Nevertheless, echoing the view of most physicians, Moertel concluded that chemo should not be abandoned, but be used essentially as ‘snake oil’ - to convince the patient that some treatments might still work. 'Patients with advanced gastrointestinal cancer and their families have a compelling need for a basis of hope. If such hope is not offered, they will quickly seek it from the hands of quacks and charlatans' (N Engl J Med, 1978; 299: 1049-52).
Despite evidence that 5-FU itself is nothing more than licensed quackery, 25 years later, this drug is still the standard treatment for colon cancer. Indeed, Xeloda, one of the latest in chemo drugs, was approved last year for use in the UK - and all it does is metabolise into 5-FU.
Even within the cancer community, a few doctors are now questioning the whole approach to treatment, openly expressing their horror at the crudeness of the un-Holy Trinity of cut, burn and poison. As US cancer expert Dr Robert Wittes put it: 'One may hope that in another 10 to 15 years, medical progress will make this edition of the Manual read like an archaic document for the Middle Ages' (Manual of Oncologic Therapeutics, National Cancer Institute, 1991).
Where will progress in cancer come from? The vested interests involved in surgery, chemotherapy and radiotherapy are hardly likely to welcome changes that might threaten the status quo - after all, as one wag put it, 'There are more people living off cancer than dying of it'.
An obvious place to look for advances is the cancer charities, supposedly altruistic bodies devoid of commercial interests. These huge institutions are the wealthiest charities in the world. Britain’s Cancer Research UK (CRUK), for example, raises nearly £300 million a year. In the UK, most of that money goes to research, mainly clinical trials. And what breakthrough cancer therapies are they researching? Answer: none. Of the 188 clinical trials currently funded by CRUK, virtually all involve existing chemo or radiotherapy. Only one trial is looking (very narrowly) at diet, and another is investigating 'guided imagery and relaxation', an already well-studied technique.
So, again, where will the breakthroughs, promised so earnestly by the cancer charities when rattling their collection tins, actually come from?
The current ‘just-around-the-corner’ hope being hyped is genetics. The prevailing theory says that cancer is caused by genetic mutations in a few oncogenes (cancer genes). All that’s required is to find drugs that will turn those genes off and hey, presto! cancer will be cured.
But, if it’s that simple, where are the cures? A growing number of geneticists believe that the reason there are no gene-based cures for cancer is that the basic theory is wrongheaded. Says biologist Professor Brian Goodwin, 'We now know that every cancer is different, so it will be very difficult to target cancer cells specifically with new gene-based drugs' (‘Rethinking cancer, from cure to prevention’, Institute of Science in Society, 8 Feb 2001; www.i-sis.org.uk).
Research from the University of California at Berkeley confirms that cancer is not primarily a genetic disease, but one in which normal cell division is disturbed by external factors, such as environmental chemicals, radiation or stress (Biochem J, 2000; 348: 497-506).
'This new/old approach to cancer shifts the emphasis from cure to prevention,' says Goodwin. 'The multiple chemicals that pollute our environment need to be screened for their cancer-causing capacity. And the phenomenon of cancer remission, in which the individual gets rid of the cancer spontaneously, needs to be much more thoroughly explored. Remissions can occur after various types of stimulus to the whole body, such as change of diet, change of lifestyle, and many other non-specific influences.'