A very senior US cancer funding official recently told me that his view is that we’ve made very little progress in treatment since 1971. (And, to your point, that most mortality curves are confounded by non-treatment factors.)
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I thought this was interesting since local incentives presumably push him to be *optimistic* about rate of progress.
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What about Gleevec et al? I'm sympathetic to the concerns over early diagnosis distorting the stats but there seem to have been some real innovations, moreso in cancer than other fields.
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Yeah, he wasn’t denying that particular breakthroughs have happened. Just arguing that *overall* improvement (lifestyle- and detection-adjusted) has been slight.
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José Luis Ricón Fernández de la Puente Retweeted Ashwin Varma
I guess you have read SSC's take on this as linked herehttps://twitter.com/varma_ashwin97/status/1228778007558529025?s=19 …
José Luis Ricón Fernández de la Puente added,
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Also, I will die on the hill that population statistics are a *bad* way to measure medical innovation. By population-level metrics, the only two useful medicinal approaches were vaccines and antibiotics. But I'll then ask you to very kindly experience cardiac surgery in 1945.
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Replying to @varma_ashwin97 @patrickc and
Because most people are healthy and treatments mean little for most of the pop? (Also you could make the argument with CAR-T or any new fancy anticancer innovations)
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Pretty much yeah. It also takes a decade for the impact of new treatments to show up in the statistics. So advanced in melanoma and lung cancer due to I/O probably won't show up yet.
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Replying to @varma_ashwin97 @ArtirKel and
Also I don't think you can easily separate the attributions of "early diagnosis" and "treatment". Yes, it's easier to treat cancer early. But better treatments have made it such that our early treatments are better than they were, and the risk of recurrences is less.
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Replying to @varma_ashwin97 @ArtirKel and
One great example is Herceptin. Initially, it was used to treat patients with metastatic patients. But it's real impact has been as a neoadjuvant therapy along with surgery for *early* treatment. The result? We're looking at a future where mortality from HER2+ breast cancer is 0
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I think these are all good points. I don't personally have a strong view on the question. Does seem surprising to me that this analysis isn't pursued more actively by e.g. NCI -- it should be easy to find a definitive analysis. (And Scott shouldn't have had to write his post…)
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I would agree with this. Noting that this analysis isn't done (or if it is, it isn't publicized well) is in keeping with the fact that the biopharma industry writ large is very bad at PR. Something that
@PeterKolchinsky and his group at RA are slowly trying to fix.0 replies 0 retweets 3 likesThanks. Twitter will use this to make your timeline better. UndoUndo
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