Closing In on a Killer :...
Twenty years ago, in a cancer-research lab, I got to know a remarkable mouse. She had conquered so many massive tumors that we called her “Old Brinksmanship.”
Brinksmanship was an inbred BALB/c house mouse, the star of our experiment in tumor immunology.
Our theory was that a prior “insult,” an injection of cells from a mouse of a different strain, would somehow get a BALB/c mouse’s immune system hopped up enough to attack and conquer cancer cells injected a few days later. Often the strategy worked. Tumors grew more slowly in “insulted” mice than in the untreated controls, and pre-treated mice usually survived longer.
Among the survivors, Old Brinkmanship was singular. Time after time, her tumor injection would grow to a lump the size of a dried prune. It was a tremendous burden, covering most of her flank. Yet she would always defeat it. I well remember the professor, stroking her belly afterward in search of the vanquished lump, shaking his head in wonder. What was it about Brinksmanship? If we could only know.
In 1968, Dr. Steven Rosenberg met a human version of Brinksmanship, a man he calls DeAngelo. While Rosenberg was working in a Massachusetts VA Hospital, he recalls in “The Transformed Cell,” DeAngelo showed up with a gallbladder problem. Records showed that 12 years earlier a cancer surgeon had admitted defeat and sent DeAngelo home to die, riddled with tumors. Yet here he was again, untreated yet cancer-free, wearing an impish, sardonic smile and an “aura of secret triumph.”
The encounter with DeAngelo triggered in Rosenberg an obsession: to discover how the human immune system can fight cancer, and thus to find a cure. Today Steven A. Rosenberg is a name you encounter in nearly every news article about cancer or gene therapy. Over two decades he has done to humans approximately what we tried with mice, but much more elegantly. He has found a factor that stimulates human immune cells, isolated immune cells that kill cancer cells and, most recently, injected patients with immune cells genetically altered to provoke an anti-cancer response.
“The Transformed Cell” is a misnomer. The book is not really about cells, but about Rosenberg himself. He regards cancer with an intimate and personal loathing, as a metaphor for the Nazis who killed some of his forebears in concentration camps. “The way cancer gradually takes over one’s body and forces its victims and their families to watch impotently as it grows and spreads makes it hateful,” he writes. “Cancer murders innocents. It is a holocaust.”
Rosenberg portrays the history of his research on several levels: as a glimpse into the minds of scientists and doctors (Rosenberg is both), as the progress of a scientific concept, and as an account of bureaucratic struggles in medical science. It’s fascinating reading, as well-paced as a detective novel, albeit tender rather than tough.
Rosenberg and co-author John M. Barry have taken the methods-and-results structure of a scientific report and fleshed it out with everything an average reader would like to know: personalities, emotions, irrelevant but interesting details. It is an achievement many science writers strain toward but can’t attain, because they aren’t inside the researcher’s head. Describing an experiment on pigs, Rosenberg recalls the stench and the slippery, bloody mess--as well as the embattled antagonism of a junior colleague. He shows us a tumor, held in the human hand. It has “an unnatural, alien appearance. . . . The black color is unrelieved, not shiny and reflective, like obsidian, but dull, as if it absorbs all things into itself.”
A novel would have Rosenberg succeed gloriously in his cancer crusade, or fail tragically. He has done neither, and he tells us so. In some patients, the experimental therapy has achieved astounding results; he has cleansed bodies riddled with tumors that other doctors had given up on. Many other patients have died, despite the best of hopes and efforts. He portrays them individually and with evident pain.
What distinguishes the survivors from the vanquished? This scientist also stands aside and shakes his head. He can tell us what their immune cells did, but not why their immune cells did it. In one sense, we have progressed very far from the professor and Old Brinksmanship. In another, we have not.
