words

A detail of the Saint John's Bible, designed and illustrated by Donald Jackson and colleagues. Monmouth, Wales, United Kingdom. Commissioned by Saint John's Abbey and University, Collegeville, Minnesota. A gift to Mayo Clinic by Stephen and Barbara Slaggie

 

 

I’ve been reading an interesting book about the proper role of women in Christian churches. What actually interests me most about the book is not its conclusions about women in Christian churches, but how the author, a conservative Christian Bible scholar and the product of evangelical divinity schools, chooses to think about the Bible. Because of her theological education in this environment, the author believes not only that the Bible is a special and supernatural book, but that the original Greek, Aramaic, and Hebrew words translated for us into English, were individually inspired by God.

 

In essence, the author works from the assumption that the Bible is not just God’s Word, it is God’s words.

 

Though this may be a common view in conservative evangelical Christianity, it wasn’t until reading this treatise on women in the church that I recognized how different is my own understanding of biblical inspiration. Readers of my blog will perhaps not be surprised to hear this, based on the past essays posted here (for example this and this and this).

 

I contend that the Bible should be understood as a scrapbook, not as a textbook.

 

Let me also be clear that what I am sharing here are my own opinions based on informal Bible study. I claim no formal divinity school training at all. I am not a Bible scholar. I read neither Greek nor Hebrew nor Aramaic.

 

 And I could be wrong.

 

But, what I write follows from 40+ years of thinking and reading since I first understood that the remedy for my guilt and moral failings comes through accepting that Jesus Christ died in my place. My faith in him undeservedly grants me his righteousness forever.

 

Is the Bible God’s Word or is it God’s words?

 

I will begin by making it quite clear that the ancient texts collected and translated as our Bible are strikingly unusual with respect to the strong evidence for their faithful and accurate transmission over centuries. Though no original manuscripts are available, the copies of copies that have been handed down provide evidence of accurate transmission that far exceeds that available for any other ancient texts. It appears that these biblical documents have been transmitted with care and accuracy.

 

This, however, does not imply that the documents are supernatural or have been supernaturally preserved from error.

 

The faithful transmission of these documents also does not tell us if they are God’s Word or God’s words. That judgement requires a decision on our part.

 

We need to remember that what Christians now call the Bible was assembled through a process over multiple centuries. This process involved collecting separate documents and various committee discussions and eventually votes on the canon, i.e. the essential compilation.

 

The Muratorian Canon fragment is a barely-legible copy of a canon list thought to date to AD 170 , including most of our familiar New Testament books, but without the letter to the Hebrews, the letter of James, and the first and second letters of Peter. The fragment is also unclear about whether the three letters of John were included. This suggests that a somewhat shorter version of the New Testament collection was recognized perhaps 140 years after Jesus’ death (the same number of years that separates me from the birth of my great grandparents).  

 

By AD 363, the Council (committee) of Laodicea had settled on the same Old Testament books that we recognize, plus the equivalent of our New Testament without the book of Revelation. Importantly, that council also recognized two Apocryphal books as belonging in the collection. These latter are books where the value and extent of divine inspiration were debated by the committee.

 

The current form of our Old Testament with five Apocryphal books and a New Testament canon with our 27 books is evident by AD 367 when Bishop Athanasius of Alexandria summarized them in a letter.

 

The Council of Carthage (AD 397) affirmed this modern list as authoritative, including the five Apocryphal books.

 

Thus within 350 years of Jesus’ death (the same number of years that separates me from Isaac Newton) a canonical Bible collection had been assembled. It should be emphasized that the value of the Apocryphal books in this canon continues to be debated even now. Catholic and Orthodox churches have voted to retain them, and Protestant churches have voted that these questioned documents should not be included in modern Bibles. Thus, although the Apocryphal books are generally not considered to carry essential Christian doctrines, we must admit that the question of which documents really belong in “the canon” is still actually unresolved.

 

Interestingly, as recently as five centuries ago professor of theology, Bible translator, and reformer Martin Luther (1483 – 1546) disputed the value of certain biblical books, suggesting that all Bible books are not equally inspired. Luther proposed what amounts to a New Testament Apocrypha.  He considered the letter to the Hebrews, the letters of James and Jude, and the book of Revelation to be disputed books with lower doctrinal value. Luther positioned these books separately in his German Bible translation, along with the traditional Apocryphal books.

