No, cancer is not the “best death,” and curing cancer would be anything but a waste of resources

Medical research is a scientific enterprise, but, like most areas of science, nonscientific considerations have a great deal of influence over what sorts of research are funded. This is true regardless of who is funding the research. When it’s the government, obviously it’s impossible to avoid some degree of politics. (Indeed, politics is largely responsible for why the National Center for Complementary and Integrative Health, or NCCIH, even exists and has been studying quackademic medicine for over 20 years.) The same, however, is true when it comes to foundation funding. Some foundations are better than others at raising money, of course, but it goes beyond that. Foundations can basically disperse grant money based on any criteria they like to whomever they like, and they don’t have to explain their criteria if they don’t want to. Then there’s the issue of some diseases drawing a lot more money than others. Breast cancer advocates, of course, are very successful at garnering funding, while, for example, pancreatic cancer advocates are a lot less so, even though pancreatic cancer is considerably more deadly than breast cancer.

Of course, people deciding to donate money to various medical research charities are free to decide where they will donate their hard-earned money based on whatever criteria they wish. Most of the time, I have little to say one way or the other about how people decide to donate to medical research. This time, however, I make an exception. The reason is that I’ve seldom come across an article so simultaneously misguided and vile as I saw popping up on Facebook in the form of an op-ed published in The Independent yesterday. It’s by Richard Smith and entitled I’ll never give money to cancer research charities – cancer is the best death and curing it would be a waste of time. Rarely have I seen a justification so depressingly callous and stupid at the same time.

The ugliness starts right in the first couple of paragraphs. No, wait. It starts in the title that says that “cancer is the best death and curing it would be a waste of time.” At first, I was willing to give Smith the benefit of the doubt, knowing that rarely do writers come up with headlines for their articles. It’s usually the editor who does that. But then I saw these paragraphs and saw that the first couple of paragraphs in the article weren’t the most vile after all:

“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? I mean, seriously? WTF? Cancer has been the “best death.” Has Smith ever actually seen a loved one die of cancer? I have. What happens to people who die of cancer before the end? Let me educate Mr. Smith a moment. I’ve written of this before, but that was seven years ago; so I don’t think it’s too soon to repeat and paraphrase it.

Dying from cancer can mean unrelenting pain that leaves you the choice of being drugged up with narcotics or being in agony.

Dying from cancer can mean unrelenting vomiting from an uncorrectable bowel obstruction. It can mean having a nasogastric tube to drain your digestive juices and prevent you from throwing up. Alternatively, it can mean having to have a tube sticking out of your stomach to drain its fluids.

Dying from cancer can mean bleeding because you don’t have enough platelets to clot. The bleeding can come in many forms. It can be bleeding into the brain, in essence a hemorrhagic stroke. It can mean bleeding from the rectum or vomiting blood incessantly. And, because so many transfusions are all too often necessary, immune reactions can chew up new platelets as fast as they’re infused. Yes, paradoxically, even when a cancer patient’s immune system is suppressed in late stage cancer, frequently it does work against the one thing you don’t want it to: Transfusions of blood products.

Dying from cancer can mean horrific cachexia. Think Nazi concentration camp survivor. think starving Africans. Think famine. Think having cheeks so sunken that your face looks like the skull underlying it. Just Google Steve Jobs or Patrick Swayze before their deaths.

Dying from cancer can mean your lungs progressively filling with fluid from tumor infiltration. Think choking on your own secretions. Think a progressive shortness of breath. Think an unrelenting feeling of suffocation but with no possibility of relief.

Dying from cancer can mean having your belly fill with ascites fluid due to a liver chock full of tumor.

Dying from cancer can mean so many other horrific things happening to you that they are way to numerous to include a comprehensive list in a blog post, even by me.

Given these various unpleasant ways to die, I would actually argue that what Smith dismisses as a failure is actually a great success. Many cancers are, more and more, becoming chronic diseases to be managed. We might not be able to cure them, but we can manage them, like diabetes. Let’s take the example of metastatic breast cancer. It’s becoming increasingly common for these women to live years with their disease—and with decent quality of life, as well. Smith seems to think that such resources are wasted. In fact, he makes an argument so ludicrous and offensive that I can’t believe he seriously thought it was a good idea to put this idea down to paper:

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.

To which I answer: Nonsense. Curing cancers and eliminating cancers are two entirely different things, which Smith seems to be disingenuously conflating. I mean, seriously. Does Smith realize how bad this argument is, how risible? Curing cancer means eliminating it after it has developed. That means the “human” developed cancer, which means that all the flaw in our growth was still there and the processes that depend on growth—growth—aging, regeneration, healing, reproduction—are all still there. In other words, there is nothing about curing cancer that makes us less human. Smith’s argument is a truckload of fetid dingos’ kidneys.

