Why "Promising" doesn't mean "Cure"

in #science4 years ago

I love the word “promising” when reading publications. It’s even better than “the results were not statistically significant” because if you don’t know better, you might think “yes! They found a cure!”. It’s often not the case though.

If you have a bunch of cancer cells in a petri dish and pour pure lemon juice over them, they’ll die. So, ** (that’s basically what this means), lemon juice kills cancer! Nice! Very promising!

And then they give a cancer patient a glass of lemon juice, testing it in vivo and … nothing happens. Maybe the patient pulls a face because the juice is too sour. Maybe they’re allergic to citrus fruit, go into anaphylactic shock and die. But the “promising” results from the petri dish didn’t appear in the actual situation they were needed in.

The testing of new drugs is, of course, a bit more sophisticated than pouring lemon juice on cancer cells, at least in most cases. But in the end, there is always the question: “Did this work because I isolated the cells from their natural environment or despite?”

To answer this, the next step is usually testing it in animals (mostly mice). For many drugs, it stops here because their effects are either not replicable or the side effects are so bad that no sane person would test this on a human. But if everything looks good (and the drug is approved for human testing), it goes into clinical trials.

In phase 0, they test the drug on a small number of people in a very low dose, generally not enough to treat anything. Behavior of the drug, movement in the body and general responses are what’s being looked at during this time. @suesa
Phase I has some more patients and is used to figure out the safe dosage, side effects and again, the effects on the disease (does the cancer shrink?).

Phase II is similar to Phase I and basically serves as the next step to Phase III, which compares the new drug to those already available. The final phase, phase IV, starts when the drug is already licensed and is looking at the long-term risks and benefits, the side effects and its effect on a larger number of patients.

You can already guess that all of this takes a lot of time and the development can fail at any stage, a medication already on the market can be taken off of it if it proves to be dangerous after all (see Contergan). But how often do we hear about that? Most of the time, I just hear people complaining about how the “promising drug X is still not on the market”.

This morning, I stumbled across the Unlucky 13 list by the GEN journal, which presents 13 drugs that failed during their clinical trials. I picked some to show you what can happen to make such a trial fail - and what the results are.


Fovista® by Ophthotech


The drug was intended to treat wet age-related macular degeneration, which is an eye disease, caused by abnormal blood vessels. It wasn’t the first study, two others that completed Phase III had failed before, as there was no benefit for the patients.

The company finally concluded that the drug was unlikely to succeed. The failed study was followed by a firing of about 80% of all employees.


Seralaxin by Novartis


The heart of pregnant women needs to do a lot more work than that of the average human. The hormone relaxin-2 is believed to help that, as it’s found in higher concentrations during pregnancy. Building on that assumption, Novartis created seralaxin, a drug similar to the hormone, which was supposed to reduce worsening heart failure and cardiovascular death.

During Phase III, it didn’t do either successfully.

There were plans to remove 500 jobs shortly after.


Tarextumab by OncoMed Pharmaceuticals


Created to help with progression-free survival ("the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse"), tarextumab didn’t provide results that were significantly better than those from the placebo group. Tarextumab combined with chemotherapy gave the patients 5.6 months of progression-free survival, chemotherapy and the placebo 5.5 months. This time, it was a failure during Phase II.


Tozadenant by Acorda Therapeutics


The failures above might be frustrating, but at least the results were just “doesn’t work” and not “is probably the reason our patients die”. During Phase III, seven patients developed sepsis and five of them died. Four of the seven had agranulocytosis, which is an acute condition with a dangerously low white blood cell count.

If patients start dying, you can’t keep researching. Obviously.


It’s almost surprising that, despite all these trials, there are still drugs that turn out to be dangerous. But the process isn’t perfect, it’s (at least right now) impossible to test new medication and include all possible genetic variations.

And considering the fact that sometimes people die during the clinical trials, it’s even understandable that we haven’t managed to get rid of animal experiments yet.

