Written by: Devin Juros ‘23
Edited by: Jason Mero ‘22
When you think of death and medicine in today’s world, you might think of a frail cancer patient on their third round of chemotherapy, an elderly person experiencing a sudden heart attack, or perhaps a COVID-19 patient on a ventilator. But, is this the image that people have always conjured up when death and medicine are mentioned? Will people imagine a cancer patient when they think of death in 50 years? The reality is that medicine has transformed massively over human history, and is akin to change again. Though cancer might seem to be the scourge of society today, it certainly was not in the past and likely will not be in the future. So, what will be the next scourge?
We can look at cancer as a model for how the focus of medicine has shifted over time. Cancer is not a recent disease; fossils of early hominids with cancerous tumors have been found dating back four million years ago . In Ancient Egypt, cancer was blamed on the gods as it was largely an untreatable medical mystery . The section on cancer in an Ancient Egyptian medical textbook was brief: “There is no treatment” .
In Ancient Egypt, cancer was not often written about. This is likely in part because it stumped doctors at the time, but also because relatively few people were actually suffering from cancer . Besides being exposed to fewer carcinogens, a primary reason why cancer was less prevalent in Ancient Egypt than today was that people often died early before cancerous growths could develop . As cancer is a disease caused by the progressive accumulation of random mutations in the genetic information in cells, most people today develop cancer after the age of 50 . However, an Ancient Egyptian who survived childhood could expect to live until around the age of 30 . Many of these Ancient Egyptians fell victim to the scourges of their time: malaria, smallpox, tuberculosis, and other infectious diseases .
This has been the story for most of human history; cancer was present but at the fringes of medicine and death, hidden by the bodies of victims of infectious diseases. Then, the tide against these infectious diseases began to shift in the 1800’s, starting with the development of the smallpox vaccine . The 19th century saw the development of a vaccine for measles and a cure for tuberculosis  . The 19th and 20th centuries included many advances in sanitation and waste disposal, slowing the spread of infections. All of these developments greatly decreased deaths from infectious diseases. In 1800, the average global life expectancy was 29, which was still around the age an Ancient Egyptian could expect to live . By 1950, global life expectancy had jumped to 46, and then to 71 in 2015, more than doubling the global life expectancy just 200 years prior .
The scourge of society shifted away from infectious disease, with cancer ready to prey on the aging global population. In 1900, the cancer death rate per 100,000 people was 63 . In 2017, even with all of our new chemotherapy cocktails and targeted radiation techniques, the cancer death rate per 100,000 people is 121, almost doubling in about a century . Cancer is now the second leading cause of death in the world, responsible for one in every six deaths . Cancer is truly the scourge of modern society, killing millions, garnering millions in annual research funding, and posing a grim image of old age for many.
The scourge of society has shifted from infectious diseases like tuberculosis and smallpox to cancer. But, will cancer remain the scourge of society? Cancer research has made a multitude of advancement in the last few decades, with a new array of targeted chemotherapy drugs, AI-monitored radiotherapy, immunotherapy, gene therapy, and more. There has also been much progress made to reduce our exposure to carcinogens and improve our early diagnosis of cancers. For these reasons and more, the cancer death rate in the United States has dropped 29% since 1991 . It seems inevitable that our understanding of cancer biology and medicine will advance to the point of being able to push cancer to the fringes of medicine and death, much as what happened to infectious diseases. So, the best question might not be if but when will cancer be replaced as the scourge of society? And, by what?
There are several potential candidates for the next scourge of society. One could be the growing threat of pandemics and epidemics due to viruses like COVID-19 and Ebola, which are spread more easily due to globalization and may have mutated ahead of some of our vaccines and antiviral medicines. Another likely possibility is that progressive age-related diseases like Alzheimers, Parkinson's, and ALS will start to take center stage as people live longer due to better cancer treatments.
This will likely include a shift in what we imagine when we think about medicine and death, along with a massive shift in the scope of medicine itself. The question of when remains difficult, though it seems inevitable that the grim reaper will once again change his grisly appearance.
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