What We Get Wrong About Cancer
Summary
TLDRThis video script delves into the multifaceted battle against cancer, emphasizing the importance of early detection over the search for a singular cure. It explores various treatment methods—surgery, chemotherapy, radiation, and immunotherapy—while highlighting the stark differences in survival rates based on when cancer is detected. The script challenges the focus on developing new treatments instead of improving early detection methods, advocating for a proactive healthcare approach to save more lives.
Takeaways
- 🛡️ Cancer is not a single disease but hundreds of different diseases, necessitating a multi-faceted approach to treatment and research.
- 📈 The rise in life expectancy due to advances in medicine has led to an increase in cancer diagnoses, as we are now living long enough to develop this disease.
- 👨⚕️ Greg Simon, who ran President Biden's Cancer Moonshot, emphasizes that cancer is a part of us, arising from uncontrolled cell division.
- ⚔️ The primary methods of fighting cancer today are surgery (cutting out tumors), chemotherapy (poisoning cancer cells), radiation therapy (burning cancer cells), and immunotherapy (melting cancer cells by activating the immune system).
- 🧬 The historical development of chemotherapy was influenced by the observation that mustard gas could stop cell division, although the connection was not direct.
- 🌟 Modern cancer treatments have made significant strides, but there is a lack of focus on early detection, which is crucial for improving survival rates.
- 🔍 Early detection of cancer is highly beneficial, with survival rates for localized cancers being much higher compared to those that have metastasized.
- 🤔 The script raises concerns about the medical community's approach to early detection, questioning why more resources aren't dedicated to this potentially life-saving strategy.
- 💉 The video discusses the potential of technologies like MRI for early cancer detection, highlighting the importance of innovation in diagnostic tools.
- 🏥 The script points out the challenges in early detection, such as the risk of overdiagnosis and the need for better healthcare systems that support proactive care without causing unnecessary stress or expense.
- 🌐 The importance of asking doctors about appropriate tests and their timing is emphasized, encouraging individuals to be proactive about their health.
Q & A
What is the current approach to dealing with cancer, as described in the script?
-The script describes a multi-front war against cancer, acknowledging that cancer is not a single disease but hundreds of them. The approach includes developing new treatments and focusing on early detection.
Why is cancer considered the 'monster under the bed' or 'inside our bodies'?
-Cancer is referred to as such because it was revealed as a major cause of death as we began to conquer other diseases through advancements in vaccines, sanitation, and modern medicine, leading to people living longer.
What startling statistic does the script present about cancer diagnosis in the US?
-The script states that half of all men and a third of all women in the US will be diagnosed with some form of cancer in their lives.
What are the four main methods mentioned in the script for fighting cancer?
-The four main methods mentioned are: surgical removal (cut), chemotherapy (poison), radiation therapy (burn), and immunotherapy (melt).
How did the script's author get involved with the topic of cancer?
-The author became obsessed with the topic after speaking to various professionals including doctors, patients, and the head of the Biden Cancer Moonshot, and getting a brain scan.
What is the significance of early detection in cancer treatment according to the script?
-Early detection is crucial because it significantly increases the survival rates and simplifies treatment, often to surgery alone, compared to late-stage detection which requires more aggressive treatments and has lower survival rates.
What does the script suggest about the current focus on new cancer treatments versus early detection methods?
-The script suggests that while there has been a significant focus on developing new cancer treatments, the importance of early detection methods, which could save more lives, has been largely ignored.
What is the role of immunotherapy as mentioned in the script?
-Immunotherapy, referred to as 'melt' in the script, works by unmasking cancer cells to the immune system, allowing it to recognize and destroy the cancer cells as foreign entities.
What potential issue does the script raise about widespread use of MRI for early cancer detection?
-The script raises the issue of overdiagnosis and the potential for causing unnecessary stress and expense to the medical system by detecting many irrelevant findings.
What is the script's stance on the importance of proactive healthcare and early detection?
