Month: February 2019

  • For $20, we won’t name anything after your ex for Valentines, because you’re not a dick and we support that.

    And also because it leaves you the option to keep hittin dat 😉

    Valentine’s is a hard day for some. Not only are beta males like us forced to watch on, desolately, as billions share their perfect love lives on social media, we’re also subjected to this shit.

    It’s seems like every zoo, and every viral news site in the world have come together to form the ultimate clickholes of clickholes this year around. I was mildly annoyed by this, so, as is my God Given Right as a MILLENIAL – I put in hours (10 minutes) of work to stop this shit. Sign the Change.org to stop this shameless attempt to generate website hits, and be sure to click this link to watch each of these photos in slideshow mode to artificially inflate the views this page gets before this leaves your news cycle.

     

     

    If you hate shameless self promotion and clickbait, be sure to check out my upcoming free e-book on how what I did to beat cancer can be used to help you with anything in life, guaranteed (and by guaranteed, I mean it may work – but I’m committed to testing the psychological, neurobiological, learning and motivation science behind this with my app – which powers and automates medical research – Centered Around You.)

    If you actually wanna make a difference, donate a mosquito net, one of the most cost effective way to save lives and billions in lost revenue according to GiveWell – which I’m sure you can name after that bloodsucking #$*!# ex of yours too.

     

    It was funny the first 100 times… Ok… I’ll be honest… It’s still quite funny. I’m just doing this for teh views lel.

    Shameless promo: Follow me on Facebook – or on insta/twitter @nikhilautar . If you wanna help make my startup a success – www.GoFundMe.com/gettosleepeasy

    Sign up to my email list.

    Follow the journey of my lifesaving startup:

     

    If you’re bored watch some of the stupid stuff I get up in hospital/when I’m less sick than usual.

     

    Read more about me here!

     

     

  • #LockEmUp. #MakeAlternativesGreatAgain. Why Is It OK for People to Fraudulently Spread BS on Health Online?

    Scroll to the bottom to report someone who’s been making dodgy health claims! Sign the change.org campaign to stop this here!

    I recently went on CoffeZilla’s podcast today, and outlined a few experiences I had with dodgy MLMers and alternative clinics who advertise on Facebook, netting them millions, and Facebook tens to hundreds of thousands. Here’s a bunch of evidence and screenshots of other conversations I’ve had with scammers/MLM grifters. It’s REALLY sad to see.

    For those who don’t know me… My name is Nikhil. I’m a medical researcher, medical student, and ex cancer patient.

    I’ve been on both sides of the medical bed in my role as a patient, future doctor, and have also been in the background too – working on, and advocating for medical research. Again, in both my capacities as a professional AND a ‘consumer.’

    I’ve looked up the literature, evaluated trials and fought to get the medicine which has probably kept me here (azacitidine, which was in early phase trials for my condition, when I’d relapsed, and needed it most). I’ve also been on numerous alternative therapies, from low sugar diets and alkaline water, to tumeric, Chinese herbs, and even medical marijuana. Both for cancer, and the resultant chronic, and potentially fatal illness my treatment has left me with (graft versus host disease).

    I know what it’s like to be desperate. I know how crappy doctors can be when considering you as a COMPLETE patient, and person – and why and how complimentary medicine DOES make a difference. Indeed – a massage therapist, and dietician have changed my life. I’m on COQ10, Fish oil and am involved in other complimentary medicine too. Indeed – UpToDate, a tool pretty much every doctor uses every day to guide treatment actually recommends these two as first line therapy for lipid and cholesterol control.

    But I also know the importance of medical science. I also know numerous friends who’ve been turned away from options which gave them a chance, and ended up dying. And in this post, you’ll read a story of HOW I MYSELF WAS ALMOST CONNED into trying Sodium Bicarbonate instead of real medicine when I’d relapsed, and given a 10% chance of surviving, and why we need to PROSECUTE PEOPLE WHO SPREAD MISINFORMATION FOR PROFIT – OR WITHOUT DISCLAIMERS (Click here to lend your voice to the the Change.Org campaign now)

    Alternative medicine can be amazing. Many, if not most medical therapies DID come from nature, and knowledge of traditional medicine. And I’d say the majority of naturopaths, massage therapists and yoga teachers only encourage you to be more healthy, mindful individuals.

    But especially today, where memes on the internet are unquestioned truth, whilst scientific articles and doctors are doubted (and routinely made to be subjects of conspiracy theories), alternative medicine can be dangerous. The following examples may shock you. But it happens all the time. And it’s literally killing people. Cancer patients who use alternative medicine as opposed to proven therapies have up to a 5.7x higher chance of death!

    A video from my series – Medical Factz – that outlines the ridiculous “Cancer is a Fungus, and sodium bicarbonate is the cure” theory that started from fraud, and ended in jailtime for manslaughter, and millions of others being deceived. 

