Thanks to Pennsylvania, lottery, scratch ass, pennsylvanians or scratching their way to fine and with new, every month, big top rises and second chance, drawings, excitements, always in order, so try, Pennsylvania, lottery, scratch offer your ticket to fund and get yours. Did I keep on scratch? It must be eighteen or older. Please pay responsibly benefits older pennsylvanians every day, for economics. Radio sponsored by progressive insurance were customers save an average of more than seven hundred fifty dollars when they switch and save visit, progressive dot com to get your car insurance quote. It only takes about seven national annual average auto insurance savings by new customers surveyed in twenty nineteen potential savings will very NED Sharpless. Director of the National Cancer Institute, so at present Nixon signed. The National Cancer ACT, one thousand nine hundred and seventy one. The thinking was that we be able to give the present at the cure for cancer by the bicentennial in a nineteen. Seventy six,

thus began the so called war on cancer. It was supposed to be a short war. There had been this right we amazing success against pediatric leukemia and the late fifties and Sixtys and so the thinking was well. If you can cure leukemia like that, we're gonna do the rest, a cancer, but that didn't happen. Why did not happen? Well? It gets this. Difference between your science and engineering the engine your sees a problem when we can build a rocket in ten years and Morocco, the moon. It was sort of that thinking that There is a problem and we need to develop a treatment and working to devote a lot of resources to it, but what we had to do really and are still doing. Today. Frankly was decades of intricate, based besides, to really understand the basic biology of cancer six science in basic biology. Perhaps but overall cancer is turned out to be incredibly complicated. When I

started in this business in the ninety nine, these we thought of cancer is like a couple diseases. There was breast cancer. There was lung cancer, there was leukemia. The essential paradigm shift in the last few decades has been. That Cancer really isn't a small number of entities, its hundreds or thousands of diseases that each have their own unique epidemiology and treatment and causes and and survivors challenges the discovery that the biology has much work. Complicated than originally thought. What was it like for clean? missions and researchers, who really thought they knew. What was what I can tell you how it happened for me have been treated. Patients with cancer has certainly taken care of many women breast cancer, and then this paper came out that use this technology expression, profiling, to look at all The irony is that of breast cancer makes and what they showed was that breast cancer was like five diseases. There is a kind of breast cancer that was very calm and maybe twenty five percent of cases that hiding in plain sight or entire career

there is that no one had ever really appreciated and like a wow if breast cancer is this complicated once gonna be for lung cancer, leukemia colleague answer. So each of those diseases requires a different way of thinking and that paradigms veneer successful. We started dinner specific kinds of cancer and made a lot of progress in certain types. But other types of cancer are harder to treat and so receive these marvels advances benefits some, but not all patients and vat Greece. This problem that there's this on evenness. These thousands of diseases combined to form the second leading cause of death in the world after cardiovascular diseases in a given year, nearly ten million people around the world, die from cancer. The covered nineteen endemic will likely result in additional cancer deaths due to huge decline in cancer screenings, as well as delays in treatment and

those delayed treatments are expected to cost much more, since those cancers will be more advanced once they are detected. On the other hand, the pandemic has disrupted the healthcare. system in ways that may benefit cancer treatment. In the long run we ve got more, customs to tell our health. Cool trials are being done remotely and there's a chance that the wildly fast development of covert vaccines, may change the structure, speed and funding for cancer treatment today, economics, radio. There are other reasons to be optimistic about cancer. There's this pace of progress like now their period in biomedical research for any disease, but of course there is still plenty of challenges. the average american citizen, would be surprised by the level of fragmentation of medical data, and a new way to approach one of the deadliest cancers. Okay, if clinical trials are working, how do we fix them? That's coming up

right after this, I'm fine this is, Brief economics, radio, the pod Catholic, explores the hidden side of everything. Here's your host Stephen dabbler. National Cancer Institute founded in eighteen. Thirty seven is part of the National Institutes of Health because The answer- I is the oldest constituent agency and because it deals with such a common and devastating set of diseases, it has strong by partisan support. It also receives its funding partly from the inner edge about six billion dollars a year which affords certain amount of self determination. In setting its agenda the ends

