[Translated from MSZ 9/84]

Two critical inquiries

IS CANCER RESEARCH ON THE RIGHT TRACK?

For your information: many advances, lots of gaps, caution required!

“The June ‘84 MSZ article ‘Advances in Cancer Medicine’ is a decidedly annoying result of the tactic used to lure readers with topics that are hashed out in tabloids with great public appeal without being adequately informed about the subject. In the following, I would like to prove with some examples that the article consists to a large extent of errors and platitudes and that the correct statements are insufficiently worked out.
– In the Tübingen university newspaper of 6/4/84, the article was advertised with the claim that medical research into the biochemistry of carcinogenesis has ‘not been expanded too little.’ Similarly, the thesis in the article itself is that the reason for the increasing incidence of cancer is known. Both of these are simply lies. For example, there are only unproven hypotheses about the development of intestinal carcinomas, which are currently on the rise; malignant neoplasms also develop in children, which can’t be explained by exposure to harmful substances; asbestos exposure is really the cause of only a small proportion of malignancies. Nor is it true that ‘the binding of cancer-causing chemical substances to cellular elements is no longer a mystery.’ At the moment it doesn't matter at all, because no matter what the mechanism is: ‘human bodies must not be constantly exposed to these substances.’
- You write: ‘as if the inability to cure a cancer patient were the same as a gap in knowledge.’ I don't understand what you have to complain about (some types of cancer are curable nowadays and were not in the past because of gaps in knowledge).
- You criticize the ‘wrong methodological interest’ and notice a ‘sense of justice’ in the researching physicians, probably based on the wrong assumption that the carcinogenesis itself has been explained (by the way, there are actually types of cancer that are coupled with viral diseases – Burkitt’s lymphoma –; there are also some in which the predisposition is inherited – congenital DNA damage with skin tumors or e.g. also frequent intestinal polyps that easily degenerate).
- You criticize the ‘ideals of compensation which still show ... what medicine ‘restores’ people for.’ There would be a point to compensation if it were possible. If there were a good remedy for asbestosis, there would be nothing wrong with compensation. Because if damage can be avoided at the level of compensation just as well as at the level of origin – o.k. But that’s just not reality!
- You would say to a cancer researcher: ‘if cancer had not occurred, everyone who ever had a tumor would have remained relatively healthy’ – what’s the point of that?!).
- That the 'the theoretical relocation of “predisposition” to inheritance announces a very learned and expertly formulated transition to the human-all-too-human' is nonsense. If I understand correctly, by 'human-all-too-human' you mean leaving scientific grounds. It is hardly possible to prove that studies which have found that the disposition to some types of cancer are inherited are not correct. So the transition quoted above does not exist.
However, they have very little to complain about the expected messes ('a point of view that is familiar with the physical ruin of people'), or they put the unreasonable demands on economic 'requirements' into perspective. (For carcinogenic substances, there are generally no MAK values (= maximum workplace concentration) which still require that if their value is observed, no health problems should occur within an eight-hour day. Rather, there are TRK values (= technical guideline concentration) for carcinogens, which based on the technical protection options and measurement technology.)
- Quote: '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’ – here the helpers are grabbed at the wrong point. They (gladly) admit that they are only repairmen. They do not, however, object much to the expected scandals (‘a point of view which knows all about the physical ruination of people’), or they relativize unreasonable demands to economic ‘requirements.’ (For carcinogenic substances, there are usually no MAK values (= Maximum Workplace Concentration), which still require that if their value is observed, no health problems should occur in an eight-hour day. Rather, there are TRK values (= Technical Reference Concentration) for carcinogens, which are based on the technical protection possibilities and on measurement technology).
- Finally, the last sentence: ‘The wrong enzyme pattern and then smoking – no wonder you have asbestosis!’ acts as if medical knowledge (asbestosis) is intentionally suppressed. But it is actually the case that anyone who wants to can find out where asbestosis comes from - only: the conceit that his health is acknowledged to be the highest good (abolition of asbestos) should be put out of his mind.
U.L., Tübingen

