentally change the way scientists understand cancer or doctors treat it. Such studies are risky, less likely to work than ones that are more incremental. The result is that, with limited money, innovative projects often lose out to more reliably successful projects that aim to tweak treatments, perhaps extending life by only weeks.

Yet again, we are hampered by the illusion that a miracle cure exists and that we’ll get there if keep on the current path.

Seeing the Mirage

Clearly we need to do more than simply waiting, perhaps in vain, for someone to find “the cure”, do more than placing the entire burden of finding ways to improve our health on “the experts”. What else should we do? That’s a topic for other posts. But, for now, not giving in to the mirage is a start.

No comments: