Friday 2 January 2015

Cancer is Social

Cancer is the best death, apparently. As a medical practitioner and former editor of the British Medical Journal, one supposes Dr Richard Smith knows what he's talking about. His argument is almost philosophical, making the case that a long descent into the grave allows for the wrapping up of one's personal affairs and prepares friends and family for life after you. Considered in isolation from the traumatic experiences this disease causes millions of people every year, I suppose there's a certain logic to it. Though I'm not too sure about "wasting" billions on curing cancer. The pharmaceutical industry and its doings are far from unproblematic, but the war against disease is a good war. It should be up to individuals when to call it a day after all.

Published simultaneously was a study claiming that the majority (two thirds) of adult cancers are the results of bad luck. You have wonky genes, or one of your stem cells might slip up somewhere. It is, however, worth noting that we're talking *types of cancer* here, not cancers in total.

As Owen points out, cancer - like a great deal of disease - has been individuated. The rise of lifestylism and the markets that feed it are constantly reinforcing the message that health is a matter of personal responsibility. If you don't want cancer, then eat well, do your exercise, and avoid smoking, boozing, and fatty foods. Treat your body like a holy shrine, not a drip tray catching the run off from a revolving hunk of doner meat. That's the hegemonic set of ideas washing about health policy, public health discourses and the common sense of lifestyle gurus. Contrasting the biologically random chance of cancer puts paid to some of the guilt tripping this industry, for that is what it is, thrives on. That, however, only goes so far. Cancer is social.

Take Stoke-on-Trent, for example. According to the 2012 Public Health Report for the city, it is the 16th most deprived local authority area in England (out of a possible 326). 60.3% of people live in areas among the top 25% most impoverished areas in the country. About half of that (31.3% of total Stokies) lived in the top ten per cent of most deprived communities. In 2008-10, the life expectancy for men in Stoke was 76.2 and women 80.2, whereas for England as a whole it was 78.8 and 82.6 respectively. Of the main causes of death in 2011, 72.9% was made up of respiratory disease, circulatory disease, and the biggest was ... cancer. It accounted for 31.7% of total mortality across the city. The equivalent figure for England is 28.1%. Among the under-75s, the average cancer mortality rate per 100,000 was 141.6. A historic low, but significantly greater than the same statistic for the country as a whole (112.5). There's considerable variation within the city too. In Meir Park ward the rate was 78.4 whereas Bentilee and Ubberley returned a figure 0f 191.8. The difference? Wealth. If you live in a wealthier area, you're a third more likely to survive a cancer diagnosis.

As befits the age, the story our culture tells about cancer is one of individuals battling against the disease, as per Stephen Sutton, or folks rallying around to to raise awareness. What it refuses to talk about the bigger picture, how diagnosis and survival is very much linked to one's material circumstances. The danger is talk of cancer being entirely random disappears the awful truth: that regardless of type it is mediated by social conditions. That makes the war on cancer more than just a medical matter. It's a political question too.


Vinyl Miner said...

I think the classic case study was between Bearsden and Drumchapel, a ten minute walk from each other, total difference. Unfortunately I only know Labour Activists from Bearsden and none from The Drum. Show my friends and family this and they say Bloody English. 30 Years ago Drumchapel was Red.

Anonymous said...

Cancer can be a very painful death; I don’t think most people take the time to tidy up their affairs, creating a countdown to their inevitable death including a detailed calendar with key dates and events (Tuesday – must sort out my insurance!). I think most try to fight the disease and hope they get cured.

I also don’t think loved ones prepare for the inevitable death either; again they hold out hope for a cure.

Maybe the doctor is inadvertently highlighting the general lack of personal planning in an individual’s life, whether sick or not, and from this follows the social choices people have to make. The rich man has far more options than the poor man.

Phil said...

Looking at the map of Stoke, Vinyl, one of the shocking stats I espied was how different cancer diagnosis and survival rates were one either side of a single road!

Phil said...

Indeed, Anon. His was an abstract idealisation that would have jarred with nearly everyone who's had to deal with the awfulness of a cancer diagnosis, whether in themselves or a loved one. GIven his tone I doubt his area of specialism was oncology.

Anonymous said...

Regarding "I'm not too sure about "wasting" billions on curing cancer" ... the proper recognition of the "inner workings" of the "war on cancer" fully supports the notion that this fight to find a cure is a big scam (read the afterword of this article on the war on cancer: ). The war on cancer is mainly a political issue, and not a medical issue.

BCFG said...

I can imagine that in a capitalist system the need to make a huge dollop of cash outweighs a proper strategy in tackling cancer; however there does appear to have been progress in treatment and survival rates, so despite the inadequacies it would seem to be wrong to say the whole thing is a scam.

It would also appear that average life expectancy and almost every other health indicator has improved over the years, and that improvement seems to be down to an attitude that believes improvements can be made. From this point of view it may be prudent to ignore Dr Smith, and if he can’t be ignored it may be prudent to attack his ideas, even if they have some modicum of truths.

I would also be wary of fully embracing the ‘bad luck’ thesis, I am not aware there is any evidence that 2/3 of cancers are caused by bad luck can be substantiated, so it appears to be reckless speculation at best.

As suggested in this article and in other criticisms, bad luck attempts to ignore all the social factors that contribute to health outcomes. If I were a suspicious type I would say it was designed to lower people’s expectations and blind them to the affects of social factors, overwork, pollution, poverty, stress etc etc etc. If I was suspicious I would also wonder if this is the science that accompanies austerity. Whenever the ruling class embark on some project or another they usually find some science to conveniently provide the justification.

They will be telling us that working til we drop is good for us next, oh hang on they are already trying that:

Vinyl Miner said...

The sad thing is where the social divide can be identified by a road as in Stoke, things get worse. The road itself takes on the role of a barrier to the oppressed on one side and to the enfranchised on the other it is defensive wall around a successful community. Here a form of social osmosis takes place as the more energetic members of the struggling community drift towards the successful one. As this happens resources from the oppressed area are transferred to the wealthier group and the articulate and energetic community activists move on to be replaced by the Poverty Pimps. In a reverse move the poorer members of the affluent community, whether through sickness, low wages or other reason, move to the oppressed area. A reprolertisation of the sick and mentally ill, a viscous circle.

Phil said...

That is precisely the problem, BCFG. A lot of medical science pretends acts as if epidemiology and public health have never existed and not been pointing out the relationships between poor health and social environments for decades. This is a particular bugbear of mine as I see it time and again in the claims made for genetics and neuroscience.

Phil said...

Indeed, Vinyl. Having worked for the local MP and dealt with casework from that part of the city, I can tell you that those on the "better off" side of the road are very, very conscious to be seen as something apart from the estate opposite.