Cancer

Saving our skins

The FDA and dermatologists are arguing over sunscreen labels.

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In retrospect, Jennifer Bernstein, a fair-skinned brunet with blue eyes
and lots of freckles and moles, fits the profile. But she didn’t think of
herself that way. She was just a Southern California native who did what
many sunny-weather natives do: worshipped the sun; so much so that she
describes her former self as a “sun goddess.” She would spend hours
soaking in its warmth all through childhood, at the beach, or even in the
outdoor cafeteria at her high school. She even thought her tan was “healthy
looking.”

But that was before. Last summer, while at work, she noticed a strange
“suspicious” dark brown mark on her left leg (“like a freckle on a freckle”), just below the knee; which is where they usually occur on women. She went to the dermatologist and got the diagnosis: melanoma, the most serious of the skin cancers, one that is expected to kill more than 7,000 people in the United States this year alone, according to the American Cancer Society. While it only accounts for about 4 percent of all skin cancer cases — the other type is non-melanoma — it is responsible for almost 80 percent of the deaths. Bernstein is one of the million cases of skin cancer diagnosed in the United States each year, most of which is thought to be sun-related. It’s also a number that is on the rise, which worries doctors.

“I was very lucky, it didn’t appear that it was very deep,” says the
26-year-old less than a year after having two surgeries to remove it. “Skin
cancer was something I thought about but didn’t really fear. Thinking back
to my youth, I remember getting so sunburned because I didn’t want to put
sunscreen on because I wouldn’t get as good of a tan.”

Doctors still believe that there’s a huge gap between what the public
perceives as being “safe” in the sun, versus what scientifically happens to
skin when exposed to sunlight. And that’s even for those who dab the
sunscreen on. They say last month’s FDA ruling on the labeling of
sunscreens just increases their concern: Sunscreens with a Sun Protection
Factor (SPF) higher than 30 will get a 30+ marking on their labels,
phasing out all of those SPF 45 and SPF 60 designations. The sunscreen
companies have two years to comply.

The reason? “The problem is that there isn’t an adequate test to determine
the effectiveness of SPFs above 30″ says a FDA spokeswoman who didn’t want her name used. In addition, the terminology was confusing, she says, so the FDA got rid of words like “sunblock” and “all-day
protection,” because there is no such thing as complete 24-hour protection
that blocks the sun’s rays completely. It also created three different
categories of protection: “minimum” (SPF 2-11); “moderate” (SPF 12-29); and
“high” (SPF 30 and up). “There was a need for this; consumers were having
a hard time understanding and making comparisons,” she says. “This is an
effort to clarify for the consumer.”

But is it in the consumer’s best interest? The new regulations, contained in what’s called the “final monograph,” have caused a furor among doctors, from the American Academy of Dermatologists to the American Cancer Society and the Skin Cancer Foundation. In fact, what the FDA did was exactly the opposite of what the American Academy of Dermatologists wanted:
to put a floor on products with less than SPF 15.

Dr. Mark Naylor, a cancer biologist and assistant professor of dermatology
at the University of Oklahoma, who has done clinical studies on the topic, says the contention really comes down to this: the FDA, dermatologists and cancer biologists see sunscreen differently. “My sense is that they [the FDA] are viewing sunscreen as a means to prevent sunburn — it’s a cosmetic thing to them, to keep people from getting these things that are just a nuisance,” he says. “Dermatologists and cancer biologists believe sunscreens are not just to prevent sunburn, they’re to prevent skin cancer and to prevent photo-aging.”

Dermatologists do say there are some benefits to the new regulations, such
as the terminology clean-up, and a new rule requiring tanning products
without SPF to have a warning label (“increase[s] the risk of skin aging, skin cancer, and other harmful effects to the skin even if you do not burn.”)

But it was difficult to find a dermatologist who would praise the monograph — most of those interviewed were upset with the cap on SPF 30, and the absence of a ruling regarding UVA rays. (UVA rays have not been included in the past because most scientists have believed that UVB rays do most of the damage; this is currently under consideration by the FDA). So when a company claims “broad spectrum” — meaning it protects against both UVB and UVA — dermatologists say consumers have no idea how much they’re being shielded from all possible dangers.

