Illness, said Susan Sontag, "is not a metaphor." It isn't, in other words, a battle you can fight, or a war you can win. Cancer, she said, and she had it at the time she said it, isn't a curse, or a punishment, or an embarrassment. Cancer, she said, in her book Illness as Metaphor, is a "highly curable" disease.
Well, yes. And no. When you get it, cancer does feel like a curse. It can feel, because human beings aren't always very rational, like a punishment. It can even feel, as those of us know who've been diagnosed with it just after starting new jobs, like an embarrassment. And it can certainly feel like a battle that's part of a war. Having lumps hacked out of your flesh can feel like quite a violent thing to do, and so can being blasted with drugs or X-rays that make you feel tired, or sick. It's the kind of thing you'd only do if you felt you didn't have many other choices. It's the kind of thing you'd only do if you felt you were fighting a war you were desperate to win.
Some people get treatment in time, and "win." Some people don't, and don't. But if cancer is a war the world is fighting, it isn't, according to some of the world's leading experts, a war that's going all that well.
Forty years ago, when Richard Nixon signed the U.S. National Cancer Act, most Americans thought a cure would be found in five years. They thought that if you could put a man on the moon, you could make sure a man wasn't killed by a few rogue cells. They were, unfortunately, wrong. You can put a man on the moon, and maybe even a woman, though most of us would rather have a nice night in with a box set, but rogue cells, it turns out, aren't so easy to control. Rogue cells, it turns out, like their power, and they're getting more of it every day.
In one way, they're not. An awful lot of rogue cells are being spotted by X-rays, and blasted with other X-rays, or with very, very strong drugs. An awful lot of them are being cut out of people's bodies, and thrown away. "In 40 years," said one expert at the World Oncology Forum in Switzerland on Monday, "we've nearly doubled the curability rates for cancer." But the trouble, said Dr. Umberto Veronesi, who sounds as if he should be a Renaissance painter, but is actually a former health minister and oncologist, is that more and more rogue cells are springing up. The goal of "eliminating cancer", he said, was now a "Utopian dream." We can, he said, "cure a patient, but as soon as we cure one patient, another patient arrives".
If you were an oncologist, or even a Renaissance painter, you might feel a bit depressed. You might think it was bad enough for the people who had been blasted with X-rays and very, very strong drugs and who had to have bits of their bodies cut off. You might worry about how they were going to pick themselves up after all that treatment, and how easy it would be for them to keep looking after their children, or doing their jobs. But if you were a health minister, and worrying about budgets, you might be tempted to give up. If, for example, you saw that by 2030 there were likely to be 22 million new cases of cancer in the world in a year. And that this, compared with 2008, was a rise of 75 percent.
You might wonder why it was that richer countries had more cancer than poorer countries, and why poor countries got more cancer the richer they got. You might wonder what was the point of getting richer, if you were going to have to spend so much money treating all the people who were getting richer, who were getting cancer. You might wonder if the answer to all this cancer was more, and more expensive, drugs.
If you were a health minister, you would know at least one thing that causes cancer. You would know, for example, that cigarettes kill more than half the people who smoke. But you'd also know, if you had looked at all the studies, and not just at the cost of treatment, that the risk of cancer goes up if you eat a lot of processed foods, and sugar, and salt, and red meat, and if you drink a lot of wine, or beer, or spirits, and if you don't do much exercise, and if you're fat. It's a shame it does. Most of us like drinking wine, and beer, and spirits, and eating sugar, and salt, and red meat, and most of us like sitting down. Most of us think it would be very, very nice if we could eat what we wanted, and drink what we wanted, and do what we wanted, and be as healthy as we wanted, but the truth, as the studies show, is that we can't.
The truth, as the studies show, is that the way we live is making us ill. We can face this, or we can ignore it. We can, of course, still spend money on research. We can still search for that magic cure. We can still tell people that their choices are their choices, and have nothing to do with big businesses, and big marketing budgets, and big profits. We can do all this, but if we do, we're going to need an awful lot of money to pick up the pieces, and pay the bills.
"Curing cancer," said one expert at the World Oncology Forum, "is certainly more complicated than landing on the moon." What he didn't say is that it's probably a lot easier to send a man to the moon, or even to fight a war, than to turn back a tide.