on the cancer frontier

Paul Marks and James Sterngold, PublicAffairs, 251 pages, $26.99

Hopes were high when Richard Nixon declared war on cancer in 1971. If scientists could build a nuclear bomb, send a man to the moon and cure polio, they could surely defeat cancer. But 40 years later, millions still die from the diseases that fall under this broad banner. Can it therefore be said that the war on cancer has failed?

No, says Dr. Paul Marks in "On The Cancer Frontier." But the goal should be containment, not victory, because the enemy is uniquely intractable. Cancer sabotages cells, then uses their resources to destroy the body. Treatments often kill good cells along with the bad. Even when forced to retreat, cancers return in more potent forms. "Medical science has never faced a more inscrutable, more mutable, or more ruthless adversary," says Marks.

He would know. As the former head of Memorial Sloan-Kettering, a leading cancer center in New York, Marks has taken part in many of the developments that have enhanced the understanding of the disease. Like an intellectual Forrest Gump, he has worked with Nobel Prize winners, counseled first ladies and been sought out by a shah. But it is the story behind the science that makes this book a compelling read. Lay readers can rely on good metaphors to decipher the jargon: (A virus that contains only RNA, and no DNA, is like "a functioning automobile with a transmission but no engine.")

Marks claims America is winning on some fronts. The death rate from cancer has fallen, though total deaths are up because of a growing and aging population. If he's right, then some of the credit must go to efforts aimed at prevention — the fact that Americans smoke less than they used to has little to do with advances in cellular biology. Still, Marks doubts cancer can be eliminated. Many will have trouble seeing that as success.

The Economist