Try Red Pepper in print with our pay-as-you-feel subscription. You decide the price, from as low as £2 a month.More info ×
Obituaries routinely inform us that so-and-so has died ‘after a brave battle against cancer’. I’m waiting for the day I get to read one that says so-and-so has died ‘after a pathetically feeble battle against cancer …’
One thing I’ve come to appreciate since I was diagnosed with multiple myeloma (a cancer of the blood) two years ago is how unreal both notions are. It’s just not like that.
The stress on cancer patients’ ‘bravery’ and ‘courage’ implies that if you can’t ‘conquer’ your cancer, there’s something wrong with you, some weakness or flaw. If your cancer progresses rapidly, is it your fault? Does it reflect some failure of willpower?
In blaming the victim, the ideology attached to cancer mirrors the bootstrap individualism of the neoliberal order, in which ‘failure’ and ‘success’ become the ultimate duality, dished out according to individual merit, and the poor are poor because of their own weaknesses.
It also reinforces the demand on patients for uncomplaining stoicism, which in many cases is why they’re in bad shape in the first place. Late diagnosis leads to tens of thousands of avoidable deaths in the UK each year. It also accounts for much of the discrepancy between UK cancer survival rates and those in France. And for those who are diagnosed and undergoing treatment, a reluctance to complain inhibits the vital flow of information between patient and doctor and thereby obstructs recovery.
Earlier this year, Barack Obama vowed to ‘launch a new effort to conquer a disease that has touched the life of nearly every American’. In so doing, he was intensifying and expanding a ‘war on cancer’ first declared by Richard Nixon in 1971. For all the billions subsequently spent by the US, British and other governments, progress in that ‘war’ has been fitful.
The age-adjusted mortality rate for cancer is about the same in the 21st century as it was 50 years ago, whereas the death rates for cardiac, cerebro-vascular and infectious diseases have declined by about two-thirds. Since 1977, the overall incidence of cancer in Britain (discounting increases caused by an ageing population) has shot up by 25 per cent.
The ‘war on cancer’ is as misconceived as the ‘war on terror’ or the ‘war on drugs’. For a start, why must every concerted effort be likened to warfare? Is this the only way we are able to describe human cooperation in pursuit of a common goal? And who are the enemies in this war? Cancer cells may be ‘malignant’ but they are not malevolent. Their ‘abnormality’ is as much a product of nature as the ‘normality’ of other cells. Like the wars on drugs and terror, the war on cancer misapplies the martial metaphor to dangerous effect. It simplifies a complex and daunting phenomenon – making it ripe for political and financial exploitation.
In the war on cancer, the search for the ultimate weapon, the magic bullet that will ‘cure’ cancer, overshadows other tactics. Nixon promised a cure for cancer in ten years; Obama promises one ‘in our times’. But there is unlikely to be a single cure for cancer. There are more than 200 recognised types of cancer and their causes are myriad. As a strategic objective, the search for the ultimate weapon distorts research and investment, drawing resources away from prevention and treatment, areas where progress has and can be made.
Thanks to collusion between industries and scientists, it took decades for the truth about tobacco and asbestos to come out. For the same reason it will probably take many more years for us to learn the truth about other cancer-causing agents in our environment. In 2007, 6 per cent of cancer deaths in the UK (10,000) were caused by occupational exposure to carcinogens. In cases such as these, what’s needed is a revolution in our tawdry health and safety regime, not new drugs.
As for ‘lifestyle’ factors, they are part of the wider environmental and social background of cancer, not a separate category applying to individuals with inadequate willpower. The context of any ‘lifestyle’ choice is a mix of opportunity and deterrence, economics and culture, personal circumstances and social conditions. A real general attack on the causes of cancer would require industrial, consumer and environmental reforms on a vast scale, not scapegoating those perceived as shirkers and deserters in a holy war.
Thankfully, as the incidence of cancer has risen, so has our ability to treat it. Survival rates have doubled in the past 30 years, with almost half of those diagnosed with cancer living for five years or more. This is less about drug breakthroughs than early diagnosis, improvements in care, and refinements in existing treatments. Today, what’s preventing cancer patients from living longer and more happily is mainly a failure to apply existing best practices universally.
The biggest single boon for people living with cancer would be the elimination of inequalities in health care. In England and Wales, over the period 1986-1999, the ‘deprivation gap’ in survival between rich and poor became more marked for 12 out of 16 male cancers and nine out of 17 female cancers examined.
Opportunists and vultures
Like other wars, real and imagined, the war on cancer is a gift to opportunists of all stripes. Among the vultures are travel insurers who charge people with cancer ten times the rate charged to others, the publishers of self-help books and the promoters of miracle cures, vitamin supplements and various ‘alternative therapies’ of no efficacy whatsoever.
