Malignant Cancer Quotes

I know that societies often have killed people who have helped to change those societies. And if I can die having brought any light, having exposed any meaningful truth that will help destroy the racist cancer that is malignant in the body of America then, all of the credit is due to Allah. Only the mistakes have been mine.

Like so many of life's varieties of experience, the novelty of a diagnosis of malignant cancer has a tendency to wear off. The thing begins to pall, even to become banal. One can become quite used to the specter of the eternal Footman, like some lethal old bore lurking in the hallway at the end of the evening, hoping for the chance to have a word. And I don't so much object to his holding my coat in that marked manner, as if mutely reminding me that it's time to be on my way. No, it's the snickering that gets me down.

--- What is the victory of a cat on a hot tin roof? --- I wish I knew ... Just staying on it, I guess, as long as she can ... [More croquet sounds] Later tonight I'm going to tell you I love you an' maybe by that time you'll be drunk enough to believe me. Yes, they're playing croquet ... Big Daddy is dying of cancer ... What were you thinking of when I caught you looking at me like that? Were you thinking of Skipper? [Brick crosses to the bar, takes a quick drink, and rubs his head with a towel] Laws of silence don't work ... When something is festering in your memory or your imagination, laws of silence don't work, it's like shutting a door and locking it on a house on fire in hope of forgetting that the house is burning. But not facing a fire doesn't put it out. Silence about a thing just magnifies it. It grows and festers in silence, becomes malignant .... Get dressed, Brick.

Hatred is the spiritual malignancy of our species, and like any other form of cancer, does its most terrible work not outwardly, but from within us.

When cells are no longer needed, they die with what can only be called great dignity. They take down all the struts and buttresses that hold them together and quietly devour their component parts. The process is known as apoptosis or programmed cell death. Every day billions of your cells die for your benefit and billions of others clean up the mess. Cells can also die violently- for instance, when infected- but mostly they die because they are told to. Indeed, if not told to live- if not given some kind of active instruction from another cell- cells automatically kill themselves. Cells need a lot of reassurance. When, as occasionally happens, a cell fails to expire in the prescribed manner, but rather begins to divide and proliferate wildly, we call the result cancer. Cancer cells are really just confused cells. Cells make this mistake fairly regularly, but the body has elaborate mechanisms for dealing with it. It is only very rarely that the process spirals out of control. On average, humans suffer one fatal malignancy for each 100 million billion cell divisions. Cancer is bad luck in every possible sense of the term.

I cannot defeat cancer. Nobody defeats cancer. There is no winning or losing. There is no surviving or not surviving. There are only coin flips: heads or tails; benign or malignant; weight loss or bloating; morphine or oxycodone; extreme rescue efforts or Do Not Resuscitate; live or die.

I know that societies often have killed people who have helped to change those societies. And if I can die having brought any light, having exposed any meaningful truth that will help destroy the racist cancer that is malignant in the body of America, then, all credit is due to Allah. Only the mistakes have been mine. - el-Hajj Malik el-Shabazz

Wouldn’t it be incredible if everyone could find the joy that comes with committing to our own goodness? Perhaps we would stop dividing ourselves into malignancies of various forms.” SCAN

Yes, I have cherished my “demagogue” role. I know that societies often have killed the people who have helped to change those societies. And if I can die having brought any light, having exposed any meaningful truth that will help to destroy the racist cancer that is malignant in the body of America—then, all of the credit is due to Allah. Only the mistakes have been mine.

...God knows, when spring comes to Paris the humbles mortal alive must feel that he dwells in paradise....it [is] the the intimacy with which his eye rests upon the scene. It [is] his Paris. A man does not need to be rich, nor even a citizen, to feel this way about Paris. Paris is filled with poor people - the proudest and filthiest lot of beggars that ever walked the earth... And yet they give the illusion of being at home. It is that which distinguishes the Parisian from all other metropolitan souls. When I think of New York I have a very different feeling. New York makes even a rich man feel his unimportance. New York is cold, glisttering, malign. The buildings dominate. There is a sort of atomic frenzy to the activity going on; the more furious the pace, the more diminished the spirit...Nobody knows what it's all about. Nobody directs the energy. Stupendous. Bizarre. Baffling. A tremendous reactive urge, but absolutely uncoordinated.

Amicable amicable amicable. Did you ever notice that you only use the word amicable in relation to divorce? Was it because it was so often used for divorce that you didn’t want to poison anything else with it? The way you could say “malignant” for things other than cancer but you never did?

Democracy is cancerous, and bureaus are its cancer. A bureau takes root anywhere in the state, turns malignant like the Narcotic Bureau, and grows and grows, always reproducing more of its own kind, until it chokes the host if not controlled or excised. Bureaus cannot live without a host, being true parasitic organisms. (A cooperative on the other hand can live without the state. That is the road to follow. The building up of independent units to meet needs of the people who participate in the functioning of the unit. A bureau operates on opposite principles of inventing needs to justify its existence.) Bureaucracy is wrong as a cancer, a turning away from the human evolutionary direction of infinite potentials and differentiation and independent spontaneous action to the complete parasitism of a virus. (It is thought that the virus is a degeneration from more complex life-form. It may at one time have been capable of independent life. Now has fallen to the borderline between living and dead matter. It can exhibit living qualities only in a host, by using the life of another — the renunciation of life itself, a falling towards inorganic, inflexible machine, towards dead matter.) Bureaus die when the structure of the state collapse. They are as helpless and unfit for independent existence as a displaced tapeworm, or a virus that has killed the host.

New York makes even a rich man feel his unimportance. New York is cold, glittering, malign. The buildings dominate. There is a sort of atomic frenzy to the activity going on; the more furious the pace, the more diminished the spirit.

I came to win, came as I always do, in order to justify who I am and what I have become; now I don't even know what that is. The rot inside me, the cancer of desire, feels unbearable, now it knows it won't be sated. There's a malignant discontent in there, and without a climb there will be no peace. When - if - I pass over to normal life I know I will drag this feeling with me.

The late Alan Gregg pointed out that human population growth within the ecosystem was closely analogous to the growth of malignant tumor cells within an organism: that man was acting like a cancer on the biosphere. The multiplication of human numbers certainly seems wild and uncontrolled… Four million a month—the equivalent of the population of Chicago… We seem to be doing all right at the moment; but if you could ask cancer cells, I suspect they would think they were doing fine. But when the organism dies, so do they; and for our own, selfish, practical... reasons, I think we should be careful about how we influence the rest of the ecosystem.

At that point, more than 15,000 women were dying each year from cervical cancer. The Pap smear had the potential to decrease that death rate by 70 percent or more, but there were two things standing in its way: first, many women - like Henrietta - simply didn't get the test; and, second, even when they did, few doctors knew how to interpret the results accurately, because they didn't know what various stages of cervical cancer looked like under a microscope. Some mistook cervical infections for cancer and removed a woman's entire reproductive tract when all she needed was antibiotics. Others mistook malignant changes for infection, sending women home with antibiotics only to have them return later, dying from metastasized cancer. And even when doctors correctly diagnosed precancerous changes, they often didn't know how those changes should be treated.

Hello, dreamers and doers! Always cut off your connection with negative shits, blocked head, cynic trivia. They all are energy sucker and plaguy mess. They callously murder (you) badass, plug your spirit into their evil workshop and equalize you. Always keep you safe distance from this malignant cancer to rescue your life from the complete annihilation.

Leukemia was a malignant proliferation of white cells in the blood. It was cancer in a molten, liquid form.

Anyway, there are two tentative solutions for getting rid of selfishness - both involving a stoic casting - off of the thin tenuous little identity which I love and cherish so dearly - and being confident that, once on the other side, I shall never miss my own little ambitions for my conceited self, but shall be content in serving the ambitions of my mate, or of a society, or cause. (Yet I will not, I cannot accept any of those solutions. Why? Stubborn selfish pride. I will not make what is inevitable easier for my-self by the blinding ignorance-is-bliss "losing-and-finding" theory. Oh, no! I will go, eyes open, into my torture, and remain fully cognizant, unwinking, while they cut and stitch and lop off my cherished malignant organs.) So much for selflove: I carry it with me like a dear cancerous relative - to be disposed of only when desperation sets in.

