We have not slain our enemy, the cancer cell, or figuratively torn the limbs from his body … In our adventures we have only seen our monster more clearly and described his scales and fangs in new ways – ways that reveal a cancer cell to be, like Grendel, a distorted version of our normal selves.
Harold E. Varmus, Nobel Prize Acceptance Speech (Stockholm, 1989).
Along with the possibility of the extinction of mankind by nuclear war, the central problem of our age has therefore become the contamination of man’s total environment with such substances of incredible potential for harm – substances that accumulate in the tissues of plants and animals and even penetrate the germ cells to shatter or alter the very material of heredity upon which the shape of the future depends.
Rachel Carson, Silent Spring (New York, 1962)
Over a decade ago my mother was diagnosed with skin cancer, in the form of a melanoma on her face. At the time this did not seem a big deal, at least once a surgeon had removed the offending growth and performed a successful skin graft. It had been caught early enough to prevent metastasis, or so we thought.
The ‘scare’ probably shook her more than we recognised. The diagnosis must have realised her worst nightmare after the loss of her own mother, to what seems to have been breast cancer at the age of just fifty.
Most obviously she became fretful at being exposed to the sun, though by then this would probably have made no difference.
In hindsight, perhaps she never fully recovered her poise. I suspect an accumulation of worries affected her health, contributing to the later metastasis of the cancer. Revealingly, a recent survey of seventy thousand women, aged seventy or over, showed that an optimistic frame of mind correlated with a reduced risk of cancer, and other fatal diseases. This bolsters Iain McGilchrist’s suggestion that all medicine should be seen as ‘a branch of psychiatry, and psychiatry as a branch of philosophy’.
Genetic determinism portrays physical bodies as distinct from minds. But this neo-Cartesian view ignores the bewildering complexity of our brains, within which McGilchrist estimates there are more connections ‘than there are particles in the known universe’.
It should offer solace to those with a genetic history of the disease that minds are exceedingly complex, and malleable, instruments.
According to Siddhartha Mukherjee, the author of The Emperor of All Maladies: A Biography of Cancer (2010), ‘the Ancient Roman doctor Galen reserved the most malevolent and disquieting of the four humours for cancer: black bile’. He attributed just one other disease to an excess of this ‘oily, viscuous humour: depression’. Indeed melancholia, the medieval name for ‘depressions’ draws its name from the Greek melan, meaning ‘black’, and khole, meaning ‘bile’; Mukherjee describes how ‘Depression and cancer, the psychic and physical diseases of black bile, were thus intrinsically intertwined.’ Moreover, Andrew Soloman quotes an expert to the effect that anxiety, ‘a response to future lost’, should be regarded as ‘fraternal twins’ with depression, ‘a response to past lost (quoted in Pollan, 2018, p.389)’.
Although during the Renaissance Andreas Vesalius (1514-64) established that black bile does not exist, the coupling of the two ailments by Galen, who informed Western medicine for over a millennium, is noteworthy. Contemporary approaches may profitably look backwards, as Mukherjee puts it: ‘Scientists often study the past as obsessively as historians because few other professions depend as acutely on it’.
That is not to say, of course, that cancer is somehow ‘all in the mind’, but increasing focus on the role of depression or stress, and ways of counteracting these, from spirituality to artistic expression or enjoying the great outdoors, would surely be beneficial.
II – The Human Genome Project
Mukherjee argues that cancer ‘is stitched into our genome’: somatic cells, along with the bacteria in our body with which we generally co-exist symbiotically, are in a constant flux of death and renewal, such that most of our cells survive no longer than seven years, before being replaced by new ones.
As we grow older glitches – entropy – enters into this process of renewal. Mukherjee writes: ‘Oncogenes arise from mutations in essential genes that regulate the growth of cells’. It is usually as if we become jaded by a lifetime’s effort, and errors creep in.
Predicting the behaviour of these mutations has, however, defied understanding since the ‘War on Cancer’ began in the early 1950s. The outbreak of certain rare forms can be traced to genetic inheritance, but the onset of the vast majority is not preordained.
Mukherjee argues that ‘the Human Genome Project will profile the normal genome against which cancer’s abnormal genomes can be juxtaposed and contrasted’. However the number of genetic mutations involved in most types runs into three figures.
At best scientists have been able to glean from genomic evidence that certain individuals do not benefit from particular therapies. But this is not the same as understanding at a cellular level why most cancers appear, and pinpointing the preventative measures which ought to be taken.
Inescapably, the claims of genomic research arrive through the prism of justifying hefty research grants.
The author of The Science Delusion: Freeing the Spirit of Enquiry (2012), Rupert Sheldrake has sought to puncture the optimism of those who believe the Human Genome Project will yield infallible algorithms predicting our future life and health: ‘The optimism that life would be understood if molecular biologists knew the ‘programs’ of an organism gave way to the realisation that there is a huge gap between gene sequences and actual human beings’.
