Apr 18, 2012 - 10:29 am
Some of the books I've been reading lately have the same underlying theme - a great favourite: clear thinking. The excellent "Bad Science" by Ben Goldacre contains material flagged by the eponymous title but the book is really about correct thinking. Charles Merrett's "The Origin of Anxieties" could have taken its title from Hamlet (Act 2 Scene2) "for there is nothing good or bad, but thinking makes it so", a theme the Bard explored so powerfully also in Othello and in the person of Leontes in the wonderful "The Winter's Tale".
Anyway, musing on thinking and on the power of mind-body medicine, prompted me to speculate about the way we talk and think about cancer. I think we do ourselves no favours by the way we characterise the disease. [Just switched off a daytime soap called "Doctors" with a depressed patient with cancer saying "No, doctor, I mean how long have I got if I don't take the treatment" - maybe a bit too topical, I felt.]
Often we talk as though we're doing battle with some malignant alien. We label 'the enemy' as "the beast" or "my little bugger" or a variety of other terms. Correspondingly, we regard the condition as one where we desperately need someone else to get "it" out of us. Invariably we think in terms of entity rather than process. We abrogate any sense of our own role in treating our plight by regarding it as one which it's some expert's job to get us out of. I recall with admiration John Neary's extended metaphor (on KIDNEY-ONC) in which he likens the experience to going through a car wash (cf. CT scans, operating theatres with robots etc) where we're entirely passive, in one end and out the other with no control of what happens in between.
The fact is that cancer is not like that at all - not an invasion of the Thing from outer space. The whole problem is precisely because the cancer is not some alien organism - it's our own cells which are simply misbehaving and this is why our immune system can be caught with its guard down. It's a case of the enemy within and our immune system failing to recognise the fact that our own cells are acting in a way inimical to our interests. The cancer isn't an invader, it's a bit of us that's acting up.
A better conceptualisation is to think of it as a programming error within our own body. We now know (more and more as the spinoffs from the Human Genome Project advance) of genetic errors that can lead to cancer. However, a danger of this thinking is the tendency once again to totally cede control. We may think that our fate is pre-determined and that under unknown conditions some bug in our biological software code is going to be called into action with dire consequences.
We need a mental model that is more flexible and also one which can accommodate the bewildering complexity of the problem. The best researchers have such models and escape the caricatures that most of us saddle ourselves with. Maybe if we can understand a little better, we can be better placed to deal with the problems cancer presents us with? We can then see the sort of strategies that could prove useful, e.g. stopping the processes that cause uncontrolled cell proliferation, cutting off blood supply to tumerous tissues, alerting our immune system to inappropriate behaviours and finding ways of encouraging apoptosis or of attacking the errant cells and recycling their contents.
Thinking better about the subject can help us to have more of a sense of involvement, if not actual control. That way we can be more receptive to all of the possibilities that the current movements or schools of thought may offer - "evidence-based medicine" and "science-based medicine" and the sort of "Participatory Medicine" that is coming into vogue, not before time and promises to shake this world up in the very best of ways.