     

    Recently, Facebook took action after a natural birth Facebook Group urged an endangered patient to not seek medical treatment at a hospital. The baby passed away.

    Right: Another pernicious danger seen often in Facebook groups… Toby is a juice advocate who sells juicing guides and products. He has no clue what cystic fibrosis is. Yet he is still trying to scam them to make a few Dollars. It’s sickening. Vertex is a pharmaceutical company who’s creating treatment for CF, by the way.

    Left: One of the biggest proponents of unproven lies about health has to be the antivaccination movement. Find out how one man fraudulently wrote one paper (composed of made up patients and made up results) which caused this movement to go, pardon the pun, viral (he now speaks at conferences for tens, to hundreds of thousands).

    This is just the tip of the iceberg. From treating children who contract various illnesses with essential oils and tumeric rather than getting them medical attention, to misleading desperate cancer patients with promises of miracle cures (something which has killed at least 2 friends of mine, to date), to prescribing natural therapy regimes which have left babies malnourished, likely suffering from developmental delays for life, we seem to hear about things going wrong for people every day these days.

     

    How I was nearly killed by bad advice.

    The picture below outlines a scam I almost fell for. When I’d relapsed, I was given a less than 10% chance of surviving. Palliative care was suggested as an option for me. A second bone marrow transplant was a long-shot, but the only curative option.

    At this time, a family friend put my family in contact with a researcher and scientist named Dr J, who promised to have a cure for me.

    I was desperate. Willing to try anything. But luckily, I also had a year of medical knowledge under my belt.

    We went in to see ‘Dr’ J one day at his apartment. He went into this theory of how sodium bicarbonate could cure cancer. One common, popular alternative therapy promoted by many, is the idea that “cancer thrives in acid, and therefore making yourself more alkaline will cure it”. He also purported another common alternative therapy – that “cancer loves, and is fueled by glucose, therefore low-sugar diets will cure it.” The former is largely known to be false. Cancers, due to their rapid, anaerobic metabolism of energy emit large amounts of lactic acid which PRODUCE an acidic environment. Not the other way around. And in any case – ‘alkaline diets’ or alkaline water will only result in less acidic urine, and slightly more alkaline saliva (not associated with alkaline blood). Your body’s buffer systems keep your blood’s pH in a 0.1 window. Even 0.01 higher or lower than normal ranges result in medical emergency. There’s no way for alkalinity to make it TO the cancer.

    When I asked him about how you could make tumor sites more alkaline… he had no response. And when I asked him a basic metabolism question any 1st year student in any health degree would understand (‘if cancer feeds off glucose… your body will produce glucose from elsewhere by breaking down fats and protein if need be. Why wouldn’t the cancer just keep using that glucose preferrentially?)… he again, couldn’t answer me.

    He showed me a few case studies from decades ago of 1 or 2 people who seemed to have had tumours regress after trying sodium bicarbonate. But even then I’d been reading on spontaneous regressions, and even then, I knew that if only a few case studies could be produced in the decades since we had this ‘common knowledge’ of how to cure cancer… then it was unlikely to be representative, or statistically significant. And after all this, he turned his attention towards my parents and started his sales pitch on why “Amway vitamins” could cure me. Again, no clear linkages as to why his vitamins were better (or why vitamins could cure cancer for that matter) were made. I later found out that Amway is a company with a pyramid-scheme model, designed to make money through the perpetual, impossible, addition of members who go on to onsell product, and earn commissions on all members they bring into the program. “Dr” J was probably locked in this trap himself.

     

    John Oliver, in his brilliant style, breaks down the fraud that is the many mutli-level marketing companies that exist worldwide. 

     

    Family and friends pressured me down his pathway. They said it couldn’t hurt. They told me to believe in him. They took me to a seminar where he waxed on and on, and brought up people with chronic conditions cured by his miracle therapies (when likely, their changed lifestyle habits were the real fix), where he wanted me to speak, to endorse his treatments.

    I didn’t.

    If he, a scientist working at the University of Sydney, couldn’t answer the questions of a 1st year medical student, why should I believe him?

    Instead, I went out and looked up every journal I could, and every clinical trial going on in my disease around the world (something easier to do than expected – thanks to this amazing site that anyone can use called ClinicalTrials.gov) – I looked through all my options and presented one – Azacitidine – as a promising option to use to increase my odds post transplant to my doctor. With my doctor’s help, I got it.

     

    It’s likely because of that drug, and hundreds of thousands of hours of work from scientists, and doctors around the world, that I’m still here today.

    Yet, if I hadn’t had the knowledge I did, “Dr” J above could have killed me.

    If you’re in a similar position – but don’t have medical training, please, PLEASE do a simple search on ClinicalTrials.Gov and/or your national clinical trial database for options. When I was looking up my own therapy – it helped me see trends of new therapies and backed my case to my doctor to get me the drug I needed. It’s simple to use – I’ve suggested it to numerous patients who’ve found second options and benefited from REAL SCIENCE through this. Please – try this first!

