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The study, from Stanford University researchers, found that the nutritional value of foods is more important to weight loss than whether you exclude fats or carbohydrates.\u003c/p>\n\u003cp>Researchers monitored the diets of more than 600 overweight adults. Even though the subjects did not focus on cutting calories, they lost an average of about 12 pounds over the course of a year. The weight changes ranged from a reduction of 60 pounds to a gain of 15.\u003c/p>\n\u003cp>The study randomly assigned participants to reduce fat or carbohydrate intake. Subjects were not provided with food. Rather, they sat through 22 health education classes, where they learned how to shop, cook and dine nutritiously. They were also encouraged to be physically active.\u003c/p>\n\u003caside class=\"pullquote alignright\">Those who ate the fewest processed foods, sugary drinks and unhealthy fats while eating the most vegetables lost the most weight, regardless of whether they followed a low-carb or low-fat diet.\u003c/aside>\n\u003cp>The results, based on self-reports from the study subjects, showed that both the low-carb and low-fat groups reduced their daily calorie intake by an average of about 500 calories. Being assigned to the low-carb or low-fat group didn't affect the results.\u003c/p>\n\u003cp>\u003cstrong>Not All Calories Are the Same\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>What did matter across both groups was the type of carbohydrates or fats participants consumed: Those who ate the fewest processed foods, sugary drinks and unhealthy fats while eating the most vegetables lost the most weight.\u003c/p>\n\u003cp>“Without focusing on calorie restriction,” said lead author Christopher Gardner in an email, “Our participants reported achieving calorie restriction, and in fact lost weight.”\u003c/p>\n\u003cp>Potentially participants felt more satiated by eating a healthier diet.\u003c/p>\n\u003cp>“If you reduce starch and sugar and you increase minimally processed healthful foods like vegetables, weight will go down naturally,\" said Dariush Mozaffarian, a cardiologist and nutrition expert\u003cstrong> \u003c/strong>at Tufts University who is not connected to the study\u003cstrong>.\" \u003c/strong>About 10 pounds a year, which is pretty substantial.”\u003c/p>\n\u003cp>\u003cstrong>No Silver Bullet\u003c/strong>\u003c/p>\n\u003cp>The results add to a growing body of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25182101\">research\u003c/a> calling fad diets into question. Scientists have yet to corroborate any alleged silver bullet for losing weight, and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/16476868\">studies\u003c/a> have found \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25182101\">negligible differences\u003c/a> in reducing capabilities between low-carb and low-fat diets.\u003c/p>\n\u003cp>Mozaffarian specifically questions the mantra that all carbs are bad.\u003c/p>\n\u003cp>\"The carbs that we should be avoiding are those that come in high doses and are digested very quickly, what you might call fast carbs,\" he says. He recommends tossing out refined flours, potatoes and sugars and stocking up on fruits, beans and minimally processed whole grains.\u003c/p>\n\u003cp>The health outcomes of the participants also improved by changing what they ate. Body fat, body mass index, waist circumference, triglycerides, blood pressure, fasting glucose and insulin went down for both the low-fat and the low-carb groups.\u003c/p>\n\u003cp>\u003cstrong>Precision Medicine Takes a Hit\u003c/strong>\u003c/p>\n\u003cp>At the beginning of the study, participants underwent analysis to identify genetic variations that are linked to how the body processes fats or carbohydrates, which the researchers thought would make each individual more likely to lose weight on a low-fat or low-carb diet. Previous research had suggested that genes could interact with different types of diets to influence weight loss. The participants' insulin levels were also taken.\u003c/p>\n\u003cp>[contextly_sidebar id=\"lR73EJFQlezW1NDSbIIGP6dv8VCGeXmF\"]But neither their genetic makeup nor insulin resistance mattered in how successful the participants were in losing weight, the study found. These results suggest that “precision medicine is not as important as eating mindfully [and] getting rid of packaged, processed food,” said lead author Christopher Gardner. To achieve the former, he recommends avoiding screens while dining, shopping at farmers markets and sitting down for meals with friends and family.\u003c/p>\n\u003cp>\u003cstrong>Other Experts Weigh In\u003c/strong>\u003c/p>\n\u003cp>The study was well-conducted, says Dr. David Ludwig, a Boston Children’s Hospital obesity researcher. But because participants were not provided with specific foods and self-reported their choices, he says, it wasn’t rigorous enough to disprove the idea that certain genes and insulin levels may affect which types of diets lead to weight loss.\u003c/p>\n\u003cp>Dr. Frank Hu, nutrition chief at Harvard’s School of Public Health who has called precision nutrition a promising approach, says the study wasn’t a comprehensive test of all gene variations that might affect individual responses to weight loss diets.\u003c/p>\n\u003cp>“In any weight loss diets, adherence to the diet and the overall quality of the diet are probably more important than any other factors,” Hu says.\u003c/p>\n\u003cp>\u003cstrong>Still On The Hunt\u003c/strong>\u003c/p>\n\u003cp>Stanford researchers plan to continue combing through the data to see if other biological factors, such as those linked to individual microbiomes or to epigenetics, for example, impacted the results. Gardener has a hunch that one key factor is satiety: Some people might feel full after eating a bowl of steel cut oats for breakfast, for instance, while others still feel hungry. Meanwhile, the same people unsatiated by oatmeal might do better with eggs and an avocado.\u003c/p>\n\u003cp>\"I think the next level of personalization is really thinking about which good carbs and which good fat foods are more satiating for some people than others,\" Gardner says.\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report and the content has been edited.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"Eating healthier foods and not following a low-fat or low-carb diet determined dieting success in Stanford study.","status":"publish","parent":0,"modified":1519695424,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":908},"headData":{"title":"To Lose Weight, Focus on What You Eat, Not How Much: Study | KQED","description":"Eating healthier foods and not following a low-fat or low-carb diet determined dieting success in Stanford study.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"To Lose Weight, Focus on What You Eat, Not How Much: Study","datePublished":"2018-02-21T02:24:39.000Z","dateModified":"2018-02-27T01:37:04.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"439593 https://ww2.kqed.org/futureofyou/?p=439593","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/02/20/to-lose-weight-what-you-eat-is-more-important-than-how-much-study-finds/","disqusTitle":"To Lose Weight, Focus on What You Eat, Not How Much: Study","source":"Hope/Hype","sourceUrl":"KQED Future of You","path":"/futureofyou/439593/to-lose-weight-what-you-eat-is-more-important-than-how-much-study-finds","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>There is not a clear winner in the battle between low-fat or low-carb diets, according to a new \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2673150?redirect=true\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published Tuesday in JAMA. The study, from Stanford University researchers, found that the nutritional value of foods is more important to weight loss than whether you exclude fats or carbohydrates.\u003c/p>\n\u003cp>Researchers monitored the diets of more than 600 overweight adults. Even though the subjects did not focus on cutting calories, they lost an average of about 12 pounds over the course of a year. The weight changes ranged from a reduction of 60 pounds to a gain of 15.\u003c/p>\n\u003cp>The study randomly assigned participants to reduce fat or carbohydrate intake. Subjects were not provided with food. Rather, they sat through 22 health education classes, where they learned how to shop, cook and dine nutritiously. They were also encouraged to be physically active.\u003c/p>\n\u003caside class=\"pullquote alignright\">Those who ate the fewest processed foods, sugary drinks and unhealthy fats while eating the most vegetables lost the most weight, regardless of whether they followed a low-carb or low-fat diet.\u003c/aside>\n\u003cp>The results, based on self-reports from the study subjects, showed that both the low-carb and low-fat groups reduced their daily calorie intake by an average of about 500 calories. Being assigned to the low-carb or low-fat group didn't affect the results.\u003c/p>\n\u003cp>\u003cstrong>Not All Calories Are the Same\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>What did matter across both groups was the type of carbohydrates or fats participants consumed: Those who ate the fewest processed foods, sugary drinks and unhealthy fats while eating the most vegetables lost the most weight.\u003c/p>\n\u003cp>“Without focusing on calorie restriction,” said lead author Christopher Gardner in an email, “Our participants reported achieving calorie restriction, and in fact lost weight.”\u003c/p>\n\u003cp>Potentially participants felt more satiated by eating a healthier diet.\u003c/p>\n\u003cp>“If you reduce starch and sugar and you increase minimally processed healthful foods like vegetables, weight will go down naturally,\" said Dariush Mozaffarian, a cardiologist and nutrition expert\u003cstrong> \u003c/strong>at Tufts University who is not connected to the study\u003cstrong>.\" \u003c/strong>About 10 pounds a year, which is pretty substantial.”\u003c/p>\n\u003cp>\u003cstrong>No Silver Bullet\u003c/strong>\u003c/p>\n\u003cp>The results add to a growing body of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25182101\">research\u003c/a> calling fad diets into question. Scientists have yet to corroborate any alleged silver bullet for losing weight, and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/16476868\">studies\u003c/a> have found \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25182101\">negligible differences\u003c/a> in reducing capabilities between low-carb and low-fat diets.\u003c/p>\n\u003cp>Mozaffarian specifically questions the mantra that all carbs are bad.\u003c/p>\n\u003cp>\"The carbs that we should be avoiding are those that come in high doses and are digested very quickly, what you might call fast carbs,\" he says. He recommends tossing out refined flours, potatoes and sugars and stocking up on fruits, beans and minimally processed whole grains.\u003c/p>\n\u003cp>The health outcomes of the participants also improved by changing what they ate. Body fat, body mass index, waist circumference, triglycerides, blood pressure, fasting glucose and insulin went down for both the low-fat and the low-carb groups.\u003c/p>\n\u003cp>\u003cstrong>Precision Medicine Takes a Hit\u003c/strong>\u003c/p>\n\u003cp>At the beginning of the study, participants underwent analysis to identify genetic variations that are linked to how the body processes fats or carbohydrates, which the researchers thought would make each individual more likely to lose weight on a low-fat or low-carb diet. Previous research had suggested that genes could interact with different types of diets to influence weight loss. The participants' insulin levels were also taken.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But neither their genetic makeup nor insulin resistance mattered in how successful the participants were in losing weight, the study found. These results suggest that “precision medicine is not as important as eating mindfully [and] getting rid of packaged, processed food,” said lead author Christopher Gardner. To achieve the former, he recommends avoiding screens while dining, shopping at farmers markets and sitting down for meals with friends and family.\u003c/p>\n\u003cp>\u003cstrong>Other Experts Weigh In\u003c/strong>\u003c/p>\n\u003cp>The study was well-conducted, says Dr. David Ludwig, a Boston Children’s Hospital obesity researcher. But because participants were not provided with specific foods and self-reported their choices, he says, it wasn’t rigorous enough to disprove the idea that certain genes and insulin levels may affect which types of diets lead to weight loss.\u003c/p>\n\u003cp>Dr. Frank Hu, nutrition chief at Harvard’s School of Public Health who has called precision nutrition a promising approach, says the study wasn’t a comprehensive test of all gene variations that might affect individual responses to weight loss diets.\u003c/p>\n\u003cp>“In any weight loss diets, adherence to the diet and the overall quality of the diet are probably more important than any other factors,” Hu says.\u003c/p>\n\u003cp>\u003cstrong>Still On The Hunt\u003c/strong>\u003c/p>\n\u003cp>Stanford researchers plan to continue combing through the data to see if other biological factors, such as those linked to individual microbiomes or to epigenetics, for example, impacted the results. Gardener has a hunch that one key factor is satiety: Some people might feel full after eating a bowl of steel cut oats for breakfast, for instance, while others still feel hungry. Meanwhile, the same people unsatiated by oatmeal might do better with eggs and an avocado.\u003c/p>\n\u003cp>\"I think the next level of personalization is really thinking about which good carbs and which good fat foods are more satiating for some people than others,\" Gardner says.\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report and the content has been edited.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/439593/to-lose-weight-what-you-eat-is-more-important-than-how-much-study-finds","authors":["11229"],"categories":["futureofyou_452","futureofyou_1062","futureofyou_1","futureofyou_73","futureofyou_1064"],"tags":["futureofyou_1461","futureofyou_597","futureofyou_1462","futureofyou_1275","futureofyou_426","futureofyou_120","futureofyou_80","futureofyou_1406","futureofyou_112","futureofyou_1463"],"featImg":"futureofyou_439683","label":"source_futureofyou_439593"},"futureofyou_438487":{"type":"posts","id":"futureofyou_438487","meta":{"index":"posts_1591205157","site":"futureofyou","id":"438487","score":null,"sort":[1516295603000]},"guestAuthors":[],"slug":"precision-medicine-in-cancer-treatment-has-yet-to-show-much-benefit-for-patients","title":"Precision Medicine in Cancer Treatment Has Yet to Show Much Benefit for Patients","publishDate":1516295603,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>People diagnosed with cancer understandably reach for the very best that medical science has to offer. That motivation is increasingly driving people to ask to have the DNA of their tumors sequenced. And while that's useful for some malignancies, the hype of precision medicine for cancer is getting far ahead of the facts.\u003c/p>\n\u003cp>It's easy to understand why that's the case. When you hear stories about the use of DNA sequencing to create individualized cancer treatment, chances are they are uplifting stories. Like that of Ben Stern.\u003c/p>\n\u003cp>In the spring of 2016, Stern was diagnosed with a deadly brain cancer, \u003ca href=\"http://www.abta.org/brain-tumor-information/types-of-tumors/glioblastoma.html\">glioblastoma\u003c/a>. His doctors at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins promptly treated him with surgery, then over the months, chemotherapy and radiation. He even got on a clinical trial to see if a leading edge drug called a checkpoint inhibitor would work.\u003c/p>\n\u003cp>Ben Stern found out abruptly that wasn't doing the trick either, when he was struck with a seizure. \"My whole right side clenched up and [my wife] Tara had called 911 in the middle of it.\"\u003c/p>\n\u003cp>The tumor had grown back, so surgeons went in again to remove what they could. Tara said the next month's appointment showed the surgery hadn't worked, either.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The tumor had already grown back and it was already bigger than the original size tumor that we had found the previous May,\" Tara Stern says. This staggering regrowth took only five weeks.\u003c/p>\n\u003cp>Stern's doctor got a sample of the tumor and sent a genetic analysis of it to what Hopkins calls its \"molecular tumor board.\" It's a small group of doctors who meet Mondays to review these genetic tests. They found an overactive gene in his tumor that's only rarely associated with brain cancer. But that mutation in other cancers sometimes responds to a particular drug. So Ben went on it as part of his ongoing treatment.\u003c/p>\n\u003cp>\"He started his next round of chemotherapy that Monday but he didn't seem to get weaker,\" Tara says, \"He was getting stronger almost every day. It was almost miraculous.\"\u003c/p>\n\u003cp>Ben says the drug even reversed his deteriorating mental state brought on by the brain tumor. At the next monthly appointment, following a brain scan, Ben and Tara got more good news.\u003c/p>\n\u003cp>\"The tumor was immeasurable on that next MRI,\" Tara says. \"It wasn't there, to put it bluntly.\"\u003c/p>\n\u003cp>Ben's eyes well up as he hears his wife telling the story. \"I was basically as I am now, which is in tears.\"\u003c/p>\n\u003cp>Eight months later, Ben was thinking ahead about his future, rather than wondering whether his life is ending.\u003c/p>\n\u003cp>\"We have to use this result with caution because we don't know how long this effect might wear on, but for the time being this is a clinically very meaningful benefit,\" says his doctor at Hopkins, medical oncologist \u003ca href=\"https://www.hopkinsmedicine.org/profiles/results/directory/profile/5037896/matthias-holdhoff\">Matthias Holdhoff\u003c/a>.\u003c/p>\n\u003cp>And while it's a good-news story for the field of precision medicine, it is also not the way most of these stories end.\u003c/p>\n\u003cp>\"We're getting better, but like many things in life, there's hope and hype. And that's also the reality with precision medicine right now,\" says \u003ca href=\"https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/breast_cancer_program/our_breast_cancer_experts/ben_parks.html\">Ben Park\u003c/a>, an oncology professor at the Sidney Kimmel Comprehensive Cancer Center at Hopkins. After noticing how much confusing genetic information was flooding doctors at Hopkins, he founded the molecular tumor board there.\u003c/p>\n\u003cp>\"The reason I started this tumor board [in 2013]... was simply because there was a patient, a young woman who had metastatic breast cancer who had a mutation on one of these reports and decided to forego standard-of-care therapies, which have been proven to actually prolong life in this setting,\" Park says. Instead, the woman enrolled in a clinical trial that didn't really make sense for her particular type of cancer and \"she almost died. She had really bad toxicity from the experimental drug.\"\u003c/p>\n\u003cp>She was drawn, Park says, by the allure of precision medicine. Patients and doctors alike are clamoring for these tests. But interpreting the results isn't easy because different companies offer these tests \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323161/\">and interpret the DNA signatures differently\u003c/a>, \"and that can make a huge difference,\" Park says.\u003c/p>\n\u003cp>\"That's where we're having difficulty right now as a field,\" he says, harmonizing test results that often disagree with each other.\u003c/p>\n\u003cp>At Hopkins, the genomic tests usually don't offer any suggestion for treatment. Only \u003ca href=\"http://ascopubs.org/doi/abs/10.1200/PO.16.00046\">about one quarter\u003c/a> of patients at Hopkins are steered toward particular drugs or toward ongoing clinical trials. Other top medical centers find they can identify potential treatments only about 10 percent of the time.\u003c/p>\n\u003cp>So far there's only been one randomized study of this approach to precision cancer care — and it \u003ca href=\"http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00188-6/abstract\">did not show a survival advantage\u003c/a> for people who went through all this genetic testing.\u003c/p>\n\u003cp>\"If you have this knowledge, it's not enough,\" Park says. \"You have to prove that acting on that knowledge — some medical intervention — will actually afford benefit for patients. That's the trickiest, toughest part about looking at all these types of genomic tests, to really prove that this is making a difference in the lives of our patients.