Why Food and Nutrition May Become the Most Important University Courses of the Future (Part 2)

 

 Why Food and Nutrition May Become the Most Important University Courses of the Future 

By: Lim Ju Boo - lin ru wu (林 如 武) 

On 20 May, I wrote an article on:  

The Most in Demand University Courses for The Future

https://scientificlogic.blogspot.com/2026/05/the-most-in-demand-university-courses.html

I promised I shall continue to write on this issue that concerns future generations of students to come. 

For generations, medicine has been regarded as one of the most prestigious and desirable university courses in the world. Parents proudly encourage their children to become doctors because medicine is associated with status, stable employment, respect and financial security. Students themselves often choose medicine believing that doctors will always remain highly demanded and better rewarded than graduates from most other disciplines.

However, over the years since the 1970's this is no longer true. Studying medicine today is no more lucrative as during my time. Why is this so? Read the reasons in the three links below later in order not be distracted here for the moment: 

1.  "Which area of healthcare is more important: "Nutrition or Medicine" 

 https://scientificlogic.blogspot.com/2024/03/which-area-in-health-care-is-most.html

2.  The Clinician vs Clinical Scientist vs Medical Scientist

 

https://scientificlogic.blogspot.com/search?q=too+many+clinics

 

3. Choosing a Right Course for a Career Pathway - Which One?

 

 https://scientificlogic.blogspot.com/2024/11/choosing-right-course-for-career.html

  

As a graduate in many disciplines of studies - from  medicine, nutrition, chemistry, zoology, physiology, food technology, and in food quality control across five  various universities that took me  nearly 18 years,  I have increasingly come to realize that the future needs of humanity may slowly shift in another direction, namely, towards food science, food technology and nutrition.

This is not because medicine is unimportant. Medicine will always remain a noble and essential profession. Humanity will always need doctors, surgeons and medical scientists to diagnose diseases, relieve suffering and save lives.

Yet when we calmly reflect upon the fundamental requirements of human existence, we begin to see that food and nutrition may ultimately become even more crucial for the long-term survival of civilization itself. I have emphasize this in my last write-up on:

The Most in Demand University Courses for The Future

Once again, every human being depends daily upon only three absolutely essential necessities for life:

1. Air

2. Water

3. Food

Without any one of these, life cannot continue.

Medicine, on the other hand, is not consumed daily by healthy individuals to sustain life. People take medicines mainly when they become ill. Even then, recovery still depends heavily upon adequate food and nutrition. A patient cannot survive on drugs alone without water, proteins, carbohydrates, vitamins, minerals and energy to nourish the body.

In reality, food itself is often the first and greatest medicine.

A starving child cannot recover merely from tablets or injections. A severely malnourished person cannot regain strength without nourishment. Even the best medications may fail when the body lacks the nutritional foundation required for healing and immunity.

At present, society may not fully appreciate the enormous importance of food science and nutrition because food is still relatively abundant in many countries. Supermarkets remain full, restaurants continue to operate and food supplies still appear secure.

But beneath this appearance of abundance lies a growing global challenge.

The world population continues to increase rapidly year after year. At the same time, agricultural land is steadily shrinking as forests and farmland are converted into housing estates, highways, factories, industrial zones and expanding cities. Climate change, droughts, floods, water shortages and environmental degradation increasingly threaten global food production systems.

Human civilization may one day discover that producing enough safe and nutritious food for billions of people is far more difficult than manufacturing medicines.

That future moment may become one of humanity’s greatest turning points.

When food shortages begin to emerge, the consequences are severe:

1. Hunger increases

2. Malnutrition spreads

3. Disease resistance weakens

4. Social unrest develops

5. Economic instability grows

6. Political tensions rise

7. Mortality increases

Under such circumstances, medicines alone cannot solve the problem because food itself becomes the primary medicine needed for survival.

History repeatedly shows that civilizations often collapse not only because of wars or diseases, but also because of famine and failure of food supplies.

Even today, whenever major disasters occur — whether earthquakes, floods, wars or droughts — what are the first emergency supplies sent to affected populations?

The priorities are almost always:

1. Food

2. Water

3. Shelter

4. Clothing

Only afterward come medicines and medical equipment.

This clearly demonstrates the true hierarchy of human survival needs.

Modern food and nutrition sciences are also no longer “minor” academic disciplines as many people once believed. These fields have evolved into highly sophisticated and rapidly expanding sciences involving:

1. Human nutrition 

2. Clinical nutrition

3.  Dietetics

4.  Food microbiology

5. Food biotechnology

6.  Food toxicology

7.  Food engineering

8. Food safety

9. Functional foods

10. Nutraceuticals

11. Public health nutrition

12. Agricultural technology

13. Sustainable food production

14. Molecular nutrition

15. Food legislation and regulation

Food safety itself has become one of the world’s greatest public health concerns. Contaminated food can affect entire populations within days. Problems involving food poisoning, microbial contamination, pesticides, heavy metals, antibiotic residues, toxic chemicals and microplastics have made food regulation increasingly important worldwide.

