It's fun to heap criticism on China's research. There's too many fraudulent results, as a culture they don't value out of the box thinking, ect. That kind of thinking hurts us, not China. But as a researcher in the US working with data collected from Human samples, I will attest that the bottleneck to progress are the regulations.
What we don't want are regulations that make it impossible to get the research started. What we want are regulations that ensure that new drugs and treatments sold on the markert actually work. This is exactly the opposite of the situation in the US today.
>It's fun to heap criticism on China's research. There's too many fraudulent results, as a culture they don't value out of the box thinking, ect. That kind of thinking hurts us, not China.
You'll have to explain how being critical of fraudulent results "hurts us, not China", unless you're implying the criticism isn't valid, but from what I've read it's a very real concern in research coming from China.
I'd say the same way any criticism hurts the party believing it, not the one it's directed at. It increases your confidence in yourself without any corresponding increase in you real performance. In this case, public perception of superiority might lead to the US keeping its drug trials slow and expensive, reducing the amount of medical technology invented there compared to China.
>I'd say the same way any criticism hurts the party believing it, not the one it's directed at.
That doesn't make any sense. If the criticism is accurate, then it hurts the criticized party because it's true, whether or not they accept the criticism.
> It increases your confidence in yourself without any corresponding increase in you real performance
You don't need to increase your performance if the other side is lying about how well it's doing and you know it. Your confidence in yourself is well-founded in this situation.
>In this case, public perception of superiority might lead to the US keeping its drug trials slow and expensive, reducing the amount of medical technology invented there compared to China.
If China is actually producing a significant amount of fraudulent research, then their development will be hindered by their own fraud, which is the point. If their technological development is premised on fraudulent research, it won't advance.
You seem to think this is just a matter of opinion that can be freely ignored. You seem to have a completely backwards understanding of the concept of criticism.
It's true whether or not anybody says it. If nobody criticized China, all those problem would still be there. Except people in the US wouldn't be so confident of their superiority. I think that would get them worried into action, like they got worried into the space race by Sputnik as the article mentioned.
It is a matter of opinion - public opinion - which is what ultimately drives how the FDA works. If the US public is clamoring for them to get their ass into gear, eventually they will.
I believe his point is that although it is useful to analyze someone to see what they're doing wrong (so that you don't repeat the same mistake), it would be more useful to study what they are doing right so that you can apply those lessons to your situation. The former is quite easy to do and runs the risk of lulling one into complacency and a false sense of security, while the latter exercises your brain and demands greater effort and a more impartial assessment of the situation.
In the grandparent commenter's case, he is saying that everyone is focusing on the negatives of Chinese research when there are some useful lessons regarding regulation that could possibly be ported to the US.
The problem is you literally cannot trust anything positive that comes out of China. This isn't jingoism, western countries have their own issues, but China is a country set up only for rewarding positive results and severely punishing negative or even neutral results. Having worked from China in numerous jobs, a good chunk of the useful information they have is a liability as it's most likely stolen from elsewhere. To be clear this has absolutely nothing to do with the individual person, but with the risk/reward structure that exists in mainland China.
I'm not interested in arguing about OP's explicit wording, but the implication is that people are too complacent about "our" lead. It can only hurt you to underestimate your opponent
The FDA and USDA come to mind as institutions with a lot of questionable health policies.
"To obtain permission to market a drug, the manufacturer must satisfy the FDA that the drug is both safe and effective. Additional testing often enhances safety and effectiveness, but requiring a lot of testing has at least two negative effects. First, it delays the arrival of superior drugs. During the delay, some people who would have lived end up dying. Second, additional testing requirements raise the costs of bringing a new drug to market; hence, many drugs that would have been developed are not, and all the people who would have been helped, even saved, are not.
In addition, because FDA approval is mandatory, industry and medicine must heed FDA standards regardless of their relevance, efficiency, and appropriateness. Not all testing is equally beneficial. The FDA apparatus mandates testing that, in some cases, is not useful or not appropriately designed. The case against the FDA is not that premarket testing is unnecessary but that the costs and benefits of premarket testing would be better evaluated and the trade-offs better navigated in a voluntary, competitive system of drug development.
