On Cancer

It is hard to know where to begin when discussing cancer. Polio stole the midcentury limelight, AIDS in the 80s and 90s, but today, cancer is by far the disease most firmly entrenched at the forefront of public consciousness. Presidents have declared war upon cancer — a telltale sign of desperation in the face of an amorphous entity that cannot simply be defeated. The truth lies in a black reality from which living organisms cannot escape. It will touch you in some way, no matter who you are. It’s part of life, a side effect of biological evolution that introduces itself to 1.7 million Americans annually. Few words trigger such a high-voltage activation of the neural semantic network. Cancer. Types of cancer. Famous people who have succumbed to that type of cancer. Family and friends, too. The causes of cancer, its subcellular interworkings and progression. The history of its treatment and the tenuous hopes for its complete eradication in the future. Our assignment included reading Mukherjee’s “The Emperor of All Maladies,” and watching its PBS documentary (produced by Ken Burns). We also saw “Cancer: The Forbidden Cure,” and “Exploring Biodiversity: The Search for New Medicines.” The book is phenomenal and obviously deserving of its Pulitzer.

Fans of biographies and obituaries know that the recounting of a life places peculiar emphasis on the end of it. Many deaths feature cancer as a central player. For the more treatable iterations, there are success stories, of course. Like Lance Armstrong overcoming testicular cancer to win the Tour de France seven times (only to have his titles and his dignity revoked after the doping scandal). But he’s still alive. Sidney Farber himself had a colostomy. As did my grandfather (he’s 95). Angelina Jolie, one of Hollywood’s most iconic actresses, recently underwent a precautionary radical mastectomy. Her case highlights just how far we’ve come since William Halsted pioneered that gruesome and disfiguring surgery. With the advent of imaging, reconstructive plastic surgery, and breast tattooing, a woman can retain her beauty. Count Jane Fonda, Nancy Reagan, and Lance Armstrong’s ex-wife Sheryl Crow among breast cancer survivors. It’s easy to mention celebrities because their struggles are so public. Millions of regular people go through the same thing in private — and perhaps that’s the better way.

For every success story, there are countless others that end on a minor chord. Death is inherently tragic, but it would be debatable to point the finger at cancer in every instance. As people age, cancer rates increase independently and proportionally. It’s likely that a 99-year-old harbors a mutation somewhere, but when they die, the coroner might chalk it up to “natural causes,” and friends and relatives will say that the deceased lived a happy life until the very end. Like Alzheimer’s, for some cancer is primarily an organic function of time. But oftentimes, death from cancer reflects a certain lifestyle or environment. These are the ones you hear about. Chain-smoking actors John Wayne and Humphrey Bogart died from stomach and esophageal cancer, respectively. Steve Jobs, smart as he was, lost his battle with pancreatic cancer, which experts say was compounded by his adherence to a “fruitarian” diet and his refusal of allopathic treatment. Bob Marley chose to honor his Rastafarian beliefs over doctors’ insistence on amputating a melanoma-ridden toe. Cancer is merciless and even vengeful; it doesn’t matter how much money you’ve contributed to fighting it. Just ask Albert Lasker.

Last year I read “This is Not a Novel” by the morbid David Markson. As advertised, it is indeed not a novel in the traditional sense, but rather a collection of sentences that describe how legendary figures met their demise. Some choice selections: “Valéry died of throat cancer.” “James Thurber died of a brain tumor.” “Rachel Carson died of breast cancer.” “William Gaddis died of prostate cancer.” “William Goyen died of leukemia.” Etc. Interestingly, cancer deaths are in the minority — most are from hemorrhages, heart attacks, tuberculosis, and suicide. Another side note: I was happy to see the author talk about Aleksandr Solzhenitsyn’s “Cancer Ward.” I picked it up a few years ago after reading “In the First Circle,” one of my favorite books and the driving force behind my prior obsession with Soviet gulags. At the beginning of Part Two, Mukherjee uses a detailed description of sick children in a 1950s Boston cancer ward that bears an eerie resemblance to Solzhenitsyn’s initial impressions of the various idiosyncratic personalities in his own hospital ward. The setting is different, but the scenes occurred contemporaneously, and the existential dread is the same.

