This book review was written by a comrade who works in the pharmaceutical sector. He combines the review with reflections on his own work. The review is a continuation of our effort to understand the ‘health complex’ from a working class point of view. We previously published thoughts on the pharmaceutical sector in a translation of a text by comrades from Italy and in a summary of a conversation amongst pharma workers. Additional material discussion can be found in this book review of a surgeon’s auto-biography and of ‘Can medicine be cured?’. As always, we are interested in your thoughts.

The book “Metastasis – The rise of the cancer-industrial complex and the horizons of care” is an analysis by an American social democrat cancer researcher of the way cancer is understood in the mainstream and the “cancer-industrial” system that has been established to address it. The latter is described as an interdependent network of government entities (i.e. regulatory bodies, politicians), NGOs (i.e. patient support organisations and private entities with a stake in health (i.e. insurance, pharmaceutical, chemical companies, hazardous workplaces, etc.) that form a powerful lobby influencing government policy in a way that maximises profit over human health leading to the perpetuation of cancer. The book places particular focus on the influence of neoliberalism, which brings ideas of “personal responsibility” as the cause of cancer and “individualised therapy” as the cure, sidelining highly effective collective approaches.

I’ve taken the time to read and summarise this book, which I found through a doctor comrade. For context, I have worked for pharmaceutical companies that manufacture and sell oncology medicines for over 5 years now, and I am a pharmacist with an academic background. Something that surprised me while evaluating clinical trials for cancer medicines as opposed to other drugs (i.e. for asthma), was their relatively simplistic and poor design, modest benefits and staggering variety and frequency of side effects. It shocked me because I was working with some of the newest and best-selling medicines in the field, so I was expecting more from them. Cancer medicines are the most profitable across all therapeutic areas currently, and near the top in terms of annual growth (1).

Vast medical resources are funnelled into the research of cancer drugs, but their benefit is sometimes dubious over generic drugs produced for over 20 years. Sometimes I questioned whether pharmaceutical marketeers and salesmen are essentially scamming doctors, profiting off the desperation of patients with what could be a placebo effect over much cheaper, older treatments. Are we jumping on the “hype” bandwagon of new cancer medicines without looking at the bigger picture? To what extent are any of the claims above true? Am I overthinking this? Will colleagues think I am a conspiracy theorist or cliché leftist, blaming capitalism for everything if I bring up this topic for discussion? All these thoughts occasionally pop up in my head, therefore, a book that offers a critique on the way cancer is understood and tackled in a capitalist society immediately grasped my attention. 

Overall I think the book offers a fair analysis with an impressive number of references provided to substantiate all claims made. I would recommend it to people interested in the topic, although it gets very technical in some areas. Some of the themes may seem repetitive (analogy between cancer and capitalism) and it shows some sentimentalism and demonisation of capitalism – typical of democratic socialist texts. The focus is solely on the USA but given the fact that America is considered since the mid-20th century the flag-bearer of cancer research (coinciding with its position as the heart of the capitalist, imperialist system), information is more or less relevant/similar to the rest of the world, especially the UK. The review is broken down by chapters below:

1) THE CAUSE

In this chapter, the author focuses on what society perceives to be the cause of cancer. The first modern explanation arose from observing increased cancer prevalence in people with specific diets/habits like smoking or in workers at specific workplaces (i.e. the chemical industry). This “environmental” cause of cancer led to significant scientific research, struggles and policy changes to reduce such environmental risks. Use of some substances deemed carcinogenic were banned from workplaces or curbed. However, such measures made production less cost-efficient and put the blame of cancer on industry capitalists and the like. The latter, in order to maximize their profits, lobbied to change this perception, by ordering, funding and promoting (biased) scientific work, downplaying the impact of the environment and workplace hazards as causes of cancer. This trend intensified after the election of Nixon in the 70s when “War on Cancer” was declared, potentially to draw attention away from the Vietnam War. Industry capitalists were put in charge of policy bureaus, leading to significant deregulation in the 80s, under the Reagan increasingly neoliberal administration. Certain banned substances returned to use with some unreliable “maximum exposure limits” set for their use. A “benefit-to-risk ratio” assessment started being required before restricting substances, meaning that heavy profit could tip the scale to unlimited use of carcinogens. Campaigns were (and still are) funded which highlight individual responsibility (i.e. early detection campaigns putting the blame on people not getting tested/diagnosed fast enough) therefore shifting the responsibility of the disease on the patient’s individual lifestyle. 

