Why cancer is like the worst employee at your company

Apologies for not blogging in a considerably long time (Even my parents have since stopped bookmarking this page. Sorry, Mom and Dad.). As delayed recompense, I thought I would include an excerpt from a small introductory speech I delivered earlier this week.

I was asked to speak about my research for five minutes to a general audience (Five minutes is nothing. Even the most socially uncomfortable scientist can bloviate about their research for hours on end.).

Instead of presenting my audience with an overwrought description of my work, I wanted to leave them with one compelling idea. Nobody except for me (and maybe my non-page-bookmarking parents, and maybe maybe my thesis committee) really cares about my research—on a deeply mechanistic level, anyway.

But they are interested in cancer. For that brief introduction, I have a responsibility to tell the audience something that they would remember, something that hopefully would change the way they thought about the disease. Grandiose, I know, but some famous person once said something about shooting for the moon and landing on the stars, and the answer is yes.

I’m writing this introduction because I want to show how important it is to consider your audience. Recently, I was fortunate enough to participate in a student lunch with a very prominent immunologist. I asked her about how she communicates her science, and she revealed that, regardless of her audience, she tailors every presentation she gives to be suitable for a group of smart high schoolers.

That was shocking to me. “Wouldn’t you run the risk of unnecessarily explaining things to people familiar with your field?” I asked. “Maybe,” she admitted, but it’s worth the fifteen seconds to explain something unnecessary in order to gain an hour of your presentation being understood by everyone.

This concept, perhaps not surprisingly, stuck with me, and influenced the way I considered my five-minute talk.

All right, without any further ado, here’s the speech, complete with cheesy asides and informal language (including sentences beginning with conjunctions—oh, the horror!):

So I work on a particularly pernicious form of blood cancer called acute myeloid leukemia, or AML. And while there’s a ton of fascinating research being done on AML at this university—and trust me, as a graduate student, it’s almost second nature to talk incessantly about my work—I want to explain what I do in the context of something called “precision medicine.”

You might have heard of precision medicine before, either in the news or in seminars and presentations like the one you’re about to hear. But what exactly is precision medicine? Well, to answer that question, especially in the context of cancer, I think we should start more broadly: What is cancer?

A couple years ago, I heard a science reporter on the radio answering this very question. Think of cancer, he said, as an alien lifeform attacking your body. The cancer cells have undergone such radical transformation that they hardly resemble normal cells anymore. Imagine cancer as some perverse Frankenstein’s monster, born of corrupting mutations in their DNA and ravaging the surrounding countryside of normal tissue.

While I like this comparison, I don’t think it goes far enough. Cancer is much more insidious and calculating. So, if you’ll bear with me, here’s another analogy:

Let’s think of your body is a gigantic corporation—and yes, for the sake of argument, corporations are people too. And cancer, in my opinion, is a disgruntled employee. Maybe he’s embezzling the company funds; maybe he’s stealing snacks from the break room.

Ultimately, cancer is trying to take down the company—your company—by whatever means necessary.

Because, you see, cancer is an insider. Cancer knows all your tricks. He’s read the company memos, knows your corporate handbook. He knows exactly how you’ll respond to his actions, and how to overcome it.

What does this mean biologically? Well, cancer makes your body work against itself. It can convince nearby cells to secrete growth factors against their will. And if you send in the immune cavalry, not only can cancer evade their detection, but they can also recruit these immune cells for its own nefarious purpose.

So the question becomes: How do you target such an enemy?

Well, for cancer, we use chemotherapy. But most of our chemotherapies are non-specific. They go after all rapidly dividing cells in the body. This includes cancer cells, yes, but also hair cells, intestinal cells, etc. It’s the equivalent of firing the entire fourth floor to get rid of one employee, or canning everyone in HR (as appealing as that might sound…).

Precision medicine is different. It targets the person directly—what’s his name, where exactly does he work. What makes him unique.

In my research, we study each leukemia individually—learning its background, identifying its causal mutations. Then, we use small molecules that bind only to those mutated proteins. This kills the cancer cells while leaving normal cells unharmed.

Brian Druker, one of the pioneers of precision medicine, famously “beat” one type of leukemia using a drug that targeted a gene mutation found only in that leukemia.

This is the new paradigm for cancer treatment, a new way of targeting the disease. And while the notion of “curing” cancer is extremely ambitious, I believe that research into precision medicine—the kind of research I’m fortunate enough to work on here at OHSU—will unquestionably help patients live longer, healthier lives.

Thank you.

3 responses to “Why cancer is like the worst employee at your company

  1. David: Excellent post! I will forever think of precision medicine with this very effective analogy in mind.

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