Cancer - The right aim, the wrong approaches

Posted by Alexander Hay

New research claims that lifestyle changes can prevent cancer, but falls into the usual trap of moral hectoring, undermining any useful contribution it could make

Cancer is certainly a medical and social issue - but should it be a moral one?If the medical profession has any vice (apart from smoking and golf), it is a tendency to wag its fingers at its patients. In part, this ties in the mutely reverential relationship we have with doctors in the UK, but it is also a self-defeating enterprise, not least because it alienates those most likely to benefit.

The latest example of this is a report identifying lifestyle as a major cause of cancer:

Nearly half of cancers diagnosed in the UK each year - over 130,000 in total - are caused by avoidable life choices including smoking, drinking and eating the wrong things, a review reveals.

Tobacco is the biggest culprit, causing 23% of cases in men and 15.6% in women, says the Cancer Research UK report.

Next comes a lack of fresh fruit and vegetables in men's diets, while for women it is being overweight...

It's actually rather obvious, though the more research that is undertaken means the more likely a better understanding of the processes that lead to cancer can be found. The problem, however, is that not that the wrong answers will be found (it's hard to doubt that smoking doesn't tend to kill you, for example), but the reception to those findings. Put simply, a creeping, moralising tone has entered the debate once more:

...The president of the Royal College of Physicians, Sir Richard Thompson, said the findings were a wake-up call to the government to take stronger action on public health.

"The rising incidence of preventable cancers shows that the 'carrot' approach of voluntary agreements with industry is not enough to prompt healthy behaviours, and needs to be replaced by the 'stick' approach of legislative solutions," he said

The government said it was intending to begin a consultation on plain packaging by the end of this year...

So rather than using science to better inform people, the response continues to be a prelude to ever greater intrusion into our lives and our choices. What is meant by 'legislative solutions' is dictating what is acceptable or non-deviant by a higher authority. In a sense, public health then has replaced the church as the mainstream source of what is right and wrong, normal and 'other'.

Nor does the report take into account the impact of living conditions, background and socio-economics on health. In a sense, it doesn't have to, being as it is directed towards finding direct links between a cause and the result. This is, nonetheless, a blinkered perspective.

As has been noted, the poorer you are and the more rundown your postcode area is, the less likely you are able to eat healthily and the more likely you are to drink, smoke and eat the wrong things. Grow up in a place where there is nowhere safe to play and where the local school hasn't the time, means or inclination to give you any physical education, and your likelihood of contracting cancer and other diseases is higher than in richer, healthier areas.

This, however, doesn't sit well with the moralising mission of medical politics. which doesn't just want to make us healthier but ensure we behave ourselves at the same time. Its roots lie in a necessary Victorian paternalism that was finally fully realised with the founding of the NHS, and which now no longer has enemies like infectious disease and malnutrition to rail against.

Desperate to justify itself, this urge to heal society has become distorted and authoritarian, with lifestyle and personal responsibility its new mantra. It is all rather patronising and sinister. But also profoundly self-defeating - no one likes being told off, and one has to wonder whether the shrill tone of medics gets in the way of the obvious value their findings reveal.


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Alexander Hay

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