Become an example to others of anti-cancer behavior. Read our American Code Against Cancer at http://www.natpernick.com/AmericanCodeAgainstCancer.html, decide what steps you can take to reduce your cancer risk and spread the word through your social networks.
* First, it is important to have an ambitious plan that itemizes what needs to be done and what needs to be better understood. Our plan might fail. But it is important to “dare greatly”, see https://en.wikipedia.org/wiki/Citizenship_in_a_Republic, and attempt to achieve our actual goals, even if we do not know precisely how to do so.
* Second, reducing the high number of US cancer deaths is a management problem that requires that we optimize each step of cancer’s clinical pathway (prevention, early detection, treatment and failure to respond to treatment). It is not primarily a problem of finding a “silver bullet” or “magic pill”.
* Third, we should study and reduce cancer deaths that occur shortly after diagnosis. These may be preventable if due to (a) overzealous treatment that does not adequately balance treatment side effects, (b) predictable infections or (c) damage to essential physiologic networks that can be normalized.
* Fourth, we speculate that for each cancer type, even the most aggressive, there exists a combination of perhaps 8-10 therapies that individually may be only partially effective but together can be substantially effective. Effective combinations not only target the cancer cells but their surrounding microenvironment; systemic networks involving inflammation, the immune system and possibly hormones; germline variations in DNA and known patient risk factors for this disease.
* Finally, we outline important therapeutic strategies, including:
– Treatment should focus on managing the malignancy to reduce death and disability, not eliminating every possible cancer cell.
– Consider achieving “marginal gains” at all steps of the disease process, which may increase possible treatment options and reduce a sense of futility.
– Therapy should be patient centered to the extent possible because patients may have markedly different therapeutic preferences.
– Aggressively enroll patients into clinical trials so physicians can learn and improve over time.
* Become an example to others of anti-cancer behavior. Read our American Code against Cancer at http://www.natpernick.com/AmericanCodeAgainstCancer.html, decide what steps you can take to reduce your cancer risk and spread the word through your social networks.
Let me know if you have comments for future letters or you have suggested contacts.
Thanks
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10 August 2021
Dear President Biden,
I
am a pathologist who developed PathologyOutlines.com, a free online
pathology textbook used regularly by pathologists worldwide.
Consistent with your goal
of ending cancer as we know it, I have developed a strategic plan to
substantially reduce cancer deaths from the current level of 600,000 per
year to 100,000 per year, see http://www.natpernick.com/StrategicPlanCuringCancer.html.
Who
do you know, in or outside government, who is willing to “think outside
the box”, and focus on this long term goal and what we need to do to
get there?
Unfortunately, most cancer physicians and scientists
are focused on short term thinking - promoting their career and not
ruffling too many feathers. They don’t want to take risks that may fail.
In addition, too many scientists are wedded to reductionist thinking
and focus on naive concepts such as “the cure” or “a world without
cancer”. However, cancer is the result of intersecting webs of disturbed
physiologic networks - we typically will need to cut many strands of
the web to destroy its function - a few drugs will usually be inadequate
to do that. We also need more ambitious prevention goals such as
markedly reducing tobacco use and obesity and making dramatic changes to
our diet if we want to substantially reduce cancer deaths.
Our
work is moving forward with the help of a growing network of interested
people, but the more people in our network, the better. I would
appreciate your help, or that of your staff, in advancing this cause by
identifying interested people to work with us.
We don’t need your money, but we do need your connections!
There are three main changes. First, we propose that success in substantially reducing cancer deaths is essentially a management task, not a technological one. Second, we have broken down treatment related goals into specific tasks that can be assigned to individuals or groups. Third, the overall plan was “tightened up” and is shorter.
We have created a table listing malignant attributes associated with pancreatic adenocarcinoma, the most common type of pancreatic cancer, see http://natpernick.com/Pancreatic%20Cancer%20Treatment%20Targets.html. We need to further refine this table by adding more attributes, by identifying more treatments that are at least partially effective against these attributes and by contacting individuals who might be interested in pursuing clinical studies testing therapies against these attributes.
We plan to create similar tables for lung and liver cancer, the other major aggressive malignancies. For colorectal, breast and prostate cancer, we have to separate out the specific types that are the major causes of cancer death since most cases have favorable survival. We plan to hire a research assistant to assist with these tasks.
We have met with public health experts at the State and County level to discuss reducing the cancer risk factors listed in the American Code against Cancer, see http://www.natpernick.com/AmericanCodeAgainstCancer.html. Although public health agencies are currently overwhelmed by the COVID-19 pandemic, we plan to work with them to discuss how to achieve the ambitious behavioral changes necessary to markedly reduce cancer deaths. We may also sponsor high school science fairs or essay contests related to cancer.
* Become an example to others of anti-cancer behavior. Read our American Code against Cancer at http://www.natpernick.com/AmericanCodeAgainstCancer.html, decide what steps you can take to reduce your cancer risk and spread the word through your social networks.
This subject was discussed in the abstract below, which was not
accepted at a recent conference. Although disappointing, the advantage
of this rejection is that I can publish it without any restrictions. The
full paper is at http://www.natpernick.com/PancreaticcancerFeb2021.html. I welcome your comments to Nat@PathologyOutlines.com.
I emailed this letter earlier this month – to date, there has been no response:
Dear President Biden,
Please identify who I should talk to concerning your goal of “ending
cancer as we know it”. To be successful, we need better management,
beginning with a strategic plan similar to the one I have developed, see
http://www.natpernick.com/StrategicPlanCuringCancer.html.
We need a challenging goal, such as reducing US cancer deaths from the current level of 600,000 per year to 100,000 per year.
We need to identify the knowledge gaps and focus on research to fill them.
We need to abandon outdated concepts, such as talking about “the
cure” or “a world without cancer”. We need to stop considering single
drugs adequate for treatment. We need to recognize that cancer is within
all older adults and that our goal should be to hold it in check, not
to eliminate every cancer cell.
We need to study and target systemic networks that nurture malignancy
and develop treatments to push cancer cells into networks that are less
hazardous.
We need ambitious goals for behavioral changes, such as reducing
tobacco use to 5% of the population, excess weight to 10% of the
population and ensuring that all Americans get regular medical
examinations to detect early disease and to promote prevention.
We need to manage cancer, both within a single patient and in our
American society. Focusing solely on technology as the answer is a
mistake.
This 3 minute video outlines our strategic plan to substantially reduce cancer deaths.
Strategic plan to substantially reduce cancer deaths
Video summary:
We need a strategic plan to substantially reduce cancer deaths.
• To focus our efforts, identify gaps in knowledge.
• Goal is to reduce annual cancer deaths from current 600K to 100K by 2030.
• It might fail – that may be why others have not attempted this, but I think we can make important progress towards this goal.
Two main aspects – prevention, combinations of treatment.
• Prevention: American Code Against Cancer – not controversial, find ways to better promote these activities (see http://www.natpernick.com/AmericanCod… ).
• Combinations of Treatment: New thesis – If we have 20+ partially effective therapies for a specific type of cancer, then some some subset, in combination, should be substantially effective, see: http://www.natpernick.com/Combination...
• Behavior of whole is greater than sum of behavior of parts.
• Target: primary tumor, also microenvironment, systemic networks.
