Medical research is a scientific enterprise, but, like most areas of science, nonscientific considerations have a great deal of influence over what sorts of research are funded. This is true regardless of who is funding the research. When it’s the government, obviously it’s impossible to avoid some degree of politics. (Indeed, politics is largely responsible for why the National Center for Complementary and Integrative Health, or NCCIH, even exists and has been studying quackademic medicine for over 20 years.) The same, however, is true when it comes to foundation funding. Some foundations are better than others at raising money, of course, but it goes beyond that. Foundations can basically disperse grant money based on any criteria they like to whomever they like, and they don’t have to explain their criteria if they don’t want to. Then there’s the issue of some diseases drawing a lot more money than others. Breast cancer advocates, of course, are very successful at garnering funding, while, for example, pancreatic cancer advocates are a lot less so, even though pancreatic cancer is considerably more deadly than breast cancer.

Of course, people deciding to donate money to various medical research charities are free to decide where they will donate their hard-earned money based on whatever criteria they wish. Most of the time, I have little to say one way or the other about how people decide to donate to medical research. This time, however, I make an exception. The reason is that I’ve seldom come across an article so simultaneously misguided and vile as I saw popping up on Facebook in the form of an op-ed published in The Independent yesterday. It’s by Richard Smith and entitled I’ll never give money to cancer research charities – cancer is the best death and curing it would be a waste of time. Rarely have I seen a justification so depressingly callous and stupid at the same time.

The ugliness starts right in the first couple of paragraphs. No, wait. It starts in the title that says that “cancer is the best death and curing it would be a waste of time.” At first, I was willing to give Smith the benefit of the doubt, knowing that rarely do writers come up with headlines for their articles. It’s usually the editor who does that. But then I saw these paragraphs and saw that the first couple of paragraphs in the article weren’t the most vile after all:

“In Glasgow, where I was born, death seemed imminent; in Canada, where I trained it was inevitable; but in California, where I live now, it’s optional,” says Ian Morrison, once president of the Institute for the Future. Death is not yet optional in Britain, and of the four main ways to die—sudden death, dementia, organ failure, and cancer—cancer has been the best. (I know you chose sudden death, but think of those around you—no time to say goodbye.)

I write “has been” because death from cancer is beginning to look like death from dementia or frailty, taking years and years with quality of life slowly draining away. Life expectancy in Britain has increased by 10 years since 1960, but the length of time in ill health has increased more—and can now be over 20 years for women. Is this progress?

What? I mean, seriously? WTF? Cancer has been the “best death.” Has Smith ever actually seen a loved one die of cancer? I have. What happens to people who die of cancer before the end? Let me educate Mr. Smith a moment. I’ve written of this before, but that was seven years ago; so I don’t think it’s too soon to repeat and paraphrase it.

Dying from cancer can mean unrelenting pain that leaves you the choice of being drugged up with narcotics or being in agony.

Dying from cancer can mean unrelenting vomiting from an uncorrectable bowel obstruction. It can mean having a nasogastric tube to drain your digestive juices and prevent you from throwing up. Alternatively, it can mean having to have a tube sticking out of your stomach to drain its fluids.

Dying from cancer can mean bleeding because you don’t have enough platelets to clot. The bleeding can come in many forms. It can be bleeding into the brain, in essence a hemorrhagic stroke. It can mean bleeding from the rectum or vomiting blood incessantly. And, because so many transfusions are all too often necessary, immune reactions can chew up new platelets as fast as they’re infused. Yes, paradoxically, even when a cancer patient’s immune system is suppressed in late stage cancer, frequently it does work against the one thing you don’t want it to: Transfusions of blood products.

Dying from cancer can mean horrific cachexia. Think Nazi concentration camp survivor. think starving Africans. Think famine. Think having cheeks so sunken that your face looks like the skull underlying it. Just Google Steve Jobs or Patrick Swayze before their deaths.

Dying from cancer can mean your lungs progressively filling with fluid from tumor infiltration. Think choking on your own secretions. Think a progressive shortness of breath. Think an unrelenting feeling of suffocation but with no possibility of relief.

Dying from cancer can mean having your belly fill with ascites fluid due to a liver chock full of tumor.

Dying from cancer can mean so many other horrific things happening to you that they are way to numerous to include a comprehensive list in a blog post, even by me.

Given these various unpleasant ways to die, I would actually argue that what Smith dismisses as a failure is actually a great success. Many cancers are, more and more, becoming chronic diseases to be managed. We might not be able to cure them, but we can manage them, like diabetes. Let’s take the example of metastatic breast cancer. It’s becoming increasingly common for these women to live years with their disease—and with decent quality of life, as well. Smith seems to think that such resources are wasted. In fact, he makes an argument so ludicrous and offensive that I can’t believe he seriously thought it was a good idea to put this idea down to paper:

I never give to people who approach me in the street asking for money to cure cancer. The reasons I don’t give are numerous: we’ll never cure cancer; too much is spent on cancer research and treatment; cancer is a better way die than most others; and the whole enterprise carries a terrifying utopian odour of trying to achieve human perfection.

