Twenty years of progress in dissecting the mechanisms of carcinogenesis - The magic of science and the demands of medicine

In the last twenty years, our understanding of carcinogenesis has evolved from a description of the natural history of cancer development, a conception inherited from Darwin, to the dissection of the underlying molecular mechanisms leading to phenotypic changes in cells, a neodarwinian interpretation. Most scientists agree that random germ cell mutations enhancing cell survival and reproduction capacities play a major role in the evolution of species and that carcinogenesis progresses from acquisition of genetic anomalies which alter the normal function of oncogens or antioncogens. Since the discovery of src, the first oncogen to be identified twenty years ago, and more recently the discovery of antioncogens such as p53, hopes and expectations have grown steadily, and passionately, often far beyond reason dietated by the real world of clinical medicine. Yet curiously, many clinicians hesitate to express one essential point: advances in science and technology, is not equivalent to advances in medicine. It is our responsability to resist the illusion of progress, for this illusion turns out to have a negative impact in our patients. To paraphrase the French philosopher Andre Comte-Sponville, the power conferred by the exercise of medicine is not based solely on scientific knowledge, but also on human compassion.