Cancer in the News

Two separate articles about cancer hit the news recently, both of which elicited a strong reaction. One was about the occurrence of certain types of cancer often being due to chance rather than environment or lifestyle, and the other about cancer being the “best” way to die.

Reactions to the first article range from “dangerous viewpoint” “irresponsible” “garbage in, garbage out” “nihilistic” “bad science” to “smoke away” “time to binge” “told you so”. The article was published by researchers at John Hopkins University in Science, a top-tier peer reviewed journal. Although that does not automatically mean that the study is correct, it does imply that the study has been reviewed and vetted by people a lot more knowledgeable than myself and the typical commenter. It is irresponsible to dismiss a study as “garbage in, garbage out” or “bad science” simply because the implications do not fit one’s worldview.

Speaking of implications, what exactly are they? The typical strawman conclusion is that a healthy lifestyle doesn’t matter. However, that is not at all what the study concluded. The study stated that about 1/3 of the cancers studied could be attributed to genes and environmental factors. It did not look at all cancers (notably breast and prostate cancers), nor at other medical conditions, such as diabetes, which are very much linked to lifestyle. Not everyone gets cancer (much less the subset studied), not all cancers are incurable, and not all deaths are due to cancer. The “dangerous viewpoint” seems to be a kneejerk reaction to an imagined conclusion, a simplistic caricature of what the study actually says. Even at face value, putting the many obvious benefits of a healthy lifestyle aside, isn’t it worth it to improve one’s chances, even if the potential is a fraction of 1/3?

Reactions to the second article seem even more extreme, and mostly negative. Dr. Smith uses Mr. Bunuel, a well-planned end-of-life cancer case, to argue that compared to the other ways of dying, cancer is preferable. It gives the patient an opportunity to reflect and wrap up. Dr. Smith did not say that cancer is good, or that dying is good, a concept many of the commenters seem to be unable to grasp; he did make a case that out of all the different ways to die, cancer is less bad than the others.

We all must face death, and not enough of us have thought about it as carefully as we should. It is an event that greatly affects many, something too important to ignore because of a visceral aversion.  It’s not like we’re getting out of this alive.

Let’s see if an analogy can help take the visceral reaction out of the equation. If one were to be downsized from a company, would it be preferable to be given a month’s notice so one could tie up loose ends and handover work in progress, to be fired on the spot and escorted to the door immediately, or to gradually have your salary cut and be abused by supervisors until you leave in disgust?

End-of-life is not so cut and dry. Cancers, treatments, and circumstances vary widely, and perspectives are very different. A doctor is trained to be detached out of professional necessity, and it seems to be this perspective that most of the commenters find offensive. The commenters seem unaware that Dr. Smith has likely seen more cancer deaths than them combined, and a view from that perspective is probably worth considering with one’s brain rather than dismissing with one’s gut. I largely agree with this first portion of his post – I would choose time and manageable pain over sudden death.

I cannot agree with the last sentence, however. He states, “…. and let’s stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death”. Even in the context of his post, it is difficult to see how such a blanket statement could be considered reasonable. He specifically said not to waste money trying to “cure cancer” – not drugs with astronomical cost but merely extend suffering by a month or two, which would have been a more defendable position. Yes, a blog post is meant to be informal, but this is something that should have been taken out or properly qualified before hitting the “post” button.

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