Archive for the 'Medicine' Category

Deep Medicine – Wellness in a very complex universe and web of life

Friday, November 5th, 2021

Inflamed; Deep Medicine and the Anatomy of Injustice, Rupa Marya & Raj Patel, 2021

Truly holistic health must contend with the elements that continue to make people unwell, locating the disease-causing entities in social structures and the grave misunderstandings that created them. Systems that position humans as supreme over the entire web of life, settler over Indigenous, a singular religion over all other-world views, male over female and nonbinary understandings of gender, white over every other shade of skin — these must be dismantled and composted. We must reimagine our wellness collectively, not simply as individuals or communities but in relation to all the entities that support the possibility of healthy lives. These relaionships, precisely because they are vital for health, are worthy of our care.
The problem is when inclusion becomes enclosure — when the radically transformative projects, theories, and futures led by Indigenous and poor people are sterilized by liberalism, and when the language and other signifiers of revolution are co-opted and incorporated into some giant soup of civil rights struggles…For those living in settler societies, the work of being in solidarity specifically with Indigenous-led movements is particularly critical. The collapse of ecological, social, and bodily health is an outcome of over six hundred years of cosmological warfare.
Forging new forms of solidarity is not easy. It requires abandoning colonial ties and creating new relations with other fugitives. Reconnecting relations that colonialism sundered is simultaneously a personal and political project. Colonialism reproduces itself through a hegemony that has been widely internalized. Transcending it won’t require just therapy, or antiracist book clubs, or some individual process of self-scrutiny. It will involve a collective journey to new forms of exchange and relations.


Yosemite Valley and Falls

The romance of the wilderness (the National Parks) was created through the erasure of the people who knew how to live sustainably in a specific place, often for thousands of years…Removing this taint (native inhabitants) on the landscape would have severe consequences not only for the people but for the entire ecosystem: the invention of the pristine wilderness inaugurated an era of catastrophic forest fires.

Inflammation is triggered when tissues and cells are damaged or threatened with damage. A complex and intricately coordinated response of the immune system, inflammation mobilizes resources to ultimately heal what has been injured. In a healthy, balanced system, once the mending has occurred, inflammation subsides. When the damage keeps coming, the repair cannot fully happen, leaving the inflammatory response running. A system of healing then turns into one that creates more harm.
As we explore inflammation in this book, we will sometime use the language of the body in analogy. So salmon are to rivers as hearts are to blood vessels. They both function as nutrient pumps in systems of circulation. We sometimes proceed by simile; dams are like vascular obstructions. We are not above metaphor. Trade routes for example, are colonialism’s arteries, moving people, capital goods, and diseases around the world system, and connecting bodies, societies, geographies, and ecologies. The metaphor helps us to show that inflammation is systemic and that the systems are linked. But we aren’t making a literary arguments so much as a medical one. The inflammation in your arteries and the inflammation of the planet are linked, and the causal connections are becoming increasingly clear; your physiological state is a reaction to social and environmental factors. Racial violence, economic precarity, industrial pollution, poor diet, and even the water you drink can inflame you.

The stories of interference in the ancient relationships between land, water, humans, and salmon demonstrates how interconnected these all are and how technological arrogance can crate downstream problems when we work to outsmart the ecologies we belong to. A disruption in one part of the web of life, within a few short decades, ends up eroding the vitality of the whole system. But the good news is that ecologically guided reparation starting at one point of the web can bring vitality back to the whole…And that ecological restoration must start with the people who were integrated into the ecology before colonialism, and who are still here working on these solutions.

The (Covid) pandemic revealed in stark terms the reality of how environmental and social injustice affects health, and also the deeper truth that under a colonial cosmology, many humans have been made disposable.

Unfortunately, we are rushing headlong into a crisis of colonial capitalism in which pollution deaths soar, driven by a climate crisis, like the Covid pandemic, in which a few profit greatly while billions suffer…Absent a serious diagnosis of the climate crisis and its impact on the exposome and our bodies, medicine will continue to treat the symptoms but will miss the opportunity for a cure.