The Sun Protection Factor works like this (regarding UVB rays): SPF 15 means it screens out all but 1/15th of the rays (or 93 percent), an SPF 30 screens out all but 1/30th (or 97 percent), and an SPF 60 screens out 98 percent. “For probably the general population, it won’t make that much of a difference, but I think for people who have sun-sensitive disorders and diseases, it’s very important to get the last percentage,” says Dr. Kathleen Behr, assistant clinical professor of dermatology at UCLA Medical Center. “I don’t think it was hurting anybody by having the 30 and 45 — it was just giving people choices.”

Besides losing the increased protection, which they say is small but important, their greatest fear has to do with how the pharmaceutical companies might react. The companies say the issue is beyond a person burning or not burning. “There are a lot of things done to the skin that are happening well before sunburn becomes apparent,” says Patricia Agin, research director for Coppertone in Memphis, Tenn. “We have looked at several things, including DNA damage and immunosuppression, which are key things caused by the sun and have demonstrated that you need SPF protection in order to protect against these biological insults.”

And while researchers at Coppertone are in the process of sending the FDA material supporting the efficacy of higher SPFs, dermatologists think that if the new regulations stand, there will be fewer companies doing research into better sunscreen products — which they say means the public will eventually pay the price.

“My guess is this will significantly affect research into sun protection,” says Darrell Rigel, president of the American Academy of Dermatology. “I don’t see pharmaceutical companies spending money on this if they can’t get credit for the protection. They may come up with SPF 100 but if they can only claim 30 — why are they going to do it? It’s extra expense for this, and they won’t see the benefit of it.”

Schering-Plough Corp., which makes Coppertone and Solarcane products, doesn’t know the answer to that. Agin says the company is still considering what to do in the wake of the new regulations. But if the regulations stand, would it stunt research? “It’s hard to imagine marketing a product that you couldn’t describe or communicate the benefits of,” Agin says.

Naylor says the monograph system was a good fix when it was introduced around two decades ago. The FDA recognized that sunscreens were becoming popular with the public and so it came out with a list of acceptable sunscreen ingredients, but since then, Naylor says, it has been difficult for companies to start using new — and maybe more effective — ingredients because the companies have to go through a new drug application process, which is very costly, or wait for the FDA to put it in its monograph. This time around, only two were added: zinc oxide and avobenzone for a total of 18 “allowed active ingredients.” Naylor says in many European countries there are products, with ingredients not approved here, that protect against certain types of photo-sensitivity diseases.

While the American Cancer Society is upset about the cap on SPFs, the next most important issue is what they call “substantivity,” or how long a product will stay on and retain its effectiveness. It wrote a letter last November asking the FDA to look into the possibility of using a different ratings system — one that would require companies to explain how often a person should reapply its products. “What’s happening is that people think that they are protected because they put on sunscreen but a lot of times it is wearing off and they don’t know it,” says Martin Weinstock, professor of dermatology at Brown University and chairman of the Skincare Advisory Group of the American Cancer Society. “The consumer doesn’t know how often to reapply. You’ve heard things, reapply every hour, every two hours, but it’s not based on that particular sunscreen. Some sunscreens you put on in the morning and you’re fine all day, and others you have to constantly reapply.” Weinstock says it has to do with the formulation of the sunscreen and that even two products with the same SPF will differ in their duration of effectiveness.

But the FDA and other doctors say that it would be difficult to implement a system like that because of the nature of skin — people are affected differently by the sun, so a uniform system would be impossible. And the FDA says it already has a warning instructing users to apply as often as necessary. It has also taken out the term “waterproof” and introduced two new designations: water-resistant (which lasts up to 40 minutes) and very water-resistant (which lasts up to 80 minutes).

And the other problem, they say, is the varying amount of sunscreen people apply. “The point is that SPF is determined at a laboratory, the amount of sunscreen that people who are being tested have put on is way above the normal consumer,” says Warwick Morison, professor of Dermatology at Johns Hopkins University and member of the Skin Cancer Foundation’s Photobiology Committee. “These are circumstances where the people are being observed, using sunscreen they aren’t paying for, and so they are more likely to do things correctly. Studies have shown that they use half what is required.” Which means they are getting half the effect. Morison says there should be a clear film on the skin that the person can see, and that one sunscreen bottle should only cover an average-size adult four times.