\"\u003c/p>\n\u003cp>Park has since passed on leadership of the molecular tumor board to his colleague, oncologist \u003ca href=\"https://www.hopkinsmedicine.org/awomansjourney/baltimore/2017_conference/lauring.html\">Josh Lauring\u003c/a>. Lauring says there are a few cancers where DNA analysis does make a clear difference, say in melanoma and certain types of lung cancer.\u003c/p>\n\u003cp>\"In other cancers, it's really kind of an open question. At the same time, this testing is available commercially as well as at academic medical centers, and is being done. Patients want it, providers want it.\"\u003c/p>\n\u003cp>So what's happening, in effect, is a huge, unorganized experiment, involving real patients, treated differently in all sorts of settings. Lauring and colleagues at Hopkins are trying to keep track of all their patients: what treatment they got, how long it was successful, and how long the patients lived.\u003c/p>\n\u003cp>\"We think it's really important to capture that information as well, to try to learn from it,\" Lauring says, \"because in many cases it's not going to be effective, but in some it is, and it's important for us to figure that out.\"\u003c/p>\n\u003cp>Therapies that target specific genetic patterns are appealing because medical scientists have some sense of the biology underlying their drugs — they aren't just killing fast-growing cells, as conventional chemotherapy does.\u003c/p>\n\u003cp>\"Unfortunately in many cases these responses, if they occur, are relatively brief.\"\u003c/p>\n\u003cp>That unfortunately turned out to be the case for Ben Stern as well. Five months after his remarkable response, Ben started feeling weaker again. An MRI suggested the cancer might be on the move. So he went back to the hospital for another round of chemotherapy and radiation.\u003c/p>\n\u003cp>They're hoping for the best.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Contact Richard Harris at \u003ca href=\"mailto:rharris@npr.org\">rharris@npr.org\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Now%2C+Sequencing+Cancer+Tumors+Holds+More+Promise+Than+Proof&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Sequencing the DNA of cancer tumors to help pinpoint treatment is an emerging element of precision medicine. While patients and doctors alike want these tests, they often don't benefit patients.","status":"publish","parent":0,"modified":1516295838,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1169},"headData":{"title":"Precision Medicine in Cancer Treatment Has Yet to Show Much Benefit for Patients | KQED","description":"Sequencing the DNA of cancer tumors to help pinpoint treatment is an emerging element of precision medicine. While patients and doctors alike want these tests, they often don't benefit patients.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Precision Medicine in Cancer Treatment Has Yet to Show Much Benefit for Patients","datePublished":"2018-01-18T17:13:23.000Z","dateModified":"2018-01-18T17:17:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"438487 https://ww2.kqed.org/futureofyou/?p=438487","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/01/18/precision-medicine-in-cancer-treatment-has-yet-to-show-much-benefit-for-patients/","disqusTitle":"Precision Medicine in Cancer Treatment Has Yet to Show Much Benefit for Patients","nprByline":"Richard Harris\u003cbr />NPR Shots","nprImageAgency":"Meredith Rizzo/NPR","nprStoryId":"572940706","nprApiLink":"http://api.npr.org/query?id=572940706&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/01/15/572940706/for-now-sequencing-cancer-tumors-holds-more-promise-than-proof?ft=nprml&f=572940706","nprRetrievedStory":"1","nprPubDate":"Mon, 15 Jan 2018 15:17:00 -0500","nprStoryDate":"Mon, 15 Jan 2018 04:44:00 -0500","nprLastModifiedDate":"Tue, 16 Jan 2018 08:12:12 -0500","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/01/20180115_me_for_now_sequencing_cancer_tumors_holds_more_promise_than_proof.mp3?orgId=1&topicId=1128&aggIds=577610728&d=388&p=3&story=572940706&ft=nprml&f=572940706","nprAudioM3u":"http://api.npr.org/m3u/1578083266-81ed15.m3u?orgId=1&topicId=1128&aggIds=577610728&d=388&p=3&story=572940706&ft=nprml&f=572940706","path":"/futureofyou/438487/precision-medicine-in-cancer-treatment-has-yet-to-show-much-benefit-for-patients","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/01/20180115_me_for_now_sequencing_cancer_tumors_holds_more_promise_than_proof.mp3?orgId=1&topicId=1128&aggIds=577610728&d=388&p=3&story=572940706&ft=nprml&f=572940706","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>People diagnosed with cancer understandably reach for the very best that medical science has to offer. That motivation is increasingly driving people to ask to have the DNA of their tumors sequenced. And while that's useful for some malignancies, the hype of precision medicine for cancer is getting far ahead of the facts.\u003c/p>\n\u003cp>It's easy to understand why that's the case. When you hear stories about the use of DNA sequencing to create individualized cancer treatment, chances are they are uplifting stories. Like that of Ben Stern.\u003c/p>\n\u003cp>In the spring of 2016, Stern was diagnosed with a deadly brain cancer, \u003ca href=\"http://www.abta.org/brain-tumor-information/types-of-tumors/glioblastoma.html\">glioblastoma\u003c/a>. His doctors at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins promptly treated him with surgery, then over the months, chemotherapy and radiation. He even got on a clinical trial to see if a leading edge drug called a checkpoint inhibitor would work.\u003c/p>\n\u003cp>Ben Stern found out abruptly that wasn't doing the trick either, when he was struck with a seizure. \"My whole right side clenched up and [my wife] Tara had called 911 in the middle of it.\"\u003c/p>\n\u003cp>The tumor had grown back, so surgeons went in again to remove what they could. Tara said the next month's appointment showed the surgery hadn't worked, either.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The tumor had already grown back and it was already bigger than the original size tumor that we had found the previous May,\" Tara Stern says. This staggering regrowth took only five weeks.\u003c/p>\n\u003cp>Stern's doctor got a sample of the tumor and sent a genetic analysis of it to what Hopkins calls its \"molecular tumor board.\" It's a small group of doctors who meet Mondays to review these genetic tests. They found an overactive gene in his tumor that's only rarely associated with brain cancer. But that mutation in other cancers sometimes responds to a particular drug. So Ben went on it as part of his ongoing treatment.\u003c/p>\n\u003cp>\"He started his next round of chemotherapy that Monday but he didn't seem to get weaker,\" Tara says, \"He was getting stronger almost every day. It was almost miraculous.\"\u003c/p>\n\u003cp>Ben says the drug even reversed his deteriorating mental state brought on by the brain tumor. At the next monthly appointment, following a brain scan, Ben and Tara got more good news.\u003c/p>\n\u003cp>\"The tumor was immeasurable on that next MRI,\" Tara says. \"It wasn't there, to put it bluntly.\"\u003c/p>\n\u003cp>Ben's eyes well up as he hears his wife telling the story. \"I was basically as I am now, which is in tears.\"\u003c/p>\n\u003cp>Eight months later, Ben was thinking ahead about his future, rather than wondering whether his life is ending.\u003c/p>\n\u003cp>\"We have to use this result with caution because we don't know how long this effect might wear on, but for the time being this is a clinically very meaningful benefit,\" says his doctor at Hopkins, medical oncologist \u003ca href=\"https://www.hopkinsmedicine.org/profiles/results/directory/profile/5037896/matthias-holdhoff\">Matthias Holdhoff\u003c/a>.\u003c/p>\n\u003cp>And while it's a good-news story for the field of precision medicine, it is also not the way most of these stories end.\u003c/p>\n\u003cp>\"We're getting better, but like many things in life, there's hope and hype. And that's also the reality with precision medicine right now,\" says \u003ca href=\"https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/breast_cancer_program/our_breast_cancer_experts/ben_parks.html\">Ben Park\u003c/a>, an oncology professor at the Sidney Kimmel Comprehensive Cancer Center at Hopkins. After noticing how much confusing genetic information was flooding doctors at Hopkins, he founded the molecular tumor board there.\u003c/p>\n\u003cp>\"The reason I started this tumor board [in 2013]... was simply because there was a patient, a young woman who had metastatic breast cancer who had a mutation on one of these reports and decided to forego standard-of-care therapies, which have been proven to actually prolong life in this setting,\" Park says. Instead, the woman enrolled in a clinical trial that didn't really make sense for her particular type of cancer and \"she almost died. She had really bad toxicity from the experimental drug.\"\u003c/p>\n\u003cp>She was drawn, Park says, by the allure of precision medicine. Patients and doctors alike are clamoring for these tests. But interpreting the results isn't easy because different companies offer these tests \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323161/\">and interpret the DNA signatures differently\u003c/a>, \"and that can make a huge difference,\" Park says.\u003c/p>\n\u003cp>\"That's where we're having difficulty right now as a field,\" he says, harmonizing test results that often disagree with each other.\u003c/p>\n\u003cp>At Hopkins, the genomic tests usually don't offer any suggestion for treatment. Only \u003ca href=\"http://ascopubs.org/doi/abs/10.1200/PO.16.00046\">about one quarter\u003c/a> of patients at Hopkins are steered toward particular drugs or toward ongoing clinical trials. Other top medical centers find they can identify potential treatments only about 10 percent of the time.\u003c/p>\n\u003cp>So far there's only been one randomized study of this approach to precision cancer care — and it \u003ca href=\"http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00188-6/abstract\">did not show a survival advantage\u003c/a> for people who went through all this genetic testing.\u003c/p>\n\u003cp>\"If you have this knowledge, it's not enough,\" Park says. \"You have to prove that acting on that knowledge — some medical intervention — will actually afford benefit for patients. That's the trickiest, toughest part about looking at all these types of genomic tests, to really prove that this is making a difference in the lives of our patients.\"\u003c/p>\n\u003cp>Park has since passed on leadership of the molecular tumor board to his colleague, oncologist \u003ca href=\"https://www.hopkinsmedicine.org/awomansjourney/baltimore/2017_conference/lauring.html\">Josh Lauring\u003c/a>. Lauring says there are a few cancers where DNA analysis does make a clear difference, say in melanoma and certain types of lung cancer.\u003c/p>\n\u003cp>\"In other cancers, it's really kind of an open question. At the same time, this testing is available commercially as well as at academic medical centers, and is being done. Patients want it, providers want it.\"\u003c/p>\n\u003cp>So what's happening, in effect, is a huge, unorganized experiment, involving real patients, treated differently in all sorts of settings. Lauring and colleagues at Hopkins are trying to keep track of all their patients: what treatment they got, how long it was successful, and how long the patients lived.\u003c/p>\n\u003cp>\"We think it's really important to capture that information as well, to try to learn from it,\" Lauring says, \"because in many cases it's not going to be effective, but in some it is, and it's important for us to figure that out.\"\u003c/p>\n\u003cp>Therapies that target specific genetic patterns are appealing because medical scientists have some sense of the biology underlying their drugs — they aren't just killing fast-growing cells, as conventional chemotherapy does.\u003c/p>\n\u003cp>\"Unfortunately in many cases these responses, if they occur, are relatively brief.\"\u003c/p>\n\u003cp>That unfortunately turned out to be the case for Ben Stern as well. Five months after his remarkable response, Ben started feeling weaker again. An MRI suggested the cancer might be on the move. So he went back to the hospital for another round of chemotherapy and radiation.\u003c/p>\n\u003cp>They're hoping for the best.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Contact Richard Harris at \u003ca href=\"mailto:rharris@npr.org\">rharris@npr.org\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Now%2C+Sequencing+Cancer+Tumors+Holds+More+Promise+Than+Proof&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/438487/precision-medicine-in-cancer-treatment-has-yet-to-show-much-benefit-for-patients","authors":["byline_futureofyou_438487"],"categories":["futureofyou_1062","futureofyou_1"],"tags":["futureofyou_103","futureofyou_112"],"featImg":"futureofyou_438488","label":"futureofyou"},"futureofyou_438146":{"type":"posts","id":"futureofyou_438146","meta":{"index":"posts_1591205157","site":"futureofyou","id":"438146","score":null,"sort":[1514989837000]},"guestAuthors":[],"slug":"precision-medicine-has-a-quality-control-problem","title":"Precision Medicine Has a Quality Control Problem","publishDate":1514989837,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>ou might not suspect that the success of the emerging field of precision medicine depends heavily on the couriers who push carts down hospital halls.\u003c/p>\n\u003cp>But samples taken during surgery may end up in poor shape by the time they get to the pathology lab — and that has serious implications for patients as well as for scientists who want to use that material to develop personalized tests and treatments that are safer and more effective.\u003c/p>\n\u003cp>Consider the story of a test that's commonly used to choose the right treatment for breast cancer patients. About a decade ago, pathologists realized that the \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706184/\">HER2 test\u003c/a>, which looks for a protein that promotes the growth of cancer cells, was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20524868\">wrong about 20 percent of the time\u003c/a>. As a result, some women were getting the wrong treatment. The trouble wasn't with the test itself — problems arose because the samples to be tested weren't handled carefully and consistently.\u003c/p>\n\u003cp>To reduce the error rate, doctors established guidelines in 2007 to assure that breast cancer specimens are handled correctly. But a decade later, that's still the only test that has such strict guidelines.\u003c/p>\n\u003cp>\u003cstrong>The weakest link in the quality chain\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Why are breast cancer patients special?\" asks Dr. \u003ca href=\"https://sols.asu.edu/people/carolyn-compton\">Carolyn Compton\u003c/a>, a pathologist and professor at Arizona State University. She has been pressuring her colleagues to improve tissue-handling standards for all types of cancer.\u003c/p>\n\u003cp>That means collecting samples quickly from the operating room, monitoring their condition, and getting them through the hospital to the pathology lab without delay.\u003c/p>\n\u003cp>\"I don't think physicians think this way about their entire medical system,\" she says. The process of delivering tissue samples to the pathology lab \"may be the weakest link in the quality chain.\"\u003c/p>\n\u003cp>This is not just a question about making sure each and every patient gets the most appropriate treatment. It affects the science behind new tests and treatments. Those tissue specimens often end up being preserved in huge collections called biobanks, which are a foundation for the field of precision medicine.\u003c/p>\n\u003cp>\"I don't see how we're going to get precision medicine at the end of the day, when everything under the hood is so imprecise,\" Compton says.\u003c/p>\n\u003cp>She is not alone in her concerns.\u003c/p>\n\u003cp>\"We need to be sure that the stuff they're looking at is valid, accurate, reliable and reproducible,\" says Dr. \u003ca href=\"https://www.baystatehealth.org/education-research/academic-departments/pathology/friedberg\">Richard Friedberg\u003c/a>, who has just finished his term as president of the College of American Pathologists. He is also chairman of pathology at the University of Massachusetts Medical School-Baystate.\u003c/p>\n\u003cp>And he agrees with Compton that the quality of samples ending up in biobanks is simply unknown.\u003c/p>\n\u003cp>\u003cstrong>'Garbage in, garbage out'\u003c/strong>\u003c/p>\n\u003cp>This isn't just about surgical samples. For example, he says, you can't tell just by looking at a tube of blood whether it's OK. \"If it was left on a window sill and hit 100 degrees, a lot of things change.\"\u003c/p>\n\u003cp>The fact is, you can still run a test and still get what looks like a valid result, \"but if it's garbage in, it's garbage out,\" Friedberg says.\u003c/p>\n\u003cp>Compton's concerns also extend to the complex, expensive equipment at the core of precision medicine, including machines that read DNA sequences. Results from one test are not necessarily comparable to results from another, run on an identical sample. And because each company that makes a sequencer uses proprietary algorithms to identify genetic mutations, it's not possible for laboratory scientists to make an independent judgement about which reading is more likely to be correct, she says.\u003c/p>\n\u003cp>The good news is that DNA samples are less sensitive to being affected by poor treatment, so sample handling is less of an issue for genetic studies. But when there are problems, \"you can't make up for a bad sample,\" Compton says. \"So even with all of this technological magic, you can't turn straw into gold with this machine.\"\u003c/p>\n\u003cp>And results from pathology labs are not even the biggest source of error in the growing field of precision medicine. Compounding the uncertainty is that patients' \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797550/\">electronic medical records are littered with all sorts of errors,\u003c/a> and that further complicates efforts to extract reliable results from this pool of \"big data.\"\u003c/p>\n\u003cp>But not everyone in the new world of precision medicine is so concerned about these quality-control issues.\u003c/p>\n\u003cp>\"I am not a believer in garbage-in, garbage out at all,\" says Dr. \u003ca href=\"http://profiles.ucsf.edu/atul.butte\">Atul Butte\u003c/a>, director of the Institute of Computational Health Sciences at the University of California-San Francisco. (He also holds a chair endowed by Mark Zuckerberg, who made himself rich by exploiting big data with Facebook).\u003c/p>\n\u003cp>\"I know that no one scientist, no one clinician or pathologist is perfect,\" Butte says. \"But I'd rather take 10 or 100 so-called mediocre data sets and find out what's in common, then to take one who says they're perfect at doing this kind of measurement.\"\u003c/p>\n\u003cp>\u003cstrong>Finding meaning in the 'noise' of big data\u003c/strong>\u003c/p>\n\u003cp>It's easier to find real things in clean data. But in the real world, he says, data are always full of errors. So when you find something in noisy data, it's more useful in real-world settings.\u003c/p>\n\u003cp>In Butte's view, it's far more important to make lots of noisy data available, and to as many scientists as possible. \"To me, I really want to see a world where I don't just see five or 10 or 20 companies working in particular area, I want a thousand drug companies. I want 10,000 drug companies.\"\u003c/p>\n\u003cp>Butte himself used noisy public data to identify genetic markers he says could be the basis for a test to help diagnose a serious complication of pregnancy, high blood pressure or preeclampsia. He founded a company to exploit that idea and then sold the company, so Butte considers his discovery a qualified success, even though human studies have not yet determined whether the test will be valid and useful.\u003c/p>\n\u003cp>Carolyn Compton says she's heard similar arguments about the value of noisy data from colleagues. She says one argued that if you have a pile of manure, maybe there's a pony in there somewhere. \"I don't see bending over backwards to create algorithms to do all the work to sort through all the manure when, in fact, you could have a pile of diamonds from the outset,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Funding agencies prize exploration over quality control research\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Compton has been pushing for more rigorous standards in specimen handling since she was an official at the National Cancer Institute a decade ago. But she says funding agencies are more interested in providing support for exploring new ideas than in funding basic research on a seemingly boring subject, such as understanding the consequences of mishandling tissue samples.