a review of
Metastasis: The rise of the Cancer-Industrial Complex and the Horizons of Care by Nafis Hasan. Common Notions, 2025
With Metastasis, Nafis Hasan has given us an incisive book about how medical science has understood cancer, its causes, and its cures. He argues that capitalism has misdirected medical research to favor a paradigm of treatment that has excelled in generating profit and failed to protect us from cancer.
To accomplish this task, Hasan reviews competing theories of the causes of cancer from the past century and a half, concentrating on the last fifty years. He describes the development of cancer drugs as a profit-motivated response that is not very effective at saving lives or improving the quality of life. But this approach does adhere to theories of cancer that continue to forge ahead without responding much to existing evidence.
He homes in on government campaigns to fund specific types of cancer research, along with less successful attempts to regulate pharmaceutical companies to address drug costs and medical debt. From there, he analyzes modern science as a product of capitalism, and finishes by exploring forms of resistance against the cancer-industrial complex, as he terms it.
Hasan, who is an Associate Faculty member at the Brooklyn Institute for Social Research, looks at some of the key differences in competing theories on the disease and how they relate to the evidence. The dominant theory is that cancer is caused by oncogenes and mutations, and cancer itself is the malignant cell, the tumor.
Another approach focuses on the interaction of multiple factors that are largely environmental, understanding cancer as the dysfunctional, damaged tissue that can give rise to tumors. This, Hasan argues, is the view best supported by research, given the low success rate of treatments informed by the dominant theory, the high rate of recurrence after treatments, and by skyrocketing cancer rates in correlation to increasing industrial and military-industrial radiation and environmental toxins.
The author documents the corporate/state cover up of the prevalence of industrial toxins and the push to refocus research on curing cancer in individuals rather than preventing it by eliminating pollution. He looks at two regulatory tools the Reagan administration adopted “from the conservative American Enterprise Institute think tank: cost-benefit analysis and risk assessment.” The former allowed the Environmental Protection Agency to establish supposedly acceptable thresholds for toxins released into the environment even though many industrial toxins and forms of radiation have been shown to pose lethal hazards at any dose.
Cost-benefit analysis means comparing the monetary value of lost profits, of research as an investment, and the monetary value of human lives saved. Cancer researchers and the medical industry as a whole embraced these ideological tools from corporate accounting and management sciences. Research institutes and government regulators collaborate with the pharmaceutical industry and with the many other industries that produce carcinogens so that the vital question, how do we respond to cancer? is actually reorganized, in political, medical, and economic terms, as how much murder can we get away with?
When the Fifth Estate reached out to me to review this book, it was a pleasant surprise. I was about two years past my own diagnosis with oligodendroglioma, a slow-moving yet incurable brain cancer. Over those two years of brain surgery, recovery, radiation therapy, (partial) recovery, chemotherapy, (partial) recovery, my partner and I were able to find the energy to do some research into more mainstream scientific studies of cancer and its treatments, experiential or traditional advice on how to mitigate the suffering caused by treatment and to decrease the likelihood of future cancers, and critical analysis of cancer on the environmental and social levels.
Metastasis has given me a much firmer ground for understanding the scientific research and the political and corporate campaigns that influenced it. Unfortunately, the book also has some major weak points.
Hasan is clearly motivated to help “free us from the shackles of for-profit healthcare, pharmaceutical industry captivity, a carcinogenic environment, and a capital-serving science.” His adherence to a Marxist framework, however, contributes scant substance to his analysis and produces more dangers than solutions.
In most instances, his Marxism manifests as nothing more than the argument that profit motive shapes scientific research and public policy, an accurate view patented as a unique contribution of Marxism though it is also expressed by plenty of other frameworks, both reformist and revolutionary. At its worst, his ideological shackle restrains Hasan from considering the dimensions of change that abolishing capitalism would realistically require, as it prevents him from appreciating a fully anti-colonial transformation of our understandings of health and medicine.
Materialism erases the non-quantifiable yet fundamental motivator of social control. Hasan contradicts his own evidence when he describes “government’s subservience” to industry after glossing over the US government’s conscious role of applying wartime strategies and infrastructures to cancer research, not primarily to benefit corporations, but to improve its own geopolitical power in the looming conflicts of the following decades.
By staying at the cutting edge of scientific research, from the space race to computing technologies to medicine, the US government has reaped military and economic rewards and maintained a competitive advantage against its adversaries. It is government initiative and government planning that drive this process and allow corporations to profit, not the other way around. Hasan obscures this by reversing the timeline, focusing first on increasing corporate involvement in the 1960s, and second on the state planning in the 1940s that made possible this entire cycle of accumulation.
Elsewhere, Hasan describes government complacency to corporate malfeasance when really he’s mischaracterizing how the government intentionally repressed researchers who were contradicting the dominant narrative around cancer. Repression is not inaction or failure to enforce the law. It is active intervention to maintain social control, based on scientific theories of counterinsurgency. When Hasan portrays the state as a “site of struggle” and a tool we could bend to our own purposes, he is erasing almost the entirety of our revolutionary history, one of the few things of value we possess.
States are active agents strategically organizing capital accumulation. We have historical examples of states without accumulation, but none of accumulation without states. And, in moments when social control is threatened, the managers of capital defer to the state and the state will sacrifice the interests of capital or be overthrown. The Marxist insistence that capital accumulation produces the state and determines state action proves itself to be both reductionist and incorrect.
Hasan’s final two chapters are limited by an unimaginative horizon. Dogmatically, the author erases the history of the labor movement, mischaracterizes prefiguration, and grossly minimizes the true impact and scale of mutual aid as a method of healthcare from below.
If Hasan used his own class reductionism on himself, we might see someone in the same ambiguous position as many cancer researchers, between privileged worker and member of the professional managerial class who ignores data in order to protect the interests of the very institutions that have always been the enemy of the lower classes.
The first four chapters of Metastasis present an accurate (though incomplete) interpretation of the problem. But especially in the last two chapters, Hasan ignores unfavorable evidence, forces complex realities into reductionist and ideologically predetermined theories, and recommends cures that—much like the profitable cancer drugs he criticizes—have been extensively tried and failed.
Metastasis has many informative, thought-provoking aspects. He discusses tissue organization field theory (TOFT) as a way of understanding cancer as accumulated damage within the tissue and not genetic mutations in individual cells. He summarizes some advancements of the state capitalist approach to medicine in Cuba, details that are likely to be unfamiliar to most US readers. And, he reviews policy changes that would make life easier for people facing cancer even if they don’t abolish its root causes.
We need more books like Metastasis that expand our understanding of the specific relationships between scientific research, our own lives, and an economy based on accumulation and enclosure. But we also need more scientists who are critical of the technocratic institutions they are trained to operate, we need to validate and develop other forms of knowledge, we need to retain a critical history of the successes and failures of past revolutionary movements, and we need to embrace an anticolonial and ecological view of health and healing.
If we can pull that off, we will increase our chances of collective survival and improve our ability to explore paths of revolutionary transformation that don’t rely on institutions that lie at the root of the problem.
Peter Gelderloos is an anarchist and the author of How Nonviolence Protects the State, Anarchy Works, Worshiping Power, and other books. https://substack.com/@survivingleviathan