 

This exercise reminds us that the Bible itself provides no table of contents. Humans are responsible for that. Christians trust that God’s wisdom influenced table of contents committees over the centuries. Those committee debates still aren’t quite settled.

 

I argue here that while the original Bible documents could be a supernatural and miraculous collection of God’s words, this is not actually a claim of the Bible authors, and it is not a necessary assumption for Christians who take the Bible seriously and seek to study it as God’s Word.

 

Instead, I see the Bible as a fascinating and complex collection of ancient documents representing many different kinds of literature written by many different authors for many different reasons over many centuries. I see the Bible as an extremely valuable collection because it tells a transcendent story that explains our purpose in the universe. This is one thing that science cannot explain. The stories told in the Bible are braided into one over-arching message of rescue and redemption. I think it is the most compelling story I’ve ever heard, and I think that’s why I believe it. It’s too beautiful not to believe.

 

Though there are facts to reference, my faith is inspired by an aesthetic argument, perhaps a surprising confession from a scientist.

 

The Bible is worth studying as the Word (that is, message) of God, but is it the words of God?

 

Beyond the story that God worked alone to inscribe the Ten Commandments on stone tablets in the book of Exodus, the Old Testament writers sometimes claim other forms of divine inspiration, using phrases like “Thus says the Lord.” In other cases, God’s voice is quoted. This doesn’t clarify whether what was inspired were ideas or individual words.

 

The New Testament claims about inspiration are more interesting. The author of the book that motivated this essay had been trained in a system where the original words of the Bible books are assumed to be supernatural and inerrant, so any biblical claims of inspiration must therefore be true.

 

What are these claims? I pick four examples (showing the New International Version translation):

 

2 Timothy 3:16-17

All Scripture is God-breathed and is useful for teaching, rebuking, correcting and training in righteousness, so that the servant of God may be thoroughly equipped for every good work.

 

This familiar passage makes a claim for all Scripture, but it is entirely debatable whether Paul thought that his own letters or other documents later collected as the New Testament should be considered to be included as what he meant by Scripture. Evangelical Christians choose to adopt this view, but it is not at all self-evident. It seems more likely to me that Paul was referencing the Jewish Scriptures. We don’t know. Moreover, it is not clear what Paul means by God-breathed. It is not necessary to interpret this as God choosing words. God can inspire in many ways to convey a message. God inspires actions and he inspires creativity in forms other than writing. God inspires art. This inspiration is not limited to written words. God is far more powerful than that.

 

Hebrews 4:12

For the word of God is alive and active. Sharper than any double-edged sword, it penetrates even to dividing soul and spirit, joints and marrow; it judges the thoughts and attitudes of the heart.

 

This powerful passage does not help us distinguish between the Bible as containing the Word of God or the words of God. It says that whatever is meant by “word of God” is powerful. Does this refer to the Jewish scriptures? More? Less? We don’t know. One thing is clear, there was no New Testament when this passage was written.

 

2 Peter 3:15-16

Bear in mind that our Lord’s patience means salvation, just as our dear brother Paul also wrote you with the wisdom that God gave him. He writes the same way in all his letters, speaking in them of these matters. His letters contain some things that are hard to understand, which ignorant and unstable people distort, as they do the other Scriptures, to their own destruction.

 

The conservative author of the book that inspired this essay uses this verse as a proof text for the Bible being the words of God. According to this reasoning, if Paul claims that all Scripture is God-breathed, and if Peter considers Paul’s letters to be like other “Scriptures” then Paul’s letters, at least, should be considered as word-for-word God-breathed Scripture. I see this as unnecessary circular reasoning to justify a narrow view of how the Bible is inspired. It's pretty much saying: “Why do I think the Bible is inspired? Because it says it is, and because the Bible is inspired then it must be true. And because ‘inspired’ must mean that every word was given by God then the whole Bible must be understood as word-for-word true.”

 

Sorry. Not convincing to me.

