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Life Within Life

A Cancer Sutra

by

F. G. Pluthero

It is sad, but all things in nature are sad when we look too closely at them. It will always be thus as long as we do not know nature's secret, or do not even know whether she truly has a secret. And should we discover some day that there is no secret, or that the secret is monstrous, new duties will present themselves. In the meantime let our hearts remark "it is sad," yet let our reason add "but thus it is." For the present, our duty is to seek out what may be hiding behind our sorrows by studying them with the same courage and interest as if they were joys. Before we judge nature, or before we complain, we should at least ask every question we can possibly ask.

- Maurice Maeterlinck, The Life of the Bee (translation)

Contents

Introduction

Chapter 1 - The Pattern Which Connects

Chapter 2 - The Face of a Disease

Chapter 3 - From Microcosm to Macrocosm

Chapter 4 - Man the Malignant?

Chapter 5 - Life Within Life

Introduction

The face leering from the front of this book is there for a reason that relates to a story that began one day long ago when a king sent an emissary to the roof of the world to locate a certain hermit who lived in a lofty mountain cave. After an arduous journey and a strenuous climb the messenger finally reached his objective one cold morning just after sunrise, and when he entered the cave he found the hermit sitting cross-legged on an antelope skin spread over the bare rock floor, his calm face framed by dreadlocks that had been freshly whitened with ashes, along with the rest of his body. The hermit's eyes remained half-closed in a profound meditation as the messenger stood on the threshold and waited for a sign of acknowledgement, and when none seemed forthcoming he decided to read out the letter he carried. It was addressed in respectful terms from the emperor of all the demons in the world, and its gist was a request - or more of a demand - for the hand of the hermit's daughter in marriage. The words failed to provoke any response, so the demon messenger took a step closer to the dreadlocked dreamer and repeated the text. Once again there was no reply. He took another step closer and drew a deep breath in preparation for a third run-through, but before a word could escape his mouth the hermit's head tilted up ever so slightly, and a third eye opened in the middle of his ash-streaked brow to release a blinding bolt of light that struck the ground next to the intruder.

When the flash, flames and smoke cleared, the messenger found himself face to face with a creature unlike any he had seen among demons, gods or men. Its lean, leonine body seethed with coiled energy, its powerful arms and sharp-clawed hands flexed in anticipation of mayhem, and most terrifying of all the voracious look in its wild eyes left no doubt that hunger had been given flesh to walk among the living. The monster's gaze struck such fear into the messenger's heart that he instantly threw himself at its creator's feet and began to plead loudly for his life with a wailing stream of pathetic apologies, larded with oaths of obedience and spiced with fulsome pledges of future good behaviour on behalf of himself and the entire demon race. In response to this supplication the hermit made the slightest of motions to signal that the rash intruder had been spared, an act that created a problem which immediately became apparent when the slavering creature turned grudgingly away from the messenger, wailed pitifully and pointed a clawed finger at his own mouth. It was his way of asking how he was to feed the hunger that was the essence of his being, now that he had been denied his intended victim.

The monster's master pondered the question for a moment, and then offered a suggestion that his creation immediately accepted by calmly commencing a banquet where his own body provided the courses. He had his toes for starters, then moved on to his feet and shins, gnashing and gulping with gusto. In quick order thighs, hips and torso disappeared into his maw, followed by fingers, hands, forearms and everything else the greedy mouth could reach, until at last only a fierce face remained to leer hungrily with wild eyes, darting tongue, smacking lips and champing teeth. This ingenious combination of self-sacrifice and self-indulgence greatly pleased the monster's creator, who was of course none other than the Lord of the Cosmic Dance. Indeed he was so pleased that he christened what remained of his creature the Face of Glory, or kirttimukh, which to this day serves as a guardian of sacred spaces along with his monstrous cousins the t'ao-t'ieh, the gorgoneion and a host of other gluttonous gargoyles.

