The Incompetent Carpenters

H/T Rose, Richard Smith, one time editor of the BMJ, and the man who reported that the BMA’s alcohol consumption recommendations had been “plucked from the air”, has been criticised for saying that dying of cancer is the best death:

Buñuel was clear about how he didn’t want to die. “I’m not afraid of death. I’m afraid of dying alone in a hotel room, with my bags open and a shooting script on the night table. I must know whose fingers will close my eyes.”

“An even more horrible death,” he wrote, “is one that’s kept at bay by the miracles of modern medicine, a death that never ends. In the name of Hippocrates, doctors have invented the most exquisite form of torture ever known to man: survival.”

Buñuel saw how Franco died and found himself pitying a man he hated. Franco’s death in 1975 still stands for the most horrible medical death, a death that only doctors could devise. Organ after organ failed, and the doctors tried to compensate. As a medical student a year before graduation, I watched in horror. I think of the death as an incompetent carpenter trying to get a table level, sawing something of one leg, then the next, and eventually ending with the table on the floor.

He recommended cancer because it allowed time to reflect on one’s life, and put one’s affairs in order.

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.

I can see what he means, of course. I suppose I’m more in favour of a sudden death.

The death that I’ve thought about most has probably been the death of my uncle Francis, after whom I’m named. He was an RAF pilot whose Spitfire caught fire over the Mediterranean, forcing him to bail out. He was last seen getting into a little inflatable dinghy. He was never seen again. One day he was a strong young man of 22 years, and a few days or hours later he was dead. He probably had plenty of time to reflect on his life, but little chance to put his affairs in order. And he probably knew he was going to die. And that there would be nobody to close his eyes.

Needless to say, CRUK and co. were hissing and screeching about Smith’s recommendations:

Cancer researchers in Britain are outraged over an eminent doctor’s claim that their efforts to find a cure are misguided because the disease offered a better death than alternatives like organ failure and dementia.

Cancer Research UK chief clinician Peter Johnson said, in a statement on Thursday, that the billions spent annually on finding a cure was money well spent because cancer killed the young as well as the old and “the more we know about cancer, the more we can give people options”.

I somehow think that a lot more old people than young people get cancer. Several commenters here said as much.

But I always suspect that these healthist cancer researchers really believe that if we don’t drink, and don’t smoke, and get plenty of exercise, we have a good chance of living forever. I once came across a paper by Sir Richard Doll about the prospects for immortality, so clearly he’d devoted time to the idea. For them, longevity is everything. Every last minute counts. They are Buñuel’s “incompetent carpenters”. And they torture everybody.

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15 Responses to The Incompetent Carpenters

  1. harleyrider1978 says:

    http://thehayride.com/2015/01/holy-smokes-heres-how-bad-a-smoking-ban-would-be-for-new-orleans/

    HOLY SMOKES! Here’s How Bad A Smoking Ban Would Be For New Orleans

    Not only would a smoking ban in New Orleans by the NOLA City Council be overreaching and ‘nanny-state’ politics at its finest, but it would also be detrimental to the city’s revenue sources, according to a report by the Louisiana State Police.

    Democrat New Orleans City Councilwomen Latoya Cantrell and Susan Guidry want to mandate to businesses, bars and individuals where and when they can smoke cigarettes and tobacco products.

    The proposal is very similar to existing laws in liberal cities like New York, which have led to more and more city government and less and less freedom for individuals.

    But, politics aside, the state police says New Orleans will lose $86 million in two years in revenue if a smoking ban ordinance is passed by the Metropolitan City Council.

    “This board doesn’t have a dog in that hunt. We’re neither for nor against smoking or smokers, but I do believe the board has a responsibility since it is our duty under the law to promote economic development through gaming in this state — and gaming huge footprint in New Orleans — we have a responsibility to put in the public record what might happen if a ban in put in place,” said board chairman Ronnie Jones.

    To be exact, the state police report concluded that in two years New Orleans would lose $86.4 million from gaming revenue sources and another $17.4 million in fees.

    The report by the state police is solely based on projections in other states, which have seen a decrease in revenue thanks to overreaching smoking ban ordinances.

    For instance, in Delaware, the state police said the state saw a 12 percent decrease in revenue after a smoking ban was enacted. And in Atlantic City, a 24 percent decrease has taken place over two years thanks to a smoking ban.

    Already, Louisiana’s revenue is down 24 percent from a 2007 state-wide smoking ban in all restaurants. And for bars and hotels, revenue is down 10 percent since 2007, according to the state police report.