Learning to listen must be the work of settlers on colonized land, of modern societies that treat the Earth as a thing to be exploited, and of health care workers, as we increasingly encounter existential threats from forest fires, pandemics, catastrophic floods, and global warming–all signs that we are critically out of balance.

Through his investments, (Bill) Gates owns 97,933 hectares (242,000 acres) of arable land, making him the largest farmland owner and occupant of stolen territory in the United States.

After the Bolivian coup to assure US extractive rights to lithium needed for his electric cars, Elon Musk tweated: “We will coup whoever we want! Deal with it.”

Colonial capitalism suppresses the equitable distribution of resources, expending great energy–through extraction, border construction, incarceration, and the creation of supremacist cosmologies and institutions–to maintain a structure that prioritizes individuals over communities. Without the networking-capacity benefits of communities, society under colonial capitalism is more vulnerable to the shocks and failures of systems within systems, which we see with pandemics, raging wildfires, and stock market volatility.

Normally, pro-inflammatory activity is self limited, turning off once homeostasis is achieved. Sustained activation means that an inflammatory stimulus is chronic or the response simply fails to stop. When it continues unabated, it produces the inflammation that is a hallmark of neurodegenerative conditions such as Alzheimer’s, Parkinson’s, Huntington’s, multiple sclerosis, and amyotrophic lateral sclerosis.

The planet, our own bodies, and our consciousness are wired for the care of others. But capitalist economic and social systems teach us to restrict the set of beings whom we’re prepared to recognize as people, and to suppress the urge to care, unless money might be made from it. They misdirect our attention and obfuscate our capacity to recognize one another, and the care we need.
Humans have broken the world. The air that renders neurological disease more likely has to be cleaned. Industrial agriculture has massively degraded the land, and it will take a profound shift in priorities to reverse the killing of the flora, fauna, and fungi beneath our feet. In the United States, as elsewhere in the world, waterways are being polluted by agriculture and fossil fuels, and the defenders of that water are being attacked.

Unlearning capitalist cosmology cannot be done alone, as a project of individual therapy. It is not about an individual decision to “be kind” or to “be antiracist.” Rather it’s about the solidarity of political communities, of networks of people, engaged in systemic change. A decolonial idea of care extends not just to other humans but to all relations in the web of life.


Water Protectors at Standing Rock

When I (Rupa) went to Standing Rock, I saw a glimpse of another way of being in community, which allowed us to reconnect to that pluripotency that has been broken by colonialism…It was as if time were standing still and we were back in the era of colonial conquest. I had already known this conceptually, but it was there that I really understood in every cell of my body that colonialism is an ongoing project that reproduces itself across generations. It never stopped. For the system to continue, its power relations must be re-created every day, and that re-creation occurs because individuals are coerced, voluntarily agree, or simply cannot imagine how not to participate in the rules set out before us.

Monopolies, Created Deserts, and Warren Buffets

Friday, July 9th, 2021

Monopolized; Life in the Age of Corporate Power, David Dayen, 2021

This book is one of the most depressing, even apocalyptic in recent memory. It is also well researched, organized, and important.
Each chapter addresses an industry segment that has fallen to monopoly: Airlines, Big Agriculture, Journalism and media, Broadband Internet, Opioid medication, Banks, Offshoring essential products, Amazon and Google, Hospitals Supply chains, Rental Housing after 2008, Prisons and Immigrant detention. The book is focused on monopolies in each of these segments. Warren Buffet is mentioned as a significant investor in monopolies in each chapter. Dayen estimates that twelve mega-billionaires like Warren Buffet effectively control the entire US economy today. What can these handful of men possibly do with the wealth they have accumulated? This is from Jeff Bezos, currently the wealthiest:

The only way I can see to deploy this much financial resource is by converting my Amazon winnings into space Travel

Tesla’s Elon Musk seems to share Bezos’ sentiment. Dayen — “Our overlords literally shoot money into space while millions around them suffer.” Here is Buffet;

We think in terms of that moat and the ability to keep its width and its impossibility of being crossed.


