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When Will We Cure Cancer?
Harold Varmus is an American Nobel Prize-winning scientist and the 14th and current Director of the National Cancer Institute, a post he was appointed to by President Barack Obama. He was a co-recipient (along with J. Michael Bishop) of the 1989 Nobel Prize in Physiology or Medicine for discovery of the cellular origin of retroviral oncogenes. He also serves as one of three co-Chairs of the President's Council of Advisors on Science and Technology.
From 1993 to 1999, he served as Director of the National Institutes of Health. As the NIH director, Varmus was credited with nearly doubling the research agency's budget. From 2000 to 2010, he served as President of Memorial Sloan-Kettering Cancer Center in New York City.
Beginning during his tenure as NIH director, Varmus has been a champion of an open access system for scientific papers, arguing that scientists should have control over the dissemination of their research rather than journal editors.
Siddhartha Mukherjee: The former NCI director, Dr. Andrew von Eschenbach established an ambitious goal of eliminating the suffering and death due to cancer by 2015. Dr. Varmus will this happen?
Harold Varmus: You’re putting me in a different position. Politically, I don’t want to bash a previous director, but I will because this was a claim that just has no reality. The argument was we’re going to banish death and suffering from cancer, not that we were going to abolish cancer, but that is just not going to happen in such a short timescale, and it creates first of all, a false aspiration, one that we clearly cannot succeed in achieving and secondly, it provides too much optimism in a setting that is—as you’ve heard around this table—a very complicated set of diseases and we are not going to conquer all those diseases and prevent death from them in such a short timescale.
Lewis Cantley: Yeah, I completely agree and I would add that I'm optimistic because I think with these target approaches and as we break cancer into more and more sub fractions we figure out how to cure the sub fractions. Every year we’re going to see another few percent get if not cured, at least have treatments that allow people to live without extensive chemotherapy approaches and so if you do that, if you project it and say we’re only going to cure 2% this year, well if we started curing 2% in 1970 today we’d be almost finished because in 50 years at 2% we could get them all.
Siddhartha Mukherjee: I'm reminded of the advertisement that came out in 1969 which said, “Mr. Nixon, you can cure cancer”, in the New York Times and the Washington Post and of course the advertisement says you can cure cancer as if it was one disease and of course the word cure. And in fact, the goal was set at that point of time by 1981, and 1981 has long passed as you know.
Harold Varmus: Yeah, I think the discussion though needs to be enlarged slightly so we remind ourselves that while it’s attractive to think about curing an advanced cancer with drugs that there are many other things we can do to reduce the burden of cancer. One of course is to prevent it and we’ve had some brief discussions about that, but we can make great- in fact, most of the reduction in mortality from cancer in this country is due to smoking cessation. Secondly, I would point out that drugs are only one of many things we do to treat cancer and perhaps the most effective thing we can do is remove a cancer, so surgery is a very important tool here, surgical methods, not much talked about, have improved. When we detect cancer early before it has spread we can cure it more frequently, so early detection, prevention and conventional therapy used early on are very important steps.
The other thing I would go back to is Dr. Von Eschenbach’s term suffering. We tend to forget that while cancer is still a terrible disease we have reduced suffering from cancer already dramatically, much better pain control, control of nausea and vomiting. Chemotherapy has gotten more tolerable. We can restore bone marrow function fairly quickly with really very superb science using hormones to stimulate the way the marrow functions after chemotherapy. These are major changes.
Deborah Schrag: And the fact that it’s no longer something that people need to keep a secret, the fact that there are many public figures who have cancer who are open about their cancer diagnoses and the numerous strategies people use to cope.
Doug Schwartzentruber: I think our strategy somewhat has changed. Yes, we continue to search for a cure, but the other C word, control and so many of our trials right now that are publishing results talk about cancer control as opposed to the term cure and getting that disease to stabilize and not progress and if we can do that it becomes an elegist to some of our other chronic diseases.
Siddhartha Mukherjee: Dr. Schrag, can lifestyle choices alone prevent cancer?
Dr. Deborah Schrag: Lifestyle choices alone can’t prevent all cancers, but they can enormously decrease the incidence, particularly of some cancers, so lung cancer would be the best example. Some of the things Harold was talking about, getting vaccinated for hepatitis B, getting vaccinated for the human papillomavirus, getting 11 year-old girls- we could probably eradicate or come close to eradicating cervical cancer. The challenge is here we’ve got a cancer that is caused by a virus and we know that just as our genes are changing and evolving so are the genes of viruses, so right now we have a vaccine that seems to work against most strains, but is it possible that we’ll have new viral strains that this vaccine will no longer work? Absolutely, that's possible, so this is going to be an ongoing process.