    With crime in New Orleans on the upswing in the more tourist-y parts of the city, it is odd to see the city’s council focusing so much on an ordinance that will not promote tourism, but instead mandate what businesses and individuals can and cannot do.

    Though Mayor Mitch Landrieu has not publicly commented on the smoking ban ordinance, we suspect he is on-board considering that he tried to hike cigarette taxes three times earlier this year.

    The smoking ban ordinance is expected to get tons of debate on Wednesday when it comes before the city’s Community Development Committee.

  2. chris says:

    ” I’m not afraid of dying; I just don’t want to be there when it happens.” –Woody Allen

  3. Smoking Lamp says:

    This plays right into yesterday’s post. Many people are afraid of dying. The lifestyle inquisitors (as exemplified by the Smoking Stasi) exploit fearfulness and a desire for security to assert their agenda. Hate becomes a powerful mechanism for sustaining the meme necessary to coerce. That is why they encourage thugs to propagate hate speech on ‘new media’ sites. They also like to suppress and censor dissent. That is why dissenting opinions are deleted. In that way smokers are not only exiled; pro-smoker sentiments are extinguished.

    Harley’s post about New Orleans is critical. They are starting to populate the news stories about the pending ban with antismoker comments. As expected the comments are starting to get vicious.

    I suspect they will intensify their tirades of abuse, propaganda, and fear-mongering as the vote becomes closer. Somehow that persecution needs to be countered. I am beginning to believe that the Antismokers are most afraid of having their fraudulent studies exposed.

  4. nisakiman says:

    Totally off topic, but I found this article rather interesting:

    British farmer forced to turn half his murderous herd of Nazi-bred Heck super cows into sausages

    http://www.independent.co.uk/environment/british-farmer-forced-to-turn-half-his-murderous-herd-of-nazi-cows-into-sausages-9958988.html

    It would seem the health Nazis are still at it with their army of useful idiots.

  5. Lepercolonist says:

    Mr. Bunuel is not in the minority:

    http://www.dailymail.co.uk/health/article-2643751/Most-doctors-terminally-ill-AVOID-aggressive-treatments-chemotherapy-despite-recommending-patients.html

    88% of doctors would choose ‘do not resuscitate’ orders for themselves.

    Clinical associate professor of medicine Dr VJ Periyakoil said: ‘Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn’t choose it for ourselves? The reasons likely are multifaceted and complex.’

    She said: ‘Our current default is “doing”, but in any serious illness there comes a tipping point where the high-intensity treatment becomes more of a burden than the disease itself.

    • Rose says:

      Do Unto Others: Doctors’ Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives
      May 28, 2014

      Conclusions

      “Our data show that doctors they have a striking personal preference to forego high-intensity care for themselves at the end-of-life and prefer to die gently and naturally. This study raises questions about why doctors provide care, to their patients, which is very different from what they choose for themselves and also what seriously ill patients want.”
      http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0098246#pone.0098246-Blondeau1

    • Rose says:

      75% of physicians in the world refuse chemotherapy for themselves – 2012

      “Polls were taken by accomplished scientists at the McGill Cancer Center from 118 doctors who are all experts on cancer. They asked the doctors to imagine they had cancer and to choose from six different “experimental” therapies. These doctors not only denied chemo choices, but they said they wouldn’t allow their family members to go through the process either! What does that say about their true opinion of this archaic method?”
      http://www.naturalnews.com/036054_chemotherapy_physicians_toxicity.html

      The Actual study – 1986

      The use of expert surrogates to evaluate clinical trials in non-small cell lung cancer

      Including –

      “Smokers showed no overall difference in attitude to the 6 trials compared to non-smokers.

      Our reason for studying the influence of smoking history was that for smokers these questions, though hypothetical, were very real ones which we believed they might have asked themselves previously.

      In their evaluation of these clinical trials the smokers do appear to be more discriminating than the rest, in that those studies which were popular overall were even more acceptable to the smokers and those which were generally unpopular were even less acceptable to the smokers.”
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001499/pdf/brjcancer00521-0092.pdf

  6. smokingscot says:

    With all due respect I feel this is a subject where it’s far too easy to slip into broad, sweeping generalisations.

    Cancer is not always terminal. It can strike anywhere; even a little bitty lump on the heel of your foot can be cancer (as one in Edinburgh discovered). Bowel cancer is one of the more survivable ones as is testicular cancer and breast cancer.

    If they can get to the tumour early enough, a huge range of cancers can be treated successfully and I feel Richard Smith has fallen into that trap.