Mukherjee also acknowledges the great variety of environmental factors, which switch on and on off the genetic mutations which give rise to cancers:
Our bodies, our cells, our genes are being immersed and re-immersed in a changing flux of molecules – pesticides, pharmaceutical drugs, plastics, cosmetics, food products, hormones, even novel forms of physical impulses such as radiation and magnetism. Some of these, inevitably, will be carcinogenic. We cannot wish this world away; our task then is to sift through it vigilantly to discriminate bona fide carcinogens from innocent and useful bystanders.
Revealingly, in a recent U.S. case a jury awarded DeWayne Johnson €289 million in damages against Monsanto, the manufacturers of Roundup a glyphosate weed killer in compensation for the onset of his cancer.
Other confounding factors include the emerging field epigenetics, our co-habitation with bacteria – itself in constant evolution – and even altered states of consciousness.
III – Metastatic Melanoma
Exposure to the sun’s UV-A and UV-B rays is considered the leading cause of melanomas. The incidence is particularly high among Australians, most of whose ancestors evolved in cool and cloudy Northern European conditions, and, surprisingly, Switzerland, where a fondness for the sunny piste seems to be to blame.
My mother was not particularly pale-skinned, and nor was she ever a sun-worshipper. I recall her scrupulously applying sunscreen on herself, and her children, on beach holidays. The best guess is the damage stemmed from sunburn as a child or young adult. That her life coincided with a depletion in the ozone layer, which filters UV rays high up in the atmosphere, could also have been a factor. It has even been hypothesised that sunscreen itself contains carcinogenic properties.
When my mother’s cancer returned three years ago, in the form of tumours on the lung it did not seem such devastating news. The first battle had been won, and why not this? If I had known that a metastatic melanoma is usually considered a death sentence, and that treatments only tend to extend life by a few months, I would have reacted differently.
I remained bullish in my assessment as, a short time beforehand, she had embraced a wholefood plant-based diet. From the start I was skeptical about the treatment, fearing this could do more harm than good; as the sixteenth century physician Paracelsus put it, ‘every medicine is a poison in disguise’.
Probably wisely however – though I will never know – I kept my counsel, at least to her, and most of my family. I cannot imagine how I would feel if I had persuaded her to get off the treatment, and she had died soon afterwards.
However, I recently revisited a passage from Professor T. Colin Campbell’ 2013 book Whole: Rethinking the Science of Nutrition, in which he describes the response of his wife Karen to a metastasised (Stage 3-Advanced) melanoma on her lymph gland. She refused any of the treatment alternatives her oncologist recommended, much to his annoyance.
Campbell writes perceptively: ‘Cancer patients intensely want to believe in their oncologist, whom they see as holding the key to their recovery’. Despite refusing treatment, including surgery, Karen Campbell, maintaining a wholefood plant-based diet had lived a further eight years by 2013 without ill-effects, and appears to be still alive today. Obviously we cannot extrapolate too much on the basis of one case, but I cannot help asking myself: ‘what if?’.
My mother was put on one trial treatment, and later a different one, of a form of immuno-therapy, which harnesses the immune system to attack cancer cells. It came as a shock to her system. Some months into it she developed a sore throat and high fever, which eventually required hospitalisation, and an antibiotic drip.
Living with my parents through much of the long treatment period I was on hand for many of the oncology treatment days, and the debilitating nausea that followed. Her vitality declined precipitously: from being a committed walker, she found it increasingly difficult to go any distance; whether the cancer played a part in this I do not know.
She managed, nonetheless, to take the odd foreign trip, overcoming her nerves, and became a grandmother to two further grandchildren in that period.
She lasted almost three years on the treatment, maintaining the plant-based diet throughout – although she did occasionally eat fish after being encouraged to increase her protein intake. According to the consultant she was top of the class on the basis of her scans. He always professed satisfaction at how well she was doing, which did not exactly chime with the increasing levels of nausea she was experiencing. This also required her to take more and more medications, which lowered further her vitality.
IV – Plant-Based Prevention?
Disconcertingly, Mukherjee characterises the history of cancer research as, ‘intensely competitive’, and featuring, ‘a grim, nearly athletic, determination’. It seems patient welfare, as opposed to survival, has not always been to the fore, as experts compete for the next breakthrough in extending life, or finding an ever-elusive cure. The same commitment has not, alas, been shown to prevention strategies, which would bring no reward to the pharmaceutical sector that generally funds the research.
In 2014 a retired Dublin G.P. John Kelly published a book entitled Stop Feeding Your Cancer in which he argued that ‘The minds of cancer specialists were so cluttered with their pharmaceutical and surgical obligations that they were unable to accommodate critical revisionary thinking.’
