Cancer: What Do They Know?

Vivian Bearing, the main character in Margaret Edson’s Pulitzer Prize-winning play, Wit, suffers from advanced metastatic ovarian cancer. Having undergone eight full-dose treatments of an experimental chemotherapy, she muses that her doctors will no doubt write an article for a journal about her.

But I flatter myself. The article will not be about me, it will be about my ovaries. It will be about my peritoneal cavity, which, despite their best intentions, is now crawling with cancer.

What we have come to think of as me is, in fact, just the specimen jar, the dust jacket, just the white piece of paper that bears the little black marks.

Bearing’s bitter reflections on the connection between her “me” and her disease call to mind long-running disputes about the sources of cancer. Does it originate in the self’s genes, a sentence of fate to the DNA “me”? Does it come from the behavior of the autonomous self, the “me“‘s styles of life and consumption? Or does it originate outside the self, in constituents of the environment that invade the organs of the “me”? The answers to these questions bear on how cancer might be treated or, better yet, prevented, and who should bear the costs of dealing with the disease.

At the turn of this century, physicians knew that some cancers ran in families—an indication that the disease came from some inheritable essence of the self. Yet they were also aware that the large majority of cancers occurred sporadically, independent of any prior family history. The latter evidence suggested that cancer originated in agents lurking in the environment. As early as 1775, a British physician named Percival Pott had linked scrotal cancer in former London chimney sweeps to their exposure to soot. By the early twentieth century a growing body of observations suggested linkages between cancer and the materials of modern industrial life.

German physicians and scientists, following their country’s strong tradition of social medicine, took a vigorous interest in the causes of cancer external to the natural self. After 1933, the Nazis mounted a broad-gauged “war on cancer,” to borrow from the title of Robert Proctor’s arresting and important exploration of the Hitler regime’s concern with the environmental sources of the disease. Proctor, a highly regarded historian of science whose works include the standard account in English of Nazi eugenics, is by no means an apologist for Nazi medical science. His purpose is partly to point out that it was complex, that along with sadism it displayed “fertile, creative faces.” He contends, indeed, that in cancer research good science did not flourish despite Nazism but because of it.

That science of high quality can arise in brutal, antidemocratic regimes should not by now be surprising, even for science under the Nazis. Proctor’s point is nevertheless worth repeating, since it remains a commonplace that science flourishes only as a ward and ally of democracy. But the value of his unblinking book …

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