With under 100 pages of The Emperor of All Maladies left to read, I am reminded more and more of a line from The Voyage Home–which was the fourth Star Trek movie. In it, Dr. Leonard McCoy is walking through a late 20th century hospital and likens what is going on there to the Middle Ages.
The history of our efforts to find the answer to cancer–in children and adults–has a truly macabre feel to it: The early surgeons trying to cure breast cancer by increasingly radical surgeries–the most intense of which left patients not only permanently disfigured but crippled as well; pathologist Sydney Farber injecting children with cytotoxic chemicals that had killed cancer cells in a test tube–but killed healthy cells just as effectively; the STAMP trials, in which patients were given such massive doses of chemicals that the treatment wiped out the bone marrow–which then had to be replaced; the use–and misuse of radiation.
The politics of it also has the feel of the medieval church and its charges of heresy over honest differences of opinion: the American Cancer Society–in the early days–pushing for federal money to find a cure, but not to do the fundamental genetic and biological research on which a more effective cure might be based; the intense dislike–bordering on hatred–that existed between chemotherapists, surgeons, and radiologists; and the deep disrespect of some of the medical people for mere researchers. Just getting people to agree that surgery, chemotherapy, and radiation therapy could
be used together to bring about some cures required years and several miracles.
And in the middle of it all are the patients who, like medieval parishioners, come before the high priests full of faith, longing, and hope for a brighter future. While the book focuses largely on the medical folks and the researchers, we see the true heroes only in brief vignettes. Sometimes their stories are achingly–albeit too briefly–told through the eyes of the author as he paces his rounds in the clinic. Other times they are the faceless thousands undergoing this trial or that new technique–all of them faithfully believing that enough pain–enough pushing closer and closer to the edge of death–will deliver a true cure–and too often being let down.
But just as the Middle Ages put down the foundation on which the Renaissance and the modern world were built, so too did the battles and sacrifices of the 20th century. While our understanding of the disease and how to fight it are still far from perfect, the strides against some forms of the disease have been impressive.
But there is still a long way to go–and it would be far better–and far less expensive in the long run–if we worked on preventing cancer in the first place. There are plenty of things that we know with certainty are carcinogenic. Limiting and ending exposures to those things–cigarettes and tobacco as well as a wide range of chemicals for a start–would put a serious dent in cancer and the heartbreak it causes.
And early detection of all forms of cancer would also make a considerable difference in people’s lives. Cancers detected as precancerous lesions or in the very early stages are much more easily dealt with than cancers that have metastasized. Early diagnosis is always better than late diagnosis.
And that is especially true of forms like NET where once the disease gets beyond fairly straight-forward surgery, we are looking at a holding action and palliation rather than any long term cure.