The previous director of the National Cancer Institute wanted to banish suffering and death from cancer by 2015. Current director Harold Varmus says this claim was not based on reality, but huge strides in prevention, detection, and treatment are being made.
Innovation in manufacturing has crawled since the 1950s. That's about to speed up.
SEAL training is the ultimate test of both mental and physical strength.
- The fact that U.S. Navy SEALs endure very rigorous training before entering the field is common knowledge, but just what happens at those facilities is less often discussed. In this video, former SEALs Brent Gleeson, David Goggins, and Eric Greitens (as well as authors Jesse Itzler and Jamie Wheal) talk about how the 18-month program is designed to build elite, disciplined operatives with immense mental toughness and resilience.
- Wheal dives into the cutting-edge technology and science that the navy uses to prepare these individuals. Itzler shares his experience meeting and briefly living with Goggins (who was also an Army Ranger) and the things he learned about pushing past perceived limits.
- Goggins dives into why you should leave your comfort zone, introduces the 40 percent rule, and explains why the biggest battle we all face is the one in our own minds. "Usually whatever's in front of you isn't as big as you make it out to be," says the SEAL turned motivational speaker. "We start to make these very small things enormous because we allow our minds to take control and go away from us. We have to regain control of our mind."
Is focusing solely on body mass index the best way for doctor to frame obesity?
- New guidelines published in the Canadian Medical Association Journal argue that obesity should be defined as a condition that involves high body mass index along with a corresponding physical or mental health condition.
- The guidelines note that classifying obesity by body mass index alone may lead to fat shaming or non-optimal treatments.
- The guidelines offer five steps for reframing the way doctors treat obesity.
A new 5-step system for treating obesity<p>To help primary care practitioners better treat obesity, the doctors outlined five steps:</p><ol><li>Recognition of obesity as a chronic disease by health care providers, who should ask the patient permission to offer advice and help treat this disease in an unbiased manner.</li><li>Assessment of an individual living with obesity, using appropriate measurements, and identifying the root causes, complications and barriers to obesity treatment.</li><li>Discussion of the core treatment options (medical nutrition therapy and physical activity) and adjunctive therapies that may be required, including psychological, pharmacologic and surgical interventions.</li><li>Agreement with the person living with obesity regarding goals of therapy, focusing mainly on the value that the person derives from health-based interventions.</li><li>Engagement by health care providers with the person with obesity in continued follow-up and reassessments, and encouragement of advocacy to improve care for this chronic disease.</li></ol><p>Insider noted that some health professionals and body-positive advocates don't think the guidelines go far enough in reframing obesity treatment. The update still points "to individual bodies as the problem, not culture," registered dietitian <a href="https://www.bodykindnessbook.com/" target="_blank">Rebecca Scritchfield</a>, told <a href="https://www.insider.com/canada-doctors-obesity-should-be-defined-by-health-not-weight-2020-8" target="_blank">Insider</a>.</p><p>But it's also possible to see how some health professionals may worry this new model could discourage patients from taking the initiative to tackle weight-loss on their own, through exercise and dieting.</p><p>In a 2020 opinion piece published in <a href="https://www.frontiersin.org/articles/10.3389/fnut.2020.00002/full" target="_blank">Frontiers in Nutrition</a>, Dr. <a href="https://www.frontiersin.org/people/u/69229" target="_blank">Elliot M. Berry</a> argued that misplaced "medical and political correctness" may lead to the abrogation of the physician's responsibility to properly care for patients.</p><p style="margin-left: 20px;">"For example, some doctors are now even reluctant to raise the issue of obesity lest they be accused of fat shaming by not accepting their patients' proportions (despite the quote at the head of this opinion piece), and thereby receive poor approval ratings in an atmosphere where popularity is equated with good healthcare."</p><p>Berry offers a list of nine steps that he thinks could help the healthcare industry better treat obesity, without shaming patients or falling prey to political correctness.</p>
Here's why you might eat greenhouse gases in the future.
- The company's protein powder, "Solein," is similar in form and taste to wheat flour.
