"Riveting and moving stuff and a wonderful antedote if you're fed up with happy clappy celebrity survivor stories and glossy cancer charrity booklets."
The Glasgow Daily Record
"Once his dad David had recovered from his first course of treatment, the two of them resolved to take something positive from their experience.
They spent a year researching the history and science of the disease for a book to help others in a similar situation."
24 July 2006
FOR MY BELOVED DAD
David Wishart died before his 'cancer' book was finished. His son completed it in his memory
By Brian Mclver
WHEN Adam Wishart found out his father had cancer, his ignorance of the disease plunged him into a state of absolute terror.
But once his dad David had recovered from his first course of treatment, the two of them resolved to take something positive from their experience.
They spent a year researching the history and science of the disease for a book to help others in a similar situation.
Sadly, David Wishart would lose his fight before One in Three was finished but his son vowed to see it published in tribute to him.
JUST 12 months after being diagnosed with the cancer that had so devastated his family, David Wishart lost his life to the illness.
Despite grieving for his father, Adam Wishart had wanted to press ahead with completing the book, which is named after the number of people who, statistically, will be affected by the killer disease.
His book tells the story of his father's illness and death but primarily aims to offer sufferers, their relatives, and anyone else who has an interest, a no-nonsense history and factual description of cancer.
Adam, 38, a documentary maker who lives in London, hopes it will give valuable information and precious hope to cancer victims and their families - by sharing the experiences of his dad's treatment and breaking down some of the scary myths about the disease.
He said: "When my dad was diagnosed, I felt a terrible kind of terror and fear and darkness, and that darkness had no limits to it.
"I didn't know if my mother was going to die from it, or my sister, or her children.
"It was just this terrible unbounded fear, and because I knew so little about it, I never had any idea of what was going on.
"I went to a bookshop and thought that 'there must be a book that can help me', and there wasn't.
"I felt very strongly that a book like this would have helped me and I just wanted to write that book.
"To begin with, the stuff about my dad wasn't going to be in the book, it was going to be quite a plain text about the history and the science of the disease, but he became a central part of it."
The family's fight against the disease had begun when David underwent operations to help rebuild his spine, which had sapped due to the aggressive nature of his cancer.
As soon as he was recovered from that bout of surgery, the patient was signed up to help with the book.
No one knew they would only have 12 months together to work on their project.
As he underwent various treatments, David acted as research manager for the book, sending Adam off from his bedside on fact-finding missions to plug the gaps in their collective knowledge.
David, from Fife, had been a studious man all his life and relished the chance to get stuck into a semi-academic project.
He was 73 when he was diagnosed in April 2002, and Adam cherished the chance to spend so much time with him, even though nobody realised just how painfully shout that time would be.
Adam recalled: "I first heard the word 'cancer' when my mum phoned from the hospital and said he had gone into emergency surgery because two vertebrae in his neck had collapsed, and were being rebuilt using a titanium pillar.
They said cancer was a possibility, but didn't know for certain at that time.
"It was a kind of reflex reaction that I thought there was bound to be some kind of book about it, and when there wasn't, I decided to write one to give to my dad.
He was a very bookish man, he did a degree at St Andrews and was a maths lecturer in Aberdeen.
He had that very Scottish tradition of education, he always wanted to know and find out things, and was obsessed with the history of science.
Just out of surgery, it was the first thing he started talking to me about and that for me was like the confirmation that he was alive. He was able to revel in the joy of just being alive to lecture his son again about the history of surgery."
He added: "From that moment on, I'd go away and research something, and come back to tell him about it at bedside. He would read the papers and cut out something about genetic therapies for me to research.
"About 10 or 20 per cent of the book is the memoir of me and my dad and the rest of it is stories of scientific discovery from the Greeks to the Victorians right through to modern times.
"Each story is supposed to tell you a basic piece of science, like what chemotherapy is, what radiotherapy is, what pathology is, what the cells are, for example."
While studying the history of cancer, Adam researched back thousands of years ago, when the disease was killing ancient Greeks and tribal Africans.
His investigations tracked the slow advancement of knowledge about the disease through the centuries.
