- Richard Smith, chair, UK Health Alliance on Climate Change
King: Good morning. This King Charles. I’m sorry to ring so early, and I’m sure that you’re surprised to hear from me. You’ll know probably that I’ve had cancer diagnosed, and by a strange coincidence while I was waiting in the hospital an aide brought to my attention the blog you posted yesterday about the meaning of cancer.1 As you may guess, I’m a man who likes to think about the big picture of everything, including cancer. That’s why I’m ringing you.
Richard: I’m honoured. The first thing I need to say is that I’m sorry that you’ve had cancer diagnosed. It’s always a shock no matter how much you might be expecting it. The second thing I must say is that my blog was based on a book Making Sense of Cancer: From Its Evolutionary Origin to Its Societal Impact and the Ultimate Solution by Jarle Breivik, a cancer researcher and doctor. He points out that having cancer is tied up with being human and that we can never get rid of cancer without getting rid of our bodies.The book is well worth reading, especially if you are interested in the big picture. Indeed, as you’ve put cancer in the spotlight—well, even more in the spotlight—you might recommend others to read the book. It hasn’t had the attention it deserves. You might also read and recommend The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee, an oncologist. He too describes how “cancer is us,” and his title shows how in the battle of diseases for pre-eminence cancer wins easily. Your time will be much better spent reading them than listening to lots of witless witterings in the media.
King: I should have more time for reading. Do you mind me asking if you have had cancer?
Richard: Well, I have. and I haven’t. In a literal sense I have—because I had a basal cell carcinoma removed from my chest.2 But nobody dies of a basal cell carcinoma, and my cancer was removed within a couple of hours of me having it diagnosed. You’ll know that when people think of cancer they think of the big cancers that can kill you—lung, pancreas, bowel, breast, and prostate. Would you mind if I was critical of you?
King: Not at all. A critical friend is the best kind of friend.
Richard: Well, I applaud you for letting the world know you have cancer. An announcement avoids the awful thing of some people knowing, some not knowing, and some knowing and not being sure whether they should do. It also dampens speculation and makes clear that there is nothing unusual about getting cancer: half of us will. But I think that you’ve made a mistake in not announcing the type of cancer. You will know that there are many sorts of cancers, all with different prognoses and treatments, and that they can be at different stages. By not announcing the type you’ve reinforced the misunderstanding that cancer is one disease. You’ve also left open the possibility that you might be either right as rain or dead in a few weeks.
King: I see your point, but you must understand that my advisers, a conservative lot, didn’t want me to say what I had at all. Others have made the same point as you, and we’ll have to think some more. Now, I know you’re not a practising doctor, but have you any thoughts on treatment?
Richard: My first thought is that you should not rush into anything. There is an exaggerated idea that days, even hours matter when treating cancer, but that’s generally not true. Your treatment is likely to be a long haul, and you should take time to consider the best path. You are likely to come under pressure—from doctors, family, public opinion, and the media—to go for aggressive treatment. You might be thought a wimp if you don’t—oh, there’s another book for your reading list: Because Cowards Get Cancer Too by John Diamond. But aggressive treatment may not be the best treatment—even if your aim is to put quantity ahead of quality of life. You should talk with a range of doctors and with patients who have opted for different kinds of treatment. My guess is that quality of life will be more important to you than quantity, and you should make your decision accordingly. We know that many people are overtreated at the end of life and as a result spend much of the time they do have in the clutches of doctors, hospitals, operations, and drugs rather than out in the Scottish glens where I suspect you’d rather be.
King: Thank you for that. I’ve cared for nature all my life, and I know that cancer is treated with poisons. Is there a relationship between the treatment of cancer and the environment?
Richard: I know that you have been concerned about the planet, the future of humanity, and justice far longer than most people—and you should think of your cancer in that context. There is a good chance that you will have treatment with very expensive drugs, not all of them poisons, which will keep you alive far longer than would have been the case if you developed your cancer even a decade ago. That treatment will add to the damage to the planet through all the carbon consumed in treating you and the waste generated. Many of the plastics and drugs end up in the rivers and sea. Most people in the world will not have access to such treatment. Indeed, many, the majority, don’t even have access to opiates and basic palliative care at the end of life. You’ll read in Jarle Breivik’s book how, despite all the investment in cancer research and treatment, we have more cancer than ever—because cancer is a disease of old people and it’s one of the ways we are programmed to die. Clearly a combination of ever more cancer and expensive, environmentally damaging treatments is not sustainable for either the planet or sickness systems.
King: Well thank you. I hadn’t thought of that but will now. I’ll discuss it with my doctors and advisers. I’m interested to find a way to develop something positive out of this bad news. Bye bye.
