Some ideas never seem to die. There is something compelling about the narrative, perhaps because it fills some explanatory need. One of those narratives is that “they” have “the cure” to cancer but are keeping it hidden from the public in order to protect the profits that result from cancer treatment. I recently received the following e-mail (partly redacted):

“I read many articles by physicians like yourself that claim secrets cannot be kept about cancer cures.  I beg to differ.

Pharmaceutical firms require their associates to sign confidentiality agreements as a condition of employment.  If they breach it, it’s safe to assume that they risk grave consequences for doing so.

These companies could care less about sick people.  They only care about the health of their bottom line.  They make far more profit on lifetime treatments rather than one-shot cures.  After the patent expiration on a cure, the steady stream of revenue comes to a halt.

A cure eliminates the need for any new drug development unless the side effects are unpalatable.  I was even told as much by a retired employee of a pharmaceutical company.  She saw the private memos from their lobbyists.

In any case, the confidentiality contracts are why secrets are kept in the pharmaceutical industry.  It’s also why cancer cures can be kept hidden as it would be treated as a trade secret.  No one wants to be brought up on a felony charge of industrial espionage.  Nor do they wish to be sued for it by their former employer.

Ask yourself the following question: would you risk your family’s future under those circumstances?  No way!  If you signed one of those legal instruments, you would never divulge such information if you came across it.”

The notion that a pharmaceutical company could hide a cancer cure is, in my opinion, and from the perspective of an academic physician who has participated in clinical research for pharmaceutical companies, hopelessly naive. The belief comes partly from looking into a complex system from the outside, without any real idea how it actually works.  First let’s talk about the science and then we’ll turn to the logistics of the conspiracy itself.

Cancer, as is often pointed out in such contexts, is not one disease. It is a category of disease, with many specific pathophysiological conditions. Every type of cell in the body potentially represents a different kind of cancer, with different mutations, and different staging. Cancers can form solid tumors, be contained in the blood, be encapsulated or infiltrating, and have different potentials to metastasize to different tissues. Different cancers have different causes and respond differently to the various cancer treatments. For this reason there likely will not be (anytime soon, or by any extrapolation of current science and technology) “a” cure for all cancer.

When scientists hit upon a new method for treating cancer, it often only applies to a subset of cancers, and often many variations on the treatment have to be developed in order to address different cancer types. The result invariably is incremental improvement in some (but not all) cancers. These advances have resulted in a steady improvement in cancer survival.

What the e-mailer is suggesting (and is often the core of such “hidden cancer cure” conspiracies is that scientists somewhere have hit upon a treatment for cancer that is orders of magnitude more effective than anything so far developed. So powerful is this treatment that “one shot” can cure any cancer. Such a belief requires profound ignorance of how cancer operates and how difficult it is to treat.

Further, the cancer cure belief is contingent upon not understanding how scientific research works. Within the public consciousness there is still this image of the lone brilliant scientist working away in a lab and making breakthrough discoveries. That’s just not the modern world of science (and really never was). Pushing human scientific knowledge forward requires a collaboration of many individuals. Major scientific breakthroughs, if you trace back the research, generally result from work that was spread out over many labs, many institutions, all building on each other’s work. That’s why the Nobel prizes are generally given to several people all contributing to an area of research. This is also why the question of – who invented X or discovered Y? – is often complex and the simple answer believed by the public is never the full story. Often someone gets credit for taking a discovery across some practical line, but they were building on the work of many others.

The cancer cure conspiracy, therefore, is contingent upon the belief that an isolated band of researchers were able to make decades worth of breakthrough advances without leaving a paper trail, without having to build upon the world’s researchers in their area, and in such a way that they could keep it secret. This is simply not possible.

We can further consider the role of pharmaceutical companies in drug development. Companies generally do not invest in basic or foundational research. They don’t do the kind of research that would discover a new “therapeutic target” or strategy. Rather, they pay experts (either as consultants or employees) to tell them what promising therapeutic targets have been identified by academic researchers. They then pick up the ball and go from there, designing drugs that can activate the therapeutic target and having all the properties necessary to make a marketable drug. They then have to take their potential drugs through all the stages of clinical research to get approval. Most candidate drugs fail somewhere along the way.

