USEFUL ECONOMISTS

Where I first courted Linda

and made Murphy's acquaintance

As some of you know, before I became a geologist I studied economics.  In fact, I graduated from Stanford saddled with that dreadful degree.  I had intended to go on to law school, and eventually into politics.  At the time I was a fervent Taft Republican; I thought Eisenhower was a dangerous radical.  Good thing I ditched law school.

Anyway, a NYTimes article sent me by Dick Ingwall proves that even economists can be useful.  Here is the article:

http://www.nytimes.com/2015/12/29/upshot/why-preventing-cancer-is-not-the-priority-in-drug-development.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0

The lead author is perhaps not your typical economist.  She is a MacArthur “genius” grant recipient and is on the faculty of MIT.  (She had two co-authors, no doubt worthy guys but perhaps lacking such sparkling credentials.)  Her name is Heidi Williams.

It appears that Williams et al have studied our friend Big Pharma, They asked the following question: Why do (cancer) drugs brought newly to market consist dominantly of stuff to fight late-stage disease (that is, buy the patient a few more months)?  In contrast, it appears, concoctions that may affect early-stage disease (and maybe thus affect a cure), or prevent the disease altogether, are relatively rare.    Why?  It might not surprise you too much to learn that this involves money.

But it MAY surprise you to learn that it’s not all attributable to capitalist greed.  Williams et al start from the assumption that drug companies have to make money.  (They are economists, right?)  Here, then, is the problem, in one oversimplified (by me) nutshell.  Suppose you are Merck, or Pfizer, or even some little start-up in downtown Seattle.  You work diligently for many months - probably years - to develop some sort of probably complex biochemical substance that you think might be useful against cancer.  The first thing you do is patent your discovery.  This gives you 20 years before two smart guys, a scientist and a chemical engineer in Moldova, in cahoots with a venture capitalist in NY, set up a plant that can turn out your stuff for next to nothing.  But this doesn't give you a 20-year head start; oh, no.  To sell your stuff, of course, you must obtain FDA approval.  As you know, a clinical trial will be required.  So, think about it:  To get robust statistical results for a drug intended to extend life for only a few months may only require a matter of a few years, whereas if your drug is intended to prolong life indefinitely the trial conceivably might require decades. Drug development and testing can cost billions.   Imagine how your stockholders would greet the news that your drug is ready for the clinic, but that the guys in Moldova will bgine selling their version in Walmart next Monday.

One obvious remedy for this, mentioned in the article, is to commence the patent period only after FDA approval.  This has complications, of course.  Other remedies also are discussed but, frankly, I am getting tired of typing exclusively with my right forefinger* – so read the article yourself.  The Comments also are useful.

*Read my last blog to understand this statement.





Are you a WATCH, or a RUBE GOLDBERG?

The Joyce sisters explore the Oregon wilderness, 2006

 

It is cold and windy outside and I have seized upon this fact as an excuse to stay indoors and play with my computer, rather than go outside and try to identify ducks, as consideration of  health would recommend.  (I typed that sentence rapidly and with confidence, with my head held up, just as Mrs. Basha Long taught me in 1948.  I made eight errors.  This is discouraging.  Hunt and peck for me from now on, I guess, although this crappy laptop may have something to do with it.)  Anyway…….

I am deep into junk DNA, learning gee-whiz facts about all the things that go on that depend on stuff that originates within the 98% of our genome that doesn’t code for proteins.  My guess is that much, maybe most, of the research action may lie here in the decades to come.  It is not clear to me how this new flood of knowledge will help conquer cancer – but surely, the more we know the better off we are.