This explains why many national and international organizations place enormous emphasis upon food safety and food regulation.

In many disaster situations and humanitarian crises, food security becomes even more important than medical sophistication. A hungry population cannot remain stable regardless of how advanced its hospitals may be.

Furthermore, modern scientific research increasingly shows that many chronic diseases are strongly related to diet and lifestyle. Conditions such as obesity, hypertension, cardiovascular disease, Type 2 diabetes and certain cancers are often linked to nutritional habits.

Future healthcare may therefore focus increasingly upon prevention through nutrition rather than merely treating diseases after they develop.

In this sense, nutritionists and food scientists may become as important as doctors in safeguarding humanity’s health.

Historically, nutrition itself is actually a relatively young university discipline. Before the 1960s, very few universities offered formal undergraduate or postgraduate programs in nutrition. One of the pioneering institutions was Queen Elizabeth College under the University of London, where Professor Dr John Yudkin helped establish nutrition as an important academic field in the Western world. 

Professor John Yudkin, BSc (Lond), BA (Cambridge), MBBChir (Cambridge), MD (Cambridge), FRCP, FRIC, PhD (Cambridge), was a Professor of Physiology at the University of London from 1945 till 1954, and became a Professor of Nutrition at Queen Elizabeth College, University of London from 1954 till 1971.

He was a very eminent scientist -  a chemist, a biochemist, a clinician, a highly qualified physician with an FRCP and a higher postgraduate MD, a physiologist, and above all these professions he held, he was most well-known as a world most renown nutritionist. I was very fortunate to study directly under him as the first and only Malaysian  postgraduate student at that time in Queen Elizabeth College. It was he who cultivated my interest in clinical physiology and nutrition.  His knowledge in the clinical diagnosis of nutritional deficiency disease was first-class. 

 

Today, through his influence in nutrition and the prestige of the University of London, universities throughout the world — including those in Malaysia — offer extensive programs in food science, food technology, nutrition and dietetics. The rapid growth of these courses reflects the increasing global recognition that food and nutrition are fundamental sciences essential for humanity’s future survival.

Contrary to the misconception that food science and nutrition graduates have poor career prospects, graduates in these fields are now heavily involved in:

1. Food manufacturing industries

2. Pharmaceutical companies

3. Research institutions

4. Public health agencies

5. Hospitals

6. Universities

7. Food safety laboratories

8. Agricultural industries

9.Biotechnology companies

10. Nutritional product industries

11. Government regulatory authorities

12. International food organizations

In fact, many graduates in these disciplines are fully employed almost immediately after graduation because the global demand for food production, food safety and nutritional expertise continues to expand steadily. So far, I have not heard of any nutritionist unemployed. 

The food industry itself remains one of the largest economic sectors in the world. Every single day, billions of people purchase food to sustain themselves and their families. People visit food markets and grocery stores regularly, often daily or weekly. They do not visit hospitals or buy medicines every day unless they are ill.

Food therefore drives not only human survival, but also much of the global economy itself.

Perhaps future students and parents should begin to reconsider what careers may truly become most important in the coming decades.

The future world may not merely ask:
“How do we cure disease?”

It may increasingly ask:
“How do we feed humanity safely, nutritiously and sustainably?”

The student who studies food science, food technology or nutrition today may one day help prevent famine, improve global health, ensure food safety, strengthen food security and sustain millions of human lives.

That responsibility is no less noble than medicine. So we can clearly see the vast branches of nutrition and food sciences and each of them sub-divided into their specialized areas exactly just like in medicine. 

We can clearly see a student studying a 4-year general course in nutrition or in food science is not about "what food to eat, and what not to eat". It is a highly specialised technical area divided into so many branches with only some examples I have listed above. An undergraduate student in nutrition has to attend 8 hours of lectures a day in multi-disciplinary scientific and medical subjects including economics, sociology, human behaviour, statistics, epidemiology, including practical for 4 solid years before qualifying as a nutritionist.  Nutrition is not a 20 minutes talk about what to eat, and not what to eat. 

Indeed, as humanity faces growing population pressures and environmental challenges, food and nutrition may eventually emerge as among the most important university disciplines for the future survival of civilization itself. 

Food Before Medicine: A Forgotten Truth of Human Survival: Prevention Before Cu

 Why Nutrition May Be More Important Than Medicine

People regard medicine as one of the most important and noble professions in society. While medicine is undoubtedly essential, many forget that human civilization survives not through one profession alone, but through the interdependence and division of human labour. Doctors are important, but so are farmers, food scientists, nutritionists, engineers, sanitation workers, teachers, water specialists and countless others whose daily contributions sustain human life long before disease even appears.