 

2 Peter 1:20-21

Above all, you must understand that no prophecy of Scripture came about by the prophet’s own interpretation of things. For prophecy never had its origin in the human will, but prophets, though human, spoke from God as they were carried along by the Holy Spirit.

 

Here again we are confronted by uncertainty about what Peter considered to be Scripture? The Jewish Old Testament? Paul’s letters? Peter’s own letters, including this one? And which prophets are being mentioned? Old Testament authors? It is again not at all clear that this passage can be applied to itself and to other documents only later collected as the New Testament. Regardless of which prophecies of Scripture are described, the inspiration resulting from being “carried along by the Holy Spirit” need not imply word-for-word dictation. That assumption has been added by conservative scholars. Why not inspired in the same sense that music, painting, sculpture, and dance are inspired?

 

Thus, I choose to believe that the documents of the Bible have been accurately transmitted through history as a wonderful scrapbook, not a textbook, and they convey God’s Word (message), not God’s words. This view is consistent with what the Bible authors, themselves, write. This view explains the complexities and cultural contexts in which the stories are embedded. This view requires that a lot of homework be done before trying to understand the documents that convey the message. This view implies that God’s Word is carried by the thrust and themes of the stories, not by their individual words. This view allows for misunderstandings, contradictions, errors, exaggerations, pride, prejudice, pre-scientific explanations, politics, myths, and folklore. All these aspects of human literature can certainly be inspired by God.

 

It is threatening to some to perceive that the thrust of a message is more important than its individual words. This means that work must be done to understand the main point and resist normalizing cultural and temporal references that are tangential to that message and that, in fact, can distract from it.

 

The conservative author whose book inspired this essay devotes hundreds of pages in preparation before confronting the following familiar (notorious?) passage from St. Paul’s first letter to Timothy:

 

1 Timothy 2:11-13

A woman should learn in quietness and full submission. I do not permit a woman to teach or to assume authority over a man; she must be quiet. For Adam was formed first, then Eve.

 

Whether or not it has been properly interpreted, this and other verses have contributed for generations to a Christian culture that represses women and minimizes female leadership. I admire her, but the conservative author whose book inspired this essay has no self-consistent option except to say that the words reproduced above are translations of God’s own Greek words. She then must engage in all manner of logical and linguistic and hermeneutical gymnastics to try to escape the plain meaning of the text. Indeed, she gets points for trying.

 

However, I find this wriggling to be tremendously unsatisfying and unnecessary. Paul was writing in a time and place separated from us by 20 centuries of scientific insight and cultural evolution. This particular section of his writing simply reveals that Paul, no matter how progressive, is a creature of his culture and particular circumstances in a land far away and long ago. We should expect no different from a historical letter transmitted accurately across the centuries. This does not require us to understand these to be God’s words to us, even though they are collected as part of God’s Word (message).

 

I am attracted by the idea that the Bible is a complex and beautiful collection of documents, organized later by wise but struggling humans doing their best to sort out texts that shed light on God’s beautiful thematic story. I have no problem believing that God’s grace somehow led to this collection, without me needing to accept the document as a collection of God’s words, and without me needing to take sides on debates about whether the individual documents in the collection are equally inspired.

 

The authors don’t claim that, and we don’t need to. The beauty and transforming power of these documents don’t require such a limited view.

 

Thus, I don’t have a problem with the passage above from Paul’s second letter to Timothy because I simply don’t think it applies in modern America. It may accurately describe Paul’s opinion at the time and place that it was written, but that’s it. It is our responsibility to do homework to determine what should or must or must not be applied here and now. We should not be surprised at all when culture and science have moved us past the context of the authors. We should read carefully and seriously, but then discern which particulars do and do not apply. This should not be surprising.

 

Inevitably it will be objected that picking and choosing will result from this approach. I agree. Picking and choosing are exactly what we should do with a complex collection of historical documents. If we are honest, we must admit that we already do this all the time.

 

What do we do to find common ground if the individual words of the Bible are not themselves supernatural, and if people disagree over what does and does not apply to our current circumstances so many centuries after these texts were composed? Easy. We focus on the major themes and the beautiful rescue message carried by the text. We avoid preoccupation by distracting minor topics where culture and history cast doubt on modern applicability.  