“Cancer, we have discovered, is stitched into our genome,” writes oncologist Siddartha Mukherjee in his Pulitzer prize-winning history of cancer, The Emperor of all Maladies. “Cancer is a flaw in our growth, but this flaw is deeply entrenched in ourselves….We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes in our physiology that depend on growth—aging, regeneration, healing, reproduction.” In other words, cancer is us. Cure of us of cancer and you cure us of being human.

To which I answer: Nonsense. Curing cancers and eliminating cancers are two entirely different things, which Smith seems to be disingenuously conflating. I mean, seriously. Does Smith realize how bad this argument is, how risible? Curing cancer means eliminating it after it has developed. That means the “human” developed cancer, which means that all the flaw in our growth was still there and the processes that depend on growth—growth—aging, regeneration, healing, reproduction—are all still there. In other words, there is nothing about curing cancer that makes us less human. Smith’s argument is a truckload of fetid dingos’ kidneys.

But, hey, doesn’t all of medicine carry a “terrifying utopian odour of trying to achieve human perfection”? What about those vaccines that build that “artificial” immunity that has prevented untold millions of babies and children from dying of vaccine-preventable diseases? Or what about those antibiotics that have allowed so many people survive diseases that killed their ancestors in droves? Or what about insulin, which allows diabetic children who wouldn’t have made it to adulthood 90 years ago to live long and productive lives? What about surgery for congenital heart defects, like Tetralogy of Fallot, which guaranteed death in childhood? What about every medical advance that ever prolonged life and alleviated suffering going all the way back to the time of Hippocrates? What is medical science but a utopian pursuit of human perfection?

What’s wrong with trying to achieve human perfection, anyway? It’s a goal we all know we can never reach, but reaching for it drives improvements in medicine that relieve suffering and prolong life.

Unfortunately, Smith plumbs new depths of bad arguments:

The commonest skin cancers can be removed without any threat to life, and deaths from childhood leukaemia have been dramatically reduced in my lifetime. But is cancer ever “cured”? Death may be averted at considerable cost, perhaps at the possibility of being able to reproduce – but cancer is always there, lurking.

Once again, Smith is disingenuously conflating two things. In this case, he’s conflating single cancers treated for cure with all cancer. Take his example of a child with leukemia who is treated successfully. That child can indeed be said to be cured of his leukemia. It’s gone. It’s not coming back. This child, of course, will grow up. Perhaps in his elder years he will get a cancer more typical of old age, such as colon cancer. So, from that perspective, yes, “cancer is always there, lurking,” but it isn’t the same cancer that was actually cured. That a person successfully treated for cancer remains at risk for developing another cancer is trivially true but meaningless as an argument. One might just as well argue that we shouldn’t treat a person for pneumonia because,that person might one day develop pneumonia or another infection again, thanks to the ever-lurking bacteria—which, by the way, are every bit a part of being “human” as aging and death, given how important our microbiome is, as we are now understanding more and more.

The vileness doesn’t end here, either:

In 2014 the UK spent £370m on cancer research, far more than on any other disease category. Compare that expenditure with £109m on mental health or £9m on injuries and accidents, the major killer of young people.

Look, I understand the problem we frequently face with cancer. Treating it is expensive. Many of the new treatments and drugs that we come up with to combat various cancers only prolong life by months, an observation that brings up legitimate questions about the value of some very expensive drugs. However, just because some areas might be underfunded is not a good argument not to donate any money to cancer research or to declare cancer research to be not worth spending more money on, as Smith does. There’s also a not-so-subtle ageism in his argument, which argues in essence that we shouldn’t bother wasting resources on old people dying of cancer? No, that’s not a straw man, either:

What is the ultimate aim of cancer researchers? Most won’t think about this: they are immersed in their particular projects, hoping to achieve further funding—sometimes by hyping their achievements. But somebody ought to think about the long term aim. Could it be immortality?

Why the latest cancer treatment breakthrough could change everything
I hope not in an overcrowded world–because without death, every birth would be a tragedy. Could the aim be the avoidance of aging? That might seem attractive to our profoundly ageist society, where the old are shoved into corners and looked after by underpaid staff, while women in their 50s are expected to look like women in their 20s.

We forget—or may never have fully accepted—that cancer is predominantly a disease of the elderly. Your chances of developing cancer increase exponentially as you age.

Yes, but so your chances of developing atherosclerotic coronary artery disease (a.k.a. heart disease for short), and heart disease kills more people than cancer, at least for now. One wonders if Mr. Smith thinks we shouldn’t waste money researching heart disease. Granted, heart disease is a bit of an easier problem, involving as it does only one organ system, but it is primarily a disease of old people.

