A Tale of Two Cancers 

From the title, I got very afraid John was about to announce he had cancer.

After reading the title of this video (post Hank’s almost-recovery videos), I was bracing myself for the news that John had cancer. Thank you for not having cancer, John.

93% treated vs 6% untreated, then John starts in on a story about young Mondeh, and I was trying to prepare myself for the worst. Thank you for sharing his story with us, I'm so, so glad he was able to get the care he needed and is in remission.

Something I've learned in medical school over the years is "lead time bias", and this is an important concept. It links the time of detection to survival rate. We're under the impression that certain types of cancer with low survival rates are just highly aggressive, while in truth the reason is often that we just diagnose them too late. Certain tumors can't go a few months without being detected, like Hodgkin lymphomas, while other tumors remain hidden for more than half a year, like pancreatic tumors. And in the latter case of course, survival time and the chances of adequate treatment are low. Often times the key to treating disease doesn't lie in the cure itself, but specialized, timely detection methods and patient education.

My niece was diagnosed with cancer ate age two. She had multiple complicated and not easy to treat diagnoses. In the fourteen months she was sick, she had three cancer diagnoses - two leukemia, one rare lymphoma. I don’t believe in transactional prayer, “I want this to happen.” If I did I would want all children to not have cancer, all people to not have cancer. If it’s transactional, the sky is the limit. Instead, I prayed, knowing she would die anyway, for better education to train researchers, more support for medical staff, because someday we will get better at treatment. Action is ultimately the only thing that counts. I decided today that after supporting PIH in various 1-time ways, I would set up a monthly donation. Action is what matters.

I think it's important to note that even in the United States outcomes can be vastly different. Even with hospitals that have the equipment, insurance can block access. I'm quite sure I have a torn rotator cuff but because I'm on Medicaid and it takes significant effort to get them to pay for the imaging required to diagnose I just have to live with the pain with no treatment. This is just one and a relatively minor example. I know people with way worse conditions that can't get treatment because they don't have access to the right tests.

I am all here for John's multi-month art project wherein he painstakingly proves to us that every imaginable subject is related to tuberculosis.

I’m glad there was a happy ending for Mondeh, but it’s terrible that it was such a long road to get there. And terrible to think about all the people who haven’t been able to get treatment. I’m glad we are working with PIH to choose a better world.

John, thank you for this video. It's really important that people know that even though Hodgkin's is a (relatively) low-risk cancer, access to care makes a world of difference. My brother was diagnosed with Hodgkin's Lymphoma when I was in middle school (2004-ish), and my family was poor and couldn't afford to get him the kind of care that he needed. Over the course of around a year and a half, I had to watch him wither away to nothing and lose all of his faculties until he finally died at home towards the beginning of 2006. Even here in the good ol' US of A, lack of access to care can make a treatable disease fatal. I sincerely hope one day we can achieve universal public healthcare here in the US so these tragically preventable deaths don't continue. Mikey, you were the coolest of all of us and I wish I could have known you longer and better. If there's an afterlife, I hope I see you there.

My mom had endometrial cancer in 2010. When she called to tell me, she pointed out, "It's the big scary C word, but if I was going to get cancer, I was lucky to get this one." In the USA most cases, like my mom's, are caught in stage 1a, because the most common symptom is when post-menopausal people start bleeding like a period. The five-year survival rate is something like 95%. She got a hysterectomy and some very short-term radiation and has been in remission ever since. But for a long, long time, people didn't talk about menopause and menstruation much, and so people didn't go to the doctor or talk about what was happening, and they died instead. (And obviously, they still do in places where there's a strong taboo, or where there's not good medical access.) In any case: if you know someone who is past menopause, and they get a "random period" out of nowhere: GET THEM TO A DOCTOR. Unexplained post-menopausal bleeding is sometimes just assumed to be endometrial cancer until proven otherwise. And it's often the *only* symptom.