Three bodies of evidence indicate that the costs of FDA requirements exceed the benefits. In other words, three bodies of evidence suggest that the FDA kills and harms, on net. First, we compare pre-1962 drug approval times and rates of drug introduction with post-1962 approval times and rates of introduction. Second, we compare drug availability and safety in the United States with the same in other countries. Third, we compare the relatively unregulated market of off-label drug uses in the United States with the on-label market. In the final section, before turning to reform options, we also discuss the evidence showing that the costs of FDA advertising restrictions exceed the benefits."
I doubt the FDA is a net killer of people. I'm sure many people die while waiting for the FDA to approve new drugs but many more people would also die, become sick, or have adverse effects if there were no standards. Furthermore the standards the FDA sets for things you put in your body creates the confidence that allows this market to exist in the first place. In a market without the FDA drugs would hit the market faster and be cheaper but still reach far fewer people because public weariness of these products would be too high, and there would be far too many products claiming to do the same thing making it difficult for consumers and doctors to find the most effective treatments. Are FDA regulations 100% optimized? No, I'm sure it's a bureaucratic nightmare. But at this point the best thing we can do is try and further optimize these regulations -- throwing them out completely isn't really an option.
Took ~2 years to get approval to be able to seek patient permission to have their discarded tissue sequenced. Now that we are forming questions with the results, I hope it won't take another 2 years to get approval to run new tests :-/ In, retrospect is it even worth it?
There are existing immunotherapies that already target PD-1 receptors, which is what the article’s treatment of T cells is doing ex vivo.
Pembrolizumab, for example, is an FDA approved first line therapy for all cancers expressing high microsatellite instability or mismatch repair which is a highly conserved attribute among people who smoke and drink, one of the main reasons for why China has such an abnormal amount of cancer in their population in addition to additional extraneous factors like rampant pollution, due to their extreme carcinogenic effects.
This article seems to imply that the risk aversion taken by the FDA is resulting in lives not being saved, but is incorrect in it’s assertions. Especially since the utilization of CRISPR is still at a stage of, what is in my opinion, the creation of an unnacceptable mutational burden, immunotherapies like pembrolizumab which work to inhibit receptors through the usage of monoclonal antibodies are the best forms of treatment. In no way do I doubt the potential of gene editing and the good it can do, however, when I say this. The point is though, is that when you rush things too quickly, it inevitably ends up hurting the patient.
This. Related, China has a huge problem with volunteer donor organ transplants because they have no easy way to get it from the donor to donee in time (they would have to take on a train or fly it in economy with china’s famous aircraft delays, no helicopters or air courier services). Part of the reason why predictable condemned prisoner donations were so important...
Now that they can’t rely on condemned prisoners anymore (at least they’ve promised the ban is for real this time), bullet train infrastructure is quite useful.
> prisoners be given the option of donating organs upon their death
> another suggests that condemned prisoners be offered the option of trading a kidney or their bone marrow in exchange for a commuted sentence of life in prison without parole
> Application of the death penalty is spasmodic and seemingly discriminatorily applied, which would suggest that these types of proposals would be coercive to particular classes of individuals--minorities and the poor.
There are so many things that would be sensible policy (i.e. using organs of dead people) were it not for the surrounding hazards they create: incentive to give death penalties, wealthy people abusing, greater chance of weak defenses, etc.
If we could solve the slippery slope problem, so may things would be possible.
US has become too risk averse, so every accident leads to yet another regulation. There was a discussion on HN last year, which discussed how death rates on public construction projects have fallen to zero (unfortunately can't find a link to that).
On the one hand, thats a great news and I certainly don't want to be the person to lose my life due to lax regulations. But on the other hand, we should also consider the lost opportunity due to progress not made either due to regulatory obstacles (like biomedical research for cancer cure discussed here) or insufficient public funds (due to overspending on public works to minimize fatalities).
Ultimately, the question boils down to how much dollar value we as a society want to put on human life. A very high value will have obvious apparent benefits but lots of non-obvious costs.
It also depends heavily on whether you believe people who work in construction (i.e. blue collar workers) are an currency expendable on behalf of people who have cushy low risk jobs.
