I have somewhat eclectic book reading habits, and I take pleasure in reading haphazardly (i.e. whatever I happen to come across). After growing bored with Moby Dick recently, I happened across a copy of Siddhartha Mukerjee’s The Emperor of All Maladies: A Biography of Cancer.
The book is compellingly written, narrating an expansive overview of the history of the treatment of cancer, while at the same time painting portraits of individual researchers, clinicians, and patients that draws the reader in. It makes oncology research and clinical practice sound exciting, which is no small feat.
As I read Mukerjee’s book, I began drawing parallels between the slow but accumulating body of knowledge on cancers to research on literacy development.
Cancer, just like reading, has seen massive investments and nationwide commitments to improve outcomes, yet with seemingly little to show for all the rhetoric, money, and effort. And just as with reading, in the absence of clear evidence and knowledge, there have been ego-driven and problematic practices and treatments, and many strong assertions with little data.
Yet through Mukerjee’s telling, it becomes clear that however zigzagging and plodding and subject to the whims of character and fortune, science and knowledge has slowly advanced and that we now have an understanding of various forms of cancer that–while no silver bullets exist for all cancers–we do have an arsenal of screening and specific treatments for specific forms of cancer that we can wield, and that however incremental, the field is advancing.
In reading and literacy and language research, it can feel at times like the “science” is a matter of opinion, and that we know not much at all. There are many who discount the value of empirical research in the field of education completely. And yet, I think we would do well to heed the history of cancer to see not only the progress we have made and can make, but to at the same time bear greater cautiousness against overzealous claims by silver bullet enthusiasts.
One passage in particular, describing the endeavors of Henry Kaplan, a radiologist in the 1960s, got me started in thinking along these lines
This simple principle—the meticulous matching of a particular therapy to a particular form and stage of cancer—would eventually be given its due merit in cancer therapy. Early-stage, local cancers, Kaplan realized, were often inherently different from widely spread, metastatic cancers—even within the same form of cancer. A hundred instances of Hodgkin’s disease, even though pathologically classified as the same entity, were a hundred variants around a common theme. Cancers possessed temperaments, personalities—behaviors. And biological heterogeneity demanded therapeutic heterogeneity; the same treatment could not indiscriminately be applied to all.
The insight described here is that while we use one term to describe the phenomena of “cancer,” researchers began to increasingly realize that different cancers manifested in incredibly diverse ways, and thus required similarly diverse approaches in treatment.
Prior to this insight, a silver bullet was sought against all forms of cancer, and all kind of ego-driven practices and over extrapolations of unclear research led to, for example, mastectomies that tore out nearly everything from the shoulder to the ribs, in the zealous belief that cancer would be rooted out.
How often do we hear “dyslexia” described as a general construct that requires a silver bullet solution? Yet increasing research demonstrates the genetic and biological variation in individual brain development that can manifest in difficulty with literacy or language — and may thus require differing forms of instruction and supports.
What are the implications for assessment? Here’s another passage that stood out on this idea of heterogeneity:
But although these alternatives did not offer definitive cures, several important principles of cancer biology and cancer therapy were firmly cemented in these powerful trials. First, as Kaplan had found with Hodgkin’s disease, these trials again clearly etched the message that cancer was enormously heterogeneous. Breast or prostate cancers came in an array of forms, each with unique biological behaviors. The heterogeneity was genetic: in breast cancer, for instance, some variants responded to hormonal treatment, while others were hormone-unresponsive. And the heterogeneity was anatomic: some cancers were localized to the breast when detected, while others had a propensity to spread to distant organs.
Second, understanding that heterogeneity was of deep consequence. “Know thine enemy” runs the adage, and Fisher’s and Bonadonna’s trials had shown that it was essential to “know” the cancer as intimately as possible before rushing to treat it.
I want to be careful about drawing too closely on an extended analogy between cancer and reading — but there is a similar need in schools to build more precise and accurate profiles of students to ensure the right form of instruction and intervention. We often land on the simple distinction of “students not meeting standards,” then rely on item analysis of standards (which are at a composite level of performance), rather than identifying the underlying literacy and language skills that could be targeted for further support.
Here’s another passage on cancer screening, which certainly has some similarities to screening for reading and language difficulty in schools:
In cancer, where both overdiagnosis and underdiagnosis come at high costs, finding that exquisite balance is often impossible. We want every cancer test to operate with perfect specificity and sensitivity. But the technologies for screening are not perfect. . . .
No; merely detecting a small tumor is not sufficient. Cancer demonstrates a spectrum of behavior. . . To address the inherent behavioral heterogeneity of cancer, the screening test must go further. It must increase survival.
For screening in schools, it must increase literacy attainment. And this is where the rubber hits the road. Even when a school is drowning in data, it does not mean the needed action will be undertaken, either to improve core instruction across classrooms, or for putting in place the right interventions for the right groups of students at the right time.
The academic specializations that result in terminology so precise it is opaque to those outside of that domain may seem extremely distant from classroom practice, but I don’t see how we can make headway until we more fully unpack how, when, and where learning happens in the brain in relation to its body and its environment, while at the same time identifying the forms and use of language and literacy that are most fundamental.
Despite the great heterogeneity of cancer, scientists have begun to recognize some universal understandings that is leading to more effective treatments:
Biologists looking directly into cancer’s maw now recognized that roiling beneath the incredible heterogeneity of cancer were behaviors, genes, and pathways. . . . Notably, Weinberg and Hanahan wrote, these six rules were not abstract descriptions of cancer’s behavior. Many of the genes and pathways that enabled each of these six behaviors had concretely been identified—ras, myc, Rb, to name just a few. The task now was to connect this causal understanding of cancer’s deep biology to the quest for its cure . . . The mechanistic maturity of cancer science would create a new kind of cancer medicine, Weinberg and Hanahan posited: “With holistic clarity of mechanism, cancer prognosis and treatment will become a rational science, unrecognizable by current practitioners.” Having wandered in the darkness for decades, scientists had finally reached a clearing in their understanding of cancer. Medicine’s task was to continue that journey toward a new therapeutic attack.
We are beginning to recognize some universals and particulars of language and literacy, as well. We can improve literacy outcomes for our society. It just may be much more complex and progress much slower than we’d like to think.
I’m not being a Pollyanna here on either front, by the way. My father died of lymphoma last December after being diagnosed in October, and his doctors seemed just as surprised as us when his artery ruptured suddenly just as his 3rd round of chemo treatment began. Some forms of cancer will continue to kill us prematurely, despite our best efforts based on our current understanding of the research and the technological tools in our arsenal. And some children will continue to struggle to read and write fluently, despite the concerted efforts of many committed educators.
My sincere hope is that every casualty along the way provides new learning that can inform improvement. If we learn from every failure, than each failure will not be in vain.