SLOW PROGRESS ISN’T FAILURE
‘We are so close to a cure for cancer. We lack only the will and the kind of money and comprehensive planning that went into putting a man on the moon.”
If this quote sounds familiar it’s because it could have been uttered during President Barack Obama’s state of the union address on Tuesday. Indeed, he said something similar to it. But no, that quote is actually taken from a fullpage advertisement published in the Washington Post and The New York Times ... in 1969.
“Mr. Nixon you can cure cancer,” the advertisement read in giant text.
Spearheaded by a socialite by the name of Mary Lasker, the campaign suggested that a cure for cancer was imminent. All that lacked was the money and the will to defeat a foe that claimed the lives of more Americans than the war in Vietnam.
Richard Nixon conceded the point. In 1971 he declared a war on cancer, a concerted effort to find the magic elixir that would cure the terror within seven years. Those who are familiar with the “war on x” construction can guess how well this went in the long run.
The U. S. has pumped hundreds of billions of dollars into cancer research in the past four decades and for all the breakthroughs we’ve made — and there have been a few — population- adjusted cancer mortality has barely budged since the 1950s. Much of the decline in mortality we have registered can be traced directly back to anti-smoking efforts.
Yet here we are again; a U. S. president trying to re- frame his legacy with a long-shot promise.
“Last year, Vice- President Biden said that with a new moonshot, America can cure cancer,” Obama said. “Tonight, I’m announcing a new national effort to get it done.”
As if a lack of can- do had been the problem up until this point.
Put aside, for a moment, the fact that a country that has since lost the ability to send men into space is still clinging to this 46- year- old accomplishment as if it were the sad apogee of its civilizational achievement.
Sending a man to the moon — even with nothing more than tin cans, rocket fuel and slide rules — is comparatively easy. We understand physics. We learned the math.
Cancer, on the other hand, is something else entirely, inextric- ably tied to our very genetic code and still poorly understood. What insights we have gleaned since 1971 increasingly raise doubts about the idea of ever coming up with a single silver- bullet “cure” for cancer. Treatments improve, but a cure remains as distant as ever.
One of the best books attempting to explain what cancer is and why the way we think and talk about it is misguided is The Emperor of All Maladies by Dr. Siddhartha Mukherjee. Cancer isn’t one disease, it explains. Cancer is hundreds of diseases that share a common mechanism — unchecked cell division. A tumour in the breast is not the same as a tumour in the bowel, or leukemia or Hodgkin’s lymphoma. Not all cancers are even fatal, necessarily.
Cancer has no single cause, but thousands of them; toxins, age, viruses, lifestyle, genetics and epigenetics. Some of these are obvious and can be easily prevented — smoking, for example, or the human papillomavirus, the cause of most cervical cancers. There are probably many other causes as well. We don’t yet know.
Because each of these diseases is so different, each has its own pathology and treatment regime; a drug that shrinks certain kinds of breast tumour may have no bearing on a tumour in the liver; one that shuts down blood flow to a bowel tumour is useless in all but the most narrow of cases.
In the foreseeable future, the real gains in cancer mortality are probably not to be found in cures at all — but rather in prevention. Cancers caused or encouraged by viruses, for example, present the possibility of a vaccine. As our understanding of nutrition and genetics advances, so too will our ability to detect and avoid malignancies.
Declaring wars and making promises may do wonders for morale and even research funding; but they also give the public hopes that can be dashed, and the sense of having lost a battle that could have been won. This kind of political rhetoric invites us to mistake gradual progress for failure. It’s a tactic that has earned us comparatively few gains in cancer mortality rates compared to heart diseases and conditions not directly related to old age. In short, this approach hasn’t worked very well.
We may one day cure cancer. But for now, let’s take our victories where we can find them.
THE PROBLEM WITH DECLARING WAR ON CANCER IS THAT THERE WILL NEVER BE A DECISIVE, OBVIOUS VICTORY.