Apart from this deliberate undermining of environmental cancer causes, the research of the human genome gave rise to a new potential cause for cancer: The theory that cancer arises from a single normal cell accumulating multiple DNA mutations over time, disrupting genes that control cell growth, leading to uncontrolled proliferation (SMT – Somatic Mutation Theory). Therefore, the blame for developing cancer is put on an individual patient’s body and mutations of their genes that predispose or cause them to develop cancer. External factors only have secondary importance as per SMT – the main culprit being within. This theory is individualistic, both in the literal sense (a single mutated cell is responsible for cancer growth) and in the sense that it treats each patient’s case as unique and based on their individual DNA and its mutations.

The writer is highly critical of SMT, stating it is a narrow-minded, reductionist theory. He claims it has produced only a couple of success stories, some of which are likely to be caused by off-target chance efficacy. Meanwhile, most drugs explored via this theory fail to show improvement and the massive spending for their research is not paying off for patients.

SMT is currently the foundation of most research and development for diagnosis and therapy of cancer. Apart from the genome hype of the time, it gained popularity both because of the above-mentioned capitalist lobbying and because of an increasingly prevalent individualistic, neoliberal way of thinking by scientists. This individualistic approach was very welcome by pharma companies, as thousands of potential gene mutations mean thousands of potential drugs. Collaboration between them and universities has increased, since mutagen research, unlike environmental risk research, is immediately monetisable. The support for this prevalent cause theory by capitalists leads to research being further skewed that way and any other theories being sidelined. As an alternative scientific explanation of the disease, the author proposes Tissue Organization Field Theory (TOFT), which explains cancers as disruptions in spatial arrangement and interactions between the stromal and epithelial tissues of the body. These may be brought about by carcinogenic factors both within and without (i.e. environmental, genetic).

I find the points raised quite fair and a great example of how science is not “neutral”, apolitical and indisputable, but organically shaped by the needs of the ruling class. That said, don’t assume SMT single-cell theory is completely wrong and related medicines are useless. It indeed has flaws, with many test drugs failing clinical trials. Approved medicines derived from it offer modest benefit and no cure, but even a modest life extension can be important for patients and their loved ones. Of course, due to the profitability of this theory, research on other, potentially effective methods of treatment, are sidelined.

2) THE DRUGS

Here the main focus is the pharma industry and cost of cancer medicines in particular. It’s worth keeping in mind that this book reflects the US reality where cancer drugs are many times more expensive than in the UK and reimbursement can only happen – usually partially – through expensive private healthcare policies or through the public “Medicare” programme, which is mainly available to persons over 65 years of age. Most countries in Europe have some form of government price controls, which related to the existence of public healthcare systems in these regions – a result of multiple struggles – now starting to fade away. 

We are told in the book how the cost of cancer treatment in the US is a massive burden for patients. Those suffering from cancer are twice more likely to file for bankruptcy and lose their savings. Sometimes, the costs can even stop them from seeking care. Studies have found that cost of treatment itself is a risk factor for early mortality. This cost is increasing year after year, with treatment cost burden rising by 37% between 2000 and 2010. In America, even prices of generic chemotherapy can cost up to 10,000 US Dollar per dose.

Pharma companies claim that the cost of drugs is generally benchmarked by how much they can improve the quality and length of life of the patient (calculated via a measure called QALY – Quality Adjusted Life Years). However, many of these calculations are based on pharma-sponsored studies, which are 3 times more likely to be exaggerated compared to public-funded ones. Even with these skewed statistics, cost-effectiveness benchmarks are still less and less met. Prices regularly exceed the QALYs gained by real-life patients. The author estimates that in practice for every new cancer medicine the price is set to an arbitrary 10-20% higher of the previously most commonly used one for that type, leading to an extreme price creep over time. Due to metastatic cancer being mostly incurable, desperate patients form a market for very expensive drugs, even though they may only have a modest benefit over older, cheaper drugs or sometimes even placebo. When given a death sentence, every promised second can count, no matter the cost. However, of 277 cancer drugs brought to market between 2011-2015, only 15% were found to improve quality or length of life to patients. Clinical trial programmes to approve a medicine are lengthy. If any of the clinical trial phases fail to show efficacy the drug is shelved. To minimize cancelled drugs (which are ever-increasing) and maximize profits, companies have been pushing for faster, smaller trials with measurable endpoints which are less valuable for patients. 

