Cancer has been in the news a lot recently. In the last few days, there have been separate reports in the newspapers about the high cost of some cancer drugs, and the prediction by a national charity that there will be a crisis of unmanageable proportions in the NHS due to the record number of people with cancer. But there were two reports that appeared over the Christmas period that caught my eye.
The First Report
The first was a story in The Independent (31 Dec 14) with the headline ‘Cancer is the best death – so don’t waste billions trying to cure it, says leading doctor’. The story originated from Dr Richard Smith, a former editor of BMJ (previously the British Medical Journal), who had argued that cancer allowed people to say goodbye and prepare for death and was therefore preferable to sudden death, death from organ failure, or ‘the long, slow death from dementia’ adding ‘let’s stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death’.
My initial reaction was to think that whilst having cancer in later life might to some be preferable to developing dementia, what of people who die of cancer much earlier in life: children and young persons, parents with young children, or just someone who happens not to even reached their 40s? What of people who die quite suddenly of cancer, within months rather than years? Another concern was about the drugs and treatments that alleviate the symptoms of cancer rather than cure it? Is it similarly misguided to incur these costs? With the prospect of us all living longer, the increasing cost of healthcare is a big challenge so perhaps Dr Smith was only joining the debate on how far can we fund these costs.
The Second Report
The second story, on the BBC News website (2 Jan 15), which had the headline ‘Most cancers types just bad luck’, came from American research, unspecified, saying that ‘new research has suggested that most types of cancer are the result of bad luck, rather than an unhealthy lifestyle or genetic factors’.
My first thoughts was to question who had suggested that a large proportion of cancers were related to lifestyle anyway. Of more concern was the notion of ‘bad luck’ as if there was nothing we could do about it. I didn’t think that scientific research recognised bad luck. There is surely a mechanism, a cause, to everything in the natural world even if the processes are beyond the limits of our current knowledge. But perhaps I don’t know enough about random events. Further, I found myself thinking that if lifestyle wasn’t the cause of two-thirds of cancers, that perhaps lifestyle wasn’t relevant either in the treatment or survival of the disease. This would of course be nonsense. Keeping fit through regular exercise or healthy eating is a vital part of managing ill-health, including cancer. And this is so even if our knowledge of exactly what it is in particular foods that makes it a good food or a bad food is imperfectly understood, given the immense difficulty of scientifically trialling particular foods.
I decided to look into the sources of these stories. How accurate was the reporting? Is the science behind the stories much more complicated than how they are presented? Are readers being misled?
Health in the Headlines
But it was not just these stories about cancer. Every newspaper seemed to run at least one quasi-scientific story each day about how to live longer or eat more healthily, or the latest cures for cancer, dementia, heart disease etc. Here are some of the headlines that I found over the last month or so:
‘Keeping cold could keep you thinner, scientists say’ (The Independent 8 Jan 15)
‘Porridge helps to protect against heart disease’ (Daily Express 8 Jan 15)
‘High blood pressure? Eat like a Viking’ (Daily Telegraph 7 Jan 15)
‘The secret of eternal youth: skin-tight Lycra and a bicycle’ (The Independent 6 Jan 15)
‘Could a pill containing Viagra cure illnesses from Ebola to brain cancer, hepatitis to MRSA? (Daily Mail 5 Jan 15)
‘Chips may cause cancer’ (Daily Mail 4 Jan 15)
‘Junk food may not be dangerous for a quarter of people, says scientists’ (Daily Telegraph 2 Jan 15)
‘Scientists crack why red meat is linked with cancer – and sugar may be to blame’ (Daily Mail 30 Dec 14)
‘Lifestyle changes ‘could protect 80,000 from dementia’ (Daily Telegraph 21 Dec 14)
‘Is ibuprofen the key to anti-ageing? Study finds painkiller extends life of flies and worms by equivalent of 12 human years’ (The Independent 19 Dec 14)
‘Tamoxifen could protect women from cancer for 20 years if taken daily (Daily Telegraph 11 Dec 14)
‘Oranges could fight cancer, new study reveals’ (Daily Express 8 Dec 14)
‘Mediterranean diet ‘slows ageing’ – and could even help you live longer’ (The Independent 3 Dec 14)
‘HIV drug ‘dramatically slows spread of prostate cancer’ (Daily Express 1 Dec 14)
Looking through these headlines, and they are a selection from only four newspapers – no magazines were covered – it’s worth pointing out that headlines claiming that scientists have found a ‘breakthrough’ drug or warnings that particular foods are dangerous, such as the Viagra, Ibuprofen and Chips stories above, are often based on laboratory experiments, particularly on mice, whose genetic material is 95% similar to our own. This is quite different from claiming that research results are applicable to human beings. In the case of potentially new drugs, results from laboratory research may be very encouraging but their effectiveness, safety and eventual approval will depend on the outcome of human clinical trials. And the time between the two, even if every stage is passed successfully, can be many years.
