Posted tagged ‘Cancer’

The Day The Newsweekly Died

March 29, 2013

Let’s say you are the editor of essentially the last rag standing, the final remnant of the once insanely influential tribe of dead-tree general-interest newsweeklies.  Let’s say you are the lord of Time.

Now, we all know Time is increasingly just another one of time’s victims, a dinosaur in a world filled with post-CGI-meteor digital mammals (extended grotesque metaphor in honor of the party of the first part).  So if you’re the editor, you’ve got a tough trick:  how to cut through all those pesky byting insects? (Consistency? we don’t got no consistency.  We don’t need no Kinky People Can Often Find Good Sex consistency!)

And finally, let’s say you have no moral compass; you don’t care about what’s true, or about the pain your decisions could inflict on millions of people touched by the subject of your cover story.

That’s when you come up with this:

Time Cancer cover

It’s not possible. We’re nowhere near what’s promised on that cover.  Hell, even conceptually, you can’t “cure” “cancer.”  It’s a family of illnesses that share certain characteristics (most importantly, uncontrolled cell division) but that present a whole host of different pathologies and possibilities for treatment; no matter what advances may come, no one who can count past three expects some unitary cure.  But rather than rant on, I’m just going to outsource my rage and disdain to my friend (and MIT colleague) Seth Mnookin, writing yesterday in Slate:

 Witness the headline emblazoned in all-caps on the cover of the magazine’s April 1 issue: “HOW TO CURE CANCER.” It’s followed by an asterisk that directs you to a subtitle, just to make sure you get the point: “Yes, it’s now possible, thanks to new cancer dream teams that are delivering better results faster.”

Which, of course, is completely, utterly, inarguably false. The roughly 580,000 Americans who will die this year from cancer know the reality all too well. For some context, that’s more people than will die from chronic lower respiratory diseases, strokes, accidents, Alzheimer’s disease, and diabetes combined.

According to Seth, the actual story is more a squib than the blatant idiocy implied by the cover, which is a minor relief.  But the cover on its own is hugely damaging — and Seth gets into what makes it so before coming to the heart of the matter:

Which brings us to the real problem with Time’s headline, which is not that it’s wrong, or even that it might create funding problems for future cancer researchers—it’s that in the context of a fatal disease with excruciatingly painful treatment options, it’s simply cruel.

Exactly.  Cancer has harrowed my own family — non-small-cell lung cancer took my mother ten days before my scheduled wedding, for one example — so I know to the bone what it feels like to encounter witless fantasies like this one.  But it shouldn’t require such a loss to grasp the fact that you don’t get to put the word “cancer” and the word “cure” in the same sentence — hell the same paragraph — unless you’ve cleared the wards and are carrying some folks to Stockholm in sedan chairs.  Go read Seth — and spit on the ground in front of the display everytime you see one of these.

Oh…one more thing: if you had any doubt that the newsweeklies had fully and fatally jumped the shark, doubt no more.

Things I Hate #476.4: Sloppy Writing About Cancer

June 2, 2012

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?

This sentence:

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.

Image: Zacharias Wagner, Crab, from Thier Buch (Animal Book), 1641.

In Which I Flame A Cancer Patient: P. J. O’Rourke edition

October 1, 2008

I’m really trying to write a post about Isaac Newton and the crisis in the credit markets (to come later today) but I keep running into the kind of moments that xkcd has made famous, so here again, I sidetrack into an issue unrelated to what I still, Kevin Bacon style, maintain is the mission of this blog.

Via Andrew, I learn (a) P. J. O’Rourke has cancer and (b) that he has written a pretty funny defense of death in response to his diagnosis.

I certainly wish P. J. well; he can be a sophomoric and unfunny jerk with the best of them, but Holidays in Hell is as funny a comedy of modern manners as you can find, and I owe a debt of gratitude to anyone willing to go to some of those places just to make me laugh.

But in the piece in which he reveals his cancer of the hemorrhoid, he commits one of the most characteristic and egregious sins of the war-mongering right in so stupid a claim that I have to trash his sorry self in public, illness or no.

He writes:

Why can’t death — if we must have it — be always glorious, as in “The Iliad”? Of course death continues to be so, sometimes, with heroes in Fallouja and Kandahar.

Asshole!  I can’t express how much rage this kind of sentimental, REMF bullshit evokes in me — and I’m one of those MFs myself.

It is only those who have neither personal experience nor the wit God or the Flying Spagetti Monster gave a mole rat who maintain death in battle is glorious.  This is, of course, a running meme of those whom someone — maybe Roy Edoroso? (corrections as needed, please)– dubbed the 101st Fighting Keyboardists.  Young and not-so-young (think the K’s:  Kagans and Kristol, among a hall of shame cast) never-fought (Dick Cheney…) love to talk about the grandeur of sacrifice and channel a bit of their inner Horace — all while maintaining a maximum safe distance from any possibility of personal engagement in same.

Tooth arm fighting folk know better of course — you don’t here real soldiers talking much, if at all, about “glorious” death.  Even that happy warrior Patton knew better — and George C. Scott was trying to capture military man’s point of view in the famous speech in the movie:  paraphrasing:  you don’t want to die for your country.  Oh no:  you want to make the other poor bastard die for his.

In fact, historically, nothing has irritated — to the point of rage — members of military at war as much as the foolish bombast of those serving safe at home.

I’m not going to go deep into the history of warfare, but one thing to remember is that while glory in war has always been an idea that rarely survived contact with the enemy, the evolution of industrialized war from the nineteenth century forward pretty much decisively separated the categories of bravery — which certainly persists — and glory.  A man covering a grenade to save his comrades is braver than I can imagine; being blown to death by shrapnel is a horror show.

From the battles of the Civil War, which is perhaps not the precise mileston, but remains a pretty good marker for the first waging of war on industrial methods, through the terrors of the so-called Great War, until now, when death comes from  head trauma induced by a homemade bomb by the road, concealed under yesterday’s rotting trash, war is no longer, if it ever was, a glorious stage on which Paris can march to his doom against Achilles — and the men and women on the front lines know it.

Meanwhile — what of us, those who have had the good fortune to live lives in a large and prosperous country; who have had the security of two big oceans protecting us from many of the world’s evils, and have never served?

We do not have the fact of experience to tell us that the myths and pulp fictions that glorify death in battle are bull shit.  But we have our brains, and we can read.  I’ve ranted long enough.  Let me give you just one quote from the trenches in World War I that I wish P. J. had remembered.  It’s from Robert Graves’ memoir of his life as a poet and junior officer in the trenches.  I used this quote in the account of the Western Front I told in my book Einstein in Berlin; the apparatus outside the quotation marks comes from that telling.

In June, 1915, Robert Graves came upon a man, still alive, whose brains were spilling out of his head into the mud at the bottom of a trench.  The sight had retained the power to shock the usually sardonic Graves:  “I had never seen brains before; I was someone who regarded them as a poetical figment.  One can joke with a badly wounded man…One can disregard a dead man.  But even a miner can’t make joke over a man who takes three hours to die after the top part of his head has been taken off by a bullet fired at twenty yards range.”

Glory talk, and the paralysis of thought such talk evokes, have a lot to do why we are in the tiger trap right now.  I’m sorry P. J. is ill.  I hope he has a full recovery.  But he needs to get his head as well as his ass right.

Image:  John Singer Sargent, “Gassed,” 1918.  Source: Wikimedia Commons.