-The script advocates for proactive healthcare, emphasizing that early detection is not just good by itself but is beneficial if it leads to better patient outcomes, and criticizes the healthcare system for not prioritizing this approach.
What advice does the script leave the audience with regarding cancer detection?
-The script advises the audience to consult with their doctors about what tests they might benefit from and when, emphasizing personal involvement in one's health.
Outlines
🔍 The Complexity and Personal Impact of Cancer
The script addresses the multifaceted nature of cancer, emphasizing that it is not a single disease but hundreds, requiring a multi-pronged approach. It discusses the shift in public health focus from curing cancer to managing it as a chronic condition due to the rise in life expectancy and the subsequent 'unveiling' of cancer. The narrator shares personal reflections, including the startling statistic that half of all men and a third of all women in the US will be diagnosed with cancer in their lifetime. The script introduces Greg Simon, who led President Biden's Cancer Moonshot initiative, and his unexpected diagnosis of leukemia. It outlines the four main methods of fighting cancer today: surgery (cutting out tumors), chemotherapy (poisoning cancer cells), radiation therapy (burning cancer cells), and immunotherapy (melting cancer cells by activating the immune system).
🛡️ The Importance of Early Cancer Detection
This paragraph highlights the advancements in cancer treatment and the paradox of not detecting cancer early enough despite these technological breakthroughs. The narrator discusses the importance of early detection, comparing it to catching diseases at their earliest stages for better outcomes. The script includes a personal anecdote of the narrator getting a full-body MRI for cancer screening, which is controversial due to the lack of symptoms or higher risk. The results of the MRI are normal, and the script introduces the concept that early detection can significantly improve survival rates, with metastatic cancers having the lowest survival rates compared to regional and early-stage cancers. The narrator argues that early detection is a cure in itself and emphasizes the need for better detection tools and strategies.
💡 The Challenge of Balancing Detection with Overdiagnosis and Cost
The final paragraph delves into the complexities and challenges of early cancer detection, including the potential for overdiagnosis and the associated costs. It points out that early detection may not always equate to a longer life, introducing concepts like lead time bias and overdiagnosis bias, which can skew survival rate statistics. The script addresses the need for skepticism in interpreting early detection data and the importance of ensuring that it leads to better patient outcomes. The narrator criticizes the healthcare system's focus on developing expensive treatments rather than improving early detection methods. The script concludes with a call to action for individuals to discuss with their doctors the appropriate tests and timing for early cancer detection.
Mindmap
Keywords
💡Cancer
💡Cancer Moonshot
💡Chemotherapy
💡Radiation Therapy
💡Immunotherapy
💡Early Detection
💡MRI
💡Lead Time Bias
💡Overdiagnosis Bias
💡Metastatic Cancer
💡Preventative Care
Highlights
Cancer is not a single disease but hundreds of diseases, requiring a multi-front approach.
The 'war on cancer' has seen progress, but no definitive cure has been found due to the complexity of cancer.
Cancer incidence is rising, particularly in people under 50, making it a pressing issue for the current generation.
Advancements in medicine and sanitation have led to longer life spans, revealing cancer as a significant health threat.
Statistics show a high likelihood of cancer diagnosis in the US, affecting men and women differently.
The speaker's personal connection to cancer through loved ones and the potential for a personal diagnosis.
Cancer's unique nature as a disease that arises from uncontrollable cell division.
Greg Simon's perspective on cancer as 'life in abundance' and his role in the Cancer Moonshot initiative.
The four main methods of fighting cancer today: surgical removal, chemotherapy, radiation, and immunotherapy.
The historical context of mustard gas leading to the development of chemotherapy.
The importance of early cancer detection and its impact on survival rates.
The controversy and potential risks of early cancer screening without specific risk factors or symptoms.
The speaker's personal experience with a full-body MRI for early cancer detection.
The stark contrast in survival rates between early and late-stage cancer detection.
The technological marvel of MRI and its role in early cancer detection.