As for whether the aim is the avoidance of aging, come on. The aim is avoiding particularly unpleasant ways of dying. It’s not as though scientists don’t know that we all have to die of something and that if one cause of death is eliminated or drastically reduced, people will die of something else. As I like to say, life is a sexually transmitted fatal disease. None of us gets out of here alive. Sure, it’s possible that the results of cancer research might also be applicable to improving longevity, but so what? Humans have been using science to push back against the inevitability of death since time immemorial. If that weren’t the case, many, if not most, of us wouldn’t make it to adulthood because we’d be felled by various nasty infectious diseases. Indeed, a mere few hundred years ago in London, roughly 65% of those born did not make it to adulthood because they died of childhood infectious diseases, for an average life expectancy of 27. Of those who did make it to age 25, only half lived beyond around 53 years of age, and only about one third made it to age 60.

When I first read this abomination of an article, it didn’t click who Richard Smith is. Then I saw his identity pointed out. This Richard Smith is a former editor of the BMJ, and he wrote something similar for the BMJ blog on New Years Eve 2014 in which he proclaimed that “dying of cancer is the best death” that’s “achievable with love, morphine, and whisky.” In it, he said basically the same thing as in this article. Apparently he’s learned nothing from the backlash against his original article.

It’s not unreasonable to discuss or question prioritization of research funding, nor is it unreasonable to express an opinion that cancer research doesn’t provide as much bang for the buck as we would like. I disagree now, given that after several decades we’ve finally developed the tools to make a real impact on cancer. Indeed, death rates from several cancers are falling; the age-adjusted death rate from breast cancer, for instance, has been steadily decreasing, down over 25% since 1990. Unfortunately, Smith clings to a romantic view of dying from cancer that is not rooted in reality or actual experience and remains utterly tone deaf in how expresses his view. I just hope he never has the opportunity to put his romantic view of death from cancer to the test.

Comments

  1. #1 Nplima
    England
    March 8, 2016

    aaah the smell of trolling in the morning!

  2. #2 Amethyst
    The Crystal Temple
    March 8, 2016

    Nonsense. The best death is to fall in battle against the enemies of the Klingon Empire. Qapla’!

    Is this guy serious? His rethoric is just a few steps behind summary execution of terminally ill people to give them the “best death”.

  3. #3 palindrom
    March 8, 2016

    Yow.

    The father of a dear friend died in his sleep a while back at a very advanced age, having kept his marbles and been in good touch with his family until the end. No cancer that I know of. I’ll take that over my own father’s suffering from cancer any day.

  4. #4 Wesley Dodson
    March 8, 2016

    Oh no, did you have to say life was sexually transmitted? LOL sorry I know it’s not funny we should have the related content box replaced or killed off this week.

  5. #5 Kristina
    Grateful for cancer research on a personal level
    March 8, 2016

    This guy ignores the reality that the elderly are not the only ones to get cancer, but if we draw an arbitrary age line on research and treatment, then we won’t have the knowledge to treat the young ones either. My 26 year old sister just got diagnosed with breast cancer, and it being a “good death” or not, who wants her to die at 26, leaving 2 small children behind? What a blinking idiot. I have no kind words in my heart for such selfishness right now. If he wants to refuse treatment for himself when he gets cancer, fine, but I want the knowledge for how to treat available when I get it, thankyouverymuch.

  6. #6 Andrew Dodds
    United Kingdom
    March 8, 2016

    I recently had a brush with the ‘Lungs filling up with fluid’ one due to kidney failure, I can attest that it’s less pleasant than Orac paints it.

    And my sister in law is currently dying from breast cancer, having kids aged 10 and 8. Curing her would not be ‘a waste of time’, pretty sure about that one.

  7. #7 Gray Falcon
    March 8, 2016

    Some would argue that the best death belonged to that of Benkei, who according to legend, stood guard at the bridge to the main gate of his master’s castle during his final battle, and slew 300 soldiers before succumbing to his arrow wounds, still standing.

    I think I’d prefer dying of old age, myself. Preferably at 300 or so.

  8. #8 Amethyst
    The Crystal Temple
    March 8, 2016

    He… he must be a Poe, right? I mean… nobody would could honestly argue that because cancer is a relatively benign way to go (in his mind at least, as Orac points out, not so much in reality) so we shouldn’t bother looking for a cure…?

  9. #9 Delphine
    wuthering heights
    March 8, 2016

    From the Babbage report — life expectancy in rural Yorkshire during the mid-Victorian era.

    The findings of Babbage’s report are shocking. Haworth was a small industrial mill town, and the view onto the moors was broken by tall smoking chimneys. Excrement ran down the street; for want of sewers, fenced in areas held human waste, offal from the slaughterhouse and pigsty waste for up to months at a time. Housing was poorly ventilated and overcrowded, with several dwellings in cellars. The average life expectancy was 25.8 years; 41.6% died before the age of six. Perhaps most appallingly, Babbage’s investigation confirmed that the graveyard, situated on the hill at the top of the town and in front of the Brontës’ home, was so overcrowded and poorly oxygenated that decomposing, putrid matter filtered into the water supply.