Science Stories Exaggerated
By co-incidence there were reports in the press a few weeks before the above two stories appeared, about a study into how the media reported science stories. One was headlined ‘Bad science reporting blamed on exaggerations in university press releases’ (The Independent 10 Dec 14).
The study, led by Professor Petroc Sumner of Cardiff University, looked at 462 press releases issued by 20 leading British universities in 2011. It found that 40% of press releases contained exaggerated health advice, 33% contained exaggerated claims about cause-and-effect, and 36% contained exaggerated inferences to humans from research on animals, compared with the corresponding peer-reviewed journal articles. And that contrary to expectations most of the hype detected didn’t arise in the media but was already present in the text of the press release produced by academics and their establishments. Professor Sumner said that university press offices have to perform the difficult job of promoting new findings and the scientists involved. A newspaper readership is not going to be interested in the dry articles published in an academic journal. ‘We probably have to accept there will have to be a balance, but this should be no excuse for exaggeration and hype’ Professor Sumner added.
A fuller account of the study which was published in the BMJ on 10 December 2014, can be read in the Guardian Online here.
So what did the research behind the ‘Cancer is the best death’ and the ‘Most cancers types are bad luck’ actually say?
The ‘Cancer is the Best Death’ Story
The story from Dr Richard Smith, former editor of the BMJ, was not in the medical journal itself but was actually what he had written in the BMJ blog online. Though some of the newspapers picked up that it was blog post, the fact that it came from such an apparently distinguished figure, meant that I had overlooked, at least at first, that it was just a point of view, and not a scientific report. In his article, which can read in full here, Smith explains that when he asked audiences how they want to die, most people chose sudden death, to which he replied ‘That may be OK for you, but it may be very tough on those around you, particularly if you leave an important relationship wounded and unhealed’. His blog continued:
If you want to die suddenly, live every day as your last, making sure that all important relationships are in good shape, your affairs are in order, and instructions for your funeral neatly typed and in a top drawer … 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.
The article prompted a critical response. It was only a few days earlier that the death at the age of 36 had been announced of Kate Gross, a head of an international charity and a former senior political aide. She had died of colon cancer and had left a husband and two twin boys aged five. In an article in the Daily Telegraph (4 Dec 14), Peter Stanford (read the full article here) speaks about his family, many of whom had died young and/or after long illnesses, including cancer. He argued that what Dr Smith is saying is that people dying of cancer, having been told that they have only months left, would have to find the strength of character to use that time well, to banish their doubts, weaknesses and terror of oblivion, in favour of making the most of every hour that is left … what an unbearable pressure to place on them!
As a result of the criticism of his article, Dr Smith posted a response on the BMJ blog (read the full article here) saying that he was sorry to upset many people who have a bad experience of somebody dying of cancer, that it wasn’t his intention; he was writing for the BMJ and so primarily for doctors. His main intention was to urge people to think much more about death and dying because he was convinced that will be good for all of us and for our society. Among the many points he then made, was recognition that dying of cancer can be a horrible death, and is particularly tragic when a child or young person died and that he had written a much calmer and more measured piece on ‘A Good Death’, which some might like to read. His central point was that as you have to die of something, it’s a question of the least bad alternative, and that we seemed to have reached a point where some behave as if death is not inevitable, and there is a sense that medical research and doctors are launched into a misguided attempt to defeat death.
