200 Years of Progress
Posted 6/1/2012
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This is an important editorial from JAMA reviewing the past 200 years of cancer research. The authors are very famous senior oncologists, and their perspective is interesting. As an aside, if you have not read it, you should absolutely read The Emperor of All Maladies by Siddhartha Mukherjee (here's the NY Times review); the subtitle is "A Biography of Cancer," and it reads like a good novel as he describes all the mythology, research, and dreams associated with curing and treating cancer throughout history.
But, back to this editorial: It is easy to get lost in the specifics of what we hope for, exciting news about new drugs that turn out to be less miraculous than first thought, our own fears and individual situations. It is helpful, I think, to be reminded of all that has been learned as well as how much we still don't know. It is also important to appreciate how very complicated and challenging a problem cancer is. Especially when we are scared, it is all too easy to be seduced by promises that Treatment X (and I am talking about diet and supplement and vitamin claims) cures cancer without side effects or to be frustrated and angry with our doctors for not having something better to offer us.
It is also important to remember that all real knowledge and progress has been achieved through careful clinical trials. We stand on the shoulders of all the women who agreed to participate, and, if we have the opportunity to do the same, we should carefully consider doing so. Trials are no longer reserved for "hopeless cases" and are often available in the treatment of early breast cancer. For women with Stage IV disease, there may be opportunities to receive a new drug that will turn out to be very helpful. There are no placebo trials in cancer care, so you are always offered something that is known to be useful versus something that may be even better.
Here is the beginning and then a link:
Vincent T. DeVita, Jr., M.D., and Steven A. Rosenberg, M.D., Ph.D.
In the 200 years since the New England Journal of Medicine was founded, cancer has gone from a black box to a blueprint. During the first century of the Journal's publication, medical practitioners could observe tumors, weigh them, and measure them but had few tools to examine the workings within the cancer cell. A few astute observers were ahead of their time, including Rudolf Virchow, who with the benefit of a microscope deduced the cellular origin of cancer in 1863, and Stephen Paget, who in 1889 wisely mused about the seed-and-soil hypothesis of metastatic disease, a theory that is coming into its own today. Other key advances were the discovery of a viral cause of avian cancer by Peyton Rous in 1911 and the proposal by Theodor Boveri in 1914 that cancer can be triggered by chromosomal mutations.
But the lid of the black box was not seriously pried open until 1944, when a retired scientist at Rockefeller University, Oswald Avery, reported the results of his beautifully clear experiments with the pneumococcal bacillus, which showed that cellular information was transmitted not by proteins but by DNA. His work led directly to the important discovery of the structure of DNA by Watson and Crick in 1953. Eight years later, the genetic code was broken by Nirenberg and colleagues, and the central dogma of biology was established; that information was transmitted from DNA to RNA and resulted in the synthesis of proteins. Then, the first of a series of totally unexpected discoveries disrupted this thinking, and we were reminded that things are not always what they seem in dealing with Mother Nature. The discovery of reverse transcriptase by Temin and Mizutani and Baltimore, which showed that information could be transmitted the other way, from RNA to DNA, had a profound influence on medicine but most particularly on cancer medicine.
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