I Told You So

I Told You So


Leonard Zwelling

         Headlines in the Chronicle Saturday morning, starring our
own Louise Strong, note the findings of a new Hopkins study in the January 7,
2015 issue of Science that draws a conclusion that I had made myself 40 years
ago. For the most part, getting cancer is just bad luck.

         Now, let’s think a moment about how we as humans deal with
untoward events that we believe have their basis in bad luck.

         Floods. Insurance.

         Fire. Insurance.

         Bad bounces on ground balls to first base. No insurance for
Bill Buckner.

         You get my drift. The best you can do about bad luck is try
to insure against its financial consequences.

         As I understand the new findings, the ever-resourceful Burt
Vogelstein has balanced the relative contributions to the development of human cancer of
environment, genes and malfunctioning stem cell division as mechanisms of
organism homeostasis. Guess what? Number three wins! I am so surprised! NOT!

         I may not have been a practicing oncologist for as many
years as many of you have been, but I knew a few things fast. Fat,
post-menopausal ladies were fully half of my initial NIH patient load when I
assumed one-third of the Breast Clinic. But some were young and thin. Some had
strong family histories. Some had cancers that were unstoppable and some had
diseases that barely progressed during the year of my caring for them.

         I had no idea what I was seeing, but I was beginning to
formulate a belief that medical oncology was like all the rest of internal
medicine. It was a field of chronic diseases with some catastrophic
emergencies. Most of what I could do was put off the inevitable, a bit. You all
do way better now than I ever dreamed of doing. Luck was a major player because
the vast majority of my patients had no relatives with cancer, did not smoke
and had only one thing in common. They were fat. And that was only the breast
cancer patients. My lymphoma patients came in all shapes and sizes and response

         Oh yes. There was one other thing. They were almost all
older than 40. Like all of internal medicine as my BW (Beautiful Wife)
pediatrician is quick to remind me, medical oncology patients are older people.
(Of course she first said this before I was old. She never will be. Lucky me.)

         The chronic diseases that we internists take on occur in
humans the vast majority of whom have fulfilled their mission on God’s Earth.
They either procreated (DNA’s preferred choice) or did not. After that, when
you take the long view, they had each become expendable parts in the massive
natural unknowable plan.

         Stop with the genomics. Stop with the Moon Shots. Stop with
the illusion that we as humans can make vast and rapid strides against the
chronic diseases that limit our time on Earth or invoke miracle cures to turn
colored ribbons into money. We should never stop trying to do so. That’s our
nature. But don’t sell the American people a pile of garbage that says we are
only a few hundred billion dollars away from making them all live forever and
never get cancer.

         Cancer is life with all of its malfunctions. And as my
favorite band of all time Jefferson Airplane reminds us in Crown of Creation:

         Life is change

         How it differs from the rocks

         We’ve seen their ways too often for our   liking

         New Worlds to gain

         My life is to survive and be alive for you

         Snap out of it Ron!

         You want to reduce the cancer incidence?

1.  Teach kids how to live lives that minimize the
environmental contribution.

2.  Improve screening so as to improve early detection as
well as discover currently unimagined genetic proclivities.

3.  Give everyone health insurance so when the flood of
cancer’s fire chooses another victim of bad luck, everyone doesn’t have to go

was that all that difficult?

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