Most doctors emphasized that sunscreen is only part of an overall sun-protection program, which includes a broad-brimmed hat, long sleeves, and staying out of the sun as much as possible. It’s a program that Jennifer Bernstein has gotten to know very well. On a recent trip to the Caribbean, she adapted to her new sun-wary role. “Now I wear a hat if I’m outdoors, if I play tennis I do it after 5 o’clock,” says Bernstein, who now lives in New York. “You can go to the beach and sit under an umbrella and still enjoy the sand and the ocean. You just have to be more careful, but it hasn’t been life-shattering.”

Dawn MacKeen covers health for Newsday.

The third breast

A couple examines its breast together.

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Dr. H.M. Pennypacker is one of the few men you’ll meet who has had a mammogram. Pennypacker had a mammogram for the same reason millions of women have mammograms: He found a lump while examining his breasts. (Like other humans with very small breasts, he found his mammogram quite uncomfortable. “Now I know why women bitch about it,” said Pennypacker, and then he apologized for his language.)

Why was Pennypacker examining his breasts? Because he knows that men get breast cancer too, though not very often. (One in 1,000 men, over the course of a lifetime, develops it, as opposed to one in eight women.) The more telling reason is that Pennypacker’s life, for the past 17 years, has revolved around breast lumps. Pennypacker is the inventor of a line of patented silicone Breast Models with Simulated Lumps, which are sold, along with videotapes and booklets, under the brand name MammaCare. At first, only medical and nursing schools bought the breasts. And they needed them: In a 1985 Journal of the American Medical Association study, 80 physicians were only able to find an average of 44 percent of the lumps hidden in a Pennypacker-designed breast model.

“The press picked up on it, and all hell broke loose,” Pennypacker recalls. “Women said, ‘What’s going on here? We trust our lives to you guys, and you can’t even find a Ping-Pong ball!’” (Actually, the biggest lump was one centimeter.) In 1988, Pennypacker came out with a self-examination breast model and video for home use.

The UPS man delivered my breast this morning. It is of average size and flesh toned, that is to say, Caucasian flesh tone (a “Breast Model of Color” is also available). It weighs about a pound and is squishy in the addictive way of those balls you squeeze in your palm when you’re stressed.

I took out the video and opened the instruction booklet. “Position yourself in front of your television so that you are lying on your back,” it said. I glanced at the sofa, which was occupied by the husband, lying on his back. On the television screen, race cars were circling a track. I explained what I needed to do. “Maybe you could drive to the 101 overpass and watch those cars go by,” I said cheerfully. Ed would have none of it. “Can I watch the video with you?”

The tape began with an attractive woman in a purple dress, explaining the importance of breast self-examinations and early detection. Ed listened thoughtfully. I was touched that he wanted to be involved in my health this way. He took my hand in his and smiled. “Think we’ll see hers?”

After the woman in the purple dress finished, there was an “interlude while you get completely and comfortably prepared.”

“This is where you go get some snacks,” said Ed, but he didn’t, because the interlude is actually when you take off your shirt. “You use that one,” he said, pointing to the Pennypacker breast, “and I’ll practice on these.”

In fact, there used to be a group of nurses in Marin County, Calif., who taught a MammaCare breast examination class for couples. Pennypacker himself supervised a doctoral dissertation on the topic of men examining their wives’ breasts. “The problem is that men wind up confusing palpation with fondling,” he told me. “First thing you know, it turns into foreplay.”

Ed suddenly lost interest in my breast tissue, because it was around this point in the video that “Kate the Trainee” took off her blouse. Kate placed the breast model on her chest, so that it sat in between her own breasts like a third eye. She laid one hand on her forehead, giving her a distraught, Scarlett O’Hara-viewing-the-embers-of-Tara look, and with the other hand began tracing dime-sized circles up and down the length of the breast model.