The challenges of early detection, including overdiagnosis, lead time bias, and the cost of medical tests.
The need for a healthcare system that promotes proactive care and avoids harmful follow-ups.
Greg Simon's call for more aggressive early detection programs despite the challenges and costs.
The societal implications of focusing on expensive treatments for fewer people versus early detection for many.
The speaker's final recommendation to viewers to consult with their doctors about beneficial tests and timelines.
Transcripts
"Cancer?"
"Cancer."
"Cancer!"
"We're gonna cure cancer -"
"cure for cancer -"
"the next frontier in the race to find a cure for cancer..."
At this point, you probably know that we're not looking for a cure for cancer
anymore. Cancer is hundreds of diseases, so really we're in a multi-front war against all of them...
"The war on cancer -"
"The new frontier in fighting cancer -"
"A new cancer vaccine -"
"It's considered one of the most promising fronts in the battle against cancer-"
"- but nearly no improvement in others"
"Cases in people under 50 are rising dramatically -"
What I didn't realize was that cancer is a problem
for our generation in a way that it wasn't for previous ones further back. Look at this:
In the US, our grandparents' grandparents' died of all kinds of things. But slowly, we began to conquer
the diseases that killed the most of us. And that's how - with developments in vaccines and sanitation
and modern medicine, just plain living longer...
We revealed cancer.
It's the monster that was under the bed the whole time.
Worse - it's the monster that was inside our bodies the whole time.
Here's the stat that really got me: Half of all men and a third of all women in the US will
be diagnosed with some form of cancer in their lives. Around the world, out of every six people
who die, one of them dies of cancer. I don't say that to scare you. I say it because if you think
this topic doesn't apply to you - specifically you - you're wrong. And me. There's an uncomfortably high
chance that at some point in my life I might get that call from a doctor. People I love already have...
So the question is: What can we do about it? Over the past couple months, I've gotten obsessed with
this topic. I've spoken to doctors and patients. I talked to the head of the Biden Cancer Moonshot.
I got my brain scanned. I'm going to show you how we fight cancer, because it is amazing. But I also
found something else. In this video, I want to make the case that though we have made enormous leaps
with new cancer treatments, we have also largely ignored the single best way to save the most lives.
"Are we winning the war on cancer?"
"War on cancer -"
"The emperor of all maladies -"
"A civil war in the body -"
"We've made tremendous progress in the war against cancer...
but we haven't won yet..."
Cancer is crazy. It's different than talking about a virus or anything else really
because cancer is... us. Too much us. Cancer takes a thing that makes us live - a human cell that divides -
and kills us because it can't stop doing that. It divides uncontrollably.
"What is cancer? Well, that's answered wrongly most of the time."
"Cancer is, to be blunt, life in abundance."
That's Greg Simon. He ran President Biden's
Cancer Moonshot. He was in charge of coordinating the whole US' massive but often
messy cancer efforts. Actually, when he was first appointed...
"They did not even know I had cancer!"
Yeah. Greg has leukemia.
"And my doctor says, your PSA is fine, and your cholesterol is fine, but by
the way you have leukemia. Now, even I know that's not how you use "by the way." It's more like, by the
way there's something on your lip. Not by the way you have a deadly form of cancer."
If you ever get a similar call, you should know
that there are four big ways we fight cancer today: cut, poison, burn, melt.
In lots of cancers, when those uncontrolled cells start to divide, they glom together, creating
a tumor. This is localized or early stage cancer. And if we catch it here, we cut it out.
"If you can see the cancer and it's early that's always what they do.
Boom. We'll just cut it out before it spreads."
But with some cancers, like Greg's, you can't do that. And with others it gets too
late. Cancers can spread into nearby tissue and then later into other parts of the body. These
are regional and then later distant or metastatic cancers. Once cancer has spread, the question that
doctors have to deal with is: how do you tell what's you and what's cancer?
So what's "poison"? You know that one: That's chemotherapy.