He also looked into the future, where there are ever-improving treatments on the horizon.
Adam said: "The trouble with cancer is the relentless degradation of our genes throughout our lives.
"Just like our face ages and wrinkles, the same happens to our cells and in the end one in 10 million goes wrong and causes the disease.
"Some people think that cancer happens because you hold your emotions in or are depressed.
"Two thousand years ago, the Greeks had the idea that a melancholic humour caused it.
"In the Fifties, Freudian psycho-analysts arrived and said it was about repressed sexuality. Then the alternative medical community came out and said it was mind over matter, if you battled it you'd be okay - and all of that's rubbish.
"Doctors used to lie to patients about their diagnosis. They would say 'it's not cancer' or 'not that bad', because they thought the absolute fear and terror that the diagnosis would provoke would be worse than the disease itself, and because there was nothing you could do, you might as well lie about it.
"That's where the phrase 'The Big C' came from because, in polite society, nobody wanted to say the word.
"But now, if you talk to the most cutting-edge surgeons, they all say it is becoming more and more a disease that we live with rather than die from."
As the pair threw themselves into their project, the outlook seemed positive.
Everyone in the family, including Adam's GP aunt, were convinced things were looking up.
Then, when they weren't expecting it, David succumbed to his illness.
Adam said: "As human beings we have such a demand for life and belief in life, that even though he was close to death, none of us could believe it.
"That moment was very strange. I didn't feel very much, it was like being in the eye of a storm.
"I and my family had been buffeted for the whole year and it just stopped in a moment of calm."
After the death and the funeral, which a disbelieving Adam had helped plan just months before although he was convinced it was years off, he was left with the task of finishing the book alone.
Still grieving and now lacking the loving but firm hand of its editor, Adam vowed to complete it any way he could.
Completing the outline that father and son had sketched together was harder than he expected, and it took him three years to complete, and eventually publish.
He said: "Having started this and been inspired to start this book with him, I felt I had to finish it.
"It was mine and my dad's last project together and only a coward wouldn't complete it. In the year following my dad's death I found it very difficult, but I had to complete it."
He added: "Having written the book has given me a different perspective. Two years ago, my mother, Eva, was diagnosed with uterine cancer.
"That's not a good moment obviously, and I still had the terror that she was going to die, but I felt my attitude to it was different than when I heard about my dad.
"Thankfully, she has now been treated for it and received a clear scan.
"I felt more practical, that here was a biological malfunction and people were going to try to deal with it, as opposed to the blind terror I felt before.
"It was easier to cope."
He finally had One in Three published this year.
Adam fervently hopes the book will inform and comfort the thousands of people who are affected by this terrible disease.
But he knows it has at least helped one person who's lost a loved one to cancer.
Himself.
'It was mine and my dad's last project together and only a coward wouldn't complete it. It was difficult but it gave me a new perspective'
One in Three by Adam Wishart is available on Profile Books, £15.
The Lancet Review
Wishart has created something that will offer comfort to thousands: patients and their relatives may now better understand the reasoning behind some of the investigations and treatments they undergo. And by highlighting successes, medicine's aim of making cancer something we live with, not die from, seems less of a distant hope.
In search of the cure
Lindsay Banham
One in Three: A Son's Journey into the History and Science of Cancer
Adam Wishart
Profile Books, 2006.
ISBN 1-861-97752-2.
Pp288. £15·00.
In my view, the best doctors are those who truly remember what it is like to lie on the examination couch. If ever there was a book that could remind health professionals of patients' need for information, empathy, and humanity, this is it.
By recounting the story of his father's illness, Adam Wishart captures so well what it is to be in a position of powerlessness and confusion when facing cancer. Offering us more than a simple narrative of his experiences, Wishart is courageous enough to try to answer the two questions “one in three” of us may eventually ask “why me?” and “why isn't there a cure?”