I was having a hard time finding the Simulated Lumps. They were down at the bottom of the silicone and required a great deal of pressure to get to. This is, according to Pennypacker, the amount of pressure it would take to press your fingers through to the ribcage beneath “a good D-cup breast.”

The alternative, Pennypacker said, would have been to make a “five-gallon breast model.” He mused that his decision may have hurt sales, though not, I would surmise, the sort of sales you want to brag about.

The lumps could be viewed by peeling off a piece of cloth stuck to the back of the model. Viewed from the back, the breast was clear, like a Lucite paperweight, and embedded in it were what appeared to be two pencil erasers, a bite of Slim Jim, a birth control pill and a piece of pimento.

“Oh no, no, no, no,” said Pennypacker when I called him the next day and told him what I thought he’d used. Pennypacker had hired a material sciences engineer who lent him a Durometer, which is a machine that measures the firmness of objects. “We had a person standing outside the operating room and when a lump was on its way from the O.R. to pathology, we took a reading. In there are plastic representatives of all types of lumps coming out of the operating room.” Including Pennypacker’s lump (the pimento variety).

His lump, by the by, turned out to be benign and remains inside his breast. “Sometimes when we train nurses and we have one whose feel is questionable, I get on the table and say, ‘OK, I’ve got one. You find it.’”

Meanwhile, back on the video, it was time to practice on myself. Using Kate’s chest as a model, the video highlighted the area to be examined, which extended in a pointy-topped square from the “bra line” up to the collarbone.

Here again, we caught Ed’s attention.

“Look,” he said. “It’s like home plate.”

I was instructed to move along doing little dime-sized circles, up and back and up and back, in rows, as though my breast were a United Airlines check-in line on the Friday before Labor Day. An A-cup is supposed to take a couple of minutes. It was going on 10. Ed offered to help.

I would have to agree with the conclusions of Pennypacker’s doctoral student as to the effectiveness of husbands doing exams on wives. Let us just say Ed’s Durometer reading went up a few points. I sent him away and finished my self-exam myself. When he came back, Kate the Trainee had returned to the screen and was showing the “nine positions for visual inspection.” When it came time for home viewers to try this, the screen showed butterflies while pretty guitar music played. Ed put the race back on. The announcer said that Andretti was in the sixth position, which is hard to do inside one of those cramped little cars.

So now I am one of the few women who actually knows what they’re feeling for when they examine their breasts. Not, I admit, as special a thing as a man who’s had a mammogram, but neat nonetheless.

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Former Salon columnist Mary Roach is working on a book about science and cadavers, for W.W. Norton

No sweat

A recent e-mail is scaring women away from antiperspirants.

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“The leading cause of breast cancer is the use of antiperspirant,” says the e-mail that popped up in my in-box not too long ago. Playing on women’s fears, the e-mail has been circulating on the Internet, warning that this seemingly benign daily activity can be putting them at risk for one of the most common cancers among women.

The concept is easy to buy into because there is so little known about breast cancer, and also because the e-mail (source unclear, subject line “Breast cancer research we need to know about”) includes lines like, “PLEASE pass this along to anyone you care about … This awareness may save lives.” The message claims that by using antiperspirant, which inhibits sweating, the body loses its ability to purge its toxins, and so they become deposited in the lymph nodes. This buildup, it says, leads to cell mutations, which lead to breast cancer. It also stresses that deodorant, which stops body odor and allows perspiration, is OK.

Never heard of the breast cancer-antiperspirant connection before? Well, neither have doctors. Dr. Michael Thun, who heads the American Cancer Society’s research on epidemiology, says “Human imagination has never been short of creative explanations for phenomena that people are frightened of.” He continues, “I think that it is a clever rumor that has some appeal because breast tissue obviously goes into a woman’s armpit and because a lot of people use antiperspirant. It’s like saying, ‘Hats cause baldness.’”

While there is still not a lot known about what causes breast cancer, researchers do know that it is caused by damage to the genes in cells that control growth. Thun says it will be far more beneficial to learn about known risk factors — obesity after menopause, alcohol consumption — and to have regular mammograms than to worry about antiperspirants.

