“If you are trying to figure out a thinker and his or her defects, see if you can spot that person’s “once-and-for-all” moves. There will be plenty of them.”

Cowen is right, though we can debate whether early closure is a defect or a feature.

Hard to say what’s better here, the article or the illustrations that accompany it. Good job, FT Magazine.

“The convergence of genomics of the cancer—be it from the person’s DNA or tumor directly or the blood (known as liquid biopsy)—matched with the appropriate therapy is leading to outcomes that are being described as ‘unheard-of’ by expert oncologists.”

So writes one Eric Topol, who seems to have made a career out of telling high-status people what they want to hear. For reasons why most of what he wrote is wrong, take a few minutes to watch Vinay Prasad’s reviews of the articles in question.

The trend disrupting medicine back when Dr. Topol was writing about its Creative Destruction turned out to be not technology but rather the opioid epidemic. As a non-expert oncologist I would wager something other than liquid biopsies is leaving its hallmark on the field right now.

“When people stopped smoking, toxic clouds disappeared from indoor spaces like bars, restaurants, and offices. I think something similar would happen if people stopped reading the news, except the detoxified indoor spaces would be our own heads.”

Brilliant.

PSA: don’t dig holes in the sand. A few years ago my wife and I finished a Thanksgiving beach outing by helping dig out a kid (not ours!) completely buried after a hole he was in collapsed. He made it out alive, but it was traumatic for everyone involved.

The NYT dostarlimab article is reverberating through international media with predictable consequences: being hailed as a miracle cure for cancer. I wrote about it in Serbian, and Google’s translation of it is readable, in an AI-generated spam sort of way.

“It is in the nature of jesters to speak their minds when the mood takes them, regardless of the consequences. They are neither calculating nor circumspect, and this may account for the “foolishness” often ascribed to them.”

Fools were everywhere. Not so much anymore.

“It was a small trial, just 18 rectal cancer patients, every one of whom took the same drug. But the results were astonishing. The cancer vanished in every single patient, undetectable by physical exam, endoscopy, PET scans or M.R.I. scans.”

You shouldn’t judge an article by its headline, so how about the first few paragraphs?

“Dr. Luis A. Diaz Jr. of Memorial Sloan Kettering Cancer Center, an author of a paper published Sunday in the New England Journal of Medicine describing the results, which were sponsored by the drug company GlaxoSmithKline, said he knew of no other study in which a treatment completely obliterated a cancer in every patient. “I believe this is the first time this has happened in the history of cancer,” Dr. Diaz said.”

So far we have “astonishing”, “vanished in every single patient”, “obliterated”, and the “first-time-in-history” gambit. Anything else?

“Dr. Alan P. Venook, a colorectal cancer specialist at the University of California, San Francisco, who was not involved with the study, said he also thought this was a first. A complete remission in every single patient is “unheard-of,” he said.”

“Unheard-of”! So be it.

Not until paragraph 18, long after it praised lack of toxicities in a 12-patient trial of a drug with a known side effect profile, and shortly after mentioning the C-word sandwiched between “remarkable” and “unprecedented” is it revealed that

“The inspiration for the rectal cancer study came from a clinical trial Dr. Diaz led in 2017 that Merck, the drugmaker, funded. It involved 86 people with metastatic cancer that originated in various parts of their bodies. But the cancers all shared a gene mutation that prevented cells from repairing damage to DNA. These mutations occur in 4 percent of all cancer patients.”

The “mutation” in questions is mismatch repair (MMR) deficiency is not actually a mutation, but that is this report’s least egregious journalistic error.

MMR deficient tumors respond well to immune checkpoint inhibitors. One of them, pembrolizumab, has broad FDA approval for all “advanced” (i.e. metastatic or unresectable) cancers with MMR deficiency. The goal of this most excellent study which absolutely should have been done is to see whether it can be used even earlier, to avoid possibly debilitating but potentially curative surgery.

And lo and behold, it can! Congratulations to the study team, immune checkpoint inhibitor manufacturers, and most of all to those people who are yet to develop an MMR-deficient tumor which is still resectable, but now maybe doesn’t need to be resected because it will melt away with immune checkpoint inhibition. NB: this is significantly less than the quoted 4%, which includes people whose cancers are advanced and who can already receive ICIs.

Note that I did not learn any of this from the new article, but rather from being a medical oncologist and reading the NEJM paper which is at least — let it not be said NYT does everything wrong — linked to early on.

How will others read it, one wonders?

Uniquely, the gun industry has legal immunity from the effects of its products. Imagine if pharma companies were shielded from the consequences of bad drugs or automakers from faulty engines. The same rules must apply to Smith & Wesson, American Outdoor Brands and other gun manufacturers.

The FT’s Editorial Board misses to note that, unlike drug toxicity and engine breakdowns, committing mass murder is the sole intended purpose of automatic and semi-automatic weapons. America is no stranger to regulation: you may not, for example, cut people’s hair without a state-issued license. That people of any age can just walk into a store and buy a weapon of mass destruction is a crime against humanity and should be treated as such.

That’s one good-looking pig. www.ft.com/content/8…