I’d be inclined to agree with you if we all had the same chance of risking our lives for the greater good and we could mutually agree on what the odds should be, but I feel like that’s why we’be come to the conclusion that it’s probably best if people didn’t die on a construction site for the same of innovation. (Also, I’d bet negligence is probably a more proper cause.)
Clinical trials for cancer are less fraught with the ethical problems of the construction worker since presumably the patient is that desperate for a cure, but we have general standards for these things like IRBs, protocols, and physicians trained to “do no harm” just to make sure the final product is safe and won’t guarantee a sooner death.
I'm not a cellular biologist or a doctor of any kind, but I consider myself a reasonably smart person. Reading the book Tripping Over the Truth by Travis Christofferson and tracking the work of Thomas Seyfried and others, it makes me think that a lot of the discussion in the battle for curing cancer is chasing a false paradigm: that cancer is a disease of genetics and if we could understand and edit the genome, we could cure the disease. The case for the Metabolic theory of cancer as laid out by Seyfried is quite compelling and if true, the implications for treatment from a patient standpoint seem to me much more preferential than the current combination chemotherapies which are only getting more and more expensive and only marginally more efficacious. Work on this front is only in its infancy, but my hope is that more people become aware, more funding directed towards metabolic therapy trials, and one day it could at least be incorporated into the standard of care.
If you read the article you'd realize that it doesn't talk about modifying the patients DNA to cure the cancer, the are just editing T cells so they will attack the cancer. Metabolic therapy seems promising, but I don't think it will ever be as effective as other forms of therapy that we will come up with.
>The treatment Wu is testing involves taking a sample of blood from each patient. A lab at a biotech company two hours away by bullet train extracts T cells from the blood. Scientists then use CRISPR to knock out a gene in the T cells known as PD-1. This engineering feat modifies the T cells so that they zero in on and attack the cancer cells, once they're infused back into each patient.
I realize the article is discussing a form of immunotherapy, but I think immunotherapy is also in its infancy, and given the nature of cancer cells and the heterogeneity of its own genetic makeup, immunotherapy still seems like a very blunt weapon in the war on cancer. For a patient who has already been beaten down by rounds of chemo and radiation, it offers a last ditch hope for survival, but its still laden with risks and adverse outcomes.
On the contrast, metabolic treatment is tough from the standpoint that it requires strict discipline by the patient to adhere to the protocol, but the "side effects" may actually enhance overall health at the cellular level. It's a treatment that at the very least could be melded with the current standard of care to achieve better outcomes, and yet there's very little awareness of it, possibly because there's not a lot of money in it for hospital systems.
I don't think that's really an obstacle. New biotech companies form all the time to try and bring new tech to market. They get zero money from any existing drugs.
I think maybe 15-20 years ago this might have been a valid concern, but technology has allowed the advancement and creation of biomedicine. Make no mistake, even if they find a cure for specific types of cancer, pharmaceutical companies branching out into biomedicine will still make money from cancer and other diseases. Editing genes are one thing, but it's going to take a long time before cancer is ever completely eradicated.
Races can be healthy - non-aggressive in nature - like racing for prestige; you can race other people on your own team too! Sharing information of course is important in case important discoveries are kept quiet by a corporation with ulterior motive.
You don’t think the prospect of treating cancer is insufficient motivation, there needs to be some poxy “race” as well? You’re selling both the motivations of researchers, and the practical rewards of that research short.
If any student comes to me and says he wants to be useful to mankind and go into research to alleviate human suffering, I advise him to go into charity instead. Research wants real egotists who seek their own pleasure and satisfaction, but find it in solving the puzzles of nature.
--Albert Szent-Györgyi
My [indefensible] impression is that altruistic culture is a strong part of the reason why the quality of biomedical researchers is so poor, and cancer research funding is so often near-fraudulent.
What is the problem with there being a race element as well?
Anyway, I don't see how it's avoidable. There'll be kudos, prestige, more grant money, etc for people who make advances, so there's going to be a race element to it as well.
> What is the problem with there being a race element as well?
What about competition makes it some universal good? The entire field of game theory exists because direct competition creates paradoxes and dilemmas, and cooperation can result in greater rewards for everyone involved.
