This is the story of cancer infused with historical depth, scientific rigor, caring, compassion, and luscious language. Mukherjee crafts the text with such skill, infusing human stories, history, and a physician’s perspective among the timeline of cancer as it’s affected human life and health. As I worked my way through this book, I found myself underlining sentences, many of them juxtaposing the hauntingly beautiful with the terrible.
Cancer, Auerbach argued, was a disease unfolded slowly in time. It did not run, but rather slouched to its birth.
Or when describing Susan Sontag’s leukemia:
“A moody, saturnine leukemia eventually volcanoed out of Sontag’s marrow.”
Although I’ve never done cancer research, I’ve learned a lot about it in my reporting. But what I’ve learned is episodic: a cellular pathway, a policy point, or a set of treatments. This volume pulls those episodes together like jewels on a necklace, creating a comprehensive picture and an understanding of a disease that’s as powerful and compelling as the stories of the patients. Not only was this book beautiful to read, but I’ll be better at reporting about cancer because I’ve read it.
Image: Human melanoma cell dividing. Credit: Paul J.Smith & Rachel Errington. Wellcome Images
It’s Nobel Prize season again, and the science behind this particular award for Medicine feels like a familiar friend. I got my crash course in telomeres and telomerase from a group meeting talk that one of my lab colleagues gave almost exactly a decade ago.
The science recognized was done a quarter century ago. DNA sequences have protective caps called telomeres that are maintained by a riboenzyme, telomerase, but the implications for the scientific understanding of aging, cancer and stem cells remain active research areas. Telomeres get shorter as we age, and maintenance of telomeres in cancer cells may help them continue to survive and divide. Part of the understanding of stem cells and their capacity for regeneration (or to cause cancer) will come from a better understanding of their telomeres.
The policy side of my reporting head has also turned to health issues over the last year or so, particularly global health. From a Western perspective, it’s easy to take for granted the scope of care and treatments that are available. But the developing world is light-years away from even hoping to have access to so many of the (not even cutting edge) medical innovations that we often take for granted.
My growing interest in global health policy and a talk by Franco Cavalli at a symposium on translational cancer research at Hunter College in January, led me to take on the issue of global cancer control planning in my article that was just published in theJournal of the National Cancer Institute (subscription required). Here are some of the stats that impressed me as I was working on the article:
More than half of the expected 27 million cancer cases in 2030 are likely to occur in low and middle income countries.
At least 80% of the world’s population lives in areas not covered by cancer control registries, that keep track of basic data about cancer, who gets it, what types and the outcomes. It’s incredibly difficult to figure out any sort of policy solution when policymakers don’t have a real handle on the problem.
Most countries in Subsaharan Africa have no radiotherapy machines available to treat cancer.
Providing better cancer care in these countries is first and foremost about developing a plan, and then figuring out how to bring in the resources to support their needs. Without a clear plan, any resources provided don’t get used in the most effective way.
I learned a lot about Tanzania’s cancer control planning. Although an extremely poor country with a number of problems to solve, it’s humbling to realize that even with their challenges– not enough facilities to meet demand and a shortage of trained medical professionals– the situation there is probably better than in most neighboring countries. As another example, India seems to have more overall resources, but planning is regionalized and care is more available in urban areas than in rural ones.
It’s these moments that make me stop and realize how fortunate I am– I was born to educated, middle-class parents in a country with a functioning (albeit sometimes dysfunctional) health care system. The tricky challenge in the developing world is finding the solutions that fit the needs of individual countries– physically and culturally– and bringing in the right combination of government, NGOs and others to put those solutions into practice.
A related note: over the last few weeks, Denise Grady of the New York Times has published articles about women’s reproductive health in Tanzania (here and here) with detailed first-hand reporting.