It is the golden era of cancer writing. Rebecca Skloot’s The Immortal Life of Henrietta Lacks was a bestseller in 2010, Siddhartha Mukherjee’s magisterial Emperor of All Maladies: A Biography of Cancer won the Pulitzer in 2011 and this year we have When Breath Becomes Air by the late Paul Kalanithi, who was a 34-year-old non-smoking neurosurgeon when he developed lung cancer.
The science journalist Alanna Mitchell’s admirable Malignant Metaphor: Confronting Cancer Myths joins this series of thoughtful writings about the most reviled disease. Mitchell examines the idea of cancer and its reviling and, in it, she gets to the core of its importance.
As she points out, cancer is not exploding. Except in North America, its varied forms, even taken together, are not the most common cause of death, and here they are so relatively common only because of the recent and startling progress in lowering the death rate from cardiovascular disease. The age-adjusted death rate for cancer is declining in most western countries and, with the exceptions of thyroid and primary liver cancer, even the diagnosis rates are flat or falling.
And yet—cancer terrifies us. It arrives as inexplicable catastrophe and the inexplicable part stokes the terror. When someone among us receives the diagnosis, we recoil. The first instinct is to establish a reason for the largely random event and so blunt the fear. The healthy want to know that they would not be likely to receive such a diagnosis. This is received by the cancer victim as blaming, and the blame compounds the tragedy and the grief.
The first instinct among the inflicted is to protest their blamelessness. Every press release and news article on Kalanithi’s death is quick to point out that he never smoked a day in his life. As if the three quarters of lung cancers that occur in people who have smoked are somehow less sad, less painful, less disastrous for the bereaved.
They are not. And the women who did not have children or did not breast feed or were obese and who develop breast cancer no more deserve their illnesses than the colon cancer patients who did not maximize their fibre intake. This is to say nothing of the odious and evidence-free discussion of the so-called type C cancer personalities.
Mitchell’s entrance point to the narrative is the story of her brother-in-law, a vibrant and accomplished man, who developed melanoma. He was found to have metastases to his lymph nodes and the data for such advanced tumours are ominous: he was told he had a 40 percent chance of dying of the disease within five years. When asked what he might do to prevent further tumour spread, his Canadian oncologist replied that there was nothing. He described the interview as “funereal.”
Mitchell clearly adores her brother-in-law and her own concern for him is apparent as she describes his struggle with this. Although she does not dispute the accuracy of the information her brother-in-law is given, she is critical of the matter-of-factness of his Canadian physicians and supports his decision to pursue alternative therapy. He opts to receive high-dose vitamin C and injections of mistletoe extract under the direction of a Toronto-area naturopath.
Interwoven through an elegant and readable account of the biology and history of cancer—frequently citing Mukherjee—is this much more personal and emotional story of terror and the need to take charge of one’s own destiny. Mitchell’s brother-in-law is a wealthy man and he can afford to spend many thousands of dollars being assessed at Sloan Kettering in New York, and then on his naturopathic investigations and therapy.
As a science journalist, Mitchell states several times that she is naturally skeptical; she is frank about her ambivalence over the evidence for the “liquid biopsy” his naturopath facilitates, sending blood to a German laboratory to quantify the “circulating tumor cells,” in order to guide the dose and frequency of the vitamin therapy. But having cancer is about more than disordered cell physiology, as she shows us. It is about rejecting the blame and, especially, the paralyzing hopelessness that can attend the diagnosis. It is about living the best days or decades of life that remain.
She is not wrong, of course. The reader feels her eagerness to believe, as her brother-in-law and his wife do, that the vitamin and mistletoe therapy keeps him alive. At least overtly, she suspends her science journalist’s skepticism here, in order to explore the more personal experience of her brother-in-law’s distress. And that is interesting. But, as a skeptical science journalist, she could have addressed the considerable evidence that vitamin therapies for cancer are frequently not just ineffective, but actually promote tumour growth.
Her brother consults Ralph Moss, who has a PhD in classical literature and once worked in the media relations department at Sloan Kettering. He offers $500/hour telephone consultations on “the latest scientific findings around,” shark cartilage, coffee enemas and goji berries, among other alternative therapies. Her account of these interactions is subtle and nuanced. She is not able to state that her brother-in-law is wasting his time and money on quacks, but the dollar figures she cites for these services mostly make the point for her.
This is where Mitchell’s compassion and skill as a writer become most apparent. She never wavers in her support for her beloved brother-in-law and never pretends that her first interest in her subject is anything but his vitality. Alongside that story of familial love she tells another one, about the intricacies of our bodies’ unpredictable and lethal habit of betraying us, of eroding and deforming us from within until we waste away and depart our protesting families. About the preposterous and courageous human need to make sense of the senseless.