Assuming this is a genuine effort and not some kind of corruption, this potentially sounds great.
But as far as bang for the healthcare buck goes, why not advocate a serious national physical fitness campaign? Many people have gained weight and lost their fitness during the last 2 years, and we're doubling down on doing counterproductive things in cities like introducing friction and barriers for people to get to the gym in the name of defending them from Covid which is completely backwards. Losing weight is probably the single best thing the nation could do for not only better Covid outcomes, but also improving a bunch of other health issues from diabetes to heart disease and possibly cancer as well, if I remember right.
It’s a worthy goal but I doubt the government could move the needle with any amount of money, much less with just $1.8 billion.
Culture is incredibly difficult to intentionally shift. People actively resist when they feel they are being manipulated even if it is supposed to be for their own good.
People wanting to feel good, be more sexually appealing, sleep better, and so on? The desire to achieve higher fitness is pretty ubiquitous, but that is always up against how hard it is to achieve. There are certainly things an org like NIH could do to make it much easier. Better tools, better information, deep subsidization of healthy alternatives all come to mind.
The idea that we cannot make substantial improvements to people’s decision-making context and instead should spend all this money trying to hack the genome is obviously ridiculous.
> The idea that we cannot make substantial improvements to people’s decision-making context and instead should spend all this money trying to hack the genome is obviously ridiculous.
Except piles of cash per year ARE spend trying to change people's habits for the healthier, and it's obviously falling in the US.
You're idea of, "Don't throw a pile cash at medical research, that's stupid! No, spend it on advertising, but healthy stuff!" seems like the obviously ridiculous idea.
Are you honestly believing that fat people don’t enjoy life and food, have bad sex, and and stay awake at night worrying about it? I think you will find instead that overweight people are of typical happiness. I think someone has mislead you with false advertising, and done a better job at sharing information than the NIH could ever hope to manage.
What a remarkable straw man argument you’ve defeated! My actual claim is that all other things held equal, people in general prefer to have higher fitness levels over lower fitness levels.
I disagree. The government could easily move the needle if it had the guts to implement nationwide financial changes that would actually make a difference on food contents - tax sugary foods & drinks, implement a sugar daily % value, end corn and dairy subsidies, etc.
I remember it being unpopular, but haven't seen results on the NYC one specifically. Wikipedia has a roundup of results on a few similar implementations, though, and they seem to somewhat work: https://en.wikipedia.org/wiki/Sugary_drink_tax#Consumption
Culture is easy to shift, Madison Avenue style ad companies specialize in it. The Frankfurt School is a positive theory that focuses on changing society. Modern nudge initiatives are continuations of this. I would say that the majority of modern culture was at some point the product of some campaign.
The ad was written in my early childhood. "Can you pinch an inch ?", was the tag-line in a Kellogg's commercial decades ago.
In part thanks to that advert, my entire life whenever I can pinch an inch I simply stop drinking my calories. Admittedly it is harder to eat healthy when you are time constrained and poor. But could there be anything faster and cheaper than pouring a glass of filtered tap water ? Can we advise that first before developing more PSAs about nutrition, exercise routines, etc.
I think there is a rather powerful fat acceptance movement paid for by food lobbyists. Being fat is only socially unacceptable among my upper class friends, I think the middle class has leaned into it.
I think being able to have healthcare discriminate based on smoking has been hugely impactful in cutting US smoking rates, I think the same should be done for being overweight.
> I think there is a rather powerful fat acceptance movement paid for by food lobbyists.
Fat anxiety is driven by food industry propagandists (more marketers than lobbyists.) Most weight-loss companies are basically high-priced subscription food services with add-on food marketing and a hook that gets people to pay for that as a service. While they've become a big enough business too often be standalone, it's not telling that Weight Watches spent a couple decades as a subsidiary of HJ Heinz.
> I think being able to have healthcare discriminate based on smoking has been hugely impactful in cutting US smoking rates
Health insurance was never prevented from discriminating on that basis, even while smoking rates went through the roof. There's plenty of policies for which there is evidence of utility in cutting smoking rates, health insurance price discrimination isn't one of them.
