The American War on Cancer

Sthabir Dasgupta

It is largely, if not precisely an American psyche in today's world to wage a war in order to reach a solution to every bit of problem. The very spirit of these wars is 'search and destroy', be it a Vietnam War or an Afghanistan War or even Cancer War. Hitler had applied the same strategy against the Jews, the Communists and Cancer, all connoting the same meaning to him. The results were not particularly brilliant. Nevertheless, the warmongers have refused to learn that the terms of these wars are never dictated by their lofty ideas and expectations. In 'cancer war' to be precise, it is the cancer cell,—the very biology of a given cancer that decides the course of the disease as well as the response to therapy, always and without exception. Still, with a view to win this 'holy war' the very bodies of millions of patients have been transformed into 'killing fields'. After more than 40 years it is now being realised that the results are less than glorious, indeed.

The so-called victory against Polio in the US in the 1950's was so exciting that the American Cancer Society (ACS) and the scientists at the National Cancer Institute (NCI) of the US thought that cancer also can be won by the same kind of war. So, they claimed that the 'conquest of cancer' was only a matter of a few years, if only right kind of money was made available to them. It was during the late 1960's and early 1970's. In response to their hyperbole President Nixon's speech was also replete with military references to 'all-out assault' against cancer. He had also obliged his favourite scientists with dollars in terms of millions every year. At the same time, the conglomerate of business agencies also joined in the lexicon, forming a real 'medical-industrial complex', or in other words a cancer establishment.

For such a 'complex' to develop and flourish it was only natural that the ethical questions would be the first victims. Ethical questions are not entertained in love and war, it is said. Even Oppenheimer had lamented that no ethical discussion of any weight or nobility was addressed to the question of using atomic weapons. Modern economic development is also described by Ivan Illich as essentially a war activity. That makes it clear why and how the 'anticancer' weapons found their free entry into the market. It is not true that nobody had protested, but their voices were and still are drowned in the din of the Establishment. 'Cancer war' eventually, has been possibly the most protracted in human history as well as the most costly, in terms of public money, human lives and scientists' careers, yielding so little that patients can enjoy.

Meanwhile, in the public eye the medical profession has earned enough disgrace rather than honour. Some argue that it is not modern science per se, but its political and unethical misuse invites disgrace. Such argument seems to be untenable since it fails to appreciate that the very nature of modern science is incorporated into the dominant economic system. Fragmentation as its essential property creates a smokescreen to blur the perception of truth. It is to be noted that modern 'scientific method' of discovery originated from 'Baconian ideas' (Francis Bacon). Such ideas and culture taught people to separate knowledge from ethics, and this in turn has given violence a safe passage in medicine. Thus while nature is interested in equilibrium and democracy, the medical men have become interested in war instead.

Use of War Jargons
This warrior mentality has corrupted the medical maruscripts in cancer practice today. These are now spiced up with war jargons and uncritical military metaphors, such as 'killer cells', 'renegade cells', or 'chemo shots' etc. In conventional war the killings of civilians and destroying their valuable properties are regarded as trivial matters, and are regarded as 'collateral damage'. The same term is used in modern cancer practice when patients suffer from undesirable and unacceptably serious adverse effects of treatment.

It is true that the people often express their liking and disliking in terms of symbols and metaphors. Medical profession also uses them because medicine after all, is largely about interpretation. However, it is also true that such metaphors and symbols reflect the outlook and idea of a given society and its people. Since war outlook snugly fits with modern American psyche, the metaphors like 'war on global warming' or 'war against poverty' are so popular to them. This very psyche claims that whatever is desirable can and must be won by war. Thus, militaristic languages like 'smoking out the rebels', 'target specific therapy' etc have also popped up in almost every sphere of daily life. Thus, when 'dose escalation' is required in cancer therapy it really means 'troops escalation' as in war. When certain case seems to be difficult, it means a 'difficult terrain' indeed.

War needs hatred towards enemy. War needs building up a sense of terror and anxiety in the public psyche. So cancer cells have been described as 'savage cells'. War needs fast actions, so the word cancer itself makes an emergency situation today. War needs simple answers, not the complicated ones. Thus in cancer war, in a given situation doctors have simple things to do, for instance, surgery, radiotherapy and chemotherapy. While assessing the treatment results, one requires simple words, clear and loud. If they are shallow, so be those. For example, the terms like 'response', 'remission', 'control' etc, although are devoid of much significance, and are dubious also, have become popular in the medical parlance. The results of this war are summarised every few years with the brevity of a military communique—'we are gaining ground' or 'we are winning war'. Winning or losing was connoted by the number of deaths from cancer, or in other words body counts.