Guys mission is to identify, fund and conduct the most worthwhile cancer research, but we certainly have really great ideas that we are unable to get too so I spend a lot of time worrying about how we can prioritize funding to make sure we always find the best science NED Sharp this has been inside director since two thousand seventeen for seven. months. During that stretch, he was acting commissioner of the Food and drug administration. Before he's, governments he spent years treating patients and conducting biomedical research. She was particularly interested in the relationship between cancer and aging. This was at the university. Of North Carolina in Chapel Hill Sharpless, also cofounded. biopharmaceutical firm and he owns ten oncology patents when he took the job at the National Cancer Institute. He took his lab, as you said at the time is very important to me

it's nice to understand the problems of a working scientists. That is correct. You grew up in Greensborough. Yes, yes, ignore. You seem to have no southern accent. What's about so I can do one if needed, first off. Secondly, I did my residency in a fellowship in Boston. You say that we're Yawl on rounds exactly one time around. Stop everyone makes fund for twenty minutes and then rounds resume against, beat it out you pretty quickly. You won the few people whose head experience as a researcher and entrepreneurs. The head of a large research institution in charge of grants and head of the regulator for drugs, a medical devices having worked in all those areas. How do you see things differently than some unless Polly Matic than that? The thing that has come very clear to me that a nuanced and hard message to tell, but is this pace of progress in cancer research is really exceptional. Like now

appeared in my life and maybe like no other period in biomedical research for any disease, but it's hard to talk about because it so heterogeneous focus on any specific area and say wise progress slow here or there, but an aggregate whatever learning is really an amazing. You know the FDA about thirty Some of the business in terms of new approvals for devices and drugs was cancer. Related. It's really remarkable over the past three decades, yourself, the death rate from all cancers in the. U S has declined roughly thirty percent in two thousand eighteen alone, the most recent year for which we have data the decline was two point: four percent, 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, some things hidden in the cancer data

that makes that thirty percent decline even more impressive for one to survive. Low rate for younger cancer patients has improved dramatically One reason so many older people are still dying from cancer is that they are not dying from cardiovascular diseases, 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 but, as I said it's uneven, there are certainly cancers were making a lot less progress. Ok, we There is less progress being made from two thousand and ten to two thousand. Sixteen death rates for women decreased for thirteen of the twenty most common cancers, including lung breasts and colorectal, but increased for five types in cancer of the uterus and liver for men. Over the same period, death rates decreased for ten

of the nineteen most common cancers, but increased for six, including liver and non melanoma. Skin cancer blotted data go to twenty. Sixteen which proceeds a lot of the widespread use of immunology drugs suit, as good as those data are. They don't include a lot of the new therapies that we develop immunity, oncology, harnessing the bar these own immune system to treat cancer. This has a long history. In the nineteen seventy, for instance, there was a lot of enthusiasm about naturally occurring proteins, called interferons who's gonna, you jack up your immune system to fight answer, and this was gonna, be this universal cure for cancer, and it was really a failure. It didn't work and as if that experience and other experiments like that, the cancers church community. Medical oncologist, like me, begin very sceptical of the idea that the immune system could treat cancer. In fact, spectacles probably not strong enough. We thought a lot of these. People work any system were literally crazy. You know you thought they were here

mean patience and irresponsible and so Was really a vilified field for many years and about a few great sir? scientists persevered in started, unify ways to coach the immune system into fighting cancer. This is hardly the first I'm in medical history that the supposedly crazy people turned out to be brilliant fact. It happens, all the time in medicine, in two thousand, sixteen, the noble eyes in physiology or medicine, went to to researchers, Jim Alison and Tussock honcho for immunity therapy research. in those there be started. The work, and so that's really become a success four and very important way to treat cancer that most in the field, myself included, were very sceptical of an early days. Let's talk about lung cancer, 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, the issue

