Things I Hate #476.4: Sloppy Writing About Cancer
In Thursday’s New York Times Andrew Pollack wrote a mostly unobjectionable, informative piece on an innovation in treatment for a variety of cancers. The trick he described involves attaching chemotherapeutic agents to antibodies that bind to specific markers on cancer cells — compounds dubbed antibody-drug conjugates. Such therapies aim at more precise targeting of cancer drugs, which researchers, drug companies and patients hope will yield more effective results with fewer side effects.
Pollack lays out the basic technology in the piece nicely, and he frames the science within the usual sorts of anecdotes about patients on some of the drugs under trial…all pretty bog-standard medical reporting.
So why am I pissed off?
By harnessing antibodies to deliver toxic payloads to cancer cells, while largely sparing healthy cells, the drugs are a step toward the “magic bullets” against cancer first envisioned by Paul Ehrlich, a German Nobel laureate, about 100 years ago.
Two thoughts: first, the lesser offense, the phrase “envisioned by Paul Ehrlich, a German Nobel laureate,” is an attempt to assert unearned authority. The dreamt-of “magic bullets” gain a quality of respectability from association with some long-dead smart guy.
That Nobel cover helps set up the second, greater claim, and the more damaging flaw in this piece: the implied outcome for someone actually receiving the hinted-at magic bullet.
Pollack, were he here, might try stop me at this point, noting that he only suggests “a step toward” the miraculous promise of a bullet to strike cancer down — and not that cure itself. And so he does.
But really, the whole framing of magic bullets is the problem. Pollack gives evidence of why this is so — at least by implication — later in the piece. The patient in his lede has breast cancer. for breast cancer. Much further down the piece we learn that the antibody-drug conjugate treatment she receives only applies to those 20% of breast cancers that express an excess of a particular protein. That speaks to one reason why magic bullets remain so elusive almost half a century into the “war on cancer:” cancer is not a disease. Rather it’s a family of illnesses that share the property of unconstrained cell division — but respond often very differently to given choices of treatment.
Again, there’s no doubt in my mind that Pollack knows of the real harm to be done by talk of cures for cancer; almost all of the article is sober enough about the gains achieved so far by this approach (real, but not curative) and of the limits the given therapies face.
But even good reporters can fall prey to the easy phrase or the inaccurate shorthand of the beat. Sometimes it doesn’t matter. No one cares if a football writer uses the phrase “smash mouth” in every piece about the Steelers-Ravens rivalry.
Cancer is different. The hunger for a cure is obviously and understandably overwhelming. But such hopes run straight into the basic science of cancer — which has undone seemingly imminent magic bullets time after time.
New hope, the prospect of more time, improved quality of life, and — with good fortune — increased remission rates. Those are all fine as ways to frame the real advances in cancer therapy. Present them with all the optimism one may reasonable feel. But to imply that we’ve moved meaningfully closer to what amounts to a cure? Until and unless that’s really true, it is beyond misleading to suggest that particular advances offer more than they do. Very rapidly we’re into the territory of the cruel.
So yeah, even as a throwaway. Even with the imprimatur of a Nobel laureate, alive or dead. Even with good intentions. This kind of carelessness bugs the living crap out of me.
No snark, no jokes, a dark subject, no fun. Nothing new here, either; I’m guessing everyone reading this has a pretty good idea that cancer is a bear of a disease(s).
What can I say? This one strikes close to home.