Why are we asking this now?
Discussion of a “cure” for cancer has hit the news as scientists announced that they had found cancer’s “Achilles heel”. Like many other treatments, the new development offered a hint at a full cure for the diseases, and a glimpse at a world without cancer.
But hoping for such a world — and spending the billions of pounds that go on research towards it — might be wrong, according to Dr Richard Smith. Dr Smith — a former editor of the British Medical Journal — caused controversy when he suggested in late 2014 that cancer is the "best death" and that we should "stop wasting billions trying to cure it".
Many of the people who would be stopped from dying of cancer would go on to die of other problems, likely far worse, soon after, he said. And spending on cancer research could perhaps be more effectively used to reduce poverty and tend to the many other problems that afflict humanity.
Why wouldn’t we want to cure cancer?
There is little dispute that working to prevent and treat cancer — and help people live longer, healthier lives — is valuable work. But Dr Swift’s thinking about cancer points out some of the other effects that process has, which also includes a prolonging of life in a way that doesn’t necessarily bring happiness to patients, he says.
Much of the work that has been done already has turned cancer into “more like dying of frailty”, Dr Smith says. “So it goes on and on.
“The period between when you develop your cancer and when you die of it, becomes a very long period during which you gradually deteriorate away.
“Extending the idea of an unhealthy life? Is that progress?”
But what if we could rid the world of cancer entirely? What would a world without cancer look like?
Cancer tends to be a disease of older people. More than three-quarters of people who die from cancer are 65 years or older, and more than half of them are 75 or older.
Lots of the people who die from cancer would probably die from one of a number of other afflictions soon after, Dr Smith said.
The world has made a huge amount of progress towards prolonging human life, some of which has included work on cancer. But that has come with what is called the “compression of morbidity” — people’s lives are lasting longer, but more and more of that extra time is spent in ill health.
Half of people who died between 90 and 95 have dementia. If we stopped people dying from cancer, other such problems await them — and would likely take their life soon after.
What would people then die of?
There are about four main ways to die, says Dr Smith.
Perhaps the most popular is the sudden death. But that is mostly people’s preferred choice for themselves — for others it leaves behind no goodbyes, and potentially plenty of things that need to be sorted out.
In fact, without cancer most people would die through dementia or frailty. But that is not a fate that many would wish for, and is an expensive state to be in.
There is also the possibility of heart failure, or respiratory failure. But that is a messy death, says Dr Smith, and one that it is hard for people to face.
Cancer, on the other hand, usually takes place over a manageable period of time: a period of weeks or months, not of years or seconds.
“So death from cancer is the best,” wrote Dr Smith, in a blog post that prompted 2,000 comments on the Daily Mail’s website alone. “You can say goodbye, reflect on your life, leave last messages, perhaps visit special places for a last time, listen to favourite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion.”
What else could we do?
The huge amount of resources that are invested in cancer research could instead be used to improve people’s quality of life, Dr Smith says. The only people that seem able to escape some of the effects of the “compression of morbidity” are those who belong to a higher socio-economic class — and we might do better investing so that more people can partake in the benefits.
“The difference in life between the rich and the poor is 20 years; maybe we’d do better concentrating resources on trying to help poorer people.”
We might also spend more money on making the most of the information that is already gained, rather than seeking to get more, he said.
“There’s a huge gap between what we could do if we implemented everything we know, and what we do now,” said Dr Smith.
Ultimately much of the work now might be harming those that benefit from it, he says.
“Undoubtedly there are developments in treating cancer,” says Dr Smith. “But a lot of them are incredibly expensive drugs which prolong life for just a few weeks — and that is on a population level, which means there are many people for whom they don’t prolong life at all.”
Dr Smith refers to studies where people have stopped receiving treatment for cancer and instead been moved to palliative care — those people have often lived for longer than those that are receiving aggressive treatment.
“That’s not surprising — some of these treatments are toxic. So the quality of life can often be very low.”
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