"I get in a chair, nurse comes in, puts on a hazmat suit. and I'm
like whoa, I'm the one getting the drugs! Why am I not covered up? She said,
well, I don't want it to be dripping on me. It's incredibly poisonous."
Here's a story: In 1943 German forces bombed an Italian
port, sinking 17 Allied ships. This one, an American ship called the John Harvey, was carrying a secret
cargo of 2,000 bombs filled with mustard gas. The toxin spread into the water as soldiers swam to
safety. And they died, horribly. And when doctors examined their bodies, they found that the gas had
stopped certain cells from dividing. This moment is sometimes cited as "leading" to chemo. It didn't. It's
an extreme early example of the chemical effect. Back in the US, researchers at Yale were already
experimenting with ways to alter this poison to stop cancer cells from replicating.
Today, chemo is often paired with radiation. That's the "burn" category -
damaging the DNA of the cancerous tissue and killing cancer cells.
"It's either burn, poison, or cut... and now there's a new one: melt.
So the drugs I get melt these cells... so the new immunotherapy drugs that activate the immune
system, they de-mask or unmask the cancer cell and the immune system goes, that's not a cop that's a
crook! How did we miss that? And they go get them..."
These methods have saved millions of lives. Cancer treatment is astonishing now
and these are just the big categories!
So yes, technologically there is a
huge breakthrough and it's happening every year in all kinds of different cancers. But here's
what's not happening: We're not detecting people early.
Okay. Let's take a second. I need to thank our
sponsor here, because they helped make this story possible. That interview with Greg, I recorded on
Riverside. In fact, I now record nearly all of my interviews on Riverside. It's great. I'd recommend
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to try it out, I can give you 30% off. Just go to riverside.fm and use code "CLEO" for 30% off
any individual plan. I'll also put a link to this in my description. Now, back to the story...
I know it's better to catch cancer early. But how much better? How does it compare to a new
treatment or something? in the course of making this episode, I got invited to get
a free screening for several different kinds of cancer all at once. There are lots of ways
to detect different kinds of cancer but the one that I'm gonna get is a full body MRI. By the way
what I'm doing is controversial. I'm getting screened for cancers with no symptoms and
without a specific higher risk that I know about. Many doctors would tell me this is a waste of my
time or worse it could give me unnecessary or even damaging care... I'll come back to that.
I can't take my camera in with me but I'm going in there alright here we go!
I'm all done...
I've never gotten an MRI before. It was really interesting. It sounds a little bit like this
BOOOM BUNGBONG DINGDINGGING "please hold your breath" WAHW- (what am I doing)
DING!
That's what it sounds like. I'm feeling a little bit nervous about the results.
Like there's no evidence that I have cancer. There would be no reason for me
to get a checkup. There's - I don't. But like that's the point, isn't it? I wouldn't know...
I'm not going to string this out. They did not find cancer. Here's what my very normal body looks like.
"Unremarkable" is the word that they use. This is the company's founder, Emi Gal, and this is Dr
Dan Sodickson, their Chief Scientific Officer and - get this - one of the inventors of how modern MRIs
work. By the way, they didn't sponsor this video or anything. You're always going to know when stuff
is sponsored. They offered me a free trial and I tested it out. Okay, the reason why they care so
much about early detection is that if you find cancer, whether you survive depends a shocking
amount on when you find it. Different kinds of cancer differ wildly but broadly speaking
"Metastatic cancer has a single digit percentage survival rate for most cancers. Regional cancer
has a slightly higher but still kind of around 20-25% survival rate. Early stage cancers, so while
still localized in the organ, has a 80-90 in some instances 99% of survival rate. So like you can
survive that cancer if only you can find it when it's localized."
These are general numbers. Specific types of cancer different wildly.
But just look at how survival rates drop across the same kind
of cancer if you discover it later. Basically you can have the same kind of cancer and have these
completely different outcomes - and treatments.
