The advent of genetic medicine has so far made little difference in the battle against cancer. In fact, despite advances in treating leukaemia and breast cancer, little overall progress has been made since the early 1970s. A new strategy is needed.by Michael Baum / February 20, 2002 / Leave a comment
Published in February 2002 issue of Prospect Magazine
As susan sontag famously pointed out, the rhetoric of cancer treatment and cancer research is couched in the terms of military conflict. Politicians claim that we are winning the war against cancer and the doctors with the highest profile are described in terms normally reserved for military leaders. At the sharp end, the patient never simply dies of the disease but loses the fight. This metaphor fixes in the public mind the idea that cancer is a foreign invader and therefore the war must destroy every last malignant cancer cell.
This is a false analogy. The cancer cells are simply an undisciplined sub-stratum of our cells. Cancer is an inevitable component of the aging process and all of us at some time in our lives co-exist with latent cancer scattered around the body. Medical oncologists often complain that the differences between the normal cell and the cancer cell are so small that they can rarely be exploited to the patients’ benefit. This is why the most aggressive modern treatments can end up killing the person, before killing the cancer. No, we are not winning the war against cancer and the annual aggregate mortality from the disease has barely changed since President Nixon declared war on it with his cancer act in 1971.
Just as Kennedy had promised to land a man on the moon in the 1960s, so Nixon would find a cure for cancer by 1980. I was working in Pittsburgh with Bernard Fisher at the time of the Nixon promise and shared his scepticism about it. When Kennedy told Americans that they would land a man on the moon, we knew with a very high degree of accuracy where the target lay. All that remained was to create the technology based on the rocketry developed in the second world war. By comparison, for cancer, we did not know in 1971 where the target was and the therapies then available were equivalent to firing off rockets in random directions.
With last year’s decoding of the human genome it is now naively believed by some people that we know where the targets are and now we need only develop the technology of the smart bomb. But do we really know what we should be targeting?