    Yes it must have been soul destroying to watch Franco die and there was something “not quite right” in keeping Ariel Sharon in a coma for 8 years (and his organs failed – one by one). And yes there are excesses, even in our NHS.

    I’m not at all sure what the outcome will be for Michael Schumacer; what I read is his family are prepared to take anything they get. Whether Michael will thank them is another thing entirely.

    But Jane Goody didn’t want to die, not at the age of 27 and not with two adorable children. Okay there were cock-up’s with the NHS, and with Jane herself, but cervical cancer is one that can be – and is – treated routinely.

    http://www.dailymail.co.uk/tvshowbiz/article-1259378/Jade-Goodys-death-unnecessary-preventable-Reality-stars-doctor-launches-attack-NHS.html

    Where I agree with Smith is I don’t think there will ever be a cure for all cancers and I also agree that throwing money at cancer charities is wasteful. I find it remarkable that an enormous amount of what we know about cancer is coming from South Korea and Japan. They’re doing really good, basic research and avoiding the entanglement with politics as well as facile claims that only lifestyle choices matter.

    In the end however, it depends on the individual. Most guys know to check their gonads for lumps. Most lassies know to check their boobs (and armpits) for the same thing. Unfortunately not all of them do anything about it until it’s virtually untreatable.

    I frequently wonder what might happen if the medical establishment, instead of whining on about us doing wrong, did the only really sensible thing and offered a full blown health checkup for free from age 40. I know the bowel screening kits we get from age 50 have caught a heck of a lot of bowel cancers. It’s optional, you don’t have to do it, but you’d be an utter moron if you didn’t. Ditto cervical screening tests.

    And the lady with the little bitty lump on the sole of her left foot. It never once occurred to her that it could be cancer. She had no clue what it was and “didn’t want to trouble the Doctor”. She gravitated to trainers until the tumour finally burst. Not a whole heap of blood, but a hellish pain. Lost the leg up to the knee, but she’s a real character and her husband’s massively supportive. Six months tooling around in a wheelchair, then a prosthetic leg. Only drawback is she thinks she looks daft in a dress or skirt, so it’s jeans or slacks. And why not? She’s only just turned 50.

  7. margo says:

    I knew someone may years ago who died of a sudden heart attack while waiting for the barman to pull his first pint of the evening. What a good way to go, among friends and in anticipation of pleasure to come.

  8. harleyrider1978 says:

    FXR • 11 hours ago

    It warms the heart to see Michael come clean after all these years.

    No one really needs to fear the smell of burning leaves. of course we knew this all along.

    His apology and the included citation, is gratefully accepted.

    “President John F. Kennedy once said:
    “The great enemy of truth is not the lie–deliberate, contrived, and dishonest–but the myth–persistent, persuasive, and unrealistic.” Here indeed, the repeated statements of the CDC and a number of prominent anti-smoking researchers have effectively created a myth, one that has become persistent and persuasive, even though it lacks evidence. And as a result, the media and in turn, policymakers, are accepting this myth as truth and making poor policy decisions because of it.”

    Well dome Michael, I trust you will sleep more comfortably tonight, it has been a while since honesty was in your corner.

    http://tobaccoanalysis.blogspot.com/2015/01/2014-anti-smoking-myth-of-year-award.html#disqus_thread

  9. Rose says:

    From a position of freely admitted ignorance, I am beginning to see what Richard Smith ment.

    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

    I have never felt confident that, after radiation and the Cancer Act 1939 banned advertising and possibly any thought about an alternative approach, seemingly, the next official attempt at treatment was the result of an accident involving mustard gas.

    “The first drug used for cancer chemotherapy did not start out as a medicine. Mustard gas was used as a chemical warfare agent during World War I and was studied further during World War II. During a military operation in World War II, a group of people were accidentally exposed to mustard gas and were later found to have very low white blood cell counts.

    Doctors reasoned that something that damaged the rapidly growing white blood cells might have a similar effect on cancer. So, in the 1940s, several patients with advanced lymphomas (cancers of certain white blood cells) were given the drug by vein, rather than by breathing the irritating gas. Their improvement, although temporary, was remarkable.

    That experience led researchers to look for other substances that might have similar effects against cancer. As a result, many other drugs have been developed.”

    “Chemotherapy differs from surgery or radiation in that it’s almost always used as a systemic treatment. This means the drugs travel throughout the body to reach cancer cells wherever they are”
    http: //www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/chemotherapy/chemotherapyprinciplesanin-depthdiscussionofthetechniquesanditsroleintreatment/chemotherapy-principles-what-is-chemo

    And we seem to have been stuck with the idea of systemic poisoning as a treatment ever since.