I know a few young people who have encountered cancer. One of my friends was diagnosed with Non-Hodgkin lymphoma in college. He underwent chemotherapy and made a full recovery. Last September, one of my best friends was driving home from Chicago when he swerved and rolled over four lanes on the highway. He totaled his car beyond recognition. Nine out of ten would not survive that crash. He only had a few scratches but was of course taken to the hospital. Brain scans, looking for injuries from the trauma, found an acoustic schwannoma that was likely benign, but surgery was strongly recommended as it would continue to expand. He had it successfully removed in a marathon operation, but the hearing in his left ear is gone. And just three months ago, my colleague, a pregnant PhD psychologist — seriously one of the kindest people I’ve ever met — received the most devastating news imaginable: her bubbly three-year-old daughter had developed neuroblastoma. Doctors are attempting radiation to shrink the tumor before conducting surgery. So far the tumor is still not small enough, and I’m not sure where her daughter’s prognosis stands. It is a nightmare scenario, the full extent of which I could not picture until I watched that little girl in the documentary with T-cell lymphoma receive injections in her spinal cord. 

Cancer may seem like a modern disease, but it has evolved with us since we were but a twinkle in the amoeba’s eye. The Ancient Egyptians were not optimistic. According to a hieroglyphic-filled papyrus on the matter: “There is no cure.” Galen, the Old World’s preeminent pathologist, held that two of the most pervasive afflictions were caused by an imbalance of “Black Bile.” Depression forms the psychological side of the continuum, cancer the physical. I found it interesting that two of the most mysterious diseases were characterized as such. It was not until the Dutch physician Vesalius came along in the 1500s that the Four Humors theory was discredited in favor of a more anatomical understanding. Still, nearly 2000 years after Galen’s time and despite all we know today, quick fixes to the archetypal antagonists of body and mind continue to evade us, at a huge social and economic cost. 

Our main story takes place between 1850 and 1950, during the Golden Age of cancer surgery. It was Rudolph Virchow who established a theory regarding the duality of cells: they are responsible for both health and disease. This realization ushered in a period of daring treatment, epitomized by Dr. Halsted’s radical mastectomy. Black and white photos of his sterile operating room offered intense imagery. In the book we learn about the evolution of other trailblazing techniques at Johns Hopkins; Hugh Hampton Young undertook urological cancer and Harvey Cushing was charged with tackling neurosurgery. At around the same time, the raw concept of chemotherapy came to light, with Wohler’s synthesis of organic urea, Erlich’s “magic bullet” eureka, and Goodman and Gilman’s research into the anti-white blood cell effects of mustard gas. We also learn about Rontgen’s X-rays and the birth of radiation oncology. When first developed, it was thought of as a miracle cure. Early pioneers did not know that radiation itself was carcinogenic, which makes its related deaths even more poetic, from well-known luminaries like Marie Curie and Emil Grubbe to the lowly glow-in-the-dark watch painters. 

If there is a true protagonist in this week’s arc, it must be Sidney Farber. There’s something to be said for those med school gunners who wear full suits to lecture every day. They might draw scorn from their peers, but everyone knows they must be on to something. Farber learned the extreme discipline of a science researcher during his childhood when his father would bring home textbooks and demand his kids master them. It was interesting to see him portrayed as an example of interwar antisemitism; he was forced to go to Germany to begin his medical education. It’s difficult to imagine Farber getting rejected from medical school today. Farber effectively assumed the role of God; his early leukemia trials with the antifolate aminopterin were extremely daring. His perception and intuition must have been divine. If stress could be measured in liquid, what he endured over the course of a single day could probably fill a swimming pool. He eventually teamed up with the determined socialite Mary Lasker, and together they revitalized the landscape of cancer research. The Jimmy Fund utilized the same effective template that the March of Dimes had, raising public awareness and millions of dollars. It opened the floodgates for the government’s prioritization of the National Cancer Institute and modern-day research. Farber and Lasker bolstered the likes of Freireich and Frei, who would devise the combination chemotherapy VAMP, and Gordon Zubrod, the creator of cisplatin. Farber was a gifted physician, a natural-born leader, and a most empathetic advocate for the sick. His legacy endures; the Dana-Farber Cancer Institute, a Harvard behemoth known around the world, is the go-to destination for when fate has other plans.

