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.
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