 

This is one reason why the history of Christianity is marked by the composition of great creeds authored by committees, the same kinds of committees that voted on the canon of documents to include as the Bible collection. The goal of creeds is to place focus on the important teachable themes and set aside distractions. If we read the great creeds, things are simplified. For example, it was in AD 325 that a committee in Nicaea first decided on this creed:

 

We believe in one God, the Father Almighty, Maker of all things visible and invisible.

And in one Lord Jesus Christ, the Son of God, begotten of the Father, God of God, Light of Light, very God of very God, begotten, not made, consubstantial with the Father;

By whom all things were made;

Who for us men, and for our salvation, came down and was incarnate and was made man;

He suffered, and the third day he rose again, ascended into heaven;

From thence he shall come to judge the quick and the dead.

And in the Holy Ghost.

 

The essay you are reading was motivated by soul-searching inspired by a thoughtful and analytical but fraught book by a conservative author struggling with a theology of gender relations in the modern Christian church, while adhering to the belief that the Bible is God’s words. I admire the author’s valiant attempts and consistency within her conservative theology. I appreciated her book because it helped me realize that the author and I love and serve the same God and have accepted the same undeserved sacrifice to set us free.

 

But we understand the Bible differently.

 

To me, the Bible is God’s Word, not his words.

 

12.22.21

truncated icosahedron

 

[Today I had the privilege of speaking briefly to groups of elementary school soccer players...]  

truncated icosahedron

That is the fancy mathematician’s name for the shape of a soccer ball, with exactly twelve 5-sided pentagons and twenty 6-sided hexagons, so 32 shapes altogether, with each pentagon surrounded by hexagons. There are 60 corners.

Why does that make me think of God?

I am reminded that we experience God in different ways. The Bible describes three of those ways as like a Father, like a Son (Jesus), and like a Spirit (that we can’t see). There are other things in this world that can appear to us in different ways even though they are all the same thing. Maybe you can think of some.

One of my favorite examples is a common kind of atom called carbon. Remember that atoms are so small that we can’t see them, but everything we can touch and see is built from billions and trillions of tiny atoms. Carbon atoms are everywhere in our bodies and the world around us.

What’s cool is that pure carbon atoms can organize in very different ways and appear to us differently, just as God does.

When organized one way, carbon atoms form graphite, like the black tip of a pencil for writing and drawing on paper. 

When organized another way, carbon atoms are crystal clear and form beautiful diamonds that look very different from carbon in the tip of a pencil. 

And not long ago, scientists discovered that carbon atoms can organize in a third way that nobody had ever imagined before – Carbon atoms can form tiny clusters of 60 atoms that are arranged exactly like invisibly small soccer balls – exactly the same arrangement of pentagons and hexagons, but all too small to see. How cool! There have been tiny soccer balls in the universe long before people figured out how to make them! That form of carbon has the funny name “buckminsterfullerene”. I think it is easier to say “soccer ball”. This form of carbon has different properties from graphite and diamond.

But, all three forms are still carbon.
 
When I see a soccer ball, it makes me think about how happy I am that God chooses to show himself to us in beautifully different ways.

8.28.21

Libertina

 

Earlier this summer I discovered monarch caterpillars on a milkweed plant in our back yard. I was delighted. I sent pictures to the girls. Almost 32 and 28 years old, and 100 miles away, I wanted to share my joy.

It seems like a lifetime ago, but both girls had shared monarch-centric chapters with our family during Middle School. Both had similar science units involving the collection of monarch eggs, rearing the various instar larval stages on milkweed leaves, dutifully weighing droppings and measuring growth to document the development of the brightly-striped animals heading toward spectacular metamorphosis. Our family was intrigued. Something about the miraculous multi-generational annual migration of the species between Mexico and the Upper Midwest remains unbelievable. Something about the transition from caterpillar to beautifully bejeweled green chrysalis, the darkening of the chrysalis, and the emergence of a crumpled adult that pumps fluid into its wings to present itself as a spectacular butterfly – something about these things is inescapably lovely and mysterious.

