I love your essay’s attempt to draw out the domains of infectious disease and compare them with regard to progress via broad measures and more specific measures.
As someone who reads a lot of the news about new papers in both domains, I see the two domains are very similar in this regard. The floor upon which cancer research rests is the commonalities between cancers. For decades there has been a War on Cancer, and lots of things are unified across cancer, including public health efforts to avoid carcinogens.
Most striking, look at the pipeline page for any pharma company with a major cancer effort—like https://www.pfizer.com/science/oncology-cancer/pipeline—and you’ll find individual drugs being tested on cancers in multiple organs. For example Pfizer calls one of its compounds Braftovi, and they have Phase 2 or 3 trials using it for melanoma, colorectal cancer, and lung cancer. Similar marketed cancer drugs, like Gleevec, which is used for leukemia and other blood cancers, gastrointestinal stromal tumors, and skin tumors)
So the pharma intrustry is clearly fighting a war against cancer as a whole. Sam’s comment is perhaps a bit of an exaggeration—I’ve never heard a cancer researcher say that cancers are “mostly unrelated to each other”—but, more important, such comments have the context that cancers are a bundle of closely-related diseases, and everyone either knows this or thinks they’re a single disease.
I recommend https://en.wikipedia.org/wiki/The_Hallmarks_of_Cancer as the major framework that pulls together cancer into the major things that make a cancer succeed, including a somatic-mutation-rich environment, chronic inflammation, ability to replicate endlessly, evade the immune system, avoid programmed cell death, grow new blood vessels, and metastasize.
Another key to understanding cancer: knowing about the Oncogenic signaling pathways (p325 here: https://www.cell.com/cell/pdf/S0092-8674(18)30359-3.pdf). As far as I can tell these are much closer to being the actual “different diseases” in play than the various cancers named by organ. I don’t know how these pathways work, or even how exactly cancer breaks them—that’s a lot of molecular biology! -- but just knowing their names I find the daily news about the cancer literature more legible.
Looping back to the comparison made in your essay between infectious diseases and cancers, I’m struck that we started fighting infectious disease a lot earlier. For example John Snow figured out that you could avert cholera by keeping sewage out of the water supply in about 1850, and if I recall Steven Johnson’s book about public health, this was the beginning of a whole series of public health interventions against infectious disease. The idea of wearing sunscreen to avoid skin cancer seems to have come in during my childhood, over 100 years later. Same for the idea of averting lung cancer by not smoking.
I would list 3 major advances that have reduced infectious disease: public health measures, vaccines, and antibiotics. For cancer, the most effective measures are probably public health measures, surgery, chemo, and now immunooncology. Those best tools are all less effective than the best tools we use to fight infectious disease. That probably has a lot to do with how late the groundbreaking research started. Immunooncology only made its transition from minor theory to major treatment in about 2010. At a research level, treating cancer requires understanding molecular biology, and that discipline only really exploded in about 2000 when sequencing became cheap enough that we first sequenced a single human genome. There are obviously more big drug discoveries in the works, like CAR-T and cancer vaccines—let’s hope those scale, and let’s hope there are more new discoveries on the way.
Yes, we did start fighting infectious disease long before the germ theory. Most notably, the first immunization techniques, against smallpox, long predated the theory. Also there were sanitation reforms that helped significantly. But these methods were limited: e.g., no vaccines for any disease other than smallpox were created, and water sanitation did not include chlorination. Indeed, sometimes sanitation efforts backfired, as when Edwin Chadwick tried to clean up the stench of London by building sewers to drain all cesspools into the Thames, and ended up polluting the supply of drinking water. Progress was much more rapid and consistent after the germ theory.
I love your essay’s attempt to draw out the domains of infectious disease and compare them with regard to progress via broad measures and more specific measures.
As someone who reads a lot of the news about new papers in both domains, I see the two domains are very similar in this regard. The floor upon which cancer research rests is the commonalities between cancers. For decades there has been a War on Cancer, and lots of things are unified across cancer, including public health efforts to avoid carcinogens.
Most striking, look at the pipeline page for any pharma company with a major cancer effort—like https://www.pfizer.com/science/oncology-cancer/pipeline—and you’ll find individual drugs being tested on cancers in multiple organs. For example Pfizer calls one of its compounds Braftovi, and they have Phase 2 or 3 trials using it for melanoma, colorectal cancer, and lung cancer. Similar marketed cancer drugs, like Gleevec, which is used for leukemia and other blood cancers, gastrointestinal stromal tumors, and skin tumors)
So the pharma intrustry is clearly fighting a war against cancer as a whole. Sam’s comment is perhaps a bit of an exaggeration—I’ve never heard a cancer researcher say that cancers are “mostly unrelated to each other”—but, more important, such comments have the context that cancers are a bundle of closely-related diseases, and everyone either knows this or thinks they’re a single disease.
I recommend https://en.wikipedia.org/wiki/The_Hallmarks_of_Cancer as the major framework that pulls together cancer into the major things that make a cancer succeed, including a somatic-mutation-rich environment, chronic inflammation, ability to replicate endlessly, evade the immune system, avoid programmed cell death, grow new blood vessels, and metastasize.
Another key to understanding cancer: knowing about the Oncogenic signaling pathways (p325 here: https://www.cell.com/cell/pdf/S0092-8674(18)30359-3.pdf). As far as I can tell these are much closer to being the actual “different diseases” in play than the various cancers named by organ. I don’t know how these pathways work, or even how exactly cancer breaks them—that’s a lot of molecular biology! -- but just knowing their names I find the daily news about the cancer literature more legible.
Looping back to the comparison made in your essay between infectious diseases and cancers, I’m struck that we started fighting infectious disease a lot earlier. For example John Snow figured out that you could avert cholera by keeping sewage out of the water supply in about 1850, and if I recall Steven Johnson’s book about public health, this was the beginning of a whole series of public health interventions against infectious disease. The idea of wearing sunscreen to avoid skin cancer seems to have come in during my childhood, over 100 years later. Same for the idea of averting lung cancer by not smoking.
I would list 3 major advances that have reduced infectious disease: public health measures, vaccines, and antibiotics. For cancer, the most effective measures are probably public health measures, surgery, chemo, and now immunooncology. Those best tools are all less effective than the best tools we use to fight infectious disease. That probably has a lot to do with how late the groundbreaking research started. Immunooncology only made its transition from minor theory to major treatment in about 2010. At a research level, treating cancer requires understanding molecular biology, and that discipline only really exploded in about 2000 when sequencing became cheap enough that we first sequenced a single human genome. There are obviously more big drug discoveries in the works, like CAR-T and cancer vaccines—let’s hope those scale, and let’s hope there are more new discoveries on the way.
Thanks for the detailed thoughts!
Yes, we did start fighting infectious disease long before the germ theory. Most notably, the first immunization techniques, against smallpox, long predated the theory. Also there were sanitation reforms that helped significantly. But these methods were limited: e.g., no vaccines for any disease other than smallpox were created, and water sanitation did not include chlorination. Indeed, sometimes sanitation efforts backfired, as when Edwin Chadwick tried to clean up the stench of London by building sewers to drain all cesspools into the Thames, and ended up polluting the supply of drinking water. Progress was much more rapid and consistent after the germ theory.