Dear editor,
According to your announcement for the cancer article in the MSZ, it should show that “everything that medicine has to find out has long been researched.” I can’t share this view. I find your characterization of medical cynicism true and correct, that it doesn’t take the results of the research, that approx. 70 to 80% of cancers are chemically induced, as a chance to take action against exposure to the well-known noxae, but rather to embarrass this knowledge for its vast ignorance of carcinogenesis. The narrow-minded and socially affirmative effort to find a strictly medical solution to the cancer problem and to innocently wash one’s hands of everything else, then causes antics like in the case of people like Grundmann, who prefers to speculate on a possible controlled use of DNA-repair enzymes, but so far we don’t know much more than that there is something being done in this direction.
However, I think it is wrong to apply the criticism of the affirmative position of cancer research to its factual endeavors. It remains scientifically an exciting question how a known carcinogen can cause a degeneration in the cell. Your self-satisfied statement that ‘if cancer had not occurred, everyone who ever had a tumor would have remained relatively healthy’ is simply anti-scientific. Likewise, your dismissal of the results of cancer research regarding viruses, immunology, and gene involvement as ideologically motivated research orientations ignores the fact that there is much more to these areas than you present. (Cf. publications Klin. Wschr., Verh. d. dt. Ges. f. Innere Med., etc.) I do not see any reason to criticize the search for a common principle behind the effects of carcinogens and possibly also to find ‘the’ remedy against cancer. For this, even the chain-smoking comrade in communism would certainly be very grateful.
Best wishes, K.D.

Some clarifications about cancer, cancer medicine, and healthcare policy

1. Knowledge and knowledge gaps

First of all, a misunderstanding should be cleared up, which is useless as an accusation against our article. We did not claim that cancer researchers know everything about the disease in question with all its subdivisions. And even less did we come up with the criticism that this beautiful knowledge was being “deliberately withheld” If the former is attached to our presentation, it is a “simple lie.”

“There may still be gaps, especially since ‘civilization’ is still good for some new things, at least in the field of diseases.”

The assertion that the biochemistry of carcinogenesis has found out some things should also not be countered with a reference to an “e.g.”: ignorance in one place does not mean that nothing has been clarified in other places either!

Therefore, once again, what we do not want to deny, even if cancer research itself celebrates the type of relativization of existing knowledge just mentioned: Pathological changes are caused by the effects of external noxae; neither the number nor the increase in chromosomal abnormalities can be explained by physiological processes, which also include spontaneous mutations in the gene area. Beyond the frequent coincidence of certain chemical, physical, or infectious noxae with circumscribed forms of cancer, the “how” of some carcinoma has been clarified: ionizing radiation destroys molecular bonds, chemical radicals change the nucleotide sequences, etc., asbestosis occurs with a certain fiber size and concentration of asbestos …

2. “How is cancer possible?” A wrong question and its answer

One thing the relevant knowledge is admittedly not: knowledge that allows medical treatment of the disease. From the point of view of repair or even prevention, the available explanations appear as findings that are (still) useless. Seen in this light, the question becomes “exciting,”

“how a known carcinogen can now cause degeneration in the cell.”

Why, dear expert, did you, like the whole cancer research guild, come up with this “can”? Because you think it is rational to continue research in the direction of possibilities? And that’s why you consider our remark to be anti-scientific, which only says that the possibility of cancer is really not up for debate!

Anyone who takes the question of the possibility seriously is concerned with how cadmium, chloromethyl ether, radon gases or the SV40 virus change the DNA structure. However, in the conviction that all causes are only “triggers,” the reason lies though in a failure, in a deficiency of the cell and the reactions that take place in it. This dissatisfaction does not concern deficient explanations, but the public health purpose of the immunity to be provided by medicine. How can one reduce the consequences of all harmful noxae if they continue to exist; a common principle would have to be found be found, what makes the body immune – vaccination against the virus, gene therapy against the cancer gene. The mistake is the same for both: The result, the damage, is claimed to be caused by the organism, so that it is only “triggered” by the known carcinogens; the platitude that without an effect nothing would be a cause is turned against the cause.

These researchers are not challenged by the fact that the DNA was not cancerous at all before the “triggering,” but even performed physiological functions:

“Oncogenes (HERVs) are of particular interest in their viral and their cellular forms, i.e. those occurring in every cell. An oncogene can be transformed from a dormant to a malignant transforming form by a point mutation (!), i.e., by exchanging a single nucleotide.... In other cases, oncogene activation was accompanied by major changes.... Solutions to some (certainly not all) burning questions of tumorigenesis are beginning to emerge." (MMW 125 (1983) 26, 585)

Seen in this way, every gene whose transformation means malignancy is an oncogene; the reason for the cancer is in the gene, because it might degenerate – the transformation of the possibility into a necessity: if the cancer was not possible, everyone would probably have remained quite healthy...

A normal gene is thus entangled in a dormant cancer gene, sometimes called an oncogene, sometimes called a proto-oncogene:

“Oncogenes appear to be descended from so-called proto-oncogenes, which are present in all normal cells and play a role in growth and differentiation. By mutation, the proto-oncogene becomes an oncogene and now produces an abnormal ‘malignancy’ making protein.” (Moku ärztl. Fortb. 34 (1984) 6,24)

When actual “solutions are emerging,” who still wants to ask big questions about cancer and mutagens? After all, these are only the triggers, whose elimination can’t eliminate “the” cancer!