And yet there is also a hint of tragedy. Monarchs are likely in the process of extinction before our eyes. Having established their life cycles and windward flights over countless millenia, their habitat is fragmented and their environment distorted by herbicides and insecticides. I have often wondered with sorrow how many more generations of human children will rear monarch butterflies in Middle School in the Midwest.

The next day I went to check the monarch larvae in the back yard and all had vanished, likely picked off by birds in spite of what we had always been told was an unpleasant monarch flavor attributable to the consumption only of milkweed leaves.

I found myself strangely saddened.

I let the girls know in a short text.

What followed was a spontaneous call to action. Both daughters expressed their commitment to seek out local stands of milkweed, identify any minuscule monarch eggs on the undersides of leaves, and shepherd the lives of tiny larva in the safety of indoor containers with gathered milkweed leaves. Each girl found a few eggs and tiny larvae nearby and conscripted a friend or a husband to join the mission. Various stages of development were observed and shared by texted photos and video calls. Comparisons were made. Larvae were named. Release plans were discussed.

But it has been a bittersweet reunion with monarchs. The process has too often reminded us that metamorphosis is a complex process, full of risks and opportunities for failure. Few larvae have survived to take their turns in transition. Those that do can find ways to touch us deeply.

That happened yesterday.

My older daughter had documented the growth and development of a monarch caterpillar collected on Independence Day and duly named (without gender confirmation) ‘Libertina.’  Not long ago, having matured on her diet of milkweed leaves, Libertina climbed to the high mesh of her enclosure, quieted herself, and then engaged in the miracle that revealed the pupa within, which hardened to a lovely green chrysalis. 

Patience.

Libertina hatched yesterday. My daughter shared a photo of Libertina hanging with her fully-developed wings unfurled and strong.

I received the photo on my phone while working in my office. My reaction surprised me. I found myself staring at the picture, overcome by a child-like sense of wonder at the beauty of this wonderful insect with its spectacular wings, poised to become a creature of flight in wind and air. I felt the emotion welling up in me. I found myself saying a prayer of thanks for the undeserved gift of sharing this world with living things such as this, carrying stories and complexities beyond beautiful.

Soon it was confirmed that Libertina had lived up to her name – she was a female.

But it was a hard day.

As evening came, word also came that Libertina was not doing well. She was not strong, her legs had not developed properly, she was unable to cling to her mesh.

She fell.

Frantic texts were sent and received. A loving friend helped arrange Libertina near freshly-cut watermelon slices. There was a valiant effort to help Libertina stretch out her tongue to taste the sweetness. There was hope for resuscitation of the beautiful insect with her beautifully open wings.

In the mid-evening word came the Libertina was gone.

She had never flown.

I felt so sad – so strangely sad. I walked alone to our dark back yard and just let myself cry.

So sad.

In my tears I found myself thinking about promises…

…and hope.

I thought about a story from more than 20 centuries ago. A promise. A description of a kind of unimaginable love and power and gentleness.

The Book of Matthew records these familiar yet mysterious words of Jesus –

“Aren’t two sparrows sold for only a penny? But your Father knows when any one of them falls to the ground.”

There is one who knows and loves and cares for all things, somehow.

All things.

I found myself remembering the one dream I have ever been given where I sensed that I was experiencing the other side – the promised place of restoration and timelessness. I have written about it in this collection.

What was perhaps most poignant about that special and fleeting dream was that my glimpse of heaven was a scene filled with evidence of living things.

Could it be that there is a place of restoration for all that has ever been created – all that will ever be created?

A place of celebration and reunion and forgiveness and freedom and completion?

A place where I will see Libertina flying high on a warm breeze…forever?

Questions and answers about cancer

 

 

A friend of mine recently posed some important and insightful questions about cancer. 

I provided answers as a molecular biologist and cancer patient, seeking to be clear and as simple as possible.

I hope these good questions and my answers might be helpful, especially to new cancer patients and their family members.

Remember – these answers are not meant to substitute for the advice of a skilled medical doctor familiar with a particular patient.