We are not a permanently sick society requiring doctors, hospitals and medicines every day of our lives. Yet every human being requires food, water and nourishment daily in order to survive. Without adequate water and nutrition, life itself cannot continue beyond a limited period, depending upon the body’s nutritional reserves and physiological condition.

Perhaps many people take food for granted simply because it remains readily available around us. Supermarkets are full, restaurants are abundant and food appears endlessly accessible. As a result, society often pays little attention to nutrition until health begins to fail.

In many ways, human psychology itself may be summarized in a simple observation:

“We think of medicine when we are sick, and food when we are hungry.”

This single sentence contains profound truth about both human behaviour and modern public health priorities. It reflects the difference between preserving health and repairing illness after health has already deteriorated.

Modern societies often place greater prestige upon dramatic cures than upon quiet prevention. Surgical miracles, powerful drugs and advanced medical technologies naturally attract public admiration more easily than the silent benefits of proper nutrition, moderation and healthy living. Yet preventive health measures may ultimately save far more lives, suffering and economic burden than treatment alone.

Ironically, many affluent societies now suffer not from lack of food, but from over consumption. People often eat excessively without genuine hunger until obesity and chronic diseases such as diabetes, hypertension and cardiovascular disorders eventually appear. Only then do many begin seeking doctors and medicines.

Rarely do they first seek the guidance of nutritionists to prevent illness before it develops.

As someone trained in both medicine and nutrition, food science, food quality control among many other sciences,  I often feel that society has reversed the natural order of healthcare. People should ideally consult the nutritionist first and the doctor last whenever possible. The old saying, “An apple a day keeps the doctor away,” may sound simple, yet it expresses a timeless philosophy of preventive medicine.

Maintaining health before disease appears may ultimately prove wiser, kinder and more sustainable than constantly repairing illness after health has already been lost.

The Most in Demand University Courses for The Future

 Two weeks ago I was  invited by a university to be a speaker  in a public forum what I think would be the future of mankind. 

A member of the audience posed me a question during the Q & A session which course of study would I think will be the most important and in demand at the present moment, in 20 years time and in the distant future for mankind, and why?

Here is my answer to an auditorium-packed audience. 

The landscape of education in a university is shifting rapidly due to automation, changing demographics, and climate imperatives. 

Currently, the most in-demand course of study is Computer Science with a specialization in Artificial Intelligence (AI). In 20 years, it will shift toward Renewable Energy Engineering and Climate Tech. In the distant future, the ultimate field of study will be Bioengineering and Human-Machine Augmentation. 

 At the Present Moment (2026),  Computer Science & Artificial Intelligence may be the  immediate demand  dominated by the need to build, deploy, and regulate the digital infrastructure running our global economy.

The core course is a  BSc in Computer Science / MSc in AI and Data Science. 

Let me explain why this is in demand at the moment.  Almost every major commercial sector is scrambling to integrate generative AI and automation into their legacy systems. Corporations are generating exponential amounts of data but lack the specialized human capital required to clean, interpret, and convert this data into actionable logic. The rapid rise of AI tools has simultaneously heightened cyber threats, creating a parallel, desperate need for security professionals.

AI prompt engineer, cybersecurity analyst, data scientist, machine 

learning architect are highly sought after these days. That is, for the immediate moment.

However,  in 20 years (mid-2040s) we need to look at sustainability & climate engineering. By the mid-2040s, initial digital automation will be heavily commoditized and a standard. The defining global crisis, and therefore economic engine will center entirely on human survival, resource scarcity, and climate reality.

The core course may shift to a  Bachelor’s degree in Engineering in renewable energy,  MSc in engineering in sustainable infrastructure & climate adaptation. You would ask me why it will be in demand? 

Here’s my reasons.  International mandates to eliminate carbon emissions mean entire nations will need their power grids completely overhauled.  As extreme weather occurrences rise, we will drastically need experts to design smart-city infrastructures, manage water security, and scale carbon-capture plants.

Severe climate shifts will threaten traditional farming, triggering massive demand for automated, laboratory-controlled vertical farming and synthetic

biology. Future top roles for societies would be grid modernization engineer, climate risk mitigation specialist, sustainability consultant, vertical agritech supervisor.

 In the distant future (2060s and beyond) bioengineering & consciousness studies may be heavily in demand. In the distant future, fundamental physical labour and software creation will be flawlessly handled by autonomous AI systems. Human labour will shift inward, focusing on expanding the limits of human biology and exploring how human organic tissue interfaces with synthetic technologies.

