October 12, 2009
Our Dogs To Get Cancer Drugs Before We Do
They sure trained us well.
Dogs with cancer in the US are now entitled to receive experimental drugs – before the drugs are available for humans. Twelve trials are under way on groups of 15 to 60 dogs, and in several of them cancers have disappeared.
"We've had dramatic remissions in dogs with really aggressive cancers," says Chand Khanna, head of the Comparative Oncology Trials Consortium newly formed in Bethesda, Maryland, by the US National Cancer Institute. "We've also had responses allowing dogs to have their original cancers surgically removed," he says.
I'd like to see a change in US Food and Drug Administration policy where people with just a few months left to live should be free to try drugs that are currently in stage I trials or even drugs which have only been tried on other animals. If you are going to die then you should be free to try anything. If I had several months left to live due to cancer I'd rather try experimental drugs even if they might kill me sooner. If the result was simply to rule out the further use of an otherwise promising drug as least I'd die for some constructive purpose.
It's easy to think that way if you narrow the options to a "chance at life" vs. "certain death". Unfortunately there are areas in between life and death and many of them are much worse than death. You have to consider the quality of life these drugs might bring - side effects, after effects, drug combination issues, etc.
In the final weeks of dying from cancer there's no quality of life. For many people there's no quality of life in the final months. Side effects: Chemo's side effects are brutal. But suppose you are past the point where any existing treatment can help. Suppose the cancer has gone to your bones and every day is more painful than the day before it. Picture yourself at that point. I've helped someone daily at that stage. I do not want to live long at that stage.
Okay, but what if one of the side-effects of an experimental drug is brain damage? Would you want to live as a cancer-free vegetable? My uncle suffered nerve damage from chemo. They were able to stop the damage early, but it could have been worse. My point is that there are reasons we do animal testing first.
The reason that they try to avoid giving experimental treatments to people in those stages is that they may die... but you don't know if it was the illness that killed them or the treatment. Allowing these treatments to be used like you describe could cause potentially lifesaving (or at least life-improving) treatments from getting to market as quickly, or at all. It's unfortunate, but the first time they tried that, when the patient died, their family would sue the doctors, hospital, and drug company involved.
Perhaps because I don't have cancer (yet), I'm optimistic: Judging from the quickening pace of research, we should be able to battle cancer to a standstill within a decade, and completely eliminate it within a decade thereafter. Though all disease will yield before the workings of the human mind, I'm not sure relative immortality would be such a good thing.
Judging from the quickening pace of research, we should be able to battle cancer to a standstill within a decade, and completely eliminate it within a decade thereafter.
The pace of research doesn't "quicken" on its own. There is a complex interplay of incentives at work - and it is about to be knocked topsy-turvy. At the very least things will slow down while everyone waits to see what the new incentives are.
Random's comments are typical of a certain mindset. First he thinks he is the only person who has thought the issue through, and that others should not be entitled to choose for themselves. Then, he pretends to pose a "what if", but actually has already concluded, based on purely anecdotal evidence, that his "what if" is a proven fact. Personally, I'd rather abolish the FDA than freedom of choice.
This is a very good point.
I recently had a long talk with pioneer British transplant surgeon Roy Calne - http://en.wikipedia.org/wiki/Roy_Yorke_Calne - and read his autobiography.
It is clear that in the early days most of the experimental transplant operations were done on volunteer dying patients, whose motivations were similar to yours.
If you would like to write-up your comments as a Correspondence item for the journal I edit - Medical Hypotheses - then e-mail them direct to me.
I would be pleased to publish this point and get the argument recorded in the mainstream medical literature.
Folks might not realize that chemo drugs for dogs are commonly available. Dogs are used during the clinical testing, and so there's a lot of information in the knowledgebase. Also, there are more than a few drugs that wash out of human trials for various reasons that still be retain their approval for veterinary use.
That dogs get access to drugs isn't really the problem.
The problem is that humans, and their medical practitioners are forbidden access. As far as I'm concerned, regulatory agencies have no role in the decision balancing the risks, uncertainties, and possible benefits for people with terminal diseases who have exhausted all the options available in the land of known science. That's between a patient, his doctor, and the best, albeit incomplete information science has to offer at the time, not some FDA bureaucrats.
As a sidebar, the best practices of medicine's standards of care will need to evolve to include these experiemental/ extremis cases, as will the issue of malpractice and criminal/civil liability.
«It's easy to think that way if you narrow the options to a "chance at life" vs. "certain death"»
Random, get a clue.
If the patient voluntarily chooses to take the untested drug, what is it to you? Man, must people try and babysit adults who are facing a life and death situation? Welcome to the nanny society!
If you're suggesting, as I gather you are, that people should be free outside of clinical research to use experimental drugs, then FDA policy is not your only hurdle. You'll have to speak to a phalanx of lawyers about immunizing doctors, nurses and pharmaceutical companies from the civil exposure that would accompany your suggestion. Otherwise, it won't matter what the FDA permits; the industry will never go along with it.
As someone who has taken care of several loved ones in terminal cancer, I would say that allowing the terminally ill to try anything they want would be great - with one caveat: they can't be charged any money for them.
People who are dying, and even more so, those who love them, are desperate. They'll pay anything for hope, and are vulnerable to the worst kind of exploitation. The snake oil salesmen don't care how much havoc they wreak - they just want to sell their product.
This isn't an easy question.
Few drugs help in the terminal fase of cancer and even then there is a big difference in the quality of life and the rules are there because there were plenty of doctors that think they have discovered the cure and experimented on their patients. Hypocratic oath be damed. There is also the question if you can make a well-informed decision when you learned you are dying soon.