The secret to battling cancer, then, is to find means to prevent these mutations from occurring in susceptible cells, or to find means to eliminate the mutated cells without compromising normal growth. The conciseness of that statement belies the enormity of the task. Malignant growth and normal growth are so genetically intertwined that unbraiding the two might be one of the most significant scientific challenges faced by our species. Cancer is built into our genomes: the genes that unmoor normal cell division are not foreign to our bodies, but rather mutated, distorted versions of the very genes that perform vital cellular functions. And cancer is imprinted in our society: as we extend our life span as a species, we inevitably unleash malignant growth (mutations in cancer genes accumulate with aging; cancer is thus intrinsically related to age). If we seek immortality, then so, too, in a rather perverse sense, does the cancer cell.

When he went through a cancer scare and had a benign tumor removed, his sometime friend Evelyn Waugh remarked that it was typical of modern science to find the only part of him that was not malignant and remove it. Randolph was an alcoholic for most of his adult life,

I cannot defeat cancer. Nobody defeats cancer. There is no winning or losing. There is no surviving or not surviving. There are only coin flips: heads or tails; benign or malignant; weight loss or bloating; morphine or oxycodone; extreme rescue efforts or Do Not Resuscitate; live or die.

book. Myeloma as a description has its origins with the Greek medical genius Hippocrates, who did the earliest known work on cancer, which he called karkinoma (carcinoma) because the tumors often resembled a crab, karkinos in ancient Greek. In modern descriptions, the condition is complex and treacherous: Plasma cells in the bone marrow become malignant and produce tumors, causing destruction of the bone and resulting in pathologic fracture and pain. A secretory form of the disease is characterized by the presence of Bence-Jones protein, a monoclonal immunoglobulin, which can cause anemia and kidney disease

For all malignant cancers, both fish eaters and vegetarians and vegans combined had significantly lower mortality than regular meat eaters [HR: 0.76 (95% CI: 0.63, 0.91) and HR: 0.82 (95% CI: 0.72, 0.94), respectively]. Vegetarians and vegans combined also had significantly lower mortality than did regular meat eaters for pancreatic cancer [HR: 0.47 (95% CI: 0.26, 0.86); P-heterogeneity = 0.065] and cancers of the lymphatic/hematopoietic tissue [HR: 0.43 (95% CI: 0.27, 0.70)], and low meat eaters had significantly lower respiratory disease mortality than regular meat eaters [HR: 0.69 (95% CI: 0.49, 0.97); P-heterogeneity = 0.14].

...turned into a horrific mistake. Lucy Willis had observed that folic acid, if administered to nutrient-deprived patients, could restore the normal genesis of blood. Farber wondered whether administering folic acid to children with leukemia might also restore normalcy to their blood. Following that tenuous trail, he obtained some synthetic folic acid, recruited a cohort of leukemic children, and started injecting folic acid into them. In the months that passed, Farber found that folic acid, far from stopping the progression of leukemia, actually accelerated it. In one patient, the white cell count nearly doubled. In another, the leukemia cells exploded into the bloodstream and sent fingerlings of malignant cells to infiltrate the skin. Farber stopped the experiment in a hurry.

He’d given her a key to his new apartment not to pull shit like this, but so they could have something that was amicable. Amicable amicable amicable. Did you ever notice that you only use the word amicable in relation to divorce? Was it because it was so often used for divorce that you didn’t want to poison anything else with it? The way you could say “malignant” for things other than cancer but you never did?

The secret to battling cancer, then, is to find means to prevent these mutations from occurring in susceptible cells, or to find means to eliminate the mutated cells without compromising normal growth. The conciseness of that statement belies the enormity of the task. Malignant growth and normal growth are so genetically intertwined that unbraiding the two might be one of the most significant scientific challenges faced by our species.

In 1994, Friedman wrote a memo marked “Very Confidential” to Raymond, Mortimer, and Richard Sackler. The market for cancer pain was significant, Friedman pointed out: four million prescriptions a year. In fact, there were three-quarters of a million prescriptions just for MS Contin. “We believe that the FDA will restrict our initial launch of OxyContin to the Cancer pain market,” Friedman wrote. But what if, over time, the drug extended beyond that? There was a much greater market for other types of pain: back pain, neck pain, arthritis, fibromyalgia. According to the wrestler turned pain doctor John Bonica, one in three Americans was suffering from untreated chronic pain. If that was even somewhat true, it represented an enormous untapped market. What if you could figure out a way to market this new drug, OxyContin, to all those patients? The plan would have to remain secret for the time being, but in his memo to the Sacklers, Friedman confirmed that the intention was “to expand the use of OxyContin beyond Cancer patients to chronic non-malignant pain.” This was a hugely audacious scheme. In the 1940s, Arthur Sackler had watched the introduction of Thorazine. It was a “major” tranquilizer that worked wonders on patients who were psychotic. But the way the Sackler family made its first great fortune was with Arthur’s involvement in marketing the “minor” tranquilizers Librium and Valium. Thorazine was perceived as a heavy-duty solution for a heavy-duty problem, but the market for the drug was naturally limited to people suffering from severe enough conditions to warrant a major tranquilizer. The beauty of the minor tranquilizers was that they were for everyone. The reason those drugs were such a success was that they were pills that you could pop to relieve an extraordinary range of common psychological and emotional ailments. Now Arthur’s brothers and his nephew Richard would make the same pivot with a painkiller: they had enjoyed great success with MS Contin, but it was perceived as a heavy-duty drug for cancer. And cancer was a limited market. If you could figure out a way to market OxyContin not just for cancer but for any sort of pain, the profits would be astronomical. It was “imperative,” Friedman told the Sacklers, “that we establish a literature” to support this kind of positioning. They would suggest OxyContin for “the broadest range of use.” Still, they faced one significant hurdle. Oxycodone is roughly twice as potent as morphine, and as a consequence OxyContin would be a much stronger drug than MS Contin. American doctors still tended to take great care in administering strong opioids because of long-established concerns about the addictiveness of these drugs. For years, proponents of MS Contin had argued that in an end-of-life situation, when someone is in a mortal fight with cancer, it was a bit silly to worry about the patient’s getting hooked on morphine. But if Purdue wanted to market a powerful opioid like OxyContin for less acute, more persistent types of pain, one challenge would be the perception, among physicians, that opioids could be very addictive. If OxyContin was going to achieve its full commercial potential, the Sacklers and Purdue would have to undo that perception.

What she and others discovered begins to explain why things like smoking or coal mining or sunbathing are so carcinogenic. Each activity injures the tissue and damages the DNA. When the tissue is damaged, the immune system kicks in and cleanses the site and helps stimulate new tissue growth. The trouble is that when the DNA is damaged, the new cells that grow can be malignant cells, some that are made up of self but that are different enough to behave like a cancer.

It is one thing to be physically naked before someone you love, exposing all those perceived blemishes and misshapen contours which, in our own eyes, make us less beautiful and desirable than someone else, but quite another, after having done so, and finding love and acceptance, even adoration, to tear beyond soft flesh and brittle bone, and reveal a cancer on our soul so dark and ugly and malignant that we cannot imagine another human being not turning away in horror.

Normal cells could acquire these cancer-causing mutations through four mechanisms. The mutations could be caused by environmental insults, such as tobacco smoke, ultraviolet light, or X-rays—agents that attack DNA and change its chemical structure. Mutations could arise from spontaneous errors during cell division (every time DNA is replicated in a cell, there’s a minor chance that the copying process generates an error—an A switched to a T, G, or C, say). Mutant cancer genes could be inherited from parents, thereby causing hereditary cancer syndromes such as retinoblastoma and breast cancer that coursed through families. Or the genes could be carried into the cells via viruses, the professional gene carriers and gene swappers of the microbial world. In all four cases, the result converged on the same pathological process: the inappropriate activation or inactivation of genetic pathways that controlled growth, causing the malignant, dysregulated cellular division that was characteristic of cancer.

They are very good odds. And I know that my scientific brain believes them, if not my panic-ridden, maternal one. Those odds should have made a difference to my reaction. I should have been able to take the diagnosis calmly, intelligently, reflectively. But that would be to assign rationality to this phenomenon. The trouble with abject fear - with searing, lurid metaphor - is that it is not rational. And the myths that spring out of fear that deep are certainly not. They are the stuff of nightmares. They are tenacious.

The point is that if you think you can pinpoint the cause, then you can fool yourself into thinking you can avert the cause. It's deeply egotistical. It's life played as a grand insurance policy. Our myth-making around cancer stems from the same impulse. Because we don't know exactly why most of it happens, we weave a makeshift wisdom around it, a false prophet, which seeps into the common story and feeds our hunger to understand why. The guilt is a byproduct, a way to assign blame and seek absolution. It's a lesser evil than the forces of randomness. And it gives us the illusion of control.