That’s a fair point, they can already discriminate. I think the insurance plans being tied to jobs led to non-smoking workplaces, and a non smoking workforce, so I think it put employment options for smokers at risk. I think the stats may have been tied to if employers could discriminate based on weight. I forgot the name of the study but I was compelled by the evidence when I saw it. It did speak to my biases so I’ve left the door open to being wrong.
It was Nixon undermining the civil rights and anti-war movements. The CIA probably did more than just turn a blind eye to the heroin importation from the Golden Triangle in Asia.
The war on drugs was never about drugs per se, and winning was never the goal. It was always primarily a political tool to marginalize certain communities and minority groups.
Why did my 99% white, upper middle class school district have a DARE program? How did that serve to advance the cause of marginalizing minority groups?
> Why did my 99% white, upper middle class school district have a DARE program? How did that serve to advance the cause of marginalizing minority groups
DARE is a program to increase public positive image of, deference to, and political support for the arbitrary action of police. (And t it's only demonstrated effect is on attitudes toward police; it doesn't have any effect on drug use.)
How that advances the cause of marginalizing minority groups is left as an exercise for the reader.
> So the claim is it was deliberately ineffective at getting kids not to take drugs because …?
The claim is keeping kids off drugs was probably never the real goal, and even if it was the program continued to expand to new places and be funded in existing places long after it was proven ineffective as anything but pro-police propaganda, which wasn't an accident by decision-makers.
Which reveals that even if keeping kids off drugs was once part of the motivation, it wasn't what sustained the program.
How did that serve to advance the cause of marginalizing minority groups?
Don't bother pointing out facts or using logic. Any time someone mentions drugs on HN, the usual group of addicts-in-denial show up parroting the same tired and disproven talking points that High Times magazine has been flogging for the last 40 years.
The overall war on drugs waged by the government was about power and control, but that doesn't mean individual persons and communities couldn't decide for themselves what they were fighting for.
Well, exactly. They tried to indoctrinate kids not to take drugs and it failed miserably. So the claim that it’s super easy for the government to shift culture seems wrong, no?
Okay. If the US government, in the form of the NIH, spent 1.8 billion dollars trying to get people to exercise more do you think we’d see substantially more exercise happening than we would have otherwise?
What about smoking and alcohol consumption, both linked to increased rates of cancer.l, as well. This is just anecdotal but alcohol seems like such an American culture and the prices are incredibly cheap as compared to Canada. I remember buying a 26oz vodka for $7.50 in Hawaii a state where they had to fly that vodka in. Vodka here in Canada would cost me about 3 times the price. Same with cigarettes they are about 2 times the cost here in Canada. People here of course still smoke and drink but I know many have quite due to price. It seems if the government really wanted to reduce cancer it would target some of the other risk factors like smoking and drinking as well.
The benefits of exercise are already well known, by pretty much everybody.
The power of government PSA campaigns is also well known. On average, they enrich advertising agencies and produce no change in the public's behaviour.
> The power of government PSA campaigns is also well known. On average, they enrich advertising agencies and produce no change in the public's behaviour.
It's not well known at all to me. What is the basis of that?
This isn't really a problem that the federal government can solve. The President’s Council on Sports, Fitness & Nutrition has existed for decades but was never very effective. We could make some minor improvements around the edges by giving income tax credits for things like sports equipment, participation fees, diet counseling, etc.
Most of the really pointless and counterproductive Covid restrictions were implemented at the state and local levels where the NIH has no real authority.
Unfortunately, although it gets high marks for awareness, trust, and organizational capacity, it doesn’t seem to have been very effective: Canadian kids are at the bottom of the rankings for fitness and activities.
What makes you think that money spent on changing peoples behavior, will actually change their behavior? What statistics do we have that would make this a "better bang for healthcare buck?"
> Assuming this is a genuine effort and not some kind of corruption, this potentially sounds great.
It’s a genuine effort to put something positive on the table for the administration as the mid-term elections ramp up. Biden, like his predecessor, is historically unpopular. The administration is desperate to do anything to maintain control of the house and senate.
This “plan” is a retread of Biden’s 2012 scheme that went nowhere.
As for corruption, probably just run-of-the-mill NIH feudalism. Even Joe Biden isn’t so brazenly corrupt that he’d directly pay his bag men while he’s the sitting President.
It’s good to see cancer get more money & attention, regardless of the motive.
