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
--------
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.
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 is a letter sent to Dr. Norman Sharpless, Director of the US National Cancer Institute, discussing our strategic plan and how substantially reducing cancer deaths is more about management than just finding a technological fix. Email me your comments to Nat@PathologyOutlines.com:
Hi Dr. Sharpless,
I read your April 2021 talk to the American Association for Cancer Research (AACR), see
This essay introduces our strategy of using
combinations of therapies directed at all aspects of the malignant process,
appropriate for each cancer type, to substantially reduce cancer related
deaths. This strategy is based on the understanding that cancer is the result
of intersecting webs of biological activity for the cancer cells, their
microenvironment and systemic networks affecting the cancer. Effective
treatment must damage the end result of these webs sufficiently so that their
overall malignant properties cannot continue. This typically cannot be achieved
by a single drug.
What are reasonable goals regarding cancer in the United States?
First, let’s discuss what is not reasonable. Conquering cancer does not mean attaining “a world without cancer” (American Cancer Society Mission Statement, accessed 12May21). Cancer will always be part of our world. New cancer cases will continue to arise because (a) cancer is part of the tradeoff inherent in the design of multicellular organisms (Jacqueline 2016); (b) new cancers will continue to develop due to random chronic stress or bad luck (Curing Cancer Blog - Part 7 - Random chronic stress / bad luck as a major cause of cancer, 2021) and (c) we cannot completely end personal behavior which promotes cancer, such as tobacco use or excess weight.
Congratulations on your proposal to "end cancer as we know it" and your efforts to increase funding for basic research.
What constitutes a cure for cancer, or ending cancer as we know it? I have developed a strategic plan with the goal of reducing annual US cancer deaths from 600,000 currently to 100,000 by 2030, see http://www.natpernick.com/StrategicPlanCuringCancer.html. To be successful, we need to improve and implement this or a similar strategic plan, which identifies research, clinical and prevention activities that need to be taken and coordinated.
Ending cancer is not analogous to landing on the moon. We are not searching solely for a "silver bullet" or other technological innovation. Instead, we need to change our approach to cancer treatment and focus on (a) attacking tumor networks, not mutations; (b) altering multiple aspects of the tumor microenvironment; (c) identifying, targeting and monitoring systemic tumor networks relating to chronic inflammation, immune system dysfunction and other tumor nurturing effects, and (d) strengthening our cancer prevention programs through promotion of the American Code Against Cancer, see http://www.natpernick.com/AmericanCodeAgainstCancer.html or similar efforts.
We need combinations of combinations of treatment and clinical trials for almost all cancer patients, strategies that led to cures for childhood leukemia, testicular cancer and Hodgkin lymphoma.
I am currently pursuing these efforts, and although I am in contact with pathologists worldwide through my website, PathologyOutlines.com, I am only an individual pathologist. It would be useful to have a partner in the federal government who could identify collaborators in federal agencies or elsewhere to more fully develop and implement this strategic plan.
Question: What's your opinion on the feasibility of adapting the mRNA technology that was used to develop the Pfizer and Moderna vaccines to treat various cancers?
Answer: Here is an article - https://www.mdanderson.org/cancerwise/can-mrna-vaccines-like-those-used-for-covid-19-be-used-in-cancer-care.h00-159457689.html.
The idea is that a cancer vaccine can generate antibodies to attack the tumor. When I was a medical student at the University of Michigan in 1980, we saw a patient with melanoma who was cured, at least at that time, with that approach. But the problem was getting it to work on a consistent basis - his case appeared to be a rare success. Today, we are more technically savvy, and we may have better results.
These points are important:
1. There will be no silver bullet. No one treatment option will likely cure a large percentage of patients with even a specific type of cancer. We will need combinations of treatments to attack different parts of the tumor. This is how we cured childhood leukemia, testicular cancer and Hodgkin lymphoma.
2. For adult tumors, unless the tumor is small, we will also need to monitor and treat the supporting networks that nurture the tumor and will create additional tumors over time [this is my proposal - it is not generally accepted].
3. We should also focus on changing our behavior, which could prevent 30-50% of all cancer related deaths, see http://www.natpernick.com/AmericanCodeAgainstCancer.html
It’s time to implement a strategic plan to cure cancer.
The era of modern cancer treatment began in 1948 when Dr. Sidney
Farber, a Boston pathologist, published a landmark study reporting that
chemotherapy could induce temporary remissions in childhood leukemia (Farber 1948, free full text-PDF download). Remarkably, this study was met not with hope and acclaim, but with skepticism and outrage (Miller 2006).
