The Scientist recently published an article about a scientific study that claims that getting cancer is often just a case of ‘bad luck’. How the scientists in question arrived at this conclusion is remarkable, to put it mildly. Their claim is a good example of the kind of confusion that can arise from the rather simplistic ‘either/or’ mode of thinking that bedevils the medical science profession today; a way of thinking that results in misconceptions that have an enormous influence on our healthcare system.
The article in The Scientist describes the research carried out at the John Hopkins University in Balitimore by Cristian Tomasetti and Bert Vogelstein. They claim that one’s chances of getting cancer in a particular organ of the body is determined to the tune of 65 per cent by spontaneous errors that occur during stem cell division. The research showed that the chances of an organ being affected by cancer are increased when the rate of stem cell division in that organ is higher compared to other organs. This explains why we are less likely to get cancer in the small intestine compared to the large intestine, as the rate of stem cell division in the former is 150 times lower than in the latter. Moreover, the influence that our genetic make-up and other factors like diet, smoking and radiation have on our risk of getting cancer in a particular organ is actually 35 per cent lower than previously assumed. However, the fact that lung cancer is a more common form of cancer is primarily the result of behaviour (e.g. smoking) and not spontaneous errors in stem cell division. A worthy piece of research with useful results up to this point, one is tempted to think.
The article then takes a surprising twist, however. Based on the results of their study, the researchers arrive at the conclusion that it is more or less a question of bad luck when one is struck down by cancer as a result of a spontaneous error instem cell division. They describe this as “the randomness of certain cancers”. Cancer of the colon, for example, is mostly down to a matter of ‘chance’ and has very little to do with your lifestyle. They then go on to suggest that more attention ought to be paid to the early detection and subsequent treatment of cancer. Unfortunately, this ‘cancer as a case of bad luck’ conclusion and the researchers’ recommendations are based on a flaw in their thinking, one with potentially serious consequences.
It has long been known that not all instances of errors in our cells invariably lead to cancer. In fact, in the vast majority of cases, our immune system is usually able to detect a rogue cell quickly and render it harmless (1, 2, 3). So, our immune system plays a crucial role in the prevention of cancer, regardless of the cause of the error in the cell. Of course, the strength and efficiency of one’s immunesystem are determined to a large extent by our lifestyle (4, 5). Sufficient sleep, not too much stress, a healthy diet, regular exercise, good relationships and positive emotions all contribute to a sound defence mechanism, which in turn ensures that an error in a cell will not develop into a malignant tumour.
Cancers that can be traced back to these so-called spontaneous errors can also be the result of our lifestyle, a fact that is completely overlooked by the researchers because they choose to ignore the immune system in their study. And they also fail to address a number of important questions: Is it correct to call those errors that occur during stem cell division ‘spontaneous’ or to attribute them merely to ‘bad luck’? Which processes occur prior to these errors? Are there more instances of errors in stem cell division today than there were say 50 years ago? And can one individual happen to experience a higher level of errors than another, and if so why? The researchers’ conclusion that a large number of cancer cases can be attributed to bad luck is premature and almost certainly incorrect; there are simply too many pieces of the puzzle missing to justify such a conclusion.
The errors in Tomasetti and Vogelstein’s research are not uncommon in medical science today, errors that usually pertain to questions that cannot, in hindsight, be answered by employing an either/or approach. For example, a debate has been raging for years on the subject of whether depression is a psychological problem caused by emotions and stressful circumstances or a physical problem that can be traced back to an imbalance in the serotonin metabolism in the brain. The answer, of course, is that is a combination of the two: persistent emotional disturbances go hand in hand with an imbalance in the serotonin metabolism in our brains and vice versa. For a long time the field of oncology was bedevilled by a protracted discussionon whether cancer was caused by a virus or by a genetic defect in our cells. Later on it was discovered that viral infections could cause changes in our genetic make-up. And a Nobel Prize was awarded to the scientists who claimed to have proven that ulcers are not caused by stress at all but by a bacterium. They seemed to have overlooked, however, the fact that stress greatly increases the chances of one developing such an infection in the first place, an oversight that I have addressed in a previous blog.
Given that I am used to basing my reasoning on the systems thinking model of Chinese philosophy, i.e. always attempting to see the bigger picture, these either/or questions never fails to surprise me. Not least because of the large number of intelligent and educated people who seem to fall far too easily into the trap of simplification. The enthusiastic reaction around the world to Tomasetti and Vogelstein’s research is no exception. I recently read an article in a Dutch newspaper in which Hans Clevers, cancer expert and chairman of the Royal Dutch Academy of Sciences,also chipped in to support this simplistic argument. He concluded that we need to put more energy into detecting cancer because there is often simply no way of preventing the disease. More treatment and less prevention in other words, and that on top of the enormous cutbacks that have already been made in research into prevention in recent years (6). He also suggests that newly developed insights could actually prove to be a great source of comfort to cancer patients, as they can be used to assure them that their cancer is more a case of bad luck than it is a matter of their own fault.
Guilt or responsibility
Not only does Clevers fail to spot the flaw in the researchers’ and indeed his own reasoning, he also pays no heed to the difference between guilt and responsibility. It’s not about whether cancer patients have done something ‘wrong’ or not; that idea is entirely redundant. If, however, it can be made clear to people that a healthy lifestyle can significantly reduce one’s risk of getting cancer, then people can be encouraged to assume responsibility for their own health. This would be of enormous benefit to public health in general and to the economy.
A false reassurance
The manner of reasoning employed by Vogelstein, Tomasetti and Clevers is typical of current medical thinking. Becoming ill is a matter of bad luck, and that is why prevention is less important than the cure. Treatment means ‘fighting the disease’ and not ‘stimulating good health’. In his book Denken over geneeskunde (Philosophising on medicine) the philosopher of science Wim van der Steen calls this way of thinking the ‘medicalisation’ of the concept of health (7). What Clevers is actually saying in his article is this: “You can all sleep soundly now; the doctor will make sure you get better.” At the very least, this is a false and dangerous reassurance.
The inventive human spirit
Thankfully, there are also positive developments to report. The approach to cancer is becoming more individual-based and a lot of work is being done in the area of non-toxic treatments (8) including, for example, immunotherapy, which makes use of the powers of our own immune system. In addition, more and more information is becoming available on the importance of a healthy diet and exercise in preventing cancer. I firmly believe that the human spirit in all its inventiveness will one day find an answer to the Big C problem, but I also believe that this can only be achieved by approaching the disease in a more individual, process-oriented and holistic manner.
7. Denken over geneeskunde, W. van der Steen, 1991
8. The emperor of all maladies, S. Mukherjee, 2012
Translation: Danny Guinan