John just largely described my challenges in getting care for my rare disease IN THE US. After 14 years of fighting I have accepted that I can no longer afford to travel all over the country for care. (I live in a major metropolitan area so this shouldn’t be the case). I can also no longer afford the crushing emotional effect of the long wait, the expensive travel, all for 15 minutes with a much-hyped doctor who who actually doesn’t give a F, doesn’t listen and doesn’t take me seriously. It’s so, SO soul crushing. I have accepted that at 39 I have experienced everything significant in my life that I ever will. I have accepted that I will be dead, entirely unnecessarily, by the time I am 50 because of these things. Having a rare disease as an adult, that virtually never effects children, is living in the land of “not cost effective”, even in wealthy countries. I have accepted all of this, but that doesn’t mean it isn’t equal parts infuriating and depressing. Knowing you are a whole human being that the society around you has simply dubbed “not worth it”- even doctors.

It is so sad to see the difference in how people get access to healthcare. If I was less lucky, I would be dead by now (cystic fibrosis).

Thanks for this. I'm a cancer survivor and honestly feel like a sham when I say so. It was caught extremely early and was an "easy" cancer to have as well. But there's so much to be said about the medical care I have access to to show for the smoothness of my treatment. I was fortunate and I wish everyone else was as well.

I can just about begin to imagine how those people and families feel - knowing there are treatments but not having them available. I was diagnosed with cancer in the UK in May and due to the NHS being underfunded, all of my treatment has been about 3 times longer to start than what the NICE guidelines recommend. It made me so angry and frustrated, even knowing that I would definitely get the treatment and have brilliant doctors and nurses eventually. To be in a position where it just wasn't available is just heartbreaking and even with the delays I recognised how lucky I was to live where I live and have the %s I have. I really hope we (as a world) can reach a much better point very soon. I watched Hank go through chemo whilst I was having surgery and now I'm experiencing the joys of EVERY SIDE EFFECT POSSIBLE. It's almost impressive that a drug can make your nose bleed, give you joint pain, trigger an early menopause, make your hair fall out, give you acne, make you feel sick...I shudder to think what the first chemo treatment was like!

As long as medical care is not considered a fundamental basic human right, something to which all humans are entitled, there will be people who could otherwise have lived who will necessarily not; not because the disease is untreatable but because our societies are so backwards that proper treatment of all cases isn't possible.

Stories like this remind me why I donate to PIH. Thanks for sharing. So glad Hank and Mondeh were able to reach remission.

My cousin passed away last year at the age of 32 from leukymia. I think when Hank first let us know what was going on with him I was still working through my cousins death, and in particular the dear Hank and John made me really cry. But somehow in the last 6 months, both Hank and I have done a lot of healing. Thank you both for bringing me along on this journey and helping me mourn.

How well said, John. It is a shame that not everyone who needs specific treatments to survive, can get it and it is also heartless how some can look down on the homeless as non humans, people to be avoided and swept aside. I love how you say, in your description, beneath your video "I'm a big fan of my little brother." I was and still am a big fan of my big brother who died from myastenia gravis 2 years ago, this past May 24th. We need more caring people, such as yourself and Hank. Thank you for the videos.

I think of the privilege of early diagnosis a lot. Due to a bizarre sequence of events featuring extensive frustrations in both my professional and personal lives, I stumbled backward into an early diagnosis. I one time was talking about the awful dominoes that led to my diagnosis, and my doctor pointed out that those terrible experiences very likely saved my life. After watching this video, I am now defining "privilege" to mean that I never even considered the most important event in that causal chain: being born in a country where an early diagnosis is even possible.

It's fascinating that sadness and hope can be so close to each other. Yet you somehow always leave us looking at the hope

Speaking of tuberculosis - I finally got around to reading the Hunger Games prequel (No spoilers ahead - don't worry!) and there's a line at one point about how tuberculosis can be treated in the Capitol (though not fully cured - they're still rebuilding from the war) but is a death sentence in the Districts. Made me think of you immediately! Suzanne Collins gets it - seems to illustrate your point here rather well.

I'm grateful for what's available to us in Cancer care access and research. We found my Stage 3 Hodgkin's Lymphoma just shortly after Hank's own diagnosis, and his journey helped me prepare for mine. Happy to say we both kicked Cancers ass.