In any case, I want you to keep this in mind: Just because a substance is described as “promising” in a publication doesn’t mean it will work as medication. Think.


Sources:

Novartis Axes 500 HQ Jobs, Adds 350 "High-Tech" Positions

Seattle Genetics Halts Enrollment in Vadastuximab Talirine Trials

What Is Acute Myeloid Leukemia?

Phases of clinical trials

After Patient Deaths, Acorda Halts Development of Parkinson's Candidate Tozadenant

OncoMed Reviews Portfolio after Tarextumab, Brontictuzumab Setbacks

Agranulocytosis

Novartis' AHF Drug Serelaxin Fails Trial Nearly Three Years after FDA Rejection

Anticipating Third Phase III Failure, Ophthotech and Novartis Rework Fovista Accord

Wet macular degeneration


Pictures taken from pixabay.com


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GIF was created for me by @saywha and @atopy , rest of the signature by @overkillcoin

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I could kill cancer with lemon juice. Just give me a container with 2500 liters of lemon juice and let me drown cancer patients in it.

But the potential medicine. It's a delight to read in the news regarding many potential new solutions for different things. A new drug which helps against specific types of cancer, heart problems, memory problems...
And in the end, they either help only a tiny bit or will kill someone.

Even though I appreciate media giving space to the new studies regarding medicine, I'm unhappy with the fact how they are presenting things as superb solutions, sometimes with no reason to do that.

People who do not understand science or medicine will get excited and disappointed in most cases.

And I feel bad, if someone actually is waiting for a cure and it turns out it doesn't work like the media portrayed it to be. Nobody wins.

the media wins.

You could think so, but how many people distrust media nowadays? Media is losing too, they haven't just noticed it yet.

you are rite...same will happen in media

they surely did

Part of the problem with the media's representation of science is that they don't understand it themselves. One of the most most fundamental rules - "correlation does not equal causation" - is blatantly disregarded in media coverage. I find this especially true for longitudinal or cohort studies, where they are trying to identify risk factors, but then the media reports every other day that drinking a glass of wine will extend your lifespan/shorten your lifespan.

Science could do a better job explaining things and translating things into a way that people can understand and people need to become better consumers of science and educate themselves on how research is presented. It is a two way street to ensure that we start winning!

That's true, regular media is also willing to cover topics they do not typically handle and journalists writing about the topics rarely know very much about the topic they write about. At worst, they are just copying another article of the topic and dropping a part out.

But at best, the articles can contain references to the original study so readers who are interested can find the studies and see through them themselves.

isn't it better to get some overall worthless medicine than not even getting something that might work for some individuals?

I'm not sure if I understood this, so can you rephrase this so I can comment properly? :)

something that will work for some is better than nothing

Ah. Well I'm assuming there is little interest in producing a medicine which works only for a small portion of people, as it would be useless for the most.

i really don't know who is this nobody ..but you are the winner for me ..

yes, I agree to your post, placebo effect tends to trick people’s mind

Lots of things kill cancer in a petri dish. I keep telling this to all the people who say weed kills cancer

I love this so much.

I think it's hard to cure illnesses that have 2,000 different sub-categories and 300 sub-reasons and a genetic component.

I think this means: we still don't know. And I also think a well working novel therapy could wipe out the profits of companies selling common therapies that then are inferior.

IF, hypothetically, there would be a not patentable cure - would companies say: ok, it works, we will forgoe this business now? If it's multi-billion dollars?

Does someone share my concerns?

That is awesome!

A powerful poison can kill anything. Including the patient. The point is to do selective killing, as they do with insecticides at crops. The thing is, life always finds a way to adapt fast and before you know it a cure no longer works after a few years, since the target gains immunity.

There can never be a panacea since life constantly finds ways to stick around.

  1. Does laetril kill cancer cells?
  2. Does laetril kill normal cells?
  3. What does the Hanover, Germany, court ruling on laetril mean for its risk profile?

I have no idea about this laetril, but like all medicine it will work differently on every patient.