 

    1    What is cancer and why does it happen?
 
“Cancer “ describes illnesses where one of the trillions of cells in the body becomes confused and starts to divide out of control. Each cell has a very complicated set of machinery, and the main set of instructions in the cell DNA has more than 20,000 different gene “recipes” or instructions for building all the tiny machines in the cell. We inherit one set of instructions from mom and a second set from dad. The two sets are slightly different, which is why mom and dad looked different from each other and why we look different from each of them. Errors can occur in these gene recipes. Some errors are inherited from our parents, but new errors in the DNA recipes can occur by accident or because of certain exposures in our environment (like cigarette smoke or sunlight) that damage the gene recipes in DNA. Some gene recipe errors confuse cells into dividing to form new cells. Cell division is a very good thing when we are growing up, but uncontrolled cell division can kill us if the growing cells (a “tumor”) spread and damage the rest of the body. Improper cell division that is slow and does not spread is called “benign.” A wart is a kind of uncontrolled cell division that is benign and can be cured by removal. On the other hand, “cancer” refers to uncontrolled dividing cells that spread within the body and damage it. “Malignant cancer” refers to cancer that is in that process of spreading, where control is harder. The weird thing about cancer is that it is part of our own body growing out of control. That makes it a hard problem to solve compared to an infection by a germ, because many treatments that kill the cancer have the potential to damage our normal cells too.
 
    2    How many different types of cancers are there?
 
Every different kind of human cell has the potential to become confused and grow out of control. Because there are hundreds of different kinds of cells in the body, there are literally hundreds of different kinds of cancer, depending on what kind of cell is growing out of control. Even more common cancers like breast cancer and colon cancer and ovarian cancer and lung cancer actually occur in different types because there are more than one kind of cell in each of these organs. Cancers are usually named for the kind of cell that is confused, and sometimes for the specific source of the confusion. For example, there are many different kinds of blood cancers including lymphomas and leukemias because there are many different kinds of cells in the blood. Because cells are so complicated, there are many different kinds of errors in the gene recipes that might confuse them. GIST (gastrointestinal stromal tumor) is caused when one of a special kind of cell called the “interstitial cell of Cajal” becomes confused and grows out of control. Even for GIST, there are different kinds of gene recipe mistakes that can confuse these cells into growing out of control. Depending on the source of the confusion, different treatments may be indicated. A common analogy is to think of a tiny, invisibly small cell as if it were a tiny car that needs to drive safely. Imagine all the mistakes in a car that could make it unsafe. Imagine if an error is present in the machinery of the brakes so the car can’t stop, or if the gas pedal is broken and stays pressed all the time. That is like cancer. Many other errors might simply prevent the car from running, and those errors would not cause cancer.
 
 
    3    What does it mean when someone is predisposed to cancer? Why does the risk factor increase?
 
Errors in the 20,000 gene recipes in the DNA of each cell can arise in different ways. Some errors are pure accidents of DNA copying by the cell machinery. Some errors are caused by our environment, like cigarette smoke or sunlight or radon gas from the earth. Those we can work to avoid by our behavior (stop smoking, wear sunscreen, get our homes checked for radon gas if we live in a part of the country where that is an issue). Some gene recipe errors are inherited from mom or dad. Each parent gives us one complete set of 20,000 gene instructions when we are formed from their single egg and sperm. That way we have two copies of each recipe, and the two versions (spellings of the recipe) from mom and dad are usually slightly different. This is a good thing, and it makes life interesting. Usually if there is a problem with one recipe inherited from one parent, the other copy of the recipe acts like a back-up! Very cool! Sometimes, however, both versions of a recipe happen to have errors, so neither can be a good back-up for the other. In other cases, the one good recipe in a cell can be damaged or lost, and then the only remaining recipes is a broken one. Now that cell has no good copy of the proper recipe and it can become confused. Some people carry damaged recipes that they have inherited. Their cells are still fine with the back-up, but the person has a cancer risk because if the remaining good recipe in a cell is accidentally lost or damaged, there is no remaining back-up and the confused cell starts to divide out of control. It is very important to remember that inherited cancer risk is nobody’s fault. It is also important to know that doctors are now better and better at checking our DNA (from a small blood sample or even cheek cells work fine for this since every cell in the body has the same collection of all the gene recipes) to look for evidence of which gene spelling variations we inherited. Doctors now know some of the most common problems. If we carry one of these, there is a chance that a cell in our body could lose the remaining good copy of the recipe and cancer could start. If we are one of these carriers, doctors may suggest that we are checked for cancer more often, so it might be caught early before it spreads. This really does save lives!
 