But most of all, there’s the pharmaceutical industry, which manipulates research, prices and availability of drugs in pursuit of profit. And with considerable success. The industry is the UK’s third most profitable sector, after finance and tourism, with a steady return on sales of some 17 per cent, three times the median return for other industries. Its determination to maintain that profitability has seen drug prices rise consistently above the rate of inflation. The cost of cancer drugs, in particular, has soared.
The industry claims high prices reflect long-term investments in research and development (R&D). But drug companies spend on average more than twice as much on marketing and lobbying as on R&D. Prices do not reflect the actual costs of developing or making the drug but are pushed up to whatever the market can bear. Since that market is comprised of many desperate and suffering individuals, it can be made to bear a great deal.
The research that this supposedly funds is itself warped by the industry. When it comes to clinical trials of their products, they engage in selective publication and suppression of negative findings and are reluctant in the extreme to undertake comparative studies with other products.
Exorbitant drug prices are at the root of recent cancer controversies over the National Institute of Health and Clinical Excellence (NICE)’s approval of ‘expensive’ cancer drugs (notably Revlamid, a therapy that can extend life in the later stages of a number of cancers, including mine) and top-up or ‘co-payments’ (allowing those who can afford it to buy medicines deemed too expensive by the NHS).
‘We are told we are being mean all the time but what nobody mentions is why the drugs are so expensive,’ says NICE chairman Michael Rawlins. ‘Pharmaceutical companies have enjoyed double-digit growth year-on-year and they are out to sustain that, not least because their senior management’s earnings are related to the share price.’
An end to win or lose
Many cancer therapies are blunt instruments; they attack not only cancer cells but everything else in sight. This is one reason people fear cancer: the treatment can be brutal. Making it less brutal would be a huge stride for people with cancer. And that requires not a top-down military strategy, with its win-or-lose approach, but greater access to information, wider participation in decision-making (across hierarchies and disciplines) and empowerment of the patient.
Because I live in the catchment area for Barts Hospital in central London, I find myself a winner in the NHS postcode lottery. The treatment is cutting-edge and the staff are efficient, caring and respectful. What’s more, I live close enough that I can undergo most of my treatment as an outpatient, a huge boon.
Cancer treatment involves extensive interaction with institutions (hospitals, clinics, social services, the NHS itself). Even in the best hospitals, the loss of freedom and the dependence on anonymous forces can be oppressive. Many cancer patients find themselves involved in a long and taxing struggle for autonomy – a rarely acknowledged reality of the war on cancer, in which the generals call the shots from afar.
As Susan Sontag noted, in the course of the 20th century cancer came to play the role that tuberculosis played in the 19th century; it is a totem of suffering and mortality, the dark shadow that can blight the sunniest day. But the ubiquitousness of cancer in our culture is of dubious value to those living with the disease. The media love cancer scares and cancer cures; they dwell on heroic survivors (Lance Armstrong) and celebrity martyrs (Jade Goody). But as Ben Goldacre has shown in his essential ‘Bad Science’ column in the Guardian, the media grossly misrepresent research findings, conjuring breakthroughs from nothing and leaving the pubic panicked, confused or complacent.
For those living with cancer, now and in the future (and that’s one in three of the UK population), the biggest threat is the coming public spending squeeze. Cuts in NHS budgets and privatisation of services will mean more people dying earlier from cancer and more people suffering unnecessarily from it. Even better survival rates will become a curse, as responsibility for long-term care is thrown back on families. A real effort to reduce suffering from cancer requires a political struggle against a system that sanctifies profit – not a ‘war’ guided by those who exploit the disease.
Nick Dowson looks at the new wave of co-ops and community groups where people are building their own truly affordable homes
Hsiao-Hung Pai meets people affected by the fire, and finds sadness and suffering mixed with a continuing wariness of the official investigations
Chris Williamson MP, winner of the election's tightest marginal, Derby North, and recently reappointed shadow minister for fire services, talks to Ashish Ghadiali about Jeremy Corbyn, the housing crisis and winning from the left
The Corbyn-supporting group is preparing for another election at any moment, writes Adam Peggs – and now has the potential to create powerful training initiatives, union links and party reform efforts
’We believe in you. We are with you. We will never forget.’ Grenfell solidarity sweeps East London in mass banner drops from housing estates
Michael Calderbank profiles Jeremy Corbyn's new supporters in parliament
The Democratic Republic of Congo (DRC) continues to witness devastating political violence, but the world refuses to act. Ishiaba Kasonga and Serge Egola Angbakodolo ask why?
