Cancer, Lung Cancer, North Carolina discussed on Freakonomics Radio
Important to me. It's nice to understand the problems of a working scientist. That is correct. You grew up in Greensboro? Yes. Yes, True North Carolina, You seem to have no Southern accent. What's that about? So I can do one if needed first off. Secondly, I did my residency and fellowship in Boston. You say the word y'all on rounds Exactly One time brown. Stop. Everyone makes fun of you for 20 minutes and then rounds resume again. So yeah, that beats it out of you pretty quickly. You're one of the few people who's had experience as a researcher on entrepreneur, the head of a large research institution in charge of grants and head of the regulator for drugs and medical devices. Having worked in all those areas. How do you see things differently than someone less polymath IQ than that? The thing that has become very clear to me that it's a nuanced and hard message to tell, But there's this pace of progress in cancer research. There's really exceptional Like no other period in my life may be like no other period and biomedical research for any disease, But it's hard to talk about because it's so Hedorah genius. Could focus on any specific area and say, Why is progress slow here there but an aggregate? What's happening is really amazing. You know, when I was at the FDA about 30% of the business in terms of new approvals for devices and drugs was cancer related. It's really remarkable. Yeah. For the past three decades or so. The death rate from all cancers in the U. S has declined roughly 30% in 2018 alone, the most recent year for which we have data. The decline was 2.4%. That is the biggest single year decline ever recorded. This is all good news. But it's also a long, long way from the Nixon era, hope that cancer was about to be cured within five years. There are, however, something's hidden in the cancer data that makes that 30% decline even more impressive. For one. The survival rate for younger cancer patients has improved dramatically. And one reason so many older people are still dying from cancer is that they're not dying from cardiovascular disease is thanks to a huge drop in mortality there. In other words, many people who in previous generations would have died from heart disease are now living long enough to die instead from cancer. But you know, as I said, it's uneven. There are certainly cancers where we're making a lot less progress. Okay, where is less progress being made from 2012 to 2016 death rates for women decreased for 13 of the 20 most common cancers, including lung, breast and colorectal, but increased for five types, including cancer of the uterus and liver. Men Over that same period, Death rates decreased for 10 of the 19 most common cancers, but increased for six, including liver and non melanoma, skin cancer. A lot of those day to go toe 2016, which precedes a lot of the widespread use of immuno oncology drugs, So you know as good as those data are, they don't include a lot of the new therapies that we've developed. Immuno oncology, harnessing the body's own immune system to treat cancer. This has a long history. In the 19 seventies, for instance, there was a lot of enthusiasm about naturally occurring proteins called interference. Was gonna you know, Jack up your immune system to fight cancer. And this was going to be this universal cure for cancer. And it was really a failure. It didn't work And because of that experience and other experiments like that. The cancer research community. Medical oncologists like me became very skeptical of the idea that the immune system could treat cancer. In fact, skeptical is probably not strong enough. We thought a lot of these people work in the music and we're literally crazy. You know, he was thought they were harming patients and irresponsible and so it was really a vilified field. For many years, and but a few great scientists persevered and start identify ways to coach the immune system into fighting cancer. This is hardly the first time in medical history that the supposedly crazy people turned out to be brilliant fact it happens all the time in medicine. In 2016. The Nobel Prize in physiology or medicine went to two researchers Jim Allison and Tasuku Honjo for immunotherapy research. And then those therapy started the work. And so that's really become a successful and very important way to treat cancer that most in the field myself included were very skeptical of in the early days. Let's talk about lung cancer for second Still the most fatal cancer but decreasing Yes, I guess you could look at it from either side that there has been progress. Or you could say, Wow, it's still killing a lot of people. Yeah, So the first thing you say is even today after a lot of progress against lung cancer that reflects various advances. It still kills more people than breast, prostate and colon combined in the United States every year, so it's a highly lethal malignancy, where we definitely need to make additional dances and also one of the major things that shaped lung cancer is the use of cigarettes and tobacco. And so tobacco control over the last few decades is starting to have some success. And then on top of that, we have some interesting new developments. So we have these drugs called kindness inhibitors that target specific subsets of lung cancer. Maybe 15 or 20% of lung cancer, United States or targeted by these pills, they're quite effective and not very toxic. And then we've also had the introduction of immunotherapy. So these checkpoint inhibitors that air Quite active against an even larger fraction of lung cancer have produced some really marvelous responses. And so now we're seeing a lung cancer mortality declined at the fastest rate in the history.