War Against Cancer
Won't Be Won Soon

By Theodore Dalrymple
Copyright 2000 The Wall Street Journal
June 12, 2000

Al Gore's recent offer to rid America of the scourge of certain cancers reminded me of the opening sentence of Evelyn Waugh's 1953 dystopian fable, "Love Among the Ruins": "Despite their promises at the last Election, the politicians had not yet changed the climate."

There have been wars on cancer before, of course, most notably those of the Nazis and of President Nixon. The former attempted to implement the measures against smoking that Mr. Gore now proposes, but came up against the kind of vested interest that Mr. Gore mysteriously omitted from his speech: a government, for example, that derived large revenues from sales of tobacco.

Mr. Gore's June 1 speech nonetheless soared rhetorically into a golden future, via a brief excursion into the realms of Mary Baker Eddy. He told the inspiring story of Camari Ferguson, a woman who most unfortunately had breast cancer before age 33, who was treated for it, and who then climbed to the top of Mount Rainier to celebrate three years of recovery.

"Camari's story is what any cancer survivor will tell you," said Mary Baker Gore. "The power to fight cancer comes from the heart, and from the human spirit. But most of all, it comes from being able to imagine a day when you are cancer-free."

This carries the implication that those who succumb to cancer -- some 500,000 a year in the U.S. alone -- might be deficient in the requisite human spirit. It also makes you wonder why so much more research is necessary when the power to overcome cancer comes from merely imagining yourself cancer-free. But of course, Mr. Gore didn't really believe what he was saying, and didn't really expect us to listen.

He went on to ask us to imagine waking up one morning and reading in the newspaper that not a single American had died of colon or prostate cancer. This indeed would be surprising, since it wouldn't be news even if it were true. How often do we read that not a single American died of smallpox or bubonic plague? Technical progress is taken for granted, and unless human nature changes greatly in the future, a single death from dog bite will be more newsworthy than the failure of 250 million people to die from cancer.

I am not against technical progress, of course, but Mr. Gore seems to have an exaggerated view of its possibilities. He looks forward to the day when simple blood tests will tell us whether we have cancer. If we do, treatment will cure us before the cancer gets hold. If not, we can rest assured for another year -- or six months, or three months, or a week or two, until the next blood test.

Screening of the kind Mr. Gore has in mind has its disadvantages as well as advantages -- a fact he didn't mention. Chief among these is the false-positive test. In Bristol, England, from 1988 to 1993, 225,974 cervical smears were performed on women. Abnormalities were found in 15,551 women, of whom nearly 6,000 underwent a colposcopic examination. But this immense labor, which in itself constituted an entire industry and undoubtedly caused great anxiety to thousands of women, had no detectable effect on the death rate from cervical cancer in the city.

The problem is that once screening has been instituted, it is impossible to stop. The slightest possibility of detecting an early cancer weighs much more heavily on the mind of the public than the strongest probability of undergoing an unnecessary medical procedure.

Mr. Gore spoke as if defeating cancer were the same kind of proposition as going to the moon. If President Kennedy could order a landing within 10 years, why cannot Mr. Gore bid the sickness cease in the same period?

It is worth remembering that very few, if any, diseases in history have been eliminated as large-scale threats to human life by curative means alone. Prevention, either by public-health measures or by immunization, has been much more effective than cure. And cancer is inherently a more difficult problem to solve than, say, polio, to whose elimination that Mr. Gore optimistically referred in his speech.

That the chances of a person suffering from cancer increase decade by decade suggests that carcinogenesis is largely a consequence of aging. Four-fifths of men over 80 have evidence of cancer in their prostates. Only a few cancers have been successfully linked to an environmental cause, and few display much of a hereditary predisposition either. In other words, we don't have much of a clue.

Mr. Gore pins his faith in genetic engineering. Perhaps the wonders of science will be able to reverse the very process of aging that is responsible for the great majority of cancers.

But this is a dream we have had before, and not so long ago. The science of hormones then seemed to the likes of Mr. Gore the key to eternal youth, and those who could afford it (even within my lifetime) had monkey glands implanted in themselves in Swiss clinics. Aldous Huxley wrote a novel about it. I need hardly add that the hope proved illusory, and by no means cheap.

Of course, it is just possible that this time we really have found the key to eternal life -- which is almost what the conquest of cancer would amount to. But so far the tremendous advances in knowledge of cell biology, of which the genome project is an example, have not been translated into practical medical benefits for the great majority of people. To raise the prospect of a cancer-free America (or anywhere) is premature and irresponsible, and will serve only to raise unreasonable expectations.

In choosing cancer as his enemy, Mr. Gore displays the moral cowardice typical of modern politicians, for who will defend cancer as a good thing? Here is hubris without the possibility of nemesis. Mr. Gore's attitude to cancer is approximately the same as President Hoover's to sin -- he is against it.

. Theodore Dalrymple is the pen name of Anthony Daniels, a British physician and contributing editor of City Journal.