Hello, I set up my blog on steemit. I like to take a selfie, travel, contact me, enter my blog and see what's new https://steemit.com/life/@beyonndkiller/asia-s-latest-selfie-sexy-goddess-daily-life4

Like you said in the end, question is how many drugs go through all the phases without actually being effective. The power of placebo is not to be underestimated. And I suppose not all can be tested on animals or behave radically different on humans.

You can't make a Zyklon B without gassing a few Jews

Dude

I knew someone who died in drug testing. The happening was so horrible. It's so sad ti hear that many are dying because of drug testing. Of course it has the most accurate results compared to testing it on animals

Media hypes a lot of stuff that relates to high visibility topics. A new theory on cancer will get a zillion times more attention than millions still dying from TB or Malaria. It's Bemjamins at the end of the day. And, moreover it's not just media that creates hype, it's the stakeholders of theories, products who sell their ideas.

Cholesterol was so much hyped by industry, professionals and media for decades, and now it turns out neither HDL nor LDL are as good or as bad as they were made out to be. Science is and will always will be driven by Dollar.

So sad but true.

Never really thought about it that way. I usually thought the drugs described as promising were the good ones, but now i know better

But @suesa, I was just wondering, how do they get people for first human trial is it voluntary or wat?

Yep, volunteers

Some people are strong. Arent they afraid of the possiblity of death during testing of the drug in phases

Love it. I think there's a real problem with the way that the media communicates science.
It's funny because the business, property and celebrity sections are never dumbed-down... but for some reason the only science we ever get is 'promising' breakthroughs. Which is to say a new substance killing cancer cells in-vitro.
:'(

This is why it is so important to have PR agencies, who specialise in science and employ people with backgrounds in science AND communication. In my opinion, a lot of miscommunication is based on misunderstandings or misinterpretations of scientific results. But of course, scientists will first have to understand the value of good science communication.

I agree... though that's a rare combination of skills to have. In all my studies I've only met a small handful of students who I'd trust to explain their research to a layperson, without just confusing them.
Hopefully as we progress and education gets better people will realize the value in investing in and spreading good scientific knowledge and information.

There is a very big broblem the communicate science my dear. Not everyone have a intimate idea about science and its branches. Most people just stop-by and say there mind. @ozumba

Extremely well written!

Another interesting concept is the whole idea regarding Post Market Surveillance. These drugs
when going through clinical trials and being pumped through the pipeline take in consideration many factors, yet each individual many respond differently than the next.

Post market surveillance attempts to monitor the safety and efficacy of a drug or device after it has been released into the market! So we know (for the most part) how Drug X works, but we do not truly know the effects of Patient A when taking Drug X AND Drug Y in combo, or how Patient B will react when taking Drug X and Drug Z... what about Patient C taking Drug X, Drug Y, and half the regular dozen of Drug Z while being on a low carb diet, sedentary life style, being a female, as well as drinking ‘average’ amounts of caffeine?

It is very interesting how these medications function in our bodies, as well as the varied effects they have on people!

Thank you for your article, it was a pleasure to read!

No single drug works the same for everyone, which is why you adjust a mixture of different drugs based on performance

There's the same problem in "my" field of science. There are loads of studies describing positive health effect of different foods and food constituents, and every day, there's a new "superfood" (how I hate this word^^) in town.
And if you look it up, it's just an in vitro study using completely irrelevant concentrations.

I think the main problem is how media presents it. We scientist know which type of study really means that you have a proven effect, and which just provide hints and preliminary data.
But the public does not, and thus jumps on every reported effect, no matter under which conditions it was produced. We need much better public reporting of science.

If someone wants to reduce their body weight, they will look for the pill, milkshake, tea, etc. that makes the miracle, rather than modify their diet and lifestyle because most people prefer the easiest way, which is used by the industry and the whole chain involved.

so true...

Oh, superfood. Such an exhausting topic..