According to Dr. Mervyn Elgart, clinical professor of dermatology at George Washington University, there isn’t a danger of building up toxins if you use antiperspirants. “If you don’t sweat enough, the toxic stuff will basically come out the kidney, meaning you pee it out,” he says. The e-mail’s explanation is, to Elgart, “a bunch of crap.” Elgart, who has studied sweating, says the worst thing that can happen by using antiperspirants is a little irritation of the skin, and perhaps, some damage to clothing.

A related fear is an old one, about the possible link between an active ingredient in many antiperspirants, aluminum chloride, and Alzheimer’s disease. Amy Graves, associate professor of epidemiology at the University of South Florida’s College of Public Health, has done research on the subject and says there’s no proof to this hypothesis, especially when it comes to antiperspirants, since they contain such small amounts of aluminum. She adds, “Aluminum is the third most common element on earth so essentially everybody is exposed to it. It’s not an easy thing to study from an epidemiologist’s perspective because you need to find people who are exposed and not exposed — and nobody is unexposed.” But as far as antiperspirant is concerned, she is not concerned. She herself remains dry by using products with aluminum.

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Dawn MacKeen covers health for Newsday.

Ted Hughes, R.I.P.

A brief obituary of the British poet Ted Hughes, who died Wednesday Oct. 28, and links to Salon's glowing review of his last book of poems, 'Birthday Letters.'

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As a poet, Ted Hughes often wrote about nature’s savagery. In his personal life, the British Poet Laureate, who died Wednesday at age 68, often seemed visited by a similar kind of cruel senselessness. His first wife, Sylvia Plath, killed herself in 1963, leaving him to raise their two children. At the time, Hughes was having an affair with Assia Wevill, who in 1969 also killed herself and their child.

Over the years, the particulars of Hughes’ tragic life took on an almost mythological dimension, one that threatened to overshadow his poetry. Relentlessly attacked by critics, especially feminists, who found him hardhearted — some of them even blamed Hughes for Plath’s death — he fought diligently for his and his children’s privacy. For 34 years he refused to discuss Plath’s suicide, and it seemed he would carry his feelings about his former wife and writing companion to the grave. But this past January, aware that he was dying of cancer, Hughes finally spoke, in an extraordinary and extraordinarily intimate collection of poems, “Birthday Letters.” In his review of “Birthday Letters,” Jay Parini wrote, “Ted Hughes has given us a huge gift here, one that has cost him dearly.” In her accompanying essay on Hughes, Kate Moses wrote, “They are poems vivid with tenderness and sincerity, appreciation, incredulity, humility and courage, and like tea
left steeping too long, tannic with sorrow.”

Born in Mytholmroyd, a remote Yorkshire town, Hughes attended Cambridge University, where he met Plath. The two were married in 1956. He published his first collection of poetry, “The Hawk in the Rain,” in 1957. The book won a new-poets competition judged by W. H. Auden, Stephen Spender and Marianne Moore and was published to wide critical acclaim. Hughes went on to publish more than 35 collections of verse, several plays and works of prose, and two opera librettos. He was also a successful children’s book writer — his most popular children’s book, “The Iron Giant,” was published in the United States in 1968.

Upon word of his death, British Prime Minister Tony Blair called Hughes “a towering figure in 20th-century literature who even in his last years was producing great works.”

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Fighting the wrong war

The government could cut cancer deaths by a third by educating Americans to eat right. But dollars for diet education are scarce, while the cancer research budget fattens up.

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Last month, 150,000 people converged on the U.S. Capitol demanding greater government funding for cancer research. Vice President Al Gore addressed the gathering, boasting of the administration’s drive to increase cancer spending. “This marks high noon for cancer,” Gore intoned. “We are determined.”

Whenever a politician starts talking about high noon, we’d do well to hold onto our wallets. Such rhetoric is usually followed by the sound of lots of money pouring down a rat hole. The U.S. government now spends $2.4 billion annually on cancer research. The day of the march, President Clinton said he wants to boost cancer research spending by 65 percent over the next five years. During his weekly radio address, Clinton told the nation: “We must never stop searching for the best means of prevention, the most accurate diagnostic tools, the most effective and humane treatments — and someday soon, a cure.”