The sanctuaries these guardians protect range from modest to magnificent, and they can be found wherever people have sought to find favour and guidance from divine forces, make connections between the transient and the eternal, or simply find a bit of peace and quiet apart from the bustling world. Such sanctuaries are also well-suited to pursuits like those described in our opening quotation: asking questions of nature and studying sorrows with the same interest as if they were joys, and it was with intent of marking out such a space that the kirttimukh was put at the front of this book. Of course with doors as thin as paper and walls as flimsy as thought, this is an uncertain sanctuary compared to a lofty temple or even a hermit's cave. But for those with the tenacity of pilgrims this modest volume should serve to ask a few questions, study some sorrows and perhaps even tackle a terror or two, such as the one mentioned the subtitle and alluded to in the tale of the glutton's grisly feast: cancer.

I expect that for most people the sight of that word brings to mind a malady that is among the most dreaded in the modern world. The dread of cancer has many roots, with the deepest arising from the fear of death and suffering that are intimately associated with malignancies like tumours and leukemias, and also with many of the treatments that have been used against them, such as surgery, irradiation and chemotherapy. We also dread cancers because they are mysterious; indeed their mystery seems to deepen the more we learn about them. For instance the incidence of most types of cancers increases with age, as with arthritis and many other degenerative conditions, yet some cancers are found only in the very young, and some appear to pass from parents to children in the manner of hereditary diseases like cystic fibrosis and sickle-cell anemia. Thankfully, most cancers are not inherited, but ancestry can still play a prominent role in determining the susceptibilities of individuals, families and populations to particular kinds of cancers, as can a host of environmental factors such as infections, diet and exposure to noxious substances; for example over the past few decades a pandemic of lethal respiratory tumours has swept around the world on the heels of lifestyle habits that have subjected increasing numbers of people to high levels of tobacco smoke. And to cap off the mystery, we have the basic biological observation that cancers are strikingly different in their physical structure and behaviour from the tissues that normally exist in the body. For example many tumours present themselves as moles and lumps that are visibly distinct from surrounding tissues, and the differences become even more marked when tumour cells are examined in the laboratory via microscopy, culturing or molecular analysis.

Fear and mystery are enough to make most people dread cancers on principle, and there are potent practical incentives as well. For instance in the part of southern Canada where I live, the incidence of many cancers has been rising for decades and we have now reached the point where a majority of patients with tumours requiring high-tech tools to locate and treat them - such as MRI scans and radiation therapy - face lengthy delays before they can receive the appropriate diagnosis and/or treatment, which can of course have a significant bearing on how well those patients do. The situation in Canada is not unique; cancers have become prominent health problems in many modern societies, where many citizens can now expect to be personally afflicted and/or affected at some point in their long lives. As a result, the disease we all know and dread has become the focus of political debates, legal battles and a global enterprize dedicated to diagnosing, treating, preventing and profiting from cancers. That enterprize has attracted its share of speculators, quacks, bumblers and frauds, but it has also underwritten a grand scientific exploration that has reaped a vast harvest of knowledge concerning everything from practical aspects of treatment to the subtle secrets of living bodies, organs, tissues, cells and molecules. This knowledge has contributed to several successes in what is often called the War On Cancer, yet the enemy remains as much of a threat as ever and may even be gaining strength in some quarters, which ensures that the war will continue for some time yet.

And what does that war have to do with this book? Well, for one thing when I started thinking about writing it I was working, fittingly enough, as a cancer researcher. I had joined a leukemia project to provide expertise in molecular biology, an area I had gone into after graduate training in less trendy disciplines like entomology, evolutionary biology, animal behaviour and genetics. As it turned out my education had not provided me with the one thing that would have been necessary to get anything worthwhile out of that particular project, which was the ability to work miracles, but the sorry interlude did provide me the opportunity learn a good deal about the basic workings of cells and tissues, and gain some appreciation of the connections that can exist between peoples' afflictions and their backgrounds as individuals, groups, populations, communities and societies. By the time my sojourn as a cancer researcher was finished I had also acquired some serious and rather dark concerns about the modern scientific enterprize, which arose from my own experiences and from other interests that began way back when I got my first library card and promptly started signing out enormous books on archaeology and ancient history. As I got older, my historical interests concentrated on the panorama of relatively recent events that most people think of as history, and like many of my contemporaries I developed a special fascination with the just-concluded 20th century, which by most standards ranks as one of the more impressive and disastrous epochs in the human journey. It is also one of the most puzzling. Indeed it seemed to me that the more I learned about what has being going on in the modern world lately, the less sense I could make of events and developments, whether they were examined in the light of individual experience, compared to what went on before or considered from the perspective of what we have learned about how nature operates. I realize that many people have found themselves in similar situations, but it is especially unsettling if you expect - as a scientist naturally does - that it should be possible to use what we know about ourselves, our past and our natural surroundings to make at least some sense of what goes on in the world we have created for ourselves.

