More than two centuries after the coal soot that caused carcinoma among chimney sweeps became the first identified occupational carcinogen, cancer remains a leading cause of death in the United States. Despite advances in cellular pathology and radiation therapy, two out of every five Americans can still expect to experience the disease during their lives, and its endurance has led to constant attention both from researchers and the public.
Politicians from Nixon to Obama have continuously promised to increase funding for cancer research in their campaigns, while the government-funded National Cancer Institute and Human Genome Research Institute exemplify the intersection between cancer and politics. Cancer also remains nearly ubiquitous in popular media; in 2012, 41% of all disease-related media mentioned cancer, as reported by HighBeam Research. Somewhere between the two spheres of media and politics lie philanthropic giants like the Lance Armstrong and Susan G. Komen Foundations, both of which have established strong public presences but continue to face criticism for the use of misleading statistics in commercial marketing. Between political contributions and media venues, over $200 billion has been invested in the nationwide focus on eliminating the disease. Cancer has become a cultural phenomenon.
Despite all the attention, progress towards finding a cure has been disappointingly sluggish, particularly when viewed in light of the monumental medical advances of the 21st century. As reported by the Center for Disease Control, progress in cardiovascular medicine has reduced fatal heart attacks by 40% since 2000; HIV, once treated as a death sentence, is now considered a chronic disease thanks to anti-retroviral therapy. Yet many of the deadliest forms of cancer remain incurable, and experts widely attribute the mere 6% decrease in cancer mortality rates since 1950 to the decline in smoking, rather than to any scientific breakthrough.
The lack of progress towards “the cure” may not be in spite of the disease’s public attention, but in part the result of it. Because the research process is detailed primarily in scientific journals that use highly technical language, these articles draw a limited audience from the public. Meanwhile, journalists for more accessible publications have the undesirable task of marketing a story to American consumers while maintaining accuracy and comprehensiveness in their report. The details surrounding new findings are often watered down to the point of total inaccuracy in order to render them compatible with the typical reader’s scientific knowledge and vocabulary. This disconnect between factual research and the public perception of the disease produces false information which, when taken as fact, lessens concern for funding the cure.
Not Sold on the Acai Smoothies
James Watson, co-discoverer of DNA’s double-helical structure in 1953 and recipient of the 1962 Nobel Prize in Physiology or Medicine, takes an unforgiving stance on the current state of cancer research. In a paper published in Open Biology on January 8, 2013, Watson emphasizes the need for a revised approach based only in pure and empirical science. This revision would greatly reduce the inaccurate representation of the disease in popular media and politics, which Watson argues has slowed progress towards eliminating the disease. Otherwise, he warns, “the never receding 10-20 year away final victory that our cancer world now feels safe to project will continue to sink the stomachs of informed cancer victims and their families.”
Watson’s position is exemplified by his claim that antioxidants, which are advertised as cancer-fighters, may actually play a larger role in causing cancer than in preventing it. Nearly everyone has heard praise of antioxidant-rich “superfoods” (think dark chocolate and acai berries) as media personalities from Oprah to Dr. Oz espouse their ability to protect our bodies from damaging free radicals. Watson, however, maintains that a diet with overly concentrated levels of these antioxidants may buffer the cancer cells themselves, making them resistant to treatment. The antioxidants block natural reactive oxygen species (ROS), which mediate the apoptosis (or controlled cell death) of cancerous cells, and there is substantial evidence that the general incurability of late-stage cancers arises from high levels of ROS-destroying antioxidants. In particular, excesses of the prominent antioxidants glutathione and thioredoxin associated with avocados, walnuts, and broccoli make cells highly resistant to ROS-induced apoptosis. While initially controversial, this research has been supported by studies by Watson’s lab and is currently being investigated in research institutions throughout the country. If confirmed, these results indicate that as nutritional supplements and marketing of “superfoods” increase our generation’s antioxidant levels to an unprecedented degree, the resultant counteraction of our natural cancer-fighting system may actually be making our cells more vulnerable. This exemplifies the danger of uninformed representation of cancer by the media.
Watson makes the accusation that the uninformed marketing of alleged cancer prevention is not only lacking substantive evidence but may actually have dangerous health consequences, particularly for those who rely on mass media to inform their health choices. A dangerous effect of this widespread misrepresentation is the unequal access to accurate information, which in turn carries the risk of leaving communities of lower educational and socioeconomic status behind. Watson argues that communities with high scientific literacy are more likely to approach information from mass media sources with skepticism, relying more heavily on health care providers to inform their health behaviors. Other groups, however, may not have the technical knowledge necessary to sort the facts from the phony marketing.
The Classism of Cancer
Dr. Melody Goodman, biostatistician and Assistant Professor of Surgery at the Washington University School of Medicine, focuses her research on the social risk factors behind health disparities and works to develop culturally competent cancer prevention strategies. She attributes the high rates of cancer incidence among marginalized communities in large part to the lexical divide between cancer researchers and the public. Central to this divide is the pattern of normalization in which poor health behaviors become the standard, rather than the exception, in underserved communities.
These detrimental behaviors may arise from reliance on inaccurate information supplied by the media, including the emphasis on excessive antioxidant intake that Watson cautions us against. Dr. Goodman explains that because the mention of cancer is nearly ubiquitous in public media, people feel they have gained a satisfactory understanding of the disease without developing the technical familiarity necessary for intellectual access to truly scientific publications. Thus, those with strong educational backgrounds will continue to have a more accurate conception of the research process because they remain skeptical. While the socioeconomic divide already creates unequal access to health care, selectively providing accurate information to the more educated communities leaves others even further behind. To combat this divide, Dr. Goodman emphasizes the importance of “marginalized communities having a level of scientific literacy,” while maintaining that “it is also important for the scientific community to have a level of literacy when it comes to marginalized communities.” In forming a common language, researchers can address public health concerns directly, “working collaboratively with communities as partners, not on communities as subjects.” This cooperative process will counteract the normalizing effects of cancer’s media presence by allowing these communities a more direct perspective on the research process.
In this way, Dr. Goodman envisions that research for a physiological cure will also address the “systematic and environmental” factors that also threaten public health. Her research group is currently working to implement the Community Research Fellows Training Program in downtown St. Louis, which will “[treat] underserved communities as partners in the research process” by inviting community leaders, public health professionals, and faith-based organizations to participate in forums and strategic planning sessions with university researchers. Designed to elucidate and address health concerns, these sessions included workshops on the collaborative promotion of health in minority populations as well as formal research training to facilitate a university-community relationship. As a provider of training sessions meant to dispel false messages from the media and develop the infrastructure for participatory research, Dr. Goodman hopes that this program will become a model for “community-campus partnerships” in other low-income areas. While unequal access to costly health care will still exist, Dr. Goodman maintains that addressing these larger problems relies on first eliminating the information divide through collaborative education.
A New Direction
Even as scientific research progresses towards a cure, normalization of poor health behaviors in underserved populations deepens class divisions as accurate information is provided preferentially to the scientifically literate.
In the same paper in which he denounces the recent stagnancy of cancer research, Watson acknowledges that today’s communication networks are potential vehicles for activism and awareness on a massive scale. If transparency between the research community and the public is made a reality, collaborative educational efforts like the one Dr. Goodman proposes may begin to address the unequal access to accurate information surrounding the disease. While the factors that give rise to social divides in cancer incidence and treatment are numerous and complex, enhancing communication and collaboration between the scientific community and the public is a key starting point for revitalizing progress in cancer research.
Alisa Owens B’15 is currently being investigated in research institutions throughout the country.