I generally feel pretty hopeless after learning about instances like this but I am so glad to be a part of a community that’s actively trying to help solve these issues

I’m so glad Mondeh is finally on remission! Thank you for sharing this inspiring yet heartbreaking story, these things renew my hope in humanity, what a survivor! It upsets me that some can’t access healthcare just because they’re less unfortunate. One of the many reasons I love this community is because we try to help on these matters, thank you for making us decrease world suck. And thanks to PIH for paving the way.

tbh this is something i learned a lot from tswgo, even though they are in the US. many times during the years (and during p4a season) they remind me that a lot of the cost issue with cancer treatment isn't the drugs and hospital themselves, especially to those of us with universal healthcare. it's stopping work to get care or care for a loved one, it's the lack of psychological care, it's the lost time at school, etc. thankful for these two stories

Disease does not treat people equally unless society treats people equally. John Green

Either the whole world is connected to TB or John is a wizard with the strange and yet incredible power to connect everything back to TB and in doing so raises awareness and sparks change. And let me tell you, I think that’s a pretty freaking cool super power :)

I just learned that my tumours have shrunk for the first time since my recurrence. Impossible to overstate how happy that made me. And it's all because my parents worked hard all their lives and I have a good credit union with good insurance. My medication, Keytruda, is top-shelf and very expensive. My country has universal healthcare, but none of the drugs in the public system worked for me. It pains me to think of the people who can't get stuff in private. Medication must be accessible to all. Global healthcare needs must be met if we are to be a serious planet.

You two are some of the most compassionate humans out there and I'm so glad you were able to create this community where we can come together and learn and make the world a better place

Your solution based focus on these topics that might other wise leave people feeling dread is really inspiring. I hope accessibility to medical care gets better in Sierra Leon. I’ve grown up watching vlogbrothers and have learned so much from you, Hank, and the community. Happy Tuesday.

It’s not just places outside the US. And it’s not just about money. When my mother-in-law was diagnosed with cancer, she went to one of the top doctors in San Francisco. He took one look at her dark skin and said, “you probably can’t afford my rates so let’s talk about palliative care.” My father-in-law whipped out his phone and told him, “how much? I’ll have the full amount wired to you right now.” The doctor’s tone changed immediately.🙄

John, the earnestness and empathy that you bring to your videos helps me remember that humanity has the capacity to do so much good when we put our mind to it. Thank you for using your voice and platform to give us all that reminder.

My uncle had kidney cancer that was caught almost too early to detect because of a completely random series of events, there weren’t even any symptoms. He was out in the county on his motorcycle, and noticed a farmers fence was down, and stayed by the side of the road to make sure the farmers cows didn’t escape. As he was there, he was hit by a passing car who was speeding and broke several ribs, and when scanning for other internal injuries, that’s when they found the cancer. He didn’t even need radiation, they just took the kidney.

It just shows how amazing Hank Green is that when he was going through something scary he still thought of others who couldnt get the treatment he could.

On reading the title, I thought 'oh, that's nice, we might take a break from TB'. On watching the video, "ah, there it is. Okay, we're still here." Thanks for the reliability, John. Also as much as talking about TB at dinner parties might not be the best choice, talking about campaigning to end TB (and our efforts in that) is a Big Hit at dinner parties. DFTBA, y'all.

My dad is in that ladder category- now his cancer is CLL, but when he gets to stage two, he knows that's it for him. I'm happy your brother has a different kind and can afford the treatment and I'm happy you was bringing some light to this issue.

When you said he "lived" in Sierra Leone, I really thought you were going to say he didn't live anymore. Not that he lived not there anymore. Thank you for the story.

My lab has been doing a study where we've developed a new test for detecting Burkitt Lymphoma (BL), which primarily affects children, in Low and Middle income countries (LMICs), currently Tanzania and Uganda, and as part of our study we managed to get various pharma companies to provide the treatments needed to treat BL (with treatment survival rates are 70-90%, without they're near 0%) at a greatly reduced price (either GDP adjusted pricing, or in some cases at-cost).

good god the amount of relief I just felt when you said he's in remission, thank goodness.

Im in awe of this video. You said so much without saying much at all. Thank you

I love when vlogbrothers videos are a dialogue like this, thank you John for this perspective

well I love this. Thank you for sharing such an inspiring story, and thank you for the earnestness and empathy that you bring to the table, this video reminded of the anthropocene reviewed ❤️ you are one of my favourite people.

