Our Evil Twin

Slate Magazine has a review of a new book called The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee, an oncologist and researcher. The review is called "Is Cancer Our Evil, Smarter Twin? A New Metaphor May Tell us What We Need to Know about the Disease." The book itself seems like a pretty straightforward history of cancer and its treatments (from what I have read about it), though written in a very compelling way.

What I find interesting in the Slate review is the idea of the new metaphor for thinking about cancer. Metaphors are comparisons that we use to understand things that we don't always understand, and the implications of that comparison can influence how we feel about that thing we're trying to understand. So when I try to explain blogging to my students who have never blogged, I could say "Think of a blog as an online diary." That "diary" metaphor is one that will emphasize for them the personal aspects of a blog. But I could also say "Imagine a blog as an online party where one person tells a story and then a bunch of others add their own stories or comment about how much they loved (or were offended by) that story." Obviously, that choice of metaphor is going to get my students to understand blogs in a different way, and to react to blogs in a very different way.

And so it is with cancer. The word "cancer" comes from Latin, meaning "crab." That's why people born under the zodiac sign of cancer have a crab for their symbol. And using that metaphor for cancer -- something that grabs hold and causes pain -- says something about the way we think of cancer. Nobody thinks very happy thoughts about cancer, but if you extend that metaphor, then cancer becomes something that invades from outside. Think "Attack of the Crab Monsters" (a really horrible horror movie from 1957 that's so bad that it's awesome).

For researchers, that kind of metaphor has meant something important: a tumor is an outsider invader that needs to be counter-attacked with everything we've got. This is why chemo became so popular after World War II. Take no prisoners. Collateral damage to healthy cells is a sacrifice we have to make. The important thing is, we killed those invading crab monsters.

Mukherjee's metaphor for cancer is something very different than what we are used to: cancer, he says, is a "more perfect versions of ourselves."

Whoa. A more perfect version of ourselves? Cancer is perfection?

Well, yes. Think about it. Cancer cells aren't outside invaders; they are copies of our own cells. My B-cell lymphocytes didn't get injected or inhaled -- they are created in my own bone marrow. And they are perfect: they have managed to reprogram themselves so they don't die on their own. For a cell, what could be more perfect? Eternal life with limitless copies of yourself. (The narcissistic little bastards.....)

And that "perfect copy" metaphor has implications for researchers that are as important as the crab metaphor had for previous generations. Trying to kill the crab means killing ourselves -- along with that perfect version of ourselves. As brave and noble as that sacrifice might sound, it's kind of pointless. We need to find treatments that kill off the evil twin without killing ourselves as well.

Thinking of cancer in this new way leads researchers back to the genetic basis for lots of cancers, including follicular lymphoma: we need to find a way to make cancer cells imperfect.

And that's exactly what so many new, targeted treatments are trying to do. The Slate review mentions some treatments that involve ways of making the body's own immune system take on and defeat the cancer -- like the vaccines I've been reading so much about, or the monoclonal antibodies that induce self-death, or the Velcade-type treatments that make the cells forget to take out the garbage. That's the future of cancer research. And the new metaphor might be the thing that makes us patients think about cancer in new ways, too.

Sounds like a fascinating book. Kind of a weird Christmas request, but I'm putting it on my list anyway.....