In “Who Survives Cancer?,” Howard P. Greenwald addresses the issue head-on. The book is Greenwald’s formal report of a study he carried out among 536 cancer patients in Seattle--enough people to allow him to address many issues pivotal to his central question. Greenwald looked at the social class of his subjects, their personalities, how their cancers were diagnosed, their treatments. Who survived? The single most important contributor, he found, was having cancer discovered before it was even suspected, during an ordinary checkup.
To avoid cancer, he would advise, establish a relationship with a good doctor, and behave sensibly otherwise. The final answer to the question he has posed may seem a trifle too pat, but he reaches it systematically. Along the way, Greenwald, who is a professor in the School of Public Administration at the University of Southern California, offers a hard-nosed analysis of factors thought to affect cancer survival, such as exposure to carcinogens, lifestyle, methods of treatment and the “will to live.”
Greenwald describes Rosenberg’s immune-cell research as he analyzes experimental therapies and asks whether it is worthwhile becoming a subject in cancer research. Doing so may help others in the long run, he concludes; it is highly unlikely to cure the volunteer himself.
Greenwald decided not to decide whether he was writing for professionals or the general public. He tends to focus on populations and not individuals, and finally launches into a discussion of public health policy that is uninteresting to the average reader. Nonetheless, for anyone who thinks about his own risk of cancer and how to proceed should the worst happen, “Who Survives Cancer?” is worthwhile--if only because it relieves useless paranoia and guilt.
It’s very current to blame cancer patients for their own illness, on the theory that diseases are manifestations of bad emotions such as anger gone astray. Greenwald takes special issue with this prejudice, scorning proponents of the behavior theory for arguing from “collections of anecdotes.” He goes at the theory with a scalpel, examining the major studies to date and saying why they fail as proof. (Many focus on animals, whose relevance to humans is suspect, and the human studies are small and give conflicting results.)
In Greenwald’s own study, the only “emotional” factor that correlated well with survival was lack of fatigue. Nonetheless, his conclusions leave open a loophole that lets behavior back into the discussion: Cancer survivors, by his own reckoning, are those who find a good doctor and have the prudence and courage to get regular checkups.
What motivates such behavior? Not repression of fears, certainly, or denial and passivity, which are the “cancer-prone” qualities described by psychologist Lydia Temoshok in “The Type C Connection.” Temoshok, who was formerly on the UCSF faculty, identified the Type-C personality by interviewing more than 150 melanoma patients. (Interestingly, she focuses on the same cancer group Rosenberg studied, and some of his end-stage patients do seem to espouse the same teeth-gritting, stoical nature that she says predisposes people to melanoma.)
Temoshok believes the Type-C personality contributes to cancer as the Type-A character does to heart disease. Type Cs, she says, do not express, or are even unaware of, anger and other negative emotions, are unassertive and cooperative, and sacrifice themselves, often to extremes. Nice people, in essence, get cancer. Temoshok proceeds to tell readers how to stop being too nice and therefore how to avoid cancer.
The book, co-authored by science writer Henry Dreher, is chatty, anecdotal and proselytizing. Details of Temoshok’s extensive studies are relegated to an appendix, and she spends most of her time telling case histories. One wishes Temoshok would locate Type Cs and otherwise similar non-Type Cs, and then watch them to see who gets cancer. That would take at least the 20 years Rosenberg has already spent.
Both Greenwald and Temoshok allude to new studies showing links between the mind and the immune system. That research is still largely descriptive, and far too young to allow us to understand the enigma presented by Brinksmanship or DeAngelo.
As the survivors have defied cancer, they also defy being categorized. For the moment, the nature of their unique survival remains mystical, beyond science.
“Cancer Therapy: The Independent Consumer’s Guide” by Ralph W. Moss, Ph.D., is a compendium of approved and “alternative” cancer treatments from algae to zinc. The author, well-known for writing about alternative cancer treatments, dismisses surgery and radiotherapy as “static,” and devotes more space to the anti-cancer actions of Indian spices than to Steven Rosenberg’s immunotherapy trials.
