When someone asks me what I do for a living, and I reply that I am doing cancer research, the next question is invariably, "Are they going to find a cure?" My usual reply is to rephrase the question and say, "If you mean will cancer go the way of smallpox or pneumonia in the foreseeable future; the answer is that it probably will not."
I have never been satisfied with that oversimplified answer, but it is hard, if not impossible, to explain the problems involved in studying the cause and treatment of cancer while standing with a cocktail glass in your hand.
The image that most people have of the cancer scientist is that he is a physician who is frantically battling to find "the answer" to "the disease" that is killing his patient. We often picture the scientists as working at a frantic pace, surrounded by a continual life-and-death drama; in short he is the image of Paul Muni as Dr. Louis Pasteur, Dr. Martin Arrowsmith, Dr. James Kildare, and Dr. Ben Casey all rolled into one. We read articles in the newspapers which lead us to imagine someone in a white coat, with a test tube in his hand, holding it up to the window and saying, "Here, gentlemen, is the cancer virus!"
In fact, it is not this way at all. The things that scientists get excited about are not in the same league as the prevention of smallpox by vaccination with material from a cow, nor the transplantation of a heart. The exciting developments in cancer research are things such as someone learning to grow cells in bottles; or viruses in these bottles of cells; or finding out the chemical composition of the gene; or finding out how genetic material can make more of itself. Even these breakthroughs are rare, and many of us get excited about things of a much smaller magnitude. It is no small victory for a scientist to find out that something that we have believed to be true for a long time is not really true at all. This kind of science is not like building a bridge or a building. It comes closer to the remodeling of an old house; it is necessary to tear out the old before you can install the new. Sometimes whole new ways of thinking have to be promulgated in order to make a little bit of progress.
The discovery of antibiotics, which in one fell swoop cured a wide variety of diseases, has led people to believe that cancer may fall the same way. I suppose that it is possible, but it does not appear to me to be very likely; and one of the purposes of this book is to explain why. I don't want to hold back the march of progress, but only to point out that much more understanding will be needed in the absence of a "magic bullet." Ultimately, the acquisition of understanding has real value even if someone should accidentally stumble on "a cure." While we're waiting for miracles to happen, it is important that we find out what the best surgical treatment for breast cancer is, and what factors in the cell make one tumor spread and another not. These are only a few of the many problems which remain to be solved.
This book is really three books in one; One book (Parts I and II) is a discussion of cancer research; the second (Part III) is a discussion of human cancer diagnoses and treatment; and the third book (Part IV) is a critique of the way that government supports cancer research. While each part might conceivably be expanded into separate books, they are all interdependent. For example: it is necessary to understand what both cancer research and therapy are all about in order to evaluate the efficacy of government programs to "conquer cancer."
Three separate books call for three different approaches:
The first book (Parts I and II) on cancer research is written from a research biologist's point of view. Research scientists are generally interested in exploring the frontiers of human knowledge. Once a problem is solved, it ceases to be of any particular interest. Scientists are therefore more concerned with new questions rather than old answers (even if the answer is only a day old). Were I a reporter or a scholar instead of a scientist, the emphasis would be on the answers that have already been found; but I'm not, so my bias is in favor of spending more time on the unanswered question.
The second book (Part III) on human cancer, is an attempt to explore the problems faced by someone who has cancer, or who has a loved one with the disease. It is fraught with recurrent feelings of my own inadequacies when faced with many of these unsolvable problems. I hope that it will be useful in helping people to cope with them. Those of us who have walked these paths before can, hopefully, contribute something to people faced with the same problems now. Since so much is unknown, and much of what we think we know will later be shown to be wrong, I have tried not to be too specific with "answers"; but have preferred to indicate directions and approaches that people can take. Each person must find his own solution to his own problems, and this section of the book might help him to do this. Furthermore, the specific answers that are eventually decided upon must be worked out in the total environment in which an individual finds himself; which includes his physician, his family, and so forth.
The third book (Part IV) on cancer politics is an attempt to change trends in the support of cancer research, which I consider to be detrimental to the basic aims of cancer research. I see the future support of cancer research as tending to favor large grandiose projects at the expense of the creative independent investigator. I do not think that crash programs to "cure cancer" are going to be effective; and in the process of supporting these large projects much of what is good in independent cancer research is being trampled underfoot. The aim of this section on cancer politics is reform.
Part I relates to all of the other parts; it attempts to explain some simple concepts which will give the reader a "place to hang his hat." These unifying concepts might lead people away from the dogmatic, one solution approach to cancer, and toward something that corresponds more closely with reality.
I have been told that cancer and humor do not mix. Cancer is a grim and serious business, and the addition of even small amounts of humor is likely to be offensive, War is also serious business, and it has produced cartoonists such as Bill Mauldin and authors such as Joseph Heller who have portrayed not only the grim, but the humorous side of war. It is because cancer is so grim that some humor should, indeed must, be included.
Besides, a bit of humor helps to remind both scientists and physicians that they are, after all, fallible human beings --not gods.
Ira Pilgrim Salt Lake City, Utah