When fire safety has become a privilege for the rich, it’s time to stop austerity and fund emergency mass works to raise standards immediately, writes Jane Shallice
Interview: Queer British Art
James O'Nions talks to author Alex Pilcher about the Tate’s Queer British Art exhibition and her book A Queer Little History of Art
Cable the enabler: new Lib Dem leader shows a party in crisis
Vince Cable's stale politics and collusion with the Conservatives belong in the dustbin of history, writes Adam Peggs
Anti-Corbyn groupthink and the media: how pundits called the election so wrong
Reporting based on the current consensus will always vastly underestimate the possibility of change, argues James Fox
Michael Cashman: Commander of the Blairite Empire
Lord Cashman, a candidate in Labour’s internal elections, claims to stand for Labour’s grassroots members. He is a phony, writes Cathy Cole
Contribute to Conter – the new cross-party platform linking Scottish socialists
Jonathan Rimmer, editor of Conter, says it’s time for a new non-sectarian space for Scottish anti-capitalists and invites you to take part
Editorial: Empire will eat itself
Ashish Ghadiali introduces the June/July issue of Red Pepper
Eddie Chambers: Black artists and the DIY aesthetic
Eddie Chambers, artist and art historian, speaks to Ashish Ghadiali about the cultural strategies that he, as founder of the Black Art Group, helped to define in the 1980s
Despite Erdogan, Turkey is still alive
With this year's referendum consolidating President Erdogan’s autocracy in Turkey, Nazim A argues that the way forward for democrats lies in a more radical approach
Red Pepper Race Section: open editorial meeting – 11 August in Leeds
The next open editorial meeting of the Red Pepper Race Section will take place between 3.30-5.30pm, Friday 11th August in Leeds.
Mogg-mentum? Thatcherite die-hard Jacob Rees-Mogg is no man of the people
Adam Peggs says Rees-Mogg is no joke – he is a living embodiment of Britain's repulsive ruling elite
Power to the renters: Turning the tide on our broken housing system
Heather Kennedy, from the Renters Power Project, argues it’s time to reject Thatcher’s dream of a 'property-owning democracy' and build renters' power instead
Your vote can help Corbyn supporters win these vital Labour Party positions
Left candidate Seema Chandwani speaks to Red Pepper ahead of ballot papers going out to all members for a crucial Labour committee
Join the Rolling Resistance to the frackers
Al Wilson invites you to take part in a month of anti-fracking action in Lancashire with Reclaim the Power
The Grenfell public inquiry must listen to the residents who have been ignored for so long
Councils handed housing over to obscure, unaccountable organisations, writes Anna Minton – now we must hear the voices they silenced
India: Modi’s ‘development model’ is built on violence and theft from the poorest
Development in India is at the expense of minorities and the poor, writes Gargi Battacharya
North Korea is just the start of potentially deadly tensions between the US and China
US-China relations have taken on a disturbing new dimension under Donald Trump, writes Dorothy Guerrero
The feminist army leading the fight against ISIS
Dilar Dirik salutes militant women-organised democracy in action in Rojava
France: The colonial republic
The roots of France’s ascendant racism lie as deep as the origins of the French republic itself, argues Yasser Louati
This is why it’s an important time to support Caroline Lucas
A vital voice of dissent in Parliament: Caroline Lucas explains why she is asking for your help
PLP committee elections: it seems like most Labour backbenchers still haven’t learned their lesson
Corbyn is riding high in the polls - so he can face down the secret malcontents among Labour MPs, writes Michael Calderbank
Going from a top BBC job to Tory spin chief should be banned – it’s that simple
This revolving door between the 'impartial' broadcaster and the Conservatives stinks, writes Louis Mendee – we need a different media
I read Gavin Barwell’s ‘marginal seat’ book and it was incredibly awkward
Gavin Barwell was mocked for writing a book called How to Win a Marginal Seat, then losing his. But what does the book itself reveal about Theresa May’s new top adviser? Matt Thompson reads it so you don’t have to
We can defeat this weak Tory government on the pay cap
With the government in chaos, this is our chance to lift the pay cap for everyone, writes Mark Serwotka, general secretary of public service workers’ union PCS
Corbyn supporters surge in Labour’s internal elections
A big rise in left nominations from constituency Labour parties suggests Corbynites are getting better organised, reports Michael Calderbank
Undercover policing – the need for a public inquiry for Scotland
Tilly Gifford, who exposed police efforts to recruit her as a paid informer, calls for the inquiry into undercover policing to extend to Scotland
Becoming a better ally: how to understand intersectionality
Intersectionality can provide the basis of our solidarity in this new age of empire, writes Peninah Wangari-Jones
The myth of the ‘white working class’ stops us seeing the working class as it really is
The right imagines a socially conservative working class while the left pines for the days of mass workplaces. Neither represent today's reality, argues Gargi Bhattacharyya
The government played the public for fools, and lost
The High Court has ruled that the government cannot veto local council investment decisions. This is a victory for local democracy and the BDS movement, and shows what can happen when we stand together, writes War on Want’s Ross Hemingway.
An ‘obscure’ party? I’m amazed at how little people in Britain know about the DUP
After the Tories' deal with the Democratic Unionists, Denis Burke asks why people in Britain weren't a bit more curious about Northern Ireland before now
The Tories’ deal with the DUP is outright bribery – but this government won’t last
Theresa May’s £1.5 billion bung to the DUP is the last nail in the coffin of the austerity myth, writes Louis Mendee