For example, the “gold standard” metric for a metastatic cancer clinical trial is overall survival (OS), representing the total time from start of treatment until death of a patient. This is a clear, unambiguous metric of treatment success that patients care about. However, in order to confirm a statistically significant and clinically meaningful trial OS, a significant number of enrolled patients needs to have died. As explained above, fewer trials now mean this outcome. Additionally, with improvements in care and multiple lines of therapy available, patients can live multiple years on average with some metastatic cancers. Therefore, the trials would take many years to complete. Every year spent in pre-approval clinical trials is a year of lost profit for the company before the patent expires. As they put it, it is also a year lost for patients who could benefit from a new treatment option. Therefore, other measurables, less important to patients, are chosen instead as trial outcomes. These commonly include the ability of the medicine to reduce tumour size and the extra time it gives until disease worsens. Studies show that these endpoints rarely translate to improved quality or length of life for patients.

The main argument that pharma companies put forward for high prices is this lengthy and risky clinical development programme. However, the author explains that this risk is exaggerated because the earliest phases of clinical development (which are the riskiest, with most drugs rejected at this stage) are mostly publicly funded. Additionally, in their cost calculations which the corporations use to justify exorbitant prices, they include the estimated lost profits for each year of clinical development plus interest. Therefore, much risk is transferred to the pockets of taxpayers and patients while the cancer drug market has an annual growth of 13%. The percentage of money from cancer medicines that goes into research and development is a trade secret, with some estimates between 30-39% (personally, working in pharma I’ve been told it’s always 25%), with usually a larger proportion actually going into marketing – essentially convincing doctors to prescribe them. We are told that most new drugs lately are slightly better versions of existing ones (me-too drugs) or highly toxic combinations of existing ones while there has been a stagnation of completely new treatment targets. Some rare exceptions in the form of CAR-T therapy which may cure (in less than 50% cases) some forms of leukaemia can cost upwards 600,000 US Dollar per dose non-including travel and hospital visit costs paid to the exclusive clinics that provide the treatment. Blame for this stagnation is put on the pharma industry and its focus on low risk (for shareholders) “me-too” drugs and doubling down on the so far ineffective SMT theory. Some of the actual breakthroughs of the last 40 years have occurred via the persistent efforts of groups or individual researchers, who did not gain any royalties from sales of resulting blockbuster medicines. Other reasons for stagnation mentioned include inbred lab mice being an ineffective therapy clinical testing platform and most importantly capitalism striving to produce low-risk/investment drugs that maximize profits instead ones that improve the quality and length or life of patients or ways to prevent disease.

Again, my view of this chapter as the reviewer is that it seems credible with reference-cited statistics that show how private organisations involved in cancer healthcare focus on maximizing profit rather than improving patients’ lives by channelling as much cost as possible to taxes paid by the working class and treatment costs paid by patients and their loved ones. An interesting anecdote from my own experience in pharma is that I once asked a higher-up manager why one of the drugs they were selling had a complicated administration method involving numerous lengthy hospital visits instead of trying to create an easy self-administration device. I received the reply that the drug sells well in private hospitals, and they wouldn’t be happy to prescribe it if it was home-administered, as that would lower profits from hospital visits. Sadly, the way science and profit develop go hand-in-hand in the current system. 

It doesn’t help that pharma company workers are detached from the object of their work and healthcare in general. Having worked in many office-based positions within the pharma industry for 6 years there is one thing I’ve noticed: no one uses the word “medicine”. Everyone refers to the drugs the company produces as “assets” or “our products”. While clinical news and publications get shared regularly, most people do not care to read them. Instead the main news to look out for are quarterly budget reviews. Did this product reach the estimated profit margin? Did Spain outsell France for that asset? Workers and bosses stress about these updates because profit margins are linked to their annual bonuses. There is constant fear: “What will happen when the main “asset” goes off patent or does not sell enough?” There may be layoffs, I might be next. This constant sense of instability and fear of getting fired is cultivated by the bosses, either out of their genuine dread of jeopardising their career and capital, or for more strategical purposes. When there is constant talk of uncertainty and looming layoffs, workers are encouraged to work harder to avoid being the next victim. Of course, this is coupled oftentimes with a careerist, self-centered and money-oriented attitude. Due to these, as well as the inherent detachment from patients, office workers forget that they are dealing in substances that can seriously affect patients’ health, adopting corrupt, unethical and dehumanising ways to increase medicine sales:

The salesmen, usually with zero medical knowledge, persuade doctors to prescribe by buying them food, or sponsored “congress” trips and even blatant bribes. Marketing teams come up with promotional materials that distort the clinical data to the medicine’s favour, hiding the fact that trials failed to show statistical significance, downplaying side effects or presenting “miracle” patient cases, that are extremely rare in clinical practice. Communication departments make press releases and create hype before a medicine’s launch to encourage people to take it and to pressure regulators into approving it. Corporate medical experts at congresses cheer when a competitor “product” fails it’s clinical trial, forgetting the fact that a failed trial means untreated or dead patients.

