[Translated from MSZ 6/84]
Advances in cancer medicine
BELIEF CONQUERS KNOWLEDGE
The expert knows, and the layman is not a bit surprised, that cancer has to be counted as one of the so-called “diseases of civilization,” along with heart, circulatory, and rheumatic diseases. The expert knows how “civilization” manages to produce its own forms of health damage, but the layman is hardly interested. First, because, as a layman, he has to leave it to the experts anyway. Secondly, because he has already been entrusted with a satisfactory insight into the source of the disease when people in the know have given it the commonly understood name “civilization.” And thirdly, because, what’s more, he gets news about the helplessness of the medical profession in messages that are always popular. He is constantly kept up to date about cancer by the experts in particular. This disease, according to those who need to know, represents “a biological mystery shrouded in enigma,” cancer research opens up a “labyrinth of fantastic hypotheses and speculations,” and the question “hereditary disease?” is as high on the list as the answer: “fate.”
The “cancer mystery” – a diagnosis
Such answers are countered not only with the pedantic observation that “fate” belongs more to the banal branch of the psychological advice business than to the realm of science. Medicine, too, has long had more to say about cancer than the tip that you “have to live with it” once you have it; for example, the sober finding that“by far the majority of cancers are caused by chemical noxae. In particular, chemically induced occupational cancers involve a plethora of chemically well-defined substances.” (K.H. Bauer)
What’s here known to be the reason for an increasing number of cancer cases does not prevent medical researchers from accusing themselves of a lack of knowledge. They want the matter to be regarded as the “last great riddle of medicine” – as if the inability to cure a cancer patient were the same as a gap in knowledge. There may still be gaps, especially since “civilization” is still good for some new things, at least in the field of diseases. However, research has expanded knowledge not just about the biochemistry of carcinogenesis. The action of various carcinogens has been traced to the structure of cellular macromolecules, and the binding of cancer-causing chemical substances to cellular elements is no longer a mystery. There is now also a secure catalog of “legally-regulated occupational cancers” and an impressive list of pollutants which, when the “human body is continually exposed” to them, do not result in cancer by chance. However, medicine is not at all satisfied with this. The practical reaction that their knowledge would suggest is plain and simple: human bodies must not be constantly exposed to these substances! Of course, this is not a medical answer in the sense demanded by representatives of the guild: “Occupational cancers are important signposts for research into the effects of chemical cancer toxins” – that’s the internal diagnosis, and the definite discovery becomes the beginning of a research program. Accustomed to dealing with disease – curbing inflammatory processes, relieving pain, sparing or removing organs that are strained to the breaking point, so that one can live and work with the disease – the medical profession sees completely different tasks ahead of it than pressing for the abolition of the causes that it knows about. New questions arise about dealing with cancer, as corresponds to the ethos inside medicine.
“Stimulus or predisposition”
Which substances cause cancer through their influence on the cell organism was already explained 40 years ago by the Noble winner Adolf Butenandt. But even for him, the banal demand that one should spare people from harmful substances was too unproductive as a path to further research. With the authority of an expert, he developed a new problem from his medical knowledge:“The decisive question as to whether the local stimulus or the general predisposition of the organism is the primary factor in the development of cancer under the effect of carcinogenic substances has deliberately not yet been discussed in detail.” (Butenandt, The Structure of Carcinogenic Substances, 1937)
The search for the “primary factor” is owed to an academic game of back and forth with cause and effect. The fact that the cause, the carcinogenic substances, can fundamentally be only moderately successful because, and to the extent, that the organism allows the effect – this observation incites the inquiring mind’s sense of justice that aims at controlling the disease. Being responsible for the damaged organism, the cancer engineer can’t help but suspect that the human physique is an extremely vulnerable device. With a gesture of the highest scientific conscientiousness, he suspects that this is possibly an equal, if not even primary, factor in the disease. That is why cancer researchers are interested in those types of people who have not had cancer even though they have been exposed to solvent vapors, asbestos dust, and other unpleasant ingredients of their “environment” throughout their working lives. With the statement that“only a part of an equally exposed group of people actually gets cancer,” (Oeser, Cancer: Fate or Fault?, 1979)
the healers give away their ideal. Victory over the “scourge of mankind,” which is incumbent on them, has to result from their yet-to-be-created ability to enable the body to deal with cancer. Translated into the logic of a research program, this simply means viewing the physique as a hypothetical failure mechanism that could be responsible for the disease. Seen in this light, it sounds very reasonable for a theorist to argue that carcinogens are“not capable of causing cancer, but can only cause cancer under certain internal conditions.” (Prof. Krokowski at the Cancer Congress in Kassel 1978)
Powerlessness and concerted efforts
are combined in the characteristics exhibited by conscientious cancer physicians. In confessing their (temporary) inability to cope in practice with the relevant diseases, they present themselves as serious and realistic: they reject hopes in their craft as futile. However, with the addition of a “yet” – because, on the other hand, they work tirelessly on a program which they have taken on themselves with the resolution to find an
intervention point in the body
as the remedy against cancer. The guiding principle for their efforts in this regard has been, and continues to be, the “insight” gained again and again from their “failure,” which puts the talk about carcinogens into perspective. For cancer researchers, physiological processes, which are well known to them, are given a new status – that of unknown conditions of the disease. And this idea is extremely productive. On the one hand, it demands constant repetition of public modesty:“We have recognized that many different causes and factors contribute to cancer disease” (pathologist Georgii, General Secretary of German cancer research).