Alexander Solzhenitsyn believed he cured himself of cancer by following the instructions of a shaman. He then wrote of his experience in “Cancer Ward”
Years later a Solzhenitsyn fan who worked for the NIH recreated the shaman’s recipe and long and behold it was a cocktail of the most promising cancer fighting chemicals the NIH was investigating at the correct dose!
If you liked the link, read Solzhenitsyn. Amazing.
But start with “A day in the life of Ivan Denisovich”, short and to the point and skip the Gulag.
The Gulag is brilliant, but its too long and depressing (Ive never made it past half way through the first book).
Also, keep in mind the fundamental difficulty of Russian novels: each character has a half dozen names, nicknames or variations of their name. Keep the wikipedia page open so you can look up the characters!
> The Gulag is brilliant, but its too long and depressing (Ive never made it past half way through the first book).
Well look at that, common ground! I've always been a compulsive reader -- up until I was about forty, forty-five, an obsessive-compulsive one: if I'd started a book, I'd finish it.
Except for a very few works. Weirdly, come to think of it, all three (that I can recall now) of them were recommendations from my best friend since lower-middle school, whose taste I still trust and whose recommendations I'd still follow -- but whose literary stamina I apparently lack.
We were assigned to read Denisovich in or just before our lower teens, and I found it quite good and interesting. After that, he read The Gulag Archipelago and said it was good, so I tried... That's the first book I can recall giving up on.
Sometime in our teens we read TLOTR, which he followed up with The Silmarillion. Strike two. Then, sometime in our twenties or thirties, he recommended Proust's In Search of Lost Time. Strike three (and you're out?).
I'm tempted by -- but dreading! -- Stephen King's The Dark Tower... OTOH, lots of other people also seem to be recommending that. And I've gotten past "my gotta finish it" fixation. So maybe, after all.
I think you may have misunderstood: Denisovich is pretty much all about his life (as the title says, a day thereof) in a Gulag. Perhaps a page or three of more general musings at the very end. And that's all there is to it, The End, nothing more after that -- it is just "the gulag part".
What you should skip, as I read the recommendation, is The Gulag Archipelago, a separate multi-volume (at least a trilogy, maybe much more) epic about the Gulag system in general and, I gather (but may be wrong) more explicitly based on Solzhenitsyn's own life therein. FWIW, I agree with this recommendation.
Maybe the third time's the charm? Richard Nixon tried this back in the 1970s and it failed. Compared to the original well-defined NASA moonshot, cancer is a complex, murky, and individual disease that's unlikely to yield to "moonshot" attempts to solve it.
Is it bad to feel depressed that this has been going for nearly half a century with No end In Sight.
In fact it’s stated goal is the dream end state of any pharma co that could cure it. Endless treatment to stave off death.
I'm all for curing cancer. I think the most effective use of resources would be to fight obesity. Obesity leads to so many other problems including cancer. My personal way of not getting obese is to just fast for a couple of days whenever I get over 185 lbs. I probably need to fast every 2 months or so. I encourage other people to use the same strategy but I somehow come off as a jerk whenever I suggest fasting.
I feel like this should have a height or bmi attached to be more general.
Overall people get very weird or think you have an eating disorder if you fast for any length of time. Luckily that is changing, but is still an issue for my partner who is in a much more traditional field and often skips meals.
Fasting is definitely a good tool to utilize and it has its own benefits other than weight loss e.g. acting as a hormetic stressor.
But by far the most useful tool I’ve come across to precisely control body composition is the skill of counting and estimating calories and macros. Once you know your TDEE, it is super easy to control body weight with precision this way.
This should be taught in schools imo. It is surprising how wildly off the layman is when it comes to estimating calories.
I've considered integrating fasting with my weight loss program, but if I don't eat for 5-6+ hours I'll occasionally get light headed with vision artifacts. This doesn't always happen and while I'll recover I'm usually starving after.
My mother says this is related to "blood sugar" but I'm unsure if there's any deeper meaning to it.
I am baffled at how easy it is to fast for three days. I do drink electrolytes ("snake juice") and water, but don't eat. What I find concerning is how it affects my muscle mass. I haven't gotten weaker so far. A caveat is that I need to take 2-3 hour walks on fasting days to actually see any fat loss.