Going back more than 2000 years to the first recorded cases of cancer may seem an over-zealous way to tackle a modern-day scourge. But such a step does remind us that we are wrestling with a very old and very complex problem. His father's love of science has influenced Wishart deeply, and shows itself in the close attention to detail he uses to guide us confidently through complex advances in specialties such as molecular genetics. Although some of the language used is necessarily quite technical, it is never off-putting. Jargon is well explained, and balanced nicely by excerpts from interviews with scientists who led their fields and made the past breakthroughs we now rely upon. Pioneering science aside, Wishart is brilliant at explaining the political manoeuvrings of researchers looking for funding and recognition. In the past, as today, politics, timing, and luck form more than just the background to many innovations.
Although professionals will benefit immensely from reading One in Three, patients are the real targets of this part-biography, part-medical history. By bravely using his father's story to add the sparkle of humanity and reality to his immaculately researched tale of medicine's struggle with cancer, Wishart has created something that will offer comfort to thousands: patients and their relatives may now better understand the reasoning behind some of the investigations and treatments they undergo. And by highlighting successes, medicine's aim of making cancer something we live with, not die from, seems less of a distant hope.
Part of cancer's power to devastate is hidden within its status as a great unknown; if we can remove some of the mystery, then perhaps we can lessen the harm it does. As I finished this book, I hoped that the author's public exposure of his own wranglings with the injustice of cancer had gone some way to answering difficult questions. And I hoped that, through writing his book, Wishart himself found some peace.
Cancer Cliche's
"The reporting of Kylie Minogue's illness has served up the usual old myths and untruths about the disease."
See the full article at the Guardian online, here.
British Medical Journal Review
Faced by his father's mortality, Adam is imprisoned by emotions. Both father and son are bound by the social stereotypes and expectations of their gender. The pursuit of understanding is the comfort zone of their relationship, and so begins the author's research into the history of cancer...... ....... One in Three offers real hope.
"I love you dad." I looked at my 5 year old son and made a mental note to complain to the school about the subversive content of its discussion forum classroom activity known as circle time. I explained that he didn't even know me and that he should wait until he was at least 40 before he started making any definite commitment. He nodded, but I wasn't sure that he understood. In Britain, understatement rules supreme, and Brief Encounter—the dullest film ever made—is considered by many as our greatest love story. Emotional Americana makes many of us squirm.
Adam Wishart's father is diagnosed as having metastatic cancer. Faced by his father's mortality, Adam is imprisoned by emotions. Both father and son are bound by the social stereotypes and expectations of their gender. The pursuit of understanding is the comfort zone of their relationship, and so begins the author's research into the history of cancer.
Names of certain medical heroes, who have caused generations of medical students' eyes to glass over, are all here: Hippocrates, Galen, Snow, Virchow, Morgagni, Lister, Marie Curie, Farber, Doll, and many lesser known luminaries.
The ancients believed that cancer was an illness of melancholy. It was not until the scientific revolution of the 17th century that these views were swept aside by the advent of medical dissection and then the microscope. Lister, influenced by Pasteur's germ theory, used antiseptics and ended the scourge of Victorian surgery—infection. Combined with new anaesthetics, effective cancer surgery became a reality and ended the butchery of the past. The chance discovery of x rays and radium at the start of the 20th century opened a new door into both the diagnosis and treatment of cancer. Chemotherapy in the 1950s cured children with leukaemia.
In the 1960s, with the love-ins and the lunar landing, humanity and especially America seemed able to conquer all. President Nixon seeking his place in history (he needn't have worried) declared a "war on cancer." The search for the magic bullet against cancer began in earnest, but death rates were unchanged.
Punk and industrial recession saw the optimism of the 1960s and 1970s vanish. Society began to question cancer care. The mutilating surgery, the poisonous chemotherapy, and the scorching radiotherapy had traumatised families and patients alike, with little seeming benefit, so patients turned away from conventional treatments. With the rise of alternative therapies, medicine was forced to relinquish its "monopoly on wisdom."
As for the modern love affair for all things "screening," Wishart neatly explains that paradoxically the individual is never likely to benefit directly from screening. Finally he looks at gene therapy and ponders whether this is the magic bullet.
The story of the author's father is woven through the book until his eventual death. Clearly, being a man and telling your father that you love him isn't easy. No circle time for us. One in Three offers real hope.