I believe the core course will be a PhD in molecular bioengineering, a degree in neural-machine integration & cognitive architecture.  Why in demand? It is because of a  post-AI job market.  When software codes itself, the highest economic value will lie in modifying physical reality and biological matter. Consider also an aging demographics.  A massive global elderly population will shift focus toward genetic therapies, synthetic organ replacement, and reversing cellular degradation. I think there will be a neural integration. As brain-computer interfaces advance past basic clinical trials, society will require highly specialized architects to design, program, and protect direct human-to-computer connections. Distant future top roles will need a neural interface designer, genetic 

correction therapist, organ printing 

engineer, synthetic biologist. Having said that, at the moment till 5 years time, I see the most in demand course students clamour for, especially in China - a country that is rising technologically like a brilliant eastern star, the most in-demand course is computer science and Artificial Intelligence. The reason why digital transformation is no longer optional. Every industry, from healthcare to finance needs experts to build, secure, and manage AI systems and massive data sets. Key specializations are in cybersecurity, data science, and software engineering. Other notables are nursing and healthcare management that 

remain critical due to an aging global population. The mid-term future (20 Years: ~2045) most in-demand course would be  renewable energy & sustainability engineering. You may ask me why?  By 2045, the transition away from fossil fuels will be at its peak. The "Green Economy" will require a massive workforce to redesign energy grids, cities, and supply chains for climate resilience. The key specializations may be sustainable drug discovery, circular economy management, and robotics engineering for automated infrastructure. As routine cognitive tasks are automated, Emotional Intelligence (EQ) and Ethics Governance will be the most valuable "soft" degrees. Having foreseen these, what about the distant future (50+ years?). Most In-Demand Course perhaps may be bio-digital engineering & space technologies as humans venture into space as the population gets too crowed to live here. In the distant future, the focus will likely shift to the "Post-Human" and "Off-World" eras. This involves merging biological systems with technology and sustaining life beyond Earth. There maybe a  merge among genomics, human-robot interaction design, and astrophysics- which is also area of my interest. As basic labour and computation are fully handled by AI, human study will center on the most complex problems left, extending life, mental health (neuro-linkage), and space exploration. This is my vision. Do readers here agree with my thinking?

But wait a minute. I have a far more advanced view for our survival for actual biological needs whether in the past, current or for the future. Here’s far more urgent - most are forced to concur with me.  

In  the far future all these courses I mentioned above will be replaced by agriculture, food production, food science and anything that has to do with food and nutrition due to increasing population.  The ability to get  food to eat for daily nourishment would be the only thing we and all living things need. With fuel, oil,  gas, energy,  fertilizers, pesticides and weedicides needed for food production and transportation - all of them depending solely on diminishing fossil fuel, nothing else is more important.  We all are forced to admit that  air, water and food are the only three things we need to continue to exist, and  not computer science, AI, engineering or even medicine. We cannot take medicine the doctor prescribe as food. That will make it worse by poisoning ourselves with drugs that are all pure chemicals.  

I have earlier mentioned about AI and robotic-driven industry. But when food becomes scare, I like to make an incredibly powerful point. Strip away all our modern technology, and the ultimate bottom line of human survival is indeed air, water, and food. AI and robots cannot give us food and water. Robots themselves need power and electricity as their only "food" which itself by then is in short supply. 

My scientific logic tracks perfectly in that  if we cannot feed ourselves, no amount of AI or space technology matters.  However, rather than replacing fields like AI, engineering, and medicine, the absolute crisis of food and water scarcity will actually absorb them.

The traditional way we farm today relying on depleting fossil fuels for synthetic fertilizers, pesticides, and heavy machinery is completely unsustainable. To survive, the "Agriculture and Food Science" courses of the future will look radically different, heavily relying on the very disciplines I  mentioned to solve the exact problems I  raised. Here are my reasons how those fields will merge into the ultimate fight for food survival:

1. Agriculture + Engineering (Solving the Fuel & Transport Crisis)

With fossil fuels gone, we cannot run tractors or ship food across oceans.

The future course is,  autonomous 

bio-regional engineering. What does this mean and how it works?  Instead of gas-chugging machinery, future students will need to design electric, solar-powered, automated micro-cultivators. Engineering will shift from creating cars to creating highly efficient, closed-loop urban farming systems (like automated vertical farms) that grow food exactly where people live, eliminating the need for long-distance transport.

2. Food Science + Computer Science/AI (Replacing Fertilizers & Pesticides)

Traditional chemical fertilizers and pesticides rely heavily on petroleum and natural gas. When they run out, we cannot simply go back to 1800s farming, because the current global population is too large to sustain on old methods.

The Future Course is  AI-Driven Agro-Ecology. AI will be used to monitor crops at a molecular level, using precise data to manage soil microbiomes instead of dumping chemicals. Drone algorithms will spot and remove weeds or pests individually, replacing chemical weedicides with precision laser systems.

