Another ten years on (nearly) piece. I was very impressed with this book at the time. Tje tone and tenor of David Adam’s “The Man Who Couldn’t Stop” , which I also reviewed for the TLS and will post here at some point, reminded me of this a lot.
Re-reading the review I am struck by Adam Wishart‘s criticism of medical “detachment” (or what I report here as such) and perhaps will re-read the book itself to explore this more. Also struck (again) by the failure of the War On Cancer and the denigration of basic research which it involved, again as described by Wishart. I would like to read more about this and perhaps read other sources – certainly if Wishart’s account is at all accurate (which I have no reason to doubt) it teaches us something important about grandiose research agendas. Again thanks to Maren Meinhardt at the TLS for providing me with the published text!
For my father
Seamus Sweeney
Published: 22 September 2006
ONE IN THREE. A son’s journey into the history and science of cancer. By Adam Wishart. 312pp. Profile. Pounds 15. – 1 86197 752 2.
When Adam Wishart’s father was diagnosed with the cancer that would kill him, he found that no book on the disease was available that father and son could “read and then discuss”. Initially this seems scarcely credible -there are a huge number of books about cancer but in Wishart’s words:
there were memoirs of celebrities who had “battled” through the disease . . . self-help guides that presented basic information but provided no wider context . . . books that described the science in detail, but they didn’t seem to connect to the experience of being a patient . . . academic histories that did not seem to bring the past alive.
The Wisharts were looking for something different. One in Three begins with the six-year-old Wishart clinging “to my Dad’s enormous hand”. They are striding through London on their way to Broad Street to look at its famous pump. John Snow, in the well-known anecdote, removed its handle, so ending the cholera epidemic of 1854. This is Wishart’s first memory of his father’s quest to educate him, a quest that directly leads to this book.
Recognizing that the Broad Street story is “a rather mythologized and child-friendly version of history”, he describes other stories of scientists and scientific progress with which his father regaled him. “For two men who never spoke about their feelings, our intimacy consisted in sharing our interests in politics, history or the progress of science.” Intellectual discovery seems to have been the substitute for emotional revelation between father and son, and One in Three is part of that process.
It is an account of medical progress and the rejection of “the false ideas of the Ancients”. Wishart’s aim is didactic: “we will all be touched (by cancer), in some way. And I have learnt that an amalgam of fear, archaic prejudices and ignorance is no way to deal with it”. Among the “archaic prejudices”, he particularly despises the Galenic idea of “humours” contributing to the disease, which is echoed in the still prevalent idea that certain temperaments are more prone to it than others; according to the doctor in Auden’s “Miss Gee”: “Childless women get it. And men when they retire; / It’s as if there had to be some outlet / For their foiled creative fire”. Nor has Wishart time for Galen’s prescription of a formal and authoritative bedside manner for doctors -“a mode of behaviour which continues to be enacted in many consulting rooms”.
From this Galenic precept, he traces the now much less prevalent but still extant medical “detachment” that can seem like callousness to a terrified, vulnerable patient.
Each chapter deals with a theme -for instance, surgery, or chemotherapy, or the rise of alternative cancer care, as well as stages of Wishart’s father’s illness, considered either directly, or through the mood of the family. So the chapter on surgery discusses Lister and Billroth along with Wishart Senior’s own experience of surgery, while that on alternative therapy discusses Penny Brohn’s disillusionment with her treatment and the foundation of the Bristol Cancer Care in the 1970s, together with the Wisharts’ occasional anger and doubts.
Wishart has an eye for what Yeats called “character isolated by a deed”, the incident that exemplifies a certain trend or moment in cancer care, or helps us to understand the personality of the cancer researchers. Many of the names in cancer treatment -Sidney Farber, Robert Weinberg, even Marie Curie -are familiar simply as names. Wishart brings these complex, driven figures to life, and it is a life that barely relates to the image of dedicated scientists piously labouring for the good of humanity. For instance, Farber’s development of a chemotherapeutic agent for acute lymphoblastic leukaemia is a story of dogged determination against discouraging clinical results -which in this context means dead children -and the opposition of junior doctors alarmed by his apparently cruel experiments and aloof, Galenic manner.
Among the most memorable characters are two formidable women -Mary Lasker and Penny Brohn, both of whom confronted the cancer establishment with apparent enormous success. Indomitable, passionate, endlessly energetic, Lasker expertly played the social and political worlds of New York and Washington to persuade President Nixon to launch his “War on Cancer”. She was contemptuous of the medical establishment’s insistence that funding should be confined to basic research rather than spent on the “moon shot” approach for a total cure (involving a massive federally funded project with a single big-picture aim, along the lines of the Apollo programme). Brohn, meanwhile, after a particularly bloody biopsy, appalled by the offhand manner of her treating doctors, became convinced that her tumour was the result of “an accumulation of un-discharged grief, pent-up guilt and layer upon layer of fear”, and this conviction prompted her to found the pioneering Bristol centre. Here care was homely and comforting. Even if an insistence on coffee enemas was unpopular, the antithetical approach to Galenic medical authoritarianism was not.
Both of these indefatigable women had equivocal legacies -towards the end of her life, Lasker admitted that basic research behind genetic manipulation, on which she would earlier have poured scorn, was far more promising than the grandiloquent “moon shot” approach. The alternative therapy movement was in one sense a reaction to the hubris of the “War on Cancer”, but often became far more dogmatic and promised far more than mainstream treatment. The medical profession learnt much from its 1970s critics, and duly became more empathetic. The Bristol centre is still operational, but is now complementary with medical oncology.
Wishart combines the story of his father’s illness and death, and medical history, with skill and dignity. Anger and disillusionment are acknowledged, but there are no intemperate judgements of past figures or of contemporary authorities. Indeed, the oly figure who emerges badly is Galen. In his final chapter, Wishart imaginatively reconstructs the possible series of events at a genetic and cellular level that led to his father’s tumour. This speculative passage, reminiscent of the chapter on carbon in Primo Levi’s The Periodic Table, leads to an epilogue focused on future tactics. As well as possible improvements in public health strategies, Wishart calls for “a thoroughgoing change in taboo-shrouded attitudes, a rejection of opinion rooted in the past, in Galen’s physiological melancholy or in Victorian fear of the incurable. And there has to be a reorientation away from the heady optimism that cancer can be cured, and its flipside that a failure to discover the ‘magic bullet’ is a tragedy for humanity”. As well as admirably filling the gap that the Wisharts identified for an intelligent and humane account of cancer, this wise, dignified book will contribute to a rejection of unsatisfactory theories and practices and the adoption of something better.
A Medical Education 