The virus and gene theories ask how the altered genetic material can come about, regardless of the substances that caused it: does a DNA virus somehow attach itself to the DNA, or is the DNA sequence that then “mutates” always been contained in the DNA strand?

With the abandonment of the virus hypothesis in favor of the gene hypothesis, however, there are also signs of an ideological transition, namely in the assignment of blame. Apparently, the focus on the virus is too much on the “outside” and does not make it clear enough that the nature of human beings is to blame for cancer. The conclusion that not all asbestos workers get cancer, so there must be something wrong with the constitution of some people, or references to the fact that Hippocrates described something like cancer 500 years before our time are departures into the “human-all-too-human.”

Unfortunately, counterexamples can also be used (Burkitt’s lymphoma, colon cancer, etc.) in the same direction. If you know that a virus is responsible for a specific disease, you don't have to hypothesize that the virus is also at work in asbestosis. We didn’t demand the opposite, as is reproachfully implied in the sentence:

“asbestos ingestion is really the cause of the development of only a small proportion of malignancies”

Rather we have criticized that even known causes for exactly circumscribed diseases are relegated to the department of mysteries, because they do not come into question for other diseases!

We have already complained that even well known causes for precisely defined diseases are relegated to the department of mysteries because they do not come into question for other diseases!

Precisely for this reason, we do not consider cancer that has been proven to be inherited to be a reason to defend the thesis that cancer is a hereditary disease, according to the motto: This disease is part of “cancer as a phenomenon of life” (Koeppe, Therapiewoche 31 (1981) 41, 6465). In contrast to real hereditary diseases, phenylketonuria or hemophilia, the “inheritance” of cancer still requires a change in the genetic material in order to become a disease at all.

This is not to say that cancer can’t be inherited: There are forms such as the radiation cancer of the descendants of Hiroshima victims where the agent hit the germ cell DNA and the altered DNA was passed on. And when children have malignancies, that’s more evidence of how the spread of carcinogens has progressed – it’s not that exposure to harmful agents is not at work here. So by inheritance, as the bourgeois apologists would have you believe:

“...we suspect that environmental carcinogenesis represents only the tip of the iceberg in the causal structure of neoplastic growth, while the most important component, the susceptibility to cancer formation, lies hidden in our ancestors.” (Anders, Klinische Wochenschrift, 1981)

Well, the old Teutons! – If that’s not a loss!

3. The health ideal: the resistant human being

With every disease – according to the ideal that the body should not get sick from it – there is a deficiency on the part of the body’s cells, a lack of resistance to damage: a predisposition. Seen in this way, the common cold would be the inability to identify viruses as they enter the cells and to prevent their permeation. In the case of rheumatism, the destruction of the joints by antigen-antibody complexes and the subsequent inflammatory reaction, there would be an inability of the antibodies to recognize the body’s own cartilage as such and not to develop antibodies against them; the lymphocytes are quite awry in this respect. – In arteriosclerosis, the myelocytes proliferate in the vicinity of the intima of the vessels, e.g. in the case of constant high pressure, the intima becomes brittle and cholesterol accumulates – why can’t the cell simply withstand the high pressure?!

The reason that it only with cancer that physicians pursue the ideal of combating disease by modifying cells is because other diseases can be managed in terms of public health: thanks to modern pharmacology, colds, rheumatism, and arteriosclerosis do not preclude people from being useful to an extent that would be detrimental to public health. It’s different with cancer: Here there are no blockers to maintain the ability to work despite damage. And DER SPIEGEL agrees with the epidemiological view of the matter (“Cancer Atlas”): “Cancer: a mountain of corpses because nothing is happening?”

Therefore, on the other hand, the brains of quite a few researchers are intent on realizing the wish to eliminate onco-genes through gene modification:

“In principle, it should be possible to introduce genes not only into any bodily cells, but also into the cells of developing embryos... Such experiments have already been successful in mice. With the methods of extracorporeal fertilization, they should also be within the realm of possibility in humans.” (DA 81 (1984) 27, 2097)

And in their usual medical manner, they weigh this intervention into the basic building blocks of the organism in a debate on effects and side effects:

“If, however, such an experiment were carried out with human embryos, whereby one would possibly even have to wait until birth or even beyond until the success of the manipulations became apparent, one would be forced to let the ‘unsuccessful’ cases live with illness or kill them.” (ibid.)