Dayen — “Morningstar offers an economic moat index fund of the twenty companies with the highest walls around their businesses.”

The average age of a farmer in America is fifty-eight. In Iowa, 60 percent of all farm owners are over the age of sixty-five; just 1 percent are thirty-four or younger. More than half of all Iowa farmland is rented out, and the startup costs of land, machinery, and other inputs are a huge barrier to entry. A substantial number of farm owners are elderly widows who inherited the land. As they pass on, Iowa could be transformed.

As Iowa and other agricultural states empty out and businesses close, the states turn into people less deserts. Mono culture (single crop) farming with huge chemical inputs are transforming formerly fertile land into barren deserts. Deserts can take many forms and empty farmland is only the first discussed here.

The news deserts created primarily by the dominance of Facebook and Google and by the crippling of the media business model have grave implications for democracy…it’s undeniable that corruption spreads, conspiracies are fostered, and truth is obscured where journalism is absent.

This is the curse of bigness in San Francisco, a city so teeming with money that nobody can afford to open a store to take it…But the truth is that the San Francisco Bay Area is the nation’s second-most dense…Big money has created a vicious spiral: a winner-take-all city keeps accumulating vacant lots, dead-eyed commuters drive for hours to their barely affordable homes, landords must keep rents astronomically high to cover their own astronomically high loans. The concentration of extreme wealth isn’t just bad for the losers in depressed counties and towns. It’s bad for the winners.

Urban deserts are not limited to Flint and Detroit Michigan, to Oakland California and Philadelphia and Baltimore. Try living in today’s San Francisco. Several of my son’s San Francisco old high school friends are living lives as nomads in the city, complete with vans.

In telecommunications including cellphone and broadband America is a disgrace with the highest prices and lowest quality and service anywhere in the world. At America’s founding, postal service was guaranteed to every American. FDR’s Tennessee Valley Authority (TVA) together with massive western dam projects guaranteed electrical power to every American. At one time every American was guaranteed phone service. Dayen describes Chattanooga, a big beneficiary of the TVA, and its TVA run utility the Electric Power Board (EPB) which decided to upgrade using fiber optics to improve the reliability of its electric grids. In 2007 EPB decided to offer fiber optics to every home in its service area paid for by a $219.8 million bond. Comcast sued to stop the plan alleging illegal cross-subsidy of electric rate payer funds. Comcast lost and residents of EPB’s service area have access to gigabit broadband access supporting phone and internet service. If you are not in EPB’s service area you are in the communications desert.
I live in the heart of Phoenix Arizona and have access to Centurylink’s (baby Bell) DSL “service” of 16MB sometimes at a cost of about $50 per month. I have a grandfathered T-Mobile prepaid phone that gets no signal at my home even after the T-Mobile Sprint merger. I can make phone calls from my home via Android wifi on my T-Mobile phone or via voice over IP (VOIP) through google voice.
I live five miles from Phoenix’s TV Towers but receive no over the air (OTA) signals for any major network on my TV. Using advanced rooftop antennas and signal amplifiers, I used to be able to receive 5 major networks 95 miles line-of-site to the towers on Mount Lemon near Tucson. Continued reduction in transmit power by network operators has reduced reception to 3 major networks today. Even these 3 are sensitive to weather. I tried to raise the issue of reduced OTA transmitter power over the publicly owned airwaves with newly elected Senator Mark Kelly and was blown off by staff members.
If you live in rural America chances are you have no access to broadband. Urban Americans may typically have two “options” for broadband, your baby bell or surviving phone company and one cable operator. Both will have atrocious customer service and questionable reliability and unconscionable low speeds. Somewhere in a streaming chain, maybe the local broadband supplier is able to restrict speeds or break a stream altogether. We could get better service almost anywhere in the world. Most Americans live in a communications desert.

Dayen talks about the mergers and acquisitions (M&A) banking business that came into it’s own in the 1960s. Today it is a huge industry dominated by the six too big to fail banks.