    Today’s news

    Cancer ‘becoming a crisis of unimaginable proportions’

    But the main reason for the crisis appears to be the dreadful damage caused in part by the treatment.
    Something you rarely hear about.

    “Charity says the NHS will soon be unable to cope with rising numbers of cancer sufferers, as figures show an extra 500,000 people now living with the disease”
    “Of the total 2.5 million people currently classed as living with cancer, 1.6 million were diagnosed five or more years ago.

    However, the charity said there was growing evidence shows that many patients do not return to full health after gruelling treatments, with many suffering from serious side effects of the disease.
    Lynda Thomas, the charity’s chief executive said: “While it is great news that more people are surviving cancer or living longer with it, progress is a double-edged sword.”

    “The charity said that while many of those diagnosed with cancer survived in good health, a large proportion would suffer long-term side-effects from treatment, such as incontinence and impotence.”

    “Eight years on from my diagnosis I’m still suffering fatigue and permanent nerve damage to my legs, hips and arms from the chemotherapy,” he said.
    “I try to stay positive as I’ve survived cancer but I’m living with the long term side effects of treatment. I wish I could do without the health services but I can’t – I see my GP for help with pain control, and have to visit the hospital for colonoscopies, neurology, and physiotherapy.”
    http://www.telegraph.co.uk/health/nhs/11325627/Cancer-becoming-a-crisis-of-unimaginable-proportions.html

    Many cries for help with descriptions of the consequences of treatment, but with no individual replies.

    Managing Chemotherapy-Induced Peripheral Neuropathy after Cancer Treatment
    http: //www.mskcc.org/blog/managing-chemotherapy-induced-peripheral-neuropathy-after-treatment

    There have been concerns expressed before.

    Chemotherapy can do more harm than good, study suggests
    2008

    Times

    “Doctors have been urged to be more cautious in offering cancer treatment to terminally-ill patients as chemotherapy can often do more harm than good, a study suggests.

    Patients with incurable cancers were promised much greater access to the latest drugs which could offer them extra months or years of life by a Department of Health review last week.
    Such medicines are often taken or injected as part of a “cocktail” of chemotherapy drugs.

    But the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found that more than four in ten patients who received chemotherapy towards the end of life suffered potentially fatal effects from the drugs, and treatment was “inappropriate” in nearly a fifth of cases.

    About 300,000 patients now receive chemotherapy in the UK each year, a 60 per cent increase compared to 2004.

    But in a study of more than 600 cancer patients who died within 30 days of receiving treatment, chemotherapy probably caused or hastened death in 27 per cent of cases, the inquiry found.”
    http://www.whale.to/cancer/chemotherapy9.html

    But as I say, I am ignorant of the subject.

  10. smokervoter says:

    An Incompetent Carpenter. Them thar’s fighting words in my universe. I’ve met plenty of them in my lifetime who would indeed employ a carpenters bubble-level to fix a wobbly table.

    Me, I’d use a water level (any container of water with some clear plastic tubing attached, used as an infallible reference mark) to determine how out-of-level the floor on which the table stood was. I’d either correct the floor or ascertain (down to 1/16th of an inch) the low point and correct the situation with a wedge of wood or a matchbook.

    I’m sure there’s an applicable, deep-think metaphor in there somewhere.

    • harleyrider1978 says:

      The cure to cancer is understanding the immune system completely. Finding what went wrong in it and then repairing that part of it.

  11. Rose says:

    It would seem that some patients agree with Richard Smith.

    Physicians’ evaluations of patients’ decisions to refuse oncological treatment – 2004

    “Results: Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients’ treatment refusals. From a medical perspective, a patient’s treatment refusal based on personal values and experience is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment.”

    “Both medical and personal considerations seem to play a role in the patient’s decision to refuse treatment, but personal values and experiences predominate. For example, patients may find it important to occupy themselves—painting, playing tennis, or walking in the mountains. If the side effects of chemotherapy would prevent them from carrying out these activities, the patients in the present study indicated that the meaning of their life would be gone and quality of life decreased.

    Our empirical study revealed that patients find quality of life to be very important. It was clear that many patients believed that quality of life was incompatible with receiving oncological treatment. More than half chose not to be treated because they believed that treatment would not result in a better quality of life and would only cause side effects and/or increase or induce symptoms.

    Some patients indicated they would rather live for a little lesser time than prolong their lives with all kinds of troubles due to treatment.”
    http://jme.bmj.com/content/31/3/131.full

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