This is not due to any inherent evil of these people. Unless we consider an “evil” the most banal of them all: putting their personal benefit first. Their money, their career development, their relationship with their boss. This way it is easy to turn a blind eye to the damage such practices cause to healthcare, until they become patients themselves and maybe realise that such practices will affect them too. Being isolated, deliberately under-informed about medicines we work with, scared and overworked in our jobs, it’s easier to forget that we are “playing” with people’s lives and take actions or even decisions that put profit over life.

I would like to note here that the writer appears to be highly critical of the resources spent by pharmaceutical companies on marketing medicines. While I completely agree that it is excessive currently and clearly reaches corruption levels, directly or indirectly bribing prescribers, some level of marketing is required for successful introduction of medicines. For example, in the USSR where pharma companies promoted their new medicines only minimally, in some cases these drugs were never prescribed. Prescribers can be reluctant to choose new, untested medicines on patients since it could be a life or death decision. Therefore, a transparent, educational promotion of its benefits is useful in my opinion.

3) THE POLITICS

In this chapter the author explores the US policy changes throughout the years. There is a lot of US specific information and themes reviewed in other chapters, so I’ll keep this short. Initial government commissions that found links between cancer incidence and workplace hazards were dismissed by owner lobbies of said workplaces. The people delegated to lead governmental research efforts were led by industry capitalists with experience in defence R&D. Therefore, the management model was based on that used for military innovation, working with contractors or giving research funds. Some of these contracts were even given to defence industries (i.e. biological warfare). 

Since 1965, there has been a form of “public healthcare” in the US, called Medicare, which reimburses to people over 65 years old some cancer drugs given intravenously by the doctor or orally administered drugs that patients can buy from pharmacies. Most of the reimbursement money comes from taxpayers, who as previously said essentially pay for both researching and buying such medicines with modest benefit. The establishment of Medicare was the result of years of struggles. Medicare did not negotiate or set price caps, because the government was getting great pushback from pharmacists and pharma companies. Pharma companies lobbied for their drugs to be added to the reimbursement list, from which they asked prices 2-10 times more than the prices paid by private doctors. The first price negotiation legislation, allowing the government to request lower than asked prices for reimbursement, only came in 2022 by the Biden administration. Big pharma sued the government over this. This legislation for price negotiation excludes “orphan drugs” (medicine for conditions affecting less than 200,000 patients worldwide). However, up to a 644% increase in new orphan drugs was noticed from 2001 to 2021. This is part due to innovation, part to avoid this legislation, part because of the SMT theory promoting individualised therapy for increasingly small cancer subgroups and part because, as mentioned above, pharma likes small trials as they are faster and more likely to get approved. Additionally, companies get tax cuts, grants and longer patents for orphan medicines, based on the concept that otherwise it wouldn’t be worth investing in such rare cancer types. However, in the US, unlike Europe, there is no need for these drugs to be better than older ones for the same disease in order to get approved/reimbursed. The great majority of newly approved orphan drugs therefore do not show benefit over older, much cheaper treatments, exploiting the “orphan” status for no new patient benefit.

Generic/biosimilar medicines, which are drugs made by different companies after the original pharma company’s drug patent expires (usually 7-10 years after entering the market), are also struggling to establish themselves in the US. There are multiple cases where big pharma pay generic companies to delay bringing generics to the market, essentially extending their monopoly patents and high prices. Additionally, private insurance payers are usually given the latest, expensive medicines to justify their policy cost while pharmacies prefer expensive branded medicines since their cut from price percentage is much larger on those. These and other issues mean that only a few generics companies are operating in the US, with lack of competition bringing their prices further up. Meanwhile, to keep prices low, generics manufacturers move production to overseas countries with cheap labour – mainly India and China, where quality control is often lacking, leading to various corruption cases.

Meanwhile, pharma companies are given large corporate tax cuts for donating free medicines to low-income patients or third-world countries, which they use strategically to offload overstocks that would expire otherwise – saving on expensive medicine destruction costs.

The author concludes that the “invisible hand of the market” envisioned by Adam Smith and carried forward by the founders of neoliberalism is clearly not working. All the above examples show that free market and weak regulations do not lower prices and increase innovation due to competition but instead creates cartels, monopolies and a plethora of low-financial risk, low-benefit drugs to maximize profit.

