SOLVING THE WRONG PROBLEM

The
first is a tenet of math that is pretty much limited to math. The second is
always a good idea whether numbers are involved or not.

Lately,
Republicans around the country have introduced, and in some instances, passed
legislation that functionally limits voting rights by demanding on site photo
identification and other inconveniences to affirm an individual’s right to
exercise this most fundamental of American guarantees. Those perpetrating these
bills claim the new laws fight voter fraud. The only problem is that voter
fraud is not a problem. It wasn’t even invoked in Bush v. Gore which had to be
the closest election in modern recollection. So why bother passing legislation
to fix a problem that doesn’t exist? Because, as so often is the case, the
stated reason for passing these bills is not the true reason.

The
true reason for this GOP nonsense is to make voting more difficult for the
constituency that is more prone to vote for the Democrats such as minorities and
the newly enfranchised. In essence, these bills are trying to peel back over a
century’s worth of progress in guaranteeing the right to vote for ulterior
political purposes. It never crossed the minds of the GOP to try to create
policies that would appeal to this population rather than try to keep them out
of the voting booth.

I
believe the current au courant push toward a singular approach to the issue of
reversing the deleterious effects of cancer on Americans is also a solution to
the wrong problem. This solution is based on a belief (and make no mistakes,
this is still more theoretical than proven) that cancer can be explained
through molecular dissection of the genomes established malignancies and the interruption
of currently known biochemical pathways. But is this true? We really don’t
know.

    Creating a drug like Gleevec that is both
disease- and biochemically-specific may have lulled us into believing that this
is a paradigm that will also translate into the treatment of more common solid
cancers that are not as well understood as CML. Perhaps, and certainly a worthy
endeavor. But it is not the only way to pursue decreasing the burden of cancer
on Americans.

Early
detection uniformly applied to the population is another. This is guaranteed to
decrease the death rates from colon, breast and cervical cancer if every
American who qualifies for screening per the USPSTF recommendations received it
for free.

Better
educational efforts both in and out of schools could improve nutrition,
increase exercise and hopefully blunt the horrible effects of obesity and tobacco
on the health of the next generation of Americans.

The
point is that if you believe that the problem with cancer lies in sequencing the
genes of explanted human malignancies, then the current popular genomics approach
makes sense. Treating established cancer based on these genetic findings would
be the way to go.

But
if you believe that cancer is a naturally-occurring consequence of a
malfunction in the homeostatic mechanisms of normal life that is both age- and
environmentally-influenced, then you will have a wider panoply of alternatives
to consider when it comes to spending the limited resources devoted to easing
the cancer burden.

It
is very important to note that the new voting laws are not really an answer to
any legitimate concerns about voter fraud, but are rather a way to further disenfranchise
those who have been disenfranchised for many years already. These modern GOP
legislative geniuses are just trying to turn back the clock of freedom by force
and deception by solving a problem that does not exist. Shifting the party
symbol from an elephant to a straw man (leaving the RINO [Republican in Name
Only] for the few Republicans who are truly in the traditional Republican
Party—no Tea served at a RINO party) would seem sadly appropriate.

In
cancer it’s more of a hammer and nail thing. If the only tool you have is a
hammer, every problem tends to look like a nail.

Cancer
is not abnormal. At its essence, it will turn out to be a logical and
explicable bodily response to internal and external insults that overwhelm
normal defense mechanisms. It is part of biology. The vast majority of cancers
occur in people who are past the age of individual procreation so the associated
cancer deaths are of no consequence to mankind’s (or DNA’s) evolutionary
destiny (see 2001: A Space Odyssey).

As
physicians, since our goal is to ease suffering and alter the natural history
of disease (making our efforts innately unnatural), we should attempt to ease
the burden of cancer on society and on the individual. But let’s make sure we
identify the real problem before conjuring the solution out of convenience,
expedience or excessive self-aggrandizement.

I
understand that the man who lost his keys at night will look for them under a
street lamp not because he lost them there, but because he can see there. The light
produced by genomics is not the only place that the keys to cancer may be
found. It’s just one of many.

The
real solution may not be under the lamp post. It may still be in the dark right
now and we need to work in many ways to enlighten each other. No one person has
the answer yet and it is unlikely one person ever will.