On the other hand, considering the usefulness of cancer-resistant individuals, one can’t simply sit back and relax in the face of the “wisdom of millions of years of evolution,” which is not so wise – in view of a “wisdom of evolution” that has “given us gene combinations for bubonic plague, smallpox, yellow fever, typhoid, poliomyelitis, and cancer." (Molecular biologist Cohen, cited in Start 1/1982)

What is being expressed here is a criticism of nature, a dissatisfaction with the organism that complains that the body can’t bear stress; a critique that does not want to change the stress, but the organism. In practical terms, the modification of the genetic material means an intervention into the cells with the purely negative content that they should no longer contain the possibility of degeneration. This intervention – apart from the new “disposition” it creates – would happen to the functioning organism with the result of reshaping the normal functioning. A remodeling of the cell is something different than a vaccination against smallpox, the use of physiological processes against the noxious agent. The perspective of a genetic modification of, e.g. prospective asbestos workers, so that they no longer get asbestos cancer, is the vision of eternal life – sorry, infinite resistance! – expressed from the point of view of public health.

On the other hand, the ideas of genetic researchers seem rather modest, examining people in such a genetically differentiated way that they can definitely bear the hazards they are expected to be exposed to:

“The increase in diagnostic possibilities and general knowledge of human genetics will make it possible to determine the disposition of individuals to certain poisons. Could this lead to industry doing large-scale genetic testing of potential workers in order to recruit only the least sensitive?... At the moment it is not a question of selecting particularly resistant workers, but in some cases of finding particularly sensitive people who are overly sensitive to a common concentration of pollutants in the workplace.” (DA 81 (1984) 27, 2095)

4. The service to health: care for a scarce good

“There would be a point to compensation, if it were possible” – says our critic; and he probably thinks, like his colleagues, of the “common principle of the effect of cancerogens,” which, once found, allows “the” remedy against cancer to be used.

Sometimes one has the impression that people die of cancer only because medicine knows nothing about it, doesn't it? Therefore, a few more remarks about the perspective,

“of finding ways to block the deadly cancer genes in time or even to reproduce anti-cancer genes in the laboratory and thus to support the body’s own defenses.” (This is the DER SPIEGEL rendition of the currently favored program).

It is a well-known fact that repair and recovery are not very effective when good health is used up, which is supposed to happen; to modestly see oneself as “only a repairman” is sometimes an exaggeration. And even in the case of diseases for which there are cures, they often have the character of an emergency solution, which is something different than getting the lost 100 bucks back: compensation. It is not by chance that every doctor asks about previous illnesses in the anamnesis, since they predispose people to new illnesses or even cause symptoms themselves. The fan of compensation also gets his satisfaction from an assumed comparison: In view of the damage caused by an inflamed gallbladder, the condition after removal of this organ is the lesser evil. The corresponding ideal is restitutio ad integrum. Compared to the healing of a cancer, what the person has gone through and in what condition he is in is negligible and a reason for the astonished question of what the criticism is supposed to be about. And the side effects that arise as a result of interventions into the “usual” and for some important cell functions, because new “dispositions” will surely open up, then fall back into the sphere of “ignorance” – but there one is doing research ...

The medical worldview remains intact and demonstrates its incomprehension at the suggestion that sometimes the inability to heal is something other than a lack of knowledge.

Certainly, from the point of view of compensation, a doctor occasionally becomes very critical: If no remedy is possible, then the harmful substances would have to be banned. The state should be active prophylactically because the public health warden gets too little of it; and sometimes, when the calculated number of victims seems too high, the state sometimes closes a dioxin plant.

In this society, health is the highest good that must be used up if one wants to exist. The point of criticism is not the limits of medicine by economic considerations, but its massive necessary use, without which modern exploitation would not work at all.

5. Cancer research: a social hygiene programs

The attitude formulated by Robert Koch after his discovery of the tuberculosis pathogen must be featured as research; then nobody recognizes it like this:

“Until now, people were used to viewing tuberculosis as an expression of social misery” (which is now called ‘civilization’) “and hoped that its improvement would also lead to a decrease in this disease. That is why the health care system does not yet have any measures actually aimed at tuberculosis. But in the future, in the fight against this terrible plague of the human race, we will no longer have to deal with an indefinite something, but with a tangible parasite, the living conditions of which are largely known and can be researched further.” (1882)

Now the misery goes without the consequences for public health that make using it impossible. What matters in view of the beautiful tuberculostatics is the note that tuberculosis is at present on the rise!

6. All that is right!

If someone smokes a cancer, he is supposed to croak instead of complaining about viruses or his “proto-cancer genes,” these old wimps. And if blocking cancer genes is successful, maybe we will put an end to the unpleasant smoking question, cunning as we are. But whether then two, three, many power stations will not then give a boost to the research into scorpion venom drugs that is then due, which reprimands the susceptibility of the DNA to ... the physicians will have to tell us.