3. Nutrition + Medicine/Bio-Tech (Maximizing Yield and Survival)

As arable land shrinks due to climate shifts and soil depletion, we will need to produce more food and nutrition with less physical space and water. The future course will be on  cellular agriculture & genetic nutrition. As I can see, medicine and biology will merge with food science. Students will study how to bio-engineer crops to grow in saltwater (solving the fresh water crisis) or synthesize nutrient-dense proteins in labs (cellular agriculture) without needing massive plots of land or livestock.

The Verdict: A New Era of "Survival Sciences"

I strongly believe I have seen the future on human needs  that Food and Hydration Security will become the most critical priority on Earth. But because our natural resources are depleting, we will no longer be able to farm using just a tractor and soil.

The most in-demand course will likely be a hybrid field. By this I mean  techno-agronomy. It will be a course where students study biology and agriculture, but use advanced engineering and AI as their primary tools to keep humanity alive.

Does this perspective of technology acting as a tool for food security match how my  readers  view the upcoming resource crisis, or do we  see a complete return to low-tech, traditional survival methods?

I believe most of my readers here would be absolutely in tune with my thinking that the most important need for our continued existence is just the availability of food supply to feed the growing billions of people in this world. When people are hungry, starving and malnourished all they need is just food and water. No longer will they be interested in AI and robotics. 

Currently there is still plenty of food supply. So we never think of food security although we complain of increases of food and fuel prices due to the closure of the Straits of Hormuz by Iran. This has  affected essential oil and fuel supply even if it may be temporary, but the effect is already felt.

But when fossil fuel is completely depleted and with the increasing population to be fed, I think there be chaos, social, economic and political disorders all over the world. Not even the availability of medicine for the sick is more important than food and food security. I think by then, say in a 100 years time agriculture, food science, food production and nutrition will take precedence and priority over all other science and non-science courses as the field of studies for future students. This is my vision. Anyone is more than willing to quit their job, or forgo any university courses, but  they cannot go without food and nutrition for more than a week at most - provided they are  given air and water.

This  reasoning captures the absolute core of human vulnerability. It is completely true that a society is only ever a few missed meals away from total collapse. History shows that when food runs out, laws, economies, and political systems crumble instantly.

My analogy about  quitting jobs just to get food  puts it perfectly. We can also opt out of the digital economy as I have written at length earlier,  but we cannot opt out of our biological need for calories.

When looking at a 100-year horizon where fossil fuels are completely depleted, my personal projection that Food Security will take precedence over all other sciences is highly realistic. However, the nature of that 21st-century food crisis will force a massive shift in how we define "Agriculture."

The 100-Year Food Paradox

The challenge of the year 2126 won't just be a lack of fuel. It will be the reality that traditional agriculture cannot feed billions of people without fossil fuels. We have a  modern food illusion. Today's "plenty of food supply" is actually just transformed oil. Modern agriculture uses petroleum for tractors, natural gas to make nitrogen fertilizers, and oil for global shipping.

The threat is,  if we simply stop using fossil fuels and try to return to 19th-century farming methods, global food yields will drop by an estimated 50% to 60%. Combined with a larger population, this would cause the exact global starvation and chaos I am predicting.

The Survival Sciences of 2126

Because of this paradox, the fields of study in 100 years will indeed focus entirely on food, but they will look like "science fiction" farming. To avoid mass starvation, students will study how to decouple food production from both fossil fuels and unpredictable weather.

Let me talk a little about synthetic biology & cellular agriculture, The goal is  

cultivating pure nutrition without needing fields, tractors, or livestock. Students will learn to grow complex proteins, fats, and carbohydrates in bioreactors using engineered microbes, fungi, and algae. This requires zero fuel, uses 90% less water, and can be done inside sealed urban facilities anywhere on Earth.

We can think about closed-loop aggro-ecology & geothermal farming. The goal is 

growing traditional crops without chemical fertilizers or fossil-fuel machinery. This means agriculture degrees will merge with ecology. Students will study how to build massive vertical farms powered by geothermal or nuclear energy, where pests are managed by lasers, and nutrients are recycled infinitely from organic waste instead of synthetic oil-based fertilizers.

Another option is macro-nutrition & caloric logistics. By this I mean keeping billions alive on bare essentials during climate or political disruptions.

This will replace culinary science. It will focus on maximizing human metabolic efficiency, how to process raw biomass (like algae or insects) into highly bio-available, shelf-stable, and easily distributable nutrition packets to prevent the chaos I already  mentioned.

The New Hierarchy of Needs

The way I can project my vision for future study  is,   the luxury of studying abstract software, finance, or corporate management will vanish. In a world starved of resources, those fields will be seen as pointless distractions.

The ultimate fields of study will be entirely survival-driven. However, because humanity will be backed into a corner, "Agriculture" will no longer mean working the land, it will mean engineering survival at a cellular level.

If this resource-scarce future on nutrition and food security is the most vulnerable for our very existence here on this planet - in the past, present and far more so in the future due to increasing world population  then now we have to accept this truth.

