The Audacity of Hope
It was early in August and the leaves had begun to turn; New York’s humidity insisted summer was far from over. Making my way through hordes of tourists on East 51st, I arrived for an audience with the extraordinary, Dr Azra Raza.
Over frosty pomegranate juice, I asked her whether a sequel to her critically acclaimed ‘The First Cell’ was in the works. Smiling, she reached for her laptop, and replied, “Why don’t I just show you?”
In the course of her life and career, Dr Azra has become synonymous with her ambitious proposition: could we learn to recognise cancer so early that people might be spared the devastation we have come to associate with surviving it?
The question stayed with me. Later, hearing her discuss these ideas with William Shatner and his daughter, Melanie, on No Time But Now podcast, I recognised the same impatience with how much suffering medicine still asks patients to endure.
As professor of medicine and director of the Myelodysplastic Syndrome Centre at Columbia University, Dr Azra has spent decades treating that suffering. Her argument begins with an uncomfortable observation. We expend extraordinary resources pursuing the last malignant cell, while the first has often been allowed to escape our attention.
There is something arresting about encountering such ambition in someone who knows precisely what she is up against. At 24, newly arrived in America, she feared someone might cure cancer before she had the chance to contribute. Decades later, the youthful confidence has acquired the weight of experience without surrendering its urgency.
Before Columbia and Roswell Park, there was Karachi: a home filled with books and poetry, parents who had migrated from India, and the conviction that education could enlarge a life. The family also carried memories of Hindu friends who had saved them during Partition. Humanity, in that household, could hardly be reduced to the identities through which people were divided.
Science offered its own irresistible questions. What allowed cancer cells to keep dividing? How did they travel elsewhere in the body? Medical school made those mysteries harder to contemplate at a distance. There were people waiting for answers, often without the means to obtain care.
Over the years, Dr Azra collected tens of thousands of patient samples, preserving opportunities to understand how illness develops and what might announce its arrival. The hope was to recognise consequential changes early enough to act upon them.
That ambition now includes the ‘Stentinel’, an experimental device whose name combines stent and sentinel. A small vascular stent fitted with miniature electronics would essentially monitor blood for signals associated with abnormal cells. Eventually, researchers hope to identify selected cells through changes in electrical impedance and destroy them with an electrical pulse.
For anyone who has watched a loved one wait between scans, the attraction needs little explanation. Cancer can continue to occupy a household long after treatment ends, its possible return quietly organising the future.
But the distance between an ingenious idea and a dependable medical intervention remains considerable. The device must prove that it can detect relevant abnormalities accurately and act safely. Destroying circulating cells would not itself establish that an underlying cancer had disappeared. Dr Azra’s hope of reaching an initial 50 recipients by 2029 remains a research target, contingent on successful development, testing and approvals.
These qualifications matter because the people awaiting progress deserve honesty. They also deserve ambition. Surgery, chemotherapy and radiation save lives; newer treatments have brought precious additional time. Yet gratitude for those gains should leave room to ask whether survival might someday exact a less punishing price.
An extra month may hold a wedding, a reconciliation or breakfast with someone beloved. The value of that time makes the quality of living through it all the more important.
For Dr Azra, that price has been far more intimate. A name: Harvey, her husband and himself an oncologist, developed a second cancer when their daughter was four. His illness brought suffering into the hours beyond the clinic, into the home and the ordinary intimacies of family life. Twenty years of treating patients could not prepare her for watching him die.
Weeks afterwards, their daughter fell ill with a cold and asthma. As she recovered, she began to cry. She now understood how awful being ill felt, and how wonderful it was to get better. Her father had never got better.
It is difficult to read that recollection and return comfortably to the language of medical progress. Every improvement is measured against a life someone wanted to keep living.
Perhaps this is why poetry belongs so naturally beside science in Dr Azra’s world. Urdu verse and Emily Dickinson offer ways of attending to what illness does to a person. A physician must explain, but must also find words that another human being can bear to hear.
Her vision of success extends beyond the laboratory. Whatever emerges must eventually reach people in Karachi as meaningfully as those within wealthy medical institutions. An invention’s promise remains incomplete when the people who need it cannot afford it.
Thinking back to that evening, I find myself returning to the persistence of her hope. She knows what cancer takes, but she continues to ask more of medicine anyway.
The science will have to withstand scrutiny. The hope behind it is easier to understand: somewhere, a child is waiting for a parent to get better.