Mind you, a biological/historical education does lead one to suspect that we will never gain much more than a vague understanding of what goes on in our corner of the universe. Certainly the complexities seem overwhelming when we consider that modern humankind embraces a vast network of individuals, groups, tribes, corporations, communities, societies, nations and other aggregations, which are continually engaged in dynamic interactions with each other and with various aspects of a vast and ancient living planet that has considerable business of its own to take care of, some of it extending well out into the cosmos. It is true that we can make some progress towards unravelling the complexities of the living world by focussing on its basic aspects, such as the struggle for existence - a universal necessity which seems to impose a certain orderliness on the interactions of living things with each other and their environments. For instance in order to survive within a community, individuals are typically obliged to obey certain rules, and most communities must meet certain criteria in order to survive within particular natural environments. Yet while the basic rules may be universal, most struggles for survival are also subject to influences that vary considerably from situation to situation and from time to time; for example many a thriving community has been suddenly wiped out by floods, earthquakes or volcanic eruptions, and on a few occasions the entire biosphere appears to have been rearranged by violent events, such as encounters with giant meteorites. Thus while the struggle to survive can help us put in context much of what we see going on in the living world, there is still plenty of room left for complexities, uncertainties and what is commonly referred to as chance.

Chance is everywhere in the living world, from the natural disasters that can shake up the entire planet to events and influences that unfold within the tiniest corners of the microcosm; for instance each time an egg and sperm come together to initiate the development of a new individual they create a novel and unique set of genomic information. Not all genomic combinations are viable, which is an example of the order that necessity can impose upon chance, but there is more than enough unpredictability and variety at every level of organization to make the living world a complex, dynamic and unpredictable place of infinite variety, with a lengthy and mostly unknowable past and an equally obscure future. It is the sort of place where we should be happy to make even modest sense of what is going on while we concentrate on our own cabbages and let the big picture take care of itself, which is pretty much what I was trying to do as a cancer researcher when my particular cabbages started whispering some ominous things about that big picture. For instance if modern humankind has indeed come to operate by rules that are divorced from those that apply to our individual experiences, our collective past and what goes on in the rest of the living world, then according to cancers our current situation is not merely confusing and unsettling, it is downright dangerous - dangerous to us as individuals, communities, societies and nations, and dangerous to the living world that supports us. Furthermore, cancers also tell us that the danger will likely increase if we keep on the way we have been going.

At first glance, the idea that there are meaningful connections between the macrocosm we inhabit and the microcosm of molecules, cells and tissues may seem far-fetched, and I admit that when I first began to see parallels I thought they might be useful as metaphors and that was about all. However, as time went on the parallels seemed to become more compelling, as did the reasons for pursuing them further. Two reasons in particular stand out. The first is intellectual: the study of cancer in the form of the disease we all know and dread has uncovered a wealth of information concerning how cells and bodies develop and interact with each other and their surroundings, so it is reasonable to expect that an exploration conducted along similar lines into the apparently cancerous aspects of human behaviour may yield some interesting insights into our interactions with each other - as individuals, groups, communities, societies - and our natural surroundings. The second reason is practical; if, as many reasonable people have come to believe, the way many people go about their business today has a significant bearing on their fate and that of other individuals, communities, societies, species, ecosystems and even the living Earth itself, then it is worth our while to explore any avenue that may lead towards a better understanding of our situation. So to make a long story short, my study of the cancers and malignancies that we can get led to an exploration of those we can become.