The first thing is that, even today, after a lot of progress against lung cancer, that the reflex various advances, it still kills more people than breast process, even colon, combined in the United States every year, so the highly lethal malignancy, where we differ, We need to make additional advances and I'll One of the major things that shaped lung cancer is the use of cigarettes as tobacco, and so too, who 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 chinese inhibitors that target specific subsets of lung cancer, maybe fifteen or twenty percent of one The United States are targeted by these pills there quite effective and not very toxic. And then we also had the introduction of EMU affair. Obesity, checkpoint inhibitors that are quite active against an even larger fraction of lung cancer, of produce, really marvels responses, and soon our seeing a lung cancer, more tat the decline in the fastest rate in the history, the we ve kept statistics about lung cancer,

once you start to see cancer, not as a disease, but as a massive array of individual diseases. You can appreciate the difficulty in overcoming it and, if you look at it in reverse from the perspective of a patient is already ill is even more difficulties for starters, not all treatments for giving cancer are effective and they often have brutal side effects than moving backwards. Not all cancers are able to be detected in time to try then going back even further. We don't know that much about what causes all these cancers. I asked dear friend, of mine, for her definition of cancer, it's some inflammatory infectious process that radically alter the activity of healthy cells. She said, but what triggers that inflammatory infectious

There is a long list of risk factors with an equally long list of caveats, and these factors generally fall into one of three baskets hereditary environmental and behavioral. inherited genetic mutations, are thought to factor into five to ten percent of cancers. As for behavioral, and environmental causes tobacco smoke. Asbestos ultraviolet rays, heavy alcohol consumption all very likely carcinogenic, although it is worth noting that twelve percent of all? U S, lung cancer patients, have never smoked but about artificial, sweeteners in charge. Me no clear or conclusive evidence. I mean take a topic like nutrition in the EFTA, It makes a lot of recommendations around the american diet, how much so should you haven't sugar should read and that's a complicated research question where very

interested for cancer, because we think obesity is one of the major drivers of cancer. But besides there's hard, it requires, Long studies is hard to de randomize trials have not impossible, and if you wanna make regulatory power I'll see on nutrition science, pretty tough thing to do. Can you explain the mechanisms by which, be city? Could be a driver of cancer? Many past the mechanisms we don't think it's a single thing obey city is associated with alterations of certain hormone levels that we think might have a carcinogenic effect obesity in some situations appears to be says with chronic information, which we think can be a driver of cancer and then obesity might be a proxy for other behaviors. That confounded this analysis and are really the cancer driver. I think the present data are quite strong that, as obesity becomes a greater, probably I states were seeing. Or if certain kinds of cancer like breast cancer, gastric cancer, liver cancer, did they tend to be

the solid organ cancers, then that predominantly driven by obesity or no, we think largely its cancers of the upper July. liver and gallbladder, and stomach certain kinds of bread, cancer associated with obesity, and then also maybe pancreas, although probably less strong for that pancreatic cancer is a good example of one of these hold out where we know we have these new, exciting therapies in these new approaches, but not yet for that disease. Modeling suggest maybe the second most deadly cancer United States soon after lung cancer. Yet let's talk about pancreatic cancer. It seems like its of particular concern for at least two big reasons: early detection, is hard and treatment is not very successful. Yes, it has the two: problems you mentioned and that it has a third problem which is its going down like lung cancer, you know so it's one, that's going up an incidence and where we,

aid, really no meaningful progress in terms of the mortality of that disease if you look over the last decade, the number of cases of pink cancer in the. U S has increased, maybe about ten thousand that is and some Yoni pancreatic cancer surgeon, who else runs a research lab at and why you languishing in New York this year. It will be about fifty eight thousand people in the: U S they get pancreas, cancer or may be half a million people worldwide. Those numbers were actually for last year. Here they will be a bit higher. Still the incidents compared to other cancers. Isn't all that high. That's one reason my pen we had a cancer was historically not well understood, didn't really a tract a lot of attention from funding authorities such as the age. There was an being advocacy group, and so it really was neglected and almost have

