There is no letter in the English alphabet more alarming than C — C for cancer. It has occupied that spot for a hundred years, though currently upstart Covid-19 has temporarily captured that position. Covid-19 may have brought mighty nations to their knees, paralysed the global economy and broken our social norms but, without doubt, this pandemic — like the bubonic plague or the Spanish flu — will be consigned to the dustbin of history in a very short time.

Not so cancer, as Dr Azra Raza tells it in her revolutionary book The First Cell: And the Human Costs of Pursuing Cancer to the Last. C for cancer is not quite ready to relinquish its spot at the top.

Eighteen million cases of cancer are reported globally each year, a good half of them fatal, and there have been no major breakthroughs in treatment strategies since the 1970s. We pride ourselves to be living at a time in history that has recorded unparalleled advances in science and technology and, yet, most of the treatments and medicines available today for cancers that have spread and metastasised are no better than snake oil.

For the past 50 years, the treatment protocol has, with some variations, consisted of surgery, chemotherapy and radiation — what Dr Raza calls “slash, poison and burn.” While treatment regimens for a few cancers — notably prostate among men and breast cancer among women — have shown a significant decline, mostly because of early detection through improved screening processes or, in the case of lung cancer, resulting from a reduction in smoking, for the rest, once the tumour cells spread beyond the immediate organ where they originated, it is open season. And cancer is winning.

The First Cell exposes the big lie surrounding the disease and brings out facts that the cancer industry — Big Pharma, hospitals, doctors and researchers looking for cancer solutions in mice and funded by captive organisations — does not want you to know.

As Dr Raza lays it out, most of the time, patients suffering from advanced cancers have one of two options: either die of the disease, or die of the treatment, whichever gets them first. And yet, billions of dollars continue to be invested in traditional cancer research work across the world, none of which has yielded anything that could legitimately be called a treatment leading to a ‘cure’.

A well-respected and experienced oncologist argues in a revolutionary and very readable book that Big Pharma, hospitals, doctors and researchers have got it all wrong in the fight against the dreaded disease

The current treatment protocols give false hopes to the patient, while destroying life and denying the patient a dignified death. As Dr Raza tells it, 95 percent of the on-going experimental clinical trials are of no or little value and fail to be approved by the Food and Drug Administration (FDA) of the United States. The five percent that do succeed, extend life by a few months for a fraction of the patients, at great pain and great cost.

Dr Raza has been working in the field of oncology since 1984 and she has created a completely unique and invaluable repository of 60,000 tissue samples obtained from her cancer patients, most of them drawn by herself, and not one cell being contributed by another oncologist. She is horrified by how cancer research has lagged behind in finding the cause, treatment and cure for cancer, hampered, no doubt, by its singular focus on finding and killing the last cell — like a dog chasing its tail in perpetuity.

This model to bust cancer — be it at the research lab or on the operating table — is based on a wild goose chase of the last cell among the 30 trillion cells that form the human body. The chase is over when the patient dies.

The complex machinery of the human body plays a shell game of hiding the mutated cells and their movements. There is simply no capability, at least as of now, of beating human cells at that game. By the time a cancerous cell is detected in one area, in many cases it has already travelled to another part of the body. The search and treatment begins again, and again ends in a vicious vortex to painful death — whoever said it’s the journey that matters did not encounter this beast of a humsafar [companion].

Dr Raza challenges the status quo. She calls out the vested interests. Her solution to reduce the incidence of cancer, or to improve the chance of curing it, is to reach out for the first cell: detect the first mutation or even anticipate it and deal with it then. She advocates preventive rather than curative strategies, which present better chances of success and much less destruction of the human body and soul. This is also a lot less costly in financial terms as well as the suffering patients have to endure.

Dr Raza is a proud alum of Dow Medical College (now Dow University of Health Sciences), Karachi, a scientist, an oncologist, mother of a gifted and successful daughter and widow of a brilliant and renowned oncologist — himself a victim of this lethal disease that he had set out to cure. And now, Dr Raza has taken over that mantle.

Dr Raza may have the head of a scientist, but she has the heart of a poet. Her first book, Ghalib: Epistemologies of Elegance, unveiling yet another layer of the infinite complexities of Mirza Asadullah Khan Ghalib’s work, was co-authored with Sara Suleri Goodyear. Heavy shades of her poetic side appear to mingle — peacefully, I think — with the hard reality of science in The First Cell, in which she quotes over 50 verses and aphorisms from Eastern and Western poets, philosophers and writers, making it a pleasure to read.

She brings cancer up close and personal to the readers by recounting “the intimacies of cancer kept confident by those who experience its anguish”, among whom was her late husband. These are haunting and all too real accounts narrated in a style that is reminiscent of Gabriel Garcia Marquez’s novella Chronicle of a Death Foretold: everyone in the village knows that Santiago Nasar will be murdered; only he does not. By the time he finds out, it is already too late to avoid it.

Beautiful and heart-catching literary references sugar-coat the cruel reality of cancer, drawing the reader willy-nilly into the mesmerising pages of the book, which is an approachable read even if one is unfamiliar with the medical terrain. Once begun, The First Cell is difficult to put down.

Dr Raza argues passionately that treatment of a cancer patient is a sacred duty and a moral imperative. But she maintains that this commitment should go beyond attending to the dying patient to ensuring that the patient never gets to the advanced stage. She demolishes the so-called ‘reductionist’ approach to finding a cure for cancer — a failing strategy for the past 50 years of research and treatment.

“The future is in preventing cancer by identifying the earliest markers of the first cancer cell rather than chasing the last. I have been saying this since 1984 and I will continue to say it until someone listens.” This is the true nature of jihad.

She has managed to get 30 of the most brilliant minds in the scientific community, under the umbrella of The Oncology Think Tank (TOTT), to agree on a platform for the search of a new paradigm, a major shift towards finding the first, rather than the last, cancer cell. She and her supporters want a change in public policy in regard to priority for cancer research: greater allocation (than the present five percent) in funding towards research on early detection and prevention; greater focus and scientific effort in this direction; and more education that leads to better understanding of all aspects of the disease.

Is she asking for too much?

The solution she proposes is the only compassionate answer to this dreaded disease, and it is a solution that can be made available globally with deliberate speed.

The reviewer is Permanent Observer of the Parliamentary Assembly of the Mediterranean to the United Nations

The First Cell: And the Human Costs of Pursuing Cancer to the Last
By Azra Raza
Lightstone, Karachi
ISBN: 978-9697161553
356pp.

Published in Dawn, Books & Authors, June 6th, 2021