 
    4    What if someone has no known family history of cancer yet they still develop cancer….why does this occur?
 
Since cancer is about cells being confused by damaged gene recipes, that damage can happen different ways. I might inherit one damaged recipe that can cause problems with no other damage. More often, I might inherit a damaged recipe that causes a problem only if the remaining undamaged recipe is damaged or lost in some cell during my life. However, gene recipes can be damaged even when only good and correct copies had been inherited. This is because the process of copying all 20,000 gene recipes has to happen every time a cell divides. The process is very complicated. Luckily, cells are extremely careful about this and the trillions of cells in the body seldom make errors. However, with so many cells, and so much gene copying, some mistakes are going to happen. If the error is in the wrong place and wrong time, the cell is confused and begins to grow out of control…the first step of cancer even when neither mom nor dad passed along any errors. As we have mentioned, some gene errors are purely random accidents where nothing could be done to prevent them. However, we know that common lifestyle choices can cause gene errors and these errors can be reduced by changing behavior. The two most obvious cases are smoking and sun exposure.
 
 
    5    How does chemotherapy differ from targeted drug therapy?
 
“Chemotherapy” really just means “therapy with a chemical.” Because all drugs are really kinds of chemicals, any therapy with a drug is a kind of chemotherapy. However, cancer doctors often speak about chemotherapy as meaning the traditional approach to slow down cancer with drugs that kill cancer cells faster than they kill normal cells. This approach has saved millions of lives, so chemotherapy can be very successful. Many chemotherapies have been improved to have fewer side effects and problems. These improvements are always continuing. Doctors now often refer to “targeted drug therapies” to describe newer drugs that are designed based in the particular confusion in a tumor cell. Rather than just trying to kill the cell because it is dividing out of control, the drug is designed to attack the particular problem. Here is an analogy. Let’s say you are a police department trying to save lives by preventing criminals from speeding over 75 miles per hour as they flee from crime scenes. This might be a good idea. How to do it? One way is to use police helicopters and radar systems to identify every single vehicle (car, truck, bus, train) going faster than 75 mile per hour and assume it is a criminal fleeing a crime and shoot out their tires to get them to stop. If we had enough police and technology, this would indeed solve the problem of criminals speeding away from crime scenes. Good, right? But, what would be the unintended side effects? We might destroy all innocent emergency vehicles driving fast for other good reasons, and trains that are supposed to go fast, and trucks on interstate highways…there are lots of unintended consequences to that approach. This is a little bit like a general chemotherapy. It may be necessary to save life, but it is a “generic” solution to the problem, with side effects. Doctors hope that targeted therapies might be smarter…like only chasing vehicles with license numbers associated with a crime scene, and maybe turning off their engines by remote control technologies rather than shooting their tires. Seem like science fiction? Hopefully more and more cancer drugs will work this way in the future. This is how Gleevec works for certain kinds of GIST!
 