One set of important “junk” actors are short segments of single-stranded RNA,  usually 20 to 23 nucleotides long.  These things help regulate which genes get “expressed” (turned into functional proteins), and in what quantities.  I wrote a blog once about a guy from the Hutch who was working in this field – he has left subsequently.  I thought he was the real deal.  Here is the blog:

http://ljb-quiltcutie.blogspot.com/2013/10/profiles-in-research-excellence-dr.html

But that is not what I am on about this blustery Sunday morning.  I have been searching for a book to supplement those by Drs. Carey and Parrington, both of which I have reviewed recently.  What I have found surprises me.  There are a number of books out there that claim junk DNA as evidence of Intelligent Design.  You know what that is, right: the notion that the overwhelming complexity of life requires a Guiding Hand.  Junk DNA has been used as a counter argument, viz – if there is a Guiding Hand, how come It was so slapdash and inefficient?  Now that the Junk has been shown to have function that anti ID argument can be set aside.  Hence, books – more theological than biological, I would bet.

I am incurably agnostic in matters of teleology and such: about the really important subjects of life and human existence I simply am not equipped to comment.  However, on Intelligent Design I do have an opinion.  As far as I can tell, biological processes are far more complicated than they need to be.  You may know the Watchmaker argument for Special Creation – that finding a fine-functioning watch in the street implies the existence of a Watchmaker.  Well, maybe so, but we are far from highly efficient Watches.  We are held together with wire and duct tape.  We use far too much energy.  We keep bad time.  We run down too quickly, and not at all gracefully 

  No one would design such a piss-poor watch on purpose, unless perhaps for amusement.  Darwin was right - but do not read too much into that statement. 

 Do you remember Rube Goldberg?  Well, if not – look him up.

 



ONCLIVE: Strictly for the enthusiast

Linda and Patches

Good friends, as you can see.

There is an outfit called OncLive that reports on developments in all sorts of cancer research.  The technical level of the reportage is somewhere between that of typical British tabloid (New Chemical Found in Carrots and Pipe Tobacco Cures Cancer in a Matter of Weeks,  says Noted Authority) and the New England Journal of Medicine (Well, I won’t try to characterize this approach: I wouldn’t understand half the words, anyway).  I have just read an OncLive article on a seminar or small meeting concerned with treatment of ovarian cancer.  It is informative, but more than a little depressing.  Here it is:

http://www.onclive.com/web-exclusives/adjuvant-hormonal-therapy-linked-to-improved-outcomes-in-ovarian-cancer

Much of the discussion revolves around the topic of which course of chemo is best used when gains made  by debulking + adjutant chemo begin to be reversed.  The debate seems to revolve around something called PFS – Progression Free Survival, or how much time elapses before the cancer begins to come back.  If I understand what I read, ultimate survival is not in question.  Whether a woman dies of the damned disease or not seems still to be in the lap of the gods.  That is why I mainly donate to the Rivkin Center nowadays: I get the impression that they are focused on genuinely innovative research.

Linda had a long stretch of PFS, and those months were amongst the best of my life.  I thank all the researchers patiently gnawing away at the immense hardwood knot that characterizes ovarian cancer.  Every nasty little chip removed helps.  However, I hope to live to see the whole damned thing blasted to Hell!

I want a cure.





ROCA AGAIN, FOR HEAVEN'S SAKE!

Linda with one of her more spectacular quilts

Probably 2010

Dear Lord above, is there no limit to the caution – pathological timidity might be a better term – of the medical profession?  For centuries medical practioners have been obedient to the stricture: First, do no harm.  Now they seem to worry almost as much about another: Whatever you do, don’t run up the cost of medical care.

 Dick Ingwall has alerted me to a nice article in the NY Times on use of the ROCA method for screening for ovarian cancer.  To read the article, click on http://www.nytimes.com/2015/12/18/health/early-detection-of-ovarian-cancer-may-become-possible.html?smprod=nytcore-ipad&smid=nytcore-ipad-share.  To learn what I think of it, continue reading.

I have written about ROCA several times in the past, the earliest being in early 2013.  ROCA seems to be the fruit of scientific labor at the MD Anderson Cancer at the University of Texas.  It is a protocol for estimating the risk of ovarian cancer – in fact, ROCA is short for Risk of Ovarian Cancer Algorithm.  To my untutored mind it seems straight forward, logical, easy to apply – and ready for prime time.  But no: all the scientific spokespersons quoted, discussing a big trial of the method in the UJK, are “disappointed”, or “cautiously optimistic”.  To generalize:  More trials are needed.  More money must be spent.  More post-docs are requiredd.  Well, nuts.