The object of research is “complex,” the “hope for a quick solution has faded,” at best one may rely on “a later overview of the individual results” ... On the other hand, “disillusioned” cancer physicians continued to work diligently at cataloging another hundred cancer substances, swab the next generation of rats with chemicals, in order to examine, for example, the “potentiating influence of asbestos dust on the carcinogenic effect of benzo(a)pyrene” (Archiv für Geschwulstforschung 82/4), and demanded the lowering of the maximum workplace concentrations, as long as the medical repair efforts of clinicians did not significantly reduce the number of “work absences due to illness.”
Meanwhile, the construction of theories never came to a standstill. With interest turned toward the physiological conditions of cancer, the well-known processes of development – various chemical substances, physical irritations, etc., lead to different types of disease – appeared as rather useless material for a methodological interest as demanding as it was misguided. With the “factor” disposition, the need to search for a common principle of pathogenesis found its way into research. With knowledge of this, finally, the prerequisites for cancer in a patient could be brought under control through treatment. This intention gave rise to the zeal for tracking down “paradigmatic processes” and aiming at “models” as the goal of successful science.
The virus theory of cancer risk
became a smash hit in cancer research centers, and today medical scientists themselves proclaim in critical retrospect:“Given the fact that viruses can produce tumors in animals, many thought it certain that these agents would provide an elegant and easy way to solve the problem of human cancers.” (T.H. Maugh/J.L. Marx, The Science Report on Cancer Research, 1978)
– without criticizing the pragmatism – “we have the right remedy for every disease” – which defines the disease on the basis of a false analogy in order to be able to treat it in an “elegant and simple way.” Instead, Mother Nature is blamed for the “widely publicized failure of this line of research” because she has not allowed “a mystery wrapped in an enigma” to be wrested from her:“Many virologists have had to realize that the problems they are tackling are much more complicated than they suspected.” (Maugh/Marx)
To explain the fact that for more than two decades the main emphasis of research in American and European cancer centers was on the virus theory, with a “euphoric hope in a quick solution to the cancer problem” (Krokowski), downplays the aim of cancer medicine. The popularity of the virus theory resulted from the notion that the“evidence of viral carcinogenesis would allow the development of a vaccine to prevent and eventually eradicate the disease, much as vaccination against smallpox has virtually eliminated it in the United States.” (Maugh/Marx)
The crazy program of examining the lung cancer of a worker in an asbestos factory, the liver cancer of a chemical worker, all those cancers that arise from the cheap use of asbestos, vinyl chloride, chromium, etc., to see whether or not a virus is involved which would allow the destruction of health to be treated as an epidemic is not due to the overzealousness of physicians who have taken on a little too much for their relief program, but rather reflects a point of view which knows all about the physical ruination of people and wants to treat it affirmatively as a medical problem which also has to be solved by medical means.
Critics see in this position an “overestimation of modern medicine,” discover the “limits of scientific medicine,” and not infrequently end with a topical plea for the limitation of medical services.
However, the radical idea of cancer researchers about the ideal solution to the cancer mystery do not spring from the fantasies of miracle-working doctors who want to create “a new man who no longer knows death and suffering” (Spiegel series: Abandoned Illusions), but only highlights the error of medical expertise: Anyone who raves about the possibilities of a vaccine that makes people resistant to carcinogenic stress, who wants to medically “eradicate” the consequences of having to be reckless with one’s health, and to “immunize” the body against its destruction, relies on ideals of compensation which still show the cause of the damage and what medicine “restores” people for. Of course, physicians, convinced of their beneficial activity, do not want to know anything about the purpose of medicine, a service which helps humans endure everything that is expected of them.
The cancer-resistant human – an ideal ...
They prefer to hold on to the ideal of their usefulness even in the field of cancer diseases – by single-mindedly searching for a means by which they can also master this “freak of nature.” In scientific terms, this task means: we must enable the human organism to resist or cope with the relevant diseases. So specialists in the field of “human defensive behavior” research so-called “killer cells” that can destroy tumors, transplant antigens to promote immune response against carcinogens, and in comparative studies track down the sick person’s “missing” in order to record deviations in the production of physiological substances that medically define the “restricted immune behavior” and that are to be remedied as a “defects of nature.”
