Paul Ehrlich’s (1854-1915) search for the “magic bullet” resonates today

“Fighting cancer.” When I think of cancer this phrase comes readily to mind. But not everyone warms up to this metaphor.  A recent opinion piece by physician and writer Jalal Baig, entitled “John McCain did not ‘lose’ his battle with glioblastoma – because cancer is not a war,” reminded me of how firmly my husband rejected the fighting metaphor during his seven years of multiple myeloma, a treatable but incurable cancer of the bone marrow.  Chuck preferred to think of his diagnosis as a chronic condition that required ongoing management like the type 2 diabetes he already lived with.  (1)

 Our doctors used military metaphors, however.  Radiation, chemotherapy, and a bone marrow transplant were presented as “weapons” which would “buy us time,” as indeed they did.  When one treatment failed, we were reassured that there were still “weapons in our arsenal” should we care to use them.  Maybe the doctors could have called them “tools in our toolbox,” but “weapons” sounded so much more potent when his life was at stake.  

After all, what else can you do to cancer if not fight it? What other language meets the challenge quite so well? Can you tackle it, outsmart it, track it down, weed it out? Do you think of it as a malfunction that needs to be repaired or an unwanted journey fraught with peril? Maybe the military metaphor isn’t so bad after all. After all, it’s been around for a long time.

In fact the notion of fighting cancer commonly comes up in three contexts, societal, cellular, and individual, and in the first two at least it has been well entrenched  (pardon my metaphor) for over a century. 

Korean War era 1952 Poster for the March of Dimes

First, military language is used on a public level to raise funds and prioritize research.  Dr. Baig suggested that perhaps this started with Nixon declaring a “war” on cancer in the seventies. Actually, campaigns against disease inspired military language long before that. An article called “Fighting Cancer,” was published in The Science News-Letter in 1938. In the same year, The March of Dimes was founded to fight polio.  A 1937 article in The Science News-Letter announced, “School Pupils Shock Troops in Battle against Malaria,” while the British Medical Journal touted “The War Against Tuberculosis,” back in 1910. (2-5)

Paul Ehrlich’s “Magic Bullet” in popular culture (1940 film)

Similarly, a vocabulary of attack and defense is used to illustrate immune functionality on a cellular level. In 1906 German scientist and physician Paul Ehlich (1854-1915) predicted what he called a “magic bullet,” a chemical agent which would specifically immobilize pathogens. In modern times the term has been applied to monoclonal antibodies used to target specific cancer cells. See, for example, Caroline Richmond’s 1998 article, “My Cancer and the Magic Bullet” or, more recently, “Magic Bullets: The Next Evolution in Cancer Therapy,” on the Eureka blog site (6,7)

Natural Killer cell portrayed on the National Institutes of Health web site

In 1975 Swedish researcher Rolf Keissling gave the name “natural killer” (NK) cells to a type of lymphocyte that attacked tumors. The name stuck. In 2018 immunologist Daniel M. Davis wrote, “As well as T cells, the white blood cells known as Natural Killer cells are also able to fight cancer. . .”  Simple and direct metaphors serve as a teaching aid for explaining immune functions. (8,9)

Superheroes from the Centers for Disease Control and Prevention web site

The Centers for Disease Control and Prevention has a web site for young people that explains the immune system in terms of “Good Guys” (cellular components of the immune system) and “Bad Guys” (antigens that elicit an immune response), in order to make the complexities clear. (10)

Clearly the fighting metaphor in the context of fundraising or cellular function is embedded in both scientific journals and popular culture.

But what does fighting mean on the personal level?  The metaphors themselves matter less than a frank discussion based on managing, strategizing, and weighing options, empowering the individual to participate in the planning process wherever possible.  And in my experience, many oncologists do this.

I still feel ambivalent about the fighting metaphor, even though in my own book I often refer to my husband’s “fight” with cancer. There were days when it felt like we were battling unseen forces just to get to the next appointment.  But there is one place where I have no doubts and that is the importance of language when the fight is over. A short search on cancer obituaries turns up many a headline announcing that someone lost their fight with cancer.

Let us not remember them as losing.    

Because, on a personal level, “cancer is not a war.”

With gratitude to:

  1. “John McCain did not ‘lose’ his battle with glioblastoma – because cancer is not a war,” by Jalal Baig. In Think, NBC News’ Opinion Section. https://www.nbcnews.com/think/opinion/john-mccain-did-not-lose-his-battle-glioblastoma-because-cancer-ncna904486
  2. 1952: This fight is yours campaign guide. https://www.worthpoint.com/worthopedia/vintage-march-of-dimes-1952-campaign-guide
  3. “Fighting Cancer,” The Science News-Letter, Vol. 33, No. 6 (Feb. 5, 1938, pp. 83-85. Published by Society for Science & the Public.
  4. “School Pupils Shock Troops in Battle against Malaria,” Vol. 32, No. 865 (Nov. 6, 1937), pp. 294-295
  5. “The War Against Tuberculosis,” The British Medical Journal, Vol. 2, No. 2594 (Sep. 17, 1910), pp. 799-800.            
  6. “Magic Bullets: The Next Evolution in Targeted Cancer Therapy,” Eureka, Oct. 16, 2012. http://eureka.criver.com/magic-bullets-the-next-evolution-in-targeted-cancer-therapy/
  7. Caroline Richmond, “My Cancer and the Magic Bullet,” British Medical Journal, Vol. 317, No. 7174 (Dec. 19-26, 1998), pp. 1739-1740. 
  8. AH Greenberg, “The origins of the NK cell or a Canadian in King Ivan’s court,” Clinical and Investigative Medicine, 1994 Dec. 17 (6):626-31. On PubMed. https://www.ncbi.nlm.nih.gov/pubmed/7895426
  9. Daniel M. Davis, The Beautiful Cure: The Revolution in Immunology and What It Mean for Your Health, University of Chicago Press: 2018.
  10. CDC Centers for Disease Control and Prevention site https://www.cdc.gov/bam/diseases/immune/immunesys.html

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