--------------------------------------------------------------------------------
Des Spence, general practitioner
Scotland on Sunday Review
"This emotionally charged account distinguishes itself not simply in the way it gracefully meshes together complex, competing theories about the disease, but in its generous use of a loved one as a case study."
Sunday Times Scotland
"It’s a neat and moving blend of science and the intensely personal."
Sunday Telgraph Review
Simon Singh has written a lovely review:
"ONE IN THREE describes Adam's attempts to understand the history, science and treatment of the illness. It is also a touching and deeply personal farewell. ... Wishart succeeds brilliantly in constructing a narrative that is a tribute both to his father and the scientists who have parly unpacked the mystery of cancer"
Literary Review - Review
General Practitioner Des Spence wrote a lovely review in this month's literary review.
"ONE IN THREE is a different type of cancer book. It is calm, factual, beautifully written, intelligent and moving. ... this book brings understanding, and most of all it also brings some hope."
Sense About Science Review
When I first heard about One in Three, in particular that it was a son’s personal journey into the history of science and cancer, I wasn’t sure what to expect. I was concerned that this book would be too grim or too personal. However, I am delighted to say that I was wrong; this is a fascinating book of the history of medicine and cancer and, in the end, reassuring.
<a href="http://www.senseaboutscience.org.uk/index.php/site/other/70
">Link
The Book's Introduction
I cling to my dad’s enormous hand. With long strides, we are rushing through London. I am six. I am sometimes catching my step, sometimes just being lifted by his forward thrust. I am wearing a bright yellow cape, with a sailor’s hat to keep the rain off, and at every puddle I splash the rushing Christmas shoppers. Dad scolds me, but I know he doesn’t mean it: we are a tight pair. We are coming from an exhibition about some ancient civilisation at the Royal Academy, where he had lifted me high above the crowds so that I could see the twinkling gold swords. Now we have to get somewhere, probably the coffee-bean shop in Soho, for he has very particular tastes. Although we are in a hurry, as we round a corner he stops sharply and I charge straight into his camel-hair coat. It is warm and wet. We have paused because he wants to tell me a story of a man called John Snow whose name and picture is on a pub sign across the road.
Many years ago, Dad says, Dr Snow had hundreds of patients dying of a particularly vicious disease. As Snow had no idea what caused it, he could neither treat nor prevent it. So to discover what connected the patients, he drew a map of London and placed dots where each one lived. Dad sweeps his hand down Broadwick Street, explaining the map: here was dark with dots, but further away the dots became sparser. Dad asks me what linked them. I scratch my head. The doctor didn’t know either. So he questioned the families about their lives. With a flourish, Dad points to the spot where a water pump once stood, and says that Snow realised that all the ill people had used this pump. Some liked the taste of its water so much that they had even travelled from afar. To stop the disease, Snow simply removed the handle of the pump. Nobody became ill again.
Dad tells me it was the first piece of work on demonology. I ask him what kind of demons, but he only laughs. It amused him that I had misheard the word ‘epidemiology’, the science of epidemics, especially since this was a subject he taught to his statistics students.
Being taught about the cholera epidemic of 1854 is my first memory of Dad’s quest to educate me – even though in hindsight Dad’s story was a rather mythologised and childfriendly version of history. From then on, he was always telling me stories about scientists, mathematicians and revolutionaries, from Marie Curie to Benjamin Franklin. From my adolescence it was our habit to stay up late and, with Mum in bed, to sit talking about these things at the kitchen table. For two men who never spoke about their feelings, our intimacy consisted in sharing our interests in politics, history or the progress of science. If I knew history, he thought, then I might be better able to navigate through my life because he had always used the past as a way to understand his place in the world. For as long as I can remember, I was the one who would eventually leave the table. Dad would lock the doors and begin to turn off the lights. I would make my way to bed. The final part of the ritual was that he would open my door just enough for him to stick his head through and wish me goodnight. Then I would listen as he darkened the house before turning in.
