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The Courage to Get Old

REFLECTIONS: My Companion, Cancer

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the twice-monthly Reflections column for Time Goes By in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation. His other column, Gray Matters, formerly published in Newsday, appears each Saturday.


Category_bug_reflections My wife and I were sitting in the very crowded oncologist’s office when I had this ugly thought. Everyone had come to check up on the treatment of their cancers. And I wondered - if there were a cure for cancer, the dozen doctors in the practice, their nurses, technicians, aides and receptionists would be out of work. Could it be possible that the cancer treating establishment is impeding a cure?

I am not a conspiracy nut, but it would not be the first time during my reporting and writing career that I have encountered money and cynicism in the cancer-fighting business.

Research to find treatments and a cure for breast cancer get twice as much money as prostate cancer, which kills as many men as breast cancer kills women. Lung cancer, the biggest killer, gets less. Why?

I’ve called the battle of the glands. The breast cancer lobby is more powerful and attractive than the prostate cancer lobby. There are too few lung cancer survivors to constitute a lobby and besides most lung cancers are blamed on the victims; they should not have been smoking.

On another occasion, when I was supervising a journalism seminar, one of my students learned that a North Carolina chapter of the American Cancer Society declined to take part in action against the tobacco industry and one of its largest companies because it was a mainstay of the local economy and had contributed to the chapter.

The American Cancer Society, one of the nation’s richest volunteer organizations, has been criticized for placing more emphasis on treatment than prevention and the possibility that the environment and chemicals are responsible for many cancers. But that begs the question, why can’t a cancer, even with a known cause, be eradicated, cured?

Having survived one cancer (esophageal) five years ago, I’m now dealing with another in my stomach as a kind of constant companion. And I find that nothing much seems to have changed. As science writer Curtis Brainard wrote in the April 12 Columbia Journalism Review,

“There’s a trope in medicine that doctors have only three ways of dealing with cancer-cutting (surgery), burning (radiation) and poisoning (chemotherapy).”

It’s true, as I’ve discovered, that surgical techniques have improved, but not everywhere; much depends on the surgeon. Radiation has its limits (I am no longer a candidate because I’ve had my full dose of radiation and doctors don’t want me to light up.) And chemo is, after all, poison that we hope will kill the cancer but not me.

In a sense, then, I feel that I’m being treated with primitive medicine in the 21st Century.

So it’s natural for a trained reporter – with or without cancer - to wonder why, 40 years after the U.S. put a man on the moon and 39 years after President Nixon called for a “war on cancer” and $200 billion spent on the war, a cure continues to elude us.

That expenditure, from government and private resources is a pittance compared to what we spend on bottomless, meaningless wars that kill but do not heal. Indeed, in too many cases and in too many places, cancer is the top killer, responsible for 7.4 million annual deaths world-wide. And 500,000 in the U.S.

To be sure, treatments have been successful in arresting the growth of cancers. Eighty percent of children stricken with leukemia used to die; now 80 percent survive. Similarly, 95 percent of testicular cancers were fatal; now the same percentage survives. Overall, the current five-year survival rate for all cancers is 65 percent compared to 50 percent 40 years ago.

That’s an important advance, but it’s not much of a leap (one percent per year). More important, the treatment may arrest cancer, but it cannot claim a cure. I survived a cancer for five years, but I wasn’t cured. We can claim survival and remission, but never a cure. A woman I know survived leukemia when she was a child, but she still has yearly checkups lest some stray cancer cells cause trouble.

How come there is no cure? Christopher Wanjek, writing last year in LiveScience explained that

“Part of the reason for having no cure is semantics. There will never be a single cancer cure because cancer refers to a family of more than 100 different diseases characterized by abnormal cell growth. These diseases arise from numerous causes, such as radiation, chemicals, or even viruses.”

But despite the knowledge, for example, that smoking causes cancer, we don’t yet know how. And even if we know the cause, we can treat, but not cure.“Most of the success,” said Wanjek, “is not from miracle cures but rather simple screening procedures such as pap smears and colonoscopies.”

But they don’t always work (my cancer was missed the first time) and at best, they find cancers at an early stage, when they can be cut, burned or poisoned but not cured.

According to the experts, there are some promising paths towards solving the mysteries of cancer: stem cell research, genetic research and even vaccines to treat and to prevent. Mark Roth, writing in the Pittsburgh Post-Gazette April 7, reported that commercial vaccines to treat as well as prevent cancers may be in the offing.

He cited the present use of a vaccine, Gardasil, to prevent cervical cancer which can be caused by a virus. Soon, he wrote, the FDA is expected to approve a vaccine, Provenge, to treat prostate cancer that has spread.

And Roth quotes researchers as saying cancer vaccines may be on the verge of wider use. Columbia Journalism Review’s Brainard trashed Roth’s optimism, partly because Roth is not a science writer, but Brainard did little to report on possible advances toward a cure, including vaccines.

