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Introductory remarks
PREVENTIVE
MEDICINE
(1976)
$478-480
Symposium: The Illusion of Immortality Introductory
Remark@
DIANE FINK
Mankind has long devised intricate mythologies to explain away its fears and to provide some rationale for what it couldn’t understand. Perhaps nothing testifies more to the imagination and creative temperament of man than the myriad ways in diverse cultures in which he constructed elaborate systems of gods, demons, or spirits to personalize and romanticize, yet render crudely understandable, the forces and elements which governed his life. Why the wind, sun, and rains and where do they come from? Why the heat and cold, the changing of the seasons? Why often too little or too much of each? For primitive man it was rendered understandable and tolerable to personalize natural elements so that their harshness and bounty could mirror the range of man’s own behavior. For surely man is uncomfortable with uncertainty. Since the first child who asked, “Why is the sky blue?” man has been concerned not so much with the accuracy of his answer but in fashioningsome elaborate explanation for all that he observed but really never understood. Of course, these mythologies had great social utility. They provided organizing forces for society, enabling crude cultures to construct magnificent civilizations on the basis of simple folklore. Moreover, mythology has been man’s most constant companion in confronting his greatest and most uncomfortable uncertainty: the contemplation of his own finitude. Seldom has there been a civilization which could accept death as simply the termination of life. Rather, down through the centuries, man has found a constant need to conjure up an image of an immortal existence for himself in this world or another; a continuation of the life-force after death in forms and realms beyond our knowing here on earth. So if mythology has proved to be an important organizing force for society, for the individual it has been the great comforter in facing the unwelcome fact of his own death. Science has been the eternal enemy of mythology. In every age there have been those who could not accept the conventional wisdom. Inquiring minds, insistent on the idea that the greatest truths lie in demonstrable facts, have engendered an advancing knowledge of the universe and man’s place in it that rendered all but the most sophisticated myths useless and unbelievable. Science, in its broadest definition, supplanted mythology as an organizing force for society and rushed man headlong into the future, compressing light-years of achievement into the span of decades. Yet, if we have pierced the web of nature’s laws enough to explain why the I Resented at luncheon preceding Symposium by Joseph W. Cullen, N.C.I. f Reprints of the Symposium are available from the Editorial Office. American Health Foundation, 1370Avenue of the Americas, New York, New York 10019. 478 Copyright All
rights
0
1976 by Academic
of reproduction
Press,
in any form
Inc. reserved.
SYMPOSIUM:
ILLUSION
OF IMMORTALITY
479
wind, sun, and rain, and increasingly assuaged man’s uncertainty with rational explanations of natural phenomena, science has done and probably only can do relatively little to comfort man about his most perplexing uncertainty: the fact of his own death. Knowing that life and death are part of the inevitable and interminable cycle of existence doesn’t help very much when one tries to imagine nonexistence. The way man relates to and reacts to the fact of his own mortality, however, is a crucial factor for medical science. The fact that death is unavoidable does not mean that disease is; the fact that disease occurs does not mean it is necessarily terminal. We have learned that the best medicine is preventive medicine. Time and again that is the way we have diminished and eradicated massive threats to human health like malaria, polio, typhus, just to mention a few. But preventive medicine is not solely the practice of medicine by its licensed purveyors, the physicians. Rather it is a massive cooperative enterprise of the entire health community, not the least partner of which is the people. The way man reacts to the thought of death is crucial for medical science. This is especially true in the case of cancer. For it is viewed as such an ominous threat to health and life that it has been endowed with its own modem-day mythology which can obstruct its prevention and cure. To be sure, cancer is a serious threat to health and life. Estimates based upon data from the National Cancer Institute’s Third National Cancer Survey indicate there will be about 665,000 new cancer cases, that is, diagnosed for the first time, in 1975. These statistics do not include superficial skin cancers or in situ carcinomas of the uterine cervix. Inclusion of these lesions could add as much as 600,000 more new cases annually. Cancer will strike over the years in approximately two of three families. About 53 million Americans now living will eventually have cancer; that is one out of every four according to the present rates. This year alone, it is predicted that about 365,000 individuals will die of the disease. As the American Cancer Society in its ever-vigilant efforts points out, of every six persons who get cancer today, two will be saved and four will die. One of the four who die might have been saved given an earlier diagnosis and prompt treatment. This means that in 1975, today, instead of saving two out of six, three out of six, or one-half of those who get cancer, could and should be saved. In the Division of Cancer Control and Rehabilitation there is an important job of translating the research of the laboratory as quickly as possible into effective means of prevention, detection, diagnosis, treatment, rehabilitation, and continuing care of potential or actual cancer patients. This not only includes informing the medical community of the latest advances and demonstrations of effective methodologies which have been developed and field-tested. It also includes, as part of a larger mission, informing the American people of the facts and not the myths about cancer, and motivating them to be cooperative and active partners in programs of preventive medicine that will reduce the incidence and deaths from this disease. It is for these reasons that a Cancer Controline Network utilizing the 17 comprehensive cancer centers is being established throughout the United States. By dialing an 800 number, medical and paramedical personnel as well as the general