    Haworth was hardly unusual, either. Depressing.

    http://www.bl.uk/collection-items/sanitary-report-on-haworth-home-to-the-bronts

  10. #10 Denice Walter
    March 8, 2016

    Please don’t tell my cousin, JB:
    she spent a great deal of time and effort trying to help her brother who had lung cancer ( they live/ lived far away so I only know of the details through phone calls).

    At first, t seemed as though he was doing well with chemo-radiation ( no discernible disease) and he even worked
    BUT then it came roaring back and he experienced many complications of both the illness and treatments for it.

    She tried to help him through visits and acquiring whatever he needed ( she got someone to build a ramp to his house and put up assistance bars on walls) as well as finding foods he might like / be able to eat and buying films for him to watch. She stopped working to be there for him in the end.

    The first 14-15 months were not so terrible but the last 4 were horrendous because of multiple emergencies and medical interventions.

    She found this very traumatic – especially because she understood very well what was happening to him. I expect her to become emotionally worse because he deteriorated during the spring and it will now be two years.

    Seeing a celebrity with cancer like David Bowie set her off in January: she commented that the final photos looked like how her brother did. To make matters worse, she is in the middle of a financial dispute between his widow ( the step mother) and 2 adult children.

  11. #11 apapjim
    Central Florida
    March 8, 2016

    “None of us gets out of here alive.”

    “I’ll Never Get Out of This World Alive” – Hank Williams

  12. #12 The Smith of Lie
    March 8, 2016

    I by no means wish anyone cancer. But one still has to wonder if mr Smith were to discover he has a cancer, if he’d still held this opinion. And if he’d refuse therapy on the grounds of cancer being the best death and the fact that any therapy he’d be offered would be result of all that unnecessary research.

  13. #13 Eric Lund
    March 8, 2016

    he must be a Poe, right?

    Some people really are that sociopathic. I’ll grant that in some cases a loved one’s chronic illness gives a person a chance to come to terms with said loved one’s death. But I know from family experience that this does not always happen (the death in question wasn’t from cancer, but a different unpleasant way to die). And this is balanced against the anguish of watching your loved one die slowly and in great pain, and knowing that little or nothing can be done about it. With a quick death, perhaps the family didn’t get to say a personal goodbye, but they also don’t have to watch the protracted agony either. They get to remember the deceased as (s)he was, memories uncolored by the months (or longer) of terminal illness.

  14. #14 Daniel Corcos
    France
    March 8, 2016

    If it is printed, it must be true.

  15. #15 Helianthus
    March 8, 2016

    @ Eric Lund

    Some people really are that sociopathic. I’ll grant that in some cases a loved one’s chronic illness gives a person a chance to come to terms with said loved one’s death.

    Yes and yes. But to emphasize your first point: Richard Smith’s very approach is still wrong.
    He is measuring the “goodness” of a death on some supposed opportunity for the survivors to say goodbye to the dying person.
    He is completely under-estimating, or even denying the level of discomfort of the one busy doing the dying.

    In short, “cancer is the best death” because it is convenient for bystanders like Richard Smith.

    Apologies for the harsh tones. Two of my grandparents died in their sleep; I didn’t have a chance to tell them goodbye, true, but I would feel like a selfish pillock to have wished they would have a longer, protracted agony, so I could drop by.
    On the other hand, one of my friends lost her dad to a throat cancer. The last days were not pretty; she was obviously very shocked. It didn’t help that she was not on good terms with her other siblings. A deathbed is not the ideal family reunion to mend disputes.
    How is this sort of death supposed to help the survivors?

  16. #16 Calli Arcale
    http://fractalwonder.wordpress.com
    March 8, 2016

    Cancer is the best death? Oh good lord.

    Honestly, I’d rather go quickly, and I’d rather my loved ones go quickly, so they did not have to suffer. And for “best death” — he forgets (or more likely doesn’t care to know) that pneumonia is often described as the blessing for a cancer patient, because as horrible as pneumonia is, it can kill you quicker. I remember my grandfather was upset when my aunt’s pneumonia was treated; she was dying of metastatic breast cancer, and since they decided to treat her pneumonia, she ended up lingering a very long time.

    I’ve had relatives who died suddenly, and relatives who lingered. Neither was easy, and he’s fooling himself if being able to say goodbye actually makes it any better. You mourn either way, and you never get to find out what the alternative would have felt with that particular relative.

    Now, if we got to choose our exit, I personally would like to die of being hit by a small but solid palladium meteorite at the age of 106, while backpacking through the wilderness, with relatives on hand to collect the meteorite, which would be sold to become an awesome estate for all my descendents. That would be perfect. But I don’t think it’s going to happen. 😉

  17. #17 Peter Dugdale
    March 8, 2016

    …not to mention that tissues can start to turn gangrenous…most people who come here won’t need have spelt out the consequences of that..