I watched the documentary Cancer: The Forbidden Cure. It had me shaking my head. Let’s start out with the positive. It got a couple things right. Yes, cancer treatment is indeed a big business. In the present era of genome-based personalized medicine, pharmaceutical companies do stand to make big bucks. Current treatment options — surgery, chemotherapy, and radiotherapy — are all expensive and come with extreme side effects. While obviously biased, the documentary was able to capture how allopathic/“heroic” medicine obliterated naturopathy in the early 1900s, a fascinating saga that I previously read about in Paul Starr’s Pulitzer-winning “The Social Transformation of American Medicine.” It was interesting to see how funding from Rockefeller and Carnegie paved the way for Big Pharma, which has long controlled medical teaching, the FDA, and funding for clinical trials. There is more than a grain of truth to this indictment.

But after this general overview, the filmmakers are on shaky ground, as they boil everything down to money-grubbing conspiracy theories. Not that it matters, because their target audience consists of people who have already been convinced. We are introduced to the story of the “quack doctor” John Hoxsey. Well, yes. He was a quack, a rich one. He had an eighth-grade education and based his alternative cure on an herbal mixture for horses. He offered that sham treatment at 17 locations across the country. I looked up Hoxsey after watching the documentary. Ironically, when he developed prostate cancer, his own prescription failed him. He then had prostrate surgery and lived for another seven years. 

The documentary tries to back itself up through dubious anecdotes. Non-objective sources (sons, biographers, random people with no credentials) are interviewed and attribute success stories to Hoxsey’s snake oil or Gerson’s detox regiment. To provide a counterexample, my uncle’s brother’s wife actually had her cancer treated in Tijuana about a decade ago. She died in Mexico. I knew she resisted traditional treatment in favor of a natural approach, but until watching this documentary never knew Tijuana was the world’s most prominent Hoxsey Method hotspot. And then there’s Gerson’s wife or daughter, who mentions how digested meat produces phosphoric acid, so therefore the body can’t function. Give me a break. That lady has never taken a toxicology course. You have statements that invoke a lot of emotion, such as saying that if alternative treatment were allowed, the cancer mortality rate would decrease by 50%. Or by calling the ban on alternative treatment “an atrocity worse than the Holocaust.” Ultimately, I do think that alternative or holistic approaches to cancer treatment have a small place, if in conjunction with standard treatment. It can be beneficial for the psyche of certain patients. I see one older gentleman in the sauna every once in a while. He tells me the same story every time. He claims that homeopathic medicine and avoiding all sugar cured his cancer. He does not have kind words for allopathic medicine. I tried arguing with him the first time, but who wants to proselytize to an old man fundamentally set in his ways? He’s happy and hale now. I don’t want to ruin his day. This film was interesting. Not for the educational content, but because you can be sure many vulnerable people have trusted the “information” presented and then died five months later. On YouTube, this video has 1300 likes and only 32 dislikes. The incredible power of “fake news.”

I also watched sociobiologist E.O. Wilson’s talk on biodiversity. I stumbled across a lukewarm piece on his latest publication, “The Origins of Creativity,” in the New York Times Book Review a couple months ago. I was tempted to scoop it up, but alas, haven’t gotten around to it. He gave a rather mumbled, general lecture to a large auditorium of students, as emeritus professors have earned the right to do. Topics included the importance of conservation, the wonders of biological life on earth, and the secrets that it holds. Eric Chivian gave a clearer, more energetic lecture on how human health is inexorably dependent on the well-being of other life on earth. He talked about his book, “Sustaining Life.” He used three different examples to depict how other animals can help us solve the problems of our own mortality. He mentioned the precarious predicament of polar bears in the face of climate change and how they represent a potential for treating end-stage renal disease. He talked about Lyme disease and the difference between competent and incompetent hosts. He also mentioned the gastric-brooding frog as a key to solving peptic ulcer disease. Dr. Chivian’s main point ultimately rested on mankind’s selfish interest in keeping endangered animals alive. Not because of their natural beauty or ecological role, but merely because they could help stave off human disease. As someone who enjoys Netflix nature documentaries like “Life” and “Planet Earth,” I propose another reason for propping up our fellow Earth-dwellers: we need more HD slow-motion shots of bizarre creatures in their natural habitat. Who doesn’t love watching polar bears and chameleons hunt? That reason alone is enough for me to put my foot down against de-foresting and pollution.