A nutritious or non-nutritious compound present in foods has your intrinsic characteristics and your power to effect changes in human health is impressive, either positively or negatively. However, this effect depends on multiple factors, it can not be taken in isolation. It is the beauty of science, to discover how it interacts with other elements and the human organism. It is incredible to see that the behavior of the same compound of a food can benefit in the fight against cancer to someone, while another person can harm it, due to genetic polymorphisms. Science never stops, fortunately!
What today is a truth, tomorrow may not be true, at least for some.

brrrr, u said the word....bibber

I'm an undergraduate in microbiology and i have to say this post was really educating. Thanks @suesa. My opinion in this is that scientist these days jumps into conclusion early without ascertaining what the effect of the promising drugs might leads to when used as medications. Two types of disease causing microorganism might have the same symptoms in human cell. Just because lemon juice kills one does not mean it can kill others.

Hi @suesa, nice to meet you. Clinical trials are described well in this post.
Sacrifices of animal is required for the greater good of scientific discovery. Drug development is not an easy path, so big thumbs up to those scientist out there working hard for the benefit of all human beings.

Very interesting read. Makes me appreciate even more all the research hours that go into any medical achievement

Thank you for this article! I think it's very difficult for non-scientists to understand the the language of scientific papers (much like it is hard for me to understand how to properly fill in the annual tax declaration - it's good we have specialists in all kinds of fields).

I like how your text pretty much shows what scientists experience on a day-to-day basis: Failure is part of the job - about 99.9 % of the time. "Promising" means a myriad of tests have to be carried out until we can be sure it really works (most of the "promising" substances only turn out to work in vitro - i.e. in the Petri dish or in a microplate). Selecting an appropriate method is essential.

I hope a lot of people will read this to understand scientific work better and to see that severe illnesses, such as cancer or diabetes, are still best treated by doctors because they get access to the products of years of scientific work.

Lemon juice can kill cancer cells was revealed to me on this day. Its sad that something that common can kill cancer cells just only out of their hosts. If it worked, it would've saved many. And it would've been a great find!

Its always a pleasure to learn anything from you. Thank you :)

Is always nice and dandy when researchers get fired for not producing a drug that lets people profit before failing but there is a hell and cancer is cured there with lemon juice.

Although on a side note, cancer cells hate excess of aerobic energy, so there could be a route for acids like vinegar that can be converted to acetate. Don't quote me on that, though.

And let's not forget that after all the work and a successful launch there will be some people suffering from side effects or people for whom it won't work and a new conspiracy theory will arise:) Unfortunately, after the initial campaign media does in the benefit of the "new cure", media will be also the one "killing" the hope by focusing on what went wrong.

Yeah, that's what I meant with it's impossible to " include all possible genetic variations".

Missed that part, my speed reading has it's flaws. I believe the pool of people writing good content decreased a lot. Thanks for still being here:)

Oh, yes, there's so much trash. But my content is usually worth reading at a normal speed :P

I think the word promising in this case often means that the medicine in tests gave a (small) improvement. I wouldnt trust any medicine untill its well tested, gave reliable results and is available on the market.

I guess those supposed failures are still advancing science and medical understanding to a degree. But those laid-off Ophthotech employees would still not be too happy about it.

I see the latest bad health trend is "raw water", which is the stupidest thing I ever heard of, untreated water is full of so much stuff that will kill you. Its why lack of clean drinking water is a thing that kills people, lots of people, in third world

I saw that and lost a good chunk of my faith in humanity.

Very well written and very informative post. There are lots of business involved in health industry and business always run over profit and for profit most of the time compromise on ethics is considered okay.
There are lots of people dies due to clinical studies of drugs and how many will be actually benefited by that medicine is not sure.
In Ayurveda or Herbal medicines are time tested and very useful in chronic diseases. More research required in the field of herbal medicine to make it more effective and valuable for human being.

Yes I agree, I only use natural herbs too instead of evil pills

Feel free to flag this lolz

You're an asshole, mobbs

Mice are fine for ordinary work like toxicology trials. Perfect for checking that no unwanted side-effects crop up when they try a new molecule. But it’s a complete mistake to think they represent a good model of human disease.

