I never give to people who approach me in the street asking for money to cure cancer. The reasons I don’t give are numerous: we’ll never cure cancer; too much is spent on cancer research and treatment; cancer is a better way die than most others; and the whole enterprise carries a terrifying utopian odour of trying to achieve human perfection.
“Cancer, we have discovered, is stitched into our genome,” writes oncologist Siddartha Mukherjee in his Pulitzer prize-winning history of cancer, The Emperor of all Maladies. “Cancer is a flaw in our growth, but this flaw is deeply entrenched in ourselves….We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes in our physiology that depend on growth—aging, regeneration, healing, reproduction.” In other words, cancer is us. Cure of us of cancer and you cure us of being human.
There are, of course, many cancers, and we must be careful of lumping them all together, although the underlying processes of uncontrolled cell reproduction are the same. The commonest skin cancers can be removed without any threat to life, and deaths from childhood leukaemia have been dramatically reduced in my lifetime. But is cancer ever “cured”? Death may be averted at considerable cost, perhaps at the possibility of being able to reproduce - but cancer is always there, lurking.
In 2014 the UK spent £370m on cancer research, far more than on any other disease category. Compare that expenditure with £109m on mental health or £9m on injuries and accidents, the major killer of young people.
And only cancer has its special fund for treatment, avoiding the rational decision-making of the National Institute of Health and Clinical Excellence (NICE). When it comes to cancer, the emperor of all the maladies, we are downright irrational. The NHS is spending millions keeping people alive for a few more weeks, which may make sense for them but not for society.
“In Glasgow, where I was born, death seemed imminent; in Canada, where I trained it was inevitable; but in California, where I live now, it’s optional,” says Ian Morrison, once president of the Institute for the Future. Death is not yet optional in Britain, and of the four main ways to die—sudden death, dementia, organ failure, and cancer—cancer has been the best. (I know you chose sudden death, but think of those around you—no time to say goodbye.)
I write “has been” because death from cancer is beginning to look like death from dementia or frailty, taking years and years with quality of life slowly draining away. Life expectancy in Britain has increased by 10 years since 1960, but the length of time in ill health has increased more—and can now be over 20 years for women. Is this progress?
What is the ultimate aim of cancer researchers? Most won’t think about this: they are immersed in their particular projects, hoping to achieve further funding—sometimes by hyping their achievements. But somebody ought to think about the long term aim. Could it be immortality?
I hope not in an overcrowded world--because without death, every birth would be a tragedy. Could the aim be the avoidance of aging? That might seem attractive to our profoundly ageist society, where the old are shoved into corners and looked after by underpaid staff, while women in their 50s are expected to look like women in their 20s.
We forget—or may never have fully accepted—that cancer is predominantly a disease of the elderly. Your chances of developing cancer increase exponentially as you age.
Geoffrey Rose, one of Britain’s leading epidemiologists, used to point out that if we were to eradicate death from cancer, life expectancy would rise by less than four years. Yet the difference in life expectancy between the richest and poorest in Britain is around 20 years.
We have much better ways to spend our money than on cancer research – which is why I urge you to spend your charitable donations elsewhere.
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