Anybody that got it died, almost everybody that got it died and now It has still a single digits survival rate of nine percent, some prominent people who have died from and create a cancer. Recently Ruth Pater Ginsburg Alex Tribeca John Louis Steve Jobs, pancreatic cancer is typically diagnosed late. Unfortunately, the early warning signals are kind of vague and non specific people. My I have some upper abdominal pain they may have some unexplained weight loss. Sometimes pancreatic cancer can print. dance with new onset diabetes, especially if its associate with weight loss instead of weight gain. One of the cardinal signs that tips people off is there began jaundice or yellowing of the eyes. The pancreas kind

tucked away it is that play a big part in the difficulty of detection. I think so it's not easy to go on physical exam. We do of ways to get a look at it with either she t scans or am our eyes or even a kind of fancy and discover Coulter zone. But those aren't tasks that people routinely have Cancer screening is its own complicated scenario, NED Sharpless again, one of the big success in screening has been colonoscopy for colon cancer and pat smears fur cervical cancer, the problem The screening is that it can be good at finding cancers that might not actually harm the patient. The classic example hears prostate cancer could be a very slow growing cancer that may not hurt the patient, but having a bit Surgery or big radiation therapy would hurt the patient and so balancing the diagnosis and over treatment with early today

sure and getting rid of bad cancers is tough challenge. The challenge with pancreatic cancer is that the most effective screenings are fairly expensive or invasive, and therefore quite rare, also by the time pancreatic answer is detected. It's often fairly advanced. Everyone always wonders what is unique about pancreatic cancer. That makes it so lethal and I would say we still have an complete understanding. One thing: we clearly know- is that pancreatic cancer spreads early or what we call me asked the sizes to organ away from the pancreas we dont, really know why that is, we do things. something unique about the micro environment in which pancreatic kin, sure, arises and grows bud the exact networks that car is it to be so resistant to therapies are still being worked out. Pegrenne cancer is actually want

the more simple it doesn't come in many flavors sale of lung cancer, breast cancer but the main flavour. It comes in turns out to be a really bad disease, where we don't have effective, fair bees. At present, don't have effective screening at present, ideal situation. The treatment would be surgical, reception, which can be quite effective. Reception, meaning you remove that part, not the entire bankers Right Europe. That part of the pancreas in its interest, They do a lot of screenings in Japan and, if you look at their data with certain over section or removal of pancreatic cancer, less than one centimeter, the five year survival rate is in the order of sixty to seventy percent, but again since pancreatic sir often spreads before its detected either

surgery isn't always an option. Only fifteen percent of patients that come to the clinic have a surgically respectable tumor outside of that fifteen percent, who were successfully respected death, happens how fast in the case of pancreatic cancer, typically months to a year and a half you ve chosen, the sub specialty. Where I met, you spend a fair amount of time telling people they're gonna die relatively soon. Yes. Well, I always try to create hope. I think it is important for patients to have hope, but we also have to be realistic, and, yes, that is the most difficult part of the job, is to tell someone that we don't have the thing that can cure them- and I hate it- I'm driven to change that conversation coming up after What city? Only in a band of like minded researchers are doing to change that conversation and how the Copenhagen

in pandemic may shake up the cancer landscape, but it requires companies to work together in ways that Historically, they haven't always thin comfortable. Also, we have just released the entire back catalogue of economics for you more than ten years worth of episodes available free on any podcast app. We have got episodes on hidden side of pretty much everything, medicine behavior change, sports sleep, food, business, pet cremation- name the for economics. Radio network also puts out to other weekly, shows no stupid questions and people. I mostly admire altogether. That is more than five hundred episodes all available free on any pocket Just in case you are planning to circumnavigate the globe anytime soon needs and company will be right back.

