If a drug company develops a heat shock protein inhibitor and tests it in cancer, the drug may shirk tumors, delay metastasis and improve survival or the drug might not— adding toxicity without benefit.
The company that makes the drug might say: it would have worked, if only…
If only… we used a lower dose
If only… we managed side effects earlier
If only… we gave it in the evening, not the morning
The problem with if only… medicine is that it can be said for anything. A drug can fail a hundred times, and you can think of 3 more ways to deliver it, and say if only …
This is why the burden of proof in medicine is to show your product works and not to keep making excuses why it didn't work, and say if only..
This lesson is not unique to drugs. It also applies to the topic of yesterday’s post: HEPA filters
A few readers wrote me saying
If only… they used more units
If only.. the increased the flow rate
Well, until your actually do that and prove it helps, it's just empty rhetoric. No different than the failed drug company.
Listening to proponents rationalize negative trials reminds me of interviews with losing sports teams.
If only.. we executed the defense
If only.. we didn't have so many injuries
If only.. we scored more points
Yes, sure but you didn't, so take the L and try again next time. The rest is just speculation.
HEPA filters have not shown they can improve any outcome in any setting in any population in all of human history. So run a positive trial, until then: if only…
I’m really enjoying these articles, even though I just purchased a bunch of HEPA filters for my home AC last week. Lol
Well now that I know you read comments.. maybe you’d consider helping change things for kids with cancer. I have a list of barriers and would love some feedback on ways to implement change. Children with osteosarcoma get the same 4-5 drugs and are sent home to die, over and over. The trials exclude most kids and it’s this fun game of it’s the fdas fault vs the fda saying they can’t require xyz (while children die). It is 2026. We don’t routinely test osteosarcoma tumors for anything until relapse. We do neoadjuvant chemo without strong evidence it improves outcomes. We do nothing until relapse, and then we only do what we know doesn’t work. In the name of safety of kids. I’m sure you’re seen a fair amount of people who die. Now imagine a child whose lungs are filled with painful bone tumors, having had limbs cut off and chest tumors from failed lung resections- dying of respiratory distress. And only having had MAP, ifos and Cabo. Kids need someone outspoken who people listen to- even if the media doesn’t like you- any attention will work. We can’t keep going on like this for the next 40 years