Pinpointing cancer’s cause: a costly, complex, maddening challenge
What exactly causes cancer? That may be, recent news reports indicate:
- a question that’s heading into the billion-dollar range for a Big Pharma firm;
- a painful conundrum for a Major League Baseball franchise;
- a difficult and lethal question for more young people with digestive woes;
- yet another awful example of how Big Tobacco targets healthy young people.
The federal Centers for Disease Control reports that in 2014, the year for which the latest, best data are available, almost 1.6 million patients were newly diagnosed with cancer and almost 600,000 died of the disease—the second leading cause of Americans’ deaths, trailing only heart disease.
Medical science has made great progress in researching how complex cancer can be, tracking with painstaking study its many possible and some proven causes.
A $417 million talc verdict
Johnson and Johnson, a drug making giant, is confronting what’s becoming almost a billion-dollar legal challenge as to whether baby powder or personal hygiene talc, one of its most familiar and common products, can be blamed in women’s reproductive cancers.
It should be, a Los Angeles jury has determined, ordering J&J to pay $417 million to a 63-year-old, longtime baby powder user who is hospitalized and undergoing late-stage treatment for ovarian cancer.
The California jurors, in their decision, accepted the argument that talc—a mineral that typically contains magnesium, silicon, oxygen and hydrogen, and is used extensively in cosmetics and personal care products—can, after persistent dusting, move from the skin of women’s private areas internally into their reproductive organs, leading to cancers.
This argument also has persuaded juries in the St. Louis area. They have ordered J&J to pay women plaintiffs $110 million, $72.1 million, $70.1 million, and $55 million.
The drug maker insists, citing conflicting studies, that medical science supports at most an association between talc and women’s cancer, and does not find it to be a direct cause.
The baby powder cases, which underscore the less-discussed but very real issues of how beauty products can pose health risks, also show some of the controversies and pragmatic problems in taking complex matters like cancer’s causes and seeing their effects in every day, real life.
The concern is rising, for example, as investigators puzzle over a distressing spike not only in the detection but the death rates among Americans in their 20s and 30s from colorectal cancer. Among adults ages 20 to 54 colon cancer accounted for 4.3 deaths per 100,000 people in 2014, up from 3.9 per 100,000 in 2004.
That’s a seemingly small increase. But it concerns doctors and medical scientists because colorectal cancers typically have been seen mostly in older patients, for whom there are much more robust, rigorous, and often expensive screening efforts, including colonoscopies, under way.
Experts aren’t sure what may be leading to the earlier and more lethal incidences, though diet, obesity, lack of exercise, and even childhood overuse of antibiotics are under study as culprits.
Individuals should monitor their own health carefully for issues with rectal bleeding, bloody stools, unexplained weight loss, fatigue and digestive complaints, persistent changes in bathroom behavior, and anemia. They should discuss these quickly and openly with their doctors, noting, too, their own family histories with colorectal cancer, polyps, and inflammatory bowel disease.
Baseball and brain cancer
Keeping track of cancers in a family or any group of people, of course, can become a haunting matter, as a notable story out of the New York Times sports pages pointed out. Jere Longman, a seasoned beat writer, reported that pro baseball and its fans have watched with dismay the number of Big Leaguers who have died of glioblastoma, an aggressive form of brain cancer for which U.S. Sen. John McCain (R-Ariz.) also has announced he is under treatment.
Former Phillies who have been reported to have died from glioblastoma since 2003 include: Darren Daulton, 55; reliever Tug McGraw, 59; infielder John Vukovich, 59; and catcher Johnny Oates, 58. Pitcher Ken Brett, who played in Veterans Stadium for one season, died at 55 of a brain cancer that has been identified in some news accounts as glioblastoma. The brain cancer also has claimed other notable players, as well as a manager, from the same era: Hall of Fame catcher Gary Carter, 57, outfielder Bobby Murcer, 62, reliever Dan Quisenberry, 45, and manager Dick Howser, 51.
The sports story does a good job of delving into the daunting complexities, statistical and otherwise, of determining whether rotten luck or something more may be at play—including stadiums built over marshes or possible use of performance-enhancing substances, or concussions, or chewing tobacco— in the many brain cancer deaths of these relatively young athletes.
Big Tobacco’s targeted harms
But if it’s disconcerting that their workplaces and their beloved sport may somehow have contributed to cancers for the “boys of summer,” it ought to be infuriating that Big Tobacco is up to yet more no good with their proven, cancer-causing products and how they’re targeted to Americans in their prime.
Truth Initiative, an anti-smoking group, deserves praise for pointing out, including in ads that were scheduled for the MTV Music Awards, that people with mental health issues, including depression, anxiety, and even substance-abuse issues, smoke 40 percent of cigarettes sold in this country. Further, 38 percent of the members of the military who smoke start this unhealthy habit only after they enlist.
Translation: Big Tobacco’s exploiting the nation’s service personnel and those with mental problems, Truth Initiative asserts.
That’s shameful, but totally in keeping with the industry’s persistent efforts to harm the public, including, as the Washington Post notes, with fancy new tobacco warming, not burning, devices to hawk still nasty wares.
In my practice, I see the huge harms that patients suffer while seeking medical services, including for cancer care. The news headlines, rightly, suggest that we’re making progress so that cancer, for many tens of millions more, may be a chronic, treatable, and survivable condition—not a fatal set of diseases. But we have far to go to understand the many potential causes of the disease and how we can ensure that the medical care for it is accessible, affordable, safe, and outstanding.