War Against Cancer
Won't Be Won Soon
By Theodore Dalrymple
Copyright 2000 The Wall Street Journal
June 12, 2000
Al Gore's recent offer to rid
America of the scourge of certain cancers reminded me of the opening
sentence of Evelyn Waugh's 1953 dystopian fable, "Love Among the Ruins":
"Despite their promises at the last Election, the politicians had not yet
changed the climate."
There have been wars on cancer before, of course, most notably those of
the Nazis and of President Nixon. The former attempted to implement the
measures against smoking that Mr. Gore now proposes, but came up against
the kind of vested interest that Mr. Gore mysteriously omitted from his
speech: a government, for example, that derived large revenues from sales
of tobacco.
Mr. Gore's June 1 speech nonetheless soared rhetorically into a golden
future, via a brief excursion into the realms of Mary Baker Eddy. He told
the inspiring story of Camari Ferguson, a woman who most unfortunately had
breast cancer before age 33, who was treated for it, and who then climbed
to the top of Mount Rainier to celebrate three years of recovery.
"Camari's story is what any cancer survivor will tell you," said Mary
Baker Gore. "The power to fight cancer comes from the heart, and from the
human spirit. But most of all, it comes from being able to imagine a day
when you are cancer-free."
This carries the implication that those who succumb to cancer -- some
500,000 a year in the U.S. alone -- might be deficient in the requisite
human spirit. It also makes you wonder why so much more research is
necessary when the power to overcome cancer comes from merely imagining
yourself cancer-free. But of course, Mr. Gore didn't really believe what he
was saying, and didn't really expect us to listen.
He went on to ask us to imagine waking up one morning and reading in the
newspaper that not a single American had died of colon or prostate cancer.
This indeed would be surprising, since it wouldn't be news even if it were
true. How often do we read that not a single American died of smallpox or
bubonic plague? Technical progress is taken for granted, and unless human
nature changes greatly in the future, a single death from dog bite will be
more newsworthy than the failure of 250 million people to die from
cancer.
I am not against technical progress, of course, but Mr. Gore seems to
have an exaggerated view of its possibilities. He looks forward to the day
when simple blood tests will tell us whether we have cancer. If we do,
treatment will cure us before the cancer gets hold. If not, we can rest
assured for another year -- or six months, or three months, or a week or
two, until the next blood test.
Screening of the kind Mr. Gore has in mind has its disadvantages as well
as advantages -- a fact he didn't mention. Chief among these is the
false-positive test. In Bristol, England, from 1988 to 1993, 225,974
cervical smears were performed on women. Abnormalities were found in 15,551
women, of whom nearly 6,000 underwent a colposcopic examination. But this
immense labor, which in itself constituted an entire industry and
undoubtedly caused great anxiety to thousands of women, had no detectable
effect on the death rate from cervical cancer in the city.
The problem is that once screening has been instituted, it is impossible
to stop. The slightest possibility of detecting an early cancer weighs much
more heavily on the mind of the public than the strongest probability of
undergoing an unnecessary medical procedure.
Mr. Gore spoke as if defeating cancer were the same kind of proposition
as going to the moon. If President Kennedy could order a landing within 10
years, why cannot Mr. Gore bid the sickness cease in the same period?
It is worth remembering that very few, if any, diseases in history have
been eliminated as large-scale threats to human life by curative means
alone. Prevention, either by public-health measures or by immunization, has
been much more effective than cure. And cancer is inherently a more
difficult problem to solve than, say, polio, to whose elimination that Mr.
Gore optimistically referred in his speech.
That the chances of a person suffering from cancer increase decade by
decade suggests that carcinogenesis is largely a consequence of aging.
Four-fifths of men over 80 have evidence of cancer in their prostates. Only
a few cancers have been successfully linked to an environmental cause, and
few display much of a hereditary predisposition either. In other words, we
don't have much of a clue.
Mr. Gore pins his faith in genetic engineering. Perhaps the wonders of
science will be able to reverse the very process of aging that is
responsible for the great majority of cancers.
But this is a dream we have had before, and not so long ago. The science
of hormones then seemed to the likes of Mr. Gore the key to eternal youth,
and those who could afford it (even within my lifetime) had monkey glands
implanted in themselves in Swiss clinics. Aldous Huxley wrote a novel about
it. I need hardly add that the hope proved illusory, and by no means
cheap.
Of course, it is just possible that this time we really have found the
key to eternal life -- which is almost what the conquest of cancer would
amount to. But so far the tremendous advances in knowledge of cell biology,
of which the genome project is an example, have not been translated into
practical medical benefits for the great majority of people. To raise the
prospect of a cancer-free America (or anywhere) is premature and
irresponsible, and will serve only to raise unreasonable expectations.
In choosing cancer as his enemy, Mr. Gore displays the moral cowardice
typical of modern politicians, for who will defend cancer as a good thing?
Here is hubris without the possibility of nemesis. Mr. Gore's attitude to
cancer is approximately the same as President Hoover's to sin -- he is
against it.
. Theodore Dalrymple is the pen name of Anthony Daniels, a British physician and contributing
editor of City Journal.
|