Nafis Hasan (Common Notions)
In 2000, then-US president Bill Clinton said: 鈥淚t is now conceivable that our children鈥檚 children will know the term cancer only as a constellation of stars.鈥� A quarter of a century later, cancer is far from banished to the celestial realm. In fact, cancer deaths are predicted to nearly double globally by 2050, and cases are rising in the under-50s across many different tumour types.
Clinton made his prediction at an event celebrating the mapping of the human genome. This promised to add new tools to researchers鈥� cancer arsenal, and did so in the shadow of the 鈥渨ar on cancer鈥�, launched by Richard Nixon 30 years earlier. What went wrong?
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In , Nafis Hasan offers an answer in the form of a sharp critique of how cancer research and cancer care interact with the money-making systems of drug development, health insurance and more. The problem with curing cancer, he argues, isn鈥檛 just an issue of unanswered scientific questions, but also of the political and economic forces that shape how we ask them, and which answers are deemed most legitimate.
It may not come as a shock to many that cancer treatments are expensive and that drug manufacturers care about their profit margins, but Hasan is well-placed to take the argument deeper, as he spends his working life between the healthcare sector, where he is a labour organiser, and research at the Brooklyn Institute for Social Research in New York.
He systematically presents the history of cancer research and discusses how we learned that cancer is caused by gene mutations, though focusing on that alone hasn鈥檛 always led to the most effective treatments. He links this both to market forces behind the scientific tools used in this research and to the philosophical inclinations of mainstream research institutions.
Hasan also underlines the rift between efforts to prevent cancer and to cure it, labelling the increasing emphasis on 鈥渟elling鈥� cures as decidedly political compared with following the science by, say, more strictly regulating chemicals people are exposed to. In this sense, Metastasis is a political book. Hasan sees capitalism, and the way science and medicine are done within it, as a key factor in the state of cancer research and the prevalence of the disease.
For instance, he discusses the labour conditions of researchers and how their wages and the pressure to produce something marketable influence the research process. And while some of the language in Metastasis may strike more conservative readers as radical, the facts Hasan presents 鈥� US government trials where only a few of the drugs produced any response in tumours, and the vast number of cancer drugs that don鈥檛 extend patients鈥� lives 鈥� are alarming enough to call for radical solutions.
Metastasis isn鈥檛 an easy read. It is dense with biology and political theory, which can make it less than accessible. An extra chapter on the basics of molecular biology would have helped, and at times the book鈥檚 tone and style felt better suited for a dissertation than popular science. But in the few instances where Hasan engages personally with readers, sharing his experience with cancer, the book benefits greatly from the reminder that it is you, me and our loved ones who are hurt by the socioeconomic forces it reveals.
Its style and density make Metastasis an imperfect book and its engagement with Marxist philosophy isn鈥檛 mainstream in US science writing. But it is also deeply necessary and illuminating. Most importantly, Hasan isn鈥檛 writing from a place of despair 鈥� the book ends with a call to imagine new horizons of care and start organising to reach them, even if they seem as distant as the stars.
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