As of 2019, the six biggest banks–JP Morgan Chase, Bank of America, Citigroup, Wells Fargo, Goldman Sachs, and Morgan Stanley–control $10.5 trillion in financial assets. These banks also happen to be serial transnational criminal enterprises, paying $182 billion in (inadequate) penalties for rap sheets of incomparable length. Few of the violations even relate to the financial crisis’s run-up and aftermath, though those were significant. Incidents of debt collection fraud, market rigging, money laundering, misrepresentations to clients, kickback schemes, and unlawful securities sales all occurred after the crisis.

The media has focused on stock buyback after tax reductions and record profits but gives little attention to the bigger story; mergers of corporations into ever larger and more unaccountable monopolies. The six big banks are key players in these mergers pocketing huge fees for their services. Goldman Sachs, in one merger featured in the book involving United Natural Foods Inc. (UNFI), continued to change the terms of the merger to favor themselves and even created and sold derivatives for hedge funds wanting to bet against the merger.

Mergers in the health care industry, especially hospitals has created large healthcare deserts in America. Hedge funds often buy hospitals for their real estate value and close them after gutting their operations. Millions of Americans are left with few options and long travel distances and time to seek services.

Monopolies create highly vulnerable supply chains often with sole source and offshore production. Dayen talks about an acute shortage of saline drip bags (cost $1) because production in sole source Puerto Rico was disrupted. This failure disrupted services in hospitals across the country. Covid19 protective equipment like masks, shields, gowns, etc. were simply not available for months. Then there are sole source parts like faulty batteries for the F-35 $100 million fighter jets that made them unable to escape Hurricane Michael in 2018. All current US Weapons systems are dependent on parts from China! Supply deserts are disruptive and dangerous and we are inundated in them.

Ten million American homes were lost to foreclosure as a result the 2008 financial subprime disaster. Dayen has an earlier book Chain of Title focusing on the struggle of American’s being illegal foreclosed on as a result of the massive production of fake documents purporting to support the existence of loans. Aaron Glantz in 2019 published Homewreckers, showing the macro side of how all these illegally foreclosed homes ended up in the hands of hedge funds and other bottom feeders and were removed permanently from the American supply of individually owned homes. Dayen here talks about how these new owners, without experience in real estate rentals and without any regard for the law or people converted these homes into badly or unmaintained rentals and profited from illegal fees, penalties, evictions, and extortion while the huge inventory of once livable single family homes are turned into slums. These few corporations make the Trumps and Kushners of the world look like petty thugs. Meantime, Americans looking to buy homes find limited options and soaring prices. Welcome to the housing desert.

We know how to handle monopolies. You restore the interpretation of the antitrust laws to cover the full spectrum of harms, beyond just consumer welfare. Then you break up dangerous concentrations of economic power, block mergers that would excessively consolidate markets, regulate natural monopolies as public utilities, structurally separate functions where necessary, intervene in the public interest so citizens are protected and empowered, and vigilantly examine markets to prepare for monopolies to emerge again. Maybe that sounds impossible in the abstract. But it is entirely possible under existing law that either hasn’t been enforced in decades or has been misinterpreted for decades. We have over a century of experience with both successfully preventing unnecessary concentrations and failing to do so. The mechanisms are clear; getting the political class to enforce them is the stumbling block.

Latex, Diamonds, Charles Taylor, Austerity, Ebola, The Perfect Storm

Saturday, May 22nd, 2021

Fevers, Feuds, and Diamonds, Ebola and the Ravages of History, Paul Farmer, 2020

Young Paul Farmer and Future World Bank President Kim Jim Yong in Haiti


Ebola was not simply a deadly disease; it was the manifestation of neolibereralism as an affliction, which wrecks havoc in the world’s most vulnerable societies. –Ibrahim Abdullah and Ismail Rashid, Understanding West Africa’s Ebola Epidemic: Toward a Political Economy, 2017