This book was written before Trump’s second term. What we are seeing now is that the Medicare budget is cut by 500 billion dollars and more attempts at price negotiations and benchmarking against other countries. While the latter might look promising on paper, there are reports that multiple big pharma companies have struck individual deals with the governments to become exempt by these price changes. As part of price benchmarking to other high-GDP countries, the US government has been pressuring some to increase prices domestically, including France and of course the UK, where the famous “zero tariff” deal was struck, after the London government promised to increase reimbursement prices by up to 25%. In the meantime, incentives are given to pharma corporations to open new factories and research centres in the US. The current government rhetoric is that for medicine “the rest of the world is freeloading on the USA”. (2-5)

4) THE WAR

This chapter analyses the war rhetoric and metaphors used in the mainstream with regard to cancer: how it came to be and how it benefits the pharma industry. Cancer therapy, as discussed above, is intrinsically linked with war  – the first chemotherapy was a reused poison gas from the trenches of WW1 to “conquer the enemies within”. The first mass cancer prevention campaigns were enacted by Nazi Germany in the form of smoking cessation and workplace personal protection laws (not applied to slave labourers). The goals were “racial hygiene” and preservation of the skilled workforce to maintain the war machine, as well as to reduce costs of their healthcare system. Workers with cancer symptoms were sometimes executed. Nazi cancer scientists that conducted human experiments in concentration camps were recruited by the US after the war and ended up advising American chemical companies. We can see here that the currently prevalent theory that solely genetics are responsible for cancer align with Nazi racial theories and eugenics. 

Apart from its wartime roots, war can cause cancer itself. Survivors of the Hiroshima and Nagasaki bombings had extremely high incidences of various cancers. Use of Agent Orange by the US to kill crops in Vietnam also showed an increased cancer incidence. In the Iraq war both occupied and occupiers showed significantly higher incidence of cancer from exposure to bomb fumes and burn pits. With Gaza Strip’s last cancer hospital closed down by Israel, its residents will soon face high cancer rates from the tons of bombs dropped if they manage to survive the bombings themselves.

Finally, the author highlights the gradual change in portrayal of cancer patients. From victims, sometimes of their own hand, as the blame was put on personal responsibility (using personal protective measures at work, smoking etc.) to “war heroes”. Pharma companies idolise metastatic cancer survivors because they are the “success stories” which drive demand and hope for their medicines. They thereby individualize patient stories. Even though such patients are sometimes rare/miracle cases, they are heavily promoted by media and pharma-sponsored patient support NGOs because they show that we are succeeding against the war on cancer – all the while hiding the thousands of people that didn’t make it or did not gain benefit from treatment as well as all the suffering that these survivors went through. 

The “enemy” in all these war metaphors is cancer and that is the current narrative promoted by patient organisations. However, this narrative whitewashes the forces that fight it (i.e. pharma companies and politicians), branding them as allies. The author claims that patients and their organisation should shift focus to the capitalist relations that are responsible for a share of cancer cases and its casualties.

In my personal experience as the reviewer, working for the pharma industry I have interacted with multiple mainstream oncology NGOs, both patient support organisations and doctor organisations. Such interactions have usually had the goal of lobbying and bypassing regulation by the pharmaceutical industry. For instance, pharma companies cannot promote medicines to the public in Europe, but they can give a “hands-off” grant to an NGO to do it for them. Patient groups are extensively funded through grants, sponsorships and invitations to present (not for free) at pharmaceutical meetings in order to develop connections and dependencies that are then used to lobby with the government in order to get medicines approved, including ones with minimal benefit for patients and overly expensive. For example, I used to work for a pharma company that “courted” a patient organisation led by a prominent Tory figure, which then convinced the Boris Johnson government to increase the NHS budget for a specific disease. I feel that major patient organisations (like some unions) have become part of the “cancer-industrial complex” and there is a need for patient organisation from below. That is not to say that patient support organisations have not done and are not continuing to do important work to raise awareness and improve rights and support of patients. The importance of patient advocacy is explored further in the last chapter.

5) THE GRIND

This part of the book explores the way capitalism has transformed scientific research into an individualistic, entrepreneurial business, operating as for-profit companies. For the author, two key milestones for this turn were: a) the legal case precedence that allowed for patenting living matter (i.e. bacteria, lab mice etc.); b) the Bayh-Dole Act which in 1980 allowed universities and researchers to patent publically funded inventions.