What this means is that at no point would a pharmaceutical company completely own the rights to a cure for cancer. All the foundational research would be published in the literature. For anything really novel, the researchers and their institution would likely patent it. Universities make a lot of money this way. They would then license the patent to different pharmaceutical companies to develop products. This is why there are often so-called “me too” drugs, because many companies try to get in on the action. Sometimes the researchers will create a start-up company to develop the drug itself –  a new company, with no prior products. Sometimes one company owns the IP, while another does the manufacturing, and yet another does the marketing and distribution.

And think of this – why would a pharmaceutical company spend hundreds of millions developing a drug they have no intention of every marketing? And you know – other countries have pharmaceutical companies. Do you think a Chinese company would hesitate for a second to cure cancer and expose Western Capitalist greed?

The nature of science and research itself is enough to completely kill any notion of a hidden cancer cure, but there’s more. One of the premises of the conspiracy is that a pharmaceutical company would have an incentive to hide a genuine cure in order to maintain the profitability of existing cancer drugs. This is also naive. All drugs go off patent, and therefore pharmaceutical companies always need new drugs in the pipeline to replace them. Replacing cancer treatments with more effective cancer treatments, financially is a good thing. Such a treatment – a genuine cancer cure – would be worth billions.

The e-mailer also makes a couple of false statements. Drugs that go off patent still make money, about 10% of the on-patent version. That’s a big drop, but it’s not nothing. Having a popular drug that will likely be useful for decades is a good thing for any company to have. But also, developing a cancer cure is not a “one and done” situation. Any new cancer treatment approach would likely spawn many drugs, with constantly improved features (which can be strategically timed to when older drugs go off patent). A “cure for cancer” would keep a pharmaceutical company busy for decades developing spin-off drugs. Any pharmaceutical company would love to have a blockbuster cancer cure that will make them billions in profit for decades. They would not shelve this to keep existing drugs that are about to go off patent anyway.

Finally there are the intangibles. Imagine the PR value of being the company that cured cancer. That would be in their logo forever – “Hey, we cured cancer!” They would never let the public forget it. Also imagine the other possibility, that a whistleblower exposed the fact that they were hiding a cure for cancer. They would be done. Imagine the lawsuits. Really put yourself in the corporate boardroom having this conversation (again, this is an impossible scenario, but just hypothetically).

I also have a huge problem with this statement: “These companies could care less about sick people.” I know there are individual people who are psychopaths and can do horrible things, and I also will grant that companies can also do very dubious things to protect their bottom line. But I do think there is a line. I don’t think even jaded corporate executives are mustache-twirling villains. They are people, and like all people they may convince themselves they are doing the right thing, but very few people are comfortable thinking of themselves as evil. And that is exactly what this is – condemning millions to death from cancer in order to tweak profits is pure evil. You can deny climate change to sell oil, but what would the rationalization even be here?

Pharmaceutical companies are full of many kinds of people, including scientists and physicians. They would know full well the implications of hiding a true cancer cure, and I have never known a single individual (let alone a company full of them) who could even contemplate such a thing, even for a moment. The e-mailer asks – would I risk my income and career to be a whistleblower? Yes, 100%, absolutely and without the slightest hesitation. I would go full Snowden on their ass in a second. Even if I were being entirely selfish, the media attention alone would be worth millions. And I would be the person who gave the cure to cancer to the world, exposing an evil company who would keep it from them. I mean seriously – this is a no-brainer.

Imagine if the government got a whiff of what was happening. How many billions does the US government spend through medicare and medicaid on cancer treatments? A company hiding a cancer cure would be costing the US government billions. You think they would take kindly to that?

Further still – everyone has people they know and love who get cancer – including people who work for pharmaceutical companies. Everyone would want such a cure to be fully developed, improved, maintained, and produced.

Part of the problem is that many people get their sense of reality from watching tv and movie dramas, which are typically completely disconnected from reality. This is just such a case. There is no “they”, and there are no supervillains capable of pulling something like this off. There is, rather, a complex web of people and institutions with different motivations and priorities, and no one entity with the power and reach to pull off such a conspiracy – even if it were possible (which it isn’t) and even if they were motivated to (which is dubious).