\u003c/p>\n\u003cp>Concerns about quality control of tissue samples were a major subject of conversation at the College of American Pathologists' annual meeting in October. \"We are moving faster and faster and faster as this whole precision medicine train is moving down the track,\" says Dr. \u003ca href=\"https://www.utmb.edu/pathology/clinical/anatomic_pathology/\">Tim Allen\u003c/a>, a pathologist at the University of Texas Medical Branch in Galveston.\u003c/p>\n\u003cp>The struggle now is that there simply isn't enough data to make science-based recommendations, but \"I suspect standardization of these things is going to become a reality much quicker than I would have expected even a few years ago,\" Allen says.\u003c/p>\n\u003cp>In the meantime, samples of unknown quality continue to flood into biobanks. That's problematic because discoveries based on noisy data often turn out to be just plain wrong. So this enterprise inevitably will generate many false leads. And the expensive and most time-consuming part of research is finding out whether something that looks great in the lab actually works in people.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>You can contact Richard Harris via \u003c/em>\u003ca href=\"mailto:rharris@npr.org\">email\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Precision+Medical+Treatments+Have+A+Quality+Control+Problem&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"The goal is to customize treatments for cancer and other diseases to a patient's own biology. But something as simple as failing to take care of tissue samples en route to the lab can derail that.","status":"publish","parent":0,"modified":1515803070,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1327},"headData":{"title":"Precision Medicine Has a Quality Control Problem | KQED","description":"The goal is to customize treatments for cancer and other diseases to a patient's own biology. But something as simple as failing to take care of tissue samples en route to the lab can derail that.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Precision Medicine Has a Quality Control Problem","datePublished":"2018-01-03T14:30:37.000Z","dateModified":"2018-01-13T00:24:30.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"438146 https://ww2.kqed.org/futureofyou/?p=438146","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/01/03/precision-medicine-has-a-quality-control-problem/","disqusTitle":"Precision Medicine Has a Quality Control Problem","nprImageCredit":"David Silverman","nprByline":"Richard Harris\u003cbr />NPR Shots","nprImageAgency":"Getty Images","nprStoryId":"572853436","nprApiLink":"http://api.npr.org/query?id=572853436&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2017/12/29/572853436/precision-medical-treatments-have-a-quality-control-problem?ft=nprml&f=572853436","nprRetrievedStory":"1","nprPubDate":"Fri, 29 Dec 2017 18:13:00 -0500","nprStoryDate":"Fri, 29 Dec 2017 11:55:00 -0500","nprLastModifiedDate":"Fri, 29 Dec 2017 12:03:47 -0500","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/12/20171229_atc_precision_medical_treatments_have_a_quality_control_problem.mp3?orgId=1&topicId=1128&d=300&p=2&story=572853436&ft=nprml&f=572853436","nprAudioM3u":"http://api.npr.org/m3u/1574693669-1558e2.m3u?orgId=1&topicId=1128&d=300&p=2&story=572853436&ft=nprml&f=572853436","path":"/futureofyou/438146/precision-medicine-has-a-quality-control-problem","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/12/20171229_atc_precision_medical_treatments_have_a_quality_control_problem.mp3?orgId=1&topicId=1128&d=300&p=2&story=572853436&ft=nprml&f=572853436","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>ou might not suspect that the success of the emerging field of precision medicine depends heavily on the couriers who push carts down hospital halls.\u003c/p>\n\u003cp>But samples taken during surgery may end up in poor shape by the time they get to the pathology lab — and that has serious implications for patients as well as for scientists who want to use that material to develop personalized tests and treatments that are safer and more effective.\u003c/p>\n\u003cp>Consider the story of a test that's commonly used to choose the right treatment for breast cancer patients. About a decade ago, pathologists realized that the \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706184/\">HER2 test\u003c/a>, which looks for a protein that promotes the growth of cancer cells, was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20524868\">wrong about 20 percent of the time\u003c/a>. As a result, some women were getting the wrong treatment. The trouble wasn't with the test itself — problems arose because the samples to be tested weren't handled carefully and consistently.\u003c/p>\n\u003cp>To reduce the error rate, doctors established guidelines in 2007 to assure that breast cancer specimens are handled correctly. But a decade later, that's still the only test that has such strict guidelines.\u003c/p>\n\u003cp>\u003cstrong>The weakest link in the quality chain\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Why are breast cancer patients special?\" asks Dr. \u003ca href=\"https://sols.asu.edu/people/carolyn-compton\">Carolyn Compton\u003c/a>, a pathologist and professor at Arizona State University. She has been pressuring her colleagues to improve tissue-handling standards for all types of cancer.\u003c/p>\n\u003cp>That means collecting samples quickly from the operating room, monitoring their condition, and getting them through the hospital to the pathology lab without delay.\u003c/p>\n\u003cp>\"I don't think physicians think this way about their entire medical system,\" she says. The process of delivering tissue samples to the pathology lab \"may be the weakest link in the quality chain.\"\u003c/p>\n\u003cp>This is not just a question about making sure each and every patient gets the most appropriate treatment. It affects the science behind new tests and treatments. Those tissue specimens often end up being preserved in huge collections called biobanks, which are a foundation for the field of precision medicine.\u003c/p>\n\u003cp>\"I don't see how we're going to get precision medicine at the end of the day, when everything under the hood is so imprecise,\" Compton says.\u003c/p>\n\u003cp>She is not alone in her concerns.\u003c/p>\n\u003cp>\"We need to be sure that the stuff they're looking at is valid, accurate, reliable and reproducible,\" says Dr. \u003ca href=\"https://www.baystatehealth.org/education-research/academic-departments/pathology/friedberg\">Richard Friedberg\u003c/a>, who has just finished his term as president of the College of American Pathologists. He is also chairman of pathology at the University of Massachusetts Medical School-Baystate.\u003c/p>\n\u003cp>And he agrees with Compton that the quality of samples ending up in biobanks is simply unknown.\u003c/p>\n\u003cp>\u003cstrong>'Garbage in, garbage out'\u003c/strong>\u003c/p>\n\u003cp>This isn't just about surgical samples. For example, he says, you can't tell just by looking at a tube of blood whether it's OK. \"If it was left on a window sill and hit 100 degrees, a lot of things change.\"\u003c/p>\n\u003cp>The fact is, you can still run a test and still get what looks like a valid result, \"but if it's garbage in, it's garbage out,\" Friedberg says.\u003c/p>\n\u003cp>Compton's concerns also extend to the complex, expensive equipment at the core of precision medicine, including machines that read DNA sequences. Results from one test are not necessarily comparable to results from another, run on an identical sample. And because each company that makes a sequencer uses proprietary algorithms to identify genetic mutations, it's not possible for laboratory scientists to make an independent judgement about which reading is more likely to be correct, she says.\u003c/p>\n\u003cp>The good news is that DNA samples are less sensitive to being affected by poor treatment, so sample handling is less of an issue for genetic studies. But when there are problems, \"you can't make up for a bad sample,\" Compton says. \"So even with all of this technological magic, you can't turn straw into gold with this machine.\"\u003c/p>\n\u003cp>And results from pathology labs are not even the biggest source of error in the growing field of precision medicine. Compounding the uncertainty is that patients' \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797550/\">electronic medical records are littered with all sorts of errors,\u003c/a> and that further complicates efforts to extract reliable results from this pool of \"big data.\"\u003c/p>\n\u003cp>But not everyone in the new world of precision medicine is so concerned about these quality-control issues.\u003c/p>\n\u003cp>\"I am not a believer in garbage-in, garbage out at all,\" says Dr. \u003ca href=\"http://profiles.ucsf.edu/atul.butte\">Atul Butte\u003c/a>, director of the Institute of Computational Health Sciences at the University of California-San Francisco. (He also holds a chair endowed by Mark Zuckerberg, who made himself rich by exploiting big data with Facebook).\u003c/p>\n\u003cp>\"I know that no one scientist, no one clinician or pathologist is perfect,\" Butte says. \"But I'd rather take 10 or 100 so-called mediocre data sets and find out what's in common, then to take one who says they're perfect at doing this kind of measurement.\"\u003c/p>\n\u003cp>\u003cstrong>Finding meaning in the 'noise' of big data\u003c/strong>\u003c/p>\n\u003cp>It's easier to find real things in clean data. But in the real world, he says, data are always full of errors. So when you find something in noisy data, it's more useful in real-world settings.\u003c/p>\n\u003cp>In Butte's view, it's far more important to make lots of noisy data available, and to as many scientists as possible. \"To me, I really want to see a world where I don't just see five or 10 or 20 companies working in particular area, I want a thousand drug companies. I want 10,000 drug companies.\"\u003c/p>\n\u003cp>Butte himself used noisy public data to identify genetic markers he says could be the basis for a test to help diagnose a serious complication of pregnancy, high blood pressure or preeclampsia. He founded a company to exploit that idea and then sold the company, so Butte considers his discovery a qualified success, even though human studies have not yet determined whether the test will be valid and useful.\u003c/p>\n\u003cp>Carolyn Compton says she's heard similar arguments about the value of noisy data from colleagues. She says one argued that if you have a pile of manure, maybe there's a pony in there somewhere. \"I don't see bending over backwards to create algorithms to do all the work to sort through all the manure when, in fact, you could have a pile of diamonds from the outset,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Funding agencies prize exploration over quality control research\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Compton has been pushing for more rigorous standards in specimen handling since she was an official at the National Cancer Institute a decade ago. But she says funding agencies are more interested in providing support for exploring new ideas than in funding basic research on a seemingly boring subject, such as understanding the consequences of mishandling tissue samples.\u003c/p>\n\u003cp>Concerns about quality control of tissue samples were a major subject of conversation at the College of American Pathologists' annual meeting in October. \"We are moving faster and faster and faster as this whole precision medicine train is moving down the track,\" says Dr. \u003ca href=\"https://www.utmb.edu/pathology/clinical/anatomic_pathology/\">Tim Allen\u003c/a>, a pathologist at the University of Texas Medical Branch in Galveston.\u003c/p>\n\u003cp>The struggle now is that there simply isn't enough data to make science-based recommendations, but \"I suspect standardization of these things is going to become a reality much quicker than I would have expected even a few years ago,\" Allen says.\u003c/p>\n\u003cp>In the meantime, samples of unknown quality continue to flood into biobanks. That's problematic because discoveries based on noisy data often turn out to be just plain wrong. So this enterprise inevitably will generate many false leads. And the expensive and most time-consuming part of research is finding out whether something that looks great in the lab actually works in people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>You can contact Richard Harris via \u003c/em>\u003ca href=\"mailto:rharris@npr.org\">email\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Precision+Medical+Treatments+Have+A+Quality+Control+Problem&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/438146/precision-medicine-has-a-quality-control-problem","authors":["byline_futureofyou_438146"],"categories":["futureofyou_1","futureofyou_1064"],"tags":["futureofyou_112"],"featImg":"futureofyou_438147","label":"futureofyou"},"futureofyou_438138":{"type":"posts","id":"futureofyou_438138","meta":{"index":"posts_1591205157","site":"futureofyou","id":"438138","score":null,"sort":[1514903453000]},"guestAuthors":[],"slug":"precision-medicine-skeptic-asks-if-were-building-biological-tower-of-babel","title":"Precision Medicine Skeptic: Are We Building 'Biological Tower of Babel'","publishDate":1514903453,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>The Mayo Clinic is building its future around high-tech approaches to research known as \"precision medicine.\" This involves gathering huge amounts of information from genetic tests, medical records and other data sources to ferret out unexpected ideas to advance health. But one longtime scientist at the Mayo Clinic isn't playing along.\u003c/p>\n\u003cp>Dr. \u003ca href=\"http://www.mayo.edu/research/faculty/joyner-michael-j-m-d/bio-00078027\">Michael Joyner\u003c/a> is a skeptical voice in a sea of eager advocates. Joyner's lab studies exercise. It is, fittingly enough, in a hospital building founded in the 1880s. While Mayo has built all sorts of new labs at its sprawling campus in Rochester, Minn., Joyner can conduct his work without glitzy DNA sequencers and other high-tech tools of precision medicine.\u003c/p>\n\u003cp>And it's not simply that he's an old-school devotee. He believes that the solution to our most pressing health problems lies in thinking about whole human beings, not breaking everything down to DNA sequences.\u003c/p>\n\u003cp>\"The enthusiasm for this [precision medicine] is occurring in a country where life expectancy is \u003ca href=\"https://www.npr.org/sections/health-shots/2017/12/21/572080314/life-expectancy-drops-again-as-opioid-deaths-surge-in-u-s\">actually falling\u003c/a>,\" he says as he walks through the old linoleum-tiled halls of St. Mary's hospital.\u003c/p>\n\u003cp>That fact alone leads Joyner to ask whether the money being poured into high-tech medical research is really solving the nation's stark health problems, like obesity, heart disease, high blood pressure, diabetes, Alzheimer's disease and cancer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Joyner says there are certainly appropriate places to use this technology, and he doesn't dispute the individual stories of success his colleagues tout. But he believes the best way to address the health concerns facing the nation is by studying — and treating — whole people, not by breaking the problems down to billions of genetic bits and pieces.\u003c/p>\n\u003cp>He practices what he preaches in both his personal life — his thorough exercise routine includes commuting by bicycle — and his physiology lab.\u003c/p>\n\u003cp>On the day I visited at the end of August, volunteer Greg Ruegsegger was outfitted with monitors, a catheter threaded into a vein and a mask to capture his breath. He would exercise to the point of exhaustion while scientists studied him. This is far more informative than any genetic test, Joyner says.\u003c/p>\n\u003cp>\"People have looked at 3,000 elite endurance athletes — these are people who compete in the Tour de France and win Olympic medals in cross-country skiing and distance running — and [scientists] have been unable to find any genetic marker for superior performance.\"\u003c/p>\n\u003cp>And when it comes to the health of ordinary people, Joyner talks about \u003ca href=\"http://www.bmj.com/content/349/bmj.g4887\">real-world studies\u003c/a>, which show that walking or biking to work has four- or fivefold more influence on a person's body mass index than that person's genetic profile.\u003c/p>\n\u003cp>Joyner is focused on how the body's systems work together during exercise, but the same interconnectedness applies to many diseases. That's why cancer drugs that target one biological pathway generally don't last long. Tumor cells simply find workarounds, exploiting the redundancies deeply embedded in biology. And that's why Joyner has so little faith in science that keeps trying to focus down on smaller and smaller details.\u003c/p>\n\u003cp>\"One of the things we have to ask ourselves when we get these big initiatives is, 'What's the definition of success?' \" he says.\u003c/p>\n\u003cp>Scientific discoveries alone don't do it for him. Doctors need to build effective treatments — and patients need to follow along. This is the promise of precision medicine in the long run, but Joyner has published articles (\u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2344586?redirect=true\">like this one\u003c/a>) skeptical of the drive to collect vast piles of information, hoping to make sense of it later.\u003c/p>\n\u003cp>\"Is this just going to be a biological Tower of Babel,\" he asks, or will this information also lead to discoveries that translate beyond the laboratory and actually change public health for the better?\u003c/p>\n\u003cp>He doesn't doubt that DNA sequencing and other tools of precision medicine are useful in specific instances, such as for diagnosing rare diseases. There are a few uses in cancer treatment, but so far there has been just \u003ca href=\"http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00188-6/abstract\">one randomized study\u003c/a> of patients assigned to treatments based on their tumor's DNA profile, and it showed no advantage over traditional medical judgment.\u003c/p>\n\u003cp>This isn't a popular point of view elsewhere at the Mayo Clinic, which is sinking hundreds of millions of dollars a year into precision medicine. The shiny new labs across campus seem a world apart from Joyner's physiology lab.\u003c/p>\n\u003cp>After my conversation with Joyner, Mayo public affairs officers eagerly led me to a series of scientists there who disagree with him. One stop was at the Medical Genome Facility.\u003c/p>\n\u003cp>This room is chock-full of machines that cost many hundreds of thousands of dollars apiece. They can analyze DNA from a person, a tumor or even a single human cell. They can read out an entire genome, or just a subset, which is called the exome.\u003c/p>\n\u003cp>\"I really do believe that understanding our genome is fundamental,\" says \u003ca href=\"http://www.mayo.edu/research/faculty/cunningham-julie-m-ph-d/bio-00078368\">Julie Cunningham\u003c/a>, one of the facility's three co-directors. Like other scientists at Mayo, she has had swaths of her own exome sequenced.\u003c/p>\n\u003cp>\"I learned that by and large I'm really lucky, but I learned that I have two [genetic] variants that affect how I respond to particular drugs that are out there.\" She had actually known that before for one of those drugs, \"but now I know exactly why I have it and it's potentially serious. That has to be good. There's nothing wrong with that.\"\u003c/p>\n\u003cp>Bad drug reactions are a serious medical problem, so in principle, a genome profile should help reduce that risk. The reality, though, is that the vast majority of genomic tests for drug sensitivity \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351041/\">give ambiguous answers\u003c/a>.\u003c/p>\n\u003cp>One of the most carefully studied examples involves the blood thinner warfarin. Four separate studies show that people who got genomic testing for this susceptibility \u003ca href=\"https://www.nih.gov/news-events/nih-research-matters/genetic-testing-doesnt-improve-warfarin-dosing\">did no better\u003c/a> — \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2654820?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jama.2017.11465\">or only marginally better\u003c/a> — than patients whose dosages were determined by traditional strategies.