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A balance of treatment, research and steady hope

Cancer, Dr. Jack Pledger explained, probably is not going to lend itself to a silver bullet. There may not be a single vaccine, or pill, or magic wand.

"Or," he shrugged and smiled, "there may be." When you are one of the people in charge of finding a cure, you remain open to all possibilities.

Pledger oversees basic research at the H. Lee Moffitt Cancer Center & Research Institute at the University of South Florida. He gave me a tour the other day.

Moffitt is one of 39 comprehensive cancer centers in the United States, providing not only clinical care (6,000 admissions, 182,000 outpatient visits last year) but also research, all done under the all-consuming banner of finding a cure.

I have to confess something that I didn't tell Jack Pledger. I came to Florida about the same time that Lee Moffitt of Tampa, the ex-speaker of the state House, was bending heaven and earth in the early 1980s to get the center up and running at USF.

It was a political boondoggle, critics said. It was a monument to ego. Even when the patients started coming, they said, well, it's just one more hospital. When the research dollars started coming, they said, well, it's taking money away from the real research.

I know, because back then I was one of 'em. But only in the early years, Lee, I swear.

Today, more than 600 people are involved in cancer research at Moffitt (part of an overall staff of 2,200). This year, the center is receiving $51.5-million in research funding, more than three-quarters of it "peer reviewed," awarded in a competitive process at the federal level.

In our tour, after getting the official stuff out of the way, we started talking about cancer itself. Pledger is really good at explaining.

To get cancer, a lot of stuff has to go wrong.

It's not just a cell going haywire; that happens all the time. After all, we have 100-trillion of those guys, and we're swapping out old ones for new ones at the rate of 20-million a second. You can see how the copy machine might make a mistake now and then.

Even so, a cell with a mistake "knows" what it is supposed to do. It is programmed to destroy itself.

Here and there, a bad cell stubbornly refuses to kill itself. Still, not to worry _ we have really good immune systems, and they usually take out the bad guys.

Only when all these things go wrong at once does cancer happen.

The good news is, this means that researchers have a lot of targets _ which is why there's not just a single "cure."

Some researchers are focusing on cells going bad in the first place. Others are trying to figure out why flawed cells fail to destroy themselves _ maybe that switch can be flipped back on.

Still others are working on the immune system. This is very cool. In animals, they are figuring out how to make tumors get "noticed" by the immune system _ like putting a bell on the cat. At the other end of the deal, researchers are extracting immune system cells, "teaching" them how to recognize tumors, then reinserting them _ and it works.

"In animals," Pledger said, wagging a cautionary finger. "In animals."

If you take the really long view, although admittedly a slightly twisted one, it is a good sign that so many human beings are getting cancer. (There's now a 1 in 3 lifetime risk.)

It means that more of us are living long enough to get it, instead of being killed off along the way by predators, a busted appendix, smallpox, polio or childbirth.

The price tag for our extra time is a higher lifetime risk of cancer.

I left Pledger's research building, enthusiastic and fired up, after having used words like "cool!" and "neat!" and "really impressive!" all morning. And then realized, seeing with fresh eyes, that across the small courtyard stands Moffitt's clinical building.

In that building, men and women and children were being hooked up to chemotherapy, or admitted and waiting for surgery, or being irradiated in the hope of getting the right cells to die off after all.

So the building filled with people trying to cure cancer directly faces the building full of people who have it. The researchers look out their windows and see it. I do not know if this was by design, but it is exactly right.

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