480
DIANE
FINK
public can obtain the most up-to-date information about methods of cancer management ranging from the prevention of cancer to the continuing care for its many forms. Using this resource one can obtain the names of the nearest and most available specialists working with specific cancers, and be referred to the nearest sites where application of the most advanced knowledge about cancer is underway. This is an important step, but only a beginning. We know we have a long way to go in establishing effective and credible communication so that the national concern about cancer and the knowledge we are acquiring about it are translated in communities throughout the country into action programs of cancer prevention and treatment. A major impediment exists, however, in achieving this goal. This brings us foursquare to the issue before us this afternoon. Effective action against cancer requires active involvement of the general public with the medical community, and the most effective treatment of cancer requires diagnosis and treatment in the earliest stages. The obstacle, essentially, is that many of us never consider ourselves potential cancer patients, despite its prevalence, nor probably as the victims of any major disease. If some of us are too mindful and preoccupied with the thought of death, to the point of neurotic hypochondria, many of us seem heedless of the inevitability of death. We live our lives as if gripped by an illusion of immortality. For example, despite the preponderance of evidence of the synergistic effects of smoking in the causation of cancer, there is no lessening in the number of smokers and, only this year [ 19751,the slightest diminution in the amount they smoke. ‘Or, ranging afield for a moment, the statistics relate the alarming incidence of highway deaths involving the use of alcohol, yet every day thousands of Americans get behind the wheel of an automobile either in a physically intoxicated state or with their senses, intellect, and motor systems so impaired from alcohol consumption that there is a virtual guarantee for the destruction of life and limb. Why are such things so? Because we are a hedonistic society? Because we are a suicidal society? I think not. Rather because many of us live with an illusion of immortality. How often have we as doctors heard the sad lament: “I never thought it could happen to me.” That is especially disheartening in the case of cancer when you learn that the lag-time between first noticing something is wrong and consulting a doctor for diagnosis could extort a fatal price. No matter what health care system emerges in this country, or how it is financed, the first step in health care is always up to the individual, as are the continuing steps of health maintenance, for the most part. No matter what the ailment, if one has an attitude that “it can’t happen to me,” if one blindly pursues that myth, that illusion of immortality, he will frustrate the best attempts of the best doctors in the best medical care system in the world to preserve and prolong his gift of life.
MEDICINE
(1976)
$478-480
Symposium: The Illusion of Immortality Introductory
Remark@
DIANE FINK
Mankind has long devised intricate mythologies to explain away its fears and to provide some rationale for what it couldn’t understand. Perhaps nothing testifies more to the imagination and creative temperament of man than the myriad ways in diverse cultures in which he constructed elaborate systems of gods, demons, or spirits to personalize and romanticize, yet render crudely understandable, the forces and elements which governed his life. Why the wind, sun, and rains and where do they come from? Why the heat and cold, the changing of the seasons? Why often too little or too much of each? For primitive man it was rendered understandable and tolerable to personalize natural elements so that their harshness and bounty could mirror the range of man’s own behavior. For surely man is uncomfortable with uncertainty. Since the first child who asked, “Why is the sky blue?” man has been concerned not so much with the accuracy of his answer but in fashioningsome elaborate explanation for all that he observed but really never understood. Of course, these mythologies had great social utility. They provided organizing forces for society, enabling crude cultures to construct magnificent civilizations on the basis of simple folklore. Moreover, mythology has been man’s most constant companion in confronting his greatest and most uncomfortable uncertainty: the contemplation of his own finitude. Seldom has there been a civilization which could accept death as simply the termination of life. Rather, down through the centuries, man has found a constant need to conjure up an image of an immortal existence for himself in this world or another; a continuation of the life-force after death in forms and realms beyond our knowing here on earth. So if mythology has proved to be an important organizing force for society, for the individual it has been the great comforter in facing the unwelcome fact of his own death. Science has been the eternal enemy of mythology. In every age there have been those who could not accept the conventional wisdom. Inquiring minds, insistent on the idea that the greatest truths lie in demonstrable facts, have engendered an advancing knowledge of the universe and man’s place in it that rendered all but the most sophisticated myths useless and unbelievable. Science, in its broadest definition, supplanted mythology as an organizing force for society and rushed man headlong into the future, compressing light-years of achievement into the span of decades. Yet, if we have pierced the web of nature’s laws enough to explain why the I Resented at luncheon preceding Symposium by Joseph W. Cullen, N.C.I. f Reprints of the Symposium are available from the Editorial Office. American Health Foundation, 1370Avenue of the Americas, New York, New York 10019. 478 Copyright All
rights
0
1976 by Academic
of reproduction
Press,
in any form
Inc. reserved.
