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Paul Ewald

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Will medical advances against cancer mainly help people in wealthy countries or can they help all of the world's people?

Treatment of cancer patient in the United States costs about $200,000 per year. If such treatment is the best way to control cancer it will be a privilege for the wealthy and the well-insured. Is the future fight against cancer going to divide the haves and have nots?

To some extent yes, but not as much as the expenditures in wealthy countries might indicate. As it turns out, the most effective methods for controlling cancer have been relatively inexpensive interventions that can be used globally. And if we are clear-headed and far-sighted we should be able to enhance this aspect of the fight against cancer in the future.

This viewpoint is developed more fully in the TED ebook, "Controlling Cancer" by Paul W. Ewald and Holly A. Swain Ewald.

This Live Conversation will begin on Jan. 17, 2012 at 2PM EST/ 11AM PST

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    Jan 17 2012: I hope it doesn't come down to the haves and have nots but I think it will. The cost is so extraordinarily high. Who is investing in R&D for lower cost technology that's just as effective? Better yet, who sets these prices?

    How do we get the word out about inexpensive treatments. Knowledge is power and some people simply aren't aware of the alternatives. Where would they go?
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      Jan 17 2012: The good news is that the most effective interventions are cheap enough for wealthy and poor countries alike. Vaccination against tumor viruses, prevention of transmission of infectious causes of cancer and in one case antibiotic treatment can prevent millions of cases of cancer in rich and poor countries alike. These interventions are already partly in place and could be fully enacted with a reasonable additional investment. The most expensive interventions, such as chemotherapy, while very important for a person who already has cancer, are generally much less effective at controlling cancer in human populations.
      Medical science has proved itself to be very effective at preventing infectious diseases, and iInfections play important roles in causing about 20% of all human cancer. We don't understand well the causes of about 75% of all human cancer. The big questions is the extent to which these 75% are caused by infection. Consideration of the broad spectrum relevant information and insight into the problem suggests that infections will play a role in most of these cancers, because we have evolved to be overprotected against most cancers that are not caused by infection. Infectious agents, especially viruses, often evolve to compromise our barriers to cancer so that they can persist within us. Our coevolutionary arms races with viruses therefore suggest that they will continue to counteract our defenses. Holly and I work through this argument more thoroughly in our TED ebook, Controlling Cancer, where we also raise the idea that the most threatening viruses will tend to be those transmitted by sexual contact and intimate kissing.
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    Jan 17 2012: What if a large percentage of the present costs of cancer treatment could be invested in its research? After all the cure for cancer is not there yet.
  • Jan 17 2012: In your book, do you show the data breakdown for the $200,000/year spent on treating cancer patients?
  • Jan 17 2012: The lower-cost tech has been "discovered" -- and then shelved, or skillfully discredited. A few months back, my brother & I were having this conversation, and he asked "Do you really think, if any of those methods worked, some company wouldn't have gotten behind it?" I was surprised at this normally-cynical man's naivete. As stated, cancer is big business. How many people would be unemployed if cancer were easily cured?
    It's true, those who have, get the best health care, and the poor don't. And that starts a whole *new* conversation.
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      Jan 17 2012: This contrast is important. Companies are very motivated to generate therapies that generate profits of many thousands of dollars per person treated. There isn't as much profit in creating a vaccine that will generate only a few dollars per person treated. We therefore cannot expect that these companies will be leading the charge to develop these more effective interventions. But we can insist that entities that are supposed to be looking out for the health of the entire population, such as the National Institutes of Health and the World Health Organization, work on generating the most effective interventions. They just may have to do it without enthusiastic support from the pharmaceutical industry.
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        Jan 17 2012: I agree with your third sentence as a statement of fact ona per-item basis. However there is also a case for market size of course - developing a $50,000 wonder drug that only 5,000 will buy is similar to a $5,000 one for 50,000. OK there are up-front development costs and of course this is a massive over-simplification, especially when it comes to pharmaceuticals.
        I know that what we are doing at my company (we make diagnostic technologies which require no expertise to use) is to approach Western and Developing Nations with a different approach for each, recognising opportunities to develop sustainable models in both and ensuring that we have appropriate products and business models to benefit mass not just niche markets.
  • Jan 17 2012: I agree that prevention needs to be the focus, not expensive interventions. Unfortunately, pharmaceutical companies seem to run the world, and preventions don't make money and are sometimes tedious. "Get more sleep, eat well, exercise, de-stress" are not glamorous solutions to the cancer problem.

