Cancer's killing fields

British Medical Journal, Jan 24, 1998 by Kamran Abbasi

Nazi scientists working sinisterly in dark laboratories; a whole town suffering the harsh discipline of the Third Reich; the triumphant Allies showering gifts on liberated townsfolk. It might sound like the storyline from a second world war yarn, but in fact these are images from Channel 4's Cancer Mrs. Billed as a "major four part series telling the story of cancer through the eyes of those who have suffered, those who have tried to combat it and those who have stood in the way," Cancer Mrs begins with Hider's Germany.

While the Jews were being terrorised, it seems Hitler was on a mission to improve the health of the Aryan race. German scientists investigated smoking and cancer and found a link. In the German town of Jena smoking was banned in public places, with the result that cancer incidence was cut by a quarter. Germans were encouraged to eat vegetables, drink mineral water, stop smoking, and take exercise. In an effort to reduce breast cancer, women were taught self examination. Ironically, when Hitler lost the war the battle against cancer was thwarted: the Americans shipped 93 000 tonnes of tobacco into Germany; the head of research at Jena University committed suicide, and his fellow researchers fled. Consequently, their pioneering work was ignored for many years.

The first episode of Cancer Mrs continued by outlining the tobacco industry's hard sell of smoking, and the way further research about the addictiveness of nicotine was suppressed. The number of smokers in the United States doubled in the 1940s as advertising campaigns persuaded consumers that smoking was cool, good for stress, and healthy. Despite increasing evidence--such as the pioneering work of epidemiologist Richard Doll that linked smoking to lung cancer--the tobacco industry's ability to find doctors to speak in its favour heightened the public's ignorance about the dangers of smoking. Cancer was further stigmatised as a deadly disease with no obvious cause and no known cure.

It was against this background that President Nixon introduced the 1971 Cancer Act, pledging $100m to cancer research and talking of a cure for cancer within five years. Though Nixon was in power at the time of the first moon landing in 1969, this historic event was always seen by the public as the fruition of John F Kennedy's vision. Consumed by his ancient rivalry with the Kennedys, Nixon wanted a triumph of his own, and the cure for cancer was to be his moment of glory.

In this way Cancer Mrs intriguingly explores the political dimensions of cancer, its cause, and its treatment over the past 50 years. Cutting between newsreel footage, interviews with pioneers in cancer research, and alarming facts stated by cancer patients in a darkened room, the programme paints a depressing picture of the struggle against this complex disease. This disturbing subject matter contrasts curiously with the soothing voice of narrator Ian McShane.

The frustrating years after Nixon's Cancer Act are explored in the second programme. As more cancers were diagnosed--notably breast cancer and mesothelioma--potential cures seemed further away. In their desperation, many patients turned to alternative remedies, such as laetrile--made from apricot kernels. Although laetrile was banned in the United States, thousands of Americans, including actor Steve McQueen, flocked to Mexico for this unproved treatment. By 1980, Americans were spending over $500m a year on unconventional therapies; the cure for cancer was proving elusive.

The effects of Ronald Reagan's and Margaret Thatcher's policies will be analysed in the third programme, with the concluding episode explaining how increased public awareness, allied with scientific progress, is now finally drawing us closer to a cure for cancer.

Although much of the content may be familiar and bleak, the political aspects put cancer research in a wider, more sinister, perspective. Indeed, a lingering image from the first episode is of the great American athlete Jesse Owens, who was later blatantly exploited by the tobacco industry to promote smoking. Attitudes have changed--what was once thought to be fashionable is now known to be deadly. Cancer Wars sees patients as the infantry, dying unnecessarily as cures fail to arrive and preventive measures are not taken; the victims of an ongoing conflict between politicians and industrialists.

Kamran Abbasi, editorial registrar, BMJ