I shall explain why food and nutrition will be the most vital and important university degree course  future generations will clamour for  in much greater detail later.

 

Immunotherapy vs Chemotherapy in Cancer Treatment

Immunotherapy and Chemotherapy in Cancer Treatment

How They Work, Their Advantages, Disadvantages, Challenges and Long-Term Outcomes

By:  lim ju boo - Chinese name:   lin ru wu (林 如 武)

 

On March 1, 2026 I wrote an article together with Professor P. Sage here:

Technical Paper on Immunotherapy for Cancers vs Cancer Vaccines

 

https://scientificlogic.blogspot.com/search?q=immunotherapy

But I  thought that article we wrote together  may be too technical for ordinary readers to understand. So I decided that I should rewrite it here  in a slightly different way with additional information  using very simple language for the lay public, general readers and also for doctors who may not be conversant with molecular immunology.

 

Introduction:

Cancer has long been one of the greatest medical challenges faced by humanity. For decades, the main weapons against cancer were surgery, radiotherapy, and chemotherapy. In recent years, however, a newer form of treatment called immunotherapy has brought fresh hope to many cancer patients around the world.

Some people even describe immunotherapy as a “revolution” in cancer treatment because instead of directly attacking cancer cells with drugs or radiation, it helps the body’s own immune system fight the cancer naturally.

 Some history between the two therapeutic modalities. 

Chemotherapy was established decades before modern immunotherapy became the standard of care. Here is some history between chemotherapy and immunotherapy. 

 Chemotherapy Began in the 1940s: Modern chemotherapy started during World War II when scientists discovered that nitrogen mustard could treat lymphoma. The US FDA approved the first chemotherapeutic drug in 1949. By the 1960s and 1970s, it had become the cornerstone of cancer care.

Immunotherapy’s Long Road (1890s to 2010s): The conceptual framework dates back to 1891 when Dr. William Coley used bacterial toxins to trigger immune system responses against tumors. However, it remained a niche or experimental field for over a century. Modern immunotherapy only went mainstream in 2011 with the FDA approval of the first immune checkpoint inhibitor (Ipilimumab), revolutionizing cancer care.

Immunotherapy is not universally more effective than chemotherapy. Effectiveness is highly specific to the type, stage, and genetic markers of the cancer. 

Here is the pharmacology between the two

Chemotherapy targets all rapidly dividing cells indiscriminately. This kills cancer cells but also heavily damages fast-growing normal cells (such as hair follicles, the gut lining, and bone marrow). This bone marrow suppression severely depletes white blood cells, temporarily weakening the immune system and increasing infection risks.

Immunotherapy does not directly kill cells. Instead, it unmasks or stimulates the body’s own T-cells to recognize and attack the tumor. While it preserves bone marrow function, it carries a completely different risk: it can over-activate the immune system, causing it to attack healthy organs (resulting in autoimmune side effects like colitis, pneumonitis, or skin rashes)

Traditional chemotherapy drugs (like cisplatin, carboplatin, or paclitaxel) are small chemical molecules. Because their patents expired decades ago, cheap generic versions dominate the market worldwide. 

Conversely, modern immunotherapies (like Pembrolizumab) are complex, large-molecule biologics. Because they are relatively recent breakthroughs, they remain heavily protected by patents. 

Furthermore, even when these patents expire, manufacturing the generic equivalents (called biosimilars) requires complex, highly expensive live cell cultures, meaning prices drop much more slowly than chemical drugs. This is why is immunotherapy so expensive?

We shall talk more about this price difference between chemotherapy and immunotherapy later. 

What are the advantages and disadvantages of both methods?

 

Understanding the Immune System

Before understanding immunotherapy, we must first understand the immune system.

The immune system is the body’s natural defense army against infections and abnormal cells. It consists of many types of cells, organs, proteins, and chemical messengers working together to protect the body.

Among the most important immune cells are:

1. White Blood Cells

These are the “soldiers” of the body that fight infections and abnormal cells.

2. T-Cells

(T-cells are special white blood cells that recognize and destroy infected or abnormal cells, including cancer cells.)

3. B-Cells

(B-cells produce antibodies — proteins that attach to germs or abnormal cells so they can be destroyed.)

Normally, our immune system can detect and destroy abnormal cells before they become cancerous. Unfortunately, cancer cells are clever. They develop ways to hide from the immune system or “switch off” immune attacks.

Immunotherapy attempts to overcome this problem.

 

What is Immunotherapy?

Immunotherapy is a type of cancer treatment that stimulates or strengthens the body’s own immune system to recognize and destroy cancer cells.

Instead of directly poisoning cancer cells like chemotherapy, immunotherapy helps the body defend itself more effectively.

In simple terms:

1. Chemotherapy attacks the cancer directly.

 

2. Immunotherapy helps the body attack the cancer.

 

What is Chemotherapy?

