THE OTHER FACE OF CANCER
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THE MYTHS OF CANCER

T he dictionary 1 defines myth as a belief given uncritical acceptance by the members of a group especially in support of existing or traditional practices and institutions. The mythology of cancer includes such facts as, that cancer is caused by an agent, ( and hence can be prevented by ridding humanity of that agent), that it can be diagnosed at a stage when a pre-emptive strike at it would assure a cure , and that these are the only essentials that need bother us about the na- ture of cancer. Never in the history of mankind has so much untruth been told so often by so few to so many, for so long, at such a back- breaking fiscal and human cost. The mythology of the whole field of cancerology is best summed up as colossal ignorance matched by

overclaiming, overdoing and overpromising.

Our ignorance starts with the apparently simple problem of defining cancer. Virchow 2 , the father of cellular pathology, remarked in the 19th century that no man, even under torture, could define cancer. The passage of more than 150 years has made no change in the Virchowian conclusion; Foulds 3 , the British cancerologist, recently stated that can- cer research will reach an outstanding landmark the day it can define cancer in biological terms.

Such fundamental ignorance explains the state of cancerology today - 'scientifically bankrupt, therapeutically ineffective, and wasteful.' This candour, by Nobel prize-winner Watson 4 of Double Helix fame, was worded differently by another Nobel prize-winner, Burnet 5 , when he stated that if there could be ' a comprehensive and unbiased survey of cancer research,' the surveyor would end up with a devastating sense of futility - the end-result of the hundreds of thousands of man- years of work on the various aspects of cancer has been 'precisely nil'. Whither cancerology?

Despite doctors' exhortations to diagnose early, remember 6-8 the num- ber of eminent cancerologists who have fallen victim to the disease they were trying to conquer. One of the earliest was Armand Trous- seau, the great clinician of Hotel Dieu de Paris who recognized migrating thrombophlebitis - Trousseau's syndrome, described by him - as the first sign of his own advanced abdominal cancer. William Mayo, co-founder of the famous Mayo Clinic, who wrote some classic papers on the surgery of stomach cancer, accidentally felt his own advanced cancer, as did Sir D.P.D. Wilkie of England, another notable name in surgery. James Ewing, the famous pathologist and research director of the Memorial Hospital, New York, died of bladder cancer. Close by us is the Tata Memorial Centre, an exclusive cancer hospital and research centre. Two surgeons from there, Ernest Borges and Sorab Mehta had their cancers diagnosed too late. Leslie Foulds, of the Imperial Research Fund and author of the two volume work Neoplastic Development , died of a colonic cancer that was very ad- vanced when first diagnosed. Other names include Frank Horsfall, the director of the Sloan-Kettering Institute who died of pancreatic cancer, and David Karnofsky, chief of SKI's chemotherapy section, who died of lung cancer. Dorn, one of the most notable named in cancer epidemiology, died of kidney cancer. Shakespeare aptly aphorised that 'By medicine life may be prolonged, yet death will seize the doctor too.'

By treatment life may be eased, yet cancer can kill the cancerologist too. Solzhenitsyn 9 has portrayed this touchingly in Cancer Ward . Ludmila Afanasyevna, radiotherapist of the hero Oleg, develops can- cer, about which she hopelessly realizes nothing can be done. The understanding by laymen that the most eminent names in the field of cancer can also get cancer and die of it, will go a long way in assuag- ing the not uncommon 'why me?' or 'why my -?' complex.

Cancer experts overclaim to breed illusions of knowledge of the cause of cancer. Despite the fact that not one cause (including smoking), advanced by them as responsible for the occurrence of a cancer, has ever proved to be the sine qua non of that cancer, cancerology con- tinues to hold everything under the sun, including the sun itself, as cancerogenic. The latest to be added to this plethora of cancerogens is the human sperm. The outcome of it all is cancerophobia, a dis- ease, aptly described by Ingelfinger 10 the late editor of the prestigious New England Journal of Medicine as 'as serious as cancer itself,' and morally far more devastating.

Cancerologists overdo - overdiagnose and overtreat - because they refuse to accept the writing on the wall that no cancer can be diag- nosed early enough, or can be treated to the point of a cure: the cancer therapist treats what he sees. The illusion of a cure following therapy lies mainly in the patient not feeling the presence of cancer and/or the clinician not being able to detect it. The classic example is that of acute leukemia where even in 'complete remission 45,98,265 the patient's body has a large number of cancer cells all the time. (See Chapter 6).

Hardin Jones 11 , from an extensive survey of varied cancers, concluded: 'It is most likely that, in terms of life expectancy, the chance of survival is no better with than without treatment, and there is the possibility that treatment may make the survival time of cancer cases less.'

Jones's 1956 assessment was reinforced in 1975 by Logan 12 of WHO, who from a global survey of breast cancer summarized that despite all the therapeutic radicalism, the mortality had not declined and had possibly increased. Thomas Dao 13 , of the Department of Breast Surgery, Rosewell Park Memorial Institute, Buffalo, put it more explic- itly: 'Despite improved surgical techniques, advanced methods in ra- diotherapies, and widespread use of chemotherapies, breast cancer mortality has not changed in the last 70 years.' This cancer occurs just beneath the skin. Its natural history has been studied for centu- ries. It is one of the most amenable tumours to self-examination, clini- cal examination, staging, grading, hormone therapy, and what have you. Breast cancer, as a paradigm, typifies the utter failure of cancer- ology. When and how should cancerology reveal this truth to the pub- lic? Left to cancerologists, it never will.

In a subtle way, cancer societies manipulate minds. When Jane Brody of The New York Times joins hands with Arthur Holleb of The American Cancer Society , the cancerological optimism takes the shape of a big book reassuringly titled, You can Fight Cancer and Win 14 . Written in reporters' journalese, the book is replete with such cliches as 'Know Thine Enemy', 'Cancer is Conquerable', and so on, and appears to be more of an advertising campaign for the cancer hospitals and societies.

The Brody-Holleb venture is a typical example of how people can be taken for a ride. For a more objective and balanced approach it is necessary to consult Hixson's The Patchwork Mouse , 8 subtitled the 'Politics and Intrigue in the Campaign to Conquer Cancer,' Hixson's book exposes the scientific double-think perpetrated at the Sloan - Kettering Institute, under the directorship of Robert Good. The sum and substance of Hixson's book: (a) 'The American public, known to the rest of the world as the originator of fads and fetishes, suffers from time to time with a pre-occupation over a single disease. Today that disease is cancer ...' and (b) 'I have some advice for young researchers in biology. Stay out of cancer research because it's full of money and just about out of science.'

The statement (b) above, made by a scientist to Hixson, reveals the most important aspect of the science of cancerology - that it is a non- science, being essentially a political and a fiscal problem, where, as Hixson 8 found out, the main pre-occupation is how to 'ask for more cash'. In Genes, Dreams and Realities the politics and funding of the non-science of cancer have been most candidly and most pertinently stated by Burnet 15 . He points out that scientists now-a-days have got used to telling 'white lies' - making announcements to justify public support for their own work, knowing fully well that their claims that their work 'will help toward discovering the cause and cure of cancer' have no scientific validity.

Regardless, excessive promises abound. June Goodfield, 16 a Fellow of the Royal Society of Medicine, and author of the reportorial book The Siege of Cancer , recently asked Robert Good about the eventual outcome. Good's reply was characteristic: 'Just keep the faith, baby. Give us time.' It has been rightly observed that when science leaves, faith begins.

 
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