Friday, May 06, 2011

Cancer: medicine, science and the flow of history

Don't read The Emperor of All Maladies: A Biography of Cancer the way I did, by ear. Dr. Siddhartha Mukherjee's Pulitzer Prize winning history is an impressive history, but the writing doesn't hold up well as an audiobook. It's a mess of overwrought and cliched metaphors, of big words where something simpler would do. For example, like too many authors recently, Mukherjee seems enthralled with "eponymous" -- an obscure adjective that adds little meaning but lots of phony erudition to the writing. Perhaps all this would be less disturbing in print.

But these quibbles aside there's a lot here. I come away from it, feeling I have some kind of outline of the evolution of medical and scientific understanding of cancer. And, like the author, I am drawn to events and people whose life paths I crossed who are part of this history.
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I grew up in Buffalo, New York in the 1950s, when the Roswell Park Cancer Institute was a community ornament, the proof that Buffalo was a happening place. (False advertising that.) I remember vividly that the annoying younger sister of one of my playmates suddenly started wasting away. I think by the end, this once lively little girl weighed about 30 pounds. She was treated at Roswell Park and Children's Hospital. She died. Dr. Mukherjee's book makes me think she had a leukemia and probably was part of the trials of that era. Children with many common cancers don't die anymore.
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As a political activist, I was impressed by the story of how political socialite Mary Lasker and Dr. Sidney Farber applied the techniques of advertising and social mobilization to create a groundswell of demand for funds for cancer research. This effort climaxed with President Richard Nixon declaring a "war on cancer" in 1971; like many of our wars on ill-understood enemies, this one has limped along, making perhaps fitful progress, but still festering inconclusively.
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About the same time, a very private friend of mine suddenly disappeared from view. She was having some sort of trouble. I knew not to ask. Only years later did I learn that she'd been diagnosed with Hodgkins Disease -- and was one of the first cohort who benefitted from new treatments, attaining remission. A few years earlier, she would have died. None of this was shared with her circle. People didn't talk about cancer in those days. I never understood the shame attached to any disease, an attitude that served me well in later years living on the fringes of the AIDS epidemic in San Francisco.
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One of the fragments from Mukherjee's history that sticks with me is science wise man Vannevar Bush's insisting in the post WWII era that progress is built out of the accumulated data banked by apparently purposeless basic research. There's a theory about how science develops underlying that assertion, a theory of incremental progress that seems confirmed by the way Mukherjee constructs his historical narrative. Yet at the same time, Mukherjee recounts science's discontinuous leaps, the occasions when observations over a century old that have fallen out of fashion or out of seeming salience prove out when someone happens to look at a problem differently. I experienced Thomas Kuhn's The Structure of Scientific Revolutions as one of my most important intellectual influences; Mukherjee seems to have melded Kuhn's insight into the discontinuity of understanding with his clinical experience of cancer medicine and his respectful historical research in a convincing whole.
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Mukherjee concludes with evidence and hope that cancer is on the way to being understood and consequently more treatable. Genetic discoveries can pinpoint what's gone wrong in cancer-afflicted individual's genes. Increasingly this understanding enables creation of medicines that interrupt the disease's uncontrolled growth. But genetic understanding may also show a more efficient routes to prevention strategies. Instead of of having to observe large populations over long periods of time in epidemiological studies looking for exposure to possible carcinogens, scientists will be able to find out what agents cause mutations to particular human genes in a Petri dish. It's a stunning prospect.
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Understanding can't come too soon. Meanwhile, The Emperor of All Maladies comes out in paperback in September.

This stream of consciousness discussion of a book is what happens when I know I can't wait to write for the months it will take to snag a print copy from the library.

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