The way people understand cancer is essential to national policy making as well as individuals’ attitude and behavior toward the disease. Earlier this year, therefore, I wrote an Op‐Ed in The New York Times  that challenged the rationale of the Obama administration's initiative for a “Cancer Moonshot” . Contrary to the President's call on America to “cure cancer once and for all” (State of the Union Address, 2016), I argued that we cannot treat ourselves out of the cancer epidemic. Cancer is a natural consequence of aging, and the better medical science gets at keeping people alive, the more cancer there will be in the population. Whether I am right or not is open to debate. What is just as interesting, however, is how people reacted to this message.
Cancer is a natural consequence of aging, and the better medical science gets at keeping people alive, the more cancer there will be in the population
The New York Times gave my Op‐Ed the provocative headline, “We Won't Cure Cancer”, for the printed paper, and “Obama's Pointless Cancer Moonshot”, for the online version, which assured broad distribution in the social media. Responses were communicated through the newspaper's online comment section, Letters to the Editor, Facebook, Twitter, and my personal e‐mail account. They communicated the voices of cancer experts and non‐experts and represent a rich material of how people understand the problem of cancer. In order to share this insight and structure further debate, I here present a summary of the approximately 200 meaningful responses, organized as seven different ways of framing the issue.
1. This is hurting. Cancer causes a lot of physical and psychological pain , and an article that presents cancer development as a natural consequence of aging may appear as a cruel provocation. “I am very distressed by your Op‐Ed. It reads as cold, heartless, and uncaring”. “I do not want to see anyone else have to go through this”. “We can't throw cancer victims to the wolves”. “So when I die of cancer at 38, because it's not worth curing me, will Prof. Breivik come to my home and raise my child?”
These reactions are understandable and humbling, and a strong reminder that cancer may look very different in the eyes of a patient and a biomedical researcher. Still, it should be noted that these reactions are based on an erroneous assumption: The scientific argument that we cannot treat our way out of the cancer epidemic does not imply that cancer patients should be abandoned or that we should stop cancer research. On the contrary, it is a strong argument for more research, especially on how to improve the quality of life for the growing number of people that are living with and dying from cancer.
2. Silence the defeatist. A phenomenon that causes immense pain and suffering is naturally seen as an enemy. People are said to win or lose their battle against cancer. Politicians launch moonshot initiatives to improve our arsenal. We wage war, and the goal is total victory , . A professor from Norway that questions this goal and attempts to humanize the enemy may thus appear as a cowardly defeatist that undermines the great cause. “You sir, are a jerk. One CANNOT fund Cancer research enough. Your piece in the Times conveys a stupidly ‘holier than thou’ attitude, based on self aggrandizement. You've unfortunately had your say, now go back to nothingness in Norway. Eat well and exercise, and hope YOU don't get cancer. Sincerely, [Registered nurse]”. “Lifestyle modifications are critically important to improving national health, but to present those efforts as alternatives to more technologically difficult efforts smacks of either defeatism or paternalism or both. [PhD student, UC Berkeley]”. “…perhaps you are contrarian because [you] like to see your byline in the popular press [Associate Director of major research center]”.
A professor from Norway that questions this goal and attempts to humanize the enemy may thus appear as a cowardly defeatist that undermines the great cause
These responses typically question the values and intensions of the messenger and ignore or dismiss the scientific arguments. They are often insulting, with the apparent purpose of silencing the “defeatist”.
3. The goal justifies the means. A related, but more intricate type of critic acknowledges the scientific argument, but defends the pursuit of “a cure” as a deliberate communication strategy , . “…from a citizen/public perspective we do need to drive the research, its funding, and the public health aspects by promoting the idea of seeking a ‘cure’. That is a necessary frame of the issue to gain public support. The US public likes to approach these matters as a ‘war on…’, even though such wars cannot actually be won. [Oncologist, MD‐PhD]”. “Remission is not sexy, cure is. If aiming for cure is what it takes to get money, then what is wrong with that? [Oncologist]”.
A gerontocracy where the billionaires live on indefinitely, while the poor continue to die prematurely, may not be the cancer‐free future that people are anticipating
This framing of the issue is typically conveyed in personal communication from oncologists and other cancer experts. It openly recognizes “the cure” as a means of propaganda and argues that we need to uphold the myth in order to assure support and funding for the good cause. Initiatives to explain the hard realities of cancer to the general public are therefore seen as counterproductive and should be avoided.
4. The cure is imminent. Some responders genuinely believe that we are about to solve the problem of cancer. “With all due respect, Dr. Breivik is wrong. Immunotherapy is radically different from other treatment mechanisms. [Anonymous]”. “…there is evidence that new approaches may change the landscape and may enable us to delay cancer beyond the lifetime of most patients. [Professor, UCSD]”. “If ever there was an opportune time for a cancer moonshot, it is now. [Professor, Tufts University]”. “…cancer technologies today are approaching the level of maturity that rocket science had in 1963. [Professor, Bentley University]”. “Prof. Breivik sounds like a physics professor in 1890 pontificating on the fact that men will never fly. [Anonymous]”.
These responses foresee a technological solution to cancer. They typically focus on promising therapeutic developments, such as immunotherapy, but do not explain how these treatments solve the problem of the aging population . Some, however, propose a more fundamental solution: “If we can understand/cure the progressive degradation of ageing on a cellular level, we cure cancer. [Professor Emeritus]”. “Stop cells from aging, cure cancer [MW]”.
