V. Who does our current understanding of cancer benefit?
“Capitalist growth entails constantly searching for ways to convert ever-increasing elements of the natural world into commodities” — Michael Friedman
Cancer is caused by genetic mutations. This is the canonical view that drives current cancer research, drug development and treatment paradigms, and even public policy (e.g. — precision medicine & cancer moonshot initiatives). This view has been entrenched in the minds of scientists and public alike, starting from the molecular biology revolution in the 60s, and especially after the sequencing of the human genome in 2003. Much has been written on whether mutations cause cancer, however, it seems that in this “postgenomic” era, the hegemony of the genocentric causation of cancer reigns supreme, a phenomenon that can be explained largely by Robert Merton’s sociological analysis. However, in the last two decades, evidence against this genocentric view, known as the “somatic mutation theory” (SMT) of cancer, has emerged.
SMT posits that cancer is a cell-based disease in which aberrant changes in the DNA that are not fixed, aka mutations, affect the control of cellular proliferation. Thus, under the SMT, the causative agents are genes and their actions are manifested in the cellular and subcellular levels of biological organization. These understandings are based on the assumption that the default state of cells is quiescence (state of inactivity), rather than proliferation. However, this assumption remains in contrast with the ideals of evolutionary theory where proliferation is the default state of all organisms. This is where SMT is epistemologically flawed — it doesn’t explain why metazoan cells would suddenly adopt quiescence as a default state, and therefore requires multiple ad-hoc stipulations to explain findings that do not fit into the theory. The SMT faces another problem where cancer as a disease manifests at the tissue level, rather than at the cellular level, as shown by disorganized tissue architecture. Under SMT, the understanding is that cells growing out of control due to mutations disrupt tissue architecture. However, a growing body of evidence show that cells with cancerous mutations can behave in a normal manner and it is the environment that dictates whether cells behave in a “normal” or “cancerous” manner. Additionally, more recent studies show that normal tissues in cancer patients harbor the same mutation as observed in their tumors, and previously known mutations attributed to causing diseases actually are harmless, so to speak. Besides these, there exists a plethora of evidence against SMT available in current scientific literature. All of this recapitulates what biologist John Cairns said in 1997 “… Although study of the molecular biology of cancer has not yet laid bare the causes of most cancers or produced a cure, it has enormously increased our understanding of the molecular biology of the mammalian cells.”
The real harm of SMT, besides misguiding cancer research, has been due to the inextricable relation between reductionist and capitalist ideologies. Biologists Richard Levins & Richard Lewontin wrote in their seminal book, “The Dialectical Biologist”, “individualism in science helps create the common belief that properties of populations are simply derivable from those of the uncharged atoms (genes) of populations or societies.” This statement, while written in context of scientific philosophy, also extends to current capitalist society in the US where individualism is seen to be the key factor in a person’s life, as exemplified by “The American Dream.”
The reductionist explanation of cancer, a complex disease, has promulgated the cancer-industrial complex, since reductionism is inherently a capitalist ideology. A reductionist view holds that parts of a whole can explain the system, and ignores any emergent properties of the system, such as cancer, thus highlighting an individualistic approach. In fact, the cancer literature is rife with blame being put on individual genes as cancer causing agents; one step further, the onus has been put on individual humans themselves, going as far to say cancer can be attributed to “bad luck”. This blame game plays along nicely into the cultural metaphors regarding illness, as the anthropologist Chelsey Kivland describes, “…that disease is a consequence of personal than societal failings.” However, it has been known for decades that incidence of cancer rates are highly correlated with environmental factors — asbestos exposure leads to lung cancer & mesothelioma, pesticide & plastic chemical exposures lead to prostate & breast cancers, smoking leads to lung cancer, to name a few. It has also been shown that 85% of risk for cancer incidence can be explained by extrinsic factors and that prevention measures, such as curbing smoking, have done more to curb cancer mortality rates than any treatment options. Even with such knowledge on hand, the belief that the genome holds the key to curing all diseases has led to the mining of volumes of data that is difficult to make sense of, as prominent cancer researcher Robert Weinberg recently admitted. On the other hand, only a small portion of NCI’s overall budget is devoted to studying environmental causes of cancer — in 2008–09, only 15% was allocated. Unfortunately, this view of cancer has allowed profiteering entities to continue exploiting vulnerable populations, while building social capital by sponsoring biomedical research.
The reductionist view also does little to benefit an individual diagnosed with cancer. The military vernacular adopted by cancer researchers in 1971 allows for the otherization of the body of the victim, thus alienating the self from its physical manifestation. This alienation further pits the victim against their own body, and offers the notion of “survivorship” when the victim has beaten its own body into submission using “potent chemical weapons.” The idea that there is going to be a “cure” for cancer has led to the search for “magic bullets”, effectively labeling every single protein in the body as a “druggable target” and every single gene dichotomized as either an “ally” (tumor suppressor) or an “enemy” (oncogene). However, from a structural biology and biochemical perspective, at best only 25% of gene products may be druggable and to date, only ~2% of all predicted human gene products have been targeted with small molecule drugs. This begs the question of why are we looking for a needle in the haystack when the needle may not even exist?And more importantly, what will be left when you have waged war against your self?
