'The Emperor of All Maladies: A biography of Cancer' is a thought-provoking book.
I chose to read the book to understand what cancer is all about in a bid to make me a better nurse, and a little bit to scare myself into committing to a healthy lifestyle.
If you have not read the first part of the review, check it out here.
In this last part, I ponder on some facts that I found worrisome and/or interesting.
Cancer is Deep in our Biology
For growth of a living thing to happen, cell division and multiplication must happen. Cancer occurs when certain cells multiply nonstop. Therefore, the same processes that we need to grow, regenerate and heal are the same processes that sustain cancer
This also poses a challenge in treatment because cancer management interferes with the normal body processes. Hence the extreme side effects of chemotherapy, radiotherapy and other treatment regimen. There is no such thing as "cured of cancer."
However, this does not mean cancer is a death sentence. Some patients have had remissions for years especially when it is diagnosed early.
Human Beings are Resilient
From the beginning of the book there are several doctors, surgeons, scientists and just ordinary individuals who devoted their lives to the war against cancer. Many lost their reputation. Dozens more lost their lives.
Marie and Pierre Curie were a couple that resigned themselves to finding sources of X-rays. They contributed to understanding the properties of X-rays that are applied to date and discovered Radium, an element which enabled higher doses of radiotherapy. In a sardonic twist of events, Marie Curie died of Leukemia in 1934 from excessive exposure to radioactivity.
In the 1950s, Min Chiu Li, a Korean born chemo-therapist, became obsessed with choriocarcinoma, a rare cancer of the placenta. After treatment with chemo, his patients were "cured". However, he kept giving them additional doses of chemotherapy, a move which did not sit well with his peers. He was even fired from the National Cancer Institute. Did this stop his work? No. Today, one of the fundamental principles of oncology is that "cancer needs to be systemically treated long after every visible sign of it has vanished"
There are several other examples of such religious devotion to the cause. Sydney Farber to Leukemia. Peter Kaplan to Hodgkin's Lymphoma. Brian Druker to Chronic Myelogenous Leukemia. Alfred Knudson to Retinoblatoma. Mary Lasker to the social front of the war, just to mention a few. Not forgetting the thousand of patients who were willing to be test subjects and enduring untold suffering for it.
If this is not an illustration of human resilience, I don't know what is.
Smoke and Mirrors
"If cancer is the quintessential product of modernity, then so, too, is its principal preventable cause: tobacco."
In the modern world, people are always ready and willing to sue companies for manufacturing and distributing products that can cause even the slightest harm to their health; whether intentionally or accidentally. This has seen product recall taking commonplace.
The link between tobacco and lung cancer has long been well established. How then is tobacco still a fast moving item on our shelves? According to WHO (2015) over 1.1 billion people smoke tobacco. How can we be fighting cancer vehemently yet consuming one of the most pronounced carcinogens? Isn't it just smoke and mirrors?
Cancer and Africa
Cancer is especially a dreaded disease in Africa. For the obvious reason that it is fatal and also because the cost of treatment is exorbitant coupled with the fact there are limited facilities offering the said treatment.
In Kenya, the lower classes are forced to wait for government offered treatment with queues lasting several months, more or less a death sentence. For the bourgeoisie, fund drives for treatment aka 'Medical Appeal' are not unusual in mainstream and social media, the promised land for therapy usually India.
That there is little mention of Africa in the fight against cancer is not a shock. What is shocking, embarrassing and saddening is that the only time Africa is mentioned in the book, it involved a con story. It is the 90s, the enemy is breast cancer and the man in line of fire is Werner Bezwoda. The place, Witwatersrand, Johannesburg, South Africa.
Bezwoda had been experimenting with mega-dose chemotherapy and transplant. He believed that he had overcome the "dose-limiting barrier", a claim that saw him instantly rise to fame. In 1999 in the annual cancer meeting, he presented phenomenal results to an excited audience. 60% of his study subjects over the course of eight and a half years were still alive.
"He rose to the podium confidently, feigning irritation that his name had been mispronounced during the introduction, and flashed his opening slide."
The beginning of the end for him was in that very conference where presentations from three other similar trials in different areas all had negative result. By February 2000, the heat had become too much. Werner Bezwoda admitted to falsifying result in a letter to his colleagues. His justification was he wanted "to make the trial more accessible to American researchers."
Hopeless or Hopeful?
After all is said and done, I ask myself only but three questions.
Am I better nurse for reading the book? Yes.
Have I scared myself into committing to a healthy lifestyle? Yes to baby steps.
Am I hopeless or hopeful? Both. Hopeless because after all these years, there is no cure for cancer. Hopeful because human beings are resilient.