The War On Cancer: Enemy Of The State
Hopes were high when Richard Nixon declared war on cancer in 1971. If scientists could build a nuclear bomb, send a man to the moon and cure polio, they could surely defeat cancer.
But over 40 years later millions still die from the diseases that fall under this broad banner. Can it therefore be said that the war on cancer has failed?
No, says Paul Marks in "On The Cancer Frontier". But the goal should be containment, not victory, because the enemy is uniquely intractable. Cancer sabotages cells, then uses their resources to destroy the body. Treatments often kill good cells along with the bad. Even when forced to retreat, cancers return in more potent forms. "Medical science has never faced a more inscrutable, more mutable, or more ruthless adversary," says Dr Marks.
He would know. As the former head of Memorial Sloan-Kettering, a leading cancer centre in New York, Dr Marks has taken part in many of the developments that have enhanced the understanding of the disease. Like an intellectual Forrest Gump, he has worked with Nobel prizewinners, counselled first ladies and been sought out by a shah.
But it is the story behind the science that makes this book a compelling read, even for non-boffins, who can rely on good metaphors to decipher the jargon. (A virus that contains only RNA, and no DNA, is like "a functioning automobile with a transmission but no engine".)
Human cells mystified scientists until the 1950s, when James Watson and Francis Crick discovered the structure of DNA. As researchers began to unravel how cells worked they also began to understand how cancer attacked and reprogrammed them. But the medical community, long focused on visible symptoms, was slow to embrace the idea of looking at cancer from the inside out. And when the government began pouring money into the anti-cancer effort in the 1970s, the debate over how to confront the scourge intensified.
Although the science behind cancer was still in its infancy, some argued that the funds should go to finding cures quickly based on existing, but incomplete, leads--the "moon shot" approach. Penicillin, after all, had been discovered without anyone knowing its exact molecular workings. Sceptical scientists wanted to continue studying cancer's biology--they still hardly knew how the enemy worked. But Nixon's war led to high expectations. "The politics had got way ahead of the science," says Dr Marks. The result was a muddled policy and a disappointed public.
Nevertheless Dr Marks claims America is winning this particular war. The death rate from cancer has fallen, though total deaths are up because of a growing and ageing population. If Dr Marks is right, then some of the credit must go to efforts aimed at prevention--the fact that Americans smoke less than they used to has little to do with advances in cellular biology. But he gives this short shrift. And though he encourages screening in order to catch more cancers early, he makes little of the controversy surrounding the needless treatments that can result.
These quibbles hardly detract from Dr Marks's fascinating journey through the world of cancer research. Scientists have made great strides in working out how cancer cells conduct their guerrilla war on the body. As a result, they have been able to develop precision weapons to replace the carpet-bombing treatments of old. Cancer is now a less lethal enemy. Still, Dr Marks doubts it can be eliminated. Many will have trouble seeing that as success.
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