- Based on a concept developed by NASA, the product has wide potential as a carbon-neutral source of protein.
- The man-made "meat" industry just got even more interesting.
Seriously sustainable<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTk0MDIzNS9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYyMjM4NTMzMX0.BCEfYnn6C3z1zUHIS38xOWjXktgamNBi5iyqklSMYK8/img.png?width=980" id="ea524" class="rm-shortcode" data-rm-shortcode-id="50533380eeb18eb5833b6b6aa3abec38" data-rm-shortcode-name="rebelmouse-image" />
Image source: Solar Foods<p>Solar Foods makes Solein by extracting CO₂ from air using <a href="https://www.fastcompany.com/90356326/we-have-the-tech-to-suck-co2-from-the-air-but-can-it-suck-enough-to-make-a-difference" target="_blank">carbon-capture technology</a>, and then combines it with water, nutrients and vitamins, using 100 percent renewable solar energy from partner <a href="https://www.fortum.com" target="_blank">Fortum</a> to promote a natural fermentation process similar to the one that produces yeast and lactic acid bacteria.</p><p>When the company claims its single-celled protein is "free from agricultural limitations," they're not kidding. Being produced indoors means Solar Foods is not dependent on arable land, water (i.e., rain), or favorable weather.</p><p>The company is already working with the European Space Agency to develop foods for off-planet production and consumption. (The idea for Solein actually began at NASA.) They also see potential in bringing protein production to areas whose climate or ground conditions make conventional agriculture impossible.</p><p>And let's not forget all those <a href="https://www.bk.com/menu-item/impossible-whopper" target="_blank">beef-free burgers</a> based on pea and soy proteins currently gaining popularity. The environmental challenge of scaling up the supply of those plants to meet their high demand may provide an opening for the completely renewable Solein — the company could provide companies that produce animal-free "meats," such as <a href="https://www.beyondmeat.com/products/" target="_blank">Beyond Meat</a> and <a href="https://impossiblefoods.com" target="_blank">Impossible Foods</a>, a way to further reduce their environmental impact.</p>
The larger promise<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTk0MDI0MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1NjU4MTg2OX0.7dZZYT5WEV_EupBuLVFwHynarTiz8RYR9aJtC6Ts2C4/img.jpg?width=980" id="3415d" class="rm-shortcode" data-rm-shortcode-id="2e6eebe06d795f844752f9e9d30040d7" data-rm-shortcode-name="rebelmouse-image" />
Image source: Solar Foods<p>The impact of the beef — and for that matter, poultry, pork, and fish — industries on our planet is widely recognized as one of the main drivers behind climate change, pollution, habitat loss, and antibiotic-resistant illness. From the cutting down of rainforests for cattle-grazing land, to runoff from factory farming of livestock and plants, to the disruption of the marine food chain, to the overuse of antibiotics in food animals, it's been disastrous.</p><p>The advent of a promising source of protein derived from two of the most renewable things we have, CO₂ and sunlight, <a href="https://solarfoods.fi/environmental-impact/" target="_blank">gets us out of the planet-destruction business</a> at the same time as it offers the promise of a stable, long-term solution to one of the world's most fundamental nutritional needs.</p>
Solar Foods' timetable<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTk0MTEzMS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTU5OTU1OTMwMn0.wnXh56iO_77x2XKV2uIPf78BKw4AJLUpmiyq_JBVGvo/img.jpg?width=1245&coordinates=172%2C146%2C62%2C135&height=700" id="0297c" class="rm-shortcode" data-rm-shortcode-id="125c9a98ec818f5c241fa28ef1423e67" data-rm-shortcode-name="rebelmouse-image" />
Image source: Lubsan / Shutterstock / Big Think<p>While company plans are always moderated by unforeseen events — including the availability of sufficient funding — Solar Foods plans a global commercial rollout for Solein in 2021 and to be producing two million meals annually, with a revenue of $800 million to $1.2 billion by 2023. By 2050, they hope to be providing sustenance to 9 billion people as part of a $500 billion protein market.</p><p>The project began in 2018, and this year, they anticipate achieving three things: Launching Solein (check), beginning the approval process certifying its safety as a Novel Food in the EU, and publishing plans for a 1,000-metric ton-per-year factory capable of producing 500 million meals annually.</p>
The protein powder Solein. Image source: SOLAR FOODS
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