Richard Smith: Schopenhauer, the Economist, and cancer

richard_smith_2014This morning I’ve read a disappointingly shallow account in the Economist of the attempt to cure cancer and a quote from Schopenhauer that could be sent as a letter to the Economist in response to its articles on cancer.

I’m an admirer of the Economist, but it’s in thrall to technology. I find the science section the weakest in the magazine, and I rarely read it. The articles on cancer argue that it’s only a matter of time before cancer will be cured. It’s true that much has been achieved in the past 60 years in stopping people dying of cancer, but it may be overoptimistic to think that this progress will continue to the point of nobody dying of cancer.

The article makes the almost universal mistake of concentrating on healthcare, failing to recognise that healthcare accounts for only around 10% of the factors that determine how long we live and how much we suffer. But the Economist’s two biggest failings are, firstly and ironically, to hardly consider the economics of it all and, secondly, to think what would happen when cancer was cured.

The point is made that most new treatments for cancer are extremely expensive, but the “opportunity costs” are not considered at all. By spending so much money on expensive treatments we divert resources from activities and investments (education, the environment, housing, community development, social care, the arts, social care, primary care, mental health) that could do much more to lengthen life and reduce suffering—and provide more “meaning.” Plus, if we wanted maximum value from our investments we would concentrate on getting the treatments that do work to those who have no access to them rather than searching for new treatments, particularly as the astronomical costs of those individually tailored treatments will increase inequality, which itself is highly harmful both to those who have and those who have not.

But let us suppose that cancer is cured? What then? We all die of something else, probably dementia or frailty. The length of life may increase, but the period of unhealthy and often dependent life will increase more. The costs of that, both emotional and financial, will be huge.

This is how Schopenhauer puts it—I have added just one phrase in square brackets.

“For whence did Dante take the materials of his hell but from our actual world? And yet he made a very proper hell out of it. But when, on the other hand, he came to describe heaven and its delights, he had an insurmountable difficulty before him, for our world affords no materials at all for this . . . . Every epic and dramatic poem [and programme to cure cancer] can only represent a struggle, an effort, a fight for happiness; never enduring and complete happiness itself. It conducts its heroes through a thousand dangers and difficulties to the goal; as soon as this is reached it hastens to let the curtain fall; for now there would remain nothing for it to do but to show that the glittering goal in which the hero expected to find happiness had only disappointed him, and that after its attainment he was no better off than before.”

Richard Smith was the editor of The BMJ until 2004.

Competing interest: None declared.

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  • Krisantha Weerasuriya

    What was nihilism (on a broader scale) 10 years ago.

    Richard Smith does write on value for money in cancer treatment

    “Plus, if we wanted maximum value from our investments we would concentrate on getting the treatments that do work to those who have no access to them rather than searching for new treatments, particularly as the astronomical costs of those individually tailored treatments will increase inequality, which itself is highly harmful both to those who have and those who have not.”

    Extract from 2007 – “Despite this, the nihilistic thought of crying a halt to drug discovery and spending all that money on ensuring the medicines that are available being used well does flit across our minds. If a fraction of these funds were spent to ensure the proper use of propranolol, hydrochorothiazide, salbutamol, paracetamol, phenytoin sodium, oxytocin (among others), would the return on avoidable morbidity and mortality far outstrip the potential of any new discovery?”

    Published in pA2 of the British Pharmacological Society in 2007 as Clinical Pharmacology in the Developing World; (Alternative – Medicines for the 80%; Clinical Pharmacology in the Developing World),

    Sadly no longer in the Archives.

    Dr Krisantha Weerasuriya
    Former Professor of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka