Rethinking Cancer

I was blown away by the scope, clarity, interdisciplinary artistry, and intelligence of Siddhartha Mukerjee’s 2010 book, “The Emperor of All Maladies: A Biography of Cancer“. Like Atul Gawande, Mukerjee somehow practices medicine, runs a world class research lab, while being married with two school-aged children. I like this quote from his wife, Sarah Sze, a MacArthur Genius grant recipient and tenured art professor/sculptor at Columbia.

“‘You can’t get lost in the everyday details. Sid and I are both totally like that, which can be not good with things like parking tickets. Sure, things are falling through the cracks all the time, but that doesn’t matter. The big things matter.'”

I haven’t read Mukerjee’s 2016 book, “The Gene: An Intimate History,” but did just finish his recent New Yorker essay, “The Invasion Equation,” about how cancer biologists are rethinking cancer. And he’s done it again, written so clearly even I can make sense of the science. His writing is deeply engaging on top and will not disappoint anyone interested in the current state of oncology.

A one-sentence caption on the second page of the essay summarizes the shift in thinking:

“We’ve tended to focus on the cancer, but its host tissue—”soil,” rather than “seed”—could help us predict the danger it poses.”

Later, he elaborates:

“It was only natural that many cancer biologists, confronting the sheer complexity of the whole organism, trained their attention exclusively on our “pathogen”: the cancer cell. Investigating metastasis seems more straightforward than investigating non-metastasis; clinically speaking, it’s tough to study those who haven’t fallen ill. And we physicians have been drawn to the toggle-switch model of disease and health: the biopsy was positive; the blood test was negative; the scans find “no evidence of disease.” Good germs, bad germs. Ecologists, meanwhile, talk about webs of nutrition, predation, climate, topography, all subject to complex feedback loops, all context-dependent. To them, invasion is an equation, even a set of simultaneous equations.”

My take-away from Mukherjee—whether you or I are likely to die from cancer depends largely on whether oncologists learn to think like ecologists.

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