To add to the built-in paradox of the for-profit healthcare system, money made from treating cancer aligns a little too comfortably with the profits made from causing cancer. In the FDA’s first attempt to bring cigarettes under their regulatory purview as a drug (nicotine) delivery device, the Supreme Court in 2000 weighed economic and physical health and, in the final opinion, explicitly noted that the tobacco industry played too important a role in the U.S. economy to be regulated by the FDA—even as it recognized that nicotine was an addictive drug whose dose tobacco companies intentionally manipulated.

While some methods of calculation find that cancer and its patients take up too many resources, from another angle, cancer patients are cash cows. Each cancer patient generates millions of dollars in revenues. If one wonders why we would extend the life of a pancreatic patient for a dozen days with a $16,000 drug, let’s remember that this money does not evaporate after twelve days; it continues to circulate in stock prices, salaries, and smaller crumbs of an infinitely profitable cancer pie. Just as the demon of communism justified the proliferation of a lucrative nuclear industry, so cancer fills the core of so many economies that if a cure were to be found, the economy might just crash.

The predominant cancer metaphor is war. We fight cancer, usually valiantly. We attack tumors and try to annihilate them and bring out our arsenals to do that, and so on. It's us against cancer. This metaphor has come in for its share of criticism within the ethical, psychological and even oncological disciplines. A main concern is that when someone dies of cancer, the message that remains is that that person just hasn't fought hard enough, was not a brave enough soldier against the ultimate foe, did not really want to win. The cancer-is-war metaphor does not seem to allow space for the idea that in actual war, some soldiers die heroically for the larger good, no matter which side wins. War is death. In the cancer war, if you die, you've lost and cancer has won. The dead are responsible not just for getting cancer, but also for failing to defeat it.

One of the four genes used by Yamanaka to reverse cellular fate is called c-myc. Myc, the rejuvenating factor, is no ordinary gene: it is one of the most forceful regulators of cell growth and metabolism known in biology. Activated abnormally, it can certainly coax an adult cell back into an embryo-like state, thereby enabling Yamanaka's cell-fate reversal experiment (this function requires the collaboration of the three other genes found by Yamanaka). But myc is also one of the most potent cancer-causing genes known in biology; it is also activated in leukemias and lymphomas, and in pancreatic, gastric, and uterine cancer. As in some ancient moral fable, the quest for eternal youthfulness appears to come at a terrifying collateral cost. The very genes that enable a cell to peel away mortality and age can also tip its fate toward malignant immortality, perpetual growth, and agelessness-the hallmarks of cancer.

Here is another example that demonstrates the tightly linked interests that both cause and treat cancer. In 1978, Imperial Chemical Industries (ICI), one of the largest companies in the world, specializing in agrochemicals and pharmaceuticals, developed the cancer drug tamoxifen. In 1985, along with the American Cancer Society, ICI founded the National Breast Cancer Awareness Month with the aim of promoting mammography as the most effective tool against breast cancer. In 1990 Imperial Chemical Industries was accused of dumping DDT and PCBs, known carcinogens, into the Long Beach and Los Angeles harbors. Zeneca, producer of tamoxifen, demerged from ICI in 1993, and later merged with Astra AB in 1999 to form AstraZeneca. Astra AB had developed the herbicide acetochlor, classified by the EPA as a probable carcinogen. In 1997 Zeneca purchased Salick Health Care, a chain of for-profit outpatient cancer clinics. Subsequently AstraZeneca launched a major publicity campaign encouraging women to assess their risk factors for breast cancer, downplaying the dangers of tamoxifen in order to create a market for its prophylactic, or chemopreventative, use and, more recently, for the breast cancer drug Arimidex (anastrozole), approved in 2002 and used as an alternative to tamoxifen (Arimidex went off patent in 2010).

In Woolrich's crime fiction there is a gradual development from pulp to noir. The earlier a story, the more likely it stresses pulp elements: one-dimensional macho protagonists, preposterous methods of murder, hordes of cardboard gangsters, dialogue full of whiny insults, blistering fast action. But even in some of his earliest crime stories one finds aspects of noir, and over time the stream works itself pure. In mature Woolrich the world is an incomprehensible place where beams happen to fall, and are predestined to fall, and are toppled over by malevolent powers; a world ruled by chance, fate and God the malign thug. But the everyday life he portrays is just as terrifying and treacherous. The dominant economic reality is the Depression, which for Woolrich usually means a frightened little guy in a rundown apartment with a hungry wife and children, no money, no job, and desperation eating him like a cancer. The dominant political reality is a police force made up of a few decent cops and a horde of sociopaths licensed to torture and kill, whose outrages are casually accepted by all concerned, not least by the victims. The prevailing emotional states are loneliness and fear. Events take place in darkness, menace breathes out of every corner of the night, the bleak cityscape comes alive on the page and in our hearts. ("Introduction")

Emotions also directly modulate the immune system. Studies at the U.S. National Cancer Institute found that natural killer (NK) cells, an important class of immune cells we have already met, are more active in breast cancer patients who are able to express anger, to adopt a fighting stance and who have more social support. NK cells mount an attack on malignant cells and are able to destroy them. These women had significantly less spread of their breast cancer, compared with those who exhibited a less assertive attitude or who had fewer nurturing social connections. The researchers found that emotional factors and social involvement were more important to survival than the degree of disease itself. Many studies, such as the one reported in The British Medical Journal article, fail to appreciate that stress is not only a question of external stimulus but also of individual response. It occurs in the real lives of real persons whose inborn temperament, life history, emotional patterns, physical and mental resources, and social and economic supports vary greatly. As already pointed out, there is no universal stressor. In most cases of breast cancer, the stresses are hidden and chronic. They stem from childhood experiences, early emotional programming and unconscious psychological coping styles. They accumulate over a lifetime to make someone susceptible to disease.

I think this book is the most healed and loving form I can make. Then should I send this book across the ocean to where my grandmother is buried-give it to the worms and bugs who live in the soil of my grandmother’s grave? But why do they deserve this sadness? Maybe I’ll just scatter it like ash in the world-as if publishing a book is like scattering ashes from an urn-in the sea, in the forest, in a city, anywhere. Maybe I will take this book to my mother’s house. I will knock on her door and go up to her and say, It’s here. On the page. Your mother’s sadness, and your sadness, and mine. Although not all of the reasons. I don’t know all of the reasons. As she reads through it, I’ll stand there and wonder: Do you think with our lives we validated your mother? Do you think we helped her at all? Did we do our job? Can her life be said to be worth what you thought it was worth? Is this the first thing we have ever done together? You carried the nightmares, and I carried them, too. Can we put them down now? In putting down this book, will you put your sadness down? Put down whatever remains of your task, and finally rest satisfied? Maybe she will say, It’s okay that you don’t know all of the reasons. When I diagnose a cancer, I don’t need to say the reasons. I’m just asked whether it’s malignant or benign. Then these tears, I will say, this pain, this sadness, this tumour-like growth. In your professional opinion, is it malignant or benign? I’ve looked it over carefully-and my opinion is that it’s benign. My suggestion is not to operate. There are more dangers associated with taking it out than leaving it inside.