The emotional appeal is undeniable. We’ve all lost friends or family to cancer. You can understand the anger of the 150,000 people in Washington, wanting the government to do whatever it takes to overcome the disease. But is pouring billions more dollars into research really our best course of action for preventing cancer deaths?

Our nation’s anti-cancer strategy — devoting almost all federal funding to finding a cure — is fundamentally flawed. While spending billions to seek out a cure for cancer may be politically popular, most of this money would be much better spent on prevention. We could eliminate one-third of all cancer fatalities without spending another dollar on research. Most experts, including the leadership at the National Cancer Institute, believe that one-third of cancer fatalities arise from poor diet — principally a lack of fruits and vegetables combined with too many foods of animal origin. The trouble, then, is that most Americans don’t know how to follow a good-tasting and nutritious diet that will lower their cancer risk. And the government devotes practically no money to teaching people about diet and food.

The government’s main nutrition program is called “5 a Day for Better Health,” which is sponsored by the National Cancer Institute. The program has a catchy logo, but it receives pathetically little federal funding — just $1 million per year for outreach and advertising. That means that for every dollar spent teaching Americans how to reduce cancer risk through diet, the National Cancer Institute spends $2,400 on research. The 5 a Day program isn’t even mentioned in the institute’s 1999 budget proposal — in which it asks for $3.1 billion, most all of it for research. Yet according to the institute’s own publications: “In the vast majority of studies … those with lower consumption [of fruits and vegetables] experience a cancer risk generally at least twice as high as those with higher consumption levels.”

The 5 a Day program isn’t perfect. It’s a bit like recommending people brush their teeth once a day for best dental health. Cancer risk has been shown to drop even further when people eat closer to 10 servings of fruit and vegetables a day. To the institute’s credit, it points out in its literature: “Remember that five is a minimum — the more the better.”

Education is our nation’s best hope for dramatically reducing cancer deaths in the near future. If funded adequately, the 5 a Day program would prevent tens of thousands of deaths year. The tragedy is that the program is all but ignored in an agency dominated by researchers.

The vast majority of the money we spend on cancer, of course, goes to neither research nor education, but to treatment. The National Cancer Institute reports that last year $107 billion was spent on cancer treatment, which is 44 times what we’re now spending on research and education efforts. If we moved a significant share of our $2.4 billion cancer research budget into educational efforts, anti-cancer nutrition advertisements could run on shows ranging from Ally McBeal to the Super Bowl, and in publications from Newsweek to Ebony.

With that kind of exposure, it’s reasonable to assume that we could get Americans eating many more servings of fruit and vegetables a day. As many as a third of cancer deaths could be prevented, saving tens of thousands of lives annually and reducing costs of cancer treatment by more than $30 billion each year.

Realistically, a move to favor education over research will not happen any time soon. The cancer research establishment is too entrenched to give up that money without a fight. But if we want certain progress in the war on cancer, a shift of priorities is in order. We shouldn’t devote most of our resources to searching for a magic pill that will eliminate cancer. Federal money should adequately publicize the overwhelming impact of eating right, so that people can take responsibility for their own health.

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Erik Marcus publishes the Vegan.com Web site.

One Blue Thing

Ren

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A six-hankie weeper in the multiple-Oscar winning, adult melodrama tradition, “One True Thing” combines considerable moviemaking craftsmanship with exactly the kind of show-stopping performance you’d expect from Meryl Streep playing a dying mom. (It’s probably exotic, at this point, for Streep to perform with an upper-middle-class East Coast accent, but she can begin dusting off a spot on her mantel in any case.) At 127 minutes, the movie’s sheer lugubrious length allows for enough powerful moments that it’ll batter many tender-hearted souls into tearful submission. For those who remain unbludgeoned, however, “One True Thing” will largely seem a turgid, endless enterprise, which — to paraphrase a writer wittier than I — spans the emotional gamut from A to B, and offers up a vision of the American family so mind-bendingly conventional it makes “As Good as It Gets” look like scathing social critique.