For example, tuberculosis in mice is simply not the same as in humans. Mice do not cough, nor are they contagious so they are testing them for no use, atleast in most cases.

Sure, but there are still many things that can be tested on mice. And people are generally happier testing new drugs on mice before killing thousands of people with it

I don't know why some people just choose to come here and drop spam comments, without reading the post.

Welcome to steemit

Thank you for this article. In my opinion the most serious consequence of this combination of poor understanding and sensationalism in the coverage of scientific discoveries is that it fuels the multiple conspiracy theories targeting the pharmaceutical industry. Since many people are constantly told that every new incremental discovery made in a specific field means that we will cure all types of cancer tomorrow, it's a small leap to thinking that all the solutions are readily available but the industry chooses to hide it from us to keep making money out of less efficient treatments.

The fight against cancer has been age-long. Sometimes, I keep wondering why we haven’t won this war yet. The most we hear is the word “promising”. But I believe that one day, cancer would go into oblivion. Also, I read about a publication that states that advances are made to fight cancer with virus. Maybe this would be the army we need to win this war. Future will tell
Nice piece buddy

Promising gives us hope that one day it’ll deliver to cure.

hope no one laughs at what an about to say @suesa, in Nigeria one of the traditional methods of curing malaria is like this. They get some roots and herbs that probably contains what is in processed drugs. They would put these herbs and roots into a big pot and when it begins to boil bringing out steem, they would then put the person close to the steem from the boiling herbs (with his cloths off) and enclosed both the person and the boiling herb. When the person comes out, before the next 24hrs, the person begins to gain massive recovery. My guess is that the steem containing what ever chemical that kills malaria passes through the sweat pores in the body to get inside. Probably same can be applied to the cancer and lemon. Forgive me if I make no sense am an engineer and not a biochemist. Loved your post-cheers

every type of disease has anti-drug, so what kind of disease needs continuous research. thanks @suesa, already share a very useful post. send regards for success

I don't believe in chemical medicaments. I would rather use a natural oil, plants and any other alternative medicine than pills.
There are more long-term side effects than benefits, and even if all kind of testings are unnecessary, it is playing God... 😏

"natural oils, plants and any other alternative medicine" contain basically the same chemicals, just in an uncontrolled amount.

human factor is the weakest link in that chain.

seeing how easy is for incompetent, mentally ill, primitive greedy and sickly ambitious people to climb up just any ladder in todays society, makes that control aspect more of risk, than benefit.

caner is who kill some one if any one did not cure and treated well,your articles,but in most cases people who do not understand medicine or science will get exited and happy and in most cases they become disappointed. But your efforts is appreciate able.

Sí esa palabra "prometedor " fuera seguida de exitoso sería un avance ante este mundo de estrés donde la aparición de nuevas enfermedades va de país en país.

Hope and faith were always the initial medicines to curing any disease. I mean, how can a patient begin his treatment if he thinks it’s incurable?

A big part of those is obviously a placebo, but imagine if there were no placebos. Human civilization would never grow past the Stone Age if people didn’t believe in long-term benefits. Religion and government always worked on the notion of “obey and we will protect you”, which is not that different from pharmaceuticals.

Promises can be empty words, since nobody has full control over the future, but nothing moves past inception if there are no promises. Nobody would invest money or time in anything if he expected direct results.

And yes, lots of drugs are useless and no more than a scam for some to make money. Can you imagine what would happen if they didn’t exist? Tens of thousands of terminal patients would run around in frenzy, or be crying all day in front of television, cursing science and the government for being unable to help. Placebos are there to shut hem up. With hope.

Now go back to your jobs, and spend a third of your life there, with the hope of money at the end of every month and a pension when you retire XD.

Is lemon juice beneficial for the destruction of cancer cells?