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I'm a surgeon can also a researcher. I've been studying, pancreatic cancer. Since the mid nineteen nineties, when we fall, so we're camping critic cancer. There were very few researchers in the field. Now I know to scientific conferences and they'll, be six or seven hundred researchers there. And then, makes a new era for pancreatic cancer semi only now practices and why you lingo and Health in New York City, full disclosure I got to know semi only through the treatment of a family member. I was impressed not just with her work as a doctor, but her zeal for busting open the paradigm for a cancer that is particularly hard to detect the treatment and therefore often fatal she is one of the ringleaders of a new collaborative platform to change how pancreatic cancer research is done on both the diagnostic and therapeutic sides

straw that broke the camel's back for me is the year before we start in this. There were new amino therapies out, and they were, I think, six different centres doing the same exact single, agent trial to C4, worked and pink the cancer and all those trials failed. In course, no one talking to each other and they're not talking to each other, because one- we all work and our own institutions everybody's got thrown grants the incentive system is for individual achievement and not group collective effort. Now I think that is starting to change, but for really complex problems like what we're talking about four pancreatic cancer it felt like we just had a we right how we work together, and so we embarked upon this effort and build a new clinical trial ecosystem. Miss Ecosystem is called precision pro thus precision promises, what's called an adaptive platform trial.

and you know it's funny, even if I asked clinicians if they know what that means a lot of people, don't because It's really a new way to do clinical trials. Precision prom, This has been rolled out in collaboration with the pancreatic cancer action network, or pan can as their affectionately known, which is a large nonprofit, patient, advocacy foundation, and the nice thing is they could serve as an honest broker. Help bring everyone together with new platform is Already enrolling patients at more than a dozen, different hospitals and research centres and hopes to expand the thirty or forty be in the next few years. You can't join them. Effort unless you're willing to work together and to share data. So data sharing, we thought was critically important. the idea,

aggregation is one of my favorite topics. This keeps me up at night that again is NED Sharpless director of the National Cancer Institute. I think the average american citizen would be surprised by the level of fragmentation medical data that is not held by any central auditory and easily searchable. So the answer I have long been frustrated by our inability to really see what's going on and has developed a number of data That's their try, an aggregate, the National Cancer story, to make it more understandable, one of the most success, Actually, this thing called seer, which was created by The nineteen seventies sear stands for surveillance epidemic apology and end results. Sears a registry of who gets cancer in who dies of cancer, but you can link it to medical care which has claims about how they got treated. But still you would like more information than that. You really liked to be able to look at the medical records of patients and understand,

what therapies have they had before in what risk factors than they ever cancer and to get that out of the medical record that turns out to be complicated? what value would there be in aggregating all that silo data? What would it actually produce in terms of research, understanding and potentially cancer treatment? I personally That would be highly valuable because you know when you realise that cancer is lots of different diseases, you I also realise that large randomize trials are hard to do when you're talking about lots and lots of uncommon cancers we really need to learn from every patient. You really need to learn what happens to each individual with cancer. So computing power is important. Diane, Simifonte again, in fact, as part of this effort, the pen critic and Sir Action network has put together a big data team. Because we realise that power of this is the data that we're gonna get from. Every patient not only in how they respond to the therapy, but we are

to have an imaging team. Looking at the imaging every patient gas, which is gonna, be standardize across all the sites and is their information. We can glean there we're gonna be Doing blood based has to see is our blood tests that will tell us more quickly if we should switch therapies for patients into waiting down the road. How do we best treat pay in how do we best treat nutrition? In fact, patients are all gonna get a fair bit. Does he hollow activity and sense? There's can help and patient care. One area where we ve seen some progress with lung cancer is used. Artificial intelligence. To look at the cat skins of people who smoke a lot because we have found these patients. We can train yea. I to look at features of that chastity and say this person's increased risk. Fur lung cancer, even though the reality would read this is normal. So I think that what you would need to do that in pancreatic cancer is thousands of patients without.