It may seem paradoxical to claim that stress, a physiological mechanism vital to life, is a cause of illness. To resolve this apparent contradiction, we must differentiate between acute stress and chronic stress. Acute stress is the immediate, short-term body response to threat. Chronic stress is activation of the stress mechanisms over long periods of time when a person is exposed to stressors that cannot be escaped either because she does not recognize them or because she has no control over them. Discharges of nervous system, hormonal output and immune changes constitute the flight-or-fight reactions that help us survive immediate danger. These biological responses are adaptive in the emergencies for which nature designed them. But the same stress responses, triggered chronically and without resolution, produce harm and even permanent damage. Chronically high cortisol levels destroy tissue. Chronically elevated adrenalin levels raise the blood pressure and damage the heart. There is extensive documentation of the inhibiting effect of chronic stress on the immune system. In one study, the activity of immune cells called natural killer (NK) cells were compared in two groups: spousal caregivers of people with Alzheimer’s disease, and age- and health-matched controls. NK cells are front-line troops in the fight against infections and against cancer, having the capacity to attack invading micro-organisms and to destroy cells with malignant mutations. The NK cell functioning of the caregivers was significantly suppressed, even in those whose spouses had died as long as three years previously. The caregivers who reported lower levels of social support also showed the greatest depression in immune activity — just as the loneliest medical students had the most impaired immune systems under the stress of examinations. Another study of caregivers assessed the efficacy of immunization against influenza. In this study 80 per cent among the non-stressed control group developed immunity against the virus, but only 20 per cent of the Alzheimer caregivers were able to do so. The stress of unremitting caregiving inhibited the immune system and left people susceptible to influenza. Research has also shown stress-related delays in tissue repair. The wounds of Alzheimer caregivers took an average of nine days longer to heal than those of controls. Higher levels of stress cause higher cortisol output via the HPA axis, and cortisol inhibits the activity of the inflammatory cells involved in wound healing. Dental students had a wound deliberately inflicted on their hard palates while they were facing immunology exams and again during vacation. In all of them the wound healed more quickly in the summer. Under stress, their white blood cells produced less of a substance essential to healing. The oft-observed relationship between stress, impaired immunity and illness has given rise to the concept of “diseases of adaptation,” a phrase of Hans Selye’s. The flight-or-fight response, it is argued, was indispensable in an era when early human beings had to confront a natural world of predators and other dangers. In civilized society, however, the flight-fight reaction is triggered in situations where it is neither necessary nor helpful, since we no longer face the same mortal threats to existence. The body’s physiological stress mechanisms are often triggered inappropriately, leading to disease. There is another way to look at it. The flight-or-fight alarm reaction exists today for the same purpose evolution originally assigned to it: to enable us to survive. What has happened is that we have lost touch with the gut feelings designed to be our warning system. The body mounts a stress response, but the mind is unaware of the threat. We keep ourselves in physiologically stressful situations, with only a dim awareness of distress or no awareness at all.

As it happened, the child’s mother was a radiologist. The tumor looked malignant—the mother had already studied the scans, and now she sat in a plastic chair, under fluorescent light, devastated. “Now, Claire,” the surgeon began, softly. “Is it as bad as it looks?” the mother interrupted. “Do you think it’s cancer?” “I don’t know. What I do know—and I know you know these things, too—is that your life is about to—it already has changed. This is going to be a long haul, you understand? You have got to be there for each other, but you also have to get your rest when you need it. This kind of illness can either bring you together, or it can tear you apart. Now more than ever, you have to be there for each other. I don’t want either of you staying up all night at the bedside or never leaving the hospital. Okay?” He went on to describe the planned operation, the likely outcomes and possibilities, what decisions needed to be made now, what decisions they should start thinking about but didn’t need to decide on immediately, and what sorts of decisions they should not worry about at all yet. By the end of the conversation, the family was not at ease, but they seemed able to face the future. I had watched the parents’ faces—at first wan, dull, almost otherworldly—sharpen and focus. And as I sat there, I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context. In the actual situations where one encounters these questions, it becomes a necessarily philosophical and biological exercise. Humans are organisms, subject to physical laws, including, alas, the one that says entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation. While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is

THE LEWINSKY PROCEDURE: A STRATEGY GUIDE FOR MINIMIZING POLITICAL SCANDAL Deny -The necessary first stage, where you question the accuracy of the facts. It will take time for all the scandalous details to come out, and if you’re careful or lucky, they may never come out. Deny everything until the point that the facts against you can be substantiated. Delay -Take every action possible to stall, postpone, impede, procrastinate, and filibuster. The longer the time between the initial news of the scandal and the resolution of the scandal, the better. Diminish -Once the facts against you have been substantiated, either minimize the nature of the scandal or its impact against you. “At this point, what difference does it make?” Debunk -Have a helpful news organization or advocacy group develop a useful counter-narrative that explains away the scandal or contradicts the facts or generally does something to get progressives back on your side. “Explanatory journalism” is a great help here. Distract -Change the conversation by talking about something else. It doesn’t matter what that might be, because there’s always something else more important, even if it’s reminding people to drink more water. Suggest that the scandal itself is a distraction from the real issues. Deflect -When in doubt, blame the Republicans. All administrative failures can be blamed on the failures of the prior administration. All political failures can be blamed on Republican legislation or Republican intransigence in not passing progressive legislation which would have fixed the problem. All personal failures can be excused by either bringing up the example of a Republican who did something similar, or by pointing out that whatever was done wasn’t as bad as serving divorce papers on your wife when she’s in the hospital with cancer, or invading Iraq. Divide -Point out that the scandal is being driven by the most extreme Republicans, and that moderates aren’t to blame. This won’t help you with moderates that much, but it will give the moderates another reason not to like the extremists, and vice versa, and this can only be positive. Deploy -Get friends and allies to talk about your positive virtues in public, without reference to the scandal. If the scandal comes up, have them complain about the politics of personal destruction. Demonize -Attribute malign intentions to the conservatives trying to promote the scandal. This approach should also include special prosecutors, judges, and anyone else who is involved in the scandal to one degree or another. Defenestrate -When necessary, shove someone under the bus. Try not to make this a habit, or you won’t have anyone around to deploy. The target for defenestration can be small (rogue employees in the Cincinnati regional office) or large (Cabinet secretary) but it needs to be someone who won’t scream overly much as they sail out the window. ❄ ❄ ❄

I’d like to start a worldwide movement to implement practices of culturally appropriate Life Honoring Celebrations. Not to replace funerals but to augment them. Personally, I think it’s impractical at best and pointless at worst to sing somebody’s praises when they’re dead. Perhaps saying lovely things about them at funerals helps us mourn. Saying the same things to them while alive may give us a jumpstart on that mourning. But why not use their dying as an opportunity to grow ourselves, to bring us into closer proximity with the reality of death, to face our fears and step willfully into our deepest hearts to speak the truth of what someone means to us? Why not tell them when they’re alive? Why not let them see some of the difference they made in the world around them? Even the most troubled and maligned person usually has positively impacted somebody. No matter how difficult anyone’s life has been they usually create some ripples of positive change. And I believe that every person longs to know that. We long to see it. To know that our existence does not all come to naught in the end. That efforts large and small have impacts seen and unseen. It serves each of us to have tangible proof of this before we pass. Life Honoring Celebrations should be every human’s birthright. Thank goodness Tracy got to receive hers. Just in time.

When people make judgments, they argued, they compare whatever they are judging to some model in their minds. How much do those clouds resemble my mental model of an approaching storm? How closely does this ulcer resemble my mental model of a malignant cancer? Does Jeremy Lin match my mental picture of a future NBA player? Does that belligerent German political leader resemble my idea of a man capable of orchestrating genocide? The world’s not just a stage. It’s a casino, and our lives are games of chance. And when people calculate the odds in any life situation, they are often making judgments about similarity—or (strange new word!) representativeness. You have some notion of a parent population: “storm clouds” or “gastric ulcers” or “genocidal dictators” or “NBA players.” You compare the specific case to the parent population.

Politicians take money from the citizenry, funnel much of it to themselves and their friends, and then use the rest of it to buy votes and to grow their power—which involves bigger and bigger government. Once a bureau is created it is never destroyed—like a malignant cancer. And government never invents the next great computer. Never produces. Only consumes.” Alyssa

In the cloudy swirl of misleading ideas surrounding public discussion of addiction, there’s one that stands out: the misconception that drug taking by itself will lead to addiction — in other words, that the cause of addiction resides in the power of the drug over the human brain. It is one of the bedrock fables sustaining the so-called “War on Drugs.” It also obscures the existence of a basic addiction process of which drugs are only one possible object, among many. Compulsive gambling, for example, is widely considered to be a form of addiction without anyone arguing that it’s caused by a deck of cards. The notion that addiction is drug-induced is often reinforced. Clearly, if drugs by themselves could cause addiction, we would not be safe offering narcotics to anyone. Medical evidence has repeatedly shown that opioids prescribed for cancer pain, even for long periods of time, do not lead to addiction except in a minority of susceptible people. During my years working on a palliative care ward I sometimes treated terminally ill cancer patients with extraordinarily high doses of narcotics — doses that my hardcore addict clients could only dream of. If the pain was alleviated by other means — for example, when patient was successfully given a nerve block for bone pain due to malignant deposits in the spine — the morphine could be rapidly discontinued. Yet if anyone had reason to seek oblivion through narcotic addiction, it would have been these terminally ill human beings. An article in the Canadian Journal of Medicine in 2006 reviewed international research covering over six thousand people who had received narcotics for chronic pain that was not cancerous in origin. There was no significant risk of addiction, a finding common to all studies that examine the relationship between addiction and the use of narcotics for pain relief. “Doubts or concerns about opioid efficacy, toxicity, tolerance, and abuse or addiction should no longer be used to justify withholding opioids,” concluded a large study of patients with chronic pain due to rheumatic disease. We can never understand addiction if we look for its sources exclusively in the actions of chemicals, no matter how powerful they are.

