One in Three: A Son's Journey into the History and Science of CancerBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7559.154-a (Published 13 July 2006) Cite this as: BMJ 2006;333:154
”I love you dad.” I looked at my 5 year old son and made a mental note to complain to the school about the subversive content of its discussion forum classroom activity known as circle time. I explained that he didn't even know me and that he should wait until he was at least 40 before he started making any definite commitment. He nodded, but I wasn't sure that he understood. In Britain, understatement rules supreme, and Brief Encounter—the dullest film ever made—is considered by many as our greatest love story. Emotional Americana makes many of us squirm.
Adam Wishart's father is diagnosed as having metastatic cancer. Faced by his father's mortality, Adam is imprisoned by emotions. Both father and son are bound by the social stereotypes and expectations of their gender. The pursuit of understanding is the comfort zone of their relationship, and so begins the author's research into the history of cancer.
Names of certain medical heroes, who have caused generations of medical students' eyes to glass over, are all here: Hippocrates, Galen, Snow, Virchow, Morgagni, Lister, Marie Curie, Farber, Doll, and many lesser known luminaries.
The ancients believed that cancer was an illness of melancholy. It was not until the scientific revolution of the 17th century that these views were swept aside by the advent of medical dissection and then the microscope. Lister, influenced by Pasteur's germ theory, used antiseptics and ended the scourge of Victorian surgery—infection. Combined with new anaesthetics, effective cancer surgery became a reality and ended the butchery of the past. The chance discovery of x rays and radium at the start of the 20th century opened a new door into both the diagnosis and treatment of cancer. Chemotherapy in the 1950s cured children with leukaemia.
In the 1960s, with the love-ins and the lunar landing, humanity and especially America seemed able to conquer all. President Nixon seeking his place in history (he needn't have worried) declared a “war on cancer.” The search for the magic bullet against cancer began in earnest, but death rates were unchanged.
Punk and industrial recession saw the optimism of the 1960s and 1970s vanish. Society began to question cancer care. The mutilating surgery, the poisonous chemotherapy, and the scorching radiotherapy had traumatised families and patients alike, with little seeming benefit, so patients turned away from conventional treatments. With the rise of alternative therapies, medicine was forced to relinquish its “monopoly on wisdom.”
As for the modern love affair for all things “screening,” Wishart neatly explains that paradoxically the individual is never likely to benefit directly from screening. Finally he looks at gene therapy and ponders whether this is the magic bullet.
The story of the author's father is woven through the book until his eventual death. Clearly, being a man and telling your father that you love him isn't easy. No circle time for us. One in Three offers real hope.
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