They were eyes had been followed for five to ten years. We don't have that data set yet and pancreatic cancer, so One of the things I realized is bothering us great science going on. We hadn't really innovated in the clinical trial space enough to have clinical trials. That could be an impact full as we needed. If you looked at how many patients are pancreatic cancer in this country on clinical trials, it's my four percent of patients and you don't get new therapies without seeing if they work through clinical trials, and so we said, okay, if clinical trials out work like we need. How do we fix them? If we wipe the slate clean Can we try to design a clinical trial system to take all that great science and change the course of this disease. That, at least, is the promise of the precision promise

what form this immunity has been building out with collaborators at a variety of big time: cancer, hospitals and research centres across the network. There are just two control groups of patients who receive what is called standard of care treatment. In this case, one of two came up there. Be protocols. The rest of the patients are randomized into one of four treatment groups, each receiving indifferent experimental therapy. So there's less we're done didn't see than there is in separate clinical trials and if one therapy fails early on patients in that treatment arm can switch to another group. In theory, the trial can go on forever. This way with failed treatment, swapped out for newer once that's why this is called an adaptive platform trial. This is a randomize trial, but me large scale randomized trials, have the same number of patients in the control arm and the experimental arm and for this trial

a thirty percent of the patients, are in the control arm in seventy percent of the patients are in the experimental arms. So that's one area, that's quite different: the ability for patients to Gatt oddball therapies has never been done before in clinical trials were both of those therapies can count for FDA approval. This is new territory, Simifonte and her collaborators in fact reached out to the FDA to help build the precision pro this platform when they were huge advocates, even assigned a senior member of the FDA, to help us the, other missing ingredient was the drug companies. so we had a hard time making advances in pancreatic cancer, because a lot of the clinical trials failed and saw pancreatic. Cancer became a graveyard for clinical trials, but by building this clinical trial eco.

system that had so many advantages to it? We actually were able to reach out to the pharmaceutical industry and bring them on board so that now we have about thirty different pharmaceutical com, needs that are working with us. So if a treatment emerges that looks potentially successful, how does this change the timing of FDA approval? It should cut in half, so it's really remarkable incentive for the pharmaceutical industry to get on board. We even got the dear to allow us to do this concept. Cuddle lead where a relative, The small number of patients say twenty to thirty patients could be tested and that the drug company could look at that. Data and then make a go. No go decision with the sixty day. Waiting period saw it d risks the pharmaceutical into. Free from investing in new therapies for pancreatic cancer. All these changes

creating collective incentives, verses, camp, the ones cycling in experimental, therapies, much faster, getting research either of the silos of multiple institutions. It is all especially necessary for pancreatic cancer. It's not a common enough Disease to generate the mountains of data that researchers would like to have, but it is doubly enough to kill most people get it. I asked NED Sharpless from the National Cancer Institute about this new approach to clinical trials. He provided a useful history less So when I was starting out in fellow most, or trials were heavily influenced by what I call the cardiology paradigm This massive trials that would have like a thousand patients in our may allow. Impatience and arm b. and army would get aspirin heparin an army would get Hepburn only right and they

follow these patients for years, and then they would see other guys you got aspirin did three percent. Better in terms of the risk of heart attack, or you know, stable, Enginrie, something then the people it didn't and that would be and the new standard than the new trial would use that regimen, plus the next rock and adding three percent here the five percent there cardiologist made a lot of progress. This is how cardiovascular mortality fell so much as we earlier one trial at a time. Subtle changes, orange randomized trials. Over and over again, we tried that in cancer and a breaks down pretty quickly, that's because you're, so much more variation in cancers, then in cardiovascular diseases, Sharpless as as well as more variation in the cause of each cancer. So this sort of fragmentation from cardiology paradigm, large randomize trials to these smaller nimble, sometimes on randomize trials, it's been a recurring theme in on quality, so you get allocated Therapy