Before we go any further, I should point out that I am well aware there is nothing novel about the notion that cancer has manifestations that go beyond lumps, tumours and leukemias. Indeed the idea is as ancient as the medical description of the disease; for instance shortly after cancers appear in the Hippocratic writings we find Socrates in Plato's Gorgias urging wrongdoers to seek judges as earnestly as the sick seek physicians, so that injustice will not become an incurable cancer of their souls. Since that time a host of people have decried all sorts of ideas, habits, parties, sects and other elements as malignancies that must be rooted out of minds and societies before they cause widespread wreck and ruin, and the modern penchant for plundering, poisoning and plowing under has led some to envisage humankind itself as a ravenous cancer spreading through devastated landscapes as it overwhelms the planet.

But what do people actually mean when they say that an idea is a cancer of a mind, a political movement a cancer within society, a community a cancer on a landscape, or a species a cancer upon a planet? In most cases they are referring to what we can call the essential cancer scenario, wherein an element develops in such a way that it gradually weakens and eventually destroys the whole it was once a part of (usually referred to as the host). This scenario is intimately associated with the term that is most commonly used to describe the nature of cancers and their relationships to their surroundings: malignant. This word literally means badly born, with the implication being that cancers have evil origins and a natural tendency to express their innate nastiness as time goes on. The related noun malignancy is often used interchangeably with cancer, and the same word can also be used to describe the state of being malignant; for instance a tumour that seems benign may still be surgically removed so that it will not have a chance to progress to malignancy. So semantics aside, the essential concept of cancer rests on two fundamental elements: 1) a scenario that can unfold within a variety of hosts, such as bodies, minds, societies and ecosystems as they are corrupted from within, and 2) the notion that malignancy is an inherent trait that naturally expresses itself as cancers go along.

This makes for quite a flexible concept; for instance it can serve as a logical tool for characterizing and classifying tumours, and as a rhetorical device for drawing attention to a variety of social situations. But how useful is it when we want to explore how and why cancers behave and develop the way they do? Not much, as it turns out. For instance studies of colon tumours have found that while they typically originate from visibly abnormal situations, they do not adhere slavishly to the ideal scenario - some patches of abnormal cells will grow wildly for a time and then settle down to form benign lumps or polyps, while others growing right next to them give rise to metastatic carcinomas. Those carcinomas do appear to become increasingly deviant and dangerous over time, but detailed studies have shown that they do not follow preordained progressions to malignancy, since neighbouring tumours can acquire different combinations of malignant traits at different rates and in differing sequences, and their unique and unpredictable journeys are shaped by many influences, including random events like mutations. Thus successful explorations of the behaviour, origins and evolution of cancers tell us that idealized conceptions are of limited use, and one of the major keys to making progress is a willingness to recognize and appreciate the uniqueness and unpredictability of individual cancers and malignancies. To me, this says that while essential concepts may be useful for pointing out general directions, it would not be a good idea to base an exploration of cancer in the living world upon the assumption that we are looking for manifestations of some sort of universal phenomenon. In fact I would say that we should be wary of the kind of logic that establishes ideals and then goes looking for their reflections in nature, because those reflections are not likely to be very illuminating.