But, hey, doesn’t all of medicine carry a “terrifying utopian odour of trying to achieve human perfection”? What about those vaccines that build that “artificial” immunity that has prevented untold millions of babies and children from dying of vaccine-preventable diseases? Or what about those antibiotics that have allowed so many people survive diseases that killed their ancestors in droves? Or what about insulin, which allows diabetic children who wouldn’t have made it to adulthood 90 years ago to live long and productive lives? What about surgery for congenital heart defects, like Tetralogy of Fallot, which guaranteed death in childhood? What about every medical advance that ever prolonged life and alleviated suffering going all the way back to the time of Hippocrates? What is medical science but a utopian pursuit of human perfection?

What’s wrong with trying to achieve human perfection, anyway? It’s a goal we all know we can never reach, but reaching for it drives improvements in medicine that relieve suffering and prolong life.

Unfortunately, Smith plumbs new depths of bad arguments:

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.

Once again, Smith is disingenuously conflating two things. In this case, he’s conflating single cancers treated for cure with all cancer. Take his example of a child with leukemia who is treated successfully. That child can indeed be said to be cured of his leukemia. It’s gone. It’s not coming back. This child, of course, will grow up. Perhaps in his elder years he will get a cancer more typical of old age, such as colon cancer. So, from that perspective, yes, “cancer is always there, lurking,” but it isn’t the same cancer that was actually cured. That a person successfully treated for cancer remains at risk for developing another cancer is trivially true but meaningless as an argument. One might just as well argue that we shouldn’t treat a person for pneumonia because,that person might one day develop pneumonia or another infection again, thanks to the ever-lurking bacteria—which, by the way, are every bit a part of being “human” as aging and death, given how important our microbiome is, as we are now understanding more and more.

The vileness doesn’t end here, either:

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.

Look, I understand the problem we frequently face with cancer. Treating it is expensive. Many of the new treatments and drugs that we come up with to combat various cancers only prolong life by months, an observation that brings up legitimate questions about the value of some very expensive drugs. However, just because some areas might be underfunded is not a good argument not to donate any money to cancer research or to declare cancer research to be not worth spending more money on, as Smith does. There’s also a not-so-subtle ageism in his argument, which argues in essence that we shouldn’t bother wasting resources on old people dying of cancer? No, that’s not a straw man, either:

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?

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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.

Yes, but so your chances of developing atherosclerotic coronary artery disease (a.k.a. heart disease for short), and heart disease kills more people than cancer, at least for now. One wonders if Mr. Smith thinks we shouldn’t waste money researching heart disease. Granted, heart disease is a bit of an easier problem, involving as it does only one organ system, but it is primarily a disease of old people.

As for whether the aim is the avoidance of aging, come on. The aim is avoiding particularly unpleasant ways of dying. It’s not as though scientists don’t know that we all have to die of something and that if one cause of death is eliminated or drastically reduced, people will die of something else. As I like to say, life is a sexually transmitted fatal disease. None of us gets out of here alive. Sure, it’s possible that the results of cancer research might also be applicable to improving longevity, but so what? Humans have been using science to push back against the inevitability of death since time immemorial. If that weren’t the case, many, if not most, of us wouldn’t make it to adulthood because we’d be felled by various nasty infectious diseases. Indeed, a mere few hundred years ago in London, roughly 65% of those born did not make it to adulthood because they died of childhood infectious diseases, for an average life expectancy of 27. Of those who did make it to age 25, only half lived beyond around 53 years of age, and only about one third made it to age 60.

When I first read this abomination of an article, it didn’t click who Richard Smith is. Then I saw his identity pointed out. This Richard Smith is a former editor of the BMJ, and he wrote something similar for the BMJ blog on New Years Eve 2014 in which he proclaimed that “dying of cancer is the best death” that’s “achievable with love, morphine, and whisky.” In it, he said basically the same thing as in this article. Apparently he’s learned nothing from the backlash against his original article.

It’s not unreasonable to discuss or question prioritization of research funding, nor is it unreasonable to express an opinion that cancer research doesn’t provide as much bang for the buck as we would like. I disagree now, given that after several decades we’ve finally developed the tools to make a real impact on cancer. Indeed, death rates from several cancers are falling; the age-adjusted death rate from breast cancer, for instance, has been steadily decreasing, down over 25% since 1990. Unfortunately, Smith clings to a romantic view of dying from cancer that is not rooted in reality or actual experience and remains utterly tone deaf in how expresses his view. I just hope he never has the opportunity to put his romantic view of death from cancer to the test.