Once again Clifton Leaf has generated a rich, circumspect, and sobering narrative on the war against cancer. Leaf takes readers on an expansive journey — one minute your sitting with him in a cancer ward, sharing a profoundly human, and personal moment between him and his father — the next your traveling through sub-Saharan Africa with a one-eyed surgeon in an old station-wagon, piecing together epidemiological clues, detailing the mechanics of an unknown cancer. All together, Leaf’s book explores every subtle nuance — around hidden corners — under every stone; he looks everywhere in search of one question: “how did we get here?” (‘here’ being the position we are in today — no closer to cures as when Nixon originally declared the war on cancer)
In the email correspondence I’ve personally had with Clifton I can tell you this — he is one of the smartest, most genuine, generous, and hard-working individuals I’ve ever encountered. He is a National treasure. So what I’m about to write has nothing to do with Clifton personally — it is just that we have arrived at different conclusions to the same question: “how did we get here?”
I picture Clifton’s book as a skyscraper — the building itself represents our countries losing effort in the war against cancer. The top-floor has a broken window — that is our governments collective denial concerning the ‘real’ cancer burden. The 8th floor has broken pipes — they represent our broken ‘cancer culture,’ a system that constricts bold science, encourages caution, and bogs-down creativity with bureaucracy. And the first floor is terrible-management of the war itself — a system that forces researchers to spend 50% of their time applying for grants. Inefficient and redundant layers of decision makers. A glaring lack of a common language and standards within the science itself — adding to inefficiency and confusion. Clifton explores every floor on his hands and knees, with a flash-light in one hand, and a magnifying glass in the other — cataloging every cracked tile, leaky air vent, and dripping faucet. It is just that there is one place Clifton forgets to look — and paradoxically — it is the place he urges us to go throughout the book: the foundation.
The foundation of the war against cancer has glaring, exposed, and obvious cracks — but only a handful of creative, intrepid, and bold-scientists are urging us to look where nobody else is looking. Clifton celebrates the creativity and boldness of a handful of scientists throughout his book, who were able to break with convention, and identify the hidden-details of cancer, resulting in great-leaps forward. In the first chapter Clifton tells the wonderful story of a Dutch-educated, Chinese Indonesian, working in a lab in Sweden, who did something extraordinary — he counted.
It was established dogma — written in every textbook, preached by the institutional leaders — that the human cell contained 24 chromosomes. Nobody questioned it. That is until Joe Hin Tjio, who didn’t know any better than to not question firmly establish theology written in script — Tjio didn’t know he wasn’t supposed to believe his own eyes. Tjio counted 23.
Sure enough the textbooks has to be rewritten — the serious scholars had to clear their throats, shuffle their feet, and admit they were wrong. All because one man, working alone at 2 in the morning, had the courage of conviction to trust his own eyes and shrug off the shackles of convention and groupthink. In fact, others, many others, had also counted 23, but thought they had counted wrong — that is the power and inertia of entrenched dogma.
Clifton celebrates examples like Tjio throughout his book — the men and women who think outside the box — he says over and over again these are the people we need to nurture — and we should dictate the conditions necessary for them to thrive.
Back to the skyscraper. The cracks in the foundations are covered by the most firmly established tenant in cancer biology — that mutations to DNA cause cancer. Under this unquestionable premise, the first chapter in every biology textbook, are festering cracks that explain so much — yet so few notice them. The cracks are the metabolic theory of cancer — that states it is dysfunction of metabolism that causes cancer, and that mutations to DNA are just a side-effect. The cracks explain why Gleevec alone is the only success story in the era of ‘targeted therapies.’ They explain why the data from the Cancer Genome Atlas Project is virtually incomprehensible. They explain why the therapies that target metabolism have exhibited remarkable results.
The entire cancer complex — the doctors, the pharmaceutical companies, the academic researchers, the huge charitable foundations, all in all, a multibillion dollar massive institution — are all banging around inside this huge, dilapidated, and crumbling skyscraper trying to figure out how to fix it — when all it needs is a new foundation, and yet nobody is looking there.
While Clifton urges America to change the conditions in order to nurture the next-generation of Tjio’s — I think they are here right now, it’s just that they can’t get anyone to listen. They are Thomas Seyfried of Boston College, Peter Petersen of John Hopkins, and Dominic D’Agostino of the University of South Florida. They are swimming against a current with biblical inertia.
But the beautiful thing about science is that it exists in the realm of physical law — the truth always revels itself in time. And it will again. I love how Clifton compares the war against cancer to going to the moon — because the real category of both endeavor is engineering. As dauntingly complex as cancer seems — the metabolic theory simplifies it. Cancer researches will tell you, the seemingly infinite heterogeneity of mutations, not only from individual to individual, but within individual tumors, renders cancer incurable. A check-mate.
Clifton tells the tale of the fabled Matterhorn. When it was thought the Matterhorn could not be summited, after countless failed attempts — a single man looked at it differently. Edward Whymper, a wood engraver, and artist from London, who had never before scaled a mountain, decided to try a route nobody else had tried. He decided to try the Northeast side. It was here that Whymper found something inconceivable to the entire climbing community — a nature-made, hidden staircase leading to the top.
Maybe, just maybe, the metabolic theory is this hidden staircase.