Cancer is a leading cause of death (and other problems). Maybe we could invest in both? Even if we had to raise the capital gains tax rate a little? A friendly reminder: The US is the richest country in the history of the world.
This is just my opinion, but cancer is my day job.
Treating, let alone curing, advanced cancer is very difficult. Just look at the numbers - a human has about 6 trillion nucleated cells. A cancer 1cm3 in size has a hundred million cells in it or thereabouts. Therefore in advanced cancer you are looking at billions of cancer cells in the person. This is a very large amount of disease biomass. And the task is to make it all go away.
Yes, there are some patients who have favourable disease biology who are otherwise healthy, not too old, relatively wealthy and have access to incredibly sophisticated and expensive cancer care who can be cured from advanced cancer. But this number is very small compared to the deaths, especially for the common cancers (Breast, Prostate, Colon). And there is no general strategy to extend these occasional wins/miracles to everybody. We can't wait to cure cancer one Nobel prize at a time. Furthermore, we are seeing large waves of ageing populations colliding with poorly resourced healthcare systems around the world, and these systems just can't deliver what one would call optimal cancer care which requires specialist surgeons, oncologists, nurses, radiologists, PET scanners, MRIs, sophisticated radiation equipment, supportive care and very, very expensive drugs.
Unlike almost any other disease, cancers start from a single cell. The endgame has to be prevention. We should be preventing as much cancer as possible. And for most common cancers, we don't even understand why it happens with sufficient detail to think about how to prevent it. Detecting cancers earlier with tests like the one from Grail is a good thing to aim for, but trust me, being told you have cancer, and the inevitable surgery plus whatever else still sucks a lot even if the chances of cure are very good.
Inflammation means many different things. There are specific cases of inflammation increasing the risk of cancer, for example inflammatory bowel disease like Ulcerative Colitis and colon cancer. At the moment, inflammation in otherwise healthy people is not well defined or characterised, so it is quite impossible to study it. On the other hand, some albeit very potent anti-inflammatory medication increases the risk of cancer (for example JAK2 inhibitors). Some conditions assocaited with chronic inflammation seem to be associated with less cancer (Familial Mediterranean Fever for example). As such I think inflammation is not the most useful concept. It is more a surrogate marker of some other undesirable behaviour related to lifestyle or diet for example, rather than a direct causative factor.
Stress is similarly complicated and not well defined or easy to measure. There are different types of stress of course. It seems like moderate to severe stress isn't necessarily harmful, based on studies of I think it was Dutch women in WWII who were definitely stressed but not in Auschwitz or open combat. There is some poorly controlled data from concentration camps that extreme stress coupled with malnutrition and everything else that went on does result in more cancers, but this doesn't really help us today.
Sugar is another complicated one. Any nutritional factor has different effects in different people. There is evidence that what sort of sugar you have, and even how you eat it matters (drinking sugars, especially fructose seems esepcially bad). Here it may be more relevant to consider the result of sugar intake, such as insulin resistance and high insulin levels.
I really appreciate the detailed reply. Really helps to hear a professional opinion for someone who doesn't know much about the topic in any real sense.
> A cancer 1cm3 in size has a hundred million cells in it or thereabouts. Therefore in advanced cancer you are looking at billions of cancer cells in the person. This is a very large amount of disease biomass. And the task is to make it all go away.
But we do successfully treat cancer in many people, and prolong life in many others.
Same analysis applies. Smaller tumours are easier to cure. Cure means eradicating every cell. That is why chemotherapy is given in cycles, to achieve fractional cell kill until there are no cells left to regrow.
Prolonging life in advanced incurable disease is important but it isn't getting us to where we want to be. Having advanced cancer is a state associated with immense suffering, as much psychological and spiritual as it is physical, even when things are under control. We can pat ourselves on the back for saying on average we have given this person an extra 6 months of life, but when you are administering these treatments or recieving them it does not feel like a win. Also, young people get cancer - eg the most common cause of non-accidental non-suicide death in women aged 25 - 40 is breast cancer. An extra year isn't enough for a woman with advanced breast cancer in that phase of life, especially as it is spent running back and forth from hospital and in various states of ill health either from the disease or treatment side-effects. Almost all of them would rather be alive and having the treatment of course, but taking a step back, I feel very strongly that we need to do better than this and we need to offer more than this, and what is the best of all is if as few people as possible ever meet an Oncologist. It's important not to lose sight of that.