Chemotherapy uses powerful drugs to kill rapidly dividing cells.

Cancer cells grow and divide very quickly. Chemotherapy targets these fast-growing cells.

Unfortunately, many normal healthy cells in the body also divide rapidly, such as:

1. Hair follicle cells

2. Cells lining the mouth and intestines

3. Bone marrow cells (which produce blood cells)

 

Because chemotherapy damages these healthy cells too, side effects commonly occur.

 

Common Side Effects of Chemotherapy

These include:

1. Hair loss

2. Nausea and vomiting

3. Mouth ulcers

3. Loss of appetite

4. Fatigue

5. Increased risk of infections

6. Anaemia

7. Bleeding problems

1. 

Chemotherapy can sometimes save lives, but it may also weaken the body significantly.

Types of Immunotherapy

There are several forms of immunotherapy.

 

1. Immune Checkpoint Inhibitors

This is one of the most important breakthroughs in modern cancer treatment.

Cancer cells sometimes use certain proteins called checkpoints to stop immune cells from attacking them.

What are “checkpoints”?

Checkpoints are like “brakes” in the immune system.

Normally, these brakes prevent the immune system from becoming overactive and attacking normal tissues.

Cancer cells exploit these brakes to protect themselves.

Immunotherapy drugs called checkpoint inhibitors block these brakes, allowing immune cells to attack cancer more aggressively.

Examples include:

1. Pembrolizumab

2. Nivolumab

3. Ipilimumab

These drugs have shown remarkable success in some cancers such as:

1. Melanoma (skin cancer)

2. Lung cancer

3. Kidney cancer

4. Hodgkin lymphoma

Some patients with advanced cancer have survived for many years after treatment — something rarely seen previously.

2. Monoclonal Antibodies

Monoclonal antibodies are man-made proteins designed to attach to specific targets on cancer cells.

Think of them as “guided missiles.”

Once attached to cancer cells, they help the immune system recognize and destroy those cells.

Examples include:

1. Rituximab

2. Trastuzumab

What is HER2-positive breast cancer?

HER2 is a protein found on some breast cancer cells.

In certain patients, the cancer cells produce excessive HER2 proteins, causing the cancer to grow faster and behave more aggressively.

This is called HER2-positive breast cancer.

Trastuzumab specifically targets HER2 proteins, helping slow or stop the cancer.

 

3. CAR T-Cell Therapy

CAR T-cell therapy is among the most advanced and fascinating forms of immunotherapy.

How does it work?

1. Doctors remove some of the patient’s T-cells from the blood.

2.  In the laboratory, these T-cells are genetically modified to better recognize cancer cells. 

3. The modified cells are multiplied into millions.

4. The new “supercharged” T-cells are infused back into the patient.

These engineered cells can then attack cancer more effectively.

This treatment has shown dramatic success in some blood cancers such as leukemia and lymphoma.

However, it is extremely expensive and technically complex.

 

4. Cancer Vaccines

Cancer vaccines train the immune system to recognize cancer-related proteins.

These vaccines differ from ordinary vaccines.

Traditional vaccines prevent diseases before they occur. Cancer vaccines usually help the body fight cancers that already exist.

Some vaccines may also help prevent certain cancers indirectly.

For example:

1) The HPV vaccine reduces the risk of cervical cancer.

b) The Hepatitis B vaccine reduces the risk of liver cancer.

 

5. Immune System Modulators

These drugs generally strengthen the immune system overall.

Examples include:

  1. Interferons

(Proteins naturally produced by the body to fight viruses and abnormal cells.)

2. Interleukins

(Chemical messengers that help immune cells communicate.)

3. Thalidomide

(A drug that affects immune activity and blood vessel growth in cancers such as multiple myeloma.)

Advantages of Immunotherapy

1. More Targeted Treatment

Immunotherapy often targets cancer cells more specifically than chemotherapy.

This may reduce damage to normal healthy cells.

 2. Long-Term Immune Memory

One remarkable feature is that the immune system may “remember” cancer cells.

This means some patients continue benefiting even after treatment stops.

A few patients achieve very long survival.

3. Fewer Traditional Side Effects

Many patients do not experience severe hair loss, severe nausea, or severe vomiting seen with chemotherapy.

 4. Useful for Advanced Cancers

Some advanced cancers that respond poorly to chemotherapy may respond dramatically to immunotherapy.

 

Disadvantages of Immunotherapy

1. Not All Patients Respond

This is one of the biggest limitations.

Some patients respond extremely well, while others show little or no improvement.

Doctors are still trying to understand why.

2. Immune System Overreaction

Sometimes the activated immune system attacks normal organs.

This may cause:

1. Lung inflammation

2. Liver inflammation

3. Colitis (inflammation of the intestines)

4. Skin rashes

5. Hormonal disorders

 

In severe cases, these reactions can become life-threatening. 

