We won't cure cancer if we don't understand it.
Technology has its place in the solution. But we need to address it mentally as well.
TLDR Summary
Curing cancer ranks high among the most important challenges of our time. We understand this problem primarily as a technological one. One that is to be solved through innovation by multinational corporations and smart technology start-ups. Fix the body through a patch like fixing a malfunctioning computer program.
To some extent it may be such a technological problem. Biotechnological innovation has delivered tremendous progress in cancer therapy. For many people a cancer diagnosis is not the same death sentence anymore that it has been in the past.
However, cancer is also a lifestyle issue that drugs can’t realistically resolve. And I am not even talking about smoking or obesity. I am talking about mental issues. Our way of life has become incompatible with our prehistoric minds. Cancer is the way our bodies send us that message. Ultimately, the responsibility for a healthy body is at the individual level. It can’t be outsourced.
How are we trying to cure cancer?
About 60 million people will die over the next twelve months. About 10 million of those will die from cancer. It’s a leading cause of death, second only to heart diseases. It’s a huge problem for our society as a whole and more importantly it is the most terrifying diagnosis to be confronted with on an individual level. A heart attack will kill you instantly in many cases. Cancer often stays with you for years until it finishes you off.
The post below is in my opinion symptomatic for how most people and our society as a whole approach the cancer problem.
We view it first and foremost as a technological problem. One that is to be solved through innovation delivered by multinational companies and technology start-ups.
Taking such a perspective is not unreasonable. Cancer research has made tremendous progress over the years, specifically with respect to antibodies. These are biotechnologically produced proteins designed to attack cancer cells in a highly targeted manner.
Some of them have become blockbusters. The largest one is Merck’s Keytruda (pembrolizumab), which was launched in 2014 and generated $30bn in revenues last year. In total, antibodies for cancer treatment raked in more than $100bn in revenues last year.
In addition to existing drugs, there are countless new compounds in corporate pipelines. One of the most promising ones is Summit’s ivonescimab which I wrote about last year here:
The global cancer therapeutics market is worth about $200bn annually and it is projected to more than double to $470bn over the next ten years.
It’s a very important industry, the importance of which is growing. What follows is not so much a bear case for the financial prospects of this industry. I am pretty confident those are bright. What follows is rather a philosophical bear case and an attempt to raise awareness for an alternative perspective.
To present this perspective, I need to explain a few scientific fundamentals first.
What is the difference between healthy cells and cancer cells?
An average adult human body contains about 35 trillion cells. All of them perform specific functions to operate the body. To serve these functions, they need energy. The primary way to produce that energy is called aerobic respiration in which the body breaks down nutrients into energy with the use of oxygen. This energy production is an essential part of a cell’s metabolism (the other one is using that energy to build molecules and structures).
For the organism to function, all these cells have to communicate and act in accordance with one another. When necessary, they create new cells by dividing and they self-destruct when they get damaged or are no longer needed.
In contrast to normal cells, cancer cells operate outside of the organism’s protocol. They stop carrying out the functions they were designed for. They divide and grow uncontrolled. And they don’t self-destruct. Eventually, they kill the body by starving normal cells of space, nutrients and oxygen. Depending on the cancer type, this can for example cause organ failures or weaken the immune system leading to infections.
How do cancer cells form?
Except for fertilization, the only way to create human cells is through mitosis, i.e. a single cell divides into two. That means cancer cells have to originate from normal healthy cells. The mutation of healthy cells into cancer cells is the central mystery in cancer research.
Today, we understand this mutation process as probabilistic in nature. Every time a cell divides, there is a chance that it mutates and this chance is subject to various risk factors.
Certain outside factors are associated with increasing the chance for mutation, such as excessive exposure to sunlight, smoking and alcohol consumption, exposure to certain chemicals or certain virus infections. Genes play a role, too. Some people are more likely to develop cell mutations than others. Age is also an important risk factor. The older we are, the more often our cells have divided and the more they divide, the more likely do mutations accumulate to make the cell cancerous.
Given that this process is probabilistic, cancer is fought through two means. First, reduce risk factors as much as possible to prevent a tumor from forming. And then attack it with medical treatments once it has formed.
There is much to be gained from this approach. But a full eradication of the phenomenon cancer is highly unlikely this way.
Warburg effect
One curious observation about cancer cells is that their energy production differs from healthy cells in that they prefer glycolysis over the aerobic respiration described earlier. Glycolysis is a process where glucose is converted into energy without oxygen. As such it is an anaerobic process, which is a term you might be familiar with if you are into sports. An anaerobic effort is much less efficient than an aerobic effort, but it can provide energy very quick, thereby facilitating short efforts such as sprinting or heavy lifting.
Cancer cells prefer this anaerobic glycolysis even when oxygen is present. There are various theories why this may be the case. For the purpose of this article it should be sufficient however to simply acknowledge this fact.
