The Cancer Chronicles burst forth when it was published last summer with some extraordinarily positive reviews including one by a much respected science writer, David Quammen, whose wonderful book Spillover I reviewed in OT's2/10/13 issue. Nonetheless, I was somewhat skeptical. The subtitle—“Unlocking Medicine's Deepest Mystery”—seemed like an overreach, even by an accomplished science writer like George Johnson. That coupled with the personal account of his wife's cancer made me suspect that this might be another book with a superficial exploration of the complexities of cancer mixed with personal anguish and anger at the diagnosis.
What I discovered, though, was a forceful and well-crafted book. It carefully examines and dispels many of the commonly held illusions about cancer causation and weaves the personal story skillfully into a dispassionate and insightful view of his wife's illness.
George Johnson writes regularly about science for the New York Times. His work has been included in “The Best American Science Writing,” and he has received literary awards from the American Association for the Advancement of Science. Although his usual focus has been on the physical sciences, his wife's diagnosis led him to do extensive research into cancer biology, reading more than 500 books and articles, attending national cancer meetings, and personally interviewing scores of the world's leading cancer researchers.
His meticulous homework shows. The result is a brief but comprehensive and authoritative examination of the history and mysteries of cancer. While one might argue that The Emperor of all Maladies (OT 2/10/11 issue) is a more satisfying book for oncologists and cancer researchers, The Cancer Chronicles is a superb book for cancer patients and their families. The science is skillfully handled and most of the common myths about environmental carcinogens, nuclear fallout, cell phones, microwaves, cancer clusters, vitamins, and the protective effects of fruits and vegetables are carefully reviewed and put in their proper scientific place.
The author uses his wife's illness as a roadmap to delve into the origins and limits of cancer treatment and to explore the relative role of environmental and genetic factors. He also provides a candid view of cancer management from a patient and loved-one's perspective. Here Johnson's writing skills are in full display as he describes the radiation experience: “For the radiation she was taken into a lead-lined room. Alone with the robot deftly swinging its arm and zapping its preprogrammed targets, she felt like she was in sickbay on the Starship Enterprise.”
As Johnson examines the history of cancer from the first identification in a 150 million-year-old dinosaur through fish, mammals, early man to the present, he senses “something comforting about the fact that cancer has always been with us.” It is not an illness brought about by something causally linked to modern history. “That it is not all our fault. That you can take every precaution and still something in the genetic coils can become unsprung.”
He notes the mutational frequencies in our cells and the myriad defense mechanisms we have to thwart the disease. He then ponders that “with so many checks and balances, a person must be extraordinarily unlucky to get cancer. Then again, with so many things that can go wrong, it is amazing that cancer doesn't happen all the time.”
During the research for the book and in the course of his wife's care, Johnson had a close look at the practice of oncology as well as the environment in which we all work. Given his thoughtful and reasoned approach to the entire subject, his reactions should give us pause. When the original diagnosis was made, the surgeon felt that referral to an oncologist would be premature since the site of the tumor was not known. Johnson's view is “that what is a crisis for the patient is routine for the doctor.”
When given the diagnosis, the doctor provided a hug, followed by reams of paper and referrals for procedures with long lines and indifferent personnel. When his wife was finally referred to an oncologist with a diagnosis of metastatic uterine papillary carcinoma, she was told “we will cure you.” Wow! A lucky oncologist indeed, since she is thus far cancer-free.
On visits to national oncology meetings, Johnson was surprised at the profuse presentations and felt it was hard to think of cancer as medicine's neglected stepchild. He was also shocked to see the burgeoning for-profit links between academics and the commercial world. His concern should remind us that many still remain uncomfortable with the growing academic/industrial linkages in oncology.
His visits to national meetings introduced him to the annual receptions: “Lavish buffet tables, bartenders at six stations with copious pours of good wine. Crowds flowed into a ballroom with more drink, dessert, and dancing.” One is tempted to dismiss such comments as expressions of frustration by someone whose wife is undergoing treatment for cancer. On the other hand, it may well be an honest view of how many outside oncology see us.
Still, I don't want to leave the reader of this review with the idea that the book is simply a rant against the oncology community. Johnson's comments about his experiences form only a very small part of the text. I highlight them here only to provide all of us food for thought.
Much of the history of cancer and the science both ancient and modern in The Cancer Chronicles will be well known to most oncologists. That said, the book is brief (204 pages), yet still comprehensive and rich. While the book falls short of “unlocking medicine's deepest mystery,” it does provide the reader with a balanced understanding of what we know and what we don't. In a curious way, it should be reassuring to the public to realize that there is not one strategy, food, supplement, or lifestyle that we are missing that is likely to markedly reduce cancer risk. As Johnson says, “Sometimes it feels like we are chasing our tails, obsessed with finding causes when there may be none.”
If you have patients or their families who want to read a balanced, accurate, informative, honest, and well-researched book on cancer, recommend The Cancer Chronicles. It's the finest book for the lay reader that I have come across in a long time.
ALFRED A. KNOPF, 2013, ISBN: 978-0-307-59514-0; AVAILABLE IN HARDCOVER, PAPERBACK, AUDIO, AND KINDLE EDITIONS
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