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In March 2001 Britain's most famous cancer sufferer finally succumbed to the metastatic squamous carcinoma of the tongue that had co-starred with him in the media for the preceding four years. It is astonishing that someone would want to share their entire personal cancer journey with us, from faltering diagnosis to near death, yet John Diamond did exactly that. He spoke about his condition to a growing audience through his weekly Times column, a documentary and a book, C: Because Cowards get Cancer Too1. Parts of his life were even dramatized as A Lump in my Throat, and performed on stage and TV. A final work, Snake Oil and Other Preoccupations2, was assembled posthumously by his brother-in-law Dominic Lawson. But this well-reasoned diatribe against alternative medicine stops abruptly in the middle of chapter 6. There was only enough new material for a quarter of a book, so Lawson padded out the remainder with other items from John's prodigious journalistic output (to call the author ‘Mr Diamond’ seems altogether too formal).
It is the selection of this additional material that bothers me. Among John's earlier pre-cancer work what, for example, is the point in including a piece lunging at herbalists for claiming that ‘chemical’ and ‘natural’ are somehow diametrically opposed when chapter 2 of Snake Oil has already expounded on the same theme? Among the post-cancer fare, why repeat verbatim nearly all of the columns already picked out for inclusion in his early book C? All the paraphernalia of this book, including a leaden introduction by Richard Dawkins (detailing randomized controlled trials when these are fully covered in chapter 5), indicate that it was rushed into print. Admittedly without Dominic Lawson's input the bon mots of Snake Oil could have been lost forever; yet I can't help feeling that a finer role for them would have been as an expansion and a lingering epilogue to a new edition of C.
At this point, readers who are not Diamond initiates may be asking why all this fuss about a dead journalist? How bon could one hack's mots really have been? Well, the short answer is, ‘very’. For any doctor who has not read C, please go and do so: it will make you a better doctor. For anyone feeling smug because they have read it, go back and read it again, for its poignancy has now increased tenfold as a result of John's death.
One of the more uniform observations in oncology is that patients with a smoking-related malignancy such as Diamond's tend to have very different mindsets from patients with breast cancer. The smokers, who are usually older and male, seldom ask, ‘Why me?’. After the initial shock of diagnosis they quickly accept that they have a limited amount of time left and concentrate on the things they want to achieve before the end comes. In contrast, and perhaps not surprisingly, young breast cancer patients with metastatic disease much more commonly rage at the injustice of their fate. Marti Caine and Linda McCartney, and the journalist Ruth Picardie in five brutal, bolshy and heart-breaking articles3, attracted vast public sympathy before their deaths.
The smoking-related malignancies, which together are more common than breast cancer, get very little of the publicity and only a fraction of the funding that breast cancer receives for research, treatment and patient support. Perhaps the victims are perceived as less deserving, having had a hand in their own downfall. Perhaps, being older, they are more likely to be labelled as having had ‘a good innings’ and their personal loss thought of as something less. But John Diamond, with humour, candour and grainy panache, contrived to enter our hearts. And on the whole, as doctors, John loved us and trusted us in return. Though he was always ready to poke a little fun whenever funpoking was due; for example, how he rubbished ‘gradual disclosure’—what last week seemed like a jolly clever communication technique for passing on bad news, but this week seems more like an excuse for medical absentmindedness. Though his writing was often moving—his postoperative narrative begins, ‘I had fallen among nurses’—John always avoided mawkishness in his ‘cancer testimony’ by concentrating on the medical facts. Indeed he seems to have had a schoolboy-like fascination with facts, with reasoning things out and with passing on that understanding. Not to wrest back control of his life by one-upping his doctors, but because he was genuinely interested. What else would make a man enter the Marsden's pathology department to view the histology of his excised tumour? As a media figure confronting death he was plagued by well-wishers and salesmen sending details of their alternative ‘cures’ (the other C-word), and the factlessness of much alternative medicine inspired his writing to the end.
At present it is politically incorrect for doctors to criticize alternative medicine practitioners (though the favour is rarely returned), and everywhere they seem to have free rein to set up shop, mislead and extort money from the vulnerable. In Snake Oil John campaigns to redress this imbalance, to take the ‘alternativists’ apart with logic and to point out the idiocy of any philosophy that believes when standardized tests show ginsengsucking not to work, it is the tests and not the treatment that should be thrown away. Sometimes a diagnosis of cancer brings out the best in a person. The everyday tragedy of the condition is that, suddenly in the middle of things, you find that they are gone.