While my father was dying, in September and October, he and I talked a lot about luck. Modern society is so intent on rationalising everything, he had come to believe, that the role of luck is forgotten.
We’re not grateful enough for our good fortune when things go right; we attribute too much of our success to our own talents. And we are not kind enough to ourselves or others when things go wrong. We forget that bad luck is an inescapable force even in our clever, coddled world.
In the same hospital, a few floors down from my daily vigil at my father’s bedside, the Sunday Times columnist AA Gill was having chemotherapy. Only 62, Adrian died days after he had filed his last, powerful piece about being struck down by what he had called a “full English” of cancer. He wrote the piece in agony, eschewing morphine which he thought was dulling his wits. He was brave enough to say, at one point, that he felt “very lucky” to have enjoyed a great life. But at the end he was desperately, horribly, tragically unlucky.
How much do we make our own luck? One of my friends, on hearing the sad news, asked almost hopefully: “Gill was a smoker, wasn’t he?”
“20% of lung cancer sufferers have never smoked. You can get it through sheer bad luck
With one in two of us likely to get cancer at some point, we seek reassurance that it won’t happen to us. We clutch broccoli stalks like talismans and join gyms in the hope of warding off the evil spirits. And these help to reduce risk, just as giving up smoking does.
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But they don’t eliminate it. Sometimes you just get ill. One of the most moving articles I ever read was by a woman who had lived an extraordinarily healthy lifestyle but still got terminal cancer. She said she felt guilty at having fallen ill, as if she had somehow not done enough to ward it off.
What Adrian came up against was the limits of medical science in coping with a lung cancer that had spread through his body. The chemotherapy failed. The revolutionary new immunotherapy drug that he took privately, because it is not available on the NHS for this type of cancer, didn’t work.
Adrian hadn’t hung around after finding himself struggling to climb a Scottish hill: he took himself straight to a doctor and demanded an instant scan. But it was already too late. The grit with which he’d kicked his alcohol addiction, and later given up smoking, could not save him.
Could it have been different? In his particular case, we will never know. But there is no doubt that Britain could be doing much better in the fight against cancer, especially the lung cancer which first afflicted him.
Lung cancer causes more deaths than any other type. Yet it gets relatively little attention. The chances of surviving breast cancer have improved considerably since the introduction of hard-hitting charity campaigns and the policy of fast-tracking GP referrals for lumps found in the breast. Lung cancer survival rates have not. Part of the reason may be that for every death from lung cancer, about £300 goes into research. For every death from breast cancer, the comparable figure is around £3,000. For leukaemia it is £7,000.
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At the end of his life Adrian came to feel quite angry about this disparity. He felt there was less public sympathy for diseases thought to be self-inflicted, and that this was unfair. Robert Peston, whose wife, Sian Busby, died of lung cancer in 2012 although she hadn’t smoked a single cigarette, feels similarly strongly. One government minister expressed incredulity when Peston told them that Sian had never smoked, saying: “That’s impossible.” But about 20% of lung cancer sufferers have not smoked. You can get it through sheer bad luck.
How we feel about certain diseases matters, because it directly affects the amount of research funding they get. We need to draw much more attention to lung cancer, which is so common.
But that is not the only thing we can change. Speed of diagnosis remains a key reason why outcomes for many cancers in England and Wales lag behind those of so many other western countries.
AA Gill’s story demonstrates the importance of spotting the disease as quickly as possible. When he pitched up at a Harley Street clinic, the doctor recommended he go for a scan on the NHS. The same doctor later said that Gill’s insistence on having a scan there and then at the clinic, rather than joining the NHS queue, was the best decision he had made, because his cancer was so advanced. But what does that say about our creaking system? Few people have the luxury of a Harley Street scan. The vast majority of us will be stuck in the NHS queue.
The problem is exacerbated by the way the NHS was created in 1948, dividing GPs from hospitals. GPs are the gatekeepers to the various tests that can spot cancer, and to the specialist consultants who authorise treatment. Yet most GPs see only seven or eight new cancers a year, and many are very hard to detect.
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Patients are left in a nail-biting limbo as referral letters and test results travel between various parts of the system. Some have to go back again and again to their GP with the same complaint. But cancer, with its especially insidious characteristic of camouflaging itself from the human immune system, does not wait.
As a result, it is hardly surprising that one in five cancers are discovered when someone turns up at A&E, sometimes for an unconnected reason, such as an accident. A tumour is revealed in an x-ray or a scan result, or even on the operating table, when doctors are trying to fix something else.
The Danes, who suffer the highest cancer rate in the world, have had the sensible idea of bringing doctors and tests together under one roof. Cancer Research UK is piloting something similar in parts of the UK. And the government is bringing in new standards to get patients a definitive diagnosis within 28 days of seeing a GP with a suspected cancer.
This is all encouraging. But it is essential that there are enough radiographers to interpret the scans fast enough. At the moment, there aren’t.
Great strides have been made in the past few years. One oncologist I know says that 10 years ago, he expected most of his patients to die; now the majority will live. New treatments are being developed, including the immunotherapy that Adrian wrote about so passionately.
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There is a big question for society about how much we want to spend on expensive drugs to prolong life. If there has to be a priority, I tend to think that it should be earlier detection. But it deserves debate.
If we take nothing else from the passing of a great writer, we should at least feel more compassion for those who have the misfortune to contract the “wrong” type of cancer.
But we should also do everything we can to increase our chances of being lucky. Adrian would not have been saved by a fun run for lung cancer; nor from faster diagnosis. But someone else would. And that should matter to all of us.
Niall Ferguson is away