\u003c/p>\n\u003cp>This lack of strong data is a problem for many areas of precision medicine.\u003c/p>\n\u003cp>\"Although we think conceptually this is going to be of high value, and it will ultimately improve health care with better quality and lower cost, we have to prove that,\" says \u003ca href=\"http://www.mayo.edu/research/faculty/stewart-keith-m-b-ch-b/bio-00027952\">Keith Stewart\u003c/a>, a hematologist who directs Mayo's Center for Individualized Medicine. \"If it doesn't all pan out the way we expect that's OK. But I think there will be plenty of unexpected areas that we haven't conceptualized yet, so I think it's a very worthwhile investment on the taxpayers' point of view.\"\u003c/p>\n\u003cp>Whether precision medicine is going to be a boom or a bust, \"right now it's just speculation on both sides,\" he says.\u003c/p>\n\u003cp>\"It is somewhat inevitable that every person in this country will have their genome sequenced.\" he adds.\u003c/p>\n\u003cp>Gianrico Farrugia, a gastroenterologist who is chief executive officer of the Mayo Clinic in Florida, agrees.\u003c/p>\n\u003cp>\"What we're beginning to see is that technology is invading and replacing traditional testing,\" says Farrugia. For example, it is already used to determine treatments for lung cancer and diagnose rare diseases.\u003c/p>\n\u003cp>And, in any event, he says medicine is already moving aggressively into this new territory and there's no going back. \"That's not only wrong,\" he says, \"it's impossible.\"\u003c/p>\n\u003cp>With the momentum now built up behind this enterprise, precision medicine will be judged like much of modern medicine: in hindsight, after it becomes entrenched in clinical practice.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>You can contact Richard Harris via \u003c/em>\u003ca href=\"mailto:rharris@npr.org\">email\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Will+Gathering+Vast+Troves+of+Information+Really+Lead+To+Better+Health%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Hundreds of millions of dollars are pouring into research labs in an effort to collect genetic information on a million people. But some skeptics say the focus should be on humans themselves, not DNA.","status":"publish","parent":0,"modified":1515803116,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":33,"wordCount":1270},"headData":{"title":"Precision Medicine Skeptic: Are We Building 'Biological Tower of Babel' | KQED","description":"Hundreds of millions of dollars are pouring into research labs in an effort to collect genetic information on a million people. But some skeptics say the focus should be on humans themselves, not DNA.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Precision Medicine Skeptic: Are We Building 'Biological Tower of Babel'","datePublished":"2018-01-02T14:30:53.000Z","dateModified":"2018-01-13T00:25:16.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"438138 https://ww2.kqed.org/futureofyou/?p=438138","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/01/02/precision-medicine-skeptic-asks-if-were-building-biological-tower-of-babel/","disqusTitle":"Precision Medicine Skeptic: Are We Building 'Biological Tower of Babel'","nprByline":"Richard Harris\u003cbr />NPR Shots","nprImageAgency":"Richard Harris/NPR","nprStoryId":"572677879","nprApiLink":"http://api.npr.org/query?id=572677879&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2017/12/28/572677879/will-gathering-vast-troves-of-information-really-lead-to-better-health?ft=nprml&f=572677879","nprRetrievedStory":"1","nprPubDate":"Thu, 28 Dec 2017 20:25:00 -0500","nprStoryDate":"Thu, 28 Dec 2017 15:55:00 -0500","nprLastModifiedDate":"Thu, 28 Dec 2017 18:05:47 -0500","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/12/20171228_atc_will_gathering_vast_troves_of_information_really_lead_to_better_health.mp3?orgId=1&topicId=1128&d=438&p=2&story=572677879&ft=nprml&f=572677879","nprAudioM3u":"http://api.npr.org/m3u/1574314972-110475.m3u?orgId=1&topicId=1128&d=438&p=2&story=572677879&ft=nprml&f=572677879","path":"/futureofyou/438138/precision-medicine-skeptic-asks-if-were-building-biological-tower-of-babel","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/12/20171228_atc_will_gathering_vast_troves_of_information_really_lead_to_better_health.mp3?orgId=1&topicId=1128&d=438&p=2&story=572677879&ft=nprml&f=572677879","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Mayo Clinic is building its future around high-tech approaches to research known as \"precision medicine.\" This involves gathering huge amounts of information from genetic tests, medical records and other data sources to ferret out unexpected ideas to advance health. But one longtime scientist at the Mayo Clinic isn't playing along.\u003c/p>\n\u003cp>Dr. \u003ca href=\"http://www.mayo.edu/research/faculty/joyner-michael-j-m-d/bio-00078027\">Michael Joyner\u003c/a> is a skeptical voice in a sea of eager advocates. Joyner's lab studies exercise. It is, fittingly enough, in a hospital building founded in the 1880s. While Mayo has built all sorts of new labs at its sprawling campus in Rochester, Minn., Joyner can conduct his work without glitzy DNA sequencers and other high-tech tools of precision medicine.\u003c/p>\n\u003cp>And it's not simply that he's an old-school devotee. He believes that the solution to our most pressing health problems lies in thinking about whole human beings, not breaking everything down to DNA sequences.\u003c/p>\n\u003cp>\"The enthusiasm for this [precision medicine] is occurring in a country where life expectancy is \u003ca href=\"https://www.npr.org/sections/health-shots/2017/12/21/572080314/life-expectancy-drops-again-as-opioid-deaths-surge-in-u-s\">actually falling\u003c/a>,\" he says as he walks through the old linoleum-tiled halls of St. Mary's hospital.\u003c/p>\n\u003cp>That fact alone leads Joyner to ask whether the money being poured into high-tech medical research is really solving the nation's stark health problems, like obesity, heart disease, high blood pressure, diabetes, Alzheimer's disease and cancer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Joyner says there are certainly appropriate places to use this technology, and he doesn't dispute the individual stories of success his colleagues tout. But he believes the best way to address the health concerns facing the nation is by studying — and treating — whole people, not by breaking the problems down to billions of genetic bits and pieces.\u003c/p>\n\u003cp>He practices what he preaches in both his personal life — his thorough exercise routine includes commuting by bicycle — and his physiology lab.\u003c/p>\n\u003cp>On the day I visited at the end of August, volunteer Greg Ruegsegger was outfitted with monitors, a catheter threaded into a vein and a mask to capture his breath. He would exercise to the point of exhaustion while scientists studied him. This is far more informative than any genetic test, Joyner says.\u003c/p>\n\u003cp>\"People have looked at 3,000 elite endurance athletes — these are people who compete in the Tour de France and win Olympic medals in cross-country skiing and distance running — and [scientists] have been unable to find any genetic marker for superior performance.\"\u003c/p>\n\u003cp>And when it comes to the health of ordinary people, Joyner talks about \u003ca href=\"http://www.bmj.com/content/349/bmj.g4887\">real-world studies\u003c/a>, which show that walking or biking to work has four- or fivefold more influence on a person's body mass index than that person's genetic profile.\u003c/p>\n\u003cp>Joyner is focused on how the body's systems work together during exercise, but the same interconnectedness applies to many diseases. That's why cancer drugs that target one biological pathway generally don't last long. Tumor cells simply find workarounds, exploiting the redundancies deeply embedded in biology. And that's why Joyner has so little faith in science that keeps trying to focus down on smaller and smaller details.\u003c/p>\n\u003cp>\"One of the things we have to ask ourselves when we get these big initiatives is, 'What's the definition of success?' \" he says.\u003c/p>\n\u003cp>Scientific discoveries alone don't do it for him. Doctors need to build effective treatments — and patients need to follow along. This is the promise of precision medicine in the long run, but Joyner has published articles (\u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2344586?redirect=true\">like this one\u003c/a>) skeptical of the drive to collect vast piles of information, hoping to make sense of it later.\u003c/p>\n\u003cp>\"Is this just going to be a biological Tower of Babel,\" he asks, or will this information also lead to discoveries that translate beyond the laboratory and actually change public health for the better?\u003c/p>\n\u003cp>He doesn't doubt that DNA sequencing and other tools of precision medicine are useful in specific instances, such as for diagnosing rare diseases. There are a few uses in cancer treatment, but so far there has been just \u003ca href=\"http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00188-6/abstract\">one randomized study\u003c/a> of patients assigned to treatments based on their tumor's DNA profile, and it showed no advantage over traditional medical judgment.\u003c/p>\n\u003cp>This isn't a popular point of view elsewhere at the Mayo Clinic, which is sinking hundreds of millions of dollars a year into precision medicine. The shiny new labs across campus seem a world apart from Joyner's physiology lab.\u003c/p>\n\u003cp>After my conversation with Joyner, Mayo public affairs officers eagerly led me to a series of scientists there who disagree with him. One stop was at the Medical Genome Facility.\u003c/p>\n\u003cp>This room is chock-full of machines that cost many hundreds of thousands of dollars apiece. They can analyze DNA from a person, a tumor or even a single human cell. They can read out an entire genome, or just a subset, which is called the exome.\u003c/p>\n\u003cp>\"I really do believe that understanding our genome is fundamental,\" says \u003ca href=\"http://www.mayo.edu/research/faculty/cunningham-julie-m-ph-d/bio-00078368\">Julie Cunningham\u003c/a>, one of the facility's three co-directors. Like other scientists at Mayo, she has had swaths of her own exome sequenced.\u003c/p>\n\u003cp>\"I learned that by and large I'm really lucky, but I learned that I have two [genetic] variants that affect how I respond to particular drugs that are out there.\" She had actually known that before for one of those drugs, \"but now I know exactly why I have it and it's potentially serious. That has to be good. There's nothing wrong with that.\"\u003c/p>\n\u003cp>Bad drug reactions are a serious medical problem, so in principle, a genome profile should help reduce that risk. The reality, though, is that the vast majority of genomic tests for drug sensitivity \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351041/\">give ambiguous answers\u003c/a>.\u003c/p>\n\u003cp>One of the most carefully studied examples involves the blood thinner warfarin. Four separate studies show that people who got genomic testing for this susceptibility \u003ca href=\"https://www.nih.gov/news-events/nih-research-matters/genetic-testing-doesnt-improve-warfarin-dosing\">did no better\u003c/a> — \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2654820?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jama.2017.11465\">or only marginally better\u003c/a> — than patients whose dosages were determined by traditional strategies.\u003c/p>\n\u003cp>This lack of strong data is a problem for many areas of precision medicine.\u003c/p>\n\u003cp>\"Although we think conceptually this is going to be of high value, and it will ultimately improve health care with better quality and lower cost, we have to prove that,\" says \u003ca href=\"http://www.mayo.edu/research/faculty/stewart-keith-m-b-ch-b/bio-00027952\">Keith Stewart\u003c/a>, a hematologist who directs Mayo's Center for Individualized Medicine. \"If it doesn't all pan out the way we expect that's OK. But I think there will be plenty of unexpected areas that we haven't conceptualized yet, so I think it's a very worthwhile investment on the taxpayers' point of view.\"\u003c/p>\n\u003cp>Whether precision medicine is going to be a boom or a bust, \"right now it's just speculation on both sides,\" he says.\u003c/p>\n\u003cp>\"It is somewhat inevitable that every person in this country will have their genome sequenced.\" he adds.\u003c/p>\n\u003cp>Gianrico Farrugia, a gastroenterologist who is chief executive officer of the Mayo Clinic in Florida, agrees.\u003c/p>\n\u003cp>\"What we're beginning to see is that technology is invading and replacing traditional testing,\" says Farrugia. For example, it is already used to determine treatments for lung cancer and diagnose rare diseases.\u003c/p>\n\u003cp>And, in any event, he says medicine is already moving aggressively into this new territory and there's no going back. \"That's not only wrong,\" he says, \"it's impossible.\"\u003c/p>\n\u003cp>With the momentum now built up behind this enterprise, precision medicine will be judged like much of modern medicine: in hindsight, after it becomes entrenched in clinical practice.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>You can contact Richard Harris via \u003c/em>\u003ca href=\"mailto:rharris@npr.org\">email\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Will+Gathering+Vast+Troves+of+Information+Really+Lead+To+Better+Health%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/438138/precision-medicine-skeptic-asks-if-were-building-biological-tower-of-babel","authors":["byline_futureofyou_438138"],"categories":["futureofyou_1","futureofyou_1064"],"tags":["futureofyou_29","futureofyou_112"],"featImg":"futureofyou_438139","label":"futureofyou"},"futureofyou_435119":{"type":"posts","id":"futureofyou_435119","meta":{"index":"posts_1591205157","site":"futureofyou","id":"435119","score":null,"sort":[1504162872000]},"guestAuthors":[],"slug":"pioneering-cancer-drug-just-approved-to-cost-475000-and-analysts-say-its-a-bargain","title":"Pioneering Cancer Drug to Cost $475,000 — and Analysts Say It's a Bargain","publishDate":1504162872,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>The Food and Drug Administration on Wednesday approved a futuristic new approach to treating cancer, clearing a Novartis therapy that has produced unprecedented results in patients with a rare and deadly cancer. The price tag: $475,000 for a course of treatment.\u003c/p>\n\u003cp>That sounds staggering to many patients — but it’s far less than analysts expected.\u003c/p>\n\u003cp>The therapy, called a CAR-T, is made by harvesting patients’ white blood cells and rewiring them to home in on tumors. Novartis’s product is the first CAR-T therapy to come before the FDA, leading a pack of novel treatments that promise to change the standard of care for certain aggressive blood cancers.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I think this is most exciting thing I’ve seen in my lifetime.’\u003ccite>Tim Cripe, oncologist with Nationwide Children’s Hospital at an FDA meeting on Kymriah in July\u003c/cite>\u003c/aside>\n\u003cp>Novartis’s therapy is approved to treat children and young adults with relapsed acute lymphoblastic leukemia. It will be marketed as Kymriah.\u003c/p>\n\u003cp>The treatment’s approval has looked a foregone conclusion for months, but its potential price has been the subject of speculation and debate. Novartis picked the $475,000 price tag in an effort to balance patient access to Kymriah while giving the company a return on its investment, said Bruno Strigini, Novartis’s head of oncology, in a conference call Wednesday. The cost is below Wall Street analyst expectations, which reached as high as $750,000 for a dose. And it’s considerably cheaper than the roughly $700,000 price tag that U.K. regulators said would be fair considering Kymriah’s potential benefits.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"QG4PnjDFa7wR6mRKag9nuRtDY12MT3jG\"]Novartis also said it is working with Medicare on a system in which the government would only pay for CAR-T treatment if patients respond within a month.\u003c/p>\n\u003cp>In a clinical trial, a single dose of Kymriah left 83 percent of participants cancer-free after three months, \u003ca href=\"https://www.statnews.com/2017/07/12/novartis-car-t-fda-approval/\">results oncologists have hailed as a major advance\u003c/a> for patients with few other options. The most frequent side effect was an inflammatory storm called cytokine release syndrome, a reaction to CAR-T that can prove fatal in some patients but is commonly controlled with immunosuppressant drugs.\u003c/p>\n\u003cp>“I think this is most exciting thing I’ve seen in my lifetime,” said Dr. Tim Cripe, an oncologist with Nationwide Children’s Hospital, at an FDA meeting on Kymriah in July.\u003c/p>\n\u003cp>Unlike well-understood pills and commonly injected biotech drugs, CAR-T presents a radical new paradigm for doctors, regulators, and payers. Each dose is custom-tailored for an individual patient, requiring a complex process in which human cells must be safely ferried across the country, reliably re-engineered, and soundly returned.\u003c/p>\n\u003cp>That creates logistical issues unseen with previous drugs. To get Kymriah, patients will have to travel to one of just 32 sites around the country. From there, doctors harvest patients’ white blood cells and ship them off to a Novartis facility in New Jersey where they can be edited and mailed back. The entire process takes about 22 days, the company said. And the $450,000 price tag covers only Novartis’s role, not the costs of travel, hospitalization, or any drugs needed to tamp down Kymriah’s side effects.\u003c/p>\n\u003cp>And it remains unclear just how lucrative a business opportunity Kymriah presents. There are about 3,100 new cases of ALL each year, but roughly 70 percent can be pushed into remission by standard therapy. That could leave just a few hundred patients who might be eligible for Novartis’s therapy, casting doubt on whether the company can get an outsize return on what will be a substantial manufacturing investment.\u003c/p>\n\u003cp>But CAR-T’s potential goes far beyond Wednesday’s approval.\u003c/p>\n\u003cp>Novartis is developing Kymriah for use in lymphoma, and its pipeline includes other CAR-T therapies targeting an array of blood cancers. Kite Pharma, soon to be \u003ca href=\"https://www.statnews.com/2017/08/28/gilead-kite-car-t-cancer/\">acquired by Gilead Sciences\u003c/a>, is awaiting FDA approval for a lymphoma therapy and is, like Novartis, developing a bevy of cell therapies it hopes can treat tumors liquid and solid. Juno Therapeutics, which slipped into a third place after its \u003ca href=\"https://www.statnews.com/2017/03/01/juno-cancer-treatment/\">lead CAR-T ran into safety problems\u003c/a>, has a similar focus.\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/\" target=\"_blank\" rel=\"noopener noreferrer\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"The FDA on Wednesday approved a futuristic new cancer treatment, and Novartis said it would charge $475,000 for it. Analysts had expected a higher price.","status":"publish","parent":0,"modified":1504194097,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":750},"headData":{"title":"Pioneering Cancer Drug to Cost $475,000 — and Analysts Say It's a Bargain | KQED","description":"The FDA on Wednesday approved a futuristic new cancer treatment, and Novartis said it would charge $475,000 for it. Analysts had expected a higher price.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Pioneering Cancer Drug to Cost $475,000 — and Analysts Say It's a Bargain","datePublished":"2017-08-31T07:01:12.000Z","dateModified":"2017-08-31T15:41:37.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"435119 https://ww2.kqed.org/futureofyou/?p=435119","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/08/31/pioneering-cancer-drug-just-approved-to-cost-475000-and-analysts-say-its-a-bargain/","disqusTitle":"Pioneering Cancer Drug to Cost $475,000 — and Analysts Say It's a Bargain","nprByline":"Damian Garde\u003c/br>\u003ca href=\"https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/\">STAT\u003c/a>","path":"/futureofyou/435119/pioneering-cancer-drug-just-approved-to-cost-475000-and-analysts-say-its-a-bargain","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration on Wednesday approved a futuristic new approach to treating cancer, clearing a Novartis therapy that has produced unprecedented results in patients with a rare and deadly cancer. The price tag: $475,000 for a course of treatment.\u003c/p>\n\u003cp>That sounds staggering to many patients — but it’s far less than analysts expected.