The Emperor of All Maladies: A Biography of Cancer (33 page)

The agent responsible for carrying the cancer, Rous concluded, was not a cell or an environmental carcinogen, but some tiny particle lurking
within
a cell. The particle was so small that it could easily pass through most filters and keep producing cancer in animals. The only biological particle that had these properties was a virus. His virus was later called Rous sarcoma virus, or RSV for short.

The discovery of RSV, the first cancer-causing virus, felled a deep blow to the somatic mutation theory and set off a frantic search for more cancer viruses. The causal agent for cancer, it seemed, had been found. In 1935, a colleague of Rous’s named
Richard Schope reported a papillomavirus
that caused wartlike tumors in cottontail rabbits. Ten years later, in the mid-1940s, came news of a leukemia-causing virus in mice and then in cats—but still no sign of a bona fide cancer virus in humans.

In 1958, after nearly a three-decade effort, the hunt finally yielded an important prize. An Irish surgeon,
Denis Burkitt, discovered an aggressive form of lymphoma
—now called Burkitt’s lymphoma—that occurred endemically among children in the malaria-ridden belt of sub-Saharan Africa. The
pattern of distribution suggested an infectious cause. When two British virologists analyzed the lymphoma cells from Africa, they discovered an infectious agent lodged inside them—not malaria parasites, but a human cancer virus. The new virus was named Epstein-Barr virus or EBV. (EBV is more familiar to us as the virus that causes infectious mononucleosis, or mono.)

The grand total of cancer-causing viruses in humans now stood at one. But the modesty of that number aside, the cancer virus theory was in full spate now—in part because viruses were the new rage in all of medicine. Viral diseases, having been considered incurable for centuries, were now becoming potentially preventable: the polio vaccine, introduced in the summer of 1952, had been a phenomenal success, and the notion that cancer and infectious diseases could eventually collapse into a single pathological entity was simply too seductive to resist.

“
Cancer may be infectious
,” a
Life
magazine cover piece asserted in 1962. Rous received hundreds of letters from anxious men and women asking about exposures to cancer-causing bacteria or viruses. Speculation soon inched toward hysteria and fear. If cancer was infectious, some wondered, why not quarantine patients to prevent its spread? Why not send cancer patients to sanitation wards or isolation facilities, where TB and smallpox victims had once been confined? One woman who believed that she had been exposed to a coughing lung cancer patient wrote, “
Is there something I can do to kill the cancer germ
? Can the rooms be fumigated . . .? Should I give up my lease and move out?”

If the “cancer germ” had infected one space most acutely, it was the imagination of the public—and, equally, the imagination of researchers. Farber turned into a particularly fervent believer. In the early 1960s, goaded by his insistence,
the NCI inaugurated a Special Virus Cancer Program
, a systematic hunt for human cancer viruses patterned explicitly after the chemotherapy discovery program. The project snowballed into public prominence, gathering enormous support. Hundreds of monkeys at the NCI-funded lab were inoculated with human tumors with the hopes of turning the monkeys into viral incubators for vaccine development. Unfortunately, the monkeys failed to produce even a single cancer virus, but nothing dimmed the optimism. Over the next decade,
the cancer virus program siphoned away more than 10 percent
of the NCI contract budget—nearly $500 million. (In contrast, the institute’s cancer nutrition program, meant to evaluate the role of diet in cancer—a question of at least equal import—received one-twentieth of that allocation.)

Peyton Rous was rehabilitated into the scientific mainstream and levitated into permanent scientific sainthood. In 1966, having been overlooked for a full fifty-five years, he was awarded the Nobel Prize for physiology and medicine. On the evening of December 10 at the ceremony in Stockholm, he rose to the podium like a resurrected messiah. Rous acknowledged in his talk that the virus theory of cancer still needed much more work and clarity. “
Relatively few viruses
have any connection with the production of neoplasms,” Rous said. But bulldogish and unwilling to capitulate, Rous lambasted the idea that cancer could be caused by something inherent to the cells, such as a genetic mutation. “A favorite explanation has been that oncogenes cause alterations in the genes of the cells of the body, somatic mutations as these are termed. But numerous facts, when taken together, decisively exclude this supposition.”

He groused elsewhere: “What have been [the fruits] of this somatic mutation hypothesis? . . . Most serious of all the results of the somatic mutation hypothesis has been its effect on research workers. It acts as a tranquilizer on those who believe it.”

Rous had his own tranquilizer to offer: a unifying hypothesis that viruses caused cancer. And many in his audience, in no mood for caveats and complexities, were desperate to swallow his medicine. The somatic mutation theory of cancer was dead. The scientists who had studied environmental carcinogenesis needed to think of other explanations why radium or soot might cause cancer. (Perhaps, the virus theorists reasoned, these insults activated endogenous viruses.)