  18. #18 SelenaWolf
    Ontario, Canada
    March 8, 2016

    Wow. Just … wow. I have no words.

  19. #19 Jazzlet
    March 8, 2016

    To use a good British insult, what a plonker!

    I’ve had a parent die a relatively quick death, a stroke, although if it hadn’t happened she’d have died of cancer and as shocking as it was I know that for her it was the better deat. I’ve also had a parent gradually cease to function through Parkinsons, it took years and the grief of seeing his mental decline in the last few of those years was awul, to the extent that it was a relief when his body finally died. Give me quick every time, kinder for the person dying and for the relatives.

    As for young people being injured and dying from accidents, there are things that could be done, but there is a limit as most young people do not really believe they will die and sadly many suffer the inevitable consequences of the risks they take as a result of that belief.

  20. #20 Dangerous Bacon
    March 8, 2016

    Another important matter we need to consider is that successful treatment of cancer interferes with bonding by concerned relatives and friends of the patient.

    In the olden days, people gathered by the bedside of the cancer patient and got to enjoy this bonding experience. Nowadays, what with prolonged remission and cures, patients stay alive considerably longer and deprive their loved ones of the intimacy that terminal illness provides.

    (note that a mom quoted on the Internet made this exact point about vaccine-preventable infectious diseases. She regretted missing out on the opportunity to comfort her measles and mumps-ridden children. Why, I remember my parents taking care of me during the weeks I was ill with just these two diseases. It was an important facet of my childhood and I wouldn’t have missed it for the world.

  21. #21 Helianthus
    March 8, 2016

    @ Dangerous Bacon

    Another important matter we need to consider is that successful treatment of cancer interferes with bonding by concerned relatives and friends of the patient.

    I think you are being facetious, but you are approaching PEH (Poe’s event horizon).

    note that a mom quoted on the Internet made this exact point about vaccine-preventable infectious diseases.

    That is actually the first anti-vax argument I came across a long time ago, while idly browsing the “health” section of a bookshop.
    I just thought then, and I’m still thinking now, if the only/main occasions someone has to bond with his/her relatives is when they are sick and unable to run away, it doesn’t say nice things about the type of human being he/she is.

  22. #22 TBruce
    March 8, 2016

    Dr. Smith responded to the uproar his BMJ article provoked: http://blogs.bmj.com/bmj/2015/01/05/death-a-response-from-richard-smith/

    This is the opening sentence from his response:

    I’m sorry that I’ve upset many people who have cancer or who have had a bad experience of somebody dying of cancer. That wasn’t my intention. I was writing for The BMJ and so primarily for doctors.

    So then he goes and submits essentially the same article to a newspaper read by the general public.

    The guy’s a troll.

  23. #23 JP
    March 8, 2016

    I sure hope somebody cures cancer soon, so I can keep smoking. I mean, I should quit at some point anyway, I’m only 28, but I won’t be 28 forever.

  24. #24 Denice Walter
    March 8, 2016

    @ JP:

    That’s entirely true.

    I smoked for a few years ( in grad school and when working and writing a lot ) and decided that I really wanted/ needed to quit: I had bronchitis once and didn’t want it again. I used everything I knew about habit and physiology to no avail- gradually increasing times between smokes, using exercises etc.. I couldn’t quit for more than a few days or a week
    .
    I then proceeded to frighten myself about lung cancer, imagining the slow, grim terminal process happening in me- a doctor telling me the diagnosis and prognosis- then not being able to breathe, struggling. No way out .

    I made various attempts to use stress reduction, meditation and supplements like tryptophan- even a few rx meds like valium.
    .
    I imagine that I ( briefly) quit about a dozen times until FINALLY one day I did for ( probably- never say never) good. It took a few years of repeated, concerted attempts
    .
    What did it? I think I knew I had to quit before a certain age that I had in my head. So I did.
    It might have been a magic number or something else symbolic that motivated me in some arcane manner and it worked. Well, so far so good. Knock on wood/ touch wood.

  25. #25 JP
    March 8, 2016

    I imagine that I ( briefly) quit about a dozen times until FINALLY one day I did for ( probably- never say never) good. It took a few years of repeated, concerted attempts

    My grandma always said, “It’s easy to quite smoking, I’ve done it a hundred times!” She did eventually quit for good, but at a fairly advanced age. Better late than never, I suppose.

    I mean, hey, Mr. Obama smokes, as do a lot of my grad school colleagues, so I don’t feel like a total pariah. Yet.

  26. #26 JeffM
    March 8, 2016

    As many here know, my wife died of metastatic BC. Her liver was involved and it was exactly as Orac described. Although she went quickly, 28 days from diagnosis, to be exact, it was not the best death. Her last hour was horrific. I would not wish that end on my worst enemy.

    Smith is demented.

  27. #27 Mephistopheles O'Brien
    March 8, 2016

    I’m only 28, but I won’t be 28 forever.

    While experience would certainly seem to side with that belief, you’ll never know until you try.