It was an example. Basically everything kills a cell culture, but you won't get rid of cancer by drinking lemon juice.

what if we soak ourselves in lemon juice for 20 min daily? or of we STARE into lemon juice without blinking for 5 min each day?

Treatments needs to be personalized for that particular patient. Everyone is different in genetics and lifestyle.

So essentially, the scientists/people conducting study have incentive to exaggerate / overstate their findings in order to stay employed. No results = layoffs. That's just the harsh reality of the business, for probably both drug and supplement companies. It gets even more mind boggling when you consider that you can find a study to support the opposite side for almost everything.

We should give our scientists better job security

I completely agree with this. Some places are better, but most scientists in the US are soft funded out of grants that they must compete for with the NIH. If they have a gap in NIH funding they often lose their University positions within the year and that is insane to me!

Wow... Nice article

LitasIO

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maybe one day the "promising" substance has the power to heal! nice and useful message. I like your writing very much. Thank you

#suesa: Informative and right in all the sense. I would like to appreciate your efforts of educating people about the evil practice of this big health care industry. When the root cause of the survival of this company is making money and accidentally healping very few people then you cannot go long in game. It just that so people are unaware and some just dont care to know or read about it. I support the initiative and i would like to support it.

The technicalities of things hidden in bogus language. I like it simple. The simplest explanation does it for me. Some of these drugs with bogus description scares me.

if promising give results it may be tested in a clinical trails on Oncology tell scientific American last year

This Post very nice and great information.. thanks for sharing this post..

i little bit steemers..i am very sorry for this comments..please withdraw flag..

Try to comment something that actually refers to the post, not just generic spam.

ok..my friend..

This kind of thinking applies to many areas in and outside of medical research. Most studies, peer reviewed or otherwise, do not actually show the efficacy or true potential of a treatment or methodology only, as you put it, promise. It is very rare that one study will change the way we view things, rather it is the build up of confirmation that results in practical change!

Awesome Article thanks for sharing wish to see some more amazing stuff from you in future am following you

Lemon is so useful God bless you that you have informed us live long with your family

Congrats on reading the first few lines, thinking you know what the post is about and then posting a comment that couldn't have missed the subject any more if you tried.

i do agree with you. many drug companies have been involved in the production of harmful products by using advertisement companies. they become more profits oriented that welfare oriented. which is disgusting to the community. our government should play a bigger part in controlling such activities but also the people should be informed on various varieties of drugs available in the market.

How is what you said "agreeing with me"

Prevention is better than cure. So we have to keep our health and to get away from the fast food because it is the real cause of cancer.

No. I mean yeah, stay healthy but you can still get cancer.

I believe the dose makes the poison. A single fast food meal does not cause cancer, same way that a single ‘healthy’ meal does not cause me to have a six pack (as much as I’d hope that be the case!!).

There are many factors to these complex and intricate disease states, an unhealthy diet definitely being a common denominator. However there are factors such as genetics, the microbiome, environmental factors, that have a huge play into the development of the these diseases.

I hope that people really embrace the practice of prevention, sooner rather than later! You are so correct that it is better than the cure! Education is key and once the public truly understands their physiology, we will be one step closer to a preventive style of care.

Wonderful article describing the process of establishing a drug for serving it's ultimate purpose, treating or curing a disease. We, the general people are getting a medicine and enjoying it's positive effect, becoming disease free, in general. but we don't know the story behind making it possible. This article brings that to us.
Way to go

cancer is allready cured they just don't want to people know that is true

Which cancer?

Inspiring post @suesa.. Keep shining.. 😎😎

They are grasping for the straws, or for the resources, or for the both.
I know it is bad to be pessimistic, it is not even my thing, I always try to keep the bright outlook at the world, if only people would not suffer so much.

Great thought about the success in life

Hey friend, I like your article, it is quite interesting, I am following you, can you follow me too?

Hello, I set up my blog on steemit. I like to take a selfie, travel, contact me, enter my blog and see what's new https://steemit.com/life/@beyonndkiller/asia-s-latest-selfie-sexy-goddess-daily-life4