Wow, just to put it in perspective, the approximate distance between Sierra Leone and Rwanda is 4800km or 3000mi. That is further apart than /any two points in the contiguous United States/. It's about 400km or 250mi further than asking someone to travel between Seattle and Miami. It's a similar distance from Lisbon, Portugal to Baku, Azerbaijan or from Vancouver, Canada to Newfoundland

This one broke me😭 love you two brothers and the stories you bring to me to see the a little more of the hidden world. 🙏

I've been thinking a lot lately about the unsexy but immensely important and difficult work of replicating good systems in additional environments to the ones they originate in. The work of building up a system for treating cancer in a country starting from scratch is monumental, and so few of the people doing it get any renown or attention or even just the resources they need to accomplish the task, even though their work is pretty much as hard as the work the discoverers/inventors/builders did the first time around. Thanks for shining some light on that work in Sierra Leone, John.

Sometimes I get ungrounded and John pulls me back down to earth. I'm sorry so many people don't have access to treatment.

My heart dropped when I saw the video title.

Partners in health is so wonderful.

It is actually terrifying when you are ready to choose death over having cancer. Because of money and all the trauma that your family goes through. My family has seen it first hand and to this day we live in fear of those days when a family member is sick.

I had to rewind to make sure I'd heard correctly. The nearest cancer centre with IV chemo therapy to Sierra Leone is/was in Rwanda!? That is bonkers!

Thank you for having this talk, it was a struggle when I had to get my lumpectomy done. My insurance didn’t cover one penny. I noticed how awful the health system in the country was and ended up going to a third world country to get the surgery. It shouldn’t be so complicated. People are dying from lack of resources not necessarily cancer itself, early detection is crucial.

Indeed. The availability and quality of care makes all the difference.

Thank you for these videos John, they mean so much to me.

Good Morning, John! I am so glad to hear that Mondeh is now NED, and doing well. The (un)availability of care depending on where one is, and how much it costs, is something I think about constantly…

Other brothers got diagnosed at about the same time. I'm glad you still have yours.

John Green. Thank you for your book, The Anthropocene Reviewed. It has encouraged and comforted me! And made me also laugh! Your honest sharing and deep thinking have become a part of my world. I give you and the book five stars!⭐️⭐️⭐️⭐️⭐️

A voice for our common humanity confronting us with the inequities. Moral vision amidst too much distraction. Thank you, John, for your prophetic voice of our shared human condition.

John keeps ‘it’ relevant for this world. Thank you.

I don't know how John does it, but he's made me cry about the healthcare system in Sierra Leone more than I've ever cried about most anything.

So happy for Monday and his recovery. Instead of sending military aid to other countries in order to prove how powerful we are, we could be using that funding for building good healthcare systems in places that truly need it. Rather than displaying force, we can demonstrate kindness and humanitarianism.

It is so heartbreaking to me whenever I think about how many people in our day still die from treatable causes. It breaks my heart to think about how both of my sons likely would have died at birth without the access to medical care that We are privileged to have. my mom died this year of a non-hodgkin's lymphoma despite having access to one of the top hospitals in the world (it was caught very late). But We got nine months with her that We would not have had otherwise. Hank's diagnosis hit very close to home for me, and I am glad that he is doing well.

i don’t know if this is a real career, but i want to go to the countries that don’t have access to cancer treatment and i want to give them that treatment. cancer sucks. it took my grandma from me when i was almost 11 and took my dadi from me before i was born. i don’t want anyone to have to go through this like i did, so i’m going to try my hardest to give these countries as much access to cancer treatment as possible.

I battled Follicular Lymphoma with targeted radiation 3 years ago and IV Chemotherapy for 6 months last year. it was rough. hearing that young man's story makes my battle sound like a walk.

My heart was beating slowly and my breath was in suspension as you told the story of mondey until you said he was getting better. So sad that he had to go thru all this.

Just got my Chizza John today. I’m so happy. It is beautiful.

I hope for equitable health care for all of us in all countries.

If the standards of Care are difernet, the outcomes will be different as well. Then we shall work together to make acsessable better standards of care for more people. It is easier to turn a blind eye. It is harder to do the right thing. To see our common humanity in those who are not us. Thank you for the inspiration and the constant guidance. Its not always easy, but nothing good in life is.