\u003c/p>\n\u003cp>The therapy, called a CAR-T, is made by harvesting patients’ white blood cells and rewiring them to home in on tumors. Novartis’s product is the first CAR-T therapy to come before the FDA, leading a pack of novel treatments that promise to change the standard of care for certain aggressive blood cancers.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I think this is most exciting thing I’ve seen in my lifetime.’\u003ccite>Tim Cripe, oncologist with Nationwide Children’s Hospital at an FDA meeting on Kymriah in July\u003c/cite>\u003c/aside>\n\u003cp>Novartis’s therapy is approved to treat children and young adults with relapsed acute lymphoblastic leukemia. It will be marketed as Kymriah.\u003c/p>\n\u003cp>The treatment’s approval has looked a foregone conclusion for months, but its potential price has been the subject of speculation and debate. Novartis picked the $475,000 price tag in an effort to balance patient access to Kymriah while giving the company a return on its investment, said Bruno Strigini, Novartis’s head of oncology, in a conference call Wednesday. The cost is below Wall Street analyst expectations, which reached as high as $750,000 for a dose. And it’s considerably cheaper than the roughly $700,000 price tag that U.K. regulators said would be fair considering Kymriah’s potential benefits.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Novartis also said it is working with Medicare on a system in which the government would only pay for CAR-T treatment if patients respond within a month.\u003c/p>\n\u003cp>In a clinical trial, a single dose of Kymriah left 83 percent of participants cancer-free after three months, \u003ca href=\"https://www.statnews.com/2017/07/12/novartis-car-t-fda-approval/\">results oncologists have hailed as a major advance\u003c/a> for patients with few other options. The most frequent side effect was an inflammatory storm called cytokine release syndrome, a reaction to CAR-T that can prove fatal in some patients but is commonly controlled with immunosuppressant drugs.\u003c/p>\n\u003cp>“I think this is most exciting thing I’ve seen in my lifetime,” said Dr. Tim Cripe, an oncologist with Nationwide Children’s Hospital, at an FDA meeting on Kymriah in July.\u003c/p>\n\u003cp>Unlike well-understood pills and commonly injected biotech drugs, CAR-T presents a radical new paradigm for doctors, regulators, and payers. Each dose is custom-tailored for an individual patient, requiring a complex process in which human cells must be safely ferried across the country, reliably re-engineered, and soundly returned.\u003c/p>\n\u003cp>That creates logistical issues unseen with previous drugs. To get Kymriah, patients will have to travel to one of just 32 sites around the country. From there, doctors harvest patients’ white blood cells and ship them off to a Novartis facility in New Jersey where they can be edited and mailed back. The entire process takes about 22 days, the company said. And the $450,000 price tag covers only Novartis’s role, not the costs of travel, hospitalization, or any drugs needed to tamp down Kymriah’s side effects.\u003c/p>\n\u003cp>And it remains unclear just how lucrative a business opportunity Kymriah presents. There are about 3,100 new cases of ALL each year, but roughly 70 percent can be pushed into remission by standard therapy. That could leave just a few hundred patients who might be eligible for Novartis’s therapy, casting doubt on whether the company can get an outsize return on what will be a substantial manufacturing investment.\u003c/p>\n\u003cp>But CAR-T’s potential goes far beyond Wednesday’s approval.\u003c/p>\n\u003cp>Novartis is developing Kymriah for use in lymphoma, and its pipeline includes other CAR-T therapies targeting an array of blood cancers. Kite Pharma, soon to be \u003ca href=\"https://www.statnews.com/2017/08/28/gilead-kite-car-t-cancer/\">acquired by Gilead Sciences\u003c/a>, is awaiting FDA approval for a lymphoma therapy and is, like Novartis, developing a bevy of cell therapies it hopes can treat tumors liquid and solid. Juno Therapeutics, which slipped into a third place after its \u003ca href=\"https://www.statnews.com/2017/03/01/juno-cancer-treatment/\">lead CAR-T ran into safety problems\u003c/a>, has a similar focus.\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/\" target=\"_blank\" rel=\"noopener noreferrer\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/435119/pioneering-cancer-drug-just-approved-to-cost-475000-and-analysts-say-its-a-bargain","authors":["byline_futureofyou_435119"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_1064"],"tags":["futureofyou_103","futureofyou_1275","futureofyou_1209","futureofyou_112"],"featImg":"futureofyou_435120","label":"futureofyou"},"futureofyou_400200":{"type":"posts","id":"futureofyou_400200","meta":{"index":"posts_1591205157","site":"futureofyou","id":"400200","score":null,"sort":[1496852709000]},"guestAuthors":[],"slug":"a-netflix-approach-to-treating-cancer","title":"A Netflix Approach to Treating Cancer","publishDate":1496852709,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Two years ago, former President Barack Obama announced the \u003ca href=\"https://obamawhitehouse.archives.gov/precision-medicine\">Precision Medicine initiative\u003c/a> in his State of the Union Address. The initiative aspired to a “new era of medicine” where disease treatments could be specifically tailored to each patient’s genetic code.\u003c/p>\n\u003cp>This resonated soundly in cancer medicine. Patients can already manage their cancer with therapies that target the specific genes that are altered in their particular tumor. For example, women with a type of breast cancer caused by the amplification of gene HER2 are often treated with a therapeutic called herceptin. Because these targeted therapeutics are specific to cancer cells, they tend to have fewer side effects than traditional cancer treatments with chemotherapy or radiation.\u003c/p>\n\u003cp>However, such treatments are not available for most cancer patients. In many cancers, the specific genetic alterations that are responsible for a cancer remain unknown. To create individualized cancer treatments, we must know more about the functional genetic alterations.\u003c/p>\n\u003cp>With data on cancer genetics growing rapidly, mathematics and statistics can now help unlock the hidden patterns in this data to find the genes that are responsible for an individual’s cancer. With this knowledge, physicians can select appropriate treatments that block the action of these genes to personalize therapies for individual patients. My research aims to improve precision medicine in cancer – by building on the same methods that have been used to find patterns in Netflix movie ratings.\u003c/p>\n\u003cp>\u003cstrong>Sifting Through the Data\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Today, there is unprecedented public access to cancer genetics data. These data come from generous patients who donate their tumor samples for research. Scientists then apply sequencing technologies to measure the mutations and activity in each of the 20,000 genes in the human genome.\u003c/p>\n\u003cp>All these data are a direct result of the \u003ca href=\"http://www.nature.com/nature/journal/v431/n7011/full/nature03001.html\">Human Genome Project\u003c/a> in 2003. That project determined the sequence for all the genes that make up healthy human DNA. Since the completion of that project, the cost of sequencing the human genome has \u003ca href=\"http://www.nature.com/news/technology-the-1-000-genome-1.14901\">more than halved every year\u003c/a>, surpassing the growth of computing power described in \u003ca href=\"https://theconversation.com/moores-law-is-50-years-old-but-will-it-continue-44511\">Moore’s Law\u003c/a>. This cost reduction enables researches to collect unprecedented genetics data from cancer patients.\u003c/p>\n\u003cp>Most scientific studies on cancer genetics performed worldwide release their data to a centralized, public database provided by the U.S. National Institutes of Health (NIH) National Library of Medicine. The NIH National Cancer Institute and National Human Genome Research Institute have also freely released genetic data from over 11,000 tumors in 33 cancer types through a project called \u003ca href=\"https://cancergenome.nih.gov/\">The Cancer Genome Atlas.\u003c/a>\u003c/p>\n\u003cp>Every biological function – from extracting energy from food to healing a wound – results from activity in different combinations of genes. Cancers hijack the genes that enable people to grow to adulthood and that protect the body from the immune system. Researchers dub these the \u003ca href=\"http://www.cell.com/abstract/S0092-8674(11)00127-9\">“hallmarks of cancer.”\u003c/a> This so-called gene dysregulation enables a tumor to grow uncontrollably and form metastases in distant organs from the original tumor site.\u003c/p>\n\u003cp>Researchers are actively using these public data to find the set of gene alterations that are responsible for each tumor type. But this problem is not as simple is identifying a single dysregulated gene in each tumor. Hundreds, if not thousands, of the 20,000 genes in the human genome are dysregulated in cancer. The group of dysregulated genes varies in each patient’s tumor, with smaller sets of commonly reused genes enabling each cancer hallmark.\u003c/p>\n\u003cp>Precision medicine relies on finding the smaller groups of dysregulated genes that are responsible for biological function in each patient’s tumor. But, genes may have multiple biological functions in different contexts. Therefore, researchers must uncover a set of “overlapping” genes that have common functions in a set of cancer patients.\u003c/p>\n\u003cp>Linking gene status to function requires complex mathematics\u003cbr>\nand immense computing power. This knowledge is essential to predict of outcome to therapies that would block the function of these genes. So, how can we uncover those overlapping features to predict individual outcomes for patients?\u003c/p>\n\u003cp>\u003cstrong>What Netflix Can Teach Us\u003c/strong>\u003c/p>\n\u003cp>Fortunately for us, this problem has already been solved in computer science. The answer is a class of techniques called “matrix factorization” – and you’ve likely already interacted with these techniques in your everyday life.\u003c/p>\n\u003cp>In 2009, \u003ca href=\"http://www.netflixprize.com/index.html\">Netflix held ahow challenge\u003c/a> to personalize movie ratings for each Netflix user. On Netflix, each user has a distinct set of ratings of different movies. While two users may have similar tastes in movies, they may vary wildly in specific genres. Therefore, you cannot rely on comparing ratings from similar users.\u003c/p>\n\u003cp>Instead, a matrix factorization algorithm finds movies with similar ratings among a smaller group of users. The group of users will vary for each movie. The computer associates each user with a group of movies to a different extent, based upon their individual tastes. The relationships among users are referred to as “patterns.” These patterns are learned from the data, and may find common rankings unforeseen by movie genre alone – for example, users may share a preference for a particular director or actor.\u003c/p>\n\u003cfigure class=\"align-center zoomable\">\u003ca href=\"https://cdn.theconversation.com/files/164115/area14mp/image-20170405-20472-c764c6.png\">\u003cimg src=\"https://cdn.theconversation.com/files/164115/width754/image-20170405-20472-c764c6.png\" alt=\"\">\u003c/a>\u003cfigcaption>\u003cspan class=\"attribution\">\u003cspan class=\"source\">Genevieve Stein-O'Brien\u003c/span>, \u003ca class=\"license\" href=\"http://creativecommons.org/licenses/by/4.0/\">CC BY\u003c/a>\u003c/span>\u003c/figcaption>\u003c/figure>\n\u003cp>The same process can work in cancer. In this case, the measurements of gene dysregulation are analogous to movie ratings, movie genres to biological function and users to patients’ tumors. The computer searches across patient tumors to find patterns in gene dysregulation that cause the malignant biological function in each tumor.\u003c/p>\n\u003cp>\u003cstrong>From Movies to Tumors\u003c/strong>\u003c/p>\n\u003cp>The analogy between movie ratings and cancer genetics breaks down in the details. Unless they are minors, Netflix users are not constrained in the movies they watch. But, our bodies instead prefer to minimize the number of genes used for any single function. There are also substantial redundancies between genes. To protect a cell, one gene may easily substitute for another to serve a common function. Gene functions in cancer are even more complex. Tumors are also highly complex and rapidly evolving, depending upon random interactions between the cancer cells and the adjacent healthy organ.\u003c/p>\n\u003cp>To account for these complexities, we have developed a matrix factorization approach called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20810601\">Coordinated Gene Activity in Pattern Sets – or CoGAPS for short\u003c/a>. Our algorithm accounts for biology’s minimalism by incorporating as few genes as possible into the patterns for each tumor.\u003c/p>\n\u003cp>Different genes can also substitute for one another, each serving a similar function in a different context. To account for this, CoGAPS simultaneously estimates a statistic for the so-called “patterns” of gene function. This allows us to compute the probability of each gene being used in each biological function in a tumor.\u003c/p>\n\u003cp>For example, many patients take a targeted therapeutic called cetuximab to prolong survival in colorectal, pancreatic, lung and oral cancers. Our recent work found that these patterns can distinguish gene function in cancer cells that respond to the targeted therapeutic agent cetuximab from those that do not.\u003c/p>\n\u003cp>\u003cstrong>The Future\u003c/strong>\u003c/p>\n\u003cp>Unfortunately, cancer therapies that target genes usually cannot cure a patient’s disease. They can only delay progression for a few years. Most patients then relapse, with tumors that are no longer responsive to the treatment.\u003c/p>\n\u003cp>\u003ca href=\"http://www.impactjournals.com/oncotarget/index.php?journal=oncotarget&page=article&op=view&path%5B%5D=12075\">Our own recent work\u003c/a> found that the patterns that distinguish gene function in cells that are responsive to cetuximab include the very genes that give rise to resistance. Emerging immunotherapies are promising and appear to cure some cancers. Yet, far too often, patients with these treatments also relapse. New data that track the cancer genetics after treatment is essential to determine why patients no longer respond.\u003c/p>\n\u003cp>Along with these data, cancer biology also requires a new generation of scientists who can bridge mathematics and statistics to determine the genetic changes occurring over time in drug resistance. In other fields of mathematics, computer programs are able to forecast long-term outcomes. These models are used commonly in weather prediction and investment strategies.\u003c/p>\n\u003cp>In these fields and \u003ca href=\"http://journals.ametsoc.org/doi/abs/10.1175/2010MWR3515.1\">my own previous research\u003c/a>, we have found that updates to the models from large datasets – such as satellite data in the case of weather – improve long-term forecasts. We have all seen the effect of these updates, with weather predictions improving the closer that we are to a storm.\u003c/p>\n\u003cp>\u003cimg src=\"https://counter.theconversation.edu.au/content/74806/count.gif?distributor=republish-lightbox-basic\" alt=\"The Conversation\" width=\"1\" height=\"1\">Just as tools from computer science used can be adapted to both movie recommendations and cancer, the future generation of computational scientists will adopt prediction tools from an array of fields for precision medicine. Ultimately, with these computational tools, we hope to predict tumors’ response to therapy as commonly as we predict the weather, and perhaps more reliably.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://theconversation.com/profiles/elana-fertig-347632\">Elana Fertig\u003c/a>, Assistant Professor of Oncology Biostatistics and Bioinformatics, \u003cem>\u003ca href=\"http://theconversation.com/institutions/johns-hopkins-university-1256\">Johns Hopkins University\u003c/a>\u003c/em>\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article was originally published on \u003ca href=\"http://theconversation.com\">The Conversation\u003c/a>. Read the \u003ca href=\"https://theconversation.com/what-netflix-can-teach-us-about-treating-cancer-74806\">original article\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The method Netflix uses to predict how much a user will enjoy a movie can also work for precision medicine, a researcher asserts.","status":"publish","parent":0,"modified":1496852928,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1462},"headData":{"title":"A Netflix Approach to Treating Cancer | KQED","description":"The method Netflix uses to predict how much a user will enjoy a movie can also work for precision medicine, a researcher asserts.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"A Netflix Approach to Treating Cancer","datePublished":"2017-06-07T16:25:09.000Z","dateModified":"2017-06-07T16:28:48.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"400200 https://ww2.kqed.org/futureofyou/?p=400200","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/06/07/a-netflix-approach-to-treating-cancer/","disqusTitle":"A Netflix Approach to Treating Cancer","nprByline":"Elana Fertig, Johns Hopkins University\u003cbr />The Conversation","path":"/futureofyou/400200/a-netflix-approach-to-treating-cancer","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two years ago, former President Barack Obama announced the \u003ca href=\"https://obamawhitehouse.archives.gov/precision-medicine\">Precision Medicine initiative\u003c/a> in his State of the Union Address. The initiative aspired to a “new era of medicine” where disease treatments could be specifically tailored to each patient’s genetic code.\u003c/p>\n\u003cp>This resonated soundly in cancer medicine. Patients can already manage their cancer with therapies that target the specific genes that are altered in their particular tumor. For example, women with a type of breast cancer caused by the amplification of gene HER2 are often treated with a therapeutic called herceptin. Because these targeted therapeutics are specific to cancer cells, they tend to have fewer side effects than traditional cancer treatments with chemotherapy or radiation.\u003c/p>\n\u003cp>However, such treatments are not available for most cancer patients. In many cancers, the specific genetic alterations that are responsible for a cancer remain unknown. To create individualized cancer treatments, we must know more about the functional genetic alterations.\u003c/p>\n\u003cp>With data on cancer genetics growing rapidly, mathematics and statistics can now help unlock the hidden patterns in this data to find the genes that are responsible for an individual’s cancer. With this knowledge, physicians can select appropriate treatments that block the action of these genes to personalize therapies for individual patients. My research aims to improve precision medicine in cancer – by building on the same methods that have been used to find patterns in Netflix movie ratings.\u003c/p>\n\u003cp>\u003cstrong>Sifting Through the Data\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today, there is unprecedented public access to cancer genetics data. These data come from generous patients who donate their tumor samples for research. Scientists then apply sequencing technologies to measure the mutations and activity in each of the 20,000 genes in the human genome.\u003c/p>\n\u003cp>All these data are a direct result of the \u003ca href=\"http://www.nature.com/nature/journal/v431/n7011/full/nature03001.html\">Human Genome Project\u003c/a> in 2003. That project determined the sequence for all the genes that make up healthy human DNA. Since the completion of that project, the cost of sequencing the human genome has \u003ca href=\"http://www.nature.com/news/technology-the-1-000-genome-1.14901\">more than halved every year\u003c/a>, surpassing the growth of computing power described in \u003ca href=\"https://theconversation.com/moores-law-is-50-years-old-but-will-it-continue-44511\">Moore’s Law\u003c/a>. This cost reduction enables researches to collect unprecedented genetics data from cancer patients.\u003c/p>\n\u003cp>Most scientific studies on cancer genetics performed worldwide release their data to a centralized, public database provided by the U.S. National Institutes of Health (NIH) National Library of Medicine. The NIH National Cancer Institute and National Human Genome Research Institute have also freely released genetic data from over 11,000 tumors in 33 cancer types through a project called \u003ca href=\"https://cancergenome.nih.gov/\">The Cancer Genome Atlas.\u003c/a>\u003c/p>\n\u003cp>Every biological function – from extracting energy from food to healing a wound – results from activity in different combinations of genes. Cancers hijack the genes that enable people to grow to adulthood and that protect the body from the immune system. Researchers dub these the \u003ca href=\"http://www.cell.com/abstract/S0092-8674(11)00127-9\">“hallmarks of cancer.”\u003c/a> This so-called gene dysregulation enables a tumor to grow uncontrollably and form metastases in distant organs from the original tumor site.\u003c/p>\n\u003cp>Researchers are actively using these public data to find the set of gene alterations that are responsible for each tumor type. But this problem is not as simple is identifying a single dysregulated gene in each tumor. Hundreds, if not thousands, of the 20,000 genes in the human genome are dysregulated in cancer. The group of dysregulated genes varies in each patient’s tumor, with smaller sets of commonly reused genes enabling each cancer hallmark.\u003c/p>\n\u003cp>Precision medicine relies on finding the smaller groups of dysregulated genes that are responsible for biological function in each patient’s tumor. But, genes may have multiple biological functions in different contexts. Therefore, researchers must uncover a set of “overlapping” genes that have common functions in a set of cancer patients.\u003c/p>\n\u003cp>Linking gene status to function requires complex mathematics\u003cbr>\nand immense computing power. This knowledge is essential to predict of outcome to therapies that would block the function of these genes. So, how can we uncover those overlapping features to predict individual outcomes for patients?\u003c/p>\n\u003cp>\u003cstrong>What Netflix Can Teach Us\u003c/strong>\u003c/p>\n\u003cp>Fortunately for us, this problem has already been solved in computer science. The answer is a class of techniques called “matrix factorization” – and you’ve likely already interacted with these techniques in your everyday life.\u003c/p>\n\u003cp>In 2009, \u003ca href=\"http://www.netflixprize.com/index.html\">Netflix held ahow challenge\u003c/a> to personalize movie ratings for each Netflix user. On Netflix, each user has a distinct set of ratings of different movies. While two users may have similar tastes in movies, they may vary wildly in specific genres. Therefore, you cannot rely on comparing ratings from similar users.\u003c/p>\n\u003cp>Instead, a matrix factorization algorithm finds movies with similar ratings among a smaller group of users. The group of users will vary for each movie. The computer associates each user with a group of movies to a different extent, based upon their individual tastes. The relationships among users are referred to as “patterns.” These patterns are learned from the data, and may find common rankings unforeseen by movie genre alone – for example, users may share a preference for a particular director or actor.\u003c/p>\n\u003cfigure class=\"align-center zoomable\">\u003ca href=\"https://cdn.theconversation.com/files/164115/area14mp/image-20170405-20472-c764c6.png\">\u003cimg src=\"https://cdn.theconversation.com/files/164115/width754/image-20170405-20472-c764c6.png\" alt=\"\">\u003c/a>\u003cfigcaption>\u003cspan class=\"attribution\">\u003cspan class=\"source\">Genevieve Stein-O'Brien\u003c/span>, \u003ca class=\"license\" href=\"http://creativecommons.org/licenses/by/4.0/\">CC BY\u003c/a>\u003c/span>\u003c/figcaption>\u003c/figure>\n\u003cp>The same process can work in cancer. In this case, the measurements of gene dysregulation are analogous to movie ratings, movie genres to biological function and users to patients’ tumors. The computer searches across patient tumors to find patterns in gene dysregulation that cause the malignant biological function in each tumor.\u003c/p>\n\u003cp>\u003cstrong>From Movies to Tumors\u003c/strong>\u003c/p>\n\u003cp>The analogy between movie ratings and cancer genetics breaks down in the details. Unless they are minors, Netflix users are not constrained in the movies they watch. But, our bodies instead prefer to minimize the number of genes used for any single function. There are also substantial redundancies between genes. To protect a cell, one gene may easily substitute for another to serve a common function. Gene functions in cancer are even more complex. Tumors are also highly complex and rapidly evolving, depending upon random interactions between the cancer cells and the adjacent healthy organ.\u003c/p>\n\u003cp>To account for these complexities, we have developed a matrix factorization approach called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20810601\">Coordinated Gene Activity in Pattern Sets – or CoGAPS for short\u003c/a>. Our algorithm accounts for biology’s minimalism by incorporating as few genes as possible into the patterns for each tumor.\u003c/p>\n\u003cp>Different genes can also substitute for one another, each serving a similar function in a different context. To account for this, CoGAPS simultaneously estimates a statistic for the so-called “patterns” of gene function. This allows us to compute the probability of each gene being used in each biological function in a tumor.\u003c/p>\n\u003cp>For example, many patients take a targeted therapeutic called cetuximab to prolong survival in colorectal, pancreatic, lung and oral cancers. Our recent work found that these patterns can distinguish gene function in cancer cells that respond to the targeted therapeutic agent cetuximab from those that do not.\u003c/p>\n\u003cp>\u003cstrong>The Future\u003c/strong>\u003c/p>\n\u003cp>Unfortunately, cancer therapies that target genes usually cannot cure a patient’s disease. They can only delay progression for a few years. Most patients then relapse, with tumors that are no longer responsive to the treatment.\u003c/p>\n\u003cp>\u003ca href=\"http://www.impactjournals.com/oncotarget/index.php?journal=oncotarget&page=article&op=view&path%5B%5D=12075\">Our own recent work\u003c/a> found that the patterns that distinguish gene function in cells that are responsive to cetuximab include the very genes that give rise to resistance. Emerging immunotherapies are promising and appear to cure some cancers. Yet, far too often, patients with these treatments also relapse. New data that track the cancer genetics after treatment is essential to determine why patients no longer respond.\u003c/p>\n\u003cp>Along with these data, cancer biology also requires a new generation of scientists who can bridge mathematics and statistics to determine the genetic changes occurring over time in drug resistance. In other fields of mathematics, computer programs are able to forecast long-term outcomes. These models are used commonly in weather prediction and investment strategies.\u003c/p>\n\u003cp>In these fields and \u003ca href=\"http://journals.ametsoc.org/doi/abs/10.1175/2010MWR3515.1\">my own previous research\u003c/a>, we have found that updates to the models from large datasets – such as satellite data in the case of weather – improve long-term forecasts. We have all seen the effect of these updates, with weather predictions improving the closer that we are to a storm.\u003c/p>\n\u003cp>\u003cimg src=\"https://counter.theconversation.edu.au/content/74806/count.gif?distributor=republish-lightbox-basic\" alt=\"The Conversation\" width=\"1\" height=\"1\">Just as tools from computer science used can be adapted to both movie recommendations and cancer, the future generation of computational scientists will adopt prediction tools from an array of fields for precision medicine. Ultimately, with these computational tools, we hope to predict tumors’ response to therapy as commonly as we predict the weather, and perhaps more reliably.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://theconversation.com/profiles/elana-fertig-347632\">Elana Fertig\u003c/a>, Assistant Professor of Oncology Biostatistics and Bioinformatics, \u003cem>\u003ca href=\"http://theconversation.com/institutions/johns-hopkins-university-1256\">Johns Hopkins University\u003c/a>\u003c/em>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was originally published on \u003ca href=\"http://theconversation.com\">The Conversation\u003c/a>. Read the \u003ca href=\"https://theconversation.com/what-netflix-can-teach-us-about-treating-cancer-74806\">original article\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/400200/a-netflix-approach-to-treating-cancer","authors":["byline_futureofyou_400200"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_1064"],"tags":["futureofyou_103","futureofyou_1294","futureofyou_112"],"featImg":"futureofyou_217336","label":"futureofyou"},"futureofyou_223729":{"type":"posts","id":"futureofyou_223729","meta":{"index":"posts_1591205157","site":"futureofyou","id":"223729","score":null,"sort":[1471369859000]},"guestAuthors":[],"slug":"precision-medicine-waits-to-come-of-age","title":"Precision Medicine: Little Benefit So Far, But Lots of Hope","publishDate":1471369859,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>There was one boy, eight years old, who Olena Morozova thinks about still.\u003c/p>\n\u003cp>He was being treated for sarcoma, a rare cancer found in bones or connective tissue. A genetic mutation was found that might partly explain his illness, but there was no therapy to fix it.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I think of all the names and all the faces of kids who have died, and I think, 'There's been too many of them. Let's change this.'\u003c/aside>\n\u003cp>“So the patient was back to square one. Even though he was in the trial, there was nothing that the trial could do,\" says Morozova, the principal researcher in the \u003ca href=\"https://treehouse.soe.ucsc.edu/CKCC\" target=\"_blank\">California Kids Cancer Comparison\u003c/a>. The project attempts to find treatment for children who haven't responded to standard therapy, by analyzing the genetics of their tumors.\u003c/p>\n\u003cp>Morozova's team had developed a tumor map, a graphical representation of how different or similar individual tumors are at a molecular level. Curiously, the boy’s tumor was genetically similar to another type of cancer called neuroblastoma, which is treated with a particular therapy considered to be ill-suited for sarcoma.\u003c/p>\n\u003cp>Out of options, the doctors gave it a try.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The patient had a partial response,\" says Morozova, \"It wasn't a complete remission, but just the idea that somebody could benefit from this analysis and we could learn something new was very exciting for us as a bioinformatics institution.\"\u003c/p>\n\u003cp>More analysis, another drug, sending the tumor into remission for several months. That gave \u003cspan class=\"\">the boy back something resembling a normal\u003cspan class=\"x_apple-converted-space\"> \u003c/span>\u003c/span>\u003cspan class=\"\">\u003cspan class=\"\">childhood.\u003c/span>\u003cspan class=\"\"> He ran, he played. His appetite returned.\u003c/span>\u003c/span>\u003c/p>\n\u003cp>But the tumor proved resilient.\u003c/p>\n\u003cp>In January, the boy died.\u003c/p>\n\u003cp>Amidst the tragedy, Morozova and her researchers found something to be hopeful about: His temporary recovery showed them their project possessed greater potential to help patients currently fighting disease.\u003c/p>\n\u003cp>It \"started us on this vision,\" she says. \"In the beginning we started out as just a research project. We didn't think that this would be immediately of clinical benefit to patients.\"\u003c/p>\n\u003cp>Now, the California Kids Cancer Comparison gets involved on an individual level, participating in the tumor board at Stanford Hospital, sharing their results with panels of experts from different medical specialties who decide, together, on treatments for patients.\u003c/p>\n\u003cp>\u003cstrong>Results Not There Yet\u003c/strong>\u003c/p>\n\u003cp>Still, the death of group's child patient points to an unhappy reality: What we call \"precision medicine\" -- tailoring treatments according to the genetics, environment and lifestyle of individual patients --still isn’t precise enough. And our growing knowledge of the genetics of cancer has yet to save many lives.\u003c/p>\n\u003cp>The concept of precision medicine grows out of a longstanding frustration in tackling disease: Some patients just do not respond to a treatment that normally works. Not only does this failure necessitate a different remedy, it also puts someone who is ill through a costly and often painful process for no benefit.\u003c/p>\n\u003cfigure id=\"attachment_224189\" class=\"wp-caption alignright\" style=\"max-width: 381px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/olena.jpg\">\u003cimg class=\" wp-image-224189\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/olena-541x600.jpg\" alt=\"Olena Morozova, principal researcher of the California Kids Cancer Comparison.\" width=\"381\" height=\"423\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena-541x600.jpg 541w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena-400x443.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena.jpg 692w\" sizes=\"(max-width: 381px) 100vw, 381px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olena Morozova, principal researcher of the California Kids Cancer Comparison. \u003ccite>(University of California, Santa Cruz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Being able to choose the right treatment from the start would be an enormous advance. The government is on board. The 2016 federal budget includes $215 million for the \u003ca href=\"https://www.whitehouse.gov/precision-medicine\" target=\"_blank\">Precision Medicine Initiative\u003c/a>. A major part of the project is the creation of a \"national research cohort,\" a group of volunteers willing to share their genomes and daily living habits with researchers from the National Institutes of Health as part of \u003ca href=\"https://www.nih.gov/precision-medicine-initiative-cohort-program\">a 10-year study\u003c/a>.\u003c/p>\n\u003cp>In the nation’s most populous state, Gov. Jerry Brown has supported the launch of the \u003ca href=\"http://www.ciapm.org/\" target=\"_blank\">California Initiative to Advance Precision Medicine\u003c/a>. But so far, public and private funders have dedicated just $3 million to the project. Still, the researchers at the California Kids Cancer Comparison, a pilot project of CIAPM, aren’t complaining.\u003c/p>\n\u003cp>\"Pediatric cancer research is very poorly funded,\" says Isabel Bjork, director of the Cancer Comparison. \"It's a demonstration project -- that was important for us, because we had some theories that we had seen work a few times, but we need bigger comparisons to really test them.\"\u003c/p>\n\u003cp>Many hospitals are conducting their own precision medicine trials, sequencing genetic information from their patients and their patients’ tumors in the hopes of finding an \"actionable mutation\" that might respond to a treatment.\u003c/p>\n\u003cp>The results to date have been underwhelming. \"In the majority of the clinical trials, the benefit has been very small, measured as two months of longer survival,\" Antonio Fojo, an oncologist at Columbia University \u003ca href=\"https://www.aacc.org/publications/cln/articles/2016/july/the-perils-and-promise-of-precision-medicine\" target=\"_blank\">reported at the American Association for Clinical Chemistry\u003c/a> in July.\u003c/p>\n\u003cp>\u003cb>'Let's Change This'\u003c/b>\u003c/p>\n\u003cp>When President Obama said in his 2015 State of the Union Address that the national initiative would \"bring us closer to curing diseases like cancer and diabetes,\" \u003ca href=\"http://www.nytimes.com/2015/01/29/opinion/moonshot-medicine-will-let-us-down.html?_r=0\" target=\"_blank\">some experts were skeptical. \u003c/a>The interplay of genetics and daily life habits are too complicated to figure out, they argued.\u003c/p>\n\u003cp>But for those who work with pediatric cancer patients, any medical advance, even the most incremental, is cause for hope.\u003c/p>\n\u003cp>Mariela Medina works at Jacob's Heart, an organization in Watsonville, California that helps kids with cancer, and their families, cope with the disease. Many of the children cared for by the organization are also part of the California Kids Cancer Comparison.\u003c/p>\n\u003cp>Medina specializes in working with teens, and she knows first-hand what they're going through. More than a decade ago, just before she turned 14, she was diagnosed with Hodgkin Lymphoma, stage IV. She's been cancer-free for 10 years now, but not before a trio of relapses.\u003c/p>\n\u003cp>Her memory of her cancer years is foggy, something she attributes to chemotherapy, but from what she recalls, the treatment was rough, with bad nausea. \"I couldn't keep anything down, I was on so many medicines,\" she says.\u003c/p>\n\u003cp>Lori Butterworth, founder and director of Jacob's Heart, says her hope is that researchers like Olena Morozova will put her out of business.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think of all the names and all the faces of kids who have died,\" she says, \"and I think, 'There's been too many of them. Let's change this.' \"\u003c/p>\n\n","blocks":[],"excerpt":"Despite high expectations for tailoring treatments to individual patients based on genetics and lifestyle, results so far have been underwhelming.","status":"publish","parent":0,"modified":1475113260,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1051},"headData":{"title":"Precision Medicine: Little Benefit So Far, But Lots of Hope | KQED","description":"Despite high expectations for tailoring treatments to individual patients based on genetics and lifestyle, results so far have been underwhelming.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Precision Medicine: Little Benefit So Far, But Lots of Hope","datePublished":"2016-08-16T17:50:59.000Z","dateModified":"2016-09-29T01:41:00.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"223729 http://ww2.kqed.org/futureofyou/?p=223729","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/08/16/precision-medicine-waits-to-come-of-age/","disqusTitle":"Precision Medicine: Little Benefit So Far, But Lots of Hope","source":"Future of You","sourceUrl":"https://ww2.kqed.org/futureofyou/","nprByline":"Danielle Venton","path":"/futureofyou/223729/precision-medicine-waits-to-come-of-age","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>There was one boy, eight years old, who Olena Morozova thinks about still.\u003c/p>\n\u003cp>He was being treated for sarcoma, a rare cancer found in bones or connective tissue. A genetic mutation was found that might partly explain his illness, but there was no therapy to fix it.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I think of all the names and all the faces of kids who have died, and I think, 'There's been too many of them. Let's change this.'\u003c/aside>\n\u003cp>“So the patient was back to square one. Even though he was in the trial, there was nothing that the trial could do,\" says Morozova, the principal researcher in the \u003ca href=\"https://treehouse.soe.ucsc.edu/CKCC\" target=\"_blank\">California Kids Cancer Comparison\u003c/a>. The project attempts to find treatment for children who haven't responded to standard therapy, by analyzing the genetics of their tumors.\u003c/p>\n\u003cp>Morozova's team had developed a tumor map, a graphical representation of how different or similar individual tumors are at a molecular level. Curiously, the boy’s tumor was genetically similar to another type of cancer called neuroblastoma, which is treated with a particular therapy considered to be ill-suited for sarcoma.\u003c/p>\n\u003cp>Out of options, the doctors gave it a try.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The patient had a partial response,\" says Morozova, \"It wasn't a complete remission, but just the idea that somebody could benefit from this analysis and we could learn something new was very exciting for us as a bioinformatics institution.\"\u003c/p>\n\u003cp>More analysis, another drug, sending the tumor into remission for several months. That gave \u003cspan class=\"\">the boy back something resembling a normal\u003cspan class=\"x_apple-converted-space\"> \u003c/span>\u003c/span>\u003cspan class=\"\">\u003cspan class=\"\">childhood.\u003c/span>\u003cspan class=\"\"> He ran, he played. His appetite returned.\u003c/span>\u003c/span>\u003c/p>\n\u003cp>But the tumor proved resilient.\u003c/p>\n\u003cp>In January, the boy died.