I stumbled over a couple of items on the direction of cancer research today, both of which are views into the issue of efficiency in research. This is a topic I discuss quite often here, in connection with the Strategies for Engineered Negligible Senescence (repairing the damage of aging) versus metabolic manipulation (slowing aging). One path is most likely much more efficient than the other in terms of achieving the end goal of a longer, healthier life - but the more efficient path is not the one gaining the greatest level of funding. Yet.
In any case, the two articles on cancer research are illustrative of the sort of debate one sees over questions of direction and efficiency in research. For a field in which not everything is known, how do you establish which direction is the most efficient? See what you think:
Failure to recognize the role of stem cells in metastasis may have led cancer researchers up "blind alleys" in countless clinical trials, said Max S. Wicha, M.D., founding director and distinguished professor of internal medicine at the University of Michigan Comprehensive Cancer Center, speaking at the National Comprehensive Cancer Network's 12th Annual Conference.
With tumor shrinkage the primary guidepost of any new treatment, valuable therapies may be aborted too early in their experimental life, he said. At the same time, clinical-trial measurements that focus only on a tumor's diminishing size may explain why some new therapeutic treatments have failed to work. If the tumor's stem cells run amok even as the tumor's girth diminishes, a patients' life may be at stake.
The answer? Begin monitoring whether chemotherapy and radiation treatments work to arrest cancer's stem cells and their progenitors - i.e., those cells that can make exact copies of themselves and "differentiate" to play specific roles. Then find ways to make chemotherapy and radiation treatments more powerfully target the tumor's stem cells while sparing healthy stem cells the body needs.
Cancer stem cells do not enjoy universal support as a potential line of greatest efficiency in cancer research - it would certainly be a very good thing if they are the path of least resistance to a cure for cancer, but the arguments of the skeptics are not to be neglected. Still, the degree of potential efficiency is so great in this case, and the level of funding for stem cell biochemistry and cancer research so high, it seems certain that this line of research will be chased down to its logical conclusion comparatively soon.
Called the Cancer Genome Atlas, it aims to identify mutations in tumor cells from the 50 most common kinds of human cancer. (A genome is the full set of genetic information in, in this case, all the malignant cells in these 50 cancers.) You can think of the mutations as misspellings in the cells' DNA; the hope is that designer drugs tailored to a patient's mutations will cure the cancer just as spellcheck cures typos. Now beginning a three-year, $100 million pilot phase, the atlas threatens to suck up ever-dwindling resources at a time of budget carnage at the National Institutes of Health, which funds it. But there's a bigger problem: the atlas's very premise may be fatally flawed.
"From a clinical and drug perspective, the cancer-genome project is so shallow it's worthless," says George Gabor Miklos, who has served as a consultant on genome projects, the holy grails of biology for a decade. NIH, he says, has "made an enormous mistake that will cost the taxpayer billions." Scientists from top institutions including the Mayo Clinic, the University of Chicago and Harvard Medical School are weighing in to denounce the project as "high-cost, low-efficiency," "not informative" and "naïve."
I'll spare you the longer version of my comments on government-funded work, efficiency and incentives. If there's less of a material incentive to produce actual results and keep costs down, you'll see far less progress per dollar spent; pretty simple, really.
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