SYMPOSIUM:
ILLUSION
OF IMMORTALITY
479
wind, sun, and rain, and increasingly assuaged man’s uncertainty with rational explanations of natural phenomena, science has done and probably only can do relatively little to comfort man about his most perplexing uncertainty: the fact of his own death. Knowing that life and death are part of the inevitable and interminable cycle of existence doesn’t help very much when one tries to imagine nonexistence. The way man relates to and reacts to the fact of his own mortality, however, is a crucial factor for medical science. The fact that death is unavoidable does not mean that disease is; the fact that disease occurs does not mean it is necessarily terminal. We have learned that the best medicine is preventive medicine. Time and again that is the way we have diminished and eradicated massive threats to human health like malaria, polio, typhus, just to mention a few. But preventive medicine is not solely the practice of medicine by its licensed purveyors, the physicians. Rather it is a massive cooperative enterprise of the entire health community, not the least partner of which is the people. The way man reacts to the thought of death is crucial for medical science. This is especially true in the case of cancer. For it is viewed as such an ominous threat to health and life that it has been endowed with its own modem-day mythology which can obstruct its prevention and cure. To be sure, cancer is a serious threat to health and life. Estimates based upon data from the National Cancer Institute’s Third National Cancer Survey indicate there will be about 665,000 new cancer cases, that is, diagnosed for the first time, in 1975. These statistics do not include superficial skin cancers or in situ carcinomas of the uterine cervix. Inclusion of these lesions could add as much as 600,000 more new cases annually. Cancer will strike over the years in approximately two of three families. About 53 million Americans now living will eventually have cancer; that is one out of every four according to the present rates. This year alone, it is predicted that about 365,000 individuals will die of the disease. As the American Cancer Society in its ever-vigilant efforts points out, of every six persons who get cancer today, two will be saved and four will die. One of the four who die might have been saved given an earlier diagnosis and prompt treatment. This means that in 1975, today, instead of saving two out of six, three out of six, or one-half of those who get cancer, could and should be saved. In the Division of Cancer Control and Rehabilitation there is an important job of translating the research of the laboratory as quickly as possible into effective means of prevention, detection, diagnosis, treatment, rehabilitation, and continuing care of potential or actual cancer patients. This not only includes informing the medical community of the latest advances and demonstrations of effective methodologies which have been developed and field-tested. It also includes, as part of a larger mission, informing the American people of the facts and not the myths about cancer, and motivating them to be cooperative and active partners in programs of preventive medicine that will reduce the incidence and deaths from this disease. It is for these reasons that a Cancer Controline Network utilizing the 17 comprehensive cancer centers is being established throughout the United States. By dialing an 800 number, medical and paramedical personnel as well as the general
480
DIANE
FINK
public can obtain the most up-to-date information about methods of cancer management ranging from the prevention of cancer to the continuing care for its many forms. Using this resource one can obtain the names of the nearest and most available specialists working with specific cancers, and be referred to the nearest sites where application of the most advanced knowledge about cancer is underway. This is an important step, but only a beginning. We know we have a long way to go in establishing effective and credible communication so that the national concern about cancer and the knowledge we are acquiring about it are translated in communities throughout the country into action programs of cancer prevention and treatment. A major impediment exists, however, in achieving this goal. This brings us foursquare to the issue before us this afternoon. Effective action against cancer requires active involvement of the general public with the medical community, and the most effective treatment of cancer requires diagnosis and treatment in the earliest stages. The obstacle, essentially, is that many of us never consider ourselves potential cancer patients, despite its prevalence, nor probably as the victims of any major disease. If some of us are too mindful and preoccupied with the thought of death, to the point of neurotic hypochondria, many of us seem heedless of the inevitability of death. We live our lives as if gripped by an illusion of immortality. For example, despite the preponderance of evidence of the synergistic effects of smoking in the causation of cancer, there is no lessening in the number of smokers and, only this year [ 19751,the slightest diminution in the amount they smoke. ‘Or, ranging afield for a moment, the statistics relate the alarming incidence of highway deaths involving the use of alcohol, yet every day thousands of Americans get behind the wheel of an automobile either in a physically intoxicated state or with their senses, intellect, and motor systems so impaired from alcohol consumption that there is a virtual guarantee for the destruction of life and limb. Why are such things so? Because we are a hedonistic society? Because we are a suicidal society? I think not. Rather because many of us live with an illusion of immortality. How often have we as doctors heard the sad lament: “I never thought it could happen to me.” That is especially disheartening in the case of cancer when you learn that the lag-time between first noticing something is wrong and consulting a doctor for diagnosis could extort a fatal price. No matter what health care system emerges in this country, or how it is financed, the first step in health care is always up to the individual, as are the continuing steps of health maintenance, for the most part. No matter what the ailment, if one has an attitude that “it can’t happen to me,” if one blindly pursues that myth, that illusion of immortality, he will frustrate the best attempts of the best doctors in the best medical care system in the world to preserve and prolong his gift of life.