Later On

A blog written for those whose interests more or less match mine.

The doctor who beat big tobacco

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Gideon Haigh reports in the Guardian:

On Good Friday this year, Dr Bronwyn King and her husband were staying with her parents in the quiet coastal town of Torquay in Victoria, Australia. They started watching a movie – although King, as she often is, was only half-there, busily pecking at her laptop.

“AXA – news …” said the subject line of the email from a French insurance executive. “In confidentiality,” it read: “we have decided to divest tobacco … If you can, let’s discuss further. Thanks for your help.” King felt momentarily giddy. It was six years since she had sent the first of tens of thousands of hopeful, courteous but determined emails with such ends in mind. She had already persuaded 35 Australian superannuation funds, as Australians call their private pension funds, controlling nearly half the total funds under management to shun tobacco. AXA, the world’s second biggest insurer, was her greatest success yet. But she passed up a celebratory glass of wine: there was work to do, on the details and timing of the announcement. When her family turned in, they left King, as they often do, at her laptop.

Two months later at Geneva’s plush Beau Rivage Hotel, King looked out over a sea of faces, mostly delegates gathered for the World Health Assembly, and introduced her “new best friend”, AXA boss Thomas Buberl. AXA, he said, would forthwith sell €200m of tobacco stocks: there was applause. It would also, he added, run down €1.6bn of tobacco corporate bonds. There was a hush. Had he just said billion?

In an old war, a new front had opened. Tobacco kills six million people a year: the McKinsey Global Institute deems it humankind’s greatest self-generated social burden, ahead even of war and terrorism. Yet as an issue, observes King’s colleague Clare Payne, it has receded in public consciousness: “There’s this tendency for people to think: ‘Oh we’re done with tobacco, aren’t we? Everyone knows. It’s just a choice thing for people now.’ When we’re actually in an epidemic – history’s first epidemic of a non-communicable disease.”

To restore it to the headlines, then, is no mean feat. “She’s a star,” says Cary Adams, CEO of the Union for International Cancer Control, who just over a year ago put King in charge of the Global Task Force for Tobacco Divestment. It’s not a mantle that rests easily with King. All the 41-year-old oncologist at Melbourne’s Epworth Healthcare feels she’s done is take to heart her hippocratic oath, especially the injunction to “do no harm”.

Into her mid-20s, King’s career had seemed mapped out. At Fintona Girls’ School in the Melbourne suburb of Balwyn, she had been a star junior swimmer, thriving on the daily pre-dawn starts and unrelenting competition, climaxing in medals at national championships and a victory in the Pier-to-Pub, a famous open water race in Australia. On completing medical studies in 1999, she became an Australian swimming team doctor, and weighed up specialising in sports medicine and paediatrics.

In February 2001, however, King began three months as a radiation oncology resident in the lung cancer unit of Peter MacCallum Cancer hospital. She was, she confesses, a reluctant conscript. Radiation oncology, which uses giant linear accelerators to beat back advancing cancers, is a technically and emotionally challenging field of medicine, undertaken underground for the containment of its x-ray emissions, dedicated chiefly to the very sick. And sickest of all are smokers.

For King it was an education. The five-year survival rate after diagnosis for lung cancer is 15%: her job was largely to alleviate its acute associated sufferings. Most people have an image of lung cancer sufferers propped in bed subsiding gently, maybe with a bit of a cough, possibly on oxygen. The reality is very different. In a fifth of cases, for example, lung cancer metastasises to the brain, inducing paralysis and loss of cognitive function: the patient, literally, loses their mind. Death can come violently too. One morning King arrived to find the corner of a ward absent not only its bedclothes but its curtains and furnishings. The night before a patient had essentially drowned in her own blood from a burst vessel, drenching staff in her death throes. In the room were three other terrified patients who had heard the whole thing.

Almost every interaction bore witness in some way to tobacco’s toll. Taking a history from a new female patient one day, King asked her age. “I’m 43,” the woman replied. “I’m getting quite old.” It transpired that her whole immediate family had died in their 40s from smoking-related cancers. “I had this overwhelming sense of the impact of tobacco,” King recalls. “The public did not know what was going on. They didn’t know because I was a doctor and I hadn’t known. Until I worked there. I started to wish I had a television camera with me, so people could see what I was seeing.”

But so much was out of sight for a reason – to which King was first introduced by an older patient who beckoned her from his bed, looked around furtively, and whispered: “This is because of the smoking, isn’t it?” When she said it probably was, he nodded and looked away. Here were lung cancer’s little-acknowledged secondary symptoms: disgrace and shame. Where families could be relied on to rally around sufferers from breast and prostate cancer, tension surrounded those with tobacco-related illness, who were perceived as having brought cancer on themselves. This has been an unforeseen impact of the public health campaign to scare smokers straight: in a recent survey, 30% of Australians agreed with the sentiment that lung cancer patients were less deserving of sympathy than other cancer patients. “Lung cancer has become the syphilis of the 21st century,” says the head of Peter MacCallum’s lung cancer unit, Professor David Ball. “Patients are regarded as victims of their own lack of self-control. Whereas they’re actually victims of a concerted and successful campaign by the tobacco industry to turn them into addicts.”

It was Ball, a fixture at Peter Mac since 1973, who became King’s lodestar. He instilled an . . .

Continue reading. There’s a lot more, and it’s interesting.

Written by LeisureGuy

6 August 2016 at 2:33 pm

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