On the emperor of all maladies
By Toh Hsien Min
Richard Smith, writing in the BMJ, has managed extremely persuasively to make the point that he should stick to his day job and forget the writing business. In an article given amplified voice over the British newspapers, he contends that cancer is the best way to die: "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." According to Smith, we should therefore "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".
Predictably, there was no shortage of people lining up to tell the good doctor where exactly he could put his opinions. If the medical profession's embarrassing ignorance of statistical science e.g. with the false positive paradox is somewhat understandable because of the unintuitive interpretation of conditional statistical error, the cognitive bias here is much simpler to avoid. If it is indeed the case that the choice is only between dying a year from now from a cancer that is diagnosed today or dying on exactly the same day a year from now in a car accident, perhaps there is a case to be made for the foreknowledge carrying significant enough value to be preferable. The trouble is, short of a Final Destination world view involving a sentient Death with a database on his iPad that registers every person's preordained date, those are never only those two outcomes. It's much more likely that the alternative to dying a year from now from cancer is, if the disease were to be successfully treated, dying perhaps twenty years later. Unless the extra nineteen years are of no value, Smith's decision framework is hopelessly flawed. And that's without even bringing into the equation the suffering that often comes with cancer.
I'm not sure why the turn of the year was filled with many reflections on this emperor of all maladies. David Fedo's Letter in our last issue had perhaps started it with a report on Jenny Diski's diagnosis, and he has in in this issue reported on a friend's death through cancer. There was a recent study published that reported that most cancers could be attributable to sheer bad luck, in the form of random DNA mutations. I had even, in the latter half of December, spent a couple of days reading John Green's The Fault In Our Stars, which more people might know through the movie. But what shook me rather was the passing of a classmate from my Keble English batch from colon cancer on Christmas Day. I hadn't been especially close to her in college, although I remember her well for her energy and dynamism, which lent an edge and energy to a small group that had more than a streak of diffidence running through it, making the posted results of Finals that much more surprising. There were just ten of us and it's a shock to know we're now nine.
Perhaps in contrast, Justin Ker makes the case for doctors to write. The review of the neurosurgeon's debut flash fiction collection, The Space Between the Raindrops, is the highlight of this issue's criticism section, alongside reviews of Aaron Lee, Joshua Ferris and that book about that man. We also publish, posthumously, a new translation of Regina Derieva's 'Letters to the Sorbonne', alongside Theophilus Kwek's 'Sonnets for Singapore', which is well timed for SG50. The three short stories are excellent, the Proust Questionnaire elicits some robust answers from Anja Utler, and we have an new contributor to the Acid Tongue, Jess C. Scott, looking over William Giraldi's takedown of Fifty Shades of Grey. Bonne année et bonne santé!QLRS Vol. 14 No. 1 Jan 2015