Big questions about “The Big C”

The Melanoma Research Foundation and others in the melanoma community got a little overexcited earlier this month when they learned that the main character of the new TV show, “The Big C,” was a woman with stage-four melanoma. In Hollywood’s disease-of the-month lottery, it appeared that melanoma’s number had finally come up. Here, at last, was a chance for free publicity, media attention and maybe even some big-time donations.

Take that, Susan G. Komen.

Then the first episode aired. It’s evident almost immediately that Cathy Jamison, the character played by actress Laura Linney, has opted out of seeking treatment and is instead pursuing life on her own sadly quirky terms. Oops. The MRF quickly put out some PR to try to spin this thing back in its favor.

So instead of touting the TV show to boost its cause, the press release from the MRF instead asks the question guaranteed to make our hearts twitch: Is a cure in sight? The answer may be yes—if you think in geologic terms. I’ve explained in previous posts that cancer drug development grinds along at a speed that would gladden the heart of a glaciologist. That’s simply the nature of the scientific enterprise. To ask rhetorically if a cure is in sight is grossly manipulative, but rarely challenged. In this case, what it attempts to do is distract attention from a TV show that may prove to be a big D (as in disappointment) to MRF’s cause.

In “The Big C,” Cathy’s choice to eschew therapy appears to open up humorous theatrical possibilities that wouldn’t exist otherwise. This decision runs contrary to the relentless mission of MRF and the melanoma establishment, however, which is all about fighting “the beast.” For reasons that are worth considering, what Cathy decides about her fictional life is not what most patients with advanced melanoma do in real life. MRF states mildly that most melanoma patients “work tirelessly” to find the best form of therapy for themselves. Well, let’s be honest: What they really do is fight like hell to survive and often put themselves in a very unhappy place in the process. Late-stage melanoma patients live in a no-man’s land littered with the crushed hopes for a cure that didn’t come soon enough for those before them.

If “The Big C” were to deal honestly with the realities of stage-four melanoma, then Cathy would likely need to be written out of the script before next season's debut. Twelve months is a pretty good survival time for a stage-four melanoma patient.

If my attitude seems cavalier, it’s not because I haven’t considered the implications of a recurrence of my cancer. I’m not sure yet what I would do if and when it does. I understand why hope is important to some people and the psychological value of having confidence that a treatment might postpone their death. I'm not betting, however, that drugs would save me. There are other things at this stage of my life that take precedence. I also believe that clinical research is, on balance, a good thing—although I question the methodology that’s often used and the priority its given. I concede that the MRF makes a positive contribution to the lives of people with melanoma—but find that it routinely overstates the capabilities of the research enterprise. Its act reminds me of cheerleaders who bounce around and kick their legs on the sidelines at a football game, but who have no impact on the outcome of the contest itself.

My patience reaches its limit when otherwise responsible people start batting around the term “cure.” It’s unkind and flatly wrong to use the term in most instances involving advanced melanoma. Based on the history of cancer research and the damnable complexities of cancer cell biology, it’s unlikely we’re anywhere near a cure for melanoma—assuming “cure” means a patient’s complete restoration to health. Melanoma researchers have good reason for being circumspect about using the term in relation to current therapies. For now, stage-four disease remains incurable. New drugs have shown promising results in clinical trials, and I’m eager to understand how they work, but progress is painstaking and incremental. I’d have more hope for a serious reduction in deaths from melanoma if some of the money spent on research went into prevention instead, but that’s not going to happen. Medical research is hugely popular with the public, most notably the “war on cancer,” and there are careers and fortunes to be made in sustaining the research status quo. To that end, a “cure” must constantly be held out as close at hand. The melanoma-industrial complex must be sustained.

Our friend Cathy on “The Big C” may know more about the horrific tradeoffs of treatment for advanced melanoma than we give her credit for. Opting out of chemotherapy or clinical trials for new drugs is a difficult but rational choice. If you don’t think so, just try to watch the movie version of the award-winning stage play, “Wit.” I wonder if Laura Linney can vomit with the panache of Emma Thompson when she’s on chemo? I appreciate the fact that humor sometimes allows us to cope with the most painful of subjects. I’m no fan of what I’ve seen of “The Big C,” but its attempt at black humor is at least easier to stomach than the ham-handed optimism of groups like the MRF.