It's strange how a person's interests converge sometimes.Last month, cable network Showtime aired a two-part documentary on one ofrock-and-roll's biggest bands, the Eagles. I, a professed "Eaglemaniac," ofcourse tuned in. For more than three decades, the Eagles' lyrics havefascinated me, and as I get older, they take on new meaning. This month, Iviewed them within the context of the other thing dominating my life at themoment: our annual cancer issue.
In 2009, from the floor of the American Association forCancer Research's (AACR) 100th Annual Meeting, I wrote that I had neverpersonally known anyone diagnosed with cancer. Last year, I shared that cancerhad affected many people in my life in various ways. This year, I'm sad toreport that it's hit close to home. In December, my uncle J.D. passed awayafter an all-too-brief battle. In January, it called home Beth Dunlap, thelovely wife of our contributing editor, Lloyd Dunlap. And it continues to wreakhavoc in the life of Mihaela Puscau, a friend's wife, whose fight against Hodgkin'slymphoma I shared with you at this time last year.
Yet, despite these personal experiences, and a continuedincrease in our cancer-related news coverage, there's a lyric by Eaglesfrontman Don Henley that sums up how I view cancer right now: "The more I know,the less I understand. All the things I thought I'd figured out, I'm learningagain."
So let's, as Henley advises, get down to "The Heart of theMatter." Where are we in cancer diagnosis, treatment, research and drugdiscovery? Breakthroughs in cancer research—from vaccines to genomic findingsto delivery mechanisms, and all that falls between—continue to be made at sucha fast pace that in 2011, we created a new website, ddncancer.com, just to keepup with all of the headlines. In this issue, we have a special report onregulatory issues in oncology drug development, a preview of AACR's show nextmonth, a guest commentary, a market research report and more than a dozen storiesthat somehow involve cancer.
But for all of these advances, at the same time, the three personalcases I mentioned above tell a far different story: one of frustrations,complications and a feeling of alienation from cancer patients and theirfamilies.
In my Uncle J.D.'s case, timely and proper diagnosis—or lackthereof—played a significant role in his quality of life in his final months.Initially and wrongly diagnosed with a blood-clotting disorder, his cancer wentundiscovered and untreated for who knows how long. By the time his diagnosiswas corrected, it was too late. His passing was swift and shocking. My familyis still trying to get all of the details on his illness and demise.
In Beth's case, she was treated for both a brain tumor andbreast cancer. Television ads for cancer centers in Chicago, near the Dunlaps'home, boasted that their patients get "better care and cure rates," Lloyd says,but he adds, "From my experience, there are many drugs to treat cancers, butfew that affect cures. There seems to be more emphasis on positioning manycancers as 'chronic' diseases. Perhaps the silver bullet is just too elusivefor most cancers, but it has to be noted that long-term cancer drug therapy isvery lucrative—much more so than a drug that cures over a short treatmentregimen."
Still, the mere mention of a cure "contributes to falsehopes among cancer sufferers, and terrible angst among their caregivers," Lloydcontinues.
"Should I have gone shopping for a resource that would haveoffered more hope?" he wonders. "Or is this picture nothing more than addedevidence that the healthcare 'industry' is exactly that? Is pharma reallyfocused on curing cancer?"
Sorin Puscau, Mihaela's husband, agrees, but is more blunt.Mihaela's battle with Hodgkin's lymphoma has encountered significant obstacles:a shortage of the chemotherapy drugs she needed; short-staffed cancer treatmentcenters; the need to travel across the country to get a bone-marrow biopsy; andnow, finally, stem cell collection and an autologous transplant. Like Lloyd andBeth, the cost of Mihaela's treatment has also been an issue, but the Puscaus havebeen lucky—they have good insurance, and Sorin has a compassionate employer whohas helped to ensure that Mihaela will be able to continue her treatments.
Holding a position in the finance and energy industries,Sorin views the situation from a sophisticated lens. Considering the economicsof cancer research and treatment, he has come to the very bleak conclusion thatwhat cancer patients want and need most is a cure, not endless, expensive,ineffective, weakening treatments—but it's the latter that the pharma industryfeels is better for business, he says.
"Curing cancer would bring a high economic impact. It couldbe devastating," Sorin asserts. "The plastics, the syringes, the staff,hospitalization, electricity consumption, etc. It could have a very broadimpact. I'm not a crazy person who is suspicious about population control, butI think that not finding a cure could also impact the human population andavailable resources. Who will pay to distribute them if there is an increase inthe population?"
So when it comes to cancer treatment, what's the "silverbullet" that Lloyd describes? It may depend on the type of dog you have in thisfight. If you're a patient or a patient's family, it's probably a cure, thetotal elimination or eradication of the disease. If you're a doctor, it may beprescribing the best possible treatment available, while maintaining a certainquality of life for your patient.
But if you're in a position to create treatments for cancer,what's the silver bullet for you? Is it creating a safe and effectiveblockbuster drug that brings in the revenue your company needs to continue workon future drugs? Is it an altruistic quest for a cure?
The three personal experiences I have shared with you haveonly made these questions loom larger for me. Henley sings, "These times are souncertain; there's a yearning undefined, and people filled with rage." I thinkit's time we get down to the true heart of the matter: Deciding what the goal ofcancer research should be.
