"The day remission is something that happens in so few cases it's a rounding error"
No, it merely has to be about as reliable as a "cure for pneumonia". It doesn't have to exceed that limit and approach a "cure for a laceration" or a "cure for appendicitis" both of which basically don't spontaneously reappear (assuming surgical removal of appendix)
> No, it merely has to be about as reliable as a "cure for pneumonia".
You're overlooking something very important -- we know what causes pneumonia, but we don't know what causes cancer. When we treat pneumonia, we're treating a cause. When we treat cancer, we're treating a symptom.
The reason for "remission not cure" is because we don't have any way to definitively say there won't be a recurrence, and this will remain true until we fully understand cancer.
Sure we know what causes cancer, uncontrolled growth of a mutated cell!
I see where you're coming from, but the differences between pneumonia and cancer aren't as great as you think.
If you have pneumonia, they give you an antibiotic. They can test for the presence of the pathogen, but they can't ever say you are "cured". Take c. difficile infections. They treat the symptoms, but you can "relapse".
In cancer you can test for the presence of the mutated cells (minimum residual disease). Often what they'll do is count the mutated cells from a biopsy, and with this current treatment, the number of remaining cells is less than the lower limit of detection.
Of course, this is only true in the liquid cancers. Solid tumor cancers don't work the same way.
> Sure we know what causes cancer, uncontrolled growth of a mutated cell!
That is an effect, not a cause. Your claim is like saying that auto accidents are caused by cars getting too close together. That's only a symptom of an underlying cause.
> I see where you're coming from, but the differences between pneumonia and cancer aren't as great as you think.
We know what causes pneumonia. Because of this, we can suggest behaviors that will prevent it before the fact, we can identify it unambiguously, and we can cure it after the fact. This isn't true about cancer -- we don't know what causes it, therefore we cannot proactively prevent it, we can't identify it very efficiently (there are always false negatives and positives) and we cannot cure it. There's no comparison.
> They can test for the presence of the pathogen, but they can't ever say you are "cured".
Of course they can. In infectious disease, they can test for the presence of the causative pathogen -- no pathogen, no disease. In cancer, to do this, we would first need to identify the cause. But we don't know the cause, we only know the effect.
> In cancer you can test for the presence of the mutated cells (minimum residual disease).
This is like saying we can test for the presence of a car crash by measuring bent bumpers and inflated airbags. That measures effects, not causes.
> Often what they'll do is count the mutated cells from a biopsy, and with this current treatment, the number of remaining cells is less than the lower limit of detection.
Counting abnormal cells only reveals how little we know. We detect cancer by detecting abnormal cell growth. We measure progress in symptomatic treatment by counting abnormal cells. We declare a remission by making that count approach zero using agents that kill abnormal cells. There are any number of cases where the count of cancerous cells was below the limit of detection, but still caused a recurrence.
In 1979, smallpox was declared to have been globally eradicated. How? By identifying the responsible pathogen, then systematically destroying it everywhere it appeared. This was only possible because we know what caused smallpox, and we could treat the cause, not the symptoms. Because of what we knew, we were able to call smallpox permanently cured.
We cannot do this with cancer, because we don't know enough about how it works. All we can do is tell people to avoid risky behaviors, behaviors that, for often-unclear reasons, increase one's chance to contract this disease. Then, once the disease's symptoms appear, we have crude methods to deal with it, like trying to kill the cell masses that represent the disease's primary symptom.
Based on a comparison with other diseases, cancer treatment is unbelievably primitive -- it would be like treating a finger infection by cutting off a person's hand. And guess what? Before germ theory and before antibiotics, that was the treatment -- cut off the infected limb before the infection spread through the body.
The reason we don't tell people they're cured of cancer is because of science. In science, there are no fairy tales -- everything depends on evidence. And we don't have the evidence science requires to declare cancer cured.
This argument appears to revolve around a very unconventional definition of the word "cure". It may be technically correct inside the oncology community or related affinity / fundraising industry group to use an alternative definition, but the original debate was about insiders using the word "cure" with the general public, where its probably vital to use the general public's definition as opposed to made up definitions. That said, I typed "definition of cure" into google and the response humorously was the exact opposite of the claimed definition, "Verb Relieve (a person or animal) of the symptoms of a disease or condition" solely focused around relieving symptoms, not total scientific analysis of the entire situation or root cause analysis or any of that much more complicated stuff.