The cancer establishment has steadfastly propagated the idea that the war must destroy every last cancer cell, as if these cells are like foreign invaders. So, while in other fatal diseases people are taken just as sick persons, in cancer they are lectured to become courageous soldiers, meant to fight valiant battle, to lose, to destroy enemies, to resort to more aggressive weapons, and even to celebrate victories now and then. The patients are thus described either as fallen heroes or as 'cancer survivors'. Little did the cancer activists realise that the use these war metaphors are misleading, and they limit the perception of the problem.

It is a chemical warfare
Of the various weapons used in 'cancer war', chemotherapy remained the most dramatic. Historically there is a close relationship between cancer medicine and the military. In truth chemotherapy came into the picture when scientists discovered the ability of Mustard Gas, used in World War I to destroy white blood cells. The chemical approach to cancer treatment evolved rapidly after World War II, attaining a dramatic proportion since the early seventies. That also denotes the intellectual fall of cancer medicine. The cancer experts started to become jubilant over the shrinkage of a tumour after chemotherapy, blissfully forgetting the elementary fact that a tumour consists of normal as well as cancer cells, and our weapons kill both of them, thereby reducing the size. Nevertheless, the experts put forward the 'cell-kill' paradigm, a model and a hypothesis that has later been proved to be wrong.

A bare fact was also ignored that this kind of chemical warfare may also cause leukaemia and other types of cancers in due course of time. In fact such risk of developing 'second cancer' had approached 30 per cent at 30 years. It is not surprising therefore to see reports in the western media that 75% of the cancer specialists said if they had cancer they would refuse chemotherapy because of its 'ineffectiveness and its unacceptable toxicity'. It is an open secret today that except in a handful of cancer types, chemotherapy does not offer any meaningful benefit. Still, chemotherapy was promoted as one of the most useful treatment modalities by the cancer establishment. As a result the cancer experts began to believe in 'Borgia's Law' that two poisons are better than one. So, the cliches also continued.

However, poisoning the patient’s body as a concept was never popular. The 'cancer establishment' was also finding it more and more difficult to suppress the frustration of the oncologists as well as their patients. So, it was promised that the blunderbuss of chemotherapy would be substituted with the 'target therapy',—sharp-shooting of a chemical that interrupts a single, evil molecule. However, the loss of life and property of millions of people treated with unnecessary chemotherapy for so long was never regretted. This is perhaps because those who practice at the behest of the 'medical-industrial complex' are seen as liberators. These liberators are now celebrating the arrival of 'magic bullets' with much fanfare. A simple fact has been conveniently forgotten,—target proteins are not produced by the cancer cells only; they are there in the normal cells also. And also, every cancer is unique by its nature. So, there is no magic in the bullets the cancer establishment is so proud of.

The flaws
The unprecedented rise in the innovation of killing machineries during and after the World War II is a fact of life. It will also be good to remember the warning of the US President Eisenhower in1961 about the imminent danger of a 'military-industrial complex'. However, even such a political prophet possibly could not envisage that a 'medical-industrial complex' was not far behind.

However, contrary to the propaganda of this 'complex', the military attitude against a disease like cancer is fundamentally flawed. It is flawed against Drugs, Terror or Religion also, for these are habits, concepts and beliefs, not outside enemies. Cancer similarly, as a constellation of diseases stems from a complex genetic systen of human cells. Thus, body counts in 'cancer war' bear no significance. While the death rates might fall sometimes in some countries, the global Number of deaths will continue to rise as long as life expectancy continues to increase. This is why it was said long back that waging a war against cancer was like trying to land a man on the moon without knowing Newton's laws of gravity.

This is why the dominant cancer research has fallen into a trap of a linear equation, such as the 'Gene mutation' theory in order to sort out such a complex biological system. This is to be noted that no cancer-specific mutations could be identified so far. Certain genetic peculiarities have of course been identified in cancer cells. Although they are believed to give rise to cancer, recent studies have indicated that those peculiarities are not the exclusive preserves of the cancer cells. All the more, valid questions have been raised whether 'mutation' is the cause of cancer or its effect.

There are other important issues as well. For instance, how is it that 60% of Asian women who have had Lung cancer were 'never smokers'? What mechanisms proceed so unevenly? How does the process of spontaneous evolution operate in life and in cancer? It is clear today that these and many other elementary questions can never be answered by the narrow angled, 'Gene centric' views.

Even if it is accepted as the 'cause' it has failed to explain the temporal gap in terms of years or even decades, between 'mutation' and the development of cancer. What mechanisms proceed so leisurely? It is clear today that there might be a prime mover of the complex phenomenon of cancer, but these are not the genes. Instead, some scientists have postulated that the intrinsic phenomenon of cancer is certainly a result of impairment of 'quantum coherence' in biology that is guided and governed by some type of 'organising field". Living system is indeed a self-organising phenomeron and the language of life is basically chemistry. In the words of Lynn Margulis, 'chemicals do not combine randomly, but in ordered, patterned ways'. Therefore, the popular terms in cancer medicine like 'sudden triggering of events', 'random mutation', 'favourable circumstances' are devoid of much significance.