The literature I’ve read and the doctors I’ve talked to during my five years of dealing with cancer tells me this: Despite the presence of and substantial funding support for the National Cancer Institute, in Washington’s suburbs, there is no central coordination of effort to find a cure for cancer, or even learn if a cure or cures are possible.

The moon landing, accomplished in eight years, the Manhattan Project, successful in less than ten years, the eradication of malaria in the U.S., cures for tuberculosis and polio, were American accomplishments in the 20th century. I see no such effort focused on the most vicious killer, cancer.

You might say I have a vested interest in this. That would be wrong. Unless someone comes up with a magic bullet tomorrow, I will have to live with my constant companion and take my chemo and hope. But too many people, and some of whom you know, are suffering and dying around us.

I remember what it was like before and after Salk. I’d like my kids to experience that feeling, when the fear of a disease is lifted.


At The Elder Storytelling Place today, Lyn Burnstine: Transcience

Comments

I couldn't agree more, my 42 year old sister has choriocarcinoma, no one seems to be sure why and the treatment is so brutal and primitive you would think that this is the very first time this disease has occurred. I am sending this to all my other sisters; thanks for your thoughts on this subject.

Barbara Ehrenreich's brilliant, hard-hitting essay 'Welcome to Cancerland'
looked at all these same issues also. She wrote that essay in Harper's nine years ago but it is as relevant as ever. I doubt that anything she described has changed except that the cancer industry becomes ever more entrenched with each passing year and the very same companies who make a fortune from chemotherapy are also the ones whose environmentally polluting chemicals are a major cause of cancer. If anyone did come up with a 'magic bullet' cure for cancer, he or she would almost certainly be assassinated fairly soon thereafter. (I recently read a novel with exactly that plot, in fact and in did not strain my credibility one bit!)

Thank you Saul for this most thought provoking subject. I was diagnosed 20 years ago with breast cancer and even now the treatment protocol is not much different. I believe treatments are a bit of a "crap shoot". There is no incentive , $$$ wise to find the cure. The incentive is for the status quo. A personal friend, a doctor, agrees. So did I win at "craps"? Time will tell. No one, in this day and age should have to play the "game".

Saul--Good piece! It is my observation that the diseases that kill children get much more attention than those that kill adults (no value judgment implied.) The older we get the more likely we are to develop cancer; but, we have already lived our useful lives (?!) so there isn't as much value in pouring money into the research (no cynicism meant.) Especially in the case of prostate cancer, isn't it a cancer that men may live with for years and might not the men may be very old by the time they succumb to it?

As I recall, the reason fund raising for breast cancer got off the ground was because women suddenly realized that the disease that had been killing (mostly) women for years was being ignored while the new disease (Aids) that was (then) killing (mostly) men was getting the attention.

In some ways we are very efficient at setting priorities, in other ways we are blind.

Good luck with your particular cells, Saul. Some of us enjoy having you around!

I don't think it's possible to be too cynical about this. A scientist at the college I work at said something along the lines of this: The chemicals in fruits and vegetables that seem to have some cancer-preventive properties aren't explored by the drug companies because you can't patent a naturally-occurring substance.

As long as health care in total is run on a for-profit basis, it will be run, well, on a for-profit basis.

Money governs all actions of big corporations. When it is more profitable to find a cure than it is to treat it, a cure will be found. You made that point very well.

I have had Meniere's Syndrome for nearly 50 years and they do not know any more about treating the disease now than they did when I got it. Basically, there is no treatment. There is no funding for research because there is no money to be made on a rather obscure disease. There are many diseases that fit this description.

Because cancer is a killer it should get top priority. I do hope some scientist dedicates his/her life to finding a cure. With two cancer deaths in my family I understand the urgency.

As my husband takes his second radiation treatment today (chemo and a radiation treatment were yesterday), I read this post with much head nodding.

Though we want to use whatever arsenal the medical community has to offer to beat the odds, I am nontheless very uncomfortable with the prescribed protocol.

When we started down this road, Kman had to sign several documents basically saying that the treatment he would receive could also cause another cancer (radiation), and that the effects of chemo on your body are basically the same as swallowing a cup full of antifreeze on a daily basis.

I have worked in the medical field in the past (12 years as an office nurse/manager), and I know the types of screw ups that happen. Doesn't give me a warm fuzzy, I'll tell you.

I suppose if you look at it another way, life is always a crap shoot, win some - lose some.

At least you were given a turn at the roulette wheel...

After being diagnosed with breast cancer last year I was told I needed surgery, chemo and radiation. After all of that I would then take a drug on a daily basis for 5 years.

My oncologist told me they couldn't tell me if any of the things I did would help me only if I did all of them I would have a 50-50 chance of being cancer free after 5 years based on the statistics.

It is scary to know you are really not cured, that you still have that companion that will be on the path with you forever.

