Have you ever wondered what illness you would prefer to die of? Cheerful of me, I know. But I’ve been thinking about this since a leading medical writer, Dr Richard Smith said we should stop wasting billions trying to cure cancer because it is the best way to go.
His intervention last week was met with predictable outrage from charities and campaign groups who pointed out that dying from cancer was pretty horrid, thank you very much.
But Dr Smith’s point was that if you compare it to the alternatives, cancer is not the worst thing that can happen to end your life, given that something has to. Think about it. If you survive cancer or don’t get it at all, then you’re going to have to die from something like dementia, or organ failure. And organs don’t fail that quickly nowadays, with modern medical advances.
Not many people get to have one of those heart attack in the night jobbies, so they go to sleep and don’t wake up after a nice dinner, a glass or two of red and a couple of episodes of Law and Order. And if you can’t have that, or fall under the proverbial bus and die instantly, the options are all a bit unappetising.
Dr Smith, a former editor of the British Medical Journal, pointed out in a controversial BMJ blog post that terminal cancer gives you a little while to get your affairs in order and say your goodbyes, so long as you ‘stay away from overambitious oncologists’, who presumably will want to blast you full of chemotherapy and experimental cures that make you wish you had never been born, never mind that you are on your way out.
I guess his theory is that it’s the alleged cure and not the cancer itself that makes for the worst of the unpleasantness.
I’m not convinced I agree completely. I’m pretty sure I would allow doctors to destroy my DNA with nitrogen mustards or some of the other nasties used in chemo if that is what the experts were saying was the only way of saving my life. The human will to survive is a ferocious thing. Even when you are old, the desire to keep going doesn’t always melt away. Question: Who would want to live to be 100? Answer: Someone who is 99.
But I do still think Dr Smith has a point, because whilst our desire to defeat all illness might be instinctive, it cannot be seen as realistic, ultimately, and would, after all, lead to a couple of billion people too many being on the planet if we had our way.
Put in the right perspective, therefore, dying from one of the 100 diseases which come under the umbrella name of cancer, and which involve abnormal cells growing out of control, could be seen as a perfectly reasonable way to go.
More than three out of five cancers are diagnosed in people aged 65 and over, after all. For most people, increasing age is the biggest risk factor for developing cancer. In general, older people (those over 65) are far more likely to develop cancer than younger people (those under 50).
Excepting those tragic cases where it strikes down young people because of environmental damage or genetic abnormalities, cancer could easily be viewed as part of the body’s in built signing off process.
Instead, we have chosen to denounce it as an aberration, to scorn it and brand it as evil. Cancer is the imposter, the invader. We put it in the stocks and throw rotten tomatoes at it. We boo and hiss and declare that we need to work harder to batter it into submission.
It fills us with fear and loathing because we have chosen to see it as the enemy.
Of all the illnesses we might take issue with, only cancer motivates us to produce television commercials with stirring music that conjure something of a Blitz spirit, in which we use the imagery of war to mobilise a spirit of national resistance.
Take the current advert for Cancer Research UK: ‘We will do whatever it takes. We will work even harder. There will be dark days. But we will all keep fighting. And together we will beat cancer.’
Something about that strikes me as egotistical. Treat cancer, sure. But what are we really saying when we declare that we want to ‘beat cancer’? Perhaps what we mean is that we want to beat death.
Does our fear of cancer mirror our fear of our own mortality? More than any other disease, there is something about cancer that channels our horror of the idea that we are all going to die, whether we like it or not.
Since the Egyptians discovered it and the Greeks mapped it as being like a crab or carcinos, we have feared it above all other illnesses because it seems to conjure the idea of an enemy within. Of something alien growing inside us.
Perhaps what we really need is a calm scientific narrative explaining the disease in purely clinical terms.
But over the years the language applied to cancer medicine has consistently conjured the emotional idea of a global, militaristic style operation to contain something truly horrifying.
In 1913, fifteen physicians and businessmen in New York City founded the American Society for the Control of Cancer (ASCC), for example.
In this country, the political campaign against the disease involves groups such as Britain Against Cancer, which holds an annual conference at Westminster.
No other disease seems to bring out this campaigning zeal or bellicosity. We never talk about waging war on heart disease, or diabetes, or stroke.
When was the last time you saw a big budget TV advert by a medical charity claiming it was going to leave no stone unturned until it found a cure for alcoholism?
‘There will be dark days ahead. But together we will stop people drinking themselves to death.’
You don’t see any such thing, of course. We have personified cancer alone into a fire-breathing monster who will surely come for us all unless we get on board the swash-buckling mission to cut its head off.
As such, cancer sufferers are not just sick people, they are warriors.
They are expected to put up a good fight and do their bit for the cause. Ideally, they ought to start a new charity and do fun runs. Or if they can’t, then their friends and family should.
That is all very well if a sufferer wants to be belligerent, brave and bolshie. But what of the news in a study last week that 65% of cancers are the result of genetic cock-ups that couldn’t be avoided and are nothing to do with lifestyle choices. No amount of campaigning will change that. It seems to bolster the theory that if anything, a lot of cancer is simply fate, the voice in the sky calling ‘Come in number…! Your time is up!’
Another down side to the idea of fighting cancer, is that necessarily there will be those who do not win, who lose their battle, who might even give up voluntarily and surrender. How do we view them?
A dear family friend in her 70s who was diagnosed some years ago with a very aggressive cancer has been trying to remain in her home. She has had to fight against the establishment view that she should either have a Macmillan nurse or go into a hospice. She doesn’t want either. She is coping just fine. Her friends and neighbours bring her shopping. Her son visits as often as he can. She really is perfectly happy with the situation, she has tried to explain. She does not want to be processed any further. There is no more militaristic campaigning to be done. I admire her.
It is only because we have been encouraged to see cancer in such a belligerent way that we cannot conceive of people settling down to make their peace with it.