The other point I was making is that successful cancer treatment is difficult and expensive, and if you are mentally ill or poor or homeless or in the wrong country or in a warzone etc then you will miss out.
> Having advanced cancer is a state associated with immense suffering, as much psychological and spiritual as it is physical, even when things are under control.
That is certainly not the experience of a great many people whose lives are prolonged. Many experience lots of healthy, productive years that they woulnd't get otherwise.
I'm not sure we are talking about the same thing, or what your conception of advanced cancer is. There are relatively few people with advanced cancer who could be considered healthy or would consider themselves that way. This is what I see in front of me with my own eyes every day. Of course they would rather have the time, or any time, than not.
You can chose an example of a slow growing low volume malignancy like a neuroendocrine tumour, but that isn't representative of the majority by any means.
I think cancer is mostly an immune problem, which has become obvious with the relative success of immunotherapies.
It worries my a bit that this moonshot effort is still listing the generation of cancer atlases as a priority. I hope these atlases will be used for the selection of epitopes towards developing cancer immunotherapies.
Previous atlas efforts made no sense, and it was very frustrating to see other great initiatives to obtain much less funding, like CAR-T cells. Research politics I guess...
It's hard to "control narrative" with trademark law, but you can go after people who are, say, illegally collecting donations or offering quack treatments.
There is a lecture on YouTube by a doctor who claims that all cancer cells ferment rather than respirate and that because of this, they are able to be starved with a combination of zero carb diet and a special protein that disrupts the fermentation of another protein that cancer cells can also use. He presents cases where he uses this method to treat a brain cancer patient. I’m on the train and not in a position to find his name or the video. Does anyone have anything to say about this?
As another commenter mentioned, the Warburg effect has been known for about 90 years, and has lots of past and current research on it. Thus, I'm going to trust that scientific process rather than some rando dr on YouTube that claims you can cure cancer with a carb free diet and a "special protein".
That thing with the fermentation is called the Warburg Effect, and it's the reason why PET scans work.
There are some cancer types where this is more prominent. But even then, it's hard to disrupt this without causing a lot of collateral damage, because normal cells also need to ferment.
This doesn’t add up. Collateral damage isn’t a concern in any other cancer treatments. And if fermentation is so necessary, how do people survive being in ketosis for years?
I know nothing about cancer treatment but here's a link to an npr article about this. I'd be really interested to hear thoughts from people who know what they're talking about.
The data suggests that this is a pointless waste of money
“Despite the Herculean effort and enormous expense, only a few drugs for the treatment of cancer were found through NCI’s centrally directed, targeted program. Over a twenty-year period of screening more than 144,000 plant extracts, representing about 15,000 species, not a single plant-based anticancer drug reached approved status. This failure stands in stark contrast to the discovery in the late 1950s of a major group of plant-derived cancer drugs, the Vinca Alcaloids -a discovery that came about by chance, not through directed research.” — Happy Accidents: Serendipity in Modern Medical Breakthroughs.
CRISPR-9 was discovered by accident while trying to understand how bacteria fight the flu. (CRISPR-9 is the acronym for gene editing brouhaha).
Penicillin was discovered via Alexander Fleming’s random mold observation.
Roentgen discovered X-ray tech by accident when he shot electric current through a special gass in a glass tube. Roentgen found out that he’d made a ray that passed through light elements, but interacted with heavy ones; the X-ray.
Vaccines were accidental too. (Edward Jenner — cowpox)
Directed effort seems to be a not-good bet in biotech.
Lesson: Let scientists advanced things in accordance with the invisible hand of scientific discovery and observation as opposed to subsidizing bridges to nowhere. Think more Ioannidis than Kurzweil.*
But as far as bang for the healthcare buck goes, why not advocate a serious national physical fitness campaign? Many people have gained weight and lost their fitness during the last 2 years, and we're doubling down on doing counterproductive things in cities like introducing friction and barriers for people to get to the gym in the name of defending them from Covid which is completely backwards. Losing weight is probably the single best thing the nation could do for not only better Covid outcomes, but also improving a bunch of other health issues from diabetes to heart disease and possibly cancer as well, if I remember right.