  28. #28 Eric Lund
    March 8, 2016

    I imagine that I ( briefly) quit about a dozen times until FINALLY one day I did for ( probably- never say never) good.

    I’ve heard similar stories from several ex-smokers. As the saying goes, it’s easy to quit smoking–many people have done it several times. Apparently nicotine is even more addictive than cocaine.

    To bring this back on topic: for many people, what leads them to finally quit smoking is a desire to spare themselves and their loved ones from the slow and painful death that results from several diseases associated with smoking: lung cancer in particular, but emphysema is also an unpleasant way to go.

  29. #29 Johnny
    127.0.0.1
    March 8, 2016

    I never smoked, but for a few years I’d put a pinch between my cheek and gum. Boy, howdy, that was a rush. The nicotine would run straight into my bloodstream and slam into my brain. It took a year or so of continuous effort to get my usage down to a coupla times a day, once I decided to stop, and then the only way was to just not buy it.

    Even after about 30 years, if I see it for sale, and I have dollars in my pocket, it’s an effort to just say no. There is no doubt in my mind I could be addicted again before the weekend.

    Dad did smoke, and, yes, cancer killed him, and also his mother. I was able to be with him at the end, and held his hand as he stopped breathing. I was also heard his last words a coupla days before. They were to ask me to help him die.

    Anyone who would call that a ‘good death’ is a f***ing idiot.

    (Dad always said that he wanted to live to be 100, and be shot by a jealous husband. I guess that would be as good a way as any to go.)

  30. #30 Roadstergal
    March 8, 2016

    My mom’s brain cancer took away her ability to speak so quickly that she never had a chance to say goodbye. We had to sit around and watch her slip away – unable to talk, barely able to look at us as it progressed, trying to find meaning in twitches and slow blinks from a fantastically intelligent PhD cancer researcher with a love of languages and music. Best death, my ass.

  31. #31 lkr
    March 8, 2016

    Smith’s comments aren’t necessarily informed by sociopathy as such — they may reflect religious indoctrination — e.g., the exaltation of pain and suffering that’s common in conservative Christianity. Mother Teresa would likely agree with him on the “good death”, for others at least.

  32. #32 Denice Walter
    March 8, 2016

    @ Johnny:

    After I had stopped a few weeks, I wasn’t tempted in the least by smoking. I didn’t care if others smoked and I even smoked MJ a few times, 10 years later, to be social. The smell doesn’t affect me negatively or positively.
    -btw- a few perfumes/ colognes use a tobacco scent which some people love.

    I must say though that smoking is helpful if you’re writing and need to really focus etc. HOWEVER there is caffeine.

  33. #33 Andrea
    Australia
    March 8, 2016

    W ell could it be that I share a home city of birth with the villain of Orac’s latest denigration piece that I understand EXACTLY what he was saying. And by happy coincidence I share his dislike of the cancer charity industry that grabs as many dollars as it poissibly can by using the emotional cards of millions of deaths.. He mentions Glasgow as death being ‘imminent’ . Perhaps something was lost in the cultural relevance of this statement where this small Scottish city which is rich in Art and culture (thanks ironically to the tobacco lords of the 19th century ) that has 4 universities within a couple of square miles,also has a unique claim to fame of having areas of Glasgow which have mortality norms for men of an average of 20 years less than even the other socially deprived areas of the U.K. Where men have a lower lifespan that they’re counterparts in Iraq, Palestine, and India, about as low ams Australian aboriginals which causes the United Nations human rights folks no end of consternation. It even has a name – the Glsgow factor,but of course no money available to find out why this hasn’t abated in the 60 odd years that I’ve been alive. His point? Why spend vast quantities of money on extending a life an average of four years when a significantly smaller amount could be spent on giving whole communities of folks an extra 20 years… Course not a crookit bawbee would go to Pharmaceuticals,but on education opportunity, and nutrition. You want vile? Smug gits who discuss their self inflicted cancer risks -in the the hope that some mug will donate so they don’t have to take any responsibility. Oh, I maybe should mention my mum died of lung cancer, so no it wasn’t a good death. but there is something very dignified and reality driven about someone who has had a hard struggle to live. She accepted at 75 that quality of life was more important than quantity. No cancer industry guinea pig – dragged along by false hope …She saw how often others had died,from ‘complications’ of medical treatment and opted for the non intervention route, the palliative care route. The best part of the whole year of her dying was that my brother was so sickened by her illness – he quit smoking. Reckon he increased his odds of not being a Glasgow statistic of the dead kind for a few years… Extending social justice – is where my money would go …

  34. #34 palindrom
    March 8, 2016

    TBruce @22 — Smith’s statement is a classic “nopology” — “i’m sorry some people got upset”.

    To which the reply is “Yeah. But you’re not sorry for what you said.”

    It’s a tactic for shifting the blame onto the people who criticize you.