     

    So why does this happen? Isn’t it illegal?

    Consumer law protection exists for this kind of stuff. Yet misinformation like the above is rife within the multi-billion dollar alternative medical industry. You can’t sell TVs or Fridges based off false statements and claims. But somehow, it’s OK to gamble with other peoples’ lives, in health.

    Why? Well, I’m not a lawyer. I’d love to hear from any medical malpractice lawyers out there who’d like to offer their own perspectives. But one major issue is that legislation against this kind of thing, around the world often lacks teeth.

    This great article discussing the UK’s  Consumer Protection from Unfair Trading Regulations 2008 in regards to alternative medicine – goes into some of the issues. Interpretations of the law are often not as clear as their intentions, in the eyes of lawyers and judges. Though it seemingly is clear that the defendent, not accuser, has to prove the claims they make are true, in practice, it often is up to the accuser to prove something’s false. Proving a negative is very difficult. And in a field where not much research is done… this becomes tougher. In addition, a lot of the time, enforcement isn’t followed up on laws. The Competition and Consumer Act 2010 (Australia), and numerous precedents and investigations done by the FTC also mark many of these practices as illegal.

    Yet millions get away with this. Indeed, social media and fake news is a big proponent of this too. There are thousands of influencers with millions of followers making millions of dollars pedaling misleading, and often dangerous misinformation. Wellness is a half a trillion dollar, largely unregulated industry. Chinese Medicine, which I tried, were found to have 127 different types of fungal contaminants in just 15 herbal mixes.  And innocuously, there are thousands, maybe hundreds of thousands, advocating for unproven therapies in Facebook groups – turning people away from real therapies – sometimes profiting, sometimes spreading misinformation. People and groups like this, I see everyday in cancer groups where I talk and interact with other patients.

    A dangerous meme from a dangerous page. Mamograms are PROVEN to save lives – and their risks and benefits have been studied and found to be effective in reducing mortality in high level studies. The amount of radiation exposure is safe and though there are new therapies coming through the pipeline – Thermographs are shown to be INFERIOR to mamographs. Natural News is a notorious ‘news site’ which spreads dangerous misinformation.

     

    Why are they never sued? Well, sometimes they are. Robert O Young, a proponent of the “cancer is acidic, and alkalysing the body is the cure” lost a lawsuit that forces him to fork over $105million to his victims. Dr Simoncini, proponent of the “cancer is a fungus and sodium bicarb is the cure” alternative theory that has been thoroughly debunked is serving a 5 year jail sentence for manslaughter, after he continued to treat people for tens of thousands of dollars a pop at his clinic, despite being convicted of manslaughter and being deregistered earlier in 2006 as well. Doctors prescribing miracle “Defeat Autism Now” therapy regimes which have no scientific basis are currently being sued too. 

    But often, quacks and frauds USE the law to continue shady practices. Another naturopath and proponent of the sodium bicarbonate cures cancer movement is suing a whistleblower to ensure she can keep her operation running. A senior member of the renowned site Quackwatch was also sued for defamation.

    And often, this stuff goes unchecked on social media. Not just from unscrupulous people like Toby (pictured above), but also from “Influencers,” and “Wellness Gurus and Coaches” who post deliberately misleading posts to millions of followers to sell their own products, or that of other, often unproven, wellness therapies.

    An example of one of Facebook’s most virulent anti-science influencer. Sure, it isn’t one of his more ludicrous posts which does things like dissuade people from getting proven, effective therapies for their serious illness, but it shows how far some of these people are willing to go to make a quick buck. Click here to check out a video I made spoofing many of those viral ‘health fact’ videos you see these days.

     

    But you know what, I’m sick of this.

    Things like this seem innocuous. But it literally kills millions every year. It scams people, many of whom are already under heavy financial strain following intense treatments, of tens of thousands. It’s taken the lives of at least 2 close friends who had other, better options still available to them, and likely many more people I’ve known too.

    Alternative and complimentary medicine can be amazing. The fact that practitioners actually sit down, and take the time to listen to you as a whole person is a big reason why it’s so popular. There are many massage therapists, yoga instructors, aromatherapists, dietitians and naturopaths out there who do know their stuff, work with doctors, abide by laws – and they help DO help millions. I benefit from many of the above.

    But it’s when they do things like this that they become dangerous.

    I believe we need to crack down on this industry, and the crooks who lead millions astray every year. We need to #MakeAlternativesGreatAgain – and when people make false health claims – we need to #LockEmUp – for the good of society – if they make unfounded health claims. If you agree – check out this change.org campaign I’m running soon.

    1) IF YOU MAKE CLAIMS PERTAINING TO HEALTH – claiming a therapy WILL cure or fix a condition, or encourage others to try such therapies, without any evidence to back up your claims, without inserting disclaimers or saying “May” – YOU SHOULD BE CULPABLE, AND YOU SHOULD GO TO JAIL if your advice ends up harming someone.