Such events really deepened the connections between private companies and public research. If pharma corporations funded public research, they could get an exclusive patent in return. Governments also increased funding since now they could see clear returns to their investments in the form of patents. The inflow of such money into cancer research led to infighting and subversion from researchers to gain the most out of it. Less than a quarter of cancer studies can be independently replicated, either due to fraud or researchers hiding data and methods to avoid other scientists from getting patents/funding by using their ideas. The situation is aggravated by the degradation of the “peer-review” scientific publication process. Multiple predatory / pay-to-publish papers have appeared (reviewer’s note: I get at least 10 emails from such per week, which are automatically sent by AI that looks up my email on published papers) while even established ones will accept almost anything for publication, as fact checking is declining. Scientists often hide conflicts of interest (i.e. pharma funding) in their papers, with the associated bias going unnoticed as a result. The fact that positive results increase or at least maintain funding, reproduces all such fraudulent practices with heavy positive bias while negative results are almost never published, leading to duplication of futile effort. Additionally, the fact that researchers are unwilling to investigate why something didn’t work, innovation and new methods are reduced. Hyper-competition for funding, contrary to Adam Smith’s dreams, encourages scientists to publish fraudulent or meaningless data to progress their careers.

The next section explores researchers as workers. Many graduates passionate about research and hoping to contribute to global collective healthcare enrol in PhD programmes. However, such students are 6 times more likely to later experience mental health issues. Less than half of PhDs continue working in academia. Funding for cancer appears to have reached a plateau. Many PhD / Post-doc students are fighting for limited academic positions, leading to very low wages and benefits despite the massive capital invested into cancer research. They are forced to sell their intellectual labour for wages to a private industry – diverting from what used to be an “artisanal” craft where a highly skilled master scientist taught a few “apprentices” with whom they had a deep personal relationship. More PhDs were awarded in 2022 from the US than any year in the past. This market flooding is partially absorbed by the private sector, with multiple pharma industry positions requiring a PhD as a prerequisite for hiring – something that would be unthinkable in the past. The author claims that these changes have proletarianised scientists in the US. 

So far he claims that scientists in the US are not politicized, or when they are, it is more a “hobby” or act of individual expression. Such cases are mainly expressed through non-violent civil disobedience or activism (i.e. climate change movement) and are largely ineffective. He claims scientists need to understand their class position and organize while recognizing that so far organizing technical workers – like scientists – has been difficult, especially when trying to organize them alongside manual workers since they hold values (i.e. professionalism, individualism) that prevent them from doing so and limit solidarity. The fact that they have career development options makes them more loyal to bosses. However, he states that labs have incorporated assembly line practices, which alienates them from the product of their labour, proletarianising them. Graduate and post-graduate researchers need to understand that their work is as meaningless as manual workers since the success of their labour (i.e. publications) are more likely to generate profits than solve healthcare problems. He remains hopeful, citing increasing academic strikes in the US.

In the author’s opinion, apart from understanding their class identity, biology scientists need to reconsider the theory they are basing their research on. Under the influence of capitalism, organisms are seen as machines, no more than the sum of their parts – life is reduced to molecules that can be commodified for profit. With this reductionist, narrow view, scientific hypotheses (like the SMT) fail to take into account the complexity of life and fail in practice. A materialist dialectical viewpoint of nature he thinks would be more effective, taking into account an organism’s interplay between its various internal systems and influence from external sources. There is a need for Marxist theory being incorporated again in science. He warns however of the danger of Lyshenkoism (6), where only environmental factors are taken into account in a “vulgar Marxist” interpretation of biology as he puts it.

As someone who dropped out of a PhD project, this chapter resonates with me. Ironically, when I presented the topic I wanted to research to a professor, she told me she only had funding for testing lung cancer medicine on lab rats so that’s what I would have to do instead if I wanted to get paid. During my time at the pharmacy lab, I experienced first hand how many trivial papers are published in prestigious journals because the journal’s reviewers are friends with professors and turn a blind eye. I saw papers get published just so scientists can add more publications to their CV, a core metric for career progression. Potentially marketable data are presented in an overly positive light in hopes of research funds from private companies or “consultation money” straight into the professors’ offshore accounts. Graduate students often weren’t allowed to finish their PhD on time, on purpose to extend the cheap labour they were providing to the lab. Especially during COVID, there were some struggles by graduate students and attempts to unionize in my home country, although with limited success. 

As for the reluctance of technical workers in healthcare research to unionize, I can also see that, at least in the UK. The “dream” for many of my researcher and pharmacist coworkers is to get into the pharma industry, where work is more well paid and less intensive than at labs or community/hospital pharmacies. If they do manage to get there, they get very defensive about their job, afraid to lose it or to become branded as a “troublemaker” and to be discussed in the small circle of UK pharma upper managers. Unionisation and struggles are minimal here. However, due to shrinking budgets, stagnation in medicine approvals and movement of UK investments to the US after the Trump administration policies, some proletarianisation is starting to appear. Some intensification techniques have appeared, with strict time monitoring via card tapping at the office or monitoring of work-laptop activity with software, as well as work quotas being set.

