One of the most compelling moments of the book comes when physician and researcher Bob Schreiber describes a lab meeting at which he presented evidence from an experiment that he had finished. The findings: animals with suppressed immune systems developed more tumors more rapidly than animals with normal immune systems. His colleagues responded that “cancer cells are too close to normal cells to be recognized as non-self,” arguing that cancer cells “are not subject to immune notice.” In short, they responded with their previous beliefs about how the immune system works; they did not think Schreiber’s data challenged their previously held beliefs. It was as if he had no data. His colleagues simply didn’t believe that the immune system could recognize the tumor, and no amount of data could change their minds.
The believers, like Schreiber, redoubled their efforts, sought out more data, ran more experiments, and developed a more nuanced picture of how the immune system works. This nuanced picture was enough to get their first drug into clinical trials.
However, those trials were designed to capture short-term results. The cancer immunotherapy drug worked on a different time scale and with different evidence of success. Previous cancer drugs had to show improvement in tumor size on medical imaging, while the immunotherapy approach relied on patient feedback in the short term. Patients reported feeling better and being able to do more, though their initial imaging looked worse. In order to demonstrate the power of immunotherapy for cancer, the FDA would have to design a new kind of clinical trial, one that took into account patients’ reports early in treatment and their alignment with imaging much later in the treatment.
The history of cancer immunotherapy is still unfolding. Graeber notes that immunotherapy is a “science built on stories.” He tells these stories in a way that honors the complexity of the roles of belief and evidence in medical and scientific research. His narrative encourages us to imagine what we could achieve if we were willing to believe more patient stories and incorporate the messiness of human life into the research process.