    We need the brightest minds in the world to actually focus on causes. Cancer cannot exist except in a hypoxic environment.
  • Jan 17 2012: Do you know the work of Ryke Geerd Hamer in New German Medecine?

    He states that cancer is caused by a SHOCK that becomes a lesion in the brain. Hamer cured himself of his cancer.
    He didn't just CONTROL Cancer, he dealt with the shock that caused it.
    Until we stop looking for a fight, a war against a dis-ease, we will not resolve it!
    Each person has shocks and the actual diagnosis of cancer is a DIAGNOSIS SHOCK for the client... So in essence our health practiciannerss are putting their patients into shock...
    Cancer is a big business which employs millions and generates tons of funds, jobs... What would we do if we cured it?
    It would be economic disaster!
    Here are some Youtubes to explain: http://www.youtube.com/watch?v=3zYWtzq4XBk

    We get disease in our brains through shocks and we heal them with our heart!
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      Jan 17 2012: I agree with your main points. I would add though that we don't yet know how much of the total spectrum of cancer could be preventable. 20 years ago, if anyone suggesting that a high proportion of stomach cancer could be prevented by antibiotic treatment would have been dismissed by most cancer experts as foolish. But now we know this is the case.
  • Jan 17 2012: Interesting question. Forgive me but I have not read your book yet, as I'm just finding out about it now. But as you mentioned, "the most effective methods for controlling cancer have been relatively inexpensive interventions that can be used globally" -- I am wondering if you are referring to nutrition-based therapies? If so, that brings about another interesting question... What will it take for countries such as the US to recognize the validity of these therapies, and actually begin implementing them knowing that doing so could result in giant losses of revenue to the pharmaceutical industry because of it? Will it ever happen? Corporations can't make such huge profits from a healthy society, and perhaps this is one of the key reasons why Western medicine focuses on treatment rather than prevention.
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      Jan 17 2012: The interventions I am referring to are preventive. Prevention of infections that cause liver cancer, cervical cancer, and stomach cancer in particular. Prevention of exposures to carcinogens (in tobacco smoke, for example) are also important (e.g., for prevention of lung cancer). When thinking about interventions, we have to realize that these kinds of interventions are not big money makers for pharmaceutical companies. We therefore have to have policies that foster identification of preventable causes such as viral infections and methods to prevent these infections. I agree that if we just let the system work without such initiatives we will be left with interventions, such as chemotherapeutic treatment, that are very profitable for the companies but are associated with extensive treatments, rather than prevention.
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    Jan 17 2012: The number one contributing risk factor for cancer is age. Sadly the poor populations of developing countries are not living long enough to suffer from cancer. Rather they are dying from illnesses we already know how to prevent and treat, for example the hundreds of thousands that are killed by waterborne diseases.
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      Jan 17 2012: Actually cancer is a leading killer in poor populations as well and the most effective actions against cancer in rich and poor countries alike have been prevention, most significantly vaccination against infectious agents that cause liver cancer (hepatitis B virus) and prevention of transmission of infectious (e.g., by screening blood supplies again hepatitis B and hepatitis C viruses).
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        Jan 17 2012: Agreed, cancer is a global leading cause of death and relatively inexpensive prevention methods will go a very long way towards reducing the human life years lost to some variants. This is sure to be a controversial statement, but in an ideal world we should be seeing an even higher number of reported cases of some types of cancer. Too many living years are lost, and thus potential victims of cancer are passing away too early in their lives due to other ailments (Hep B & C among them). We should strive to comprehensively distribute preventative treatments for a plethora of illnesses among the most at risk populations. Once we've created a population with a higher median age, we'll then face the real dilemma of the expensive treatments of cancer.