Charles Taylor Liberian Warlord

There can be no understanding of this medical wasteland, and its vulnerability to Ebola, without knowledge of the shared and distinct histories… Their shared history has long involved rapacious extraction and forced labor regimes. Rapacity on this scale requires and foments violence, resulting in more illness and injury…That’s (colonial rule) where control-over-care strategies originated…In the first part of the twentieth century at least, black doctors were shunted aside or formally excluded from the colonial medical services…Many West Africans still harbor memories of campaigns to isolate (and sometimes destroy) settlements afflicted by smallpox, cholera, and vector-borne diseases such as plague, malaria, and trypanosomiasis. In the course of many of these epidemics, and for a century or more, funerals and wakes were banned, travel restrictions imposed, and punitive measures (from fines to incarceration) routine. Medical care was not…After independence, tardy efforts of link disease control to care were nonetheless under way in Guinea and Sierra Leone and, to a lesser extent, Liberia. But health expenditures of any sort remained a tiny fraction of postcolonial national budgets. That fraction shrank further when their governments signed on to structural adjustment programs (austerity) — and geared up for war…Neglectful policies first written by the sanitarians of fading colonial governments have left a disastrous imprint, but other disastrous policies were advanced by development institutions claiming to represent the poor, or frail or failed states. Few of these ventriloquists were natives of West Africa…Externally imposed austerity meant that governments lost much of their scant capacity to engage in anything resembling caregiving.

Commentary on most epidemics sends history down the drain. That’s no accident. Surely the successful rebranding of European empires as “Western democracies” and the inevitable focus on “local” disasters of African politics or epidemiology stand as impressive examples of willed amnesia. This entire process of shrugging off human agency — a.k.a. history — lets external actors and forces off the hook, allowing expatriate pundits and self-dealing global bureaucrats to argue that local greed and tribal grievance are the primary cause of independent Africa’s woes, including its poor economic, political, social, and physical health. But those without shelter are of course obliged to pay closer attention to the clouds above.

…if you want to address the delivery problems, you need a social medicine incorporating staff, stuff, space, and systems. But Western Africa, like the northern Congo, has not known this sort of social medicine, because of the extractive arrangements that I’ve described in the previous four chapters; slavery, racism, colonialism, and war. Its medical and public-health systems have failed repeatedly to delivery on the promise of discovery.

Ebola, like Marburg has received scant attention from the best basic scientists and clinical researchers, and from the world’s largest research based pharmaceutical concerns, for a simple reason: there’s not much money in it.

The critical step in preventing future epidemics will be finding ways of delivering vaccines and therapies to those who need them — and who need them in part because they live in a clinical desert that was created when their predecessors were enslaved and subjugated so that people and nations in other parts of the world could amass great wealth and prosperity.

Public-health nihilism and its control-over-care variant retain their force largely among the poor living in what are now called low-income countries. These countries are, of course, the former colonies; strains of the paradigm run rampant within them, and in the field now widely known as global-health.

The postcolonial world still suffers from control-over-care logic, and from the plague. In the Indian state of Gujarat, population forty-five million, plague killed hundreds in the 1990s–with the diamond polishing city of Surat the epicenter of a major outbreak in 1994.

One of the few happy aftermaths of the Western Ebola epidemic has been the development of what appears to be be a safe and protective vaccine… We can expect the usual debates about whether further and different clinical trials are needed, and which regulatory hurdles must be cleared before it and other vaccines are licenses, and by which agencies…Ebola-nomics is sure to influence these discussions, since the disease’s victims, like those sickened by cholera and plague, are mostly poor people of color, as are their primary caregivers.

…Ebola and other public-health calamities strike most often in places from which human capital and raw materials have been extracted for centuries. From the rural reaches of Haiti and Rwanda, from the prisons of Siberia, and from the slums of urban Peru; for thirty years, I’ve been pointing out how the epidemics that people have suffered in these places have arisen because of the inequalities — political, economic, and medical –that such extraction invariably worsens.

