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29Mar 2013

Time magazine wins the war on cancer!

Time magazine wins the war on cancer!

If you can't read it on the image, here is Time magazine's cover language in full: 

"HOW TO CURE CANCER* 

*Yes, it's now possible--thanks to new cancer dream teams that are delivering better results faster."

Never mind cancer genes and clinical trials. All researchers needed was a new organizational chart.

The cover is dated April 1.

Time's cover language doesn't simply say that a cure is close; it says that a cure is now possible. Time describes this as a "conspiracy" to end cancer. It's a poor choice of words that could fuel the mistrust that many Americans already have of conventional cancer treatment and research.

The story, by Bill Saporito with reporting by Alice Park, begins with the unsurprising news that cancer is "hundreds" of diseases. As he says this, Saporito throws around terms such as "growth inhibitors" and "epigenomes" but doesn't define them, which creates the impression that he has done all the hard work of understanding cancer and doesn't want to bore readers with the details. He quotes the MIT biologist and Nobel laureate Phillip Sharp, who says  the complexity of cancer "is stunning." Again, not terribly surprising.

This narrative, hardly under way, is then interrupted by Saporito's recitation of the usual statistics: "Cancer still kills in large numbers: an estimated 580,350 people will die of the disease in the U.S. this year..." How can that be, if a cure is now possible Shouldn't next year be looking much better?

But never mind this digression. Because now we get the first hint of the dream teams: 

For the past four years, he [Sharp] has been wrangling dream teams funded by Stand Up to Cancer (SU2C), an organization started by entertainment industry figures unhappy with the progress being made against America's most deadly disease.

What it took to cure cancer, in other words, was not simply an organizational chart, but the leadership of entertainment figures, who apparently recognized something that escaped the thousands of people who have devoted their lives to cancer research. Who are the entertainers that cured cancer? Saporito doesn't say yet; but it's coming.

Then we get this assertion, without attribution:

Cancer research--indeed, most medical research--is typically about the narrowly focused investigator beavering away, one small grant at a time. But advances in genetic profiling of malignancies and the mutations that cause them are telling scientists and physicians they must stop working in these kinds of silos, treating lung or breast or colon or prostate cancer as distinct diseases.

Again, this is not surprising, because it's not true. Decades ago, the National Cancer Institute organized cancer research in specialized university cancer centers, creating exactly the kind of teams that Saporito seems to be talking about. And here is the list of authors on a cancer-research paper that appears in the current New England Journal of Medicine:

Analysis of Circulating Tumor DNA to Monitor Metastatic Breast Cancer

Sarah-Jane Dawson, F.R.A.C.P., Ph.D., Dana W.Y. Tsui, Ph.D., Muhammed Murtaza, M.B., B.S., Heather Biggs, M.A., Oscar M. Rueda, Ph.D., Suet-Feung Chin, Ph.D., Mark J. Dunning, Ph.D., Davina Gale, B.Sc., Tim Forshew, Ph.D., Betania Mahler-Araujo, M.D., Sabrina Rajan, M.D., Sean Humphray, B.Sc., Jennifer Becq, Ph.D., David Halsall, M.R.C.Path., Ph.D., Matthew Wallis, M.B., Ch.B., David Bentley, D.Phil., Carlos Caldas, M.D., F.Med.Sci., and Nitzan Rosenfeld, Ph.D.

Does that suggest the image of a narrowly focused investigator beavering away? Many, many cancer-research papers come with a long list of authors--teams, you might say. Saporito's image of a lone beaver is something out of the 19th century, if it was even true then.

Now Saporito tells us that the figures behind Stand Up To Cancer are the late producer Laura Ziskin, the newscaster Katie Couric, and former Paramount CEO Sherry Lansing. Their goal, he writes, was "attacking cancer the way you make a movie: bring the best and most talented possible people together, fund them generously, oversee their progress rigorously and shoot for big payoffs--on a tight schedule."

That's one way to make a movie. Another is to scrape together whatever funds are available, hire local people, take all the time you need, and make Beasts of the Southern Wild, an Oscar nominee for best picture last year. 

The point is that Lansing and company do not have the only answer for how to cure cancer. They might have one answer--the big budget solution. But that is a 40-year-old idea. It comes from Richard Nixon, who signed the legislation launching the war on cancer in 1971. That was precisely the plan Lansing has now "discovered"--find the best people and fund them generously.

At this point, we're one column into a 10-column story. Saporito writes that "what started in Hollywood is now being embraced by the very heart of the research establishment." To back this up, he quotes Francis Collins, head of the National Institutes of Health, who says that he favors collaborations and "building dream teams."

That's not exactly embracing what started in Hollywood. The NIH organized a pretty good dream team to sequence the human genome years ago, on a scale perhaps even Sherry Lansing could not have imagined.

Saporito then briefly discusses M.D. Anderson Cancer Center's "moon shots" program to cure cancer, which involves--yes--the creation of dream teams. The "moon-shot analogy is not a marketing gimmick," Saporito writes. Yes, it is a marketing gimmick. See my earlier post: Worst "cancer-cure" hype ever?

Things get worse as Saporito tries discuss the science underlying cancer research with curious hand-waving that somehow gets to the conclusions without explaining how he got there. "Today the physics of cancer are known; what remains is massive engineering," he writes. First of all, cancer is a biological problem, not one concerned with quarks and black holes. (Note to Time's copy desk: "physics" is singular.) This is a play off the moon-shot idea. The physics of delivering a spacecraft to the moon were understood; all that was needed was the massive engineering.

The analogy breaks down immediately. Researchers are far from understanding the basic biology in many kinds of cancer, and even farther from figuring out how to correct that biology. Many cancers have been cured, but often without a clear understanding of the biology. Radiation and chemotherapy have solid biological rationales, but the people who discovered and refined them figured out how they worked by trial and error, not be understanding the "physics" of cancer, whatever Saporito might mean by that.

The story continues with Saporito quoting folks who are optimistic about curing cancer, but who also tell him how difficult it's going to be. He mentions one study in which researchers doubled the two-year survival rate of pancreatic cancer--to 9 percent.

How did Saporito distill this into the cover language saying that dream teams know how to cure cancer? 

And after all the talk about the urgency to devise teams and the futility of the lone, beavering scientist, he writes in the penultimate paragraph that the lone researcher "will always have a niche in this new ecosystem." What?

Seth Mnookin makes similar criticisms of the story in a good analysis at Slate, and notes other important issues, too, that I haven't commented on. And the real problem with Time's story, he writes, is not that it is wrong, but that "in the context of a fatal disease with excruciatingly painful treatment options, it’s simply cruel."

I agree. Imagine cancer patients and their families spotting Time on the newsstand. Could this be what we've been waiting for? Time says it's now possible to cure cancer. 

Or imagine someone who has just lost a child or a parent or a sibling to cancer. What would they think? That a cure has come along only a few days too late?

-Paul Raeburn

Comments

Shame on me for not noticing the ad, and shame, shame, shame on Time for publishing it. This is worth a separate post; it's outrageous.

Thanks, John.

Almost as distrubing as the content was the full page ad for MD Anderson, the focus for much of the gushing praise, in the middle of the story! (How did you not note that Paul?--read it online?) I'd like to hear how that came about without any editorial/advertising walls being knocked down. Jocelyn Kaiser did a more sober take on one of the initial cancer dream teams a few years ago  http://www.sciencemag.org/content/330/6004/576.full

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