This review is written in loving memory of my mother and grandmother who died of cancer, who deserved far more from the healthcare system than what they got.
Cancer has a smell.
And it’s a different, distinct, lingering smell, different than the acrid, plastic smell of medical equipment, nitrile gloves, hospital soap, isopropyl alcohol, or wet wipes, or the depressing smell of bundles of “Get Well Soon” flowers in varying stages of decay, or the smell of a human body that can no longer shower regularly or use the toilet independently.
This smell was the worst thing about having to spend days with my grandmother, who died of a “metastatic cancer of unknown primary” in 2008, and it’s what still lingers as one of the strongest memories of saying goodbye to my mother in late September 2023. My mother died of an incredibly aggressive skin cancer in late October 2023.
Outside of the recent history of having to watch my mother, an energetic woman dedicated to volunteering for any number of community initiatives, waste away and die within the span of six months, “cancer awareness” and advocacy efforts dominate my social media, including news from friends fighting their own battles with cancer or sharing updates and GoFundMes in support of loved ones. Walks/runs/bike rides for any number of cancers are a staple of local news. At Jewish communal events at a synagogue, Jewish school, or JCC building, I will inevitably find a poster in or near the bathroom, imploring me to get tested for BRCA or any other number of hereditary cancers found in Ashkenazi or Separdi Jewish communities. Cancer is everywhere. Why can’t we ever seem to beat cancer despite mass awareness and billions of research dollars?
Nafis Hasan’s new book Metastasis: The Rise of the Cancer Industrial Complex and the Horizon of Care cuts through the seeming inescapability of cancer and the “cancer industrial complex” by laying out a contemporary political history of cancer treatment in the United States, with a focus on how policymakers, medical associations, and pharmaceutical companies have worked to prioritize a framework of cancer as a primarily genetic disease rather than a disease caused by environmental factors such as pollution and dangerous working conditions. By individualizing cancer down to a person’s DNA, the entire cancer treatment industrial complex can frame cancer as an individual failing (as if people have any control of their DNA), rather than the result of massive amounts of pollution, environmental destruction, and dangerous working conditions created by the ruling class.
The book is a quick and brutal read that lays out, in depressing and enraging detail, the history of our current cancer treatment industrial complex and the series of political and economic decisions made by the ruling class to bar providers of cancer treatment, advocacy organizations, and researchers from fully confronting how war, imperialism, pollution, and dangerous working conditions drive cancer rates.
Terms like “The War on Cancer” and “fighting a battle with cancer” have dominated popular rhetoric, since the 1971 War on Cancer Act. In fact, as Hasan bluntly states, with a trove of supportive data, war itself causes cancer. Exposure to atomic radiation and agent orange directly caused cancer in both American soldiers and Japanese and Vietnamese civilians during World War II and Vietnam. Leukemia rates skyrocketed in Fallujah during the U.S. invasion of Iraq, and U.S. veterans suffered a wide variety of cancers in the aftermath of their deployment. Hasan notes in the acknowledgements that the book was written during the ongoing U.S.-funded genocide on Gaza, and notes the destruction of all Gazan hospitals and that Gazan cancer patients have no place to get treatment, let alone escape American bombs (which are themselves carcinogens).
These sections of the book were the hardest to read in a book dedicated to the not-remotely-a-beach-read topic of cancer treatment in a socialist framework. I live in Chicago, which is approximately the same size as Gaza, and spent many hours contemplating what the hell I would do if I needed to somehow drop everything and transport my mother (who was incapable of standing up on her own) to the other side of the city, or how on earth she’d get treatment while her hospital was being bombed to rubble.
Hasan’s overview of every ugly connection between current cancer organizations and their origins is difficult reading. The American Cancer Society was started by the owners of Lucky Strike Cigarettes. Hitler simultaneously described Jewish people as a cancer needing eradication, considered cancer caused by smoking a Jewish invention, and enacted an aggressive anti-smoking campaign as a way of preserving Aryanism — a campaign that was then copied by American public health advocates after the war. I would not recommend reading this book via phone, tablet, or e-reader unless you have Herculean self-control because these excerpts and more will be enough to drive you to pitch your device across the room with destructive force.