The Crisis in Cancer Research and Treatment

Friday, January 24th, 2020

The First Cell; and the Human Costs of Pursuing Cancer to the Last, Azra Raza, 2019

Dr. Azra Raza and Dr. Harvey Priesler

This book is intended as a wake up call for all of us that may have assumed cancer research was making progress. The articulate Dr. Raza has spent her career helplessly watching patient after patient die with only fifty year old therapies available (slash, poison, burn), including her own husband Harvey, himself a specialist in the very cancer that killed him. The book combines introducing us to some of her special and unique patients with a description of the complexity of cancer that is impenetrable reading for us laymen, to a plea for rebooting the entire field of cancer research and treatment. It is best to present the very articulate argument for rebooting our approach in Dr. Raza’s own words.

Over the twelve-year period from 2002 to 2014, seventy-two new anti cancer drugs gained FDA approval; they prolonged survival by 2.1 months. Of eighty-six cancer therapies for solid tumors approved between 2006 and 2017, the median gain in overall survival was 2.45 months…A study published in the British Medical Journal showed that thirty-nine of sixty-eight cancer drugs approved by the European regulators between 2009 and 2013 showed no improvement in survival or quality of life over existing treatment, placebo, or in combination with other agents.

Identifying predictive markers that allow for individualizing therapy by matching drugs to patients remains the treasured yet elusive holy grail of oncology… More than 90 percent of trials ongoing around the county make almost zero attempt to save tumor samples for post hoc examination to identify predictive biomarkers…Who is pushing this short-term agenda driven by the singular goal of getting a drug approved with alacrity as long as it meets the bar of improving survival by mere weeks in a few patients?

A pioneering and revolutionary paper was published in 1976 by Peter Nowell. His clairvoyance about cancer being an evolving entity has been largely ignored. From “The Clonal Evolution of Tumor Cell Populations”:
Peter Nowell

Tumor cell populations are apparently more genetically unstable than normal cells, perhaps from activation of specific gene loci in the neoplasm, continued presence of carcinogen, or even nutritional deficiencies within the tumor. The acquired genetic instability and associated selection process, most readily recognized cytogenetically, results in advanced human malignancies being highly individual karyotypically and biologically. Hence, each patient’s cancer may require individual specific therapy, and even may be thwarted by emergence of a genetically variant subline resistant to the treatment. More research should be direct toward understanding and controlling the evolutionary process in tumors before it reached the late stage usually seen in clinical cancer.

…in 2009, Gina Kolata reported in her New York Times column the jaw-dropping statistics that despite the infusion of more than $100 billion into cancer research, death rates for cancer had dropped by only 5 percent between 1950 and 2005 when adjusted for size and age of the the population. The war on cancer was not going well.

A review of where the research funds go reveals the inherent biases perpetuated by the peer-review process as detailed by Clifton Leaf in his eye-opening book, The Truth in Small Doses: Why We’re losing the War on Cancer and How to Win It. Enormous sums of money from the government continue to fund the same institutions and universities over and over…The saddest part is that upon serious examination of what is published, 70 percent of the basic research is not reproducible and 95 percent of clinical trials are unmitigated disasters.

A recent study titled, “Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer,” published in the October 2018 issue of the American Journal of Medicine, tabulated the chilling economic burden borne by patients with newly diagnosed cancer. Using the Health and Retirement Study Data, this longitudinal study identified 9.5 million estimated new cases of cancer between 1998 and 2012 in the United States. Two years from diagnosis, 42.5 percent of individuals had depleted their entire life’s assets, and 38.2 percent incurred longer-term insolvency, cancer costs being highest during treatment and in the final months of life. The most vulnerable groups were those with worsening cancer, older age, females, retired individuals, and those suffering from comorbidities like diabetes, hypertension, lung and heart diseases, belonging of a lower socioeconomic group, or on Medicaid.

