“Beating cancer: the new frontier of molecular medicine,” enthuses a cover story of The Economist. An opposite mood pervades a cover story of Fortune, “Why we’re loosing the war on cancer.” Both articles appeared in 2004, thirty-three years after President Richard Nixon signed the National Cancer Act that declared “war on cancer.”
The difference between them would not be the last in a long line of controversies on cancer research that stretched back to the beginning of the war if not earlier. Undoubtedly all sides are united in their hope of beating cancer. They disagree, sometimes bitterly, on the manner in which the war is waged and the achievements so far. The debates involve many issues, including science under siege. Here we will concentrate on problems regarding the levels of complexity, more specifically, how much scientific knowledge on the level of cancer genes contribute to needs on the level of health care.
Americans have poured roughly $200 billion, in inflation-adjusted dollars, into cancer research and cancer drug development between 1971 and 2004. Almost one-half of the bills went to several government agencies, the balance to philanthropies and pharmaceutical companies. In comparison, the government put up about $ 3 billion, matched by a similar contribution from the private sector, for the thirteen-year-long human genome project. That research money bought duplicate catalogs of human genes. What has the much larger fund for cancer research bought?
In 1986, the director of National Cancer Institute predicted the eradication of cancer by 2000. Reality was not anywhere close. In 2004, a new director envisioned “the elimination of the suffering and death due to cancer by 2015.”13 Critics deem such unbridled optimism irresponsible; unending rosy promises raise false hopes that turn into cruel disappointments for patients and their families.
Sure, generous research funding has bought enormous knowledge about the biology of cancer. However, critics complain that this knowledge about mechanisms on the molecular and cellular levels has little practical impact. Few new cancer drugs have resulted, and drying pipelines hang like a stubborn black cloud over the pharmaceutical industry. On the level of human suffering and death, the 1.5 million papers on molecular cancer biology seem to contribute less than the campaign to dissuade people from smoking.
Cancer death rate in America, after climbing unrelentingly for a century, peaked in 1990. Since then it has dropped by 12 percent back to its level in 1960. It was a welcomed relief, but hardly a victory. The largest decline occurred in lung cancer, which was attributable less to breakthrough research than to decreasing prevalence of smoking among men. Furthermore, cancer still claimed 564 thousand American lives in 2004, which constituted 24 percent of deaths from all causes.
The picture is a little different in the developing countries, where cancer death rate is lower but rising. Worldwide in 2000, cancer caused 6.7 million deaths or 12 percent of total. The World Health Organization estimated that if unchecked, annual global cancer deaths could rise to 15 million by 2020.
Although cancer is an ancient disease that afflicts humans and other animals, its prominence in the Western world rose from the nineteenth century to become “a disease of civilization.” There are several explanations of this. Cancer is primarily a disease of elders; its risk increases roughly as the fourth power of age. Thus it was less threatening when infectious diseases and grinding poverty killed before it could strike. Its turn came when gradual alleviation of harsh conditions lengthened life expectancy, first of the aristocracy then of the general population.
A subtle and complex disease, it was difficult to diagnose. Identification of cases increased with development of microscopy and scientific knowledge. Case load itself also increased, less because of environmental pollutions than because of changes in diet and life style. An affluent diet rich in meat and refined carbohydrates is enjoyable but not always healthy, so is a comfortable life spared of physical exertion. Widespread tobacco usage is the worse scourge. These demographic and life-style trends are being repeated in the developing world. The “disease of civilization” is spreading.
Not all is grim, however. Much could be done to stem the trend, although it would not be easy. The World Health Organization stated: “World Cancer Report provides clear evidence that action on smoking, diet and infections can prevent one third of cancers, another third can be cured.” Is this cautious optimism warranted?
From : Sunny Y. Auyang Journal