My theory is that cancer deaths are preventable, at least for the short term, for many patients who die quickly of cancer. Their deaths are due to cancer's marked disruption of physiologic systems necessary for life. Sophisticated medical treatment can counter this disruption and the patients can live much longer. This is analogous to diabetic ketoacidosis, which often kills patients with new onset diabetes unless they receive sophisticated treatment to reverse the marked disruption of physiologic systems associated with this disease.
Network to receive weekly status updates by clicking here (note: this project is independent
of PathologyOutlines.com).
Our strategic plan is to reduce US cancer deaths from 600,000 in 2021 to 100,000 by
2030. To do so, we must better understand how cancer actually kills people. We conclude
that cancer often kills by promoting marked physiologic instability which disrupts life’s
essential networks and by creating a sense of futility which causes individuals and the
medical system to give up the fight. Other direct mechanisms include hemorrhage, infection, side effects of therapy, central nervous system changes and second tumors.
The American Code Against Cancer focuses on actions that individuals can take to help
prevent cancer. Successful cancer prevention also requires supportive governmental policies
and actions. Following these recommendations reduces cancer risk from 30-40%, and should
produce substantial progress towards our strategic plan goalof reducing annual US
cancer deaths from 600,000 to 100,000.
1. Do not smoke or use any form of tobacco.
2. Make your home smoke free.
3. Try to achieve a healthy body weight with a BMI of 25 or less.
4. Be physically active.
5. Have a healthy diet based on vegetables, fruits and whole grains. Limit sugar, fat,
processed meat and red meat.
6. If you drink alcohol, limit your intake. Not drinking alcohol reduces your cancer risk.
7. Avoid too much sun, especially for children. Use sun protection. Do not use sunbeds.
8. Protect yourself against cancer causing substances in the workplace by following health
and safety instructions.
9. Check that your residence does not have high radon levels.
10. For adults:
* Get a physical exam every 1-2 years to detect possible problems, discuss risk prevention and
get needed tests, screenings and vaccinations.
* Get a one time screening for Hepatitis C if you were born between 1945 and 1965.
* Get an annual lung screening if you are a current or former heavy smoker age 55-80.
11. For adult women:
* Breastfeed your baby, if you can, to reduce your cancer risk.
* Limit use of hormone replacement therapy.
* Get screened for colon cancer, breast cancer and cervical cancer.
12. For adult men:
* Get screened for colon cancer.
13. For children:
* Get vaccinated for Hepatitis B and HPV to reduce cancer risk.
This
is the third paper in a series discussing the top 20 causes of US
cancer death and how they arise based on complexity theory (see How Lung Cancer Arises-Pernick 2021 (PDF), How Colon Cancer Arises- Pernick 2020 (PDF)).
We first discuss the population attributable fraction of pancreatic
cancer risk factors and their mechanism of action, then integrate these
mechanisms into our theory about how cancer arises in general and in the
pancreas, and finally suggest curative treatment approaches for
pancreatic cancer.
Highlights:
Countering pancreatic cancer requires optimizing all factors affecting it, even if not directly part of the malignant process.
Five
“super promoter” mechanisms cause pancreatic cancer: random chronic
stress (bad luck or cellular accidents); chronic inflammation; DNA
alterations; immune system dysfunction (individual and “societal”) and
hormones (insulin-IGF system).
The
5 major causes / risk factors of pancreatic cancer are random chronic
stress (causes 25-35% of cases); non O blood group (17% of cases);
excess weight, particularly at younger ages (15%); cigarette smoking
(15%) and type 2 diabetes (9%).
Cancer arises in part because risk factors activate embryologic and inflammatory pathways in a manner that cannot be turned off.
In
the pancreas, tumor cell spread may occur even before a primary
malignancy arises, explaining why advanced disease is often found at
diagnosis.
Treatment
approaches should focus on network dysfunction not mutations;
combinations of combinations of treatment to block multiple webs of
network abnormalities; treating and monitoring key systemic network
changes outside the primary tumor; enrolling all patients in clinical
trials and creating stronger public health programs to prevent these
cancers or detect them earlier.
Click here for the HTML version, here for the PDF download.
TV actor Dustin Diamond, age 44, died of widely disseminated (stage 4) small cell lung cancer only one month after diagnosis (NBC News).
