Reading Room
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One in Three by Adam Wishart When I first heard about One in Three, in particular that it was a son’s personal journey into the history of science and cancer, I wasn’t sure what to expect. Sharing Adam’s situation of having a father with an incurable prostate cancer, I was concerned that this book would be too grim or too personal. However, I am delighted to say that I was wrong; this is a fascinating book of the history of medicine and cancer and, in the end, reassuring in many ways highlighting as it does the huge advances that we have made in the developed world towards treating all diseases, not just cancers. The book charts cancer’s existence, social reaction and treatment from 1831 to 2003. However, Wishart makes it clear from the outset that cancer is a disease with a very long history even though it only began to haunt the medical profession’s conscience in the early 19th Century. When first identified in ancient times it was responsible for only a tiny proportion of deaths; life expectancy was short and few people lived long enough to develop a life-threatening tumour. It was only as we began to conquer diseases like tuberculosis and epidemics like dysentery, typhus and cholera that cancer became more prominent. Today, two-thirds of cancer cases occur in the over 65s and it is seen in part as a disease of longevity. The early stages of the book serve as a reminder of how far we have come in our treatment of disease. Wishart documents the experience of one of the first public operations on a cancer patient: 32 year old Chinese labourer Hoo Loo. Loo had an enormous – four foot in circumference – tumour. Doctors in Canton had refused treatment and he travelled to London with the correct belief that doctors there would operate on him. Unfortunately, in 1831 there was no anaesthetic (being first used in an operation in 1846) and the trauma of having such a procedure was enough to kill Hoo Loo on the operating table. There was also no understanding of hospital disease, or the importance of sterile conditions, these factors made early operations a risky venture both for patient and doctor. Today, a popular view on the causes of cancer is that rising incidence is due to the increased amounts of pesticides, fertilisers, food colourings and other chemicals released into the environment by modern industrial practices. One of the most influential proponents of this theory was Rachel Carson in her book Silent Spring (1954). Caron’s book was informed, Wishart writes, by the work of Wilhelm Heueper a German doctor. Heuper worked in the 1930s for a laboratory funded by Du Pont. Whilst there he recalled a published paper which suspected certain aromatic amines to have caused bladder cancer in dye workers. Heuper suspected that Du Pont’s workers were also at risk. Heueper dedicated his career to investigating what he thought were the environmental causes of cancer with mixed results; many considered his work to be against scientific and industrial progress. Hueper’s theory was eventually dismissed in the face of new scientific investigation: Richard Doll’s research into lung cancer and smoking. Hueper was disparaging of Doll’s research but when the US Surgeon General established a Committee of Smoking they found, after reviewing Doll’s evidence, that cigarette smoking was linked to cancer. Further, Hueper’s theory about the dangers of industrial chemicals was rejected: “It must be emphasized quite strongly that the population exposed to industrial carcinogens is relatively small and that these agents cannot account for the increasing lung cancer risk in the general population.” Although the causes of certain cancers remain contested or unknown, this important chapter in the history of cancer is worth flagging showing as it does how new scientific investigation began to inform the understanding of what caused cancers allowing a shift away from the guesswork of the past. Wishart’s book is packed with interesting material and research about cancer. The chapters on prevention outlining the lengths ‘healthy’ people will go through to reduce their risk of cancers, such as the women who took tamoxifen before they had breast cancer, illustrate the fear that the ‘c’ word strikes in people. The trials and tribulations of different cancer treatments from chemotherapy to radiotherapy to hormone treatments bring home the enormous amount of research and at times personal determination of medics and other individuals to beat the disease. The time line approach of how we have taken on cancer, the progress made and the lessons learned, are valuable to anyone with an interest in the subject. I would recommend this book to anyone interested in the history of medicine. The meticulous documentation of the politics and science of cancer are both enthralling and illuminating.
Published by Profile Books Ltd, ISBN# 1861977522
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