BOOK REVIEW / A disease-ridden life: The Transformed Cell - Steven A Rosenberg and John M Barry: Chapmans, pounds 15.99

STEVEN ROSENBERG made the discovery that determined the course of his career by inserting his hand underneath a man's ribcage and running it around the liver - gingerly, to avoid puncturing the rindless organ. To his astonishment, he found nothing. Nor did he find, anywhere in the abdomen, any trace of the aggressive cancer that should have killed the man 12 years before. It had just cleared up, like a cold.

The meaning of this revelation was that the immune system was capable of erasing cancer. The goal thus created was the development of techniques that would use immune mechanisms to destroy cancerous cells in ordinary patients, not just this fantastic exception. That was in 1968. The struggle continues.

Rosenberg, now Chief of Surgery at the US National Cancer Institute, says that a scientist should learn to love failure. It is certainly a far more common means of acquiring knowledge than success. In his field, though, failure is not an intellectual abstraction. The torment in his story accumulates with each patient he loses; the dead far outnumber the living. Some of his treatments work at first, but the cancer recurs; some have an effect, but not enough. On occasion, the treatment itself has

killed: the scientific imperative to develop new knowledge may conflict with the Hippocratic injunction to do no harm. Immune therapy may be as heroic - that is, difficult to bear - as established ways of treating cancer.

Yet each death reiterates the need to find new ways of treating cancer. Rosenberg calls it a 'holocaust', explaining that his mission arises indirectly from the fate of his relatives during the war. He himself is a second-generation Jewish-American. In adulthood, his entire life has been ordered by cancer, and so, to a large extent, have the lives of the people around him. Nightly discussions about the disease became a family ritual. Cancer justifies his singlemindedness; it allows him to hate.

Rosenberg unselfconsciously uses the standard-issue military imagery to describe the 'war' against the disease, but the warrior metaphor fails to obscure a generalised unease. The public looks askance at warriors, and they now look askance at themselves. Moreover, as he observes when explaining his reasons for writing this book, 'science today often seems under siege'.

The science in Rosenberg's book is straightforward enough, if a little too closely bound up with clinical history and personal narrative - the glossary is useful, but a scientific summary would have been a welcome inclusion. The abiding questions concern the patients, and the intense relationships that develop between them and their doctors. One of Rosenberg's colleagues once observed that the harder their treatment was, the more the patients loved him. And faith may be more shocking than hostility. Rosenberg was stunned by a patient who, told his tumours seemed to be shrinking, matter-of-factly replied 'Yeah, I knew this was going to work'. It wasn't that this patient was the first to have believed in Rosenberg's treatment. It was that all the rest had, too.

At the end of Rosenberg's story, the value of his work is embodied in a handful of surviving patients, several treated only recently. He does not claim that any of his techniques have become established therapies; even for the two diseases, kidney cancer and melanoma, upon which his studies have concentrated.

Much of his research has been devoted to interleukin-2, a substance that stimulates the growth of lymphocytes, white blood cells involved in immune activity. It works for some patients, but is dauntingly toxic. The ideal is to apply toxins only to cancerous cells and keep them away from healthy ones. Rosenberg is now trying to achieve this with tumour-infiltrating lymphocytes, which can be prodded into producing a tumour-killing substance.

The work is always in progress. While the popular imagination takes to the notion that cancer is controlled by states of mind, all Rosenberg can promise is blood, sweat, toil and tears. It's not alluring, but it is honourable.