This essay discusses, in a relatively nontechnical manner, important
aspects of this disease and prospects for future curative treatment (MedPage Today).
This
is my seventh essay about curing cancer based on the principles of
complexity theory (follow my blog at https://natpernickshealthblog.wordpress.com). This essay discusses random chronic stress / bad
luck, a major cause of pancreatic cancer (Pernick 2021) and lung cancer in nonsmokers (Pernick 2018).
Key
concepts discussed are: (1) random chronic stress / bad luck is a major
cause of cancer at some sites; (2) cancer often develops through rare
bursts of activity in cells and their networks, not in a gradual,
step-wide manner; (3) cancers due to random chronic stress may have
better survival and other clinical differences compared to cancers due
to traditional risk factors; and (4) due to the presence of random
chronic stress, cancer will always be with us, although we can prevent
some cases, we can detect it earlier and we can treat it more
effectively.
These essays are technical but I will highlight the major findings in a conversational style here. If there is interest, I can expand on this discussion. I am happy to answer questions about cancer in general or about my theories. Unfortunately, as a pathologist who no longer provides patient care, I do not have the training or expertise to answer “What should I do” questions, which may be more appropriate for oncologists.
Complexity theory analyzes systems with strongly interacting parts. This includes not only the human body but earthquakes, the stock market and the economy.
The predominant framework for understanding disease is reductionism - the behavior of the whole equals the behavior of the sum of the parts. Thus, treatment is about finding the “bad part” and fixing it. In contrast, complexity theory states that the interactions between the parts, in the form of networks, are vital to understanding how nature works. Human life is composed of thousands of biologic pathways that interact in a complex web. On their own, each pathway may perform a limited function, but together, they provide more sophisticated functions that enable life. They also change their overall patterns of behavior over time, starting as a fertilized egg that focuses on constant cell division, then forming a general body plan in the embryo, then differentiating into cells that provide the functions we are familiar with in our organ systems. As we enter childhood and adulthood, different pathways are shut down because their activation would be harmful.
My theory is that cancer is due to dysfunction in networks affecting not only the primary (main) tumor, but also in systemic networks that nurture and maintain the malignancy. Thus, curative cancer treatment must attack the dysfunction in these systemic networks as well as targeting the primary tumor. Many of these dysfunctional systemic networks involve the inflammatory system, which protects us against microorganisms and emerging cancer cells, and also repairs damage due to various types of trauma. The inflammatory system, similar to embryogenesis, is relatively unstable due to its ability to quickly “ramp up” when triggered by foreign substances or trauma. These triggers also start the process of resolving the inflammatory process - both occur simultaneously, so as the triggers are effectively countered, the inflammatory process is also diminished. However, cancer risk factors trigger inflammation through other processes that do not simultaneously initiate the resolution process. This means the inflammation persists indefinitely; its instability propagates (spreads) to other networks over years to decades, which ultimately promotes malignancy.
This essay discusses systemic networks that must be “normalized” and monitored to provide curative treatment.
I briefly discuss the concept of an attractor. Cells have thousands of reactions occurring simultaneously, and each cell has the same DNA that allows it to become 350+ different cell types (muscle, skin, thyroid, etc.), so why are cells so stable? It turns out that the interactions between each reaction and cell create constraints that limit what they can do, which is called an "attractor".
This is not so different from human interactions. Today, I could decide to try to become a basketball player, but it is not likely I would make all the necessary changes to move in that direction. These constraints and other control mechanisms provide stability that prevent cells from becoming malignant. On the other hand, once cells do become malignant, they also have "cancer attractors", and it is hard to change them back. This is why chemotherapy is often ineffective.
This is my fourth essay about curing cancer based on complexity theory – follow my blog at https://natpernickshealthblog.wordpress.com, click at http://www.natpernick.com/CuringCancerPart4.pdf for a PDF download or http://www.natpernick.com/CuringCancerPart4.html . In part 3, I summarized my recommendations on curative treatment for advanced adult cancers with a poor prognosis, such as lung and pancreatic cancer. In this essay, I discuss these principles of curative treatment in greater depth: network medicine, blocking multiple pathways, combinations of combinations of treatment, monitoring key networks, clinical trials and strong public health programs.
I am happy to respond to comments or questions about my research or cancer in general or to learn of your experiences, but I lack the experience and training to answer treatment or "What should I do" questions. You can also email me at Nat@PathologyOutlines.com.