Estonia mutations, the molecular genetics, if cancer that's really different and that poses a lot of interesting challenge is one of them is for the FDA right. The FDA is used to seeing eight hundred pay randomize, controlled placebo, controlled trials and now The developers of these drugs are coming to them. Here I got like fifty patients with my Loma. They got this drug. All of them responded in a historical control like a third of them would respond. All of them has gotta be better than a third. So therefore, you should approve by drug, and as a regulator. That's a tough challenge. We win. Can you trust This on randomize design verses. When should you insist on the gold standard of purity, the issue that comes up as this one called equipoise, which is the EFTA refers to the state in which you can no longer accept the hypothesis that the drug doesn't work at some point. You pass Equipoise and then we think that its unethical do not provide that drug to the patient when there's

the successful treatment that comes on market, what usually makes the headlines if it makes a headlines, is the cost straight. So this is a source of common public outrage that Treatments, especially for rare cancers, are extraordinarily expensive. What do we, the public now I understand that you know you know. Drug pricing is very complicated topic. I think defies simple solution within their lots of things. Was that you know have this trade off between stifling the innovation of new medicines, because expensive make verses you know these immense costs to patients. So I would make a couple of comments. The first one is it bothers me as a physician that any pay, with cancer has to choose between their medicine and their rent. That happens need it states. Unfortunately, I feel tremendous empathy for their patience and I think that when we are able to do something about that, we should in approving or generic medicines. That is something we have today wants to do. That will lower drug prices eventually other can take longer than you would like. Second things:

it is very expensive to make new drugs is really hard to do most of them fail and it really does cost billions of dollars per successful drug, that the pharmaceutical industry He says this is why they have charge so much. It is true. But let me say one other thing that I think is a really important point, which is that having a drug that works for someone but which is tremendously expensive, is a better problem than having no drug it all right and- and that's it cancer. Often what we're talking about once you have an expensive drug that works, that becomes an engineering challenge. How do you make that drug cheaper? How do you make another version of it, and we are much more successful tackling that problem? Then we our developing totally new out of the box, therapies, therapeutic, are one major goal of Diana Semiramis endeavour, but that is just one goal as with all therapeutics, and especially for something as vicious as pancreatic cancer

they're more viable when the cancer is detected earlier, so clearly, early detection as the holy GRAIL for pancreatic cancer, there's been a fair amount of efforts to try to develop a task, but I will say it span relatively small scale, its ban, scattered small efforts instead of eight concentrated, coordinated one but there are some moves afoot to change that moves afoot to change that and the whole ecosystem around pancreatic cancer from the root causes to early detection, two viable therapeutics, all in the hopes of shifting the curve of war. one of the most fatal cancers, one of the goals I've put out there for our field There is for all of us to say out loud that we're gonna have a fifty percent survival rate for pancreatic in ten years, and I think we can do it for strategic bow.

In developing, more effective therapies, but clearly and importantly, I figured out whose at risk better testing for susceptible they genes and putting people and screening programmes. someone were to develop a pancreatic cancer, its found when it's much smaller and the ability to respect it surgically, can approach nine percent as opposed to the typical fifteen percent were dealing with. Now I think we can get to that fifty percent We may be tempting when you look back at the last several decades of cancer research to focus on all the failures there have and a lot of failures, as they're usually are when you're trying to advance science. One big problem in all scientific research is that negative results are often forgotten. Even buried. Ned Sharpless of the National Cancer Institute says that's a big mistake, but

its changing one of the happy things about the internet era and changes in publication practices that negative data are getting better than they used to Sony all days. You do trials and it didn't work and wouldn't publishing and someone else to do the same trial and it would work that was bad for you reason spat for patients wasted resources, but now try to make negative data available. Particularly when involves human subjects I mean now of data is some of the most important data to me as a scientist, you expect this store and then you try it and it fails. That can be one of the most informative things that moves biology so I can give one nice example of this. We have been trying to treat, he is called Neurofibromatosis in kids for decades. There at risk developing these tumors and was tumors can turn into cancer, but they can also be very very. Disabling and We did lots and lots and lots of clinical trials none of worked. It was really really fresh.