A diagnosed cancer is only the tip of an iceberg, for the human body is flooded with cancerous cells prior to the appearance of a tumour. It follows therefore, by plain logic that the rationale of modern cancer therapy based on the concept of extermination of the 'evil' is unsound. Cancer cells are but the normal cells of human body, which just behave cancerously. Cancer is otherwise inevitable component of the 'senescent' process and all at some point of time in their lives co-exist with 'latent cancer'. The more rational approach would certainly therefore be to find ways how to neutralise and contain those cancerous cells instead of killing them. Still, after the pathetic fall of'gene hunting', 'virus hunting' has now taken the stage, for some of them have been castigated as the 'cause' of certain types of cancer. Here also, the cancer establishment has evaded one of the most fundamental questions: Why are cancers not contagious if they are caused by viruses?

Indeed, it seems to be a paradox. The central dogma that the gene as the absolute monarch will solve the paradox has collapsed under the weight of fact. The conventional approach to cancer research tends to miss and ignore similar, numerous paradoxical aspects from time to time. One can recall Niels Bohr who said, 'How wonderful that we have met with a paradox. Now we have some hope of making progress'. The same wisdom should apply to cancer research.

Why do they insist on war, still?
A 'medical-industrial complex' has only followed the footsteps of 'military-industrial complex'. Just as the latter has to search and find out the 'evil' nations or people, the former has to search and destroy the 'evils' in biology. Just as the latter has its compulsions to justify wars and encourage 'kick backs', the former has to find ways to manufacture demands and corrupt the medical men. While the latter solemnly pledges that it will create a 'just' world, the former boasts that it has unravelled the mystery of creation, and so it can create life. It claims that it can create Dollies and 'magic bullets' in the animal world and engineered seeds and soybeans in the agricultural world. Thus, a common man today has no other option but to stare with utter dismay that these are malpractices, with potentially dangerous consequences which can lead to fatal diseases.

It is the compulsion of the corporate community to treat the human body like a machine. It is lucrative for them to rely on the enormously influential idea (thanks to the double helix famed James Watson) that there are good genes and bad genes. So, it is preached that a perfect human being must get rid of bad genes. In this way only, they can build up a good society. This is plain 'eugenics'.

The American war on cancer has been described by some as 'fraud'. Some have found it 'misplaced'. In the name of this war a new eugenics is afoot.

'What is to be Done?'
It seems to be a relief after a span of about 40 years that the NCI has acknowledged only recently in 2011, that the war metaphor against cancer was indeed wrong. However, during this period the 'medical-industrial complex' has become so powerful and greedy that they can easily ignore even such parental bodies of cancer research.

Yet overall, science is a human endeavour to search for truth, knowledge, and enlightenment, for the betterment of all beings. Keeping this in mind, it seems now that a kind of medical renaissance is urgently needed. It is another question whether such a renaissance would be brought forward by the medical profession, for it is difficult now to get rid of 'collective tunnel vision'. Life is not a machine and health cannot be treated as a commodity. Health is a right. It cannot fall prey to the greed and lust of the medical-military-industrial complex. 

Notes:
Ivan Illich. Medical Nemesis, The Expropriation of Health. Pantheon Books. 1976.
Francis Bacon, the first philosopher of modern science: A non-western view. Jatinder K. Bajaj. In Ashis Nandy (ed.), Science, Hegemcny and Violence: A Requiem for Modernity. Oxford University Press. 24-67 (1988)
Guy Faguet. The War on Cancer: An Anatomy of Failure, A Blueprint for the Future. Springer, 2005. '
Kothari Manu & Mehta Lopa: The Other Face of Cancer, Ed III, Bhalani Publishing, 2009.
Bhatia S and Others. Breast Cancer and Other Second Neoplasms after Childhood Hodgkin's Disease. New Eng J Med, March 21, Vol 334, No 12, 1996.
Michel P. Coleman. War on cancer and the influence of the medical-industrial complex. Journal of cancer policy. 1, 2013, e31-e34.
Frank SA, Nowak MA. Cell biology: Developmental predisposition to cancer, Nature 2003, 422:494. Pubmed Abstract.
Margulis, L. The Symbiotic Planet. London, UK. Weidenfield and Nicholson. 1998.
Ho, M. W. Genetic Engineering: Dream or Nightmare? Turning the Tide on the Brave_New World of Bad Science and Big Business,Gateway, Gill and Macmillan, Dublin, Continuum Books, New York. 1999.

Frontier
Vol. 47, No.11-14, Sep 21 - Oct 18 2014