Ever since Richard Nixon declared a "war on cancer," science policy leaders, foundations, and the pharmaceutical industry have been promising imminent breakthroughs against cancer. The much heralded "cracking of the genetic code of life" has led to renewed optimism. President Clinton's assurance that "we are learning the language in which God created life" has been accompanied by prophecies of medical breakthroughs. The business press speculates on likely winners among the drug manufacturers. Unfortunately, as long as the focus in this war remains on genetics and miracle cures, corporate profits are likely to exceed the gains in longevity.
Political leaders launched the cancer war when it became apparent that cancer rates had increased dramatically in the post-World War II period. Yet genetic changes cannot explain the increased incidence of cancer. A half century is but the blink of an eye in terms of human evolution. Nor can higher cancer rates be explained simply in terms of an older population.
There has been great progress against some relatively rare forms of cancer, and chemotherapy seems to have achieved modest successes against more common cancers. Nonetheless, careful analysis suggests that some of the gains claimed in the cancer war are statistical artifacts. More precancerous lesions are discovered early, but some of these would not have led to the death of the patient. Our apparent cure rates go up faster than longevity. Even more telling than the controversial statistical nuances is the nature of many cancer cures. The cost is enormous and side effects often take a toll on both the patient and the family.
The new genetic medicine promises that approaches tailored to the individual patient will be able to avoid the worst side effects of current chemotherapy regimes. Certainly one cannot rule out such an eventual outcome, but sober assessment of the current breakthroughs suggest caution. As one specialist in the field pointed out in a recent op-ed in the Toronto Globe and Mail: "our current state of knowledge regarding human genetic makeup is like citing an incomplete copy of The Concise Oxford English Dictionary as the model from which Shakespeare created his plays. All that remains now is to find the prepositions, grammatical rules and phonetic indications ... story lines, dialogue and literary devices ... Genes are codes for the synthesis of the proteins that give a particular cell its characteristic structure and functions. They are, as it were, alive and dynamic architectural and mechanical plans. Whether the plan becomes realized depends on far more than the gene itself."
That "far more" includes a large environmental component. Epidemio-logical evidence suggests that environmental factors play a large role in the increased incidence of cancer. A Scandinavian study of 90,000 twins reviewed by Robert Hoover in the July 13 New England Journal of Medicine strengthens arguments many epidemiologists have made over the last decade. For cancer at four of the five most common anatomical sites, "estimates of the proportion of risk due to environmental factors were all 65 percent or greater."
Unfortunately, last year nearly 20 percent of the NIH's $15.7 billion budget went to the cure-oriented National Cancer Institute. Less than 3 percent of the NIH's budget was allocated to the National Institute of Environmental Health Sciences, which supports research into the causes of cancers. Barbara Brenner, director of Breast Cancer Action, has sought to mobilize support for a bill in Congress recently introduced by Sen. Dianne Feinstein (D-Calif.) to renew the breast cancer stamp. That unique first-class stamp cost 40 cents, with the extra seven cents going to cancer research. Brenner advocates that it be amended so that future funds raised by the stamp be allocated to the National Institute of Environmental Health Sciences. Maine 's two women senators could, of course, play a pivotal role in the future of this legislation. Though the funds involved are not large, the bill raises important issues.
Medical researchers like Hoover are not suggesting that genetic studies are inappropriate. Information about environmental exposures can point to genes that might modify risks, and identification of genes associated with risks can suggest previously unidentified environmental risks. Unfortunately, faith in the genetic code as "the book of life" will lead us to exclude these interactional approaches.
A cancer war based on genetically engineered cancer cures leads us away from messy battles over possible environmental carcinogens. It also offers prospects of new profits from patentable genetic modifications. Yet these research and science policy agendas cannot be explained solely by corporate interests. They square with long standing cultural faith in technology. They are sustained by the normal confidence of researchers who devote large portions of their lives to technical disciplines. Nonetheless, before we cheer victories in the latest cancer research battles, we need to take a closer look at the role the politics of science and corporate finance continue to play in that war.
John Buell lives in Southwest Harbor and writes regularly on labor and environmental issues. He is co-author, with Etta Kralovec, of The End of Homework: How Homework Disrupts Families, Overburdens Children, and Limits Learning (Beacon Press). He invites comments at firstname.lastname@example.org