Many years later, when Dad became ill, we began spending more time together again and we continued to tell those stories, although this time they would be about the scientists, doctors and patients who had struggled against cancer across the centuries. I searched for a book that we could both read and then discuss. There were memoirs of celebrities who had ‘battled’ through the disease, but I knew that Dad would have no interest in those. There were selfhelp guides that presented basic information but provided no wider context. There were books that described the science in detail, but they didn’t seem to connect to the experience of being a patient. And there were academic histories, which did not seem to bring the past alive.
Even without a book to fall back on, Dad pondered the big questions. Why was there no cure yet, for instance? And I would search libraries for biographies of those who had tried and the reasons why they had failed. Dad would show me a newspaper cutting about the latest genetic cancer cures, and I would try to paint in the background with my recently acquired knowledge. It was like some game from my childhood, but with dark undertones, because the purpose was to provide a distraction from the blizzard of pain.
This book is, in part, the culmination of that journey. It tells the history of cancer medicine, from the Victorian surgical solution to the latest developments in gene therapy, through a dozen stories of scientific endeavour. These are stories of maverick doctors searching for a cure although their colleagues thought them to be charlatans, and of patients campaigning to stay alive. Running through them is a vein of the wider history of medicine, and of the development of science’s understanding of human biology. At the same time, these stories address some of the basic questions that Dad and I had about cancer: what is the biology of the disease, how does a tumour grow, why is it so difficult to detect sometimes, and how does radiation or chemotherapy work?
Dad’s illness mirrored these historical moments. At times, medicine’s history had direct relevance to his own experience. At others, the spirit of some historical age seemed to resonate with the mood of the family. As a consequence, the story of Dad’s illness forms a counterpoint to the broader history of humanity’s struggle against cancer.
It is almost four years since that moment when I was told that Dad was ill and I became filled with fear. I wish that I had known then what I know now. Because learning something about cancer calmed some of those terrors.
When I began writing this book, I thought not only that the disease was becoming more common, that more and more people were dying from it, but that medicine had failed to cure it. But as I met more doctors I realised that, in fact, the last decade has been historic for cancer research: death rates have been falling, in the UK, the US and across Europe, for the first time; and we now understand the biology of cancers in much greater detail than ever before. As a result, in the last few years the first treatments based on understanding the genetic mechanism of the disease have arrived on the market. Many doctors are therefore predicting that in just a few decades cancer will become a disease more like diabetes, one that we will live with rather than only die from.
Most importantly, this book has prepared me for the next time the disease strikes – whether that be within myself, against one of my friends or within a member of my family. I know that this will come, because one in three of us will develop the disease in our lifetimes. When we count our families, our friends and our work colleagues, it is evident that we will all be touched, in some way. And I have learnt that an amalgam of fear, archaic prejudices and ignorance is no way to deal with it. It is time that this disease is no longer shrouded by a dangerous taboo.
Adam Wishart, February 2006
From The Herald
""Cancer is about mutated genes,, as is life's diversity. You couldn't have evolution without the ability of genes to be robust and mutable. It's entwined with how human life works. Dad might have died from it, but there was little that could have prevented that and his life probably couldn't have been extended. Death and life are part of the same thing."
Sunday Times Review
An imaginative fusion of anecdotal detail, medical science and poignant, elegiac narrative marks every chapter of this unusual book..... What emerges is a unique profile of a father-son relationship, poignantly affectionate yet utterly devoid of sentimentality.
Every year a great many books are published about cancer. Scientific studies in oncology proliferate as medical science expands. There is a virtual publishing industry, moreover, in objective, information, advice, and self-help for a general readership. There are also books that tell the stories of individual sufferers; they do not make comfortable reading. Yet some accounts succeed in giving both sufferers and those close to them hope and strength. It is this cathartic effect that raises CS Lewis’s A Grief Observed (later made into the film Shadowlands), into a work of literature. And now there is Wishart’s book, which inhabits a remarkable genre of its own.
New Scientist Review
From the New Scientist
"THIS book does two things well. First, it details the history of medical science's crusade against cancer, from the brutal surgery of the early 19th century to the latest work on its genetic origins, while explaining the biology of the disease and how it spreads so successfully. Secondly, alongside this the author interweaves a frank story of his father's fight against cancer. He spares few details, from the effects on his father's state of mind to the defective p53 gene in his prostate. The result is perhaps the most readable and comprehensive account out there of our battle with the big C."