While I agree with the book’s call for a theoretical rethinking of medicine research, I believe a theme not explored is the fact that capitalism doesn’t care about the quality of life of workers, only about the ability to extract surplus value from them as long as possible. This narrow vision leads to prioritisation from the cancer industrial-complex of “band-aid” therapies that can send people back to work for a bit longer, rather than preventative or holistic treatment methods. The fact that the median onset of cancer is around 66 years of age does not help, since the disease does not generally affect the reproduction of the working class, which is desirable by capitalists.

6) THE HORIZON

In this final chapter, the book highlights examples of successful actions and struggles and suggests ways to resist capitalism’s chokehold on cancer care. The only way we are told is through struggles on various levels:

• Reduce or completely ban carcinogens:

Around 2,000 new chemicals enter the US market per year, only a fraction of those are put under exposure controls under pressure of labour unions and environmental groups. Any such controls are epidemiological, meaning they are conducted only after the chemicals have started being used. Therefore, there is no unexposed demographic control group in their studies. Since the nineties some regulations exist in Europe and specific US states which call for companies to minimise use of chemicals found to be toxic or carcinogenic. Such efforts should be expanded, not only to chemicals but industry and all consumer products (i.e. food and cosmetics). The burden of proof to prove a “quarantined” potentially toxic substance is safe should lie on the company to prove. This demand should be framed as an effort to protect both consumers and workers at industrial/chemical plants. The author understands that even successes in regulation can be bypassed by the industry. Therefore, he suggests we take inspiration from the workerist movement of 70s Italy, which held the position that there can be no “safe levels” of toxicants or carcinogens. If even a single worker is harmed by the work environment, the latter must be considered noxious. They tied the fight against environmental pollution with the fight against capitalism.

• Phasing out fossil fuels: 

Communities living near fossil fuel infrastructure sites have a higher incidence of cancer. These sites release multiple carcinogens, while fossil fuel products like plastics and pesticides are also carcinogenic. It’s usually poor and non-white people that live and work in such plants in the US, through deliberate schemes. In the short term, the author calls for support of climate change legislation and renewable energy. Ideally, workers and frontline communities should join struggles against the noxiousness of their environment, supported by the working class.

• Abolishing patents:

Calling on the example of the unpatented polio vaccine that saved millions of lives, the author calls for patent sharing, nationalizing patents and ultimately abolishing them

• Public medicine manufacturing:

Calling on the example of Cuba’s state capitalism style pharma industry, the author advises reconsidering whether private drug manufacturing is the best model.

• Providing Universal healthcare:

And call for a dialectical multicausal theoretical basis which takes social, workplace and historical conditions into account along with the biological particulars of the disease.

• Increase patient power:

Call for militant cancer patient organisations that don’t just focus on the cure and early scanning (which has proved somewhat ineffective against some types of cancer) but on having increased collaboration with healthcare workers, struggling for increased funds and resources on all aspects of care, increasing equality in care and even fighting to create “healthy environments” against carcinogens. Examples cited include the ACT UP AIDS activist group demanding HIV drug accessibility and affordability through demos, die-ins and distributing educational materials about AIDS.  The government eventually integrated them into the agency responsible to develop a cure for HIV, which fractured the group and stopped its push for “health justice”. The SPK (Sozialistisches Patientenkollektiv) in 1970s Heidelberg was a group of psychiatric patients that demanded to abolish the concept of sick people as consumers and demanded treatment for all. A final example is the Breast Cancer Action group, formed in the 90s in San Francisco, fought for a healthier environment, patients rights, ending racial inequalities in care and even launched a campaign against another patient organisation receiving funding from the Bank of America, a major funder of carcinogen industries. They joined coalitions to achieve environmental protections against fossil fuel and pesticide industries. 

Final words from me

This text only intends to introduce the themes, some key data and my personal notes on the book. If this looks interesting, I recommend reading the book itself for a deeper dive. It’s worth noting that as the title “metastasis” suggests, the focus is on Stage 4 – also known as advanced or metastatic (or even terminal for some types) – cancer. This is the last stage of cancer, where the cancer has spread from the original site it developed to other parts of the body. Around 90% of cancer deaths are related to metastasis. When some cancers are found at earlier stages i.e. via ultrascans, feeling for lumps etc. they might not progress to the metastatic stage. For example, around 90% of breast cancers are detected early and around 30% progress to Stage 4. (7,8)

At these earlier stages of cancer, surgical techniques (performed at around 80% cancer patients) and radiotherapy – blasting the cancer site with toxic radiation – (performed at around 50% cancer patients) are the main curative methods, leading to most cases of long term survival for cancer patients (remission/cure). In fact, using chemotherapy at these earlier stages is only associated with improved survival in 2.5% of cases. Even at stage 4, medical treatment is only associated with complete remission in around 8% of cases. (9)

