Ambrosini is wrong about cancer

Although Ambrosini’s personal pain and anguish must be acute, his article The Politics of Cancer published on the Daily Maverick is filled with perilous misconceptions.

Ambrosini writes, “Cancer is science’s greatest failure. After 100 years of research, with unlimited funding and under immense social pressure, we still have no scientific understanding of the cause of cancer, and there is no cure. Science appears to be looking in the wrong direction, with the wrong paradigm.”

While progress against cancer is sometimes frustratingly slow, there has been progress. The United States has excellent and easily available data, so I cite theirs. The death rate from cancer has declined 16% since the early 1990s in the US. In the 1970s, about one out of two Americans survived five years after diagnosis. Today, it is about two out of three. The five-year survival rates of several types of cancers, including breast cancer, are now over 90%, unthinkable a few decades ago. The management of side effects from chemotherapy has also improved (see American Society of Oncology). Surgery to remove cancers has been around for centuries, but has improved dramatically in the last 150 years.

Because of science, the prevention of cancer has also improved, perhaps most because of the work of Richard Knowles and other epidemiologists who, in the 1950s, discovered the link between smoking and cancer. Hepatitis B and human papillomavirus vaccines are also likely to reduce cancer rates.

Ambrosini writes, “thorascopy and pathology exams revealed a malignant mesothelioma covering my entire pleura with advanced metastases.” As horrifying as this diagnosis is, it is because of the medical science he lambasts that Ambrosini has such detailed insight into his illness.

Ambrosini misunderstands medical science and he flippantly characterises it as a “paradigm”, implying that it is one among many alternatives that can find cures for cancer. But what is medical science with respect to cancer medicines? It is a method that involves using our knowledge of biology to identify possible treatments, testing these in laboratories on cancer cells, then taking the most promising compounds and testing them on animals (unfortunately without their permission) and then on humans (with their permission).

Although that’s a simplified explanation, it is essentially how it works. And the question that follows is what other effective way is there to know that a remedy for cancer works? The scientific method is carried out by people, so of course it is imperfect and subject to politics, greed, ego and error. But it is the best and only reasonable method we have for finding treatments for cancer. Any effective remedy can be discovered using this methodology, whether it is categorised as traditional, natural, complementary or alternative. If it works, it would become part of the assortment of medicines recommended for treating cancer.

Ambrosini presumably knows this, so he offers a frequently made argument in response: no one tests cheap remedies like bicarbonate of soda (a remedy used by Ambrosini) because it is not patentable and there’s no money to be made from it. But this is false. It is not only profit-making pharmaceutical companies that conduct clinical trials on cancer treatments. Publicly funded research institution, like the US National Cancer Institute (NCI) also run trials, often very successfully. If scientists at these institutions thought there was merit in testing bicarbonate of soda or any other household remedy against cancer, they would do so. And so too would the companies that make bicarbonate of soda!

The same goes for so-called natural remedies. Many commonly used medicines, discovered by medical science, are derived from plants. For example, Taxol is an extract from the bark of the Pacific Yew Tree. It is also a successful cancer treatment, discovered and mainly tested by the NCI using the scientific method (see NCI).

Ambrosini says “There are potential cures for cancer. But in South Africa, as in the rest of the world, we have created a legislative framework which prohibits them. In medicine, every treatment is prohibited until proven effective and harmless through clinical studies costing millions of dollars.”

This is inaccurate. Not every treatment is prohibited until proven effective and harmless. And no effective medicine is harmless. Ambrosini is quite within his rights to try bicarbonate of soda. But no health worker may claim to patients that it is a treatment for cancer. Some substances, however, because they are extremely dangerous, are strictly regulated, irrespective of whether or not they are medicines. It just so happens that many dangerous substances are medicines too.

An unfortunate problem with health-care is that the people offering treatments typically know much more than the people being treated. Patients are also often vulnerable and desperate. We have laws that protect consumers from being ripped off by financial brokers and even car salespeople. If we accept these laws are needed, then laws that protect our health are even more vital. One of the reasons for the legislative framework for medicines is that quacks, or pharmaceutical companies, will not hesitate to sell dangerous or useless products to vulnerable people. Much of our legislative framework evolved following the thalidomide scandal, when thousands of babies were born with deformities because this drug had not been properly tested. The medicines legislative framework is nevertheless imperfect and poorly enforced in South Africa.

Ambrosini says, cancer “is more widespread than TB or HIV-AIDS …” This is misleading. Cancer is actually a name for many diseases with many causes. What cancers share is the characteristic of cells dividing uncontrollably. The risk of some, like Kaposi’s sarcoma, are exacerbated by HIV infection. Also, the risk of cancer increases with age, while HIV primarily kills young adults and children. In South Africa, HIV and TB are responsible for more lost life-years than cancer. Ambrosini’s political party, Inkatha, has its base in Kwazulu-Natal (KZN) which has the country’s highest burden of HIV. This is an important point. Ambrosini wants the South African government to “host a serious centre of alternative and integrated cancer therapy.” Why? Because no “other social issue could be more pressing.”

Sorry, but this is a terrible idea. Cancer is very serious, but research institutions in rich countries are much better placed to focus on it, and they should not waste money on unlikely remedies. Resources need to be deployed where they are likely to get the most gains. With the burden of HIV and TB in South Africa, it makes sense that these diseases are a current research priority here. Perhaps in the future as antiretroviral treatment restores more people with HIV to almost normal life-expectancy, it will make sense to prioritise cancer in our research institutions. (And of course, I am in favour of good research on cancer that is presently done in South Africa.)

Finally, I am a fan and avid reader of the Daily Maverick. But I have to question why the editor published Ambrosini’s article. I am not questioning Ambrosini’s right to express himself; he could publish his views as a blog. But every editor has to make decisions whether or not to publish based on quality of arguments and facts, even for opinion pieces.

The Maverick would not publish a piece claiming that Jacob Zuma is a Martian sent to rule South Africa (except perhaps as parody), because such an assertion would obviously be false. Ambrosini’s article is no less absurd, but it is more difficult for readers to see this because it deals with science which many find hard and because it is written from a personal perspective by a man in mortal peril, always a riveting offer of engagement. Moreover an article claiming our President is a Martian would be mostly harmless, but articles that encourage people to make bad choices about their health-care are potentially deadly.

Thank you to several people who commented on the draft of this article. I take sole responsibility for this article.