Things begin promisingly enough: When young New York magazine reporter Ellen Gulden (Renie Zellweger) returns home to Langhorne, a leafy, gracious town somewhere in the Northeastern megalopolis, for her dad’s 55th birthday party in 1987, she seems to be walking into a haute-WASP suburban burlesque. Her mother, Kate (Streep), an appallingly sunny Suzie Homemaker type, actually answers the door dressed as Dorothy from “The Wizard of Oz” — she has asked guests to come as their favorite literary characters because her husband, George (William Hurt), is an esteemed academic who won the National Book Award for his study of T.S. Eliot. When Ellen and her best friend, Jules (the appealing Lauren Graham), show up in identical black minidresses and tights, Ellen’s brother quips, “Who are you guys? The Sylvia Plath twins?”

These early scenes offer far sharper observations on the nature of family life than anything that happens after the tear-jerker plot line kicks in. Ellen feels the wounded, besotted love of a daughter for the illustrious father whose opinion she takes much too seriously, and she can’t stand her mother or the Minnies, Kate’s Stepfordian group of do-gooder Langhorne housewives. But even Ellen understands that the marriage between the distracted academic and the ditzy nest keeper — who thinks Jane Austen and Louisa May Alcott are too anti-feminine — has its own mysterious internal chemistry; like all successful relationships, it functions on a level invisible to even the closest outsiders.

But when Kate is diagnosed with cancer and Ellen is guilt-tripped into moving back home to take care of her, this subtle, comic interplay, suggestive of a much better movie we’ll never get to see, is swept away in a roaring Niagara of overdetermined pathos. At various times, Hurt and Streep, dignified veterans who have survived worse movies than this (and quite a few better ones, thankfully), manage to poke their heads above the torrent. Streep may sometimes be ridiculed as a caricature of the overly serious method actor, but she knows what she’s doing. Anyone who’s ever suffered through the death of a loved one from cancer will find her portrayal of the needy, emaciated and pain-stricken Kate, torn between despair and attempts to be noble, distressingly close to the bone. Hurt is less memorable, but George’s preoccupied, self-involved demeanor, endearing at first, becomes almost sinister as Ellen watches him retreat into booze and womanizing — an eerie if familiar caricature of the glib, sycophantic, immature husband.

Zellweger, who is meant to be the emotional center of this triangle, is instead its catastrophically weak link. Her acting is perfectly acceptable in the early going when the film has some buoyancy and the other two actors can support her, but she’s a mousy, inoffensive presence at best, never evincing the charisma the role demands. Ellen seems less like a hard-bitten big-city journalist than a domineering Girl Scout patrol leader or perhaps a whiny head cheerleader — at any rate, a character significantly less mature than Buffy the Vampire Slayer. As her mother grows sicker and her father increasingly disappoints her, she spends much of the movie pouting, stomping her feet and turning various shades of mottled red meant to convey rage, or self-doubt, or perhaps just exasperation.

Evidently the point of this whole exercise (adapted by screenwriter Karen Croner from the novel by former New York Times columnist Anna Quindlen) is that the ambitious ’80s career woman needs to integrate the lessons learned and sacrifices made by her stay-at-home mom in order to become a well-adjusted grown-up. Beyond this conception and its relentless downward slope toward Kate’s death, “One True Thing” really has no plot.

This might have worked if the director and lead actress had the kind of intense mutual understanding that, say, Ingmar Bergman had with Liv Ullmann, or John Cassavetes had with Gena Rowlands. But Carl Franklin — who has yet to live up to the potential of his gripping 1992 debut, the marvelous neo-noir film “One False Move” — seems ill-suited to this cast and this material. With Zellweger standing by like a weeping onlooker at a road accident, “One True Thing” deteriorates into a lurid, almost hallucinatory horror show, snatching incoherent fragments from “Cries and Whispers,” “Meet Me in St. Louis” and “It’s a Wonderful Life” as it careens to a close. When the Gulden family reunites for Langhorne’s almost fascistic Christmas-tree ceremony, I felt as if I were watching the dire climax of some dystopian sci-fi epic, rather than a picturesque American catharsis. In this film’s emotional universe, resistance is futile, and Soylent Green is people.

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