As one can see from these statistics, even though they bring the greatest bulk of profit for the “cancer-industrial system”, medicine only brings a fraction of long-term benefit for cancer benefits. Clinical research in cancer surgery has stagnated, but due to advancements in robotic surgery with potential for large profits from tech companies, a surge in investments can be seen, with even cases of remote surgery via the internet. (10)

As for radiotherapy, research has also stagnated, with radiologists being forced to research combinations of medical therapy and radiotherapy in clinical trials in order to secure funding from pharma. That is not to say that such combinations may not be effective, but one has to question the value that the addition of drugs will bring. In fact due to lack of potential investments and patents in this field, healthcare systems are neglecting radiotherapy. In the UK for example, hospitals lack machinery and staff for radiotherapy wards, leaving patients without such beneficial treatments. (11)

Such examples show that public healthcare systems, such as the NHS, are also part of the “cancer industrial system” choosing to focus funding on therapy methods that may bring profit through private investments, clinical trials and patent potential rather than what may bring most benefit to patients.

By no means is medical treatment futile, and the fact that it is tasked to curb cancers that have progressed the most (Stage 4) makes their job much harder. Even with these odds, there are medical treatments that achieve remarkable results. For example, for some types of metastatic cancer, around 10% of patients treated with immunotherapy show an unprecedented long-term survival of more than 5 years. (12)

To answer the cliché conspiracy theorist statement that “Big pharma have found the cure to cancer but their hiding it because multiple ineffective treatments are more profitable” – Ignoring the fact that there cannot be “a cure for all cancers” as this is a highly variable disease, I think this book shows that it’s not that anyone is hiding anything, but that the fixation on profit from the whole cancer-industrial capitalist system has influenced cancer research in such a way that if a cure is found and produced it may be despite the system, not because of it – involving the struggles of groups and individuals.

Overall. I believe that while topics like this might be “taboo” to some extent, the limitations and potential of current medicine deserve to be discussed so that we can find ways to improve their benefits to patients, healthcare workers and ultimately to work towards the main goal of medicine: maintenance and improvement of health in the global human society.

Footnotes

1. https://www.dcatvci.org/features/tracking-pharma-growth-leading-therapeutic-sectors/
2. https://www.bloomberg.com/news/articles/2025-12-19/trump-administration-proposes-models-to-cut-medicare-spending
3. https://www.statnews.com/2025/12/23/trump-drug-pricing-deals-medicare-most-favored-nation-demos/
4. https://www.bbc.co.uk/news/articles/cn0k520v4xro
5. https://www.aa.com.tr/en/americas/trump-says-he-secured-drug-price-hikes-in-france-with-tariff-threats/3791839
6. Trofim Lysenko was a prominent Soviet biologist during the Stalin period who found Darwin’s interpretation of evolution – survival being decided by random mutations in a specific organism that makes it more competitive against others – to be incompatible with Marxist theory because it was liberal, anti-collectivist and minimised the value of the struggles during an organism’s life, since it couldn’t pass them on. Therefore, his supporters rejected Darwinism in favour of a narrow-minded “material dialectical” theory that evolution is mainly decided by the interactions of an organism with its environment, in a “dialectical” transformation. There is some resurgence of Lyshenkoism, especially in Russia, with advances in epigenetics being seen as confirmation of his theories. However, while there does seem to be some DNA, altered through the life of an organism and passed on to offspring, this is minor and unpredictable, with the main form of inheritance being genetic. Lyshenkoism is very commonly brought up as a warning against Marxism in science.
7. https://www.nfcr.org/cancer-types/cancer-types-metastatic-cancer/#:~:text=Metastasis%20causes%20more%20than%2090,treatment%20checkups%20and%20annual%20screenings.
8. https://cancerblog.mayoclinic.org/2023/10/31/metastatic-breast-cancer-when-cancer-spreads-beyond-the-breast/#:~:text=Female%20breast%20cancers%20are%20diagnosed%20at%20stage,breast%20cancer%20can%20progress%20to%20metastatic%20disease.
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC6896199/#:~:text=Current%20common%20cancer%20treatments%20include,Committee%20(P147/2013)
10. https://www.england.nhs.uk/2025/06/millions-to-benefit-from-nhs-robot-drive/
11. https://www.theguardian.com/society/2025/oct/03/more-than-60000-cancer-patients-in-england-not-getting-any-radiotherapy-research-shows
12. https://pmc.ncbi.nlm.nih.gov/articles/PMC10992808/