And what is the alternative? Very simple: instead of assuming that cancers and malignancies are everywhere, we will begin our exploration where we know we can definitely find them: within our own bodies, and once we have a handle on what cancers are and how they work, we can go looking for them in the world at large. It may sound simple, but this plan of exploration is enormously ambitious. In order to carry it out we will be required to track cancers from the intricacies of biomolecules, cells, tissues and organs, through the complexities of societies out into the expanses of the living Earth and back in time, and along the way we must cross the frontiers of intellectual disciplines such as molecular biology, physiology, ecology, psychology, sociology, history, philosophy and geology, just to name a few. It would be as unreasonable of me to expect readers to possess encyclopaedic knowledge of these fields as it would be for you to expect it of me, nor can we assume that everyone is coming to the exploration from the same intellectual or educational background. Thus in an effort to level the ground I have decided to precede the exploration of cancer proper with a chapter that is largely concerned with putting together a simple yet robust conceptual picture of the living world, the essence of which is captured by the chapter title: The Pattern Which Connects. My actual working title for that chapter was Biology 101, and in fact readers with strong backgrounds in the life sciences may find it largely superfluous. I would nevertheless recommend that everyone at least skim through this chapter, because the conceptual model of the living world I intend to use for our exploration has a few differences from the one most of us absorb in school. For example some key concepts have been reworked - such as organisms and ecosystems - and a few have been eliminated, including species.

The justifications for these reworkings and omissions are presented at the appropriate points in the text, and in most cases the basic idea was to avoid the standard approach of making sense of things by trying to fit what we observe into arbitrary classifications and structures. Everyone understands that approach, and it has certainly proven its power in efforts to impose order upon nature, both intellectually and physically. But the goal of our exploration is simply to understand nature, and in order to do that it is a good idea to allow things to call attention to themselves on their own merits - or in technical terms look for emergent patterns rather than imposed ideals. This requires a rather different attitude towards exploration than many readers may be used to, and if I thought I could define that attitude for you I would try, but the best I can do for now is sketch out some of the basic elements. One is an intellectual value system that puts the real above the ideal, yet appreciates the usefulness of concepts as well as facts, and recognizes that knowledge is not a treasure to be accumulated but a currency that must be shared, circulated and continually retested in order to retain its worth, which does not necessarily come from bringing us any closer to the absolute truth. An explorer with this kind of intellectual equanimity is as willing to plunge into the depths of mystery as to re-examine the obvious, and can accept that novelty, originality and familiarity are often illusions arising from our perceptions of time, space and identity, while certainties carved in stone usually turn out to be monuments that mark where others either ran out of questions, or simply decided to stop asking them. For those who prefer more concise descriptions, the best ones I could find for the sort of attitude I would like to adopt towards this exploration come from two sources. The first is the opening quotation by Maeterlinck, which from my reading comes down to the willingness to observe and question with a non-judgemental but not dispassionate eye. The second comes from Shunryu Suzuki's description of what he called the beginner's mind, where there are many possibilities, in contrast to the expert's mind, where there are few.

This is not to say that I have anything against experts. Indeed there would be no point in setting out on this exploration at all if we could not depend on expert knowledge at each step of the way for information, intellectual tools and critical insights. However, in keeping with our basic aims and attitude, and for reasons that will be easier to explain at the end of our exploration, I intend to move through a considerable amount of expert information in a rather non-expert way. Most notably, few if any of the original sources of the facts, concepts and examples presented in the text will be explicitly recognised. This serious breach of professional ethics (I was once an expert, after all) means that instead of a precise, professional, up-to-date report bulging with references, footnotes and appendices, you have before you an account of a journey presented in the somewhat archaic literary form mentioned in the subtitle, the sutra. Sutras can take on a variety of forms, but the most effective are constructed as narrative journeys that lead the reader towards a particular way of thinking about and looking at a particular aspect of the universe. For example the classic Yoga Sutra discusses the nature of consciousness while developing a method for perceiving the pond of the universe without imposing our own mental ripples upon its surface, which can ultimately lead to a place that lies beyond the wind of consciousness, or nirvana.

I cannot promise anything so grand as a glimpse of nirvana to the readers of this book - nor could the author of the Yoga Sutra for that matter, since it is asking a lot to expect every reader to get everything there is to get from a particular journey. What I can promise is that you will fascinated, frustrated, challenged, irritated, badgered, baffled and with any luck illuminated to a modest degree. If you find yourself becoming lost or bored then go back or skip ahead, but for heaven's sake don't worry about "getting" everything the first time through. I still learn something every time I go through this journey even after covering the same ground scores of times, which I suppose is what happens when one travels with something like the proper attitude.