Two superficial theories were thus stitched audaciously—and prematurely—into one comprehensive whole. One offered a cause:
viruses caused cancer
(although a vast majority of them were yet undiscovered). The second offered a cure:
particular combinations of cytotoxic poisons would cure cancer
(although specific combinations for the vast majority of cancers were yet undiscovered).

Viral carcinogenesis clearly demanded a deeper explanation: how might viruses—elemental microbes floating from cell to cell—cause so profound a change in a cell’s physiology as to create a malignant cell? The success of cytotoxic chemotherapy provoked equally fundamental questions: why had a series of rather general poisons cured some forms of cancer, while leaving other forms completely unscathed?

Obviously, a more fundamental explanation lurked beneath all of this, an explanation that would
connect
cause and cure. So some researchers urged patience, diligence, and time. “
The program directed by the National Cancer Institute
has been derided as one that puts the cart before the horse by searching for a cure before knowing the cause,” Kenneth Endicott, the NCI director, acknowledged in 1963. “We have certainly not found a cure for cancer. We have a dozen chemicals which are somewhat better than those known before the program began but none are dramatically better. They prolong the patient’s life somewhat and make him more comfortable, but that is all.”

But the Laskerites had little time for such nuanced descriptions of progress; this cart would have to drag the horse. “The iron is hot and this is the time to pound without cessation,” Farber wrote to Lasker. The groundwork for an all-out battle had already been laid. All that was necessary was to put pressure on Congress to release funds. “
No large mission or goal-directed effort
[against cancer], supported with adequate funds has ever been organized,” Mary Lasker announced in an open letter to Congress in 1969.

Lasker’s thoughts were echoed by
Solomon Garb, a little-known professor of pharmacology
at the University of Missouri who shot to prominence by publishing the book
Cure for Cancer: A National Goal
in 1968. “The theme of this book,” Garb began, “is that
the time has come
for a closer look at cancer research and for a new consolidation of effort aimed at cure or control of cancer. . . .
A major hindrance
to cancer effort has been a chronic, severe shortage of funds—a situation that is not generally recognized. It is not enough, however, to point this out or to repeat it; it is also necessary to explain how additional funds would be used, what projects they would pay for, why such projects deserve support, and where the skilled scientists and technicians to do the work would come from.”

Garb’s book was described as a “springboard to progress,” and the Laskerites certainly sprang. As with Farber, a doctor’s word was the ultimate prescription. That Garb had prescribed precisely the strategy advocated by the Laskerites instantly transformed him in their eyes into a messianic figure. His book became their bible.

Religious movements and cults are often founded on a tetrad of elements: a prophet, a prophecy, a book, and a revelation. By the summer of 1969, the cancer crusade had acquired three of these four essential elements. Its prophet was Mary Lasker, the woman who had guided it out of the dark wilderness of the 1950s into national prominence just two decades later.
Its prophecy was the cure for childhood leukemia, inaugurated by Farber’s experiments in Boston and ending with Pinkel’s astonishing successes in Memphis. Its book was Garb’s
Cure for Cancer
. The final missing element was a revelation—a sign that would auger the future and capture the imagination of the public. In the spirit of all great revelations, this one would also appear unexpectedly and mystically out of the blue. It would apparition, quite literally, from the heavens.

At 4:17 p.m. EDT on July 20, 1969
, a fifteen-ton spacecraft moved silently through the cold, thin atmosphere above the moon and landed on a rocky basalt crater on the lunar surface. A vast barren landscape—a “
magnificent desolation
”—stretched out around the spacecraft.
“It suddenly struck me
,” one of the two astronauts would recall, “that that tiny pea, pretty and blue, was the earth. I put up my thumb and shut one eye, and my thumb blotted out the planet.”

On that pea-size blue planet glimmering on the horizon, this was a moment of reckoning. “
It was a stunning scientific and intellectual accomplishment
,”
Time
reported in July 1969, “for a creature who, in the space of a few million years—an instant in evolutionary chronology—emerged from primeval forests to hurl himself at the stars. . . . It was, in any event, a shining reaffirmation of the optimistic premise that whatever man imagines he can bring to pass.”

The cancer crusaders could not have asked for a more exuberant vindication for their own project. Here was another “programmatic” effort—planned, targeted, goal-oriented, and intensely focused—that had delivered its results in record time.
When Max Faget, the famously taciturn engineer
of the Apollo program, was later asked to comment on the principal scientific challenge of the moon landing, he could only come up with a single word: “Propulsion.” The impression was that the moon walk had turned out to be a technological cakewalk—no more complicated than building a more powerful jet plane, magnifying it several dozenfold, and pointing it vertically at the moon.

The Laskerites, transfixed in front of their flickering television sets in
Boston, Washington, and New York on the evening of the moon landing, were primed to pick up on all these analogies. Like Faget, they believed that the missing element in the cancer crusade was some sort of propulsion, a simple, internal vertical thrust that would transform the scale and scope of their efforts and catapult them toward the cure.