Biology in the News Explained

Is playing the cancer “cure” lottery simply the American way?

“The American economy wasn’t built just on good ideas and hard work. It was also built on hope and hype” (Surowiecki, 2014).

James Surowiecki was writing in the New Yorker recently about the seemingly American penchant for the celebration of con men. He ties this forgiving attitude to the same one that helps make America what it is — that is, our never-ending faith in the long shot. Con men (and for that matter, lotteries) do so well here because Americans like to believe that someday we will be the ones to hit it big, and con artists are good at telling us what we want to hear, seeming to believe it themselves. It is this belief in a long-shot jackpot future that also spurs a lot of entrepreneurism itself, and without it, where would we be? It is hard to admire the entrepreneur without admiring the con artist, Surowiecki argues, because sometimes it is extremely difficult to draw a clear line between the two and how they operate in order to drum up the necessary capital to sustain their internal mythologies of never-flagging optimism.

This suggests that there is a type of “hope” that could be uniquely American, and thus well integrated into other walks of life, such as in the realm of medical treatment for a generally incurable disease (under the current treatment paradigms) such as metastatic cancer. Perhaps our entrepreneurial culture is actually dependent on the idea that anything is possible, despite the “odds”, and this spills over into the medical world and more generally our ability to accept death and face it head on. Is this a double-edged sword that we will never quite be able to overcome as a culture?

It’s a compelling argument that this aspiration has helped make our country what it is and is what has led us over the years consistently to be world leaders in innovation. Aspiration to be one of the successful few is one of the traits that makes America great, and so different from other countries (in a good or bad way, depending on one’s perspective). But this mind set becomes destructive, even tragic, when it comes to dealing with terminal illness, because of the very real suffering it causes in the name of “bravery” or “doing what has to be done” to catch the holy grail of “cure.” If we don’t believe that we will be in the 5% of (real) survivors, the implied, though generally unvocalized, suggestion is that we deserve to die.

Roulette wheel

No doubt there are many Americans who will disagree, who will always believe that if cancer patients lose “hope” than that guarantees treatment failure. But that misses my point, which is that the problem with cancer treatment in the first place is locked into the “going for broke” mentality. Worst of all, even those who do not share this mentality are usually swept up in it by the dominant culture. There is no option presented to choose either longer-term disease management or to take a stab in the dark at cure. There’s only shoot the moon, pay your dues by being utterly miserable along the way, and “hope” you are in the 5%, which 95% of us can never be.

It seems probable that we are continuously reinforcing needless suffering and premature death in the name of “hope” simply by refusing to offer any other option than playing the lottery. Because Americans clearly believe in the lottery, there has been very little push back against this paradigm. So for decades, all we have heard about is the continuing quest for a cancer cure, instead of recognizing that we have been lodged in a cul-de-sac of thinking about how best do deal with what is actually a huge array of complex diseases that we hold under one umbrella out of convenience as well as political and economic expedience, and that what we are doing is simply not working for the great majority of people.

But imagine a different world, in which long-term cancer management paradigms were given the type of research scrutiny given to each successive and non-breakthrough chemotherapy drug.* What if this option could be provided for those who want it, in order to live out the remainder of their lives in relative health and peace, but allow the shoot-the-mooners to choose the option they want? It seems that should satisfy those who would not give up the American rags-to-riches mind-set because of what it means to them, but it would give those who want it the space to opt out and simply try to live with their disease without being constantly given the message that the only possible choices are playing the cure lottery, or death.


James Surowiecki, The New Yorker January 13, 2014. “Do the Hustle.”

*Many chemo drugs ironically could be an important part of the tool kit in management for long-term, high quality of life under different dosing regimens, but those who study and promote how to do this are mere voices in the wilderness.


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