He acknowledged that one reason why his blog attracted so much attention was his dismissive final comment on wasting money on cancer research. He had meant we might get a better return on our investment by spending less on cancer and more on the many other areas of research like neurological and mental health issues, and unglamorous areas of research such as health systems and nursing. Finally, he returned to the point that we should all think about our deaths, and we should all, old and young, have advance directives (living wills) that specify our wishes about the end of life.
My thoughts on Dr Smith’s original article was that he ought to have thought more carefully about what he wanted to say before he put pen to paper. The headline to the blog ‘Dying of cancer is the best death’ certainly didn’t help, and the more useful points that Dr Smith did make were lost in the adverse reaction that his article had provoked.
The ‘Most Cancers Types Just Bad Luck’ Story
The source of the second story was a research paper by Bert Vogelstein and Cristian Tomasetti of Johns Hopkins University in Baltimore, USA, which was published in the journal Science on 2 January 2015. The title of the paper was ‘Variation in cancer risk among tissues can be explained by the number of stem cell division’, but the press release from the university was titled ‘Bad Luck of Random Mutations Plays Predominant Role in Cancer, Study Shows’ and the summary by the editor of Science ended:
This suggests that random errors occurring during DNA replication in normal stem cells are a major contributing factor in cancer development. Remarkably, this ‘bad luck’ component explains a far greater number of cancers than do hereditary and environmental factors.
To understand science behind this story was quite hard going, but the researchers in a further press release did provide an analogy to put their results in perspective which can be read here.
Following the press release, Cancer Research UK published a forthright response on its science blog titled ‘Cancer ‘mainly bad luck’? An unfortunate and distracting headline’.
The response explained that the researchers had found a mathematical relationship between the rate that stem cells divide in a tissue (stem cells are specialised cells which renew and replenish the tissues in our bodies), and the rate of cancer in that tissue, and that according to the researchers the maths could explain two-thirds of the variation between different tissues as being due to chance, but Cancer Research UK then quoted a Professor Spiegelhalter:
This may be a fairly reasonable statement to make about population rates in different tissues, but of course it says nothing about variation in risks between individuals, and it certainly does not say that two-thirds of cases are just luck.
Cancer Research UK also said that the study had another weakness: it only looked at cancer types where there was hard data about the rates of stem cell division, and this excludes two of the most common cancers: breast cancer and prostate cancer.
Cancer Research UK concluded:
There are a whole host of things that affect the chances of DNA damage developing in a dividing cell which are not simply random mutation, so to ascribe a particular patient’s cancer to ‘bad luck’ is essentially impossible. It’s a combination of myriad influences, some of which we can control, others which we can’t.
It seems a huge shame that something that is, as far as these things go, established scientific fact – that cancer rates are affected by lifestyle – has been called into question.
You can read Cancer Research UK’s response in full here. The response includes quite a number of links to others who agreed that the research was flawed. One link was to a scathing criticism of the research on The Guardian website titled ‘Bad luck, bad journalism and cancer rates’ which can be read in full here. Unfortunately, there’s quite a bit of maths involved so I won’t attempt an explanation. Having read the article several times though, I can’t work out if The Guardian is saying that journalists are at fault or the American researchers, or both.
So what conclusions have I reached? Quite a few, but I don’t think they are very profound.
- Health headlines are invariably written to attract readers. Longer articles usually deserve more attention than short ones.
- If a health story is of interest, find the source of the story and read that if it’s not too technical, or see if it is reported in more detail somewhere else. Don’t get bogged down by the story, since if it stands up, it will be in the news again sooner or later.
- Be wary of headlines about medical breakthroughs or warnings that certain foods are dangerous as the research is often based on laboratory experiments which is not at all the same as clinical trials on humans
- Even if a story comes from someone in the medical profession, it may not be as a result of medical research, it may just be their point of view.
- Be aware that health stories in the press may have been exaggerated, and not just by media, but in the press releases from the research institutions themselves.
You may not know what lies ahead, but healthy eating and exercise remains the best way to maximise your chance of a long and healthy life, though don’t overdo the porridge. And you don’t have to wear the Lycra.