Normal cells are identically normal; malignant cells become unhappily malignant in unique ways.

For specific causes of death, compared with regular meat eaters, low meat eaters had ~30–45% lower mortality from pancreatic cancer, respiratory disease, and all other causes of death, fish eaters had ~20% lower mortality from malignant cancer and ~20% higher circulatory disease mortality, and vegetarians and vegans had ~50% lower mortality from pancreatic cancer and cancers of the lymphatic/ hematopoietic tissue. These findings were essentially unchanged on further adjustment for BMI, and generally were robust across categories of sex, smoking, and BMI for the 6 most common causes of death.

When I think of New York I have a very different feeling. New York makes even a rich man feel his unimportance. New York is cold, glittering, malign. The buildings dominate. there is a sort of atomic frenzy to the activity going on; the more furious the pace, the more diminished the spirit. A constant ferment, but it might just as well be going on in a test tube. Nobody knows what it is about. Nobody directs the energy.

Fifteen miles above us, as was first discovered by the British Antarctic Survey nine years before, a hole in the ozone layer opened up at this time of the year (at its worst in November) and allowed dangerous levels of ultraviolet rays to descend unfiltered to Antarctica and southerly lands like Australasia and Patagonia. Every year the hole grows bigger and more animals, including humans, suffer the resulting cancers, blindness and weakened immune systems. In Australia and New Zealand malignant melanomas have taken over from other cancers and heart disease as man's chief killers. In Patagonia, where sheep outnumber humans, whole flocks are going blind.

The Oregon researchers began by creating, as a starting point, a very simple algorithm, in which the likelihood that an ulcer was malignant depended on the seven factors the doctors had mentioned, equally weighted. The researchers then asked the doctors to judge the probability of cancer in ninety-six different individual stomach ulcers, on a seven-point scale from “definitely malignant” to “definitely benign.” Without telling the doctors what they were up to, they showed them each ulcer twice, mixing up the duplicates randomly in the pile so the doctors wouldn’t notice they were being asked to diagnose the exact same ulcer they had already diagnosed. The researchers didn’t have a computer. They transferred all of their data onto punch cards, which they mailed to UCLA, where the data was analyzed by the university’s big computer. The researchers’ goal was to see if they could create an algorithm that would mimic the decision making of doctors. This simple first attempt, Goldberg assumed, was just a starting point. The algorithm would need to become more complex; it would require more advanced mathematics. It would need to account for the subtleties of the doctors’ thinking about the cues. For instance, if an ulcer was particularly big, it might lead them to reconsider the meaning of the other six cues. But then UCLA sent back the analyzed data, and the story became unsettling. (Goldberg described the results as “generally terrifying.”) In the first place, the simple model that the researchers had created as their starting point for understanding how doctors rendered their diagnoses proved to be extremely good at predicting the doctors’ diagnoses.

Of course, OxyContin was stronger than morphine. That was a simple fact of chemistry—but one that the company would need to carefully obscure. After all, there are only so many cancer patients. “We are better off expanding use of OxyContin,” Friedman wrote. The real jackpot was “non-malignant pain.” OxyContin would not be a “niche” drug just for cancer pain, the minutes of an early Purdue team meeting confirm. By the company’s estimates, fifty million Americans suffered from some form of chronic pain. That was the market they wanted to reach.

Green tea (matcha)[38] : Inside green tea are polyphénols which are antioxidants (compounds that protect the body's cells from damage caused by free radicals). They are called catechins (EGCG). A Japanese study carried out on a large number of patients has shown that we could limit the growth of malignant cells as well as the growth of the vessels that nourish them in the context of prostate cancer. On the other hand, it would prevent diseased cells from absorbing the glutamine on which they feed. I take it in the form of tablets and powder which I mix with sparkling water and mint which I drink throughout the day. It is a variety of tea from Japan and I chose it because it has 137 times more EGCG than regular green tea. This makes it one of the most powerful antioxidants in the world. In addition, it has long been considered a real medicine by the samurai ! A tea made to measure for me, isn't it ?

I think breast cancer results from a complex interaction of genetic and environmental factors, in which lifestyle choices, such as diet, use of alcohol, and exposure to estrogenic toxins, may have much more influence than emotions. I do believe that grief and depression may suppress immunity, giving malignant cells the chance to grow into perceptible tumors; but I reject the idea that people give themselves cancer by failing to express anger and other emotions.

As was stated in one study published in the Autophagy journal, “one well-recognized way of inducing autophagy is by food restriction, which up regulates autophagy in many organs including the liver” (Alirezai et al. 2010). The study goes on to point out that autophagy has been recognized as a crucial defense mechanism to protect against malignancy (cancer), infection, Alzheimer’s disease, and neurodegenerative diseases.

For example, having been in the rare position of working in the fields of both healing and management, I could not help but notice that the batting average in the war on cancer and the batting average in the struggle to heal chronically troubled institutions are remarkably similar, with cancer perhaps a little ahead. I have been struck by how families, corporations, and other kinds of institutions are constantly trying to cure their own chronic ills through amputations, “strong medicine,” transfusions, and other forms of surgery only to find that, even when successful for the moment, the excised tumor returns several years later in “cells” that never knew the “cells” that left. “New blood” rarely thwarts malignant processes, anywhere. Indeed, with both cancer and institutions, malignant cells that appear to be dead can often revive if they receive new nourishment. Or, to put the problem another way, when we say something has gone into remission, where do we think it has gone?

I think our government has gotten so far off track that it’s high time something like this happened. All of these partisan politicians. You can see where they’ve gotten us. They cultivated this cancer, fought senselessly over how they should treat it, and now they’re shocked to find that it’s malignant and spreading? I’ll tell you how we need to treat it. We need to oust the sons-a-bitches and bring the control back to the people. We’re going to have to start this whole country up from scratch, using the Constitution, of course. We need to stick a cork in all of these special interests and get back to doing what’s best for us. We’ve got this moment in history to set things right. Does that make sense to you guys?

Here are just two stand-out facts from a major study in the Annals of Epidemiology entitled ‘Vitamin D for Cancer Prevention.’[3] “Women with higher solar UVB exposure had only half the incidence of breast cancer as those with lower solar exposure.” “Men with higher residential solar exposure had only half the incidence rate of fatal prostate cancer.” To put that in simple English, if you spend longer in the sun, you may be far less likely to die of breast and prostate cancer (and lots of other cancers as well, but more on cancer later). But what about the increased risk of dying of skin cancer! I hear you cry. Well, what of it? Around 2,000 people a year die of malignant melanoma in the UK each year. If increased sun exposure were to double this figure, we would have 2,000 more cases. On the other hand, breast cancer kills around 20,000 a year, as does prostate cancer. If we managed to halve the rate of breast and prostate cancer, we would reduce cancer deaths by 20,000 a year. Which is ten times as great any potential increase in deaths from malignant melanoma.

I would imagine that fighting an unwelcome colonial occupation is like fighting a malignant cancer. Destroying the cancerous cells one by one becomes a necessity for one’s very survival. Shooting down members of a colonial occupying force one by one is the exact equivalent of destroying those cancerous cells. And to some extent, one assumes, more satisfying to those trying to be rid of the cancer.

Let us say that you might have become a telepathic cancer, a malignant mentality which in its inevitable dissolution would have poisoned other and greater minds.

It would mean that the decisive factor in malignant cancer is not the accumulation of genetic damage in cells, much of which is unavoidable, but how diets change the environment around cells and tissues to promote the survival, growth, and then metastasis of the cancer cells that do appear.

incidence. Exposure to natural or manmade radioisotopes also occurs during cancer radiotherapy, whereas the radioactive compounds iodine-131 and technetium-99m are exploited to diagnose and treat benign and malignant thyroid diseases

When my mom was first diagnosed with cancer, I learned the word "malignant" and heard the word "spread" and knew the word "hope" was a mirage, a fantasy that would only make things worse. But then I learned the word "remission," and the doctors loosened their ties, cracked bad jokes (said her blood type was B-positive, so we should be optimistic, too), and they increased the odds of her survival to fifty-fifty, like she was something to wager on in Vegas. I slept well and ate well and celebrated on the inside. My kidneys shook pom-poms, my liver did an Irish jig, my small intestines did the worm. The future was bright with a likely chance of sunshine--and then it was over.

