Cancer – Up Close & Personal

I’ve long understood that cancer was the second biggest killer of both men and women in the world today and that, as deaths from heart disease continue to fall, cancer is well on its way to number one position. What I did not fully grasp until recently was the scale of the grim reality of what that represents in human versus demographic terms.

My wife of some twenty years is an extraordinary woman in many respects, not least because she is a four-time survivor of breast cancer. She started far too young, so only had one bout on my watch, as recently as 2004. But apart from her history of cancer, until her fourth recurrence after a 20-year interval, cancer had not impinged directly on my life directly as I now find it does.

In the last year or so no less that eight family or close friends whom I have known getting on for 30 years have either succumbed to or have battled against cancer. Three men and five women, four of them with breast cancer.

All eight are, or were, pretty much contemporaries of mine give or take five years either way. That is to say, two war babies and six baby boomers. These demographics conform to the fact that cancer is primarily a disease of older people, rising sharply for those in their 50s, peaking through their 70s to fall back slightly in their 80s. With the exception of breast cancer, which peaks much earlier for women aged 25-49 continuing high thereafter, the cancers that strike older people are different than for the under fifties, comprising lung, bowel and prostate cancers in the main. My particular cohort consisted of four breast cancers, three bowel cancers and one melanoma. Of the eight, two of the men have succumbed, to colon cancer and melanoma respectively, while one of the women died from breast cancer.

I suppose the fact that so many of us fall victim to cancer and the chronic degenerative diseases that kill us in increasing numbers from our 60s onward should come as no surprise. Yet it does. Those of us at this age, who pretty much continue to enjoy good health and try to look after ourselves having survived our youthful excesses, tend to believe we’ll continue an active life well into our 80s and kick the bucket in our early nineties in a quick demise. While that is certainly possible, it is unlikely, unless we are unusually dedicated. We live longer, yes. But we don’t fully take aboard the odds that we are more likely to shuffle this mortal coil after a decade of growing decrepitude, hospitalisation and drugs, while the health care industry strips us of whatever wealth we may have accumulated through our productive years.

It therefore comes as a shock as we lose our friends and loved ones in increasing numbers as we grasp more fully that health demographics apply just as much to ourselves. And those of us who have accompanied loved ones into the belly of the beast that is modern medicine and understand what that involves, get a salutary wake up call.

Most of my particular cancer cohort were open to alternative treatment yet in the final analysis most of them elected to go the conventional route, combining in varying degrees alternative and adjuvant add-ons. Only one adopted a totally alternative approach, battling his cancer for two years before finally accepting surgery and chemotherapy. Another, who had actually invested in a genetic medicine start-up spent an obscene amount on a new drug costing US$100,000 p.a., yet quickly succumbed to his melanoma. My elder brother, who recently died from colon cancer, used various adjuvant therapies quite extensively, in addition to his chemotherapy, to no avail as the cancer had already metastasized by the time it was diagnosed.

The thing about cancer treatment today, and indeed most chronic degenerative disease, is that patients are forced to choose between conventional medicine and anything else, or what is lumped together and broadly dismissed as ‘alternative’. The problem is this rules out effective scientifically-based functional medicine and clinical nutrition as well as the pernicious and the woo-woo. As a result we are invariably forced to go with the conventional approach for the simple and pressing reason that it is the most likely means of saving us from immediate extinction to the exclusion of our other valid considerations.

This is particularly worrisome when it comes to oncology. Few doubt that chemotherapy saves lives. The medical odds show this. If it did not, one would hope that oncologists could not possibly inflict the pain and suffering that they do on women, and of course men also. But at what cost? Patients who survive their cancer only to have a recurrence or fall victim to other diseases through the destruction of their immune system, is not a desirable result. The problem is treatment is by numbers, not the individual. What’s more, no other therapy is possible while undergoing chemotherapy. Oncology is a distinct and powerful field of medicine and oncologists tend to insist they get first shot. Other treatments, apart from radiology, are not viewed as acceptable options and it is only a very determined patient who can reject chemo for other options and expect to be treated within the medical system. Only at late stage when chemotherapy has been tried and failed is anything else permitted.

Many patients are unhappy about this and fear they may be swapping immediate extinction for a long managed decline to the same destination, as the marvels of modern medicine overcome the challenges along the way until they eventually expire from the rigours of treatment.

The degree of specialization within modern medicine today is both wonderful and a concern. The downside is it can lead to the treatment of symptoms, while not identifying the underlying pathology. A patient has to be unusually on the ball or supported if their life beyond the urgency of immediate treatment is to get a look-in. In theory the need is recognized but too often imperfectly addressed. Ideally such oversight would come from a cadre of super GP’s who would look after us generally but have sufficient expertise to monitor, but not overrule or unduly interfere with, what the specialists need to do.

The frustration of my cancer cohort, and I would say the suffering public at large, is the inability of the medical profession to accept that drugs and surgery are only a part, albeit a very important part, of the solution. If you cannot cure an autoimmune disease, like lupus say, it does not automatically mean that the disease is incurable by other means. Big medicine and the surgeon’s knife may be a vital intervention but it is blinkered and arrogant to dismiss any other scientific approach to healing.

The practice of medicine is many things today; above all it is hugely complex. For doctors it is an intuitive art, a scientific practice and a calling; one, which confers status and often considerable wealth. Anybody who understands the discipline and dedication required to practice medicine effectively will know that both the money and the respect are well-earned. Medicine is also a vast industry with huge political and financial ramifications. It would be naïve to expect that this does not affect patient treatment at many levels.

Doctors, researchers, nurses and technicians all do a difficult job and do it well in the main. The major faults in our medical system are invariably political and financial and can hardly be laid at the door of doctors, unless they are also political lobbyists - which some of them are.

The fault with doctors, if fault there be, is the perception much of the public has that as a profession they have drawn their remit to broad or too narrow, depending on the point of view. Too broad, in that they defend their patch and stand on their prerogatives too staunchly for the general good. Too narrow, in that they seek to exclude or unduly restrict the contribution that scientists, researchers, nurses and other responsible health givers can legitimately and usefully provide.

A more informed and generous approach on this score would not only free up the resources for a much more effective medical planet and, far from encouraging the proliferation of quacks, crooks and unskilled practitioners of all sorts as they fear, it would put them out of business. Ultimately, who gets treated and how is our responsibility. We get the medical system we deserve.