More specifically, doesn't anybody else remember the numerous scientific misconduct scandals that have plagued China? In their race to be first they've been willing to sacrifice research integrity to get there. When we see 40% of biomedical papers from China having problems (http://retractionwatch.com/2017/05/18/four-10-biomedical-pap...) I'm not entirely sure I'd trust their result claims.
> What about competition makes it some universal good?
You're criticising a strawman. Nobody said it was a universal good.
I said it was unavoidable (it is intrinsic to the research process), and I said (in various comments) that it's a good thing (i.e. a net positive), including that there's clear historical evidence of this.
> I said it was unavoidable (it is intrinsic to the research process)
No, it isn't. It's intrinsic to our research culture and that's wildly different.
Look, competition gets us things like Microsoft Windows and iOS. Cooperation gets us things like BSD and Linux. Competition gets us the Google Play App store. Cooperation gets us the Debian repository.
> and I said (in various comments) that it's a good thing (i.e. a net positive), including that there's clear historical evidence of this.
Except you don't cite anything.
What about the fact that essentially nobody does repeat experiments because they're all busy racing for original research? (https://en.wikipedia.org/wiki/Replication_crisis) What about the fact that people often select studies based on what will attraction attention, rather than what will actually best advance the field. Boring and uninteresting but extremely important research topics get ignored because they don't result in glory for the university or researcher. We're emphasizing the importance of breakthroughs over incremental research while simultaneously not reproducing those studies to confirm their findings!
That is how a culture of competition over cooperation in research and science harms our ability to solve problems and conduct research.
> Look, competition gets us things like Microsoft Windows and iOS. Cooperation gets us things like BSD and Linux. Competition gets us the Google Play App store. Cooperation gets us the Debian repository.
So first, which of those two competitors, BSD and Linux, was the wasted effort, then?
And, using Macs, Windows, and Linux all on a regular basis: based on that example I can't help but be fairly pro-competition. Windows is a far smoother experience to set up than Linux. Photoshop and Lightroom beat the hell out of Gimp/Darktable/Krita/whatever. Office similarly doesn't really have effective competitors. Those things all got good through competitive pressure, having to beat out the alternatives in order to be good enough for people to pay for.
We can't predict the future, what paths will be useful and what ones won't, well enough to scrap it.
Competition has its downsides and has to be corralled, but cooperation can lead to waste just as easily. Groupthink. Missed opportunities. Unexplored areas in the solution space because we guess wrong.
I don't know about "vital" but I do think competition is intrinsic to it. They want to make a contribution to addressing this important problem, which means they want to beat others to it. It adds impetus.
Also, the motivations I mentioned apply, to some extent, to the funding bodies.
Every one of those individuals and their bosses, and fundraisers all are or will be affected by cancer, either personally or in their close relationships. There is a reason why cancer research is so well funded, both privately and through charity.
There are a ton of people researching cancer and fighting for cures, and doing so solely because they have lost loved ones or are passionate about the science
But that is not enough. Cancer is quite a formidable foe. one researcher in a lab can only do so much.
as you say, science is collaborative. but getting medicines approved requires more than just government or philanthropic funding. it requires collaboaration with for-profit entities: venture funding, and big pharma r&d budgets. that money requires profitability. and in business, speed matters. competition can be very healthy in regards to pushing researchers to the next level
oncology is one of the most funded areas of research not just because it impacts a lot of people. it is also one of the most profitable. fda incentives reduce the cost of drug development, and drug developers can charge high prices because they are creating a lot of clinical value. this is perhaps a cynical viewpoint, but if you look at the leading causes of death in the US, and the diseases with the most VC / pharma funding, only cancer is in both groups
as further evidence of the importance of profits in funding decisions: cancer consistently ranks in the top two disease areas in terms of VC and pharma investment. it receives about double the next fields (infectious disease) in terms of pharma investment, VC investment and FDA approvals
however, cancer funding is in third place in terms of NIH funding, with roughly 1/3 the funding of neuro / neuropsych disease and less funding than infectious disease. cancer is well funded largely because of profit motives, and profit-driven groups are the ones that get cancer drugs out of the lab and to patients. not ideal, but thats the status quo
Why are you equating races to be first with ideology? I do not see any connection at all.
