Saturday, October 09, 2010

Why you won't find my bra colour as a status update

According to a message in my Facebook inbox, October is Breast Cancer Awareness Month. I'm not quite sure what this means, other than that I am expected to contribute to this raising of awareness by updating my status to reflect the location of my handbag thusly: "I like it [insert location of handbag here]". Last year's event saw women posting just the colour of their bra as a status update, the general idea being to arouse curiosity amongst one's Facebook friends, who then ask what it's all about. I may be wrong, but I think the instruction was to tell female friends to follow suit, but keep the whole thing secret from the men-folk.

Evidently men have no need to be aware of breast cancer: according to Cancer Research UK, they make up less than 1% of new cases in the UK [1], perhaps a sufficiently small minority to be largely ignored in terms of risk of developing breast cancer. Yet the same data set reveals that in 2007 there were more than 45,000 new cases in women, a substantial proportion of whom, it is safe to assume, will have fathers, husbands and sons who are significantly affected by breast cancer.

The divisive and unnecessary gender bias of this 'make cancer fun on Facebook' campaign isn't the only reason to take exception. The very notion of raising awareness of breast cancer in some directionless do-good sense renders this a pointless exercise. Highlighting the risks and the efficacy of self-examination would be an excellent idea; pointing out the need for greater investment in valid cancer research is a suitably worthy cause. However, it is arguable that this campaign can even succeed in challenging the terrible taboo that leaves many breast cancer patients socially isolated. Breasts, femininity and sexual attractiveness are so intricately and complexly tangled; add to this the still widely held belief that cancer kills and we are dealing with a monster that threatens our every instinct.

Or rather, we are not dealing with it at all. Soldiering on at the front line of 'the enemy that must not not be named' are organisations such as Macmillan Cancer Support [2]. They are brave and heroic and we admire them, although until we are inadvertently thrown into the line of fire, we do so from a very safe distance. We can dismiss the advances of most major killer diseases through some simple blame-laying - lifestyle aetiology can more readily be applied to HIV and heart disease than to the generally indiscriminate nature of cancer - a certain penchant for risk behaviours can sometimes do the trick here too.

Even with highly specific aims, cancer awareness campaigns are, at best, troublesome. Advertising undertaken by Macmillan and Cancer Research UK undoubtedly increases the profile of cancer and much-needed donations. "For just £4 a month...", the mantra of daytime TV, enables most of us to give regularly to charity without noticing the cost or having to think too much about what it is we are funding. Indeed, direct debit has become the most popular way of donating to charities [3], accounting for most of the £9.9 billion donated in 2009 in the UK alone, with the top causes being medical research and hospitals and hospices [4]. In spite of only half of the UK adult population donating and an 11.4% decrease in real terms from 2008, that's still an awful lot of money.

But there is something very wrong with this picture, for it is not us, the average Joes, who should be worrying about whether we can afford a couple of quid a month in order to morally avoid facing cancer. Consider this: if all 5.7 billion adults [5,6] on the earth gave £4 a month for a year (a ridiculous proposition), the total would still fall £56 billion short of the £256 billion annual revenue earned by the top 20 pharmaceutical companies in 2009 [7]. And it gets worse: whilst no. 1 company Pfizer's CEO Jeffrey Kindler warned shareholders against the dangers of using their dollars to line a single basket of golden eggs (or should that be purple diamonds?), the cut-throat world of pharma R&D, at a time when revenue is down (i.e. profit growth is less than in the previous year), means incomplete trials and a reluctance to invest in anything but 'dead cert' blockbusters [8].

A pertinent example here is the development of PLX4032, a trial drug for the treatment of advanced melanoma. In the early stages, melanoma treatment is relatively easy and successful. However, the one year prognosis and a history of failed trials for treatment of advanced melanoma have been met with a reluctance on the part of large pharmaceutical companies to invest in further research, according to Peter Hirth, CEO of Plexxikon - the small biotechnology company in California who developed PLX4032 [9]. It comes as no surprise then, that after early successes with small-scale trials of PLX4032, Plexxikon attracted the interests of larger companies and in 2006 reached an agreement with Swiss company Roche, "one of the leading pharmaceutical companies in oncology" [10], with an annual revenue of around $5.1 billion [11], placing them just outside the top 20, no doubt hoping to improve their chart position with a new blockbuster and most of the heavy legwork out of the way.

So, taken at face value, the innocent plea in my Facebook inbox is benign enough, but there is no ignoring the fact that in the midst of juggling our miniscule monthly incomes in the hope we can scrape off a little surplus and somehow beat cancer, we forget about the big, fat, rich benefactors of the pharmaceutical industry, who don't feel the guilt we do and are no more compelled to share intimate details about their underwear than they are to risk shareholders' money on treatments that don't have that Wow! factor. A vague call to raise awareness may lead to a few more charitable donations, which in essence is our consent to maintaining the status quo. Cancer is not a battle that can be fought on two fields and we foot soldiers must now become conscientious objectors.

And for the record, it's black and I like it behind me; both rather apt responses, all things considered.

* CIA (2010) statistics for aged 15 and over equate to approximately 73% of 6.9 billion global population (US Census Bureau, 2010).

  1. Cancer Research UK (2007) Breast Cancer - UK Incidence Statistics http://info.cancerresearchuk.org/cancerstats/types/breast/incidence/.
  2. Macmillan Cancer Support (2010) About Us. http://www.macmillan.org.uk/Aboutus/AboutUsHome.aspx.
  3. Goodey, L. and Harrison, R. (Charities Aid Foundation) (2006) Individual giving in the UK: findings and context. NCVO Conference Paper.
  4. 4. Charities Aid Foundation and National Council for Voluntary Organisations (2009) UK Giving 2009: An overview of charitiable giving in the UK, 2008/9.
  5. Central Intelligence Agency (2010) The World Factbook. https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html#People.
  6. US Census Bureau (2010) World POPClock Projection. http://www.census.gov/ipc/www/popclockworld.html.
  7. Roth, G.Y. (2010). 2010 Top 20 Pharmaceutical Companies Report. http://www.contractpharma.com/articles/2010/07/2010-top-20-pharmaceutical-companies-report.
  8. Contract Pharma (2010) #1 Pfizer. http://www.contractpharma.com/articles/2010/07/pfizer
  9. Ledford, Heidi (2010) Rare victory in fight against melanoma. http://www.nature.com/news/2010/100907/full/467140b.html.
  10. Plexxikon (2006) Plexxikon and Roche enter partnership to develop targeted cancer therapeutic medicine PLX4032. http://www.plexxikon.com/view.cfm/58/Press-Releaseshttp://www.plexxikon.com/view.cfm/58/Press-Releases.
  11. Wikipedia (2010) Hoffman-La Roche. http://en.wikipedia.org/wiki/Hoffmann%E2%80%93La_Roche.