Paul Ewald

Louisville, KY, United States

Someone is shy

Paul hasn't completed a profile. Should we look for some other people?

Comments & conversations

143545
Paul Ewald
Posted over 2 years ago
Will medical advances against cancer mainly help people in wealthy countries or can they help all of the world's people?
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.
143545
Paul Ewald
Posted over 2 years ago
Will medical advances against cancer mainly help people in wealthy countries or can they help all of the world's people?
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.
143545
Paul Ewald
Posted over 2 years ago
Will medical advances against cancer mainly help people in wealthy countries or can they help all of the world's people?
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.
143545
Paul Ewald
Posted over 2 years ago
Will medical advances against cancer mainly help people in wealthy countries or can they help all of the world's people?
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.
143545
Paul Ewald
Posted over 2 years ago
Will medical advances against cancer mainly help people in wealthy countries or can they help all of the world's people?
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).