I didn't need to cry on my lunch break but really appreciate putting it into perspective so well, amazing video as always xxx

I have stage 4 synovial sarcoma. If I did not live near a teaching hospital (free care) who had a sarcoma specialist I would have never been given a chance... and here Iam 7 years later. lucky.

If you have a limited budget, it totally makes sense to think about cost-effectiveness. Like if you donate ten thousand dollars, would you want that to pay for one cancer treatment or 500 TB treatments? Cost-effectiveness is totally the right framework to use in that situation. I take John's argument to say that we should massively increase funding for global health, so we don't need to obsess anymore about prioritizing healthcare based on cost-effectiveness.

I literally said, "Oh no," when I saw the title because I thought you were going to say that you had it, too 😭relieved that isn't the case, and thanks for the informative video.

good to see you john. i am glad there is some care in these developing countrys, more would be good, but even roads are an issue in most of them

You can’t go scaring us with that title, John. I appreciate you sharing this story.

These stories are so important - as is the reminder that each story also represents hundreds of others like it (in varying degrees). Without the stories, it's really easy to lump it all together as statistics, which is just math, and numbers can be manipulated in ways that make us feel like the problem went away.

Wow hir me right in the heart John. Thanks.

Inspired me to become a monthly donor to Partners in Health, DFTBA.

Somehow, unshaved graying John Green is most appropriate for the serious topics such as this while more groomed and touched up John Green is a good fit for more light-hearted matters. If only the hair would obey.

The fact that we even think of saving lives in terms of cost effectiveness is truly a damning indictment of modern society. Especially when its a relatively easy thing to cure, like TB or Hodgkin Lymphoma.

We need the Green parents to write a book on how they raised their boys, so we can figure it out and replicate the proceess. The world needs more Greens!

In the same storm but not the same boat

Not first but close HAPPY TUESDAY JOHN. I received my coveted Pizzamas rug last week and placed it at the top of the stairs which lead to my home office, so now every time I ascend to start my work day I have that glaring face rise up in front of me. It’s a great laugh, without fail.

I love these two guys. Thank god for the Greens

Just noticed your Harvey poster in the background for the first time John! Nice addition.

I'm an american with no insurance and i've had an unidentified mass for over a year now. the medical facilities in my area have failed me or outright shunned me, and i don't want to die when i could have lived.

Odd note but I love your jacket! I have the same one and it is super duper comfy.

Back in 2013-14 as a wee little Alex i was skeptical when John and Hank talked about reducing world suck. A decade later, im happy to be wrong. We are indeed reducing world suck and in a far greatsr capacity than young Alex could've dreamt of

john, respectfully that title was terrifying. thankfully was not what i thought it meant. point taken & appreciated though

This is so important.

Your videos really do make the dark times worth it ✨️💜✨️ thank you

Had me there for a second.

just donated to Partners in Health. afterward, in the email receipt, there's a link to a one-question survey of how did you find out about PIH? this video and/or "saw in a RU-vid video" was not an option. But "mentioned by a friend" was, so I chose that one. it was either that or "documentary" - I mean, kinda... anyways, just fyi.

My great uncle died at 34 of hodgkins lymphoma. Doctor was making a house call for his brother in a wheelchair and noticed a lump on his neck, diagnosed him and he was dead relatively soon after. This was in the 80s.

ngl bestie john i was scared this was a john cancer reveal

If you wanted to make me cry, you succeeded. My three types of cancer were diagnosed fairly early, I have been getting treatments since then, and my insurance (for which I pay a lot of money) has covered the cost. My skin color is pale olive and I live in the USA. Nuff said?

This is so important but who else thought this video was John's Cancer announcement

I think John could tie anything back to TB. I'd actually love to see him take some wildly unrelated nouns and connect them back to TB. Tigers, UFC Wimbledon, NASA, I bet he could do it all.

I had an US to check for fibroids in my uterus and thankfully it came back clear, because the $900 copay I still have to pay for that US taught me that if I had cancer, even as an American citizen, I wouldn’t be able to afford treatment and my kids would lose their mother.

Did anyone else see that title and have thier heart drop thinking it was gonna be john having cancer too.

An important reminder of just how lucky the lucky are.

A great video with perspective, so informative.