Cancer is an example. Although claims are made yearly that the cure rate is steadily improving, people with the leading kinds of cancer are no more likely to survive than they were a generation ago. Deaths from cancer continue to rise yearly in the United States, even though we have spent about $18.5 billion on research since the national Cancer Act of 1971 was passed and "the war on cancer" declared. By comparison, it cost about $10 billion to develop and launch the first space shuttle.

Even with all the powerful anticancer drugs, new forms of radiation therapy and surgical approaches, little progress has been made in the last 25 years on the biggest cancer killers - cancer of the lung, the breast, the colon, and the prostate. Since many tumors metastasize quite easily, researchers have recognized that radiation therapy and surgery will never be "the answer," and no magic bullet is likely to be found.

Despite the lack of major therapeutic advances, there is now "high confidence" among biomedical researchers about making a significant impact on cancer. A better understanding of the disease is emerging from fundamental research on how cancer develops. As a result, "cancer finally has the look of a soluble problem." Basic molecular discoveries and the "astonishing technology" of recombinant DNA have turned cancer research into "something like a running hunt. The fox is not yet within sight, but it is at least known that there is indeed a fox, and this is a great change from the sense of things 20 years ago." Exciting new insights are thus being gained on what cancer is, how it arises from genes we all have and need for life, and how most of us have defenses that protect us when tumor cells try to develop.

A second reason for optimism comes from the recognition that the majority of cancers seem to be initiated or promoted by factors we can control. "Diet and nutrition appear to be related to the largest number of human cancers, tobacco smoking is related to about 30 to 40 percent."

Our moods seem to be a strong influence in what foods we choose to eat, and the more people perceive uncontrollable stress in their lives, the more they may turn to diets that place them at greater risk of cancer as well as heart disease. What we can do mentally and behaviorally such as watching more carefully what we eat is an emerging new theme in cancer prevention efforts. Psychosocial factors are strongly suspected of promoting the growth and spread of tumors by suppressing the immune system, which apparently plays a big part in keeping incipient cancer cells from developing.

That our attitudes and coping reactions may contribute to whether we get cancer is an idea now supported by evidence beyond anecdotal and retrospective studies. When the prestigious Science magazine published a review of the subject, the title given the report was "Cancer and the Mind: How Are They Connected?" not "Are They Connected?" Overselling Germs and Stress

Just as we have been oversold on the notion that we are helpless victims in a world full of germs and other malevolent forces, the popular wisdom in recent years has also told us that stress is making us sick. Stress is depicted as another one of those powerful external agents that victimize us, so it is not that different from its kissing cousin, germ theory. The evidence disputing both these ideas comes out of a larger concept of disease that shifts the focus from the stresses of life and the ubiquitous bugs of the world to how we respond to them. It turns out that how we react is more important than is the fact that life can be hard or fraught with peril.