The use of the body's own defense substance “interferon” – a product of genetic research – and cancer vaccinations with tumor material were well-known and unsuccessful applications of cancer immunology which, with the theory of the cancer-resistant human body, gave rise to the naturopaths, whom it accuses of being charlatans who use mistletoe extract and oranges to increase resistance to cancer.
Health policy makers are encouraged by the establishment of medical screening, and true to the revealing medical logic “where a cure is not possible, screening is all the more important," the research plans of the national cancer centers promptly include efforts to expand screening into pre-screening:“The goal is to identify individuals at increased risk of cancer due to or related to genetic or behavioral factors and to form cancer risk groups.” (German Cancer Society Research Program)
Anyone who puts themselves at risk due to poor immune system defenses or even through an unhealthy lifestyle will be deemed unfit for the relevant tasks, prevented from ruining their health prematurely and unnecessarily, and allowed to let others take precedence. So oncologists are striving to provide a service that was previously reserved primarily for colleagues in companies who, when hiring, checked to see whether the person being examined was in good enough health to spend it. Nowadays, therefore, no one needs to fear that medicine could be misused and that they might fall victim to the outdated prejudice that “the Jewish race is twice as susceptible to cancer as the Aryan race” (one Prof. Frisch in 1942) – medical screening is carried out solely according to proper criteria.
... and its resignation: cancer-susceptible humanity
The guild sees this as the “realistic” consequence of the envisaged, but failed, breakthrough. Resignedly, they record what has come of their program:“Despite the unprecedented efforts of the last two decades, the success of cancer therapy has been improved by a maximum of 2%.” (Toxicologist Henschler)
Oddly enough, this resignation finds its way into theory construction – and in such a way that the explanations of cancer finally come in the form of ideas that reckon with the predisposition to cancer:“According to our present knowledge, it is the realistic hypothesis at the molecular level. According to this theory, carcinogenic information is already contained in the DNA molecules of normal cells, but cannot take effect because this dangerous part (or parts) of the DNA is suppressed by appropriate blocking proteins.
When a carcinogen binds to the blocking protein, it can be released, and the carcinogenic part of the DNA is free to transmit its information to the RNA, which is then translated into proteins.” (Ladik/Otto, New Ideas on the Mechanism of Chemical Carcinogenesis, 1979)
This “reading-error” theory subordinates all the knowledge about DNA and its role in matters of heredity to the poor logic that the possibility of cancer is inherent in the human genome. These enthusiasts for the image of “information,” which tend to be used to explain biochemical processes, will hardly benefit from being told: if cancer had not occurred, everyone who ever had a tumor would have remained relatively healthy. With their “localization” of the possibility in the genetic material, they finally go beyond the message that already exists in terms of a “predisposition” of the organism. With their “realistic hypothesis,” it will probably be important for them to inform mankind that the ability to develop cancer, because existing in DNA molecules, either takes effect or remains latent!
No doubt, the theoretical relocation of “predisposition” to inheritance, against which nobody can really do anything, announces a very learned and expertly formulated transition to the human-all-too-human.
Physicians today no longer tell “suffering mankind” that they will eliminate cancer with the help of their knowledge, but have changed their position to a rather skeptical view of things. They see the idealistic claim to compensate for the consequences of social destruction of health with medical means being relativized by their own standards of success, but they do not let this shake their self-confidence. If even the decades of efforts of their science have not brought a victory over cancer, then this must be in the nature of this disease, goes their logic, and every new discovery about the biology of the cancer cell provides scientific proof that cancer is a peculiarity of the human species like the appendix.
With the discovery of the cancer gene, the mystery of cancer has been solved. The scientific fact: by fusing human cells, which have previously been converted into cancer cells by carcinogens, with healthy cells from mice, various cell hybrids are created in which the genes of the DNA that had been damaged and thus caused the tumor growth could be detected. Since it is clear to every scientist involved that the generation of cancer-damaged DNA pieces in their experiments is the starting point for the growth of cancer cells, it requires some contortions to claim that“cancer genes are probably a normal component of all cells.” (Biochemists Reith and Gutjahr in their NZZ article: Cancer and Heredity, Disease as Fate?)
… and fault
However, the mission of medicine with its insights into “fate” has not been dropped. The moralist in the doctor, who has discovered the human being as a walking cancer risk, suddenly remembers the “environment,” which has been reduced to a “factor.” That means you have to be careful where you go:“Each individual has his or her own particular cancer risk; it depends in part on genetic factors that determine enzyme patterns, but also on the environment. Many substances, including drugs, but also alcohol and tobacco...”
The wrong enzyme pattern and then smoking – no wonder you have asbestosis!
The chain-smoking gene“Twin studies demonstrate that genetic factors predispose to certain forms of smoking and that different forms of smoking indicate genotypic differences.” (Prof. Oeser, Cancer: Fate or Fault?, p. 136)
Two critical letters to the editors in response to this article and the MSZ reply here:
Is cancer research on the right track?