The unfortunate reality is that not a single marker for response is examined in the majority of clinical trials being conducted even today. Why? Because this is how the system has evolved. The pharmaceutical industry sponsoring the trials is only interested in reaching a statistical end point to get their agent approved. The companies have usually invested almost a billion dollars already to bring an agent to the point of a phase 3 trial. It would add a staggering amount of money to their stretched budgets to perform such detailed biomarker analysis. I suggest saving all the money being squandered on testing the agents in pretherapy, preclinical models of cell lines, and mouse models and instead investing the resources in biomarker analysis. Some bold changes are needed at every level. To harness rapidly evolving fields like imaging, nanotechnology, proteomics, immunology, artificial intelligence, and bioinformatics, and focus them on serving the cause of cancer patient, we must insist on collaboration between government institutions (NCI, FDA, CDC, DOD), American Society of Clinical Oncology, American Society of Hematology, funding agencies, academia, philanthropy, and industry.

Contrast the putative scientific gold standard of a reproducible animal model with the known fact that every patient’s cancer is a unique disease, and within each patient, cancer cells that settle in different sites are unique. When a malignant cell divides in two, it can produce daughter cells with the same or radically different characteristics because during the process of DNA replication, fresh copying errors constantly occur. Even if two cancer cells have identical genetics, much like identical twins, their behavior can differ depending on genes expressed or silenced according to the demands of a thousand variables, such as the microenvironment where they land, the blood supply available to them, and the local reaction of immune cells. The resulting expansive variety of tumor cells that exist withing tumors are unique within unique sites of the body. Multiply this complexity further by adding the host’s immune response to each new clone and you get a confounding, perplexing, impenetrable situation in perpetual flux.

So what is the solution? The first step is to descend from our high horses and humbly admit that cancer is far too complex a problem to be solved with the simplistic preclinical testing platforms we have devised to develop therapies. Little has happened in the past fifty years, and little will happen in another fifty if we insist on the same old same old. The only way to deal with the cancer problem in the fastest, cheapest, and, above all, most universally applicable and compassionate way is to shift our focus away from exclusively developing treatments for end-stage disease, and concentrate on diagnosing cancer at its inception and developing the science to prevent its further expansion. From chasing after the last cell to identifying the footprints of the first.

The heyday of reductionism, looking for one culprit gene at a time and searching for the one magic bullet, is over. The era of big data, cloud computing, artificial intelligence, and wearable sensors has arrived. The study of cancer is evolving into a data-driven, quantitative science. Merging information obtained from liquid biopsies (RNA, DNA, proteomics, exosome studies, CTC), with histopathology, radiologic, and scanning techniques, aided by rapid machine learning, image reconstruction, intelligent software, and microfluidics can–and will–revolutionize the way we diagnose and prevent rather than treat cancer in the future. The ideal strategy will emerge from harnessing cutting-edge technology for a multidisciplinary systems biology approach through a consilience of scientists with expertise in molecular genetics, imaging, chemistry, physics, engineering, mathematics, and computer science.

Research is also ongoing in all these areas funded by the National Institute of Health, but the investment remains paltry compared to funding provided for studies conducted on cell lines and animal models. Through redirection of intellectual and financial resources from the same old grant proposals to grant incentives for early detection using actual human samples, and by posing exciting challenges to competitive scientists, progress will be accelerated dramatically. The piece that is missing from the equation is an admission of failure of current strategies and a willingness to take a 180-degree turn to start all over again.

Antonio Fojo of the NCI extrapolating the implications of one trial:

“In the lung cancer trial, overall survival improved by just 1.2 months on average. The cost of an extra 1.2 months of survival? About $80,000. If we allow a survival advantage of 1.2 months to be worth $80,000, and by extrapolation survival of one year to be valued at $800,000, we would need $440 billion annually–an amount nearly 100 times budget of the National Cancer Institute–to extend by one year the life of the 550,000 Americans who die of cancer annually. And no one would be cured.

This is how complex cancer is. It is pure arrogance to think the problem can be solved by a few molecular biologists if they put their minds to it. Cancer is a perfidious, treacherous, evolving, shifting, moving target, far too impenetrable to be deconstructed systematically, far too dense to lend itself in all its plurality to recapitulation in lab dishes or animals.