The treatment for a 50-50 chance is so horrendous that it could not be imagined and in reality cannot be described. When you have gone down the path you look at the world different. Maybe one advantage of breast cancer support that makes it so different is that the "Sister Survivors" are always there to help, to listen and to cry with you and to pray for you.

Are you a candidate for cyber knife surgery. My friend Marion B...

http://www.opendiary.com/entrylist.asp?authorcode=D445350

...had an advanced lung cancer, and her doc told her that this surgery was going to be only pallitive. Then again, they had no statistics to tell her otherwise. She just finished her first book, and she is cancer free tho tired.

I too have lost friends through too much radiation, then again there's my mother and her many cancers from 1948 on with no radiation or chemo. She died in 1989 with renal failure. One never knows.

I guess I feel differently about this. (For the record, I am a cancer survivor.)

There's no reason for the people who treat cancer to focus on prevention: They spend the time they have addressing a problem that is already there. They do have an interest in early detection, and it's my experience that they are conscientious about pushing that.

Finding a cure makes for good marketing and PR, but the real payoff is in reducing each cancer to a chronic condition. And advances are being made: In radiation oncology, for example, new technology can detect and map a tumor down the pixel. It's a matter of time before radiation can be directed solely at the tumor, preserving the surrounding tissue from harm and eliminating radiation limits.

The problem will be the old one of access: Suburban hospitals in affluent areas will get this equipment well before cities, middle-class exurbs, rural areas, and small towns.

Hey, Citizen K: good point. Sometimes I forget that there is half a cup of water in a half-empty glass. Cynicism can be so seductive.

I, too, have pondered some of the issues you raise, Saul, as loved ones and dear friends have fought the cancer battle.

One family member and her two sisters had ovarian cancer, but no cancer history in her family. The girls grew up in Okla. in oil fields community where their father worked. Our family consensus attributes their disease to this exposure during their young formative years.

I've speculated dollars for pharmaceutical companies to a degree are an issue since orphan diseases often are considered to be not cost effective to research -- wouldn't be a large enough market for cure, if found.

Am glad aspirin was discovered many years ago as had it been discovered in later years I expect the pharmaceutical companies would be charging big bucks for that treatment.

Citizen K has a point since I know chemo treatments have become more refined from when they first started administering them. I just wish there was more readily available legalized known relief treatment available for the nausea so many experience as did my family member those many years ago.

Yes, efforts are focusing on pinpointed laser treatments with expected increased benefits. We can feel encouraged progress is happening, but just not as fast as we desire. I think we sometimes forget that as much as science knows there is so much more that is not known.

Man plans and God laughs....we can only live and hope and take care of our needs as best we can...Hope your therapys will harbor success for you, Saul. Refuah Shlaymah!!!!

Keep an eye on this:

http://www.l-nutra.com/products/chemolieve

Apparently fasting before and after chemo provokes protective mechanisms in healthy cells but not in many kinds of cancer cells; therefore, fasting makes chemo more targeted and the side effects (nausea, hair loss) much less.

However, fasting is difficult and can be weakening. So this company is attempting to formulate "medical foods" that have much the same effect as fasting (they restrict the key factors the scarcity of which provokes protective mechanisms in healthy cells) but make it easier. This is based on totally respectable scientific work. I have some behind-the-scenes knowledge of it.

Cancer has cut a swath through my extended family that has left those of us who are so far spared feeling shaken, traumatized, and full of foreboding. Scientific American Magazine, a regular read at my house, publishes interesting research regularly, but I concur with your findings: there's no one thing to be cured, but a Hydra from an unknown Hell. Or just normal cell processes that have gone too far. If I was a praying person....

Japan and many other countries use medicinal mushrooms like AHCC, Reishi, Maitake, Chaga, Turkey Tail, etc. They are not used much in America because they can't be patented and sold for big bucks.

There is a lot of snake oil out there but to find things that really work read medical articles online at PubMed. In addition to the above, look up modified citrus pectin, IP6 and oleander extract. I hope this helps someone.

Friedman,

There are 867 different types of cancer: add genetic factors, biochemistry, temperament, toleration of treatment, and the fact that the cells can hide anywhere, and what do you expect? All you can do is make the best decisions one can, and trust. By the way there are 10 million cancer survivors today and NIH has a special department for survivors. What about diet, exercize, and eliminating smoking?
In the meantime, hang in there

Your Old Friend

In the late 90s, after breast cancer was "missed" on the prior 4 mammograms, having insisted on an objective "2nd read" it was discovered and I was the first woman to have metatastic cells from "just DCIS." Calcium tracks had changed, elongated, and the malignant cells moved on into other tissues.

Selecting the best oncologist I could find, and have NCI re-do all the pathology from biopsies, and surgery, I decided that radiation causes cancer, so declined it after each mastectomy, with my oncologist's support. Aggressive chemo is the understatement, but there wasn't much option. And, I'm 'here' today, having also passed up reconstruction in favor of helping my body rest, and rebuild my immune system.

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