In this perspective, the goal is not just to cure cancer, but to prevent the process of aging . Such anti‐aging research is promoted by an increasing number of researchers and wealthy tech titans, and the apparent goal is to defeat death altogether . It is therefore pertinent to ask what kind of society this research is heading for. A gerontocracy where the billionaires live on indefinitely, while the poor continue to die prematurely, may not be the cancer‐free future that people are anticipating.
5. There is an alternative solution. Some responses are characterized by their conspiratory, simplistic, or bizarre understanding of cancer. “Follow the money and you will see why we really just can not cure cancer”. “…it seems unlikely that the body would spontaneously destroy itself. The truth is, it doesn't. We do. We do it with chemicals applied to our bodies”. “Cancer is NOT a disease of the elderly, that is just when we see the results”. “There are great developments in using ketogenic diet for starving cancers”. “…researchers are discovering new benefits to using natural plants, herbs and minerals to enrich our lives and even make us healthy and cancer free”. “Life on Earth goes through 4 ages, two of which are kali‐yuga and sat‐yuga […] I recently read that horseradish kills cancer cells”.
Such responses typically come from non‐experts and represent an important reminder that public understanding of cancer is influenced by other sources than evidence‐based medicine. But they also convey an element of truth: Cancer involves strong commercial interests that favor expensive therapeutic approaches over far more cost‐effective preventive measures, and people are right to question the prioritization of resources , .
6. Let's be realistic. Although the amount of negative and critical feedback was substantial, most of the responses were positive. The Op‐Ed was widely shared on social media, and many people expressed a sense of enlightenment. “I like your honesty in describing the future of ‘cancer cure’”. “This opens the conversation to medical ethics and public (i.e., societal) policy for how we will fund all the treatment costs involved in an increased number of persons diagnosed and living with cancer”. Cancer survivor and sports celebrity Lance Armstrong posted the following Twitter message to his 3.8 million followers: “Brutally honest oped from Prof. Jarle Breivik in 2day's @nytimes. Surely not a popular opinion but I fear he's right”.
In this context, it is interesting to point out how the Livestrong Foundation (www.livestrong.org), a major cancer advocacy organization founded by Mr. Armstrong, has fundamentally changed its mission. While previously aiming for “A world without cancer”, Livestrong now “fights to improve the lives of people affected by cancer now”. The uncompromising pursuit of “the cure” has apparently been replaced by the realization that cancer is here to stay and that we need to find better ways to live—and die—with the problem.
In order to understand cancer, we need to integrate all the different perspectives, including the ones that are painful and difficult to accept
7. Beware of politics. Lastly, there are the responses from colleagues who highlight the dangers of challenging the establishment , . “Finally, someone has the courage to state the obvious about this natural biologic process. [Professor of Medicine, UCSF]”. “It's very brave of you to make this point. I've espoused this point of view for 40 years […] and as you know, people absolutely hate it, calling it defeatist and short sighted and somehow morally offensive. And it can hurt funding unless very carefully phrased, as you have done. Although I admire president Obama, I cringed when he announced this scheme during his State of the Union address. Like the Emperor's clothes, pointing out the truth about cancer cures […] can be a bit dangerous. But it needs to be said. [Professor Emeritus]”. “‘The public’ believes us when we tell them that if they, or Biden in this case, give us enough money we'll find ‘a cure for cancer’. This is dangerous for us because sooner or later they're going to wake up to the fact that we've declared war on cancer a number of times and thoroughly lost each war. ‘Fool me once…’ We should have said no to Biden, but I see that he's already convened some huge kick‐off meeting […] so it's quite clear that most of ‘us’ are going to blush, take the money, and keep our mouths shut. [General Manager, PhD]”.
Tell the whole story
Combined, these responses demonstrate our society's complex and conflicting relationship to cancer. How we see the problem depends on who we are and where we stand. To patients and their loved ones, cancer is something personal and painful. A politician may see an enemy of society, while a researcher sees a technological problem. In the eyes of the pharmaceutical industry, cancer is a growing market, while others see the cancer industrial complex as a grand conspiracy. There are those who believe that cancer research should be aiming for immortality, while some of us argue that cancer and aging are integrated aspects of humanity , .
My point is not to decide who is right or wrong, but to demonstrate that there is more than one side to the problem. In order to understand cancer, we need to integrate all the different perspectives, including the ones that are painful and difficult to accept. More people are getting cancer, living with cancer, and dying from cancer than ever before. This is happening because of, not despite of, scientific and societal progress. It is the consequence of our relentless struggle to live as long as possible, and a “Cancer Moonshot” to accelerate technological developments will not solve the problem , .
What we need is an initiative that goes beyond the idea of finding “a cure”. Our society is in the midst of a biotechnological revolution that is redefining the boundaries of human life. People need to understand what is going on, and as scientists we have an obligation to tell the whole story, not just the pieces that attract research funding. We need a moonshot for education, scientific integrity, and open dialogue that dares to ask the difficult questions about cancer, aging, and the future of our civilization.
Conflict of interest
The author declares that he has no conflict of interest.
- © 2016 The Author