    2) – If you profit from the sales, in any way, of products with purported health benefits, YOU SHOULD HAVE TO MAKE THAT CLEAR, and it SHOULD BE YOUR RESPONSIBILITY, to check the validity of those health claims.

    I’ll even go so far as to say:

    3) If you share misinformation, without any reasonable scientific or other evidence behind it, and it ends up harming someone – YOU SHOULD BE PROSECUTED AS WELL.

     

    If not… scumbags like these will continue to exist, and prosper off the suffering of good people. Check out the Change.org campaign I’ve made and add your voice to this campaign for science and reason.

    Bell Gibson fraudulently made millions after faking that she cured brain cancer with diet and alternative therapies. Millions of dollars escaped fines. But how many she led astray of real options will probably never be known. Full article here. She joins other fitness and wellness ‘experts,’ such as Sarah Stevenson who’ve falsely claimed they’d beaten a cancer which spontaneously regresses in over 1/4 people due to diet and wellness alone, and then gone on to fraudulently provide wellness coaching sessions, for $300 per 50 minutes (rates doctors who’ve studied for decades don’t charge).

     

    There are numerous examples of scumbags like this out there. You may well already be following them. If you are, and you don’t see links to journals, or any kind of evidence which backs up their claim – do me a favour. Unfollow them. And if they say something which you feel may be harmful to society – tag me, @nikhilautar, or use the #LockEmUp to help bring them down.

     

    What I’m doing about it.

    I’ll be running this campaign soon, this is one thing. But my Startup – Centered Around You – actually aims to be the first app of its kind to not just provide evidence based wellness advice – but TEST IT TOO. A combination of machine learning, my own passion for research, and inputs from world leading clinicians, researchers, and coders/designers, advised by CEOs, senior VPs and heads of national operations of international and ASX listed firms advise us. We won Australian Student Startup of the Year not long ago. Along with numerous other prizes (we made the finals of the Global Impact Challenge, won NSW Student Startup of the Year in a separate competition, and have received numerous other grants and rewards for our work).

    Our medical devices will also make life safer and easier for elderly and disabled patients. We are testing with some of Australia’s largest nursing home chains in the near future.

    And our products have also generated interest and pre-sales from people interested in getting a better night’s sleep too!

    Check out www.GetToSleepEasy and CAroundYou.com for more information.

     

    I’m always here to talk. You can reach me (I am incredibly busy, but strive to read all my emails) at info [at [ nikhilautar.com – or via this contact form.

    Wanna report a dodgy influencer who may be breaking the law?

     

    [hubspot type=form portal=6338483 id=591a44ae-86cf-4457-a4dd-b700c0c7e181]

     

    Common, Inaccurate Medical Claims being Bandied About Online

    Check out Nikhil’s Series – Medical Factz – where he breaks down common cancer (and other health and wellbeing) trends, and finds out which are myths and which have merit!

    Cancer is a fungus?

    Nikhil breaks this one down below!

     

    Vitamins cure cancer; Vitamin C Cures Cancer?

    Vitamins are often claimed to be efficacious in cancer treatment when this is far from the case. SBS did a feature on this recently. A compounding pharmacist was telling patients – as A NON CLINICIAN – someone who can’t legally advise on clinical judgements according to Australian, TGA legal guidelines – claimed that Vitamin C supplements could cure cancer or help patients. The 2 largest systematic reviews – the highest quality of evidence possible – have said a LOT more evidence is required. There hasn’t been phase 3, randomised controlled trials for this.  It is NOT indicated by the TGA as a treatment for cancer so even if her clinic is supported by GPs – its use is questionable and something I would be interested in reporting to authorities. Would you want big pharma skipping protocols and promoting unfounded claims before approval? No… Why should someone with NO training in this space get a pass? Multiple studies have discontinued high dose therapy use due to high toxicity. It should NOT be advocated for as a viable treatment. She did just that on national TV.

    Could it help? Possibly – early studies have shown some improvement. Almost no cures. It it generally well tolerated. But toxicities have also been noted. I’ve been in a desperate position before… There are many options MUCH higher on my list of things I’d try if things got more dire.

    Vitamin B6 and B12 was found in a prospective, observational study of over 77,000 patients (one of the highest quality long term therapies) have been associated with 30 – 40% higher risks of lung cancer (a 2x higher risk for patients taking high doses). Vit b12 has been shown to increase esophageal cancer as well.  Many studies show no positive impact on survival. SBS – the news channel which put this together an ‘unbiased show’ where professionals with years of experience and with backing of millions of patients worth of data in research were given an equal platform to individuals who ‘just felt better’ – even reported on an American study which showed vitamin supplements increased risk of all causes of death. Indeed – vitamins nearly killed me.

