Winning the battle against cancer ~ the reason why I transformed myself from “Nobunaga Oda” into “Ieyasu Tokugawa"

 Dr. Nakamura's columns that was published in the Yomiuri Shimbun newspaper on Feb. 3rd, 2015

http://www.yomidr.yomiuri.co.jp/page.jsp?id=111184

Most people who have known me pick up Nobunaga Oda, when they are asked to guess “Which of three famous Samurais—Nobunaga Oda, Hideyoshi Toyotomi, or Ieyasu Tokugawa— does my personality resemble?”  I also believed that I had a Nobunaga-type personality.  In scientific fields, there exists only gold medals; there are no bronze ones.  If our research outcomes are not first place, we would be simply one among many others.  Of course, “world first discoveries” are not simple, and they are also classified into various levels of impact.

 The iPS cell reported by Prof. Shinya Nakayama is a real-breakthrough, no-comparable research outcome exists, and it is in fact a “world first” class discovery.  On the other hand, there are a huge amount of less-impactful “world first” research outcomes.  For example, some cancer study might report a “first” outcome in colon cancer, but similar results may have already been reported in many other cancer types.  Then, the outcome is certainly “world first” in colon, but its contribution in the whole scientific community is limited.  Anyway, if other researchers publish similar results before us, the value of our reports is significantly reduced. To gain the “world first” position is extremely competitive, and my thinking has been that the only way to survive in this world as a scientist was to behave like Nobunaga, not Ieyasu who said, “Nakanu nara, naku made matou, hototogisu (If the cuckoo does not sing, wait for it).”

 However, I was forced to become very patient, like Ieyasu, when we began a big clinical trial initiative of a cancer vaccine treatment.  I felt a huge responsibility through the voices of hundreds of patients and their families who had suffered from despair and had tried to find some hope in the battle against cancer.  In addition to this responsibility to cancer patients, I really felt enormous guilt because I could not help the survivors of the Tohoku earthquake, even though I had a position in the Japanese cabinet at that time.  These kinds of deadlocked situations made it difficult for me to stay in my cabinet position, and also to stay in Japan.

Of course, moving to Chicago did not mean I could escape my responsibilities to help cancer patients.  Questions and treatment requests from more than 1,000 Japanese patients have been delivered to me since I left Japan.  Furthermore, the need for a new drug was expressed from all over the world after the publication of a TOPK inhibitor that we developed. One day, I was asked:

“How can you manage such a big sense of responsibility or commitment to patients?”

Of course, I have been suffering and feeling pain, and sometimes I was almost crying, but I replied to him, “I can manage without any problem because I can easily put these thoughts behind me.”  However, in reality nothing can relieve me of my responsibility to all these patients.

Mother’s death transformed my life

 My attitude to medical science was dramatically changed through the experience of my mother’s death by colon cancer. The day before her surgery, she apologized to me that she had colon cancer because she knew that I had been working on colon cancer research and thought that she might embarrass me by her having the very same disease.  Her words struck my heart so strongly and of course, I could not find any words to her apology. Soon after her operation, she was found to have metastases, and her pained face and edematous legs were enough to show me the hopelessness of my research.

One day before her death, I visited her and we talked about my research.

“At last I might be able to do what I dreamed.  An important meeting is going to be held at the Ministry of International Trade and Industry at Tokyo the day after tomorrow.”

Then she briefly replied, “You must attend the meeting, even if anything happens to me.”

She probably realized that the moment of leaving was coming very soon.  Her condition and words worried me very seriously, but I returned to Tokyo from Osaka (my mother’s town) that night anyway.  Next morning, she passed away without saying good-bye to me.  I went back to Osaka immediately.  Usually, one’s funeral is held on the next day following the funeral wake, however, my father decided to hold it 2 days after because of her final wishes.  This arrangement made my sadness even stronger.

 I made a one-day business trip to Tokyo and attended the meeting as my mother wanted me to do.  The “Millennium Genome Project,” conducted by the late Prime Minister, Keizo Obuchi, was begun in 2000 on the basis of this meeting.  On the Shinkansen express, the very magnificent view of Mt. Fuji moved me to tears. The revenge against cancer which killed my mother began from this moment.  During the two years of the phase 1 Millennium Project, I had never drunk to restrict myself until I achieved my goal.  There was no choice for me to fail because the failure would have made my mother very sad.

 However, I have had to fight with a lot of people such as selfish scientists, irresponsible ministry officials, and cranky media reporters to keep at my cancer research. Unfortunately, sometimes those that I trusted disappointed me.  But for the sake of all cancer patients I and my supporters (although the number of such doctors and researchers may be small) cannot stop our battle against cancer until we achieve victory, a gold prize.

Patients lose the game with cancer at the moment they give up the battle against cancer.  The only way to win is to keep battling with cancer.  They have to go forward step by step to find their oasis.  I really wish and hope that cancer patients and their families will never give up.  Finally, I would like to ask the Japanese government to establish a big database of patient treatment histories to help improving the quality of all cancer treatment, so as not to waste the precious records of these patients’ battles.

Supplementary information from the translator

In this article, Prof. Nakamura mentioned three famous Japanese SAMURAI warrior lords from the medieval civil war period (c.1467-c1603). Nobunaga Oda was a quick-tempered and aggressive lord, whereas Ieyasu Tokugawa was mild and patient. The contrasting personalities of these three famous lords have often been expressed in poems:

Nobunaga: “Nakanu nara, koroshite shimae, hototogisu” (If the cuckoo does not sing, kill it.)

Hideyoshi: “Nakanu nara, nakashite misho, hototogisu” (If the cuckoo does not sing, make him sing.)

Ieyasu: “Nakanu nara, naku made matou, hototogisu” (If the cuckoo does not sing, wait for it.)