Kelly’s account, which has been criticised for cherry-picking data, was inspired by his reading of the same T. Colin Campbell’s The China Study (2005). Campbell, no ethical vegan, conducted experiments on two groups of laboratory rats infected with cancer. The first group were given a diet comprising twenty percent animal protein. They all promptly died, but the second group were given a diet of only five percent animal protein, and all survived.
Campbell performed these experiments in the Philippines after observing a lower survival rate among affluent cancer patients with diets high in animal products, compared to their impoverished peers on diets low in meat and dairy. In the laboratory Campbell also found vegetable proteins did not promote cancer, even when consumed in large quantities.
IV Cure or Cause?
The heartening news at the beginning of this year was that my mother’s tumours had all but disappeared from her lung, but she nevertheless continued to get sicker and sicker.
Over time her face took on a disturbingly yellowish hue, which was eventually diagnosed as jaundice – in Galenic terms an excess of yellow bile. A good friend who is a G.P. confided to me that the overwhelming likelihood was that this was linked to her cancer.
Still it was a great shock when the news came through of another tumour blocking her bile duct.
It required a painful operation, on an already weakened patient, inserting a tube to stanch the flow of bile into the bloodstream. It never worked properly, and she declined painfully from that point, despite my father’s best efforts to master the appendage.
I cannot help wondering whether, considering the prolonged bouts of nausea, the treatment itself had caused the inflammation which produced the tumour; the history of cancer is replete with examples of ‘cures’ doing more harm than good. For example, many chemotherapy agents are known carcinogens, and listed on the International Agency for Research on Cancer (IARC) Group 1 list as such.
Mukherjee also describes chemotherapists as acting like ‘lunatic cartographers’ who ‘frantically drew and redrew their strategies to annihilate cancer’. My mother went through immuno-therapy, but the basic approach of poisoning the body in order to kill the cancer appears to be the same.
It also begs the wider question as to whether a prolonged period on a debilitating cancer treatment is a life worth living.
The absence of preventative cancer programmes in our systems of public health is nothing short of scandalous. The Chicago Tribune acknowledged in 1975 that the idea of ‘preventive medicine is faintly un-American. It means, first, recognizing that the enemy is us’. Where America leads other nations appear to follow.
In Plato’s idealised Republic, Socrates castigates doctors that prolong the life of patients without curing them. He pays tribute to the carpenter who, after being prescribed a lengthy treatment regimen, replies:
that he had no leisure time to be ill and that life is no use to him if he has to neglect his work and always be concerned with his illness. After that he’d bid good-bye to his doctor, resume his usual way of life, and either recover his health or, if his body couldn’t withstand the illness, he’d die and escape his troubles.
There are of course now many procedures that are relatively simple – such as removing skin cancer – but I cannot help feeling, notwithstanding medical advances, that I too would prefer to die on the job rather than go through a debilitating, long-term course of cancer treatment. I prefer the preventative measure of a plant-based diet to reduce my own risk of developing cancer
V – Depression
Like many patients after a terminal diagnosis my mother developed symptoms of depression for which she was prescribed medication. She also benefitted greatly from spiritual counselling in the Catholic tradition from a devoted friend.
She cast away doubts and annoyances with the Church, realising great benefit from simple prayer, during what the philosopher John Moriarty has described as a universal Golgotha experience. This may give Christianity an enduring relevance, despite historic failings.
Those resistant to religion might consider the effect of psychedelic drugs on terminal cancer sufferers who experience depression. In How to Change Your Mind: The New Science of Psychedelics (2018) Michael Pollan reveals how in NYU and Hopkins trials 85% of cancer patients showed ‘clinically significant reductions in standard measures of anxiety and depression that endured for at least six months after the psylocybin sessions’. Fascinatingly, in both trials ‘the intensity of the mystical experience volunteers reported closely correlated with the degree to which their symptoms [of depression] subsided’.
There are no simple answers to the questions I have raised in this article, but based on my experience of losing a close relative to cancer, and reading up on the subject, I would argue that we need to alter the paradigm of research, to explore more fully preventative strategies rather than simply addressing the disease after it has emerged.
Cancer is not all in the mind, and nor does it ever seem likely to be eradicated fully, but that correlation between good health and a sunny disposition is notable. Can general practitioners, in particular, develop ways of lifting our moods – without recourse to medication – while retaining a focus on physical signs of illness? Perhaps we need to train a new kind of physician, with mindfulness at the core of their study.
Finally, why is it that public health authorities do not display the same commitment to dietary change as is shown towards curbing tobacco smoking? One conclusion that might be drawn is that pharmaceutical companies, and other vested interests, are an obstacle to this coming about.
Jacqueline Armstrong RIP