This preference of cancer cells for glycolysis is called Warburg effect because Otto Warburg was first to discover it in the 1920s. He received the Nobel prize in 1931 for related research.
The affection that cancer cells have for glycolysis is the reason why many people associate sugar intake with cancer risk and cancer growth. Dialing down sugar intake is therefore often one of the first measures taken by patients shortly after their diagnosis and it is part of the reason why health-conscious people prefer ‘low carb’ diets.
But this is not just about physical nutrition. It’s also about mental nutrition. To understand why requires understanding a very important hormone:
Adrenaline
Adrenaline is a hormone that is produced in the adrenal glands above the kidneys. It prepares the body for an emergency by mobilizing energy and sharpening the focus. Specifically with respect to cell metabolism, it stimulates the breakdown of glycogen in the liver and muscles into glucose. This provides more fuel to power the muscles and the brain. It prepares the cells to perform glycolysis as described earlier.
To understand the importance of this for cancer research, think about a caveman 20,000 years ago. He sees a lion. Adrenaline shoots through his body. His blood sugar spikes. And then he outruns the lion for long enough to survive. The sugar is burned in the muscles. Adrenaline has fulfilled its biological and evolutionary function. The mechanism gets passed on to the next generation because the caveman survived.
Fast forward 20,000 years. You work in middle management with tons of responsibility, but very little authority. You agreed with your wife you will pick up the kids from daycare today. On your way out of the office, your phone beeps. Email from the boss with no text in the body. Just a ‘.ppt’ file and a subject “pls fix by EoD”…You sit in traffic. No car is moving. 7mins til daycare closes. It’s a war. Driver against driver…At home you open a letter from the bank. Mortgage payment will increase from the latest rate hike…You check the stock market. NVIDIA stock mooned today. You sold it six month ago. Palantir mooned as well. You own puts in your Robinhood account...Evening routine with the family. No grandparents around to help because they live 300 miles away…Some doomscrolling before bed…5h sleep…Repeat it all next day.
This is the reality for millions of people in their 30s and 40s. Every day your body is churning out adrenaline, pumping up your blood sugar. This helped your ancestor to outrun lions and survive. But does it help you? Certainly not. You would love to convert the sugar into a power burst. But running away from your job, traffic, family and personal finances wouldn’t fix anything.
The healthy cells don’t need the sugar. But that one odd cell in the corner of your pancreas. It appreciates the sugar rush very much. Swallows it. Splits into two. A tumor is born, ready to kill you five years.
But wait, there is more.
Cortisol
In a stress event, the adrenal glands release another hormone: cortisol. It prepares the body for a longer lasting stress response (hours vs. minutes). It keeps the blood glucose high and provides steady fuel for tumors similar to adrenaline.
It also suppresses the immune system, presumably as an energy-saving and survival strategy to overcome the emergency. Again, while this is helpful for the caveman against the lion in the bush, it is disadvantageous for the chronically stressed office worker in the 21st century. If the immune system keeps getting suppressed, abnormal or pre-cancerous cells are more likely to escape detection and are hence more likely to develop into cancer cells that become unstoppable.
Stress is the most underappreciated carcinogen out there.
Our bodies are made to deal with acute stress because caveman primarily dealt with acute stress. We aren’t made to deal with chronic stress. Our bodies react to it in a way that slowly kills us. Cancer is the primary mechanism to accomplish that.
Sure, some people are more resilient than others. They can grow old and stay healthy even with a very stressful and fast-paced life. But that is in my opinion rather the exception than the rule. The vast majority of health issues out there are stress related in my opinion.
I am not claiming that nobody is aware of the importance of stress among cancer risk factors. However, I do believe that its importance is underappreciated by many. Many people take their health very seriously these days. Self-optimization is a huge trend. Longevity gurus like Bryan Johnson have a massive following. In his case more than 640,000 followers on X.
But how many are seriously addressing the stressors in their lives? That would require slowing their days down a lot. Probably to a point where their lives would be considered boring by most people whose opinion about them they deeply care about.
It may be possible to destroy one or two tumors through the medical technology we have today and tomorrow. But the stress most of us live with is more akin to constant machine gun fire on our bodies.
It’s unlikely that this machine gun fire will stop anytime soon. If at all, the speed of our lives is even accelerating still. Revenue of cancer drugs will therefore likely keep rising. But cancer will not be eradicated that way.
Sincerely,
Rene
Dang this hit hard on the dopamine adrenaline illustration "or were you looking into my life" 😂 in addition to stress that can be so harmful. I see no way out of all the demands of life.
This might forever be your most important piece. Without good health, nothing else matters. I've always heard how "stress kills" but I see your point vs acute stress and chronic stress. We as humans are adapted perfectly for acute stress, however, cancer can thrive off the chronic stress of our modern way of living.
Sleep well, eat fresh, exercise, socialize, let God handle the rest. Perfectly said, it is a shame that now a days people eat more processed than ever, exercise less than ever, socialize face to face less than ever, and believe in God less than ever. Scary.