Can we cure cancer?
In my previous post I paraphrased my understanding of why the cancer workshop was called as the premise: “cancer is an evolutionary process; the cure for cancer is within reach, and is mostly an engineering problem now that we have the right model; and what can we do collectively to work towards and achieve the goal of a cure”. Here’s the current scorecard in my mind:
“The cure for cancer is within reach” –>
- The nature of “cancer” is more complex than I originally imagined.
- Cancer is both real and fictional at the same time, just like every other model.*
- To make any progress on the fundamental understanding of cancer, we need to admit that whatever definition we use of the concept of “cancer” — and there are many proposed and competing ones — proscribes/limits the set of all possible models that you have to work with.
- Ultimately in order to make progress on what you thought was the goal (e.g. “cure cancer”), you have to be willing to change the definition (of “cancer” itself).
- But changing the definition, then changes the goal because the “underlying reality” you thought you were studying is ultimately just the model you created in the first place.
- For instance, if “cancer” turns out to be a normal consequence of life, then perhaps what we are really after is extending life by looking at cancer as — and treating it as if it is — a chronic condition which flares up from time to time.
- Ultimately the new models you use to understand the nature of cancer and what it would practically mean to “cure” it, are just new models and will inevitably be show to be wrong at some point.
- The new models we create will undoubtedly have explanatory power (by which I mean they are as true as anything is) in other domains — for instance we, we may find “cultural cancers” just as we find “computer viruses”.
“Cancer is an evolutionary process” –>
- Yes, but it is also a process that involves other dynamics like metastasis, self-organized criticality, ecology dynamics, etc.; “evolution”** alone cannot sufficiently describe cancer to give us the understanding we seek.
- And these are all just models, imperfect to the bone. Any model that adds predictive power to the current best hypothesis is worth exploring.
“Curing cancer is mostly an engineering problem now that we have the right model” –>
- We don’t have the “right” model and never will; we only have an ever more refined model as we learn.
- Do we have a refined enough model to cure cancer? No, because our conceptions of “cancer” and “cure” have shifted and will continue to shift as we learn more.
- Can we re-frame the question of curing cancer and be more precise about what we mean? Yes, for instance we can re-frame our notion of “cure” to be “extending life by detecting and halting tissue-level metastatic process in tumors indefinitely”.
- But something similar to cancer can crop up at a different level of organization, so be careful about using “indefinitely” and confining yourself to the tissue level.
- Can we say we don’t care if we die because we didn’t understand cancer enough to stop those same cancer-like behaviors at other levels? Yes, but we still end up dead.
- Can we say that we don’t care if we die “eventually” as long as we’ve staved off death from well-understood processes? Yes, as long as we are happy with the improvement in life-span and don’t mind dying of other causes.
- In other words, if we say we want to increase life-expectancy by a specific length of time (say 15 years) by controlling the class of of maladies commonly referred to as cancer, then I believe it’s an engineering problem (but a very large one).
“What can we do collectively to work towards and achieve the goal of a cure” –>
With a re-framing of cancer and a re-framing of cure, we can do the following in parallel:
- Work on engineering related to achieving the re-framed goal.
- Continue the “meta-science” of cancer, by which I mean engage in a process of continually challenging our assumptions (no matter how basic) about all levels of organization, including levels above the human body (such as mind, society, computation) and levels below the level of DNA (such as molecules, atoms, subatomic particles, etc).
- We need to develop new intuitions about how to think about complex adaptive systems (which is to say, everything) because our intuitions are what drive and constrain the models we build and use to understand the world.
* Which is to say, everything we can ever know as humans about reality is based on models, which are by definition convenient fictions. A cheeky way I heard of saying this was “all models are wrong, but some are more wrong than others”.
** Most people think of evolution as Darwin suggested, roughly, selection on populations of creatures with heritable traits. But you get more predictive power when you add an evolving environment (as in “co-evolution”), punctuation (as in “punctuated equilibrium”), meta-stability (as in a more dynamic notion of equilibrium), phase shifts, strange attractors, etc, etc, etc.