But now, in the last couple of years we have it in a fine new therapies and that there be quite effective its appeal. The kids can take every day it makes their tumors stop growing and we think even increases the risk to turning into real forborne cancer, later sorts of immense clinical benefit, and if we didn't have all that negative data, if we had known what doesn't work over and over again, we wouldn't have really fully, Confidence in this positive results, so the positive result was really empowered by the decades of negative data. before we go. Let me for one last reason to think that cancer, research and treatment may continue to improve as devastating as covered. Nineteen pandemic has been to our lives and livelihoods. It is also

Spirit, one of the most impressive medical responses in history, maybe the most impressive at least three successful vaccines have already been developed in roughly one tenth. The time the vaccine usually takes the bench science spin formidable, but clinical try isles large in diverse the regulatory approval speedy as it gets last August a few months before the Madonna and Pfizer by on tech, vaccines were given emergency use authorization by the FDA. We interviewed former FDA Commissioner Peggy Hamburg. I asked if she thought that the mechanisms developed and the alliance is built in pursuit of a coordinating vaccine might prove beneficial for the treaty, of other diseases I am. Lately, do I think that some of these advances were already under way to some degree and we are seeing

The real value of systematic attention to the infrastructure for clinical trials, as well as the importance of innovation in how clinical trials are done, testing multiple different drugs against one placebo. Arm allows you to learn a lot about a lot of drugs as quickly as you can, with more people getting access to one of the potential candidates with just the one placebo arm covered. Nineteen, I think marks a hugely important moment in time when the scientific research community came together across disciplines and sectors and borders in order to collaborate- and I heard,

we want less that spirit of collaboration, because I think it is absolutely essential, but it requires companies to work together in ways that historically, they haven't always been comfortable. We also interviewed tall sex, the chief medical officer, modern though they are now famous or their covin. Nineteen vaccine Medina has also been applying. Their m are in a technology toward cancer and other therapeutics. I asked sacks: what kind of knock on effects

their vaccine success might have for other treatments. I think for my perch, looking specifically at a more nay technology, it will have done two important things. We will have proven the ability of this technology to scale up manufacturing and that scale up of manufacturing will have implications not just for other vaccines, also for other emerging medicines coming down the pike, and I think the proof that this vaccine works will translate into a much higher degree of confidence and the probability of success overall for emanate medicines, as well as the ability to scare them up. I think the broader thing that I hope we all take away from this is the strength of collaboration that this pandemic has forced. I think none of us who are in the throes of doing this will ever go back to bed.

This is usual when it comes to relationships and interactions between companies between government agencies, at least I hope That's our show for this week, thanks to all the scientists who took the time to teach us today tells acts Peggy Hamburg, and especially NED Sharpless from the National Cancer Institute and die and semi Yoni from my? U Lang gone and precision promised project. We will be back with another show next week until then take care of yourself, and if you can someone else too for economics. Radio is part of the four economists radio network and is produced by stature in rend, bud. Radio we can be reached at radio at for economic start. Come this episode was produced by Matt Hickey, with help from Daphne Chen or staff also includes Alice, incredible Mark Mccluskey Gregg Ribbon,

Zack Kinsky married Duke and immaterial. We had help this week from Jasmine, cleaner. Our theme song is MR fortune by the hitchhikers. All the other music was composed by Luis scare. You can get the entire archive of economics rate one on any podcast up. If you want to read transcripts or show notes visit for economic stock, as always, thanks for listening, Can you has? No sorry sorry guys got kicked? Can I get you you stature.