Assuming Responsibility
Judging from the conflicting advice I received about my treatment alternatives, the answer seems to be that we must assume responsibility for our own care. That means the less informed among us will probably suffer. Who will be the advocate for the poor, the elderly and the uneducated?
Here is a very modern memoir from the Chicago Tribune. It nicely portrays how patients are being asked more and more to discover their own treatments.
It's too late for my father but perhaps not for me
From The Times:
On a visit home for lunch one Sunday four years ago, I found Dad chopping and cooking vegetables — but instead of charging around the kitchen as usual, he was sitting on a stool. He was hunched-up and his head had retreated into his shoulders. He said that he had a little back pain.
His GP made an appointment for an X-ray, which revealed that one of the neck vertebrae had crumbled and a second was cracking. The hospital couldn’t be sure of the cause but my mother, a doctor, was certain. “The odds are it’s cancer,” she told me in her plain and doctorly way.
My first reaction was to search for a book that we could read and discuss. I found memoirs of celebrities who had battled the disease, self-help guides containing basic information and others that described the science in detail. None seemed to connect.
I started talking to doctors with the idea of writing the book that I could not find. Like many people, I believed that cancer was becoming more prevalent and that medicine had failed to cure it. But as Dad underwent surgery to remove his tumour, I learnt that the past decade has been historic for cancer research and that in a few more decades it will be a disease that we live with rather than die from.
Let's Change What We Think About Cancer
The Dana Centre are putting on an event:
The 'C' Word: Demystifying cancer
Break through the malignant myths surrounding cancer with scientists and those affected by the disease. Death rates are falling and our understanding of cancer is increasing, yet damaging misconceptions prevail. Join the discussion challenging the way we think about cancer.
Professor Karol Sikora will be speaking. As will Sandy Craine, a one time leukemia patient, and so will I.
Come along its free!
A vaccine, at last
Late in September 1970, many in the US cancer establishment were promising that a vaccine for cancer was imminent. They thought they had found virus particles in a whole variety of cancers. They thought that cancer would succumb to human endeavour just as Polio had a decade or so before.
In the end, cancer turned out to be a more intractable problem. Yet there was one cancer were a virus was pretty clearly the cause. That was cervival cancer.
In the 36 years since the virus cancer fad of the early 1970s, much has been done. And finally last week, the US FDA announced that it had licensed a vaccine for cervical cancer. What a result?
The Boom in Drugs
About 400 cancer drugs from 178 companies are in clinical trials, according to the Pharmaceutical Research and Manufacturers Association. That is twice the number of drugs in trials for illnesses like Alzheimer's disease and depression and nearly three times as many as for heart attack and stroke.
For patients, the flood of drugs is generally good news because it means a better chance of finding one, or a combination, that will work for them. "From the standpoint of the patients there is never too many," said Dr. Robert J. Motzer, a kidney cancer specialist at Memorial Sloan-Kettering Cancer Center in New York City.
Increased competition could also mean that drug companies will put more effort into reducing side effects. In the past, it was considered acceptable for drugs to have noxious side effects because cancer was a fatal disease.
Our strange ideas about drugs
So at last the National Centre for Clinical Excellence has recommended that a new class of breast cancer drugs be allowed on the NHS. This news has taken a long time in coming. There has been some clinical trials that have shown the benefits of these newer and more expensive drugs for years.
What I find interesting is how aromatase inhibitors have been treated differently to Herceptin. The latter was hailed as a wonder drug. Tens of patients have been campaigning for their 'life-saving' drug. There has been a massive media campaign.
Yet arguably, aromotase inhibitors will save many more lives. The Daily Mail said they'd save 1000 lives a year in the UK. Of course, unlike Herceptin they are not based on the wonders of genetic manipulation. And they are only an improvement of an existing sort of drug - Tamoxifen has been working in a roughly similar way for twenty years. And as a consequence, they have sort of given a lower priority.
Its little wonder that patients find it so difficult to navigate the treatment choices - when the coverage in the newspapers is so lopsided.