\u003c/p>\n\u003cp>Amidst the tragedy, Morozova and her researchers found something to be hopeful about: His temporary recovery showed them their project possessed greater potential to help patients currently fighting disease.\u003c/p>\n\u003cp>It \"started us on this vision,\" she says. \"In the beginning we started out as just a research project. We didn't think that this would be immediately of clinical benefit to patients.\"\u003c/p>\n\u003cp>Now, the California Kids Cancer Comparison gets involved on an individual level, participating in the tumor board at Stanford Hospital, sharing their results with panels of experts from different medical specialties who decide, together, on treatments for patients.\u003c/p>\n\u003cp>\u003cstrong>Results Not There Yet\u003c/strong>\u003c/p>\n\u003cp>Still, the death of group's child patient points to an unhappy reality: What we call \"precision medicine\" -- tailoring treatments according to the genetics, environment and lifestyle of individual patients --still isn’t precise enough. And our growing knowledge of the genetics of cancer has yet to save many lives.\u003c/p>\n\u003cp>The concept of precision medicine grows out of a longstanding frustration in tackling disease: Some patients just do not respond to a treatment that normally works. Not only does this failure necessitate a different remedy, it also puts someone who is ill through a costly and often painful process for no benefit.\u003c/p>\n\u003cfigure id=\"attachment_224189\" class=\"wp-caption alignright\" style=\"max-width: 381px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/olena.jpg\">\u003cimg class=\" wp-image-224189\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/olena-541x600.jpg\" alt=\"Olena Morozova, principal researcher of the California Kids Cancer Comparison.\" width=\"381\" height=\"423\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena-541x600.jpg 541w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena-400x443.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena.jpg 692w\" sizes=\"(max-width: 381px) 100vw, 381px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olena Morozova, principal researcher of the California Kids Cancer Comparison. \u003ccite>(University of California, Santa Cruz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Being able to choose the right treatment from the start would be an enormous advance. The government is on board. The 2016 federal budget includes $215 million for the \u003ca href=\"https://www.whitehouse.gov/precision-medicine\" target=\"_blank\">Precision Medicine Initiative\u003c/a>. A major part of the project is the creation of a \"national research cohort,\" a group of volunteers willing to share their genomes and daily living habits with researchers from the National Institutes of Health as part of \u003ca href=\"https://www.nih.gov/precision-medicine-initiative-cohort-program\">a 10-year study\u003c/a>.\u003c/p>\n\u003cp>In the nation’s most populous state, Gov. Jerry Brown has supported the launch of the \u003ca href=\"http://www.ciapm.org/\" target=\"_blank\">California Initiative to Advance Precision Medicine\u003c/a>. But so far, public and private funders have dedicated just $3 million to the project. Still, the researchers at the California Kids Cancer Comparison, a pilot project of CIAPM, aren’t complaining.\u003c/p>\n\u003cp>\"Pediatric cancer research is very poorly funded,\" says Isabel Bjork, director of the Cancer Comparison. \"It's a demonstration project -- that was important for us, because we had some theories that we had seen work a few times, but we need bigger comparisons to really test them.\"\u003c/p>\n\u003cp>Many hospitals are conducting their own precision medicine trials, sequencing genetic information from their patients and their patients’ tumors in the hopes of finding an \"actionable mutation\" that might respond to a treatment.\u003c/p>\n\u003cp>The results to date have been underwhelming. \"In the majority of the clinical trials, the benefit has been very small, measured as two months of longer survival,\" Antonio Fojo, an oncologist at Columbia University \u003ca href=\"https://www.aacc.org/publications/cln/articles/2016/july/the-perils-and-promise-of-precision-medicine\" target=\"_blank\">reported at the American Association for Clinical Chemistry\u003c/a> in July.\u003c/p>\n\u003cp>\u003cb>'Let's Change This'\u003c/b>\u003c/p>\n\u003cp>When President Obama said in his 2015 State of the Union Address that the national initiative would \"bring us closer to curing diseases like cancer and diabetes,\" \u003ca href=\"http://www.nytimes.com/2015/01/29/opinion/moonshot-medicine-will-let-us-down.html?_r=0\" target=\"_blank\">some experts were skeptical. \u003c/a>The interplay of genetics and daily life habits are too complicated to figure out, they argued.\u003c/p>\n\u003cp>But for those who work with pediatric cancer patients, any medical advance, even the most incremental, is cause for hope.\u003c/p>\n\u003cp>Mariela Medina works at Jacob's Heart, an organization in Watsonville, California that helps kids with cancer, and their families, cope with the disease. Many of the children cared for by the organization are also part of the California Kids Cancer Comparison.\u003c/p>\n\u003cp>Medina specializes in working with teens, and she knows first-hand what they're going through. More than a decade ago, just before she turned 14, she was diagnosed with Hodgkin Lymphoma, stage IV. She's been cancer-free for 10 years now, but not before a trio of relapses.\u003c/p>\n\u003cp>Her memory of her cancer years is foggy, something she attributes to chemotherapy, but from what she recalls, the treatment was rough, with bad nausea. \"I couldn't keep anything down, I was on so many medicines,\" she says.\u003c/p>\n\u003cp>Lori Butterworth, founder and director of Jacob's Heart, says her hope is that researchers like Olena Morozova will put her out of business.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think of all the names and all the faces of kids who have died,\" she says, \"and I think, 'There's been too many of them. Let's change this.' \"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/223729/precision-medicine-waits-to-come-of-age","authors":["byline_futureofyou_223729"],"categories":["futureofyou_1062"],"tags":["futureofyou_103","futureofyou_80","futureofyou_112"],"featImg":"futureofyou_224152","label":"source_futureofyou_223729"},"futureofyou_223572":{"type":"posts","id":"futureofyou_223572","meta":{"index":"posts_1591205157","site":"futureofyou","id":"223572","score":null,"sort":[1471282184000]},"guestAuthors":[],"slug":"ibm-watson-replaces-experts-brainpower-in-cancer-treatment","title":"IBM Watson Replaces Experts' Brainpower for Cancer Treatment","publishDate":1471282184,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>A computer may soon be able to offer highly personalized treatment suggestions for cancer patients based on the specifics of their cases and the full sweep of the most relevant scientific research.\u003c/p>\n\u003caside class=\"pullquote alignright\">Time is of the essence in formulating precision treatment plans for cancer patients. 'By the time we got through with this patient, the patient died.'\u003c/aside>\n\u003cp>IBM and the New York Genome Center, a consortium of medical research institutions in New York City, are collaborating on a \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02725684\">project\u003c/a> to speed up cancer diagnoses and treatment.\u003c/p>\n\u003cp>The work, which got underway in 2013, is exploring the use of computers to help analyze a wide range of genetic information and the scientific literature with the goal of quickly formulating precise treatment plans for cancer patients.\u003c/p>\n\u003cp>The line of research is being orchestrated by \u003ca href=\"http://www.nygenome.org/authorbio/robert-b-darnell/\">Robert Darnell\u003c/a>, the founding director of the New York Genome Center and a neuro-oncologist at Rockefeller University. A project on brain tumors aims to bring cancer experts in New York City to bear on treatment plans that take advantage of the very latest scientific evidence.\u003c/p>\n\u003cp>An essential assistant on Darnell's team is supercomputer \u003ca href=\"https://www.ibm.com/watson/\">IBM Watson\u003c/a>, which helps by comparing the genetic differences between healthy cells and tumor cells in patients, as well as fetching the newest treatment ideas from medical journals.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Watson wasn't always part of Darnell's lineup. When he started the project, he relied on the collective brainpower of a bunch of medical researchers in New York City. Fifteen of them, including Darnell, spent three weeks evaluating the case of the first patient of the project. But, he says, \"by the time we got through with this patient, the patient died.\"\u003c/p>\n\u003cp>Speed matters, given how fast cancer can spread. Information overload is a particular challenge.\u003c/p>\n\u003cp>\"Cancer is not giving you the luxury of time,\" says \u003ca href=\"http://researcher.watson.ibm.com/\">Ajay Royyuru\u003c/a>, the director of IBM's Healthcare and Life Sciences Research. And, he adds, there are \"more papers published in each year than cancer researchers can read and remember.\"\u003c/p>\n\u003cp>In contrast, IBM's supercomputer Watson, famous for defeating former champions in \u003cem>Jeopardy!\u003c/em> \u003ca href=\"https://www.youtube.com/watch?v=WFR3lOm_xhE\">in 2011\u003c/a>, is able to read \"800 million pages per second ... from medical literature to patient records to doctors' notes,\" according to Christine Douglass at IBM Watson Health.\u003c/p>\n\u003cp>Upon learning about Watson's abilities, Darnell approached IBM. By 2014, a human-computer coalition to fight cancer \u003ca href=\"https://www.washingtonpost.com/business/on-it/ibms-watson-new-york-genome-center-partner-on-brain-cancer-treatment/2014/03/18/35019894-aba7-11e3-af5f-4c56b834c4bf_story.html\">was born\u003c/a>.\u003c/p>\n\u003cp>\"Compare what the genetics in the healthy cell looks like to what the genetics in the cancer cell looks like, you get the list of differences,\" says \u003ca href=\"http://stevejamesharvey.com/\">Steve Harvey\u003c/a>, vice president of Watson Health at IBM. \"Watson will first try to figure out what are the differences that could be causing cancer. For each of those potential genetic issues, it will go through databases and literature to find\" known treatment options, he says.\u003c/p>\n\u003cp>With the help of Watson, Darnell's group studied 30 patients with glioblastoma, an aggressive form of brain cancer, and developed personalized treatment options for each patient \"based on genetic mutations present in the tumor,\" according to Darnell. Darnell declined to comment on the specifics of the findings before they're published. But, he says, \"there are patients who will benefit\" from this study. A preliminary report on the findings has been submitted to \u003cem>The Journal of Clinical Oncology\u003c/em>.\u003c/p>\n\u003cp>Both IBM and the New York Genome Center are moving on to find out whether Watson can apply what he learned from Darnell's research to a larger group of glioblastoma patients.\u003c/p>\n\u003cp>\"We'll be \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/06/28/fact-sheet-cancer-moonshot-summit-vice-president-biden-announces-new\">working with\u003c/a> the Veterans Health Administration,\" says Harvey. According to Harvey, \"The VHA overseas the largest population of cancer patients — 3.5 percent of all cancer patients in the US are from the VHA.\"\u003c/p>\n\u003cp>According to Darnell, the paper his group submitted will \"lay the groundwork for the larger, more comprehensive paper on the same study.\" Darnell says the current research project is not yet a clinical trial, and he hopes to execute a large-scale clinical trial in the future, recruiting \"any cancer patient who is sick, not necessarily from glioblastoma.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's not going to be doable without the machines,\" says Darnell.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Doctors+Want+A+Computerized+Assistant+For+Cancer+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"There's more information on genetic mutations and in the scientific literature than cancer doctors can process easily. Smart, fast computers might be able to help.","status":"publish","parent":0,"modified":1471282273,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":698},"headData":{"title":"IBM Watson Replaces Experts' Brainpower for Cancer Treatment | KQED","description":"There's more information on genetic mutations and in the scientific literature than cancer doctors can process easily. Smart, fast computers might be able to help.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"IBM Watson Replaces Experts' Brainpower for Cancer Treatment","datePublished":"2016-08-15T17:29:44.000Z","dateModified":"2016-08-15T17:31:13.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"223572 http://ww2.kqed.org/futureofyou/?p=223572","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/08/15/ibm-watson-replaces-experts-brainpower-in-cancer-treatment/","disqusTitle":"IBM Watson Replaces Experts' Brainpower for Cancer Treatment","nprByline":"Mark H. Kim","nprImageAgency":"Courtesy of New York Genome Center","nprStoryId":"487943961","nprApiLink":"http://api.npr.org/query?id=487943961&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/08/12/487943961/why-doctors-want-a-computerized-assistant-for-cancer-care?ft=nprml&f=487943961","nprRetrievedStory":"1","nprPubDate":"Fri, 12 Aug 2016 12:35:00 -0400","nprStoryDate":"Fri, 12 Aug 2016 12:35:31 -0400","nprLastModifiedDate":"Fri, 12 Aug 2016 12:35:31 -0400","path":"/futureofyou/223572/ibm-watson-replaces-experts-brainpower-in-cancer-treatment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A computer may soon be able to offer highly personalized treatment suggestions for cancer patients based on the specifics of their cases and the full sweep of the most relevant scientific research.\u003c/p>\n\u003caside class=\"pullquote alignright\">Time is of the essence in formulating precision treatment plans for cancer patients. 'By the time we got through with this patient, the patient died.'\u003c/aside>\n\u003cp>IBM and the New York Genome Center, a consortium of medical research institutions in New York City, are collaborating on a \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02725684\">project\u003c/a> to speed up cancer diagnoses and treatment.\u003c/p>\n\u003cp>The work, which got underway in 2013, is exploring the use of computers to help analyze a wide range of genetic information and the scientific literature with the goal of quickly formulating precise treatment plans for cancer patients.\u003c/p>\n\u003cp>The line of research is being orchestrated by \u003ca href=\"http://www.nygenome.org/authorbio/robert-b-darnell/\">Robert Darnell\u003c/a>, the founding director of the New York Genome Center and a neuro-oncologist at Rockefeller University. A project on brain tumors aims to bring cancer experts in New York City to bear on treatment plans that take advantage of the very latest scientific evidence.\u003c/p>\n\u003cp>An essential assistant on Darnell's team is supercomputer \u003ca href=\"https://www.ibm.com/watson/\">IBM Watson\u003c/a>, which helps by comparing the genetic differences between healthy cells and tumor cells in patients, as well as fetching the newest treatment ideas from medical journals.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Watson wasn't always part of Darnell's lineup. When he started the project, he relied on the collective brainpower of a bunch of medical researchers in New York City. Fifteen of them, including Darnell, spent three weeks evaluating the case of the first patient of the project. But, he says, \"by the time we got through with this patient, the patient died.\"\u003c/p>\n\u003cp>Speed matters, given how fast cancer can spread. Information overload is a particular challenge.\u003c/p>\n\u003cp>\"Cancer is not giving you the luxury of time,\" says \u003ca href=\"http://researcher.watson.ibm.com/\">Ajay Royyuru\u003c/a>, the director of IBM's Healthcare and Life Sciences Research. And, he adds, there are \"more papers published in each year than cancer researchers can read and remember.\"\u003c/p>\n\u003cp>In contrast, IBM's supercomputer Watson, famous for defeating former champions in \u003cem>Jeopardy!\u003c/em> \u003ca href=\"https://www.youtube.com/watch?v=WFR3lOm_xhE\">in 2011\u003c/a>, is able to read \"800 million pages per second ... from medical literature to patient records to doctors' notes,\" according to Christine Douglass at IBM Watson Health.\u003c/p>\n\u003cp>Upon learning about Watson's abilities, Darnell approached IBM. By 2014, a human-computer coalition to fight cancer \u003ca href=\"https://www.washingtonpost.com/business/on-it/ibms-watson-new-york-genome-center-partner-on-brain-cancer-treatment/2014/03/18/35019894-aba7-11e3-af5f-4c56b834c4bf_story.html\">was born\u003c/a>.\u003c/p>\n\u003cp>\"Compare what the genetics in the healthy cell looks like to what the genetics in the cancer cell looks like, you get the list of differences,\" says \u003ca href=\"http://stevejamesharvey.com/\">Steve Harvey\u003c/a>, vice president of Watson Health at IBM. \"Watson will first try to figure out what are the differences that could be causing cancer. For each of those potential genetic issues, it will go through databases and literature to find\" known treatment options, he says.\u003c/p>\n\u003cp>With the help of Watson, Darnell's group studied 30 patients with glioblastoma, an aggressive form of brain cancer, and developed personalized treatment options for each patient \"based on genetic mutations present in the tumor,\" according to Darnell. Darnell declined to comment on the specifics of the findings before they're published. But, he says, \"there are patients who will benefit\" from this study. A preliminary report on the findings has been submitted to \u003cem>The Journal of Clinical Oncology\u003c/em>.\u003c/p>\n\u003cp>Both IBM and the New York Genome Center are moving on to find out whether Watson can apply what he learned from Darnell's research to a larger group of glioblastoma patients.\u003c/p>\n\u003cp>\"We'll be \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/06/28/fact-sheet-cancer-moonshot-summit-vice-president-biden-announces-new\">working with\u003c/a> the Veterans Health Administration,\" says Harvey. According to Harvey, \"The VHA overseas the largest population of cancer patients — 3.5 percent of all cancer patients in the US are from the VHA.\"\u003c/p>\n\u003cp>According to Darnell, the paper his group submitted will \"lay the groundwork for the larger, more comprehensive paper on the same study.\" Darnell says the current research project is not yet a clinical trial, and he hopes to execute a large-scale clinical trial in the future, recruiting \"any cancer patient who is sick, not necessarily from glioblastoma.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's not going to be doable without the machines,\" says Darnell.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Doctors+Want+A+Computerized+Assistant+For+Cancer+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/223572/ibm-watson-replaces-experts-brainpower-in-cancer-treatment","authors":["byline_futureofyou_223572"],"categories":["futureofyou_452","futureofyou_1"],"tags":["futureofyou_120","futureofyou_1014","futureofyou_80","futureofyou_112"],"featImg":"futureofyou_223573","label":"futureofyou"},"futureofyou_217172":{"type":"posts","id":"futureofyou_217172","meta":{"index":"posts_1591205157","site":"futureofyou","id":"217172","score":null,"sort":[1470675610000]},"guestAuthors":[],"slug":"beautiful-but-deadly-images-of-cancer-up-close","title":"Beautiful But Deadly: Images of Cancer, Close Up","publishDate":1470675610,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Sometimes, nature is an abstract expressionist.\u003c/p>\n\u003cp>Below are selected images from the National Cancer Institute's \"\u003ca href=\"https://visualsonline.cancer.gov/collection.cfm?groupid=4\" target=\"_blank\">Cancer Close Up 2016\u003c/a>\" collection, posted last month.\u003c/p>\n\u003cp>The NCI in February put out a call to researchers for \"spectacular microscopy photographs of cancer-related cells, tissues, and molecules that colorfully illustrate significant research conducted by NCI-designated cancer centers.\"\u003c/p>\n\u003cp>The NCI said it was particularly interested in images related to precision medicine, for which the agency receives funding as part of the federal government's \u003ca href=\"https://www.whitehouse.gov/the-press-office/2015/01/30/fact-sheet-president-obama-s-precision-medicine-initiative%22%20target=%22_blank\" target=\"_blank\">Precision Medicine Initiative.