Cancer Isn't a Disease

Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.

A reader who works in biotech responds to the TAD question, “What is a common and/or annoying misconception about your vocation?”

Here’s an interesting one I just thought of for my field in cancer research: Sometimes I’m asked why we haven’t come up with a “cure for cancer.” This may sometimes come packed with assumptions that the biopharmaceutical industry is deliberately trying to avoid “curing” cancer because there’s so much money in drugs.

The reality is, cancer is hundreds of different diseases, and it’s still deeply complex and far from fully understood. So since there’s no clear solution to stopping cancer, therapy is the next best answer, since patients are suffering now. I’m definitely not saying that companies in my industry are doing their absolute best (they’re only as good and smart as the people who run them), but the collective of scientific knowledge says that nothing about this line of research is easy.

Here’s a quick reply from a reader who spent 15 years working in Big Pharma:

That fact alone—that cancer is a collection of diseases—dissuades Pharma from attacking it, with the absence of blockbuster potential. It’s becoming reminiscent of antibiotics, albeit for somewhat different reasons.

The first reader adds:

But antibiotics are an interesting case as well; they’re not getting any more effective. Before long we will need another means of fighting dangerous bacterial infections. Some serious work to be done in that area.

Speaking of that work, Sarah Zhang just last week had an alarming Atlantic piece about antibiotic resistance:

One by one, over the years, the drugs used to fight the most stubborn infections have fallen by the wayside as bacteria have evolved resistance to them. For certain infections, the only drug left is colistin. Then on November 18, 2015, scientists published a report in the British medical journal The Lancet: A single, easily spreadable gene makes the bacteria that carry it resistant to colistin, our antibiotic of last resort.

Chinese scientists had found this gene, called mcr-1, in pig farms and on meat in supermarkets. Why pigs? Herein lies in the irony. Colistin is an old drug and, by modern standards, not a great one. It can cause severe kidney damage. As scientists developed better antibiotics over the decades, colistin fell out of human use. So in China, farmers started using it by the tons in animals, where low doses of antibiotics can promote growth.

Now it’s come full circle. Bacteria have evolved resistance to so many of those “better” antibiotics that colistin is critical for human health again. China didn’t use colistin in humans, but many countries including the U.S. do as a last resort.

Even more worrisome in the Lancet report was evidence that mcr-1 had already leapt from pigs to humans.

Read on for the disquieting details. In a followup post, Sarah sounds another alarm:

[On January 12, 2017, the CDC] released a report about a Nevada woman who died after an infection resistant to 26 antibiotics, which is to say all available antibiotics in the U.S. The woman, who was in her 70s, had been previously hospitalized in India after fracturing her leg, eventually which led to an infection in her hip. There was nothing to treat her infection—not colistin, not other last-line antibiotics.

An expert response to that piece came from Dr. James M. Wilson, the director of the Nevada State Infectious Disease Forecast Station (“we forecast infectious disease activity like you do with the weather”—examples here and here):

I think it is crucial to keep in mind the context of this case. This occurred in our community, and it was astute frontline healthcare providers who asked the right questions regarding a travel history. They were able to get control of the situation so the pathogen did not colonize the ICU. When you read these MMWRs [Morbidity and Mortality Weekly Reports], you need to keep in mind the public health officials are leveraging untold heroism on the clinical side.

When I was asked about this event by the media, I emphasized two key points for the state of Nevada:

  1. That further importations will continue to occur. We do not live on an island.
  2. That we actually have erosion of drug susceptibilities across multiple drug classes for a wide range of bacteria. For example, at the population level, our E. coli isolates exhibit drug resistance to an alarming diversity of drugs.

Bottom line, while the media is reacting to this single imported case, we have been relentlessly losing ground with our own endemic bacteria.

From another doctor among our readership:

Many years ago at medical school in Sydney, the Infectious Disease doctors were very strict about what antibiotics could be used in the hospital vs the community. They would point at the “Brigham effect,” where ciprofloxacin use around Boston hospitals had led to resistance. They fought against other doctors to severely limit what was available on prescription.

They also fought against Big Pharma that wanted to sell more product. Yet again, this is a result of the intersection of business and the populace. It is a great example of market failure and will ultimately cost humanity.

Using probiotics when on antibiotics is useful [link]. Perhaps more useful is microbiome manipulation—the use of fecal transplant to reset gut microbiology and introduce susceptible bacteria.

Olga Khazan has covered fecal transplants before—ones that are ingested orally. Happy lunching.