Also, I think the reasons you give are exactly why you should want there to be races involved, because they will help speed progress. You said they weren't vital to doing the research, and I concede that, but you haven't argued that progress will happen at the same or a faster pace without competition.
I don't think that I need to given the universal stakes I’ve described. Neither you nor the original poster I replied to have explained why a much less significant “race” aspect would be helpful, and I’m not eager to adopt that burden for you.
Science works best as a collaborative effort, and races breed insular teamwork. There is already tons of money tomfoht cancer, not in the least because of the fame and fortune awaiting anyone making signifanct inroads to curing cancer.
So what does this additional “race” crap add that isn’t already there?
> Neither you nor the original poster I replied to have explained why a much less significant “race” aspect would be helpful
and
> Science works best as a collaborative effort, and races breed insular teamwork.
The answer to these is easy: history clearly shows that competition makes a big difference, in both science and technology.
Have you considered also that these collaborations often occur within a larger framework of competition between competing groups?
> fame and fortune awaiting anyone making signifanct inroads to curing cancer.
As I said in an earlier reply to you, this is a reason why competition is intrinsic. It's not a choice about whether you want it or not, it's going to happen, and the quoted part of your comment is pretty much admitting that.
> some poxy “race” ... a much less significant “race” aspect ... what does this additional “race” crap
you keep describing it in pejorative terms, without explaining why it is supposedly so bad. The only thing I can see is you mentioning "races breed insular teamwork". Do you have any evidence that races actually slow down progress, or is it just that you find the idea of them distasteful?
And I'll ask again, what has competition (there being races) have to do with ideology?
> You’re selling both the motivations of researchers, and the practical rewards of that research short
You're selling the evidence short [1][2]. Commercial, political and basic research opportunities compete for resources from the same well. Competition increases the tap to basic research. That, in turn, increases output. (Up to a point [3].)
The motivation comes from seeing or experience loved ones you know suffering, up to dying, from cancer - and perhaps from seeing the barbaric feeling treatments that exist for cancer currently.
Edit: I suppose having races is positive hype-marketing machine, hopefully playfully tapping into our dopamine reward systems.
Sure, altruistic motives and races aren't necessarily mutually exclusive. Their ends goals are to find cure for cancer, but researchers should be able to use different, competing approaches to find the best solution to the problem.
It is less about individuals and more about the organizations and funding systems that accumulate over time. Any research worth their salt can tell you stories of opportunities missed due to bureaucratic constraints.
The fact that the US unnecessarily hamstrings cancer research over dubious moral qualms clearly indicates that yes, treating cancer is itself insufficient motivation in this country.
The world is teamed up more than ever: as soon as there was result it was published on internet. The ongoing study was published on a U.S. website. The lots of interesting trials that are going on is the opposite of what was happening in the last 30 years when it took many years for a drug company to publish any result of any interesting test that it had made.
Spoiler alert: I wouldn't want any other country to follow the example of China. Sometimes, human lives are more important than KPIs and being first...
Some interesting parts:
> The Chinese ministry of health has to approve all gene-therapy clinical trials in China, but these regulations appear relatively relaxed. According to the WSJ, at Hangzhou Cancer Hospital, for example, a proposal to test a cancer treatment that modifies patients’ immune cells was approved in a single afternoon. One member of the hospital’s approval committee told the WSJ that she did not really understand the science laid out for her in a 100-page document, but was told that the side effects were mild. This was enough for her to give it the go-ahead.
...
> China is taking the lead in the global race to perfect gene therapies.
> Scientists have genetically engineered the cells of at least 86 cancer and HIV patients in the country using Crispr-Cas9 technology since 2015, the Wall Street Journal reports (paywall). Although no formal scientific papers have been written about these experiments, doctors told journalists at the WSJ that some patients have improved. There have also been least 15 deaths, seven of which were in one trial.
What we don't want are regulations that make it impossible to get the research started. What we want are regulations that ensure that new drugs and treatments sold on the markert actually work. This is exactly the opposite of the situation in the US today.