> imho, cancer is a fundamental disease/property of multicellular life

I like analogizing between multicellular organisms and nation-states, in that both are complex systems built upon the coordination of many individual systems (cells/people). In the case of cancer, what we have is essentially rebellion, a failure of control: individual cells decide to stop cooperating and instead begin competing with the body that houses them. So I agree with you... rebellion is always a threat to any system of control.

Unlike actual rebellion, though, there's no way the cancer can "win" in the sense of taking over control of the body. If only cancer could realize the futility of its crusade...

In principle it shouldn't matter that cancer is not well defined, if health is well defined. "Just" visit every single cell and repair its gene sequence to your body's consensus sequence, and similarly for the epigenetic state to the extent necessary -- the latter requires more knowledge to do correctly, but otoh seems less crucial.

This is of course ridiculously ambitious compared to the current state of the art, but I think it's a reasonable start to countering the claim that a general cure for cancer is impossible in principle.

A cell /is/ epigenetic state, and the effect of any piece of DNA is profoundly controlled by other pieces of DNA, RNA, proteins, RNAs interacting with RNAs, RNAs interacting with proteins, proteins interacting with proteins, etc. Scrubbing the proteins, RNA, and so forth from a cell without killing it is inconceivable.

That said, I don't want to say that cancer is fundamentally beyond us. I think cheap sequencing and emerging highly targeted DNA editing systems, along with better understanding of the immune response to cancer, will get us most of the way there in a practical sense.

Repairs of all these things are performed by the cell itself without killing itself, so they're surely physically possible. But they're limited by a lack of outside information -- e.g. if the DNA is too corrupt, the repair processes can't check the uncorrupted DNA of other cells. That could be fixed with advanced enough technology.

killing the cell is actually not a big deal, any given cell is generally replaceable.

What you suggest is more or less what I mention; you could, say, try to add back some genetic machinery for the cancer cells to recognize that they're defective, and then they kill themselves. Or help the higher level repair mechanism (the immune system) target cancer cells.

To my understanding, trying to fix anything at the level between whole cell and DNA mutation is much harder.

Yes, I'm not gonna pretend to know what avenues are promising or how long it'll take to invent -- maybe humans will go extinct or obsolete first. I just disagree with the article's pooh-poohing towards "why don't we include in our portfolio of bets some actually trying for a cure someday".

This argument doesn't follow. The fact that most multicellular organisms get some cancer yet organisms with quadrillions of cells exist is good evidence that cancer rates can be driven to arbitrarily small levels; there's no fundamental lower bound. In the ancestral environment, cancer rates are set by a resources trade-off, and, since we have vastly more resources, there's no a priori reason to think we can't drive the cancer rate vastly lower than today.

It's like arguing that entropy always increases and therefore fighting disease is fundamentally hopeless, or requires non-logical approaches. Yes, of course "ill health" can't be cured in general, but we can drive disease rates ever lower.

I agree in a long term sense (we'll figure it out eventually, and fuck evolution), but I don't think we can assume evolution leaves us in a situation where cancer is easy to solve, and we just need to tie off some loose ends, or turn up a few knobs. And I don't think the understanding of cancer levels in, say, whales is developed to do more than guess something is going on. Some theories suggest better repair mechanisms, others that it's simply different selective effects at the cellular level in larger organisms.

> I don't think we can assume evolution leaves us in a situation where cancer is easy to solve, and we just need to tie off some loose ends, or turn up a few knobs.

Sure, but no one disputes this. Silicon valley investing in cancer research does not imply anyone takes such a silly position.

Surprisingly, it isn't fundamental to multicellular life! Consider the naked mole rat. In decades of study, and exposure to mutagenic compounds, there are been only one or two documented cases of cancer in naked mole rats. The reason why isn't clear, but it shows that it is possible to dramatically reduce the prevalence of cancers of all kinds. I agree cancer can't be completely gotten rid of, but the likelihood of it can be reduced by orders of magnitude, and least in theory.