  35. #35 Vicki
    March 8, 2016

    He seems to have forgotten that doctors are human, and thus include people who have had cancer, and whose siblings, spouses, parents, children, and best friends have had cancer.

    If he, personally, wants morphine, whiskey, and love as his way out, he can have the first two out of three whether he has cancer or not–and cancer won’t improve his chances of being loved.

  36. #36 Bob
    March 8, 2016

    Ugh, why bother even breathing? I mean, you’re just going to have to breath again in a few seconds.

  37. #37 Panacea
    March 8, 2016

    My father died of liver cancer. It was NOT the best death, and I did not have time to say good bye the way I would have wanted to. By the time he was actually diagnosed, the cancer had spread incredibly rapidly. I was not able to get to the bedside in time.

    I never wish ill on other people. But I am feeling very tempted at the moment.

  38. #38 Old Rockin' Dave
    March 9, 2016

    I spent half my career as a PA tending to patients with cancer, AIDS, and sometimes both. I can attest to all the horrors of cancer deaths Orac details above, and a few more.
    We’ve all seen movies where the villain promises the hero a lingering death, a death for which the hero will beg long before it comes. It’s no cliche. That’s exactly the horror so many cancer and AIDS deaths are like.
    I almost wish that Richard Smith could experience it in the first person, but in the end not even I can be so cruel and vindictive, and believe me, you don’t want to see how vindictive I can be.
    As to his immortality gabble, in the Middle Ages they used to say, “We all owe God a death.” That’s going to remain true as long as I live, and it will be true for my children, my grandchildren, and for many more generations to come.

  39. #39 Daniel Corcos
    March 9, 2016

    @ Andrea
    In France there are many people like Smith and you, especially among journalists and teachers, for whom equality is more important than prosperity. If cancer could kill capitalists and not the poor they would support it actively. But killing both is a trend toward equality. Come in France and enjoy.

  40. #40 Adrian
    Calgary
    March 9, 2016

    I havent been this angry in quite some time. The logic employed in that article, and I use the term logic generously, is just shocking.

    Regarding “best death” I have to wonder if he has ever spent any time with patients who are dying of cancer.

    A friends mother developed an obstructed bowel from ovarian cancer and spent the last few weeks of her life vomiting up her own feces. There are no pills to ease that discomfort, nor the psychic pain that must have accompanied it.

    Another thing he seems to neglect to discuss is the mental aspect. Either through brain mets, or a combination of malnutrition/cachexia or hormonal and metabolic changes due to the tumor load, many cancer patients experience terrible delirium. I remember my mother screaming at the top of her lungs because she was cognizant enough to recognize she was in a hospital and likely wasnt getting out, except it had transformed in to a nazi medical experiment facility and she could hear my father screaming as they tortured him in the next room. This even though he was right beside her trying to comfort her.

    The worst part was that between sedation she would wake and do everything she could to try to save us. Can you imagine seeing your mother who is so weak she cant even support her own weight, screaming at us to run, still trying desperately to get out of bed so she can take care of her family and save us from Nazi torture. And the anguish of thinking she had failed when she couldnt do it and continued to hear our screams of agony day in and day out. Her identity was so heavily rooted in caring for us that it was the worst kind of torture to take that away from her during every waking moment.

    I watched cancer rob my mother of every concept of health that exists. She was in physical pain and mental anguish for weeks. There is nothing about that which makes it a good death. I would not wish that on anyone, not even the misguided author of the article. I do wish he would spend a few weeks vomiting up his own feces though.

  41. #41 TBruce
    March 9, 2016

    I do wish he would spend a few weeks vomiting up his own feces though.

    How do you think he wrote the article?

    Yeah, cheap shot, but I couldn’t pass it up.

  42. #42 Man Called True
    Minnesota
    March 9, 2016

    I’ve had relatives die slowly (my paternal grandmother died of kidney failure) and quickly (my maternal grandmother died from a ruptured aneurysm). I think the latter is the better death, if only because I didn’t have to watch her fall apart over the course of several months. As such, Richard Smith, may you be eaten by carcinogenic rats.

  43. #43 Renate
    March 9, 2016

    My mother died of a brainhemorage. No, I didn’t have time to talk things out and we didn’t know what her final wishes were, but I defenitly take this over the dead of the wife of a nephew from cancer, leaving him with 2 children in puberty.

  44. #44 Politicalguineapig
    March 10, 2016

    Screw Mr. Smith, preferably with a railroad spike. He’s obviously never known or interacted with any cancer patients ever, and he should get his license pulled for his exhibition of sociopathy. I’ve lost two out of three grandparents to cancer, and Grandpa was barely keeping it at bay. While they all went peacefully enough, compared to the commentariat’s horror stories, I’d still prefer to cure cancer. Not to mention that it’s one of my personal nightmares.
    Mr. Smith’s comments are almost as bizarre as the guy I saw on another site claiming that childhood cancers were punishment for the parent’s sexual immorality and that cancer didn’t exist until the 20th century.