For the first time, I understood the ancients' need to find explanations for why things happen. It's a quintessential human imperative. Random is not emotionally satisfying. Therefore, lightning was the bolt from an angry god. Crop failure was punishment for failing to honor the gods with a fatted calf. The plague happened because you took the Lord's name in vain or coveted your neighbor's wife. Going to church regularly and praying could forestall illness. And on and on.

In the bloodstream, virtually all insulin-like growth factors are attached to small proteins that ferry them around to various tissues where they might be needed. But the IGFs, when attached to these proteins, are too large and unwieldy to pass through the walls of blood vessels and get to the tissues and cells where the IGF might be used. At any one time, only a small percentage of IGF in the circulation is left unbound to stimulate the growth of cells. These binding proteins constitute yet another of the mechanisms used by the body to regulate hormonal signals and growth factors. Insulin appears to depress the concentration of IGF-binding proteins, and so high levels of insulin mean more IGF itself is available to effect cell growth—including that of malignant cells. Anything that increases insulin levels will therefore increase the availability of IGF to the cells, and so increase the strength of the IGF proliferation signals. (Insulin has been shown to affect estrogen this way, too, one way in which elevated levels of insulin may potentially cause breast cancer.) The

The binary of illness/wellness is always porous, whether or not we notice. In Illness as Metaphor, Susan Sontag wrote, “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.” I used to believe Sontag uncritically. Now I know that the two kingdoms don’t exist; it’s one kingdom, in a quantum state. We are all constantly both sick and well, sick/well, sick and well both, our body and immune system in conversation with a world rich in microbes, viruses, and bacteria, almost all of them either benign or beneficial, countless microbes in me here as I write and in you there as you read. The quantum state of sick/well. Let me take cancer, that disease so long synonymous with death. Cancer is not a binary. We’re willing to acknowledge this, but only when one has already crossed over into the sick category. Cancer has stages. Stage 1 cancer is still small, mostly easily treatable; stage 4 cancer is aggressive, malignant, deadly. Many prostate cancers require no intervention at all. They are subclinical. We live with them until something else kills us. Cancer is not black and white but gray, and further, there is no white to begin with. There is no absence of cancer as long as we have a body. We make cancerous cells every day our cells divide, which is to say every day. In order to keep living, and keep making—for example—new skin to push the outside world out, our cells have to divide. With each cell division, a cell will make mutations. Mutations are the raw material of cancer. Carcinogens and sunlight cause cancer because they cause mutations and damage to our DNA. But without cell division, no life. To risk cancer, to make it day by day, is to live. The absence of cancer is death. So cancerous cells are a normal part of life. In the popular imagination, we see the immune system as mainly protecting us from infectious disease, from bacteria and viruses. But just as importantly, our immune system protects us against cancer, the cells in our own body that mutate to become other, to pose a threat. At almost 40, I’ve certainly had cancerous cells in me, cells that mutate so they can divide and divide and divide. It’s my immune system that finds those cells and kills them so that I, a whole organism, can survive. But because I don’t have cancer doesn’t mean I haven’t had a cancer cell in me. I have, and survived it, so far.

Burr was in. He enthusiastically sent one of his contraptions back with Langman to his wards, where, in an initial group of 100 women, he strapped one electrode to the lower abdomen above the pubis, and the other either on or alongside the cervix.6 Women whose troubles turned out to be caused by ovarian cysts or other non-cancerous medical issues almost always had a positive reading. Women with malignant tumors, however, showed an electrical “marked negativity” of the cervical region every time.7 Langman confirmed their diagnosis with a pathological examination. Cancerous tissues, it appeared, emitted an unmistakable electrical signature. Langman repeated the technique in about a thousand women to see whether his results stood up. They did: 102 of his patients exhibited the characteristic voltage reversals. When Langman operated on them, he confirmed that 95 of the 102 had cancer.8 Even more remarkably, often the masses had not even progressed to the point where the symptoms would have driven them to visit the doctor, never mind obtain a correct diagnosis. After removing these cancers, the electrical polarity shown on the electrometer would normally flip back to a “healthy” positive indicator—but it did not always. When it stayed negative, Burr and Langman suspected that this indicated that they either hadn’t got it all, or the cells had metastasized. Somewhere in the body, a cancerous mass was still sending its nefarious signals. What struck them as especially strange was that the electrode inside the genital tract did not have to be placed directly on, or even particularly near to, the malignant tissue for the anomaly to be detectable. It was like a distress signal was being sent over distances through the body’s healthy tissue.

Dr. Paul Brand points out that every cell in the body has its own specific job, in interdependence with every other cell. The only cells which insist on being independent and autonomous are cancer cells. Surely that should be a lesson to us in the churches. Separation from each other and from the rest of the world is not only disaster for us, but for everybody from whom we separate ourselves. We must be very careful lest in insisting on our independence we become malignant.

Within the class of neuroendocrine cancers, carcinoid is the most common specific cancer, but there also is a wide variety of other, much less common neuroendocrine cancers such as gastrinomas, somatostatinomas, VIPomas, etc.  All of the neuroendocrine cancers have symptoms which can partially mimic mast cell disease.  However, in the vast majority of cases of these rare tumors, the total range and duration of symptoms, and the pattern of progression/worsening, don’t come anywhere close to what’s typically seen in mast cell disease.  Nevertheless, in part because of the partial symptom mimicry, patients who are ultimately found to have mast cell disease often have been previously suspected of having – and thus have been intensively tested for, and sometimes even treated for – a neuroendocrine malignancy for which definitive diagnostic evidence cannot be found.

But if libertarian free will is a delusion, nothing more than a neurological magician’s conjuring trick, then can we ever feel that someone is morally responsible for his or her actions? If our thoughts come from our neurons, and we can’t actively control our neurons with some magical material we call our minds, then the way we think and the actions our thoughts produce are not so different from thoughts and actions swayed by a tumor. One act is swayed by malignant tissue, another act swayed by healthy tissue, but does that make them morally different? We can’t control healthy tissue within our brains any more than we can control cancerous cells. If we can accept that I couldn’t choose to be interested in the Civil War, but rather my thoughts and fascination were the inevitable result of neurological and biological processes according to the laws of physics, then why would it be any different for choices that had moral weight? We don’t choose our genes, our parents, our childhood experiences, or the physical composition of our brains, yet those factors clearly determine our future behaviors. Does it make sense to blame people for their actions—or to praise them for their achievements? If not, that’s incredibly disconcerting, as it seems to let “evil” people off the hook. It’s a difficult notion to stomach, and it raises an even more problematic question: How could we justify punishing criminals if they had no free choice?*

Since 2007, Alzheimer’s has been the sixth leading cause of death in the United States, and for people eighty and over, it’s now in fifth place for men, third for women. But even that isn’t quite right. For the most part, the causes of death that have led the CDC listings for the last century are broad categories of disorders such as “diseases of the heart,” “malignant neoplasms,” and “accidents” (unintentional injuries). As a result, many diseases fall under each heading, and the numbers of deaths counted are high. If we list heart attacks, heart failure, arrhythmias, and other cardiac conditions separately but cancer as a single entity, for example, heart diseases would not top the list; cancer would. But cancer would also drop lower down the list if we separated out the different types—listing breast, lung, skin, prostate, colon, blood, and each of the many others individually. Yet the CDC considers Alzheimer’s a separate disease on its own, rather than grouping the many dementias together. A more taxonomically consistent approach would be to have a dementia category that included vascular, Lewy body, frontotemporal, and all the other dementias. This matters because where a condition appears on this and other lists affects all aspects of medicine—from doctor training to money for research and departments within health systems, as well as the public’s imagination and our political and social priorities.

So, I ordered that 2nd diagnosis for another ridiculously high amount of money and unfortunately it turned out that the first diagnosis was correct. It became a brutal fact, written as if it were hammered in stone that the tumor was indeed a malignant liver tumor. And yet, I will never forget how and with a never-felt-before, deep intensity Blissy looked at me when the vet let me alone with the information that I should put her down. To me, Blissy seemed to be able to look right into my heart and right into my soul saying something like: PLEASE, PLEASE PLEASE do not give up on me yet.