\u003c/a>\u003c/p>\n\u003cp>Most of the images were created using fluorescence microscope, an NCI spokesperson said. Some used an electron microscope. The images will adorn its exhibit booth at annual cancer research meetings and will be featured in public image galleries (not to mention \u003ca href=\"https://www.instagram.com/ncivisualsonline/\" target=\"_blank\">Instagram\u003c/a>).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>You can \u003ca href=\"https://visualsonline.cancer.gov/collection.cfm?groupid=4\" target=\"_blank\">see the full collection here\u003c/a>, but we liked these the best. The descriptions are from the NCI and have been lightly edited.\u003c/p>\n\u003cfigure id=\"attachment_217174\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncilipid.jpg\">\u003cimg class=\"wp-image-217174 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncilipid.jpg\" alt=\"ncilipid\" width=\"720\" height=\"720\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid.jpg 720w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Altered lipid metabolism may be a key signature of cancer. This image reveals the storage of cholesterol ester in lipid droplets (bright dots) in aggressive human prostate cancer. This finding may lead to new cancer drugs that work by blocking the activity of cholesterol esterification. \u003ci>(Ji-Xin Cheng/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217176\" class=\"wp-caption aligncenter\" style=\"max-width: 672px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncioncoprotein.jpg\">\u003cimg class=\"wp-image-217176 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncioncoprotein.jpg\" alt=\"ncioncoprotein\" width=\"672\" height=\"511\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncioncoprotein.jpg 672w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncioncoprotein-400x304.jpg 400w\" sizes=\"(max-width: 672px) 100vw, 672px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Infection with certain types of human papillomavirus (HPV) is associated with various cancers. Researchers are working to understand the processes by which HPV can transform a healthy cell into a cancerous one. This image shows actin (stained in green), a protein involved in cell motion, in HPV-16 E6 and E7-expressing human foreskin keratinocytes. (\u003ci>Ewa Krawczyk/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217203\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncibreasttumor.jpg\">\u003cimg class=\"wp-image-217203 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncibreasttumor.jpg\" alt=\"ncibreasttumor\" width=\"720\" height=\"720\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor.jpg 720w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This image of a breast cancer tumor and its microenvironment was obtained from a live mouse model. The image was obtained without any fluorophores, stains, or dyes, using only the metabolic co-factors of NADH and FAD, which are already inside of cells, along with second harmonic generation to see collagen. This technique has important clinical potential for patients who require label-free imaging, and may lead to more effective diagnoses and treatments. Tumor cells display in cyan, macrophages in red, collagen fibers in green. (\u003ci>Joseph Szulczewski, David Inman, Kevin Eliceiri and Patricia Keely/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217205\" class=\"wp-caption aligncenter\" style=\"max-width: 965px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciimmunotherapy.jpg\">\u003cimg class=\"wp-image-217205 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciimmunotherapy.jpg\" alt=\"nciimmunotherapy\" width=\"965\" height=\"803\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy.jpg 965w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-400x333.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-721x600.jpg 721w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-768x639.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-960x799.jpg 960w\" sizes=\"(max-width: 965px) 100vw, 965px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shown here is a pseudo-colored scanning electron micrograph of an oral squamous cancer cell (white) being attacked by two cytotoxic T cells (red), part of a natural immune response. Nanomedicine researchers are creating personalized cancer vaccines by loading neoantigens identified from the patient's tumor into nanoparticles. When presented with immune stimulants, this activates the patient's own immune system, leading to expansion of tumor-specific cytotoxic T cells. (\u003ci>Rita Elena Serda/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217207\" class=\"wp-caption aligncenter\" style=\"max-width: 864px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciDrosophilia.jpg\">\u003cimg class=\"wp-image-217207 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciDrosophilia.jpg\" alt=\"nciDrosophilia\" width=\"864\" height=\"864\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia.jpg 864w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-150x150.jpg 150w\" sizes=\"(max-width: 864px) 100vw, 864px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The human CBFA2T3-GLIS2 fusion protein is a key driver of pediatric acute megakaryoblastic leukemia (AMKL), and confers a poor prognosis. Researchers found a way to express CBFA2T3-GLIS2 (red) in larval fruit fly wing disc cells. This confirms a major role for a pathway that may provide a target for new therapies. Nuclei (green) and actin filaments (purple) are also shown. (\u003ci>Suresh Marada/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217209\" class=\"wp-caption aligncenter\" style=\"max-width: 768px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nci-nanoparticles.jpg\">\u003cimg class=\"wp-image-217209 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nci-nanoparticles.jpg\" alt=\"nci nanoparticles\" width=\"768\" height=\"768\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-150x150.jpg 150w\" sizes=\"(max-width: 768px) 100vw, 768px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Treating cancer in the brain is particularly difficult because most drug molecules are not small enough to penetrate the blood-brain barrier. Researchers wonder whether nanoparticles can serve as a drug-delivery mechanism. This image shows nanoparticles (red) being taken up in the brain of a live rat model with glioblastoma (in green). Nuclear DNA is in blue; tumor-associated macrophages in white.\u003ci> (Eric Hoyeon Song, Alice Gaudin, W. Mark Saltzman/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp>More detail on how the images were created from \u003ca href=\"https://www.washingtonpost.com/national/health-science/deadly-and-beautiful-the-mesmerizing-images-of-cancer-research/2016/07/11/307edb24-43a3-11e6-8856-f26de2537a9d_story.html\" target=\"_blank\">The Washington Post\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Most of the photos ... are made with fluorescent optical microscopes with attached digital cameras. Scientists use various fluorescent stains to highlight specific cellular structures ... and these stains and dyes “light up” when exposed to specific wavelengths of light. (Often) the final multicolored images obtained are composites — overlays — of separate images taken using different wavelengths.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>And from \u003ca href=\"https://www.statnews.com/2016/07/15/cancer-cells-slideshow/\" target=\"_blank\">STAT\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The photographic techniques that produced them are allowing scientists to understand how the interactions between cellular proteins and the cell nucleus allow cancer cells to invade far-flung tissue, for instance, and how certain molecules allow tumor cells to withstand chemotherapy.\u003c/p>\u003c/blockquote>\n\n","blocks":[],"excerpt":"Spectacular microscropy images from the National Cancer Institute.","status":"publish","parent":0,"modified":1470677697,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":12,"wordCount":689},"headData":{"title":"Beautiful But Deadly: Images of Cancer, Close Up | KQED","description":"Spectacular microscropy images from the National Cancer Institute.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Beautiful But Deadly: Images of Cancer, Close Up","datePublished":"2016-08-08T17:00:10.000Z","dateModified":"2016-08-08T17:34:57.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"217172 http://ww2.kqed.org/futureofyou/?p=217172","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/08/08/beautiful-but-deadly-images-of-cancer-up-close/","disqusTitle":"Beautiful But Deadly: Images of Cancer, Close Up","source":"Personalized Medicine","path":"/futureofyou/217172/beautiful-but-deadly-images-of-cancer-up-close","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sometimes, nature is an abstract expressionist.\u003c/p>\n\u003cp>Below are selected images from the National Cancer Institute's \"\u003ca href=\"https://visualsonline.cancer.gov/collection.cfm?groupid=4\" target=\"_blank\">Cancer Close Up 2016\u003c/a>\" collection, posted last month.\u003c/p>\n\u003cp>The NCI in February put out a call to researchers for \"spectacular microscopy photographs of cancer-related cells, tissues, and molecules that colorfully illustrate significant research conducted by NCI-designated cancer centers.\"\u003c/p>\n\u003cp>The NCI said it was particularly interested in images related to precision medicine, for which the agency receives funding as part of the federal government's \u003ca href=\"https://www.whitehouse.gov/the-press-office/2015/01/30/fact-sheet-president-obama-s-precision-medicine-initiative%22%20target=%22_blank\" target=\"_blank\">Precision Medicine Initiative.\u003c/a>\u003c/p>\n\u003cp>Most of the images were created using fluorescence microscope, an NCI spokesperson said. Some used an electron microscope. The images will adorn its exhibit booth at annual cancer research meetings and will be featured in public image galleries (not to mention \u003ca href=\"https://www.instagram.com/ncivisualsonline/\" target=\"_blank\">Instagram\u003c/a>).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>You can \u003ca href=\"https://visualsonline.cancer.gov/collection.cfm?groupid=4\" target=\"_blank\">see the full collection here\u003c/a>, but we liked these the best. The descriptions are from the NCI and have been lightly edited.\u003c/p>\n\u003cfigure id=\"attachment_217174\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncilipid.jpg\">\u003cimg class=\"wp-image-217174 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncilipid.jpg\" alt=\"ncilipid\" width=\"720\" height=\"720\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid.jpg 720w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Altered lipid metabolism may be a key signature of cancer. This image reveals the storage of cholesterol ester in lipid droplets (bright dots) in aggressive human prostate cancer. This finding may lead to new cancer drugs that work by blocking the activity of cholesterol esterification. \u003ci>(Ji-Xin Cheng/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217176\" class=\"wp-caption aligncenter\" style=\"max-width: 672px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncioncoprotein.jpg\">\u003cimg class=\"wp-image-217176 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncioncoprotein.jpg\" alt=\"ncioncoprotein\" width=\"672\" height=\"511\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncioncoprotein.jpg 672w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncioncoprotein-400x304.jpg 400w\" sizes=\"(max-width: 672px) 100vw, 672px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Infection with certain types of human papillomavirus (HPV) is associated with various cancers. Researchers are working to understand the processes by which HPV can transform a healthy cell into a cancerous one. This image shows actin (stained in green), a protein involved in cell motion, in HPV-16 E6 and E7-expressing human foreskin keratinocytes. (\u003ci>Ewa Krawczyk/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217203\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncibreasttumor.jpg\">\u003cimg class=\"wp-image-217203 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncibreasttumor.jpg\" alt=\"ncibreasttumor\" width=\"720\" height=\"720\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor.jpg 720w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This image of a breast cancer tumor and its microenvironment was obtained from a live mouse model. The image was obtained without any fluorophores, stains, or dyes, using only the metabolic co-factors of NADH and FAD, which are already inside of cells, along with second harmonic generation to see collagen. This technique has important clinical potential for patients who require label-free imaging, and may lead to more effective diagnoses and treatments. Tumor cells display in cyan, macrophages in red, collagen fibers in green. (\u003ci>Joseph Szulczewski, David Inman, Kevin Eliceiri and Patricia Keely/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217205\" class=\"wp-caption aligncenter\" style=\"max-width: 965px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciimmunotherapy.jpg\">\u003cimg class=\"wp-image-217205 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciimmunotherapy.jpg\" alt=\"nciimmunotherapy\" width=\"965\" height=\"803\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy.jpg 965w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-400x333.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-721x600.jpg 721w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-768x639.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-960x799.jpg 960w\" sizes=\"(max-width: 965px) 100vw, 965px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shown here is a pseudo-colored scanning electron micrograph of an oral squamous cancer cell (white) being attacked by two cytotoxic T cells (red), part of a natural immune response. Nanomedicine researchers are creating personalized cancer vaccines by loading neoantigens identified from the patient's tumor into nanoparticles. When presented with immune stimulants, this activates the patient's own immune system, leading to expansion of tumor-specific cytotoxic T cells. (\u003ci>Rita Elena Serda/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217207\" class=\"wp-caption aligncenter\" style=\"max-width: 864px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciDrosophilia.jpg\">\u003cimg class=\"wp-image-217207 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciDrosophilia.jpg\" alt=\"nciDrosophilia\" width=\"864\" height=\"864\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia.jpg 864w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-150x150.jpg 150w\" sizes=\"(max-width: 864px) 100vw, 864px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The human CBFA2T3-GLIS2 fusion protein is a key driver of pediatric acute megakaryoblastic leukemia (AMKL), and confers a poor prognosis. Researchers found a way to express CBFA2T3-GLIS2 (red) in larval fruit fly wing disc cells. This confirms a major role for a pathway that may provide a target for new therapies. Nuclei (green) and actin filaments (purple) are also shown. (\u003ci>Suresh Marada/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217209\" class=\"wp-caption aligncenter\" style=\"max-width: 768px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nci-nanoparticles.jpg\">\u003cimg class=\"wp-image-217209 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nci-nanoparticles.jpg\" alt=\"nci nanoparticles\" width=\"768\" height=\"768\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-150x150.jpg 150w\" sizes=\"(max-width: 768px) 100vw, 768px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Treating cancer in the brain is particularly difficult because most drug molecules are not small enough to penetrate the blood-brain barrier. Researchers wonder whether nanoparticles can serve as a drug-delivery mechanism. This image shows nanoparticles (red) being taken up in the brain of a live rat model with glioblastoma (in green). Nuclear DNA is in blue; tumor-associated macrophages in white.\u003ci> (Eric Hoyeon Song, Alice Gaudin, W. Mark Saltzman/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp>More detail on how the images were created from \u003ca href=\"https://www.washingtonpost.com/national/health-science/deadly-and-beautiful-the-mesmerizing-images-of-cancer-research/2016/07/11/307edb24-43a3-11e6-8856-f26de2537a9d_story.html\" target=\"_blank\">The Washington Post\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Most of the photos ... are made with fluorescent optical microscopes with attached digital cameras. Scientists use various fluorescent stains to highlight specific cellular structures ... and these stains and dyes “light up” when exposed to specific wavelengths of light. (Often) the final multicolored images obtained are composites — overlays — of separate images taken using different wavelengths.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>And from \u003ca href=\"https://www.statnews.com/2016/07/15/cancer-cells-slideshow/\" target=\"_blank\">STAT\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The photographic techniques that produced them are allowing scientists to understand how the interactions between cellular proteins and the cell nucleus allow cancer cells to invade far-flung tissue, for instance, and how certain molecules allow tumor cells to withstand chemotherapy.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/217172/beautiful-but-deadly-images-of-cancer-up-close","authors":["80"],"categories":["futureofyou_452"],"tags":["futureofyou_103","futureofyou_80","futureofyou_112"],"featImg":"futureofyou_217338","label":"source_futureofyou_217172"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. 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You ask the questions. You decide what Bay Curious investigates. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us","airtime":"SUN 2pm-3pm, MON 12am-1am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png","officialWebsiteLink":"https://www.wnycstudios.org/shows/otm","meta":{"site":"news","source":"wnyc"},"link":"/radio/program/on-the-media","subscribe":{"apple":"https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2","tuneIn":"https://tunein.com/radio/On-the-Media-p69/","rss":"http://feeds.wnyc.org/onthemedia"}},"our-body-politic":{"id":"our-body-politic","title":"Our Body Politic","info":"Presented by KQED, KCRW and KPCC, and created and hosted by award-winning journalist Farai Chideya, Our Body Politic is unapologetically centered on reporting on not just how women of color experience the major political events of today, but how they’re impacting those very issues.","airtime":"SAT 6pm-7pm, SUN 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Our-Body-Politic-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://our-body-politic.simplecast.com/","meta":{"site":"news","source":"kcrw"},"link":"/radio/program/our-body-politic","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/our-body-politic/id1533069868","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9feGFQaHMxcw","spotify":"https://open.spotify.com/show/4ApAiLT1kV153TttWAmqmc","rss":"https://feeds.simplecast.com/_xaPhs1s","tuneIn":"https://tunein.com/podcasts/News--Politics-Podcasts/Our-Body-Politic-p1369211/"}},"pbs-newshour":{"id":"pbs-newshour","title":"PBS NewsHour","info":"Analysis, background reports and updates from the PBS NewsHour putting today's news in context.","airtime":"MON-FRI 3pm-4pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.pbs.org/newshour/","meta":{"site":"news","source":"pbs"},"link":"/radio/program/pbs-newshour","subscribe":{"apple":"https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2","tuneIn":"https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/","rss":"https://www.pbs.org/newshour/feeds/rss/podcasts/show"}},"perspectives":{"id":"perspectives","title":"Perspectives","tagline":"KQED's series of of daily listener commentaries since 1991","info":"KQED's series of of daily listener commentaries since 1991.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Perspectives-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/perspectives/","meta":{"site":"radio","source":"kqed","order":"15"},"link":"/perspectives","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/id73801135","npr":"https://www.npr.org/podcasts/432309616/perspectives","rss":"https://ww2.kqed.org/perspectives/category/perspectives/feed/","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"}},"planet-money":{"id":"planet-money","title":"Planet Money","info":"The economy explained. 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