If you detect cancer early, you can do surgery and
most of the time you're done. If you detect cancer late, you can you need to do surgery, radiotherapy,
chemotherapy, and the five-year survival rates decrease significantly.
I strongly believe we have a cure for cancer. It's early detection.
At this point in the episode I was expecting
to be talking about cancer vaccines or kinase inhibitors or immunotherapy - something that
I keep hearing about in the news. Those things are crucial. But the number of lives that we could save
if we just got the right people access to what we already have... my whole understanding of this topic
just shifted. And because I'm always interested in the tech angle let me nerd out for a sec: The
detection tools that we have now deserve the same kind of awe and like fawning headlines that we
give our new cancer treatments. Like do you know how an MRI works? Until I made this episode, I did
not. It is WILD. And it became widely available in our lifetimes! Just quickly: An x-ray is a shadow picture.
Like a hand with a flashlight but for your bones.
An MRI is a water map, made from radio emissions from your body.
"It turns out that the nuclei inside the atoms inside the water
in you actually point in a certain direction. They have
what's called a "spin" which you can think of like a compass needle...
So I was inside a big magnet which was moving and making those sounds
DINGDINGDINGWAHWAAH-[I'M SORRY OK]
which was then causing my little water compass needles to go
[what]
and emit a radio signal that was detected and made the image.
That is the signal, this radio signal
that our bodies are emitting that we then detect. How do we detect it? With a radio antenna.
So we can see our smushy insides and detect possible tumors and that's just one tool! There's so many
options now for how we can better see ourselves. I started to imagine a world where getting cancer
screenings was like getting an annual dental checkup or something. You catch them early
and you cut them out and you save lives. But it's not that simple...
The problem is if I were to just do an MRI on everybody
who walked in, I'd probably find a bunch of largely irrelevant stuff. Well then
you're following up on lots and lots of nonsense, and you're terrifying patients,
and your increasing expense to the medical system."
"So our medical system waits until you have a sign of cancer..."
But for many cancers by the time you have symptoms, you're past the early stages. It's frustrating but
there are good reasons to be cautious here. For one thing, detecting someone early might mean
that they live longer after their diagnosis but not that they live longer total. Imagine detecting
someone at 60 versus 67 and they both die at 70. This is lead time bias. Or you might catch a lot
more cases that are mild, so it might look like your survival rate went up but actually nothing
changed. This is overdiagnosis bias. These are good reasons to treat the data with healthy skepticism.
Early detection isn't good by itself. It's good if it actually leads to better outcomes for patients.
And there's another conversation about costs. How do we make these tests cheaper? How do we
make them more accessible? How do we make sure that people don't go into medical bankruptcy?
But if you hear people say that more information is worse for the individual somehow. That it's scary or
that it might cause harmful follow-ups... I don't get stopping there. Like, first of all, keeping
information from people is paternalistic. But more importantly it's on us to develop a health care
system that incentivizes proactive care and doesn't incentivize harmful follow-ups. Not to
say, "oh we can't get more information because we might act poorly on it." Like, what?? And don't get
me started on the messed up incentives here. I'll let Greg handle this one:
"So why don't we go out and be more aggressive in the way we detect?
Money. Lack of focus. And there's not a lot of glory in
creating an early detection program compared to developing a new a new drug."
And as a result we're lagging on things that in the context of curing cancer
should be straightforward....
Cancer is deeply human. And it seems to me like the fight against cancer is too. We're fighting
our own bodies. And we also need to fight our tendency to look toward the next shiny thing.
"What does it gain society to develop more and more expensive treatments for fewer and fewer people, if
we don't find a way to treat the more and more people who are dying of treatable cancers?"
It's not that people should get tested all the time. It's the in the push for new treatments we've
ignored a lot of people that could be helped by what we have right now.
This story was really eye-opening for me and if I can leave you with one final thought:
I said this story was relevant for specifically you. Now, after watching, if there's one
thing that you should take away from this, it's:
Ask your doctor about what tests you might benefit from and when. I know I'm glad I did.
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