There was Paige before she met Aaron. And Paige now. Aaron Corval was scum—obvious, unsubtle scum—and when you blended scum and purity, the purity was forever sullied. Simon never got the appeal. Aaron was thirty-two years old, eleven years older than his daughter. In a more innocent time, this age difference had concerned Simon. Ingrid had shrugged it off, but she was used to such things from her modeling days. Now, of course, the age difference was the least of it. There was no sign of Aaron. A small bird of hope took flight. Could Aaron finally be out of the picture? Could this malignancy, this cancer, this parasite who fed off his daughter have finished his feast and moved on to a more robust host?

Science embodies the human desire to understand nature; technology couples that desire with the ambition to control nature. These are related impulses-one might seek to understand nature in order to control it-but the drive to intervene is unique to technology. Medicine, then, is fundamentally a technological art; at its core lies a desire to improve human lives by intervening on life itself. Conceptually, the battle against cancer pushes the idea of technology to the far edge, for the object being intervened upon is our genome. It is unclear whether an intervention that discriminates between malignant and normal growth is even possible. Perhaps cancer, the scrappy, fecund, invasive, adaptable twin to our own scrappy, fecund, invasive, adaptable cells and genes, is impossible to disconnect from our bodies. Perhaps cancer defines the inherent outer limit of our survival. As our cells divide and our bodies age, cancer might well be the final terminus in our development as organisms.

Hodgkin may have been disappointed by what he thought was only a descriptive study of his disease. But he had underestimated the value of careful observation—by compulsively studying anatomy alone, he had stumbled upon the most critical revelation about this form of lymphoma: Hodgkin’s disease had a peculiar propensity of infiltrating lymph nodes locally one by one. Other cancers could be more unpredictable—more “capricious,” as one oncologist put it. Lung cancer, for instance, might start as a spicular nodule in the lung, then unmoor itself and ambulate unexpectedly into the brain. Pancreatic cancer was notoriously known to send sprays of malignant cells into faraway sites such as the bones and the liver. But Hodgkin’s—an anatomist’s discovery—was anatomically deferential: it moved, as if with a measured, ordered pace, from one contiguous node to another—from gland to gland and from region to region.

We suggest that the vast catalog of cancer cell genotypes is a manifestation of six essential alterations in cell physiology that collectively dictate malignant growth.

Lung cancer is the second most frequent cancer in the United States, but it is also the deadliest, causing the most fatalities of all malignancies.

Small cell lung cancer, which accounts for around 15% of all lung malignancies, is less prevalent than non-small cell lung cancer. This kind of lung cancer grows quickly, is likely advanced at the time of diagnosis, and swiftly spreads to other parts of the body.

Haematopoietic stem cell transplantation is not a term that is immediately recognizable to the general public but it is actually the same as the much more familiar ‘bone marrow transplantation’. The rather long phrase haematopoietic stem cell transplantation (HSCT) is now preferred because it covers not just transplantation of bone marrow itself but other types of transplant where the blood-forming (haematopoietic) stem cells of the graft come from non-marrow sources such as peripheral blood or umbilical cord blood. Worldwide, about 50,000 HSCTs are carried out each year making this overwhelmingly the most important type of stem cell therapy in current practice. Most are done for treatment of cancer, mainly lymphomas and leukaemias, with about 5 per cent for treatment of non-malignant blood diseases and a few other conditions.

Censoring Measuring response rate and progression offers more problems than measurement error. We may not be considering the right denominator of patients. In 2017, the FDA approved the first cellular cancer therapy, called tisagenlecleucel (Kymriah, Novartis), or CAR-T, for short. A CAR-T is a chimeric antigen receptor T-cell, basically a genetically modified cell taken from a patient that is trained to attack cancer cells and then placed back in the patient. In the data submitted to the FDA, 88 patients had the cells removed, but 18% (16/88) did not receive the cells because some patients died and some patients’ cells could not be manufactured.17 Unfortunately, the FDA excluded these patients from the denominator and assessed response only in patients who got the cells. This violates a principle called intention to treat, that is, you should judge a drug based on all patients allocated to get it, irrespective of whether or not they received it. Why? Because therapies that take a long time to give (this CAR-T took approximately 22 days to make) may exclude the sickest patients who die while waiting, thus distorting their benefit. In fact, if I have a patient in my office and we decide to treat with tisagenlecleucel, the response rate from the package overestimates her chances of success, as I am unsure she will live long enough to receive the cells.

Among parents who lost an adult son to an accident or military conflict, the authors reported increased occurrence of lymphatic and hematological malignancy—cancers of the blood, bone marrow, and lymph nodes—along with skin and lung cancer.8 War kills, and so, it seems, can deep emotional loss. As for cancer, so with other illnesses. In a Danish nationwide study, grieving parents had double the risk of multiple sclerosis.9

Chance’ simply means historical contingency - this happens rather than that. It is not automatically to be given the tendentious adjective “blind”, as if it were an unambiguous sign of meaninglessness. Rather, it may be seen as signifying the shuffling exploration and realization of fertile possibilities, by which creation makes itself. This due independence of process is a good gift, but it has a necessary cost attached to it. Raggednesses and blind alleys, as well as fruitful outcomes, are inescapable accompaniments of this evolving self-realization. Biology even helps theology a little with the deep question of theodicy, the problem of the evil and suffering of the world. Exactly the same biochemical processes that enable some cells to mutate and produce new forms of life - in other words, the very engine that has driven the stupendous four billion year history of life on Earth - these same processes will inevitably allow other cells to mutate and become malignant. In a non-magic world, it could not be different, and the world is not magic because its Creator is not a capricious Magician. I do not pretend for a moment that this insight removes all the perplexities posed by the sufferings of creation. Yet it affords some mild help, in that it suggests that the existence of cancer is not gratuitous, as if it were due to the Creator’s callousness or incompetence. We all tend to think that if we had been in charge of creation we would have made a better job of it. We would have kept the nice things (flowers and sunsets) and got rid of the nasty (disease and disaster). The more science helps us to understand the process of the universe, the more, it seems to me, to cohere into a single ‘package deal’. The light and the dark are two sides of the same coin. John Polkinghorne, “Understanding the Universe”, Cosmic Questions, James. B Miller, ed.

Garlic[43] : This amazing aromatic plant, the most powerful antioxidant known, has been used to treat and cure illnesses through the ages. Even Hippocrates recommended consuming large amounts of crushed garlic as a remedy. A study in China finds that consuming raw garlic regularly cuts the risk of lung cancer in half, and previous studies have suggested that it may also ward off other malignant tumors, such as colon cancer. It is best to let it sit for at least fifteen minutes after the pods have been crushed. This time is needed to release an enzyme (allicin) that produces antifungal and anti-cancer compounds. Alliates (garlic, onion, chives) and their cousins (leek, shallot) improve liver detoxification and therefore help protect our genes from mutations. I take it in three forms: tablet, powder and fresh. I use it in almost all my dishes and sauces, it is the anti-cancer food par excellence. Vegetables[44] : To avoid disease, nothing like a diet rich in raw and organic vegetables. The daily intake of vegetables would prevent cancers of the mouth, pharynx, esophagus, lung, stomach, breast, colon and rectum. I eat it abundantly; you could even say that it has become my staple food. I eat of course all the cabbage, garlic, onion, pepper but also asparagus, mushrooms, leek, cucumber, scallions (green onions), zucchini, celery, all salads, spinach, endives, pickles, radishes, green beans, parsley and aromatic herbs. At first, I ate cooked tomatoes but stopped because they contain too much sugar. Omega 3 :   Omega 3, in cancer, are anti-inflammatory. Omega 6 or linoleic acids (found in sunflower and peanut oils) are inflammatory. You must always have an omega 3 / omega 6 ratio favorable to omega 3. This is why I take capsules of this fatty acid in addition to eating sardines and anchovies[45]. An inflammatory environment is conducive to the formation and proliferation of cancer cells. To restore the balance, it is necessary to consume more foods rich in omega 3 such as fatty fish, rather small ones because of mercury pollution (sardines, anchovies, mackerel, herring), organic eggs or eggs from hens fed with flax, chia seeds and flax seeds, avocados, almonds, olive oil. These good fatty acids help in the prevention of several cancers including breast, prostate, mouth and skin.

Sometime in the near future, we will learn to pitch the innate immune system’s wrath against cancer cells; to calm it in the case of autoimmune diseases; to augment it to create a new generation of vaccines against pathogens. Once we teach our innate immune cells to attack malignant cells in humans, we will have invented an entirely new mode of cell therapy that harnesses inflammation. Perhaps we might describe it, metaphorically, as a pox on cancer.

