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.

Exercise and Cancer

More reminders. Life is fragile. A three year old child at our church has a brain tumor. Same with the English Teacher/coach at our local high school.  Same with Iram Leon.

Unless you’re already perfectly appreciative of your health, see a picture of Iram and read his entire story here.

Short version. Iram is 32. Kiana, his daughter, is 6. Iram Leon has an untreatable and inoperable cancerous tumor lodged in his brain. Statistics suggest the tumor will kill him before he is 40. He recently lost his job as a juvenile probation officer because his thinking is clouded and he says, “I was making too many mistakes on the stand.”

Instead of retreating into sedentary hopelessness, he runs. To the surprise of the medical community, a few weeks ago he ran a 3:07:35 marathon. While pushing Kiana in a baby jogger. “She had a blast,” Leon said, “listening to Disney songs and getting food from volunteers.”

From the story. “Recent research clearly shows that exercise improves outcomes for cancer patients.” And “Few other leads have shown as much promise as physical activity in extending the lives of cancer survivors, ” said an editorial last year in the Journal of the National Cancer Institute.

The problem is oncologists often urge their patients to take it easy. But the American Cancer Society and other medical groups now encourage exercise among cancer survivors including encouraging breast cancer survivors to lift weights.

A doctor in the story says, “Mr. Leon gives us someone to point to when a person fighting cancer says, “I can’t do it.”

I say Mr. Leon gives us someone to point to whenever anyone is trying to be a good father and human being. He’s only racing in events that will allow him to bring along Kiana. “I want her to have as many memories of me as possible,” he says. “I want her to remember us having fun together, not me being sick.”

Thanks Iram for the inspiration.