    How cancer patients in particular are at risk

    Cancer patients who take alternative treatments are more l

    Some alternative treatments also reduce the efficacy of treatments or prom0te tumour growth! For example, antioxidants may actually cause cancers to grow once established by reducing cancer-killing, toxic reactive oxidative species (ROS). Some drugs which mediate tumour cell death through inducing more ROS’s will also be less effective if you’re on a high antioxidant diet.

     

    Wanna report a dodgy influencer who may be breaking the law?

     

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  • Think Medicine Sucks? Think You Don’t Make a Difference? Try This.

    So recently, a I was linked this article by many people. It’s been all over my Facebook feed, and I’ve been told to read it by many.

    It’s really well done and articulates the challenges of hospital well. On both the doctor’s and patient’s side. It goes into the powerlessness patients feel, the confusion they face in hospitals, and the struggle of being a junior doctor in a system that’s pushed to its limits, and seems not to care. It features some really amazing artwork, and is told in the form of a cartoon, that really does capture your eye. As much as I may seem like I’m bagging on it now… it really is well done, and I highly recommend you give it a read.

    photos and full article available at The Guardian. 

     

    But regarding the “novel” realisation that being a patient sucks…

    A) No Shit.

    Every 2 months a ‘profound’ article comes out after a doctor enters ED or faces his own health challenge and suddenly realizes – “holy crap I was treated like shit,” and i slapmy head. Hard (it’s probably why my memory sucks so much)…

    You see it all the time in your patient’s eyes. It doesn’t take huge amounts of ’emotional intelligence’ to see that. You get used to it and start thinking “that’s just how it has to be.” and you are, quite reasonably, tired yourself, and often unable to do anything.

    B) Where you can, instead of clapping your hands and crying ‘amen,’ go do something about it.

    Take it from someone who knows… the tiny, little things which HARDLY takes time out of your day make a HUGE difference. When someone asks for pain meds, and they need it, chart it asap. And tell them, or get your nurses to tell them if it’s gonna take time, and explain why if it is going to take a while. “I haven’t got time right now, but I’m gonna try my best to get it to you asap” reduces suffering 90% compared to just being left hanging. Believe me, it does. Same goes for if you’re late, generally, in a clinic, or whatever.

    Ask patients if they understand what you said when you chat to them, and if they have any questions. It’s not wasting time. It ensures that they buy into your treatment plan and comply with recovery, and they’ll trust you, divulge everything, and give better histories. If you’re too busy, let them know that you’ll get around to it when you can or to ask the nurses when they’re around next.
    Asking about those little things like work, if they’re okay to get home, how they get their medications, is, for similar reasons, not a waste of time. And, importantly, they make you feel cared for.

    The tiny things – greeting people warmly. Asking how they’ve been, talking about things important to them as you walk to your consult room… they are HUGE. My haematologist does that. There’s a reason why I drive, or take a train 1-1.5 hours each way to see him.

    Because I feel CARED FOR.

    That feeling is EVERYTHING. It’s your most powerful tool as a healer.

    From someone who’s gone through enormous amounts of physical agony… trust me that I know what I’m talking about when I say that psychological/ emotional agony is 100x worse. And you ALWAYS have the power to change that. No matter what.

    I get it. It feels hard to keep giving. Day in and day out, when you work such a stressful job and face failure on a constant basis… when you’re depressed and when everything feels even harder to do than normal… giving back becomes even harder. It seems futile. For many reasons – we doctors don’t take it as seriously as we should. Just going on and telling yourself you can’t do much is how we cope with it. But that’s the biggest trap of depression. Though playing the victim and focusing on the things that stop you is easier at the time, it really makes you feel shitter in the long run.

    In truth though, doing the right thing – going “that extra mile”… it’s really as hard as it seems. The little things make just as much of a difference as huge, epic gestures. And ultimately, you being the good person I know 99% of doctors are underneath, wherever you can, helps YOU too. It reminds you why you got into this. It reminds you that you DO and CAN make a difference.

    It isn’t that hard to do. And, like with anything in life, making the decision to give back where possible becomes habitual too. It becomes your norm. So anyone reading this… next time you’re out there… go that ‘extra’ foot or two. I guarantee you. It’s worth it.

    This was a talk I did for the Australian Indian Medical Graduate Association’s annual general meeting a few years ago. I was quite raw… I’d just come from the funeral of an old friend and fellow medical student who’d taken his own life. I hope it helps those of you struggling out there, wondering, “what’s the point?” realise, that you can and always do make a difference.

     

     


     

  • How to Ensure Cancer Treatments Keep Imrpoving and Make the Drug Development Cycle more Efficient.

    Last post:                                     My Story:                                         Next One

    This was my submission to an essay competition run by the Cancer Council of Australia a few years ago. It was shortlisted but didn’t take down first place unfortunately! I was probably a bit too industry/business model focused for what they were looking for! It does outline major challenges facing drug development though – something fascinating to many, for sure! Let me know your thoughts!

