Good morning, John.

This morning, I was watching an old vlogbrothers video with Orin and he said, "Dada, that's you before your injury." Now when I tell you I did not know what to say, it's because I did not know what to say. But when I think about how it affected him, this makes sense because it was, like, "Daddy couldn't do a lot of stuff. You had to be careful with me. I, like, parts of me hurt really bad. I couldn't pick him up or wrestle. I was injured, I had an injury." We talked about it as cancer, but we didn't really explain what cancer was to him in part because, like, I know what cancer is and it's really complicated. And I'm just not the kinda guy who, like, makes stuff simple.

So it's not surprising that he would be confused especially because everyone is confused, epitomized by the fact that we still are calling cancers cancer. I'm on a mission to get this to stop. There is no such thing as cancer, just like there's no such thing as virus. There are cancers and there are viruses. You don't get injury, you get an injury. Different injuries are different from each other. Cancer is anywhere between, like, hundreds to billions of diseases.

Hundreds because there are some common pathways through which normal healthy cells can become cancerous cells. Classical Hodgkin lymphoma is a pathway through which normal healthy cells can become cancerous cells and because of that, Classical Hodgkin lymphoma cells behave similar to each other so people with Classical Hodgkin lymphoma have similar prognoses and respond roughly the same to similar treatments. Billions because every single cancer is genetically distinct, just like every person is genetically distinct. And so, two people with the exact same kind of Classical Hodgkin lymphoma can respond differently to treatment because their bodies are different. The micro-environments between their cells are different, their genomes are different, their epigenetics are different, their immune systems are different.

Indeed, by the time a cancer is advanced you don't really even have one cancer anymore. There's a lot of genetic variation in the population of cancer inside of a body, which is why late-stage cancer is so difficult to treat because there's a lot of genetic variation which allows the cancer to handle whatever we throw at it. Now, of course, I understand that this is going to seem pedantic to a lot of people, but I think that calling cancers "cancer" does harm in at least two specific clear ways that I experienced.

First, people who have watched someone live through and then die of a cancer will then think when they see someone else who has cancer or when they themselves get cancer, they will think that that that's going to be the same situation. And that can create a lot of hopelessness and a lot of sometimes even resistance to treatment. I had a friend who upon hearing kinda started to treat me as if I was already dead because that's how he was thinking that, "Cancer is cancer, and I've seen how this goes." And second, it leads to this belief that I hear over and over again that we have failed. That despite all the mountains of money and time and effort we have thrown at trying to cure cancer, we have failed at curing cancer, and this is just wrong. Not because we haven't cured cancer, because cancer doesn't exist. It's not a disease, it's a kind of disease. We also haven't cured bacteria, like, people still die of bacterial infections. Some bacterial infections are uncurable. Most of them are curable, but some aren't. There's some cancers that we can cure, some cancers that we cannot and there's a whole spectrum in the middle of cancers that respond variously well to different treatments.

In fact, we recently passed a milestone in the U.S. More than half of people diagnosed with cancer will not be killed by that disease. They will either be cured or they will die with it, rather than of it. This is gonna sound kinda nihilistic because this is how we're used to talking, but a cure for cancer cannot exist because there are at minimum, hundreds of cancers and they're all different from each other. Glioblastoma is as different from Hodgkin lymphoma as ebola is from the common cold. We don't get to cure cancer, we have to cure cancers, and that's just more work but it's the truth of the matter.

Weirdly enough, calling my cancer an injury—for me—is actually more accurate than calling it cancer because at least we understand in our brain that not all injuries are the same.

John, I'll see you on Tuesday.