 
    6    Why are some cancers harder to treat than others?
 
Cancer cells are cells growing out of control because they have gene errors that cause them to be confused. Different gene errors cause different kinds of confusion. Cells confused so badly that they grow and divide very fast can be very hard to treat. On the other hand some slow cancers are also tricky because the confused cells aren’t that different from normal cells. Imagine in the previous analogy if the criminals escaping from crime scenes are only driving at 69 miles per hour rather than 75? Will we even be able to distinguish those getaway cars from normal drivers? [OK, having lived in Los Angeles, I know these particular speed numbers wouldn't make sense in California!] Another very important thing to understand about cancer cells is that they change. The original confused gene recipe that started a cancer cell growing out of control is passed to the new cancer cells every time that cell divides. BUT, the many, many, many dividing cells also have new chances for making copying mistakes of their own. That means that new gene recipe errors can crop up in the descendants of the original cells. Cancer tumors can have billions and billions of cells, so, unfortunately, many new chances for new gene recipe errors to occur by accident. Every new error has a chance of confusing cells in new ways. If there are a mixture of cancer cells with different errors starting to live together in the tumor, if a new drug is introduced by a doctor, some cells may respond to the drug and die, as desired. However, some of the cells could have gene recipe errors that cause them not to die in the presence of the drug. These cells will keep dividing and the tumor will keep growing because the surviving cells take over. It is important to know that the tumor isn’t “trying” to escape the drug therapy. The tumor doesn’t know anything about drugs – it is just a confused part of your own body. It is just that with so many cells, there will always be some variations with different gene recipe errors, and these different cells may be able to grow when a drug stops all the others. This idea that tumors have different cells with ever-changing gene recipe mistakes means that tumors evolve (a perfect example of the theory of evolution with survival of the fastest-growing cells).
 
 
    7    What is the difference between chronic illness vs acute illness?
 
A chronic illness lasts a long time and may persist for the entire life of the patient, being managed perhaps without being cured. Diabetes is a good example. Though, sadly, too many people still die from diabetes and its complications, more and more get care so they can manage their diabetes without it ever being cured. An acute illness refers to an illness that lasts a short time and is either cured or kills the patient. More and more acute illnesses can be treated and cured by modern medicine, so the patient completely recovers and is like new again. We all wish that cancers can be acute illnesses where patients are completely cured after a short time and go back to living normally. I actually have a different dream. I would like to dream that more cancers will be chronic illnesses like diabetes, so that with good drugs and strategies we learn to live with our cancer rather than die from it. I have been blessed to have lived with my SDHB-deficient familial paraganglioma cancer for more than 45 years. Sometimes it has not been a picnic, but it most of the time I don’t need to think about my cancer at all. It is also very important to say something else at this point: from the moment we are conceived, we each are on a path toward death. That is what it means to be a human. It is important to embrace that reality rather than denying it. You might say that our purpose in life is to come to terms with how to make this short life beautiful, and to consider how to learn if there is more beyond this time and space.
 
 
    8    What can we hope to see from cancer research and development in the next 25 years? 50 years?
 
The very best things we can learn to do are to 1) prevent more cancers from even starting, and 2) learn to catch more and more cancers early so they are small, have not spread, and can be cured by a small operation to remove the confused cells. We could save a massive amount of cancer suffering very quickly if we could simply convince people to stop smoking and to use sunscreen. Those two steps alone would save thousands of lives and billions of dollars every year. No fancy drugs or new kinds of surgery is required for either. Other cancers can be prevented by simply eating and drinking moderately. So prevention is the simplest, cheapest, and best solution for the future. Because the gene recipes in cells can be damaged throughout our lives, the older we are, the greater the chance of confused cells. There is no escaping that. This is why the next area for improvement is detecting cancer early so it can be cured. Simple life-saving examples are skin checks, breast self-exams, pap smears, and colonoscopies to check the lower intestines for small tumors. Removing such small tumors can completely cure them, whereas larger colon tumors can spread and kill. In the future we will learn to do more and cheaper tests (like the new colon cancer tests that can be done by collecting a stool sample at home and mailing it in to the lab). Over the coming decades I think the biggest reduction of cancer suffering will therefore come from better prevention and better early detection. Because cancer will also always be a disease of aging, no matter how much prevention or early detection, we will need to keep understanding gene recipes and all the ways they can be damaged and all the kinds of cell confusion that can result. That will be a lot of work because many of the 20,000 gene recipes can cause different kinds of confusion if damaged in different ways. We molecular biologists will be busy, and plenty of government funding will be needed for years to come to help develop new smarter and safer drugs that work specially for certain kinds of cancer. A goal will be to find solutions that are less expensive and more accessible as well. Some solutions will be about helping the body help fight off the cancer itself. Some solutions will involve learning about the details of the cell confusion so we can imagine ways to take advantage of it. My own dream is that some cancers will turn out to result from unusual kinds of confusion that may reveal interesting and unusual kinds of drug treatments that are safe and inexpensive!

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