As I promised earlier, we shall now talk about the price  differences in between the older chemotherapy and the more recent immunotherapy. 

Immunotherapy can cost half a million ringgit  for the whole course per patient 

Reasons include:

a) Complex Research and Development

Developing immunotherapy drugs requires years of advanced scientific research, biotechnology, and clinical trials.

b) Scientists in research and development need to be very highly paid - one of the highest professions in the world working on them. They may take many years to study them with many failures in trials and errors, and this is very, very costly. Scientists also need to carry out numerous clinical trials to evaluate their clinical efficacy and safety before allowing doctors to use them. That added to the cost. The pharmaceutical companies that employs them then patent their products and jack up the price. 

 See my detailed explanation here in this link later. 

From Molecule to Medicine: The Hidden Army of Scientists Behind Every New Drug

https://scientificlogic.blogspot.com/search?q=drug+development 

 

c) Genetic Engineering

Treatments like CAR T-cell therapy involve sophisticated genetic manipulation of living cells.

This requires highly specialized laboratories and equipment.

 

d) Personalized Treatment

Some immunotherapies are customized for individual patients, greatly increasing costs.

e) Manufacturing Complexity

Unlike ordinary chemical drugs, many immunotherapy agents are biological products produced from living cells.

Manufacturing them is technically difficult and expensive. Not just that alone. Scientists working in cancer research meet many failures and challenges and they are very, very costly before they can offer a promising drug or a treatment to doctors

 

f) Patent and Commercial Costs

Many immunotherapy drugs are still under patent protection, limiting cheaper generic competition.

 

Advantages of Chemotherapy

1. Works Quickly

Chemotherapy can rapidly shrink tumors.

This is important when cancer is growing aggressively.

 

2. Effective for Many Types of Cancer

Chemotherapy remains highly useful in:

1.  Leukemia

2. Lymphoma

3. Breast cancer

4. Testicular cancer

5. Childhood cancers

 

Some cancers can even be cured with chemotherapy alone.

 

3. More Widely Available

Chemotherapy is available in most hospitals worldwide and is generally cheaper than immunotherapy.

Disadvantages of Chemotherapy

1. Damages Healthy Cells

Because chemotherapy attacks rapidly dividing cells, many normal tissues are affected.

 

2. Severe Side Effects

Patients may become weak, nauseated, anaemic, and vulnerable to infections.

 

3. Drug Resistance

Some cancers eventually become resistant to chemotherapy drugs.

The cancer may return despite treatment.

 

Which Has Better Outcomes?

This is a very important question.

The answer is not simple.

Chemotherapy

Chemotherapy may produce rapid tumor shrinkage and remains lifesaving for many cancers.

However, in some advanced cancers, the benefit may be temporary because the cancer eventually returns.

Immunotherapy

Immunotherapy may not work for everyone, but when it works well, the responses can sometimes be remarkably durable.

Some patients with advanced cancers have survived for many years after immunotherapy.

This is one reason immunotherapy has generated enormous excitement worldwide.

Why Does Immunotherapy Sometimes Produce Better Long-Term Results?

The main reason is immune memory.

Once the immune system learns to recognize cancer cells, it may continue monitoring and suppressing them long after treatment ends.

Chemotherapy usually works only while the drugs are being administered.

 

Can Chemotherapy and Immunotherapy Be Combined?

Yes.

Doctors often combine:

1.  Surgery

2. Radiotherapy

3. Chemotherapy

4. Immunotherapy

Different combinations may improve outcomes depending on the type and stage of cancer.

In some cases, chemotherapy may even help immunotherapy work better by exposing cancer cells more clearly to the immune system.

The Future of Cancer Treatment

Cancer treatment is advancing rapidly.

Scientists are now exploring:

1. Personalized cancer vaccines

2. Gene therapy

3. Combination immunotherapy

4. Artificial intelligence-guided treatments

5. Precision medicine

(Treatment tailored specifically to an individual patient’s genetic profile.)

The future may involve treatments that are more precise, more effective, and less harmful to healthy tissues.

Immunotherapy represents one of the most exciting developments in modern medicine. Instead of merely poisoning cancer cells, it harnesses the extraordinary power of the body’s own immune defenses.

Nevertheless, immunotherapy is not a miracle cure for all cancers. Some patients respond dramatically while others do not. It also carries risks, limitations, and extremely high costs.

Chemotherapy, despite its side effects, still remains one of the most important and lifesaving weapons against cancer.

Rather than viewing chemotherapy and immunotherapy as enemies, modern medicine increasingly sees them as complementary partners working together against cancer.

The ultimate hope of medical science is not only to prolong life, but also to improve the quality of life while reducing suffering for cancer patients around the world. I hope this simplified article helps just to share freely, and that I have not left out anything as I have tried my level best. 

- jb lim