prevention versus cure

There is another contraversy raging on the lung cancer support site. It is a wonderful site, in general, filled with people with big hearts struggling against one of the nastiest diseases in the whole world. Anybody who has anything to do with lung cancer whatsoever should make a regular stop by there. Read anything ever written by DeanCarl. It will take a while, but it will be worth it. The web address there is www.lchelp.com.

Somebody came up and asked about how many of the never smokers with cancer had a large exposure to second hand smoke in their lives. Which seems like an innocent enough question, but it is the kind of question that ruffles feathers. (For the record, Becky was a never smoker, and my understanding is that her father did smoke until she was eight or ten years old, and then never again smoked in the house. So she had some, but less than most, exposure to second-hand smoke. And she had basically zero family history.) Now the reason this ruffles feathers is that lung cancer patients are often treated like second-class citizens. Becky dealt with this. The first question she was always asked was, "Did you smoke?" The implication being that only non-smokers deserve sympathy, or at least deserve more sympathy than smokers. And it is just a small jump from that step to say that smokers deserve their cancer. It cannot be said loud enough nor often enough that noone deserves this disease.

The reason this has real ramifications is that so much of the money spent to combat lung cancer is spent on prevention, especially on smoking cessation programs. So little money is spent on researching how to defeat this disease, at least if you compare it per death with other types of cancer, AIDS, etc. All the smoking cessation programs in the world wouldn't have saved Becky once she was diagnosed. And for someone who either has the disease or who is caring for a loved one with the disease, the cure is the only thing that matters. Our world shrivels up, and we really don't even care so much about the disease in general as the one tumor inhabiting one body. Two years ago, if God had offered me a chance to cure Becky's tumor or to lose her and eradicate the disease, I cannot honestly say what I would have done. I am glad those things are always hypothetical.

And now my entire focus has shifted. I can't win the battle I wanted to win a couple of years ago, and so now the tumor I am fighting against doesn't even exist. I am fighting to make sure Katie doesn't get this disease - she now has a scary family history - and that she survive it should - heaven forbid - she ever get it. And so now prevention is more important to me personally than cure. Science has reasonably demonstrated, I think, that 90% of lung cancers are caused by smoking in some fashion.

I know it is naive to talk about simply banning smoking. Banning alcohol was a disaster and trying to do either again would be an even bigger disaster now. Are the restrictions going far enough? In San Antonio, it is illegal to smoke in restaurants period unless the smoking section is walled off and has its own ventilation system. That seems reasonable. Any place that we can be compelled to be - public schools, government offices, and so forth, should be smoke free.

But even if we completely eradicate smoking, we will still have thousands upon thousands of people with lung cancer. Prevention is not enough. At the same time, cure is not enough either. It is reckless to ignore the science that tells us that the causal link between smoking and lung cancer exists. It is much more cost effective to convince people to avoid the causes.

So I can't come down on either side of the argument. It rages every month or so on the board. A balance seems necessary. Whether the scale is leaning too far one way or the other is tough for me to know. It seems like we really need a bigger pie to split up. More money for research and more money for smoking prevention.

And now I must sleep. I don't know if any of this made sense to anyone tonight. But if nothing else, I needed to sort out my own thoughts.