July 4, 2021
Letter to Director, National Cancer Institute,
4 July 2021
Hi Dr. Sharpless,
I read your April 2021 talk to the American Association for Cancer Research (AACR), see
http://www.natpernick.com/AACRSharplessApril2021.pdf, and am distributing it to my
In my view, reducing the high number of US cancer deaths is primarily a management
problem to be solved by creating a strategic plan that identifies necessary management and
medical / scientific tasks:
1. Our goal should be to reduce annual US cancer deaths from 600,000 currently to 100,000
by 2030, as discussed in our strategic plan,
http://www.natpernick.com/StrategicPlanCuringCancer.html. Although your goal of
reducing age-adjusted cancer death rates in half is rational, this is too abstract to resonate
with the hundreds of millions of Americans who must feel compelled to act.
2. I believe that we can substantially increase survival for aggressive pancreatic, lung,
colorectal and breast cancers by using large combinations of partially effective therapies
targeting different malignant attributes. For each cancer histological type, we should identify
20-30 important malignant attributes and then identify or develop therapies with at least
partial effectiveness for each attribute, see
http://natpernick.com/Pancreatic%20Cancer%20Treatment%20Targets.html. Then, our
oncologists and pharmacologists can find combinations of 8-10 of these therapies that will be
substantially effective, http://www.natpernick.com/CombinationsOfTherapy.html. This
proposal is based on complexity science – the behavior of the whole is greater than the
behavior of the sum of the parts. We should also reduce the number of clinical studies using
only single agents (after initial trials establish their efficacy) – we know that single agents
typically cannot be successful because they cannot adequately damage the weblike nature
of the malignant process.
3. To determine the malignant attributes of each cancer histological type, we need to identify
systemic network disturbances that nurture the cancer, such as microenvironmental factors,
inflammation, unicellular-type programming, dysfunctional immune systems and hormones.
We also have to better understand cancer cell stability (“cancer attractors”,
https://pubmed.ncbi.nlm.nih.gov/19595782) and how to disrupt it with therapies that move
tumor cells into less hazardous networks, https://pubmed.ncbi.nlm.nih.gov/31921665.
4. We need to investigate and reduce cancer deaths occurring within 30-60 days of
diagnosis. These deaths, when due to infections, treatment side effects or disruption to vital
physiologic networks, are often preventable,
http://www.natpernick.com/CuringCancerPart9.html. Some of these cases may be
analogous to diabetic ketoacidosis – with proper management, the life threatening episode
can be resolved and the underlying disease can then be managed.
5. Long term, we can reduce cancer deaths by 30-40% through prevention and improved
screening. We must reduce tobacco use to 5% or less of the population, improve the
American diet to be predominantly plant based, reduce excess weight from 60% to perhaps
10% of the population and ensure that all Americans get adequate medical care including
regular examinations to promote prevention and detect early disease.
My training is in mathematics, computer science, pathology and law,
http://www.natpernick.com/, but my management experience is in creating a free online
textbook in 2001, now used by most pathologists in the English speaking world,
https://www.pathologyoutlines.com/ and creating (last month) a worldwide directory of
pathologists, https://www.pathologyoutlines.com/directory.
Please contact me or have one of your staff contact me regarding the next steps we can take
Nat Pernick, M.D.
Curing Cancer Network:
* Strategic Plan – http://www.natpernick.com/StrategicPlanCuringCancer.html
* American Code Against Cancer –
* Blog – https://natpernickshealthblog.wordpress.com/
* Newsletter – https://lp.constantcontactpages.com/su/onz6IND
* Grants – https://www.pathologyoutlines.com/grants.html