    Ensuring Cancer Treatments

    Improve with

    Advances in Research

     

    Nikhil Autar
    University of Western Sydney
    Cancer Council 2015 Essay Competition

     Outline

    Cancer treatment has come far over the ages; from the barbaric beginnings of radical mastectomies and infusions of mustard gas1, to the robotic thyroidectomies of today, and cancer outcomes have followed suit2,3.  This is largely attributable to dramatic leaps forward in medical knowledge garnered from research4. In order for advancements in treatments to continue, it becomes apparent that continuing our investment into research is necessary. But in order to maximise our impact, we must consider the direction oncology and treatments are heading, invest in the most
    promising of prospects, and ensure our research system has maximal efficiency. In this essay, I’ll discuss the changing nature of cancer treatments and outline where and how we should direct our research to achieve maximum improvements for patients. I’ll also delve into the challenges clinical and academic research face, and suggest systemic solutions that will ensure research of all kinds are done in the most time-and-cost efficient manner.  And finally, I’ll discuss the importance of preparing future physicians to deliver the fruits of research.

    Epidemiological:
    Increasing Incidence Due to Age

    Before discussing solutions we need establish how the field is changing. Largely preventable cancers, like lung and colorectal cancer, are declining or stabilizing in most-all developed
    nations5,6, following improved treatments, systems, screening programs and prevention measures7,8. But overall, in the developed world, cancer incidence by type is changing slowly5. The major epidemiological change is an increase in overall cancer incidence due to an older population9-11, who, through various intracellular and extracellular processes, are more likely to develop cancer12,13. Hence research, especially clinical-trial research, should reflect lower tolerance of toxicities, higher rates of co-morbidities14, and other factors prevalent in older populations.

    Biological:
    The Targeted, Personalised Future

    Where oncology is changing most though is in the direction of new treatments, and advances in cancer genomics is driving much of this change. The human Genome sequence set the ground-layer of this field, allowing for cancer genome analysis to occur, and predictions of cancer genomics leading to cancer biology discoveries and guiding patient treatments are already proving true15. Large projects such as The Cancer Genome Project and The Cancer Genome Atlas, which identify and store tumour-mutation profile in databases and direct research from data collected, have already elucidated aspects of cancer biology and development47,48, found potential targets for therapeutics17,18and highlighted many tumour profiles that influence clinical management of individual patients today16,19-21The latter benefit of genomics describes another growing trend of  personalisation in cancer treatment, and this has led to new lines of treatment that differ from traditional small-molecule (small, biochemically active molecules that engage with pathways of cancer development and progression) applications. Biologicals, such as monoclonal-antibodies and growth factors are being recognised for their more targeted, less toxic applications25as well as their increased likelihood to pass early drug development23, and are already attracting more pharmaceutical patents than small-molecules24. Biologicals also offer novel avenues of delivering drugs to cancer sites and cells26,27, especially significant given our growing knowledge of the importance of the tumour-microenvironment in promoting tumour survival and protecting them from drugs39-41,49,50 , joining the ranks of other innovative delivery systems such as nanotechnology28,29. Microenvironment importance has also driven new lines of therapy targeting angiogenesis50, epidermal-growth-factor and downstream pathways109,110, and the newfound understanding of the role of stem cells in tumour growth and recurrence are leading to new therapeutic lines too42-44.
    Biologicals have also opened up many exciting avenues in an already exciting field of therapy; immunotherapy22. In addition to the recent discovery and early trial successes of checkpoint inhibitors that work on CTLA4, PD1 and PDL1, which work by allowing patients’ immune systems to recognise and kill cancers30,31, the use of biologicals like monoclonal antibodies, which attack cancers by targeting or attaching to proteins on cancer cell or host tissue surfaces32-34, cancer-antigen vaccines35-37and T-Cell Modification therapies38, which prime patients’ immune cells to recognise and kill tumours, are promising potential treatments. 
    When these are combined with increasing discoveries into processes that aid cancer treatment and research, such as the discovery of new bio-markers and the development of adaptable trial-designs45,46, future avenues of cancer research are promising, varied and diverse. But due to the more isolated nature of these targets, the heterozygous natures of tumour mutations, and the multitude of tumour-genesis and survival pathways15,41,42-44, these treatments need be combined for maximal clinical benefit.  