Its OK to have a near religious belief in unusual definitions; its just useless when trying to talk to the general public, especially if they operate under the logical opposite of your personal definition. I believe this is a "Startup Lesson". Redefine words for yourself and folks in your affinity group all you want, but trying it with the general public is likely not to work very well.
For example of what the general public defines as a cure, examine the 1850-whatever cholera outbreak in London. The prevailing theory of "bad air" was pretty much blown away when statistical analysis pointed to one particular water well, which had its handle removed. That outbreak of cholera was successfully cured, without understanding much other than it had nothing to do with air and apparently revolved around the use of one particular water well.
> This argument appears to revolve around a very unconventional definition of the word "cure".
It's not at all unconventional -- in fact, it is the most common definition, and cancer doesn't meet it, which is why medical ethicists insist on "remission".
The point is that, given the public's common understanding of the word "cure", i.e. that after treatment a particular disease has been eradicated, cancer cannot be cured, only placed in remission.
> That outbreak of cholera was successfully cured ...
Now you're desperately trying to inject this word into sentences where it has no place. The cholera outbreak was stopped, but the problem of identifying the cause remained, just as with cancer. Therefore, no cure -- it's the wrong word.
Another example would be to respond to a Plague outbreak by moving to the country, as Newton did. Is that a cure? Of course not -- it's a survival strategy, but it has no depth or insight.
Remember that Semmelweiss was unable to get doctors to wash their hands, even though he had excellent statistical support for his suggestion, because he couldn't explain why his suggestion worked.
> Its OK to have a near religious belief in unusual definitions; its just useless when trying to talk to the general public, especially if they operate under the logical opposite of your personal definition.
Thank you for making the exact point I have been trying to make, to wit: in fairness we must pay attention to the public's understanding of this quotidian term. Most diseases that have treatments in modern medicine, also have cures. Cancer doesn't. To claim otherwise is to violate medical ethics.
Hey, I see what you're saying, but I don't think most scientists approach it that way.
Pneumonia is not cured by testing for the presence of the pathogen. You are given antibiotics (chemotherapy) and when you get better, you are cured. In fact, many people who never get pneumonia with test positive for the pathogen. Why don't they get sick? We don't know.
So? That's a state of our knowledge. When we learn more about cancer and find a way to treat the underlying causes, we will have actual cures: treatments which result in complete remission in >95% of cases.
This will happen. It may take the tools provided by molecular nanotechnology, and a generation of oncological research, but it will. To accept that cancer is special is irrational deathism.
> When we learn more about cancer and find a way to treat the underlying causes, we will have actual cures: treatments which result in complete remission in >95% of cases.
You clearly haven't decided what position you're taking. A cure is not remission in 95% of cases. A cure is a cure, with no chance of a recurrence if there is no further exposure to the responsible pathogen. Take malaria, for example -- do you think malaria victims experience spontaneous recurrences, far from the anopheles mosquito and its hitchhiker, plasmodium falciparum?
> To accept that cancer is special is irrational deathism.
In modern scientific medicine, anything we don't understand is special and deserves our attention. We don't understand cancer and it's deadly. Therefore it's special for perfectly scientific reasons.
To call cancer just another disease is simply irrational -- and dangerous thinking.
And you clearly don't know how medical statistics work. Take the simple flu shot: chance of developing Guillain-Barre syndrome from the vaccination is about 1 in a million, and about 1 in 20 of those die from complications (odds are better if you seek prompt treatment). Does the flu shot provide benefit 100% of the time? No: in some cases it's killed people.
So it goes with even the most advanced, futuristic cancer treatments. There will always be cases where the treatment kills the patient, or fails to affect the disease in any way. It will be the job of medical research to make those rare cases rarer.
And by the way, if cancer is not a disease, then what the heck is it?
No, it merely has to be about as reliable as a "cure for pneumonia". It doesn't have to exceed that limit and approach a "cure for a laceration" or a "cure for appendicitis" both of which basically don't spontaneously reappear (assuming surgical removal of appendix)