The Breakthrough

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My purpose in this life, which I have been certain of for quite some time, is to change the way people perceive the world. I focus more on the roots of their faulty thought patterns rather than attacking their ideas, which are direct results of incorrect cognitive processing.

I haven’t done a book review in a while. I used to do them frequently, and it isn’t that I don’t read as much—because I actually read more now—but it takes me an inordinate amount of time.

This one feels particularly worthy to me due to my recent cancer diagnosis and the exploration of treatment options.

Side note/rant: Evidence-based internet trolls often misunderstand the true nature of science. Robust science doesn’t always have immediate, conclusive data to support it—at least not initially. Immunotherapy serves as a prime example; until very recently, it was dismissed as quackery.

To those who champion PubMed uncritically: what exactly is “alternative medicine”? Medicine either works, or it does not. If it works, it is not “alternative.” If it does not work, it is not medicine. So what, then, defines “alternative medicine”?

The most fitting definition seems to be: practices that are not taught in conventional medical schools.

Why not?

Because medical schools adhere strictly to a criterion called “evidence.” For good reason! Cancer patients, for instance, have the right to expect that a course of action recommended by an oncologist has a reasonable probability of efficacy.

However, in scientific discourse, evidence means statistically significant results from properly controlled experiments, as evaluated by experts in the field.

The absence of evidence does not necessarily indicate that a particular treatment is ineffective.

It simply means that it has not yet been demonstrated to work. And that is when it can be termed “alternative.” Once sufficient proof is established, “alternative” transforms into “conventional.”

“Alternative” medicine encompasses a vast array of treatments, ranging from the potentially useful but unproven (cancer vaccines, deuterium-depleted water, hyperbaric oxygen therapy, intravenous vitamin C, etc.) to the absurd (faith healing, homeopathy, diet modifications alone, standing on your head for exactly eighteen minutes twice daily, etc.).

It is imperative to employ one’s own critical thinking and judgment in these matters.

Now that I’m done ranting, let’s dig into the book.

BREAKTHROUGH — THE RACE TO CURE CANCER

They sure don’t conduct human studies like they used to. Why do I say that? Let me provide some background.

Coley, known as the “Father of Immunotherapy,” conducted experiments on his patients that would be considered highly unethical today. He applied dirty bandages to open wounds, resulting in some deaths—all in the name of science.

Coley was at least a century ahead of his time in understanding the immune system. He was dismissed as a charlatan, and when he began bottling and selling his “cancer-fighting toxins,” he was labeled a snake oil salesman. Like many true scientists, he was obsessed with an observable phenomenon in his patients that he couldn’t yet explain. He wouldn’t abandon it simply because there was no PubMed link available.

Generations of oncologists and cancer biologists either heard nothing about Coley’s observations or dismissed them as cancer quackery. Immunology became a vaguely disreputable idea in cancer research.


It took an immunologist, not a cancer biologist, to crack the code on this. James Allison realized it wasn’t that the immune system needed boosting. Instead, molecules on tumor cells that thwarted the immune system needed to be disabled.

Allison figured out how to disable those molecular brakes, or checkpoints, and allow the immune system to rip. His discovery led to the first approved “checkpoint inhibitor” cancer drug in 2011 and won him a share of the 2018 Nobel Prize in medicine.

With checkpoint inhibitors like Allison’s, which target the molecular brake called CTLA-4, followed by inhibitors of brakes called PD-1 and PD-L1 and then genetically engineered T cells called CAR-Ts, once-hopeless cancer patients are actually obtaining something physicians have been loath to mention: a cure.

Pioneers had to wrangle fellow scientists into investigating the interaction of the immune system and cancer. These determined few valiantly fought a cancer hierarchy that viewed the whole thing as a dead end.

Gatekeepers at prestigious science journals rejected research papers in the stubborn belief that the immune system couldn’t attack cancer—data be damned. Eventually, the data could not be denied.

The PD-1 and PD-L1 inhibitors, including one that has helped former president Jimmy Carter survive melanoma that spread to his brain, also work for only a minority of patients. Researchers hope that combining immunotherapy drugs with each other or with chemotherapy or radiation might increase that fraction; some 1,500 clinical trials are testing such combinations.

Sharon Begley


So friends, let me emphasize this point: the first-line standard of care treatment being recommended to me was considered quackery not that long ago. Let that sink in…

This book is quite dense in biology and not recommended for those who don’t enjoy science. It would be far too dry for most. However, I found it fascinating.

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