    Translational: Less New
    Drugs, More Expensive Research

    Yet though there are many avenues, and much research directed to new treatment pathways, less and less are being translated into treatments. Industry, which funds the vast majority of clinical trials51, is bringing significantly less new molecular entities(NMEs) to the market each year52-55, despite exponential increases in the amount invested into trial research53-55The tremendous, increasing cost of developing and funding drugs through  clinical trials and approval is the reason behind this reluctance to invest in new therapies. Funding a drug from early trials to approval costs in excess of a billion dollars70-73, with more recent analyses showing companies spend as much as 4-11billion per drug78. This takes between 11 and 14years74; all for a 6-11%75-77chance of being approved for sale. Most of this is attributable to increased regulatory requirements79, reduction in effective patent, marketable, length, by a third80,81,a shift to more targeted treatments, causing drug peak-sales to halve82,and higher attrition rates in early discovery81.
    Big-Pharma has reacted. Since 2008, pipeline sizes have decreased by a fifth in top Companies like Pfizer, with the proportion of budget diverted to R&D following suit56-60, and patent filings have also fallen by nearly a third industry-wide61, highlighting this reluctance to initiate new projects. Simultaneously, marketing and sales, which obscure and corrupt physician judgement62,83and harm investor confidence through bloated sales forecasts63, have increased to half the budget; double that of R&D spend62,64. The nature of drugs developed are also impacted by the nature of pharmaceutical investments, with more “Me-Too”, copy-cat drugs; ones that mimic the actions of already developed drugs, hence producing only-slightly-better-than-previous outcomes, being funded in preference to novel ones65,66. Also observable is a focus on blockbuster drugs, those targeting diseases with larger markets, which garner higher returns67,68over rarer, underfunded diseases like neuroendocrine cancers4,69. Other factors such as managerial pressure to deliver short-term profits exacerbate this68, but the reluctance to initiate projects by industry is by far motivated mostly by this cost/time intensive, risky investment that is drug development. In order to stimulate industry, more streamlined, innovative trial structures must be enacted to reduce costs and foster innovation.
    The changing nature of oncology established above highlights that systematic changes need be implemented to ensure continued improvement of cancer outcomes. The Australian government can play a crucial role in strengthening clinical trial infrastructure and funding to support industry in Australia, and electronic databases may present a unique opportunity to do this. Research, both industry-funded and academic, should be directed toward promising avenues of cancer research, and strategic direction and partnerships can improve output.

    Improving
    Clinical Trial Infrastructure

    Australian clinical-trial centres have great potential in attracting more industry activity that benefits not only oncology, but also overall care for Australians. Australia is already renowned as a quality nation to conduct trials in; we produce high quality, reliable data accepted by regulatory bodies around the world, have fast ethics-approval structures and an informed and willing population84,85. But Lisa Askie, the manager of the Australia/New-Zealand Clinical Trial Registry, professed, in an interview I conducted with her that Australia needs “more investment in clinical trial infrastructure”, as sites are “underequipped” and “many trials are done on investigator initiative” with little in the way of compensation made for clinical staff conducting trials85. The government’s role in this is clear. Though industry funds nearly 70% of trials in Australia51, it employs only a quarter of clinical-trial staff51. She pointed to the UK’s system in particular as one to emulate.
    The UK implemented the National Cancer Research Network after noting their cancer survival and cancer-trial recruitment rates were remarkably low compared to other developed nations86-88. The central features of this overhaul included increasing the number of clinical trial sites along geographic distributions, increasing clinical-trial staff, coordinating both research focuses and enrolment services nationally to increase synergy in the system, and increased funding to public research bodies86,88,89. And it worked. Cancer clinical trial participation increased five-fold88 to world-leading rates, clinical-trial recruitment target fulfillment nearly doubled88, and, most importantly, improvements in patient outcomes and access to trials and new drugs were noted90-92. Hospitals that conducted trials provided better care with lower mortality rates, likely due to more trained, up-to-date physician teams92. Increased economic benefits from industry was also observed, with industry-funded trial staff and investigator numbers rising88. Liverpool Hospital, Sydney, has self-funded the establishment of its own clinical-trial site to a point where it’s self sustaining, and even bringing profits to the hospital, showing such increases to infrastructure is feasible in Australia too137. With Australia’s already positive physician perception of clinical trials51and the fact that industry provides $650million in investments93 and $100million in healthcare savings to the nation94, it’s clear that any government investment that facilitates more clinical trials in Australia is a wise one.   

    Using
    Technology to Reduce Time and Costs Taken to Trial.

    Though structural changes to clinical trial funding is invaluable as a means of reducing time/cost taken to trial, technology has even greater potential to streamline the clinical trial process. actors that have escalated the time-and-cost of conducting clinical trials exponentially are systemic and greatly increase pre-trial attritions of potentially game-changing compounds too68,100. 90% of clinical trials are finished later than scheduled, with patient recruitment accounting for a quarter, and data collection and discrepancy resolution taking up two-fifths, of time96,97. The reasons for the former are varied; physicians don’t even consider clinical-trials 40% of the time98, patients are hardly aware of their existence98,136, and even physical encumbrances like distance from trial centre hamper patients’ trial enrolment rates98,99.
    In his best-seller, Bad Pharma, Ben Goldacre not only lambasts Big-Pharma for their unscientific, unethical practices, but also suggests a novel solution for these issues that is currently being trialled in the UK83,95. He proposed that Electronic Medical Records (EMRS) be harnessed as tools to conduct live, randomised trials, arguing key issues prolonging time to trial like time spent recruiting patients, data-collection delays, and also that overall trial costs would fall significantly through such a scheme83,101. They have added benefits of being able to conduct retrospective analyses; saving millions in PhaseIV study costs, provide more clinically relevant and representative results, and can even evaluate combinational therapies101. Research applications of EMRs has been recommended by the American College of Physicians103, but in establishing such a system in Australia, measures like communicating benefits and privacy-securing measures to the public; why UK’s Care.Data failed to pass parliament102, ironing out ethics and efficiency issues101,104, and forward thinking in database-design, which minimises complex, costly data-mining and ensures data quality105,106, need to be considered to ensure our E-Health Record is widely used and effective for research purposes.
    The ability to study the effects of combinational therapies is a promising application of trial-friendly EMRs, but even if they were to exist now, industry and regulatory bodies need to modify policy to facilitate their trialling. Many upcoming drugs, due to the trend of more targeted therapeutics being developed, isolate single strands of the web of cancer-cell biology, and, when used alone, will allow cancers to survive down alternate pathways, resulting in reduced success and increased relapse rates15,41,42-44,107-110. Hence combination therapies warrant further investigation. However, though there are many examples of combinational therapies improving care outcomes significantly, between both standard114-116, and more targeted therapies111-113, regulatory bodies’ policies currently restrict their investigation. The FDA heretofore have required such therapies to be given in fixed-dose combinations; in the same vial or tablet with set compound ratios117; understandably hard for biologics, which usually require intravenous administration25, personalised immunotherapies, and personalised dose-analysis studies, to do. They’ve responded to the need though by drafting a policy that allows two therapies to be combined into one “co-development” study, and data to demonstrate the contributions of each drug to be attained from earlier trials or pharmacological studies rather than expensive, time-consuming, clinical-trials118. This should stimulate more investigation. But another factor which stops these combination studies from happening is the conflicting financial interests of pharmaceuticals.

    Teamwork
    Strategies That Unite Researchers From All Sectors

    The latter factor is one that seems impossible to evade, but recently, teamwork has become prominent in cancer research; something much needed45. Consortia, an association of multiple bodies with shared research goals, bring together all sectors; not-for-profits, government and industry, to create broadly-usable tools such as biomarkers (useful for diagnostics, clinical trial evaluation and acceleration of drug discovery/development121) that would otherwise be deemed too economically infeasible to fund by singular entities120. Data-sharing is also a focus of many consortia, reducing wasteful duplication of research and producing invaluable knowledge-platforms, such as the cancer genomics consortia discussed above47,48,120. The development of innovative Intellectual Property contracts in Industry Consortia, that allow short term exclusivity of discoveries made by members, also spells out future hope for industry working together on projects where both parties can benefit, such as combinational therapies117.

    Strategically
    Directing Basic research

    Foundation and government research is a lifeline for treatment development, and should also be optimised through teamwork and strategy. Basic research required to discover biochemical pathways and therapeutic targets and proof of concepts, seen as the investment “valley of death” by pharmaceuticals122, for their inability to deliver profits, are essential to therapy development. 85% of this research is funded by governments and foundations123. In addition, rare or neglected diseases, and recent personalised immunotherapy developments, which are largely unprofitable,
    require this sectors’ funding4,120,122,124
    Innovative,  assertive, collaborative strategies, such as the one used by Australia’s own Cure Bain Cancer Foundation, reduce wastage and increase output in this vital research stage125. The Foundation proactively outreaches to researchers when providing grants, saving over a month of work per-researcher-per-year135, collaborates, and indeed, directs research strategies for the Global Brain Exchange consortia126, and works actively with industry to ensure treatments reach patients125. Similar strategies, if employed by others, would lead to leaps-forward in treatment prospects, and thence, patient outcomes. 
    The complexities associated with the personalisation of clinical management and our ever-expanding discoveries in fields like genomics are already stumping doctors127. Though innovative educational tools, such as medical calculators129and the Regulome Explorer genome-map128, and technological training are being provided to bring doctors up-to-date, the most effective way to ensure future physicians are aware of, and can apply these advances is to teach them in medical school. This knowledge isn’t just necessary for future oncologists. All specialists are becoming more involved in cancer care due to multidisciplinary, team-based care130, and GPs, comprising nearly half the profession131, have the most important, currently underused role, in prevention and co-management of cancers132-134. With cancer burden only rising9-11, this becomes vital.
    The changing landscape of oncology due to advances in research has made it essential we transform and optimise our clinical trial infrastructure, focus of research and research partnerships, so patient outcomes continue improving. The recommendations made in this essay provide benefits not only to science and patients, but also to industry, researchers and Australia’s health system, and many suggestions can be implemented around the world too. There are many other complex interactions and strategies that can further increase the output of new treatments that couldn’t be discussed in the length of this essay. I’m actually writing a book on the topic. But the fact that there are many pathways and much desire to improve treatments makes the future of cancer treatments bright. Hopefully, these suggestions, if implemented, will make them even brighter.    
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