The inefficacy of many of the most high profile and expensive cancer treatment drugs (we’re talking about millions of dollars per dose here) is another theme of the book, with a direct connection to the greed of the pharmaceutical industry and horrific publish-or-perish research conditions that harm graduate students and postdoctoral researchers the most. Hasan expertly weaves together the political and economic decisions that led to the monstrously high cost of drug development and subsequent high drug prices, the overall ineffectiveness of the newest (and most expensive) array of “miracle” cancer drugs, cancer research’s own serious “replication crisis” in research, and the neoliberalization of the university and working conditions for scientists from the most elite, to the most ignored and devalued positions. Science was professionalized — a strategic decoupling of scientific work and scientists as workers as an impediment of class consciousness and worker organizing. The dynamic was familiar to me as a social worker (where a similar process occurred in the 1960s). Increased organizing among graduate and postdoctoral workers is shared as a glimmer of hope in an otherwise extremely bleak scientific political economy.
The book’s prescription to our capitalism-fueled cancer industrial complex is socialism, and, specifically, a socialized single payer healthcare system, robust state regulations banning the use of carcinogenic pollutants, and militant worker power with corresponding high union density. This should not be a surprise for a book where the author includes a recognition of DSA and an exhortation to join it in the acknowledgements section.
However, we begin four more years of Trump, who has no interest in reshaping our healthcare to be more socialist and may take another go at repealing the Affordable Care Act (ACA). So what do we do right now? Hasan points to the history and legacy of AIDS Coalition to Unleash Power (ACT-UP) as a lodestar for how cancer organizations and cancer industrial complex workers can fight back against political repression and a for-profit healthcare system. ACT-UP is still around and still engaging in robust public facing direct actions that target the people in power preventing people from getting affordable healthcare, using a theory of change that makes space for grief and uses grief as a catalyst for social change. While some breast cancer organizations refused to partner with ACT-UP in the 80’s for (bullshit) respectability politics reasons, a new group of groups led by patients both in active treatment and remission are already challenging the actions and complicity of the large nonprofits such as the Susan G. Komen Foundation and the corporate “pinkification” of breast cancer advocacy. It was the work of disabled and chronically ill people literally blocking the halls of power in 2017 that prevented the repeal of the ACA. There is plenty of room and opportunity for socialists to lead these efforts.
There are a few shortcomings to an otherwise excellent book. I wished to see more of the personal stories about the struggles to survive cancer in our capitalist hellscape which periodically dot the text. Examples in the text included a direct quote from the r/fuckcancer subreddit to Hasan’s accounts of friends, comrades, and healthcare workers from his labor organizing job and their often tragic experiences due to inadequate healthcare or paid time off. People need to understand that the policies and political decisions made about cancer aren’t abstract. They directly contributed to the horrific pain and suffering my mother and grandmother experienced in their last days — pain and suffering that didn’t need to happen. While Hasan also mentions the evidence behind some specific hereditary cancers (such as the aforementioned high rates of BRCA in Jewish communities), I was surprised to see no connection between war, imperialism and trauma and why these conditions exist in the first place. There is also some evidence indicating that sexual abuse and domestic violence are correlated with future diagnoses of breast cancer in women — a clear demonstration fo the body keeping the score in a truly gruesome way.
Most critically, there is a tension between Hasan’s detailed account of how new and expensive cancer drugs are often ineffective and insurance companies’ “cost saving” practice of denying claims for these and other treatments. It is important to acknowledge the limits of an approach to cancer care that focuses on blockbuster medical interventions — but the same system that promotes these treatments for some denies access to them for many others. Recently, outgoing FTC Commissioner Lina Khan accused United Healthcare of contributing to the high cost of cancer treatment by overcharging patients for cancer treatment. UHC and all private insurance companies regularly deny a wide variety of treatments, including cancer treatment, on the basis of “inefficacy” and “cost savings.” It is important to connect capital to every failure in the system: from ineffective and outrageously priced drugs, insurance companies rationing care via denying treatment, and poor working conditions and treatment conditions for healthcare workers and patients. I wish Hasan had more clearly made these connections in the closing argument of the book. Our goal is drugs that work, that don’t cost millions of dollars per dose, and are covered by insurance while we fight for a single payer system for the future.
These are minor critiques in an excellent, essential read for anyone who cares about creating a world without cancer in our lifetimes, whether you work in healthcare, are currently receiving cancer treatment or are in remission, or have a loved one staring down a cancer diagnosis and treatment. Metastasis is the prescription we need now for why the cancer industrial complex refuses to assign cancer to the dustbin of history and a treatment plan for building the healthcare system and the cancer and capitalism free world we want.