Is There an Answer?

Every speculation was once a guess, a hunch, a dream, a fancy, that the practical mind would dispose of at once. Imagination often flies in the face of logic, and soaring independently a discovery is made. All the work in library and laboratory never created a brilliant hypothesis. The hypothesis is the winged thought of the imaginative mind.
Harold L. Stewart, "The Cancer Investigator"

Several times a year, there is an article in the popular press that states that someone has just made a discovery about the cause of cancer. These announcements vary from modest reasonable claims to statements that imply that we now know the answer, and that the cure is not far behind. The fact is that we know more than we did five or ten years ago, and considerably more than we knew sixty or seventy years ago, but we are a long way from having solved the important basic problems. When we know what life is, then, perhaps, we may be able to understand what cancer is. It is natural that the cell biologist thinks that his discipline has the key that will unlock the door; as does the biochemist, the pathologist, and so on. It is natural, because scientists are also human beings; and being human beings they would like to think that what they are doing is of crucial importance. Unfortunately, none of this is true. No one can predict from which direction the major discoveries will come, and it is reasonable to expect that many discoveries will emanate from many quarters.

I have written Part II from the point of view of a scientist, which is quite different from that of a physician or a patient. The attitude of the scientist is sometimes hard to understand. Imagine a town being inundated by the lava flow from a neighboring volcano, and while everyone else is picking up their belongings and running as fast as they can, the scientist stands there with his notebook and camera recording the entire process. It is just this kind of detachment that makes for good science. Discoveries are made because a scientist looked at something in a way that is different from the way the rest of mankind looks at things.

I am in cancer research because of some personal events in my own life. I found out very early in the game that in order to be a good scientist it is necessary that I either approach subjects that I am not emotionally involved in, or figure out some way of short-circuiting that emotional element so that it doesn't get in the way (which may well be impossible). I find that I can make more headway if I approach the problem of life in general, rather than the problem of cancer as a "disease."
Before I take off my scientist's hat, and put on my "human" hat, I would like to say a few thing about how the cancer problem appears to me, and why I think that the answers that we are all searching for are not going to miraculously appear tomorrow.
It is characteristic of primitive man to accept totally everything that he sees around him as the natural course of events, and to view anything different as a miracle. Thus, childbirth and the growth and development of the child are viewed as a natural process, while virgin birth is considered to be a miracle. Illness is also viewed as a natural process, and the recoveries from severe illness as a miracle. To the student of nature, things are often reversed. The longer that one studies life, the more miraculous the so-called natural processes seem, and the more one wonders why congenital anomalies, cancers, tumors, and disturbances of all kinds do not occur more frequently. To the naturalist, the order of things is astounding. The physicists tell us the natural tendency of things is toward disorder. In view of this, life seems even more miraculous. In order, therefore, to understand cancer it is necessary that we know a good deal about why that order exists and how it is regulated. This is not a simple problem. Nature guards her secrets well.
To the ancients, illness was illness; and you either got well or died. The growth of scientific medicine now makes it possible to say with a reasonably high degree of probability that there are very large numbers of illnesses where your chances of dying are very slim and others where the chances of your dying are great. It is little more than a generation ago that the dread disease pneumonia became curable. The suddenness with which the cure for pneumonia came led many people to believe that all diseases may fall in much the same way; including cancer. It is of course conceivable, but it does not seem to me to be very likely. We do not have instruments that enable us to peer into the future, so the understanding or cure of cancer remains, like prosperity, always just around the corner, where it will probably remain for a long time.
It is possible to find a cure for a disease without understanding the disease itself. We can "cure" headache and fever with aspirin, but we don't know how the drug acts. The cure may come before understanding, but we can't count on it. The understanding will be valuable with or without a "cure" because it will enable us to relieve a good deal of physical and emotional anguish; as understanding always does.
The understanding of cancer will not come by itself. It will take many, many, creative scientists working in a good many fields to even make a little bit of progress toward understanding cancer. It is from these people that the ultimate understanding will come, and it is very important for the public to resist the temptation to say, "We will not support you because you are not working directly on cancer." It is even more difficult for the public to avoid this attitude because the scientist's attitude is hard to swallow. It was expressed in a toast, attributed to the Royal Society in England, that says, "Here's to our research; may it never be of any use to anyone." It is important for the public to understand that this attitude is the scientist's way of retaining his objectivity, and without this device he might easily fall into the emotional traps that often catch the experimental therapist.

What has science contributed so far? I would like to mention a few things which, although they may not seem like much, have nonetheless either contributed toward the lessening of human suffering, or have offered a means for preventing it in the future. The discovery of chemical carcinogens has in a large measure prevented their introduction into our foods (butter yellow, a potent liver carcinogen, was once used to color butter). The clear demonstration that cigarette smoking causes cancer opens the way to preventing an immense amount of human suffering. The discovery (by a wine chemist) that bacteria cause disease led to the development of aseptic surgery, which makes all of the treatments for cancer possible today. The discovery of viruses has an even greater potential for the future. There is a long list of discoveries which we now pretty much take for granted that originated as a result of creative people following their curiosity, with no therapeutic aim in mind. Stop and think of the immense impact of subjects such as genetics, biochemistry, laboratory medicine, to name just a few subjects, that were not even in existence a hundred years ago.
In short, there has been an immense amount of progress made toward our understanding of life in general and cancer in particular since the turn of the century. More is on its way. There are, however, some clear dangers which might considerably impede our future progress. These are discussed in Part IV. The progress will never stop because, somehow, there are people with free minds who manage to remain active despite oppressive social systems.

Optimism with regard to the outcome of current cancer research seems to be inversely proportional to the experience of the person Those people who have had extensive experience in this field know that we have made progress. They expect further progress, but are reasonably certain that there will be no miracles and that every bit of ground will be conquered with difficulty. Novices often think that the cure is just around the corner. I think that I felt much the same way when I was younger. A good analogy can be made with the way that people approach trout fishing. A person who has never fished before, who decides to start, goes to the store and purchases some tackle and some bait. He then goes to some body of water in which he has seen fish frequently caught, and fully expects to go home that evening with a mess of fish. It comes as a surprise to him that he is not nearly as successful as he expected to be. It is no accident that 10% of the fishermen catch 90% of the fish. The experienced angler is aware of the uncertainties, has a good idea of how to go about catching what kind of fish in what area. But he knows that he will periodically get skunked, there will be times when he will have to settle for one or two small ones, and that it may be a very long time before he breaks a record or catches the lunker in his favorite fishing hole. You can be pretty suspicious of the man who tells you to make sure to have the frying pan heated up by the time he gets home. There are, of course, sure ways of catching fish. One of them is to go to a trout "catchery" in which the fish are conditioned to bite at empty hooks, and another way is to buy them at the corner supermarket. There are scientists who approach science in much the same way, and they are always successful. All you have to do is pick a problem that someone else has already solved, go over it in a slightly different way, and publish your results, and if your timing is right you can become famous. I know a number of scientists who have done this, but if I mentioned names I might make enemies of a large segment of the scientific community. I probably will anyway, since some scientists are almost sure to pick up the shoe, try it on, and find that it fits.

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