    That said, a lot of the charities need to do some work. For example, in the Susan Komen scam, maybe a dime out of every dollar actually goes to research? I’ve never contributed to them and never will, unless I see some sign that the money is actually going to labratories and not just being spent on TV ads.

    JP: Hey, my grandma was 28 for 80 years, and I’m celebrating the third anniversary of my 28th in a couple of months, so you never know until you try. (I just plain can’t smoke, myself. Even secondhand smoke makes me wheeze.)

  45. #45 DLC
    March 11, 2016

    My maternal grandmother died of cancer back in the 1970s. She was first diagnosed with breast cancer, then even after a double mastectomy (they only did double radical mastectomy back then) and radiation and chemo, she got cancer again, in the lungs this time. Watching someone you love die of lung cancer in the 1970s was fairly horrific. So no, I’m sorry, I don’t agree with Mr Smith. I also do not agree that public health has to be a zero-sum game. There is enough money to go around, if we but bothered to allocate it.

  46. #46 Amethyst
    The Crystal Temple
    March 11, 2016

    So I was just playing “Dying Light: The Following” the other day and in it there is a character dying of cancer who pretty much fits the “dignified death” mentioned by Mr. Smith: becoming reclusive and a drunkard, sitting in his dimly lit house with a glass of whiskey just awaiting the inevitable end – with no other symptoms you see in real life when it comes to cancer.

    That made me realise that it is a pretty common trope in all kinds of media, such as video games, movies and television. If Mr. Smith is indeed serious on his position on the topic, I am pretty sure his opinion has been tainted by such fictional portrayals of cancer sufferers.

  47. #47 Daniel Corcos
    https://www.researchgate.net/profile/Daniel_Corcos2
    March 11, 2016

    @Amethyst
    Smith was a medical journal editor. He probably did not read the papers he was accepting or accepted to read only those where cancer patients died peacefully. In any case, he knows how to boost an impact factor.

  48. #48 Helianthus
    March 11, 2016

    @ Amethyst

    That made me realise that it is a pretty common trope in all kinds of media,

    It’s a quite ancient trope, indeed. See TVTropes: Victorian Novel Disease

  49. #49 Nomad
    March 28, 2016

    I hope a late comment to this post will be considered acceptable, because there are things I want to say in relation to this story.

    One of my grandmothers was afflicted with cancer. Multiple times. She underwent surgery twice. I don’t want to minimize the trauma of undergoing surgery, but honestly, as far as cancer stories go, she seemed to have it fairly easy. Her chemotherapy made her slightly nauseous. Not the horror stories that everyone seems to always tell about chemo. Her life was extended considerably by the treatments, and it was a genuine quality of life, not the extended chronic illness that Mr Smith seems to think we’re turning cancer into. When she finally did pass on, my dad was there and had a chance to talk to her first. She was weak, but she didn’t seem to be in any significant pain. He told me about how he really appreciated having the time to talk with her that last time. That couldn’t have happened without modern cancer treatment. It would have been a far different experience if Mr Smith had his way.

    I have a friend who was afflicted with a particularly nasty case of cancer. When last we spoke he’d already been in for surgery and he’d had part or all of multiple organs removed. But it came back, and was big enough that his doctors wouldn’t operate unless it could be shrunk enough with chemo first. He got put on some sort of study chemo drug after conventional treatments failed. It hurt him badly, it put him into kidney failure. But it shrunk the cancer enough that he was scheduled for surgery the last time I talked with him.

    Forget it being a disease of the elderly. I don’t think he’s over 30. He wasn’t ready to die yet, he hadn’t had his full chance to live yet. If Mr Smith had his way that study drug wouldn’t have existed. Forget utopian. Forget death being made optional. His choice was between dying hard and young, or else getting a fair shot at experiencing the rest of his life. Needless to say he doesn’t believe dying young of cancer was his best option.

    My boyfriend told me a story too. About his stepfather, lying dying in a hospital. He almost cried, telling me how hard it was to see the strongest person he’d ever known brought down to the point of crying from the pain he was in. That’s his last memories of the man. He didn’t get the experience of the one last positive memory. He got suffering and pain. Even taking the cynical view of being more concerned about the convenience of those around you, there was nothing ideal about that death.

    He told me that he wanted to get ahold of Mr Smith and choke him, to within an inch of his life, and when he was about to die he’d let him have just enough air to keep him alive, and then start choking him all over again. I’m not sure, but I think he was unintentionally mimicking something from the movie Deadpool as the worst thing he could do to him.

    I can’t really defend his torture fantasy. except to say that he wouldn’t really torture him. That’s just how upset he was, he has to be really aggravated to get to that point. He was trying to come up with a scenario in which he could share what extended suffering was really like.

  50. #50 angela coral eisenhauer (FB)
    Albany Western Australia
    May 10, 2016

    The smell of trolling, good god, this whole science blog thing is one big troll, who pays this ridiculous place to be so damn pro pharma?

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