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A note for our readers: the views reflected by the authors do not reflect the views of ASPA.
By Michael W. Popejoy
If you pose this question to cancer researchers, likely you will not get a straight answer. Saying yes to the question results in the next question, when can we expect the cure to be announced and be available to doctors? Hey, people are dying here! If the answer is no, then we ask why then are we investing so much funding in sponsored cancer research with so little results? Since 1971, in the U.S. alone, we have invested over $300 billion. No laboratory scientist wants to see their research funds dry up. The lights go out as labs close which means unemployment for both senior scientists and their young aspiring students. So it is helpful to keep the hope alive that well-funded labs are advancing the war on cancer to some ultimate victory. However, the unhappy news is things are not really going as expected after all these decades of costly research.
We are just past the first decade into the third century of what can be called “modern” science. We have made significant strides against many human infectious diseases, although we have lost ground as these infectious microbes have developed their own resistance to antimicrobial drugs. In a future column, I will discuss methicillin-resistant staphylococcus aureus (MRSA) and the dangers we face.
Cancer, however, is a chronic, noninfectious disease that has plagued mankind since the dawn of human history. One curious aspect of chronic diseases is their direct and indirect relationship to individual lifestyles. With public health education and a realized commitment on the part of the public, many devastating chronic diseases can either be prevented or effectively managed. Who in today’s modern society is not aware of the adverse health impacts of smoking, sedentary lifestyles, excessive drinking, unprotected sex, driving while intoxicated, driving recklessly without seatbelts and in unmaintained vehicles (bald tires, bad brakes) and of course, poor diet. All of which can be causes of life threatening and life span shortening diseases and suffering. Cancer is one of those diseases related to lifestyle choices, especially diet and habits such as smoking and excessive drinking. I guess we have to ask how much cancer is our own fault versus how much of the incidence resides in our genes, environmental exposure or just bad luck.
I would propose here that we as members of western civilization have a mechanistic rather than a holistic belief in the curative powers of medicine. In other words, we can live the lifestyle of bad choices rather than one of prevention since we depend on the machinery of medicine to cure us. It is expected that the modern medical center, with all of its advanced machinery and the applied medical/surgical skills of medical practitioners, can cure us of what our bad behaviors have wrought upon our bodies. Unfortunately, the return on investment on the billions of dollars of capital investment medicine has made in technology (and research) is appalling low in terms of lives saved. This is not meant to imply that medical technology has not had any positive impact at all. It is only to state that medical technology has not completely overcome the poor health choices we make while we expect medical technology to save us.
What about the “cure” for cancer? It is often difficult to understand that the best cure for cancer is prevention. Once cancer is marching through the body, it is a life-long battle ending most often not with a cure but with death, either by the cancer itself, by the toxic treatment for the cancer or something else opportunistically attacking the cancer-weakened body.
It is hard to accept, and just as hard to communicate to cancer victims, that many cancers (not all) are directly or indirectly the fault of the patient. Yes, there are genetic factors leading to cancer and of course, there are toxic environmental causes. In many unknown pathways, such as poor health choices, genetics and toxic environments all work together to usher in this devastating disease. For patients who have all three of these disease triggers, I would have to say there is bad luck!
My concern for the readers of this column is what can we do ourselves to prevent cancer? People make poor choices because they assume that if “the emperor of all maladies” strikes, that modern medicine and its expensive technology will save them. Unfortunately, this is all too often not the case.
There is an old saying that goes, “an ounce of prevention is worth a pound of cure.” It is tragic to report that millions of people annually die from illnesses and injuries that could have been prevented. Well then, how do we define “cure”—the total eradication of the disease with no recurrence—ever? This absolute level of “cure” is not possible now or in the scope of our current lifetimes. If an oncologist states a cure is possible, then you must pin him/her down to his/her definition of what a cure is and determine if that definition is sufficient to give you comfort and hope.
In addition, what are the conservative odds that achieving the cure is possible? For instance, in men with prostate cancer, the survival tables illustrate that fully 55 percent of all men diagnosed will be dead in 15 years regardless of which treatment option is selected. If I could do something that could prevent prostate cancer, I would rather do that than risk the odds that I could possibly be cured.
People though play the odds. If you are a smoker, you play the odds that you will or will not get one of the smoking related cancers. If you get one of the cancers, you play the odds that the treatment is successful. If the treatment is successful, you play the odds that the cancer won’t come back. That is a lot of gambling!
I will be writing more in later columns on research funding, especially funding for many of our catastrophic diseases that seem to elude a successful cure, and how that money is awarded and managed. For the time being, it is important to note that universities invest a great deal more in their football programs than they do in their laboratory research programs.
Author: Michael W. Popejoy, M.B.A., Ph.D., M.P.H., M.S., FRSPH teaches both graduate public administration and graduate public health and is cross trained with his Ph.D. in public administration and the M.P.H. in public health from a CEPH accredited school of public health. He is currently studying for the CPH examination.