Luck, cancer, me, and you

A colleague of mine wanted to implement an idea put to him by one of his friends, when faced with a pile of CV’s  – a hundred or more – belonging to job applicants. He would throw them in the air, and then chuck half of the randomly scattered CV’s in the bin. He knew he didn’t want to employ them, because “they’re the unlucky ones. I don’t want unlucky people”.

A neat circular argument, and actually, when you think about it, a correct one. They are indeed unlucky. In fact, the best argument against the scheme is to say that ‘luck’ as a personal attribute, irrespective of its ubiquity in everyday speech, doesn’t actually exist.

...his luck ran out
…his luck ran out

A tricky one. Napoleon famously said “I know he’s a good general, but is he lucky?”, which suggests that he did view it as a personal quality. He muddied the waters a bit by expanding in a subsequent conversation: “All great events hang by a hair, I believe in luck, and the wise man neglects nothing which contributes to his destiny”. Which suggests that the ideal, where someone is so fortunate they can sit around without making any practical efforts, probably didn’t entirely convince Bonaparte either. This chimes with the associated famous quote of Gary Player, which everyone knows, “the harder I practice, the luckier I get”.

This is on a day when the papers have latched on to the tantalising concept that most people who get cancer are just…unlucky.  All those bad habits – and a few good ones  – usually aren’t involved.

This unlucky thing makes sense, at first. The scenes out of Breaking Bad, or the British TV ads that show the bad news being delivered – you’ve got a tumour – are pretty close to the mark. Not a moment you forget.  And yet, there is another perspective. Richard Smith was the editor and (former) clinician who transformed the august British Medical Journal into the public health/global warming obsessed lefty house rag that it is today. After accomplishing that he then amusingly skipped off into the enormous international private healthcare business. For all his faults though, he’s not an idiot, and he’s just got himself into some trouble with the counterintuitive (at first sight) observation that getting cancer could actually be a lucky thing. The caveat, perhaps, is it depends how old you are. Here’s the Daily Mail quote:

Death from organ failure – respiratory, cardiac, or kidney – will have you far too much in hospital and in the hands of doctors. ‘So death from cancer is the best… You can say goodbye, reflect on your life, leave last messages, perhaps visit special places for a last time, listen to favourite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion.

‘This is, I recognise, a romantic view of dying, but it is achievable with love, morphine, and whisky. But stay away from overambitious oncologists, and let’s stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death.’

As it happens, I blogged on this a bit last May. Smith has a point. The original BMJ blog is beautifully observed, and well worth reading, as is the thoughtful response after he’d endured his 10 minutes of gleefully overhyped public indignation, and a Twitterstorm. As I write, I can report that the acute takes in my hospital are crammed with elderly people with variable degrees of cognition, multiple pathologies and travelling from care home to hospital, then back again. Many are in their nineties. There is such a thing as living too long.

A semi-detached clinician like Smith, then, gives a valuable ‘alternative’ perspective. Two economists of sorts provide more. Christopher Snowdon of the Institute of Economic Affairs has a brilliantly acerbic blog which performs the truly valuable function of skewering numerous self regarding ‘public health’ initiatives and propaganda. Here he is musing on the bad luck argument versus the ‘ban everything’ crowd:

This is really just another way of imparting the same information. ‘Large minority of cancers caused by lifestyle factors’ is no different to ‘Most cancers not caused by lifestyle factors’ except in its emphasis…….But the change in emphasis is very significant. The Boxing Day story was inspired on a Cancer Research UK press release whereas today’s report is based on a study published in Science. Moreover, the CR-UK press release gives a much higher estimate of how many cancers are lifestyle related. It attributes more than 40 per cent to lifestyle factors (smoking, diet and drinking, mostly) whereas the new study finds that only a third of cancers are due to lifestyle factors, environmental factors and hereditary factors combined.

None of this is to decry cancer research or cancer medicine, but a more philosophical overview has its place. We’re all going to die eventually, as Richard Smith eloquently notes. Tim Worstall, something of a polymath, offers a counterweight,  in this blog from the invaluable Adam Smith Institute:

But we’re afraid that it’s still an insane thing for anyone to say that we should not try to cure cancer. The mistake is akin to that made by so many of the slower thinkers about market interactions. Sure, if there’s only one single market interaction then as game theory tells us the incentive is to rip off the other party. But most market interactions are not one off transactions, they’re simply a part of a number of iterations of the same transaction. In which case the incentive is to cooperate to mutual advantage.

Looking to cancer the assumption being made is that OK, once suffered from one should simply fold one’s tent and steal away into that long dark night. Which is to entirely ignore the fact that as cancer treatments get better it’s possible to have a series of iterations. That first, that skin cancer, say is treated and two decades later the luck of the draw brings on, say, colon cancer which may or may not be treatable. The whisky and heroin option taken at that first iteration would then have robbed one of that 20 years of life. It’s entirely possible that cancer is that “good death” but surviving one or two brushes with it before succumbing would be even better.

This post began with luck, and ends with it. Worstall again:

It’s necessary not to starve to death, avoid being eaten by sabre toothed tigers, not get smallpox, for long enough for those multiplying cells to go wrong. Something is going to get you and the later, whatever it is, the more luck you’ve had.

...here's one I made earlier. Genuinely.
…here’s one I made earlier. Genuinely.

 

 

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