A different cancer story

THERE IS life after a cancer diagnosis. It's not all pleasant, but as Mike Marqusee shows us in The Price of Experience: Writings on Living with Cancer, it is not necessary, or even healthy, to accept the enforced isolation of most treatment regimens.

Marqusee, who has already exceeded the prognosis for his multiple myeloma by several years, widens our understanding of what such a diagnosis means for the patient caught up in the complex world of the cancer industry. This is not a confessional cancer story, but a provocative examination of what having cancer in the 21st century can tell us about social relationships, and what an encounter with mortality might achieve.

To begin, the author rejects the common approach to the cancer story, which often portrays the patient bravely battling the disease. This battle often suggests an isolated, lonely existence--and, when the patient succumbs, personal failure. The ideology of fighting cancer, Marqusee notes, "mirrors the bootstrap individualism of the neoliberal order, in which the poor are poor because of their own weaknesses."

Marqusee's cancer was diagnosed in 2007. Since that time, he has gone through multiple regimens, including two bone marrow transplants provided by his sister. While we learn about his treatments and their progress, we learn a great deal more about health care in the neoliberal era. Marqusee's approach takes us beyond the pain of chemotherapy and probing needles, into the complex relationships of patient, medical staff and even "the circling vultures," like "travel insurers who charge people with cancer 10 times the rate charged to others."

By broadening his understanding of where he stands in relation to the social, political and economic forces of modern health care, Marqusee finds another therapeutic regimen. Indeed, his relational medicine is a powerful antidote for the isolated patient trapped in a world with no seeming control.

Marqusee challenges the assumptions that govern much of cancer treatment. Making cancer treatment "less brutal would be a huge stride forward for people with cancer. And that requires not a top-down military strategy, with its win-or-lose approach, but greater access to information, wider participation in decision-making across hierarchies and disciplines, and empowerment of the patient."

AS A transplanted American, Marqusee is well aware of the differences between the health care systems of the two countries he has called home.

For example, Britain's National Health Service (NHS) flew his sister from California to London because she was vital to his care. There is much more to learn in the chapter "A Tale of Two Health Systems": for example, "of the two million Americans who went bankrupt because of medical bills in 2008, three-quarters had health insurance."

Yet for all its benefits and superior care, the NHS is under attack and facing severe reductions in services. This will affect all involved, but not equally. For example, the bondholders, who bet on hospital construction, will not lose. Their profits are assured by the trusts that oversee the various hospitals and clinics. Or as Marqusee puts it, "hospitals like Barts will not be run for profit, but by profit."

To help us understand the impending damage that will be done to St. Bartholomew Hospital--the author's treatment center--we learn some of the history of this august institution, established in 1123, making it "the world's longest-established provider of free medical care to the poor."

No part of the health care complex gets more scorn than "big pharma." Indeed, this industry holds the whole system hostage. With its average profit margin of 17 percent, the drug companies have no equal in the care industry. Marqusee's current drug regimen is Revlimid and costs the NHS nearly $9,000 for a 5 milligram, 21-day cycle. "Who knew multiple myeloma could be such a money-spinner?"

Understanding, the role of big pharma in his treatment elicits not submission but resentment: "The way my illness, my vulnerability, has been exploited, used by a group of self-serving parasites to gouge the public purse."

Marqusee has nothing but gratitude for the care he's been given. His gratitude does not stop with doctors and nurses, but includes the porters, janitors and even the researchers who began the search for treatments and cures for his cancer in the 1840s. As he puts it, "I'm being kept alive by the contributions of so many currents of human labor, thought, struggle, desire, imagination." It is this broader sense of community that raises The Price of Experience above other cancer survival stories.

In the end, what Marqusee has given us is a dialectics of illness. He approaches his care, not with resignation, but with a spirit of engagement and a connection to the complexities of modern health care. From a plea for health care providers not to be used by the money managers just because compassion is their calling, to a wonderful appreciation of the contradiction in seeking independence through a community of struggle, Marqusee outlines a survival strategy for all of us.

As he writes: "What we need is not a 'war on cancer,' but a recognition that cancer is a social and environmental issue, and can only be fully addressed through far-reaching economic and political change."