The discovery of this “uncloaking” medicine was the culmination of radical advances in cellular biology that date back to the 1950s: an understanding of the mechanisms used by T cells to discriminate the self from the nonself, the identification of the proteins that these immune cells use to detect foreign invaders, the uncovering of pathways by which our normal cells resist being attacked by this detection system, the way cancer cells co-opt it to make themselves invisible, and the invention of a molecule that would strip the malignant cells of their cloak of invisibility—each insight, built atop an earlier insight and each dug by cell biologists out of hard, cold earth.

NK cells mount an attack on malignant cells and are able to destroy them. These women had significantly less spread of their breast cancer, compared with those who exhibited a less assertive attitude or who had fewer nurturing social connections. The researchers found that emotional factors and social involvement were more important to survival than the degree of disease itself.

Cancer demonstrates a spectrum of behavior. Some tumors are inherently benign, genetically determined to never reach the fully malignant state; and some tumors are intrinsically aggressive, and intervention at even an early, presymptomatic stage might make no difference to the prognosis of a patient. To address the inherent behavioral heterogeneity of cancer, the screening test must go further. It must increase survival.

A Republican seizure of power based not on the strength of the party's ideas but on massive disfranchisement denies citizens not only their rights, but also the "talisman" of humanity that voting represents. The lie of voter fraud breaks a World War II veteran down into a simple, horrifying statement: "I wasn't a citizen no more." It forces a man, a retired engineer who was instrumental in building this nation, into facing a bitter truth: "I am not wanted in this state." It eviscerates the key sense of self-worthy in a disabled man who has to pen the painful words "My constitutional rights have been stripped from me." It maligns thousands of African Americans who resiliently weathered the Missouri cold and hours of bureaucratic runarounds as nothing but criminals and frauds. It leaves a woman suffering from lung cancer absolutely "distraught" and convinced that "they prevented us from voting," because none of her IDs could penetrate Wisconsin's law. It shatters the dying wish of a woman who, in her last moments on earth, wanted to cast a vote for possibly the first woman president of the United States. But an expired driver's license meant none of that was to be.

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To begin the ending, we must end the beginning. Prevention will be the only compassionate, universally applicable cure. It is not prevention through lifestyle changes. Individuals with pristine eating and exercising habits get cancer because cancer-causing mutations accumulate as natural consequences of reproduction and aging of cells. The new strategy must go beyond early detection as practiced currently through mammograms and other routine screening tests. The prevention I am talking about is through identification and eradication of transformed cancerous cells at their inception, before they have had a chance to organize into a bona fide malignant, incurable disease. This may seem an unattainable, utopian dream, but it is achievable in a reasonable time. We are already using sophisticated technology to detect the residues of disease that linger after treatment, the last cancer cell. Can we not reverse the order of things and use the tests to detect the first?

If I can die having brought any light, having exposed any meaningful truth that will help to destroy the racist cancer that is malignant in the body of America—then, all of the credit is due to Allah. Only the mistakes have been mine.

Recorded in the history of human suffering are cancers of such malignant character that even minor contact aggravates them, engendering overwhelming pain. How often, in the midst of modern civilizations have I wanted to bring you into the discussion, sometimes to recall these memories, sometimes to compare you to other countries, so often that your beloved image became to me like a social cancer. Therefore, because I desire your good health, which is indeed all of ours, and because I seek better stewardship for you, I will do with you what the ancients did with their infirmed: they placed them on the steps of their temples so that each in his own way could invoke a divinity that might offer a cure. With that in mind, I will try to reproduce your current condition faithfully, without prejudice; I will life the veil hiding your ills, and sacrifice everything to truth, even my own pride, since, as your son, I, too, suffer your defects and shortcomings.

There was a very interesting Australian study that looked at a number of women who had lumps suspicious for breast cancer, so they had to have biopsies. And they put these women through a psychological questionnaire before the results came back. And after the results came back, it turned out if a woman was emotionally isolated, that by itself did not increase the risk of that lump being cancerous. Similarly, if a woman was stressed, that by itself did not increase the risk of that lump being cancerous. But if a woman was stressed and emotionally isolated the risk of that lump being cancerous was nine times as great as the average. And the physicians and the scientists who did the study couldn't understand this because how do 0 and 0 add up to 9? But if, for example, you were stressed right now, which means there are high levels of stress hormones in your body, cortisol and adrenaline, but a friend of you next to you said "hey, how are you feeling? Do you want to talk about it?", the stresses would go right down. But if you are emotionally isolated and you are stressed then your cortisol level will stay high for a long time and cortisol suppresses the immune system, which means that malignancies are more likely to develop. Which means that cancer is not a disease of the individual. The development of cancer in the individual reflects a lifetime and history of relationships through family, culture and society. Which then might explain to us, for example, if you look at black Americans.. they are more likely to get prostrate cancer and more likely to die of it and not because of lack of medical care. And black women are more likely to die of breast cancer even if they have access to good medical care. Why is that? Well.. maybe there is something about being a minority in this particular culture, that it is so highly stressful, that it deranges the immune system. So is it an individual problem, again? Or is it a social problem? So what I'm saying is that you can't separate the mind from the body and you can't separate the individual from the environment. And the only way of looking at human beings is a bio-psycho-social view, which is to say that the biology can't be separated from the psychology and that can't be separated from the social environment.

For a moment of nearly five seconds Nemed had wanted to correct, to interject with the boasting recitation of a child who has just learned something interesting about the subject at hand and wants to amaze the adults; he had wanted to tell Emer that the Inrisus were not magical or truly evil, and that their medicine was amazing. The tablet suggested that the Inrisus were entirely made of tumor cells; long ago, blue historians believed, the Inrisus had conquered cancer and found a way to separate its resilience to radiation and chemical attack from its malignancy, producing cells both immortal and functional. Their brains and hearts and other parts would keep showing up on medical scans, like blotches in a smoker’s lungs. Carcinogens simply made an Inrisus pregnant. But then Nemed realized that Emer was wearing beaver hide, that no part of his costume even had a zipper; he might not even know what cancer was. He wouldn’t know that it could be treated with radiation or chemicals; he wouldn’t appreciate the Inrisus and their ability to turn cancer into eternal life. He would probably call it necromancy, or a form of vampirism, stealing the life of an unborn infant because that was supposed to be the only way to live forever in the old stories of the Folk. I think less of him, Nemed realized. Him, and the others.

There was little precedent in other diseases for such an astonishing diversity of causes. Diabetes, a complex illness with complex manifestations, is still fundamentally a disease of abnormal insulin signaling. Coronary heart disease occurs when a clot, arising from a ruptured and inflamed atherosclerotic plaque, occludes a blood vessel of the heart. But the search for a unifying mechanistic description of cancer seemed to be sorely missing. What, beyond abnormal, dysregulated cell division, was the common pathophysiological mechanism underlying cancer? To answer this question, cancer biologists would need to return to the birth of cancer, to the very first steps of a cell’s journey toward malignant transformation—to carcinogenesis.

Every patient’s cancer is unique because every cancer genome is unique. Physiological heterogeneity is genetic heterogeneity.” Normal cells are identically normal; malignant cells become unhappily malignant in unique ways.

as the University of Toronto cancer researcher Vuk Stambolic would later describe it, these breast-cancer cells seemed to be “addicted to” insulin, and when weaned off it in the laboratory they responded by dying. This kind of phenomenon was seen also in cancers of adrenal and liver cells. As one 1976 report put it, insulin “intensely stimulated cell proliferation in certain tumors”; another, by researchers at the National Cancer Institute, described one particular line of breast-cancer cells as “exquisitely sensitive to insulin.” By then, researchers had established that malignant breast tumors had receptors to insulin, which were absent in healthy breast tissue, and that the more they had, the more insulin-sensitive they were.

the other way to initiate the cancer process, according to these researchers, is to increase the levels of insulin and blood sugar in the circulation itself. Insulin resistance would do that. Thus whatever is causing insulin resistance would be promoting the transformation of healthy cells into malignant, metastatic cells by increasing insulin secretion and elevating blood sugar and telling the cells to take up increasingly more glucose for fuel. This leads those like Cantley and Thompson directly back to sugar. As Cantley has said, sugar “scares” him, for precisely this reason. If the sugars we consume—sucrose and HFCS specifically—cause insulin resistance, then they are prime suspects for causing cancer as well, or at the very least promoting its growth.