I admit that ROCA falls short of having ideal sensitivity (telling you you’ve got it, if you do) and specificity (not telling you you’ve got it if you don’t).  This entails, inevitably, more anxiety and expense associated with false positives, not to mention heartbreak from false negatives. I stack this up against the 14,180 American women expected to die this year of OVCA.  Can’t the medical profession put some version of ROCA to work right now, if perhaps only for high risk women?  Can’t the NCI get off its fat ass and at least make some recommendations?   As I said earlier, nuts.

And as you can tell, I am in an intolerant mood.

I have written five blogs about ROCA, which you might want to read.  I think I have found a way for you to search all my blogs for a particular topic.  Google Myrl’sBlog, then look for an inviting line (on my machine, it is on the upper left) and type in a search term.  You should get all the blogs I have written which contain that term.  I hope it works.  Please let me know if it doesn’t.





A SIMPLE REVIEW OF A COMPLEX BOOK

Linda and Florence at a Relay for Life

Do you know that there are about 100 billion nerve cells in the human brain, about equal to the number of stars estimated to exist in the Milky Way galaxy?  Well, now you do.  Furthermore, each nerve cells make a vast number of connections with other nerve cells – amounting to the order of 100 trillion little entanglements.  That’s a truly staggering number.  In fact, the only larger number that occurs to me offhand is the odds against my Kalamazoo relatives voting for Donald Trump in the next election.  I cite these facts mostly to introduce the chief unifying factor of the book I am about to “review”:  complexity.

The book is The Deeper Genome, John Parrington.  It was published by Oxford University Press; Parrington seems to be an Associate Professor in the School of Pharmacology at that venerable and justly praised institution.  Parrington’s book intends to make sense of the recently verified observation that the vast majority of DNA does not code for proteins, and that the differences in protein-coding sequences in humans and worms (not to mention chimps and mice) do not seem sufficient to account for our obvious dissimilarities.  These differences arise from business conducted by processes that go on in The Deeper Genome: regulatory business.  Regulatory processes are why you don't grow toenails in you eyeball.  They also account for the fact that a human gene, while very similar to the same gene in a worm, can do a hell of a lot more.  Let’s face is, this stuff is, well – PRETTY DAMNED COMPLICATED!  And so is this book.

Nessa Carey’s latest book covered much of this ground, only better.  I read all of this kind of material that I can find because I think it is of the greatest importance for molecular biology, and cancer research in particular. However, I don't inflict it all on you - you would Unfriend me on Facebook!  Besides, what else would I be doing?  I figure that Dr. Parrington spared me from many dozens of hours of daytime television.  I have entered it in my blog “The Cancer Researcher Wannabe’s Bookshelf”

http://ljb-quiltcutie.blogspot.com/2014/10/the-cancer-researcher-wannabes-bookshelf.html

with a grade of B-



A POTENT VEGETABLE?

Lady Astor's little British getaway

On the Thames, above London

There I a flurry of publicity surrounding some new clinical confirmation that using birth control pills reduces your likelihood of getting ovarian cancer.  You knew that already, right?  The problem remains, however: by the time a woman reaches the age range where she is most likely to get OVCA, she is past worrying about birth control.   Now, if we had Abu Bakr al Bagdadi for a leader, instead of our kind and somewhat hesitant president, all girls would be put on the pill at age 11 and only permitted to stop when more future jihadi were needed.  So, bummer.

However, here is something you almost certainly didn’t know:  there is a vegetable that may help prevent/cure both ovarian and breast cancer.  The stuff is called Sojne danta, and seems to be popular in India.  If you Google it, you will find recipes.  Nothing that I have read explains how it does its thing – other than by "stimulating apoptosis"which, as you know, is short for “programmed cell death.”  A clutch of scientists from India are presenting a paper on this plant, and initiating a formal trial.  I am hopeful, but skeptical.

I had forgotten how much I hate this computer!