Frequent Infinite Regress linkee Ruxandra Tesslo wrote an op-ed for The New York Times about why we can’t get new cancer cures. Unsurprising for those who have read her past work, she places the bulk of the blame on the glacial speed by which clinical trials are designed, set up and run, at least in the US. Biotechs are looking at other countries — yes, including China — for their next first-in-human trial. All the cures we need are right there in the lab, you see, it is these darn trials that are too slow, keeping patients away from life-saving medicines. There is a nice n-of-one story about a patient with KRAS-mutated lung cancer who received a RAS inhibitor in a phase 1 trial to set the tone.
Vinay Prasad calls out a few big omissions in Tesslo’s article, and the number one point he brings out is the number one point I have issue with as well: the science is, in fact, lacking. There are no miracle cures locked in a drawer somewhere, not reaching patients because of government bureaucracy or a big pharma conspiracy.
But how can that be, with all the money thrown into cancer research ever since Dick Nixon’s War on Cancer? Well. Though I don’t know this for a fact, I have a strong suspicion that the answer to the curious lack of cancer cures is the same as the answer to that other question no one dares ask: if trials being so slow and expensive is a huge bottleneck, why are they so slow and expensive in the first place? It’s also the reason why a discerning reader of this blog may have noticed that my writing has taken a slight but unexpected anti-market turn.
Financialization, once the great enabler of garage-based startups, has turned every field of American endeavor into a casino and given one too many a bullshitter enough money to choke the competition. Biomedicine is particularly susceptible to bullshit large and small. Even if decently financed, the honest players — of which there are quite a few — have to fight for other limited resources in the ecosystem, from PhDs to do the actual research and clinical trial sites to attention. The result is hyperinflation of trial costs and a veritable bullshit bonanza in the biomedical literature, and this is not even taking into account the more personal motives of academics to fill the field with dreck.
My big fear is that no one is talking about the negative impact of financialization because it is water. Kudos to Tesslo for not talking about billion dollar drugs, but that seems to be the default, even among science journalists. Mr. Market will give you cheaper 4K TVs — surveillance comes for free — what it won’t give you is cancer cures.
A note on the title: I have come to detest The NYT’s